The Future of Healthcare: Embracing AI for Real-Time Quality Assurance to Decrease Cost, Improve Quality
- EvaluCare
- Sep 29, 2025
- 7 min read
Updated: Dec 20, 2025
The Stalled Progress in Preventing Harm
For more than two decades, American healthcare has struggled with preventing harm in hospitals. Since the Institute of Medicine’s landmark report To Err is Human (1999), we’ve seen numerous quality improvement initiatives. Hospitals have invested in safety protocols, reporting systems, performance measurement frameworks, and improvement initiatives. Yet, despite billions spent, the pace of improvement has stagnated.
Recent research shows that preventable harm still affects 1 in 4 patients admitted to U.S. hospitals.
Mortality and morbidity rates tied to safety events remain stubbornly high.
CMS continues to penalize hospitals under the Hospital-Acquired Condition Reduction Program and Readmission Reduction Program, costing the industry billions annually.
The core issue? Our system still relies heavily on spot retrospective quality improvement (QI) rather than real-time quality assurance (QA).
Complex Patients, Complex Care
Patients today are sicker and more complex than ever. This complexity arises from several factors:
An aging population with multiple comorbidities.
Rapidly advancing treatment technologies requiring specialized oversight.
Care delivered by large, interprofessional teams across fragmented settings.
Ongoing challenges with interoperability.
Staffing shortages.
As complexity rises, the margin for error shrinks. A single deviation from evidence-based practice can lead to harm, extended lengths of stay, readmission or even death. Traditional approaches, such as select case reviews based on suspected quality issues, preparation for root cause analysis, or responses to patient complaints or lawsuits, simply cannot keep pace. While retrospective reviews are necessary for learning, they do nothing to protect the patient receiving care.
Why 1–3% Quality Reviews Aren’t Enough
Most hospitals today review only 1–3% of patient cases, typically those tied to adverse outcomes or flagged events. This means 97-99% of patients do not benefit from structured quality oversight of their care, unless something goes wrong that gets noticed or flagged.
This reactive approach has several drawbacks:
It identifies patterns and systemic issues only after harm has occurred.
It often relies on voluntary reporting, which under-captures events.
It misses opportunities to intervene before problems escalate, with similar harm affecting multiple patients.
If aviation safety or nuclear power oversight operated this way, reviewing only accidents instead of monitoring every operation, we would never accept it. If only 1-3% of parts were inspected before installed on an aircraft most wouldn't fly. Healthcare should raise the bar of inspection and more real time monitoring of care.
The Case for 100% Quality Reviews
Transforming healthcare quality and safety requires a shift to comprehensive, reviews for every patient, every time. Here’s why this model is essential:
Proactive Error Prevention
Concurrent reviews flags deviations from evidence-based care more real time. Clinicians can course-correct at the bedside instead of waiting weeks for a retrospective Root Cause Analysis.
Equity in Oversight
Every patient deserves the same level of safety monitoring, not just those involved in adverse events. A 100% review ensures oversight for routine cases, complex cases, and everything in between.
System Learning at Scale
With a full dataset, hospitals can identify patterns across all care delivered, not just outliers. Hospitals can live the principles of a learning organization.
This accelerates organizational learning and enables systemic fixes that improve safety universally.
Financial Stability
Hospitals face millions in penalties for readmissions, hospital-acquired conditions, infections, longer length of stays for and poor performance.. 100% reviews provide the foundation to avoid these penalties and improve reimbursement.
Evidence-Based Standards Must Be Enforced More in Real Time
Take sepsis as an example. Evidence-based bundles are well-defined: early antibiotics, fluids, and monitoring. Yet compliance is often below 50%, leading to thousands of preventable deaths annually.
With retrospective review, a missed bundle element is discovered long after harm has occurred, in many cases the patient has died. However, with more extensive and concurrent review, deviations in bundle compliance can be flagged, allowing clinicians to intervene and recognize the systems issues that may be present. This principle applies across conditions: stroke, myocardial infarction, obstetrics, pediatrics, and nearly every clinical care delivery system in existence. Clinical guidelines are only meaningful if they are applied consistently.
The Financial and Operational ROI
Hospitals under financial strain need solutions that protect both patients and margins. Consider the following:
Regulatory Penalty Avoidance: CMS programs can cut up to 6% of Medicare payments for poor performance. For a $1.5B revenue hospital or health system, that’s up to $36M annually at risk. These shortfalls in poor quality rest on the backs of taxpayers who fund payer programs and the patients and families effective by poor quality.
Malpractice Reduction: Preventable harm fuels lawsuits. Even a 10–20% reduction in malpractice costs can save millions.
Efficiency Gains: Adhering to best practices shortens lengths of stay and prevents readmissions, reducing costs while increasing capacity. Identifying a missed falls risk assessment in real time can refocus care to avoid falls with injuries and excessive stays in a hospital, which are not reimbursed.
Cost Avoidance: Intervening to correct care deviations will prevent unnecessary care and avoid costs.
Labor Savings: Automating reviews eliminates the need for large manual teams, freeing clinicians for patient care.
Conservatively, moving from 1–2% reviews to 100% concurrent reviews can generate $44M–$85M annually in value for a large hospital system, through cost avoidance, efficiency savings, risk reduction, and revenue capture.
Why Smaller Hospitals Need This Most
Smaller community hospitals face even greater challenges:
Limited budgets restrict the ability to hire dedicated quality staff.
Case volumes may be lower, but patient acuity and complexity often remain high.
Quality penalties and malpractice costs hit harder when margins are thin.
Concurrent AIs-powered technology like EvaluCare's Eva Software as a Service for hospitals levels the playing field, delivering enterprise-grade oversight without requiring armies of reviewers.
Past Time for Critical Access Hospitals
Critical access hospitals with lower volumes and fewer discharges are subject to dramatic quality swings from a single failure. With cost-based reimbursement, all reasonable costs are reimbursed under the funding model.
Many critical access hospitals do not participate in CMS quality programs and overlook the need to focus on failures. They often lack the internal staffing to stay updated on surveillance, reporting, and improvement activities.
Introducing Eva an AI-Powered Software as a Service (SaaS): Designed for Transformation
Eva SaaS by EvaluCare is the first of its kind medical care review platform designed to transform hospital quality programs from reactive to proactive through 100% concurrent medical care reviews. Reviews are delivered at a lower cost, with faster results and higher quality than traditional clinical analysts can provide. It transforms a typical reactive, fire-fighting quality program into a full-time quality assurance program. It is a pay-as-you-go service, allowing hospitals to pay only for what they need, and is an innovative cloud-based platform built specifically for concurrent medical care review.
What Eva Does:
Conducts near quality reviews for every inpatient discharges.
Provides flexiblity in review type. Reviews include: quality reviews, mortality reviews, peer reviews, M&Ms, and utilization reviews.
Scales from small hospitals to large health systems.
Serves the entire continuum of care in all care settings.
Integrates with EHRs or can stand alone for seamless data capture and intervention, regardless of the level of IT integration.
Who Benefits:
Hospitals & Health Systems: Avoid penalties, reduce costs, improve patient safety, and transform quality programming.
Insurers: Gain assurance of appropriate, evidence-based care delivery.
Risk Management: Obtain accurate, independent case reviews to help defend against professional liability claims.
Patients & Families: Gain confidence that care is monitored and safe.
US Healthcare: We won't bend the curve with continuous quality improvement if the complexity curve is increasing at an exceeding rate. Quality assurance will keep pace.
The Future of Quality Is Concurrent, Not Retrospective
We cannot continue expecting different results while reviewing only a tiny fraction of care after the fact. The stakes, lives, reputations, finances, are too high.
The future of healthcare quality and safety requires 100% concurrent quality reviews as the next leap forward. Just as checklists transformed surgery and infection prevention transformed ICUs, real-time QA can reduce harm across the entire healthcare continuum. The tools now exist to make this possible. Eva SaaS is the platform designed by healthcare quality leaders for this exact mission. Our healthcare system demands it. The alternative is the status quo. If that alternative sounds good. then you surely wouldn't mind flying on an airplane where only 1-3% of the parts have been inspected to meet quality standards.
Summary
For the last decade, we’ve plateaued in reducing patient harm. Retrospective reviews alone will never be enough. With growing complexity, tighter margins, and rising expectations, the time has come to embrace a 100% quality assurance approach in healthcare to build a high-reliability system that patients and families expect.
Learn more at evalucare.net or contact info@evalucare.net.
About the Author
Jason Minor is a healthcare quality and transformation leader with nearly 30 years of continuous improvement experience. A Certified Lean Six Sigma Black Belt, Certified Professional in Healthcare Quality, Certified Professional in Patient Safety, and Certified Utilization Review Professional, he has led thousands of end‑to‑end improvement projects, mentored dozens of quality professionals, and pioneered healthcare SaaS innovations.
As Board Chair of the Vermont Program for Quality in Health Care, Jason has partnered with hospitals, non‑profits, and state agencies to elevate patient safety and care quality statewide. Previously, as Network Vice President of Quality at the UVM Health Network and through the Jeffords Institute for Quality, he guided the redesign of a system‑wide quality framework and led initiatives that achieved a number‑one patient safety ranking among the nation’s top academic medical centers.
In 2020, Jason founded EvaluCare to help organizations shift from episodic improvement to a robust quality assurance approach.
EvaluCare’s Eva platform leverages AI‑powered natural language processing, machine learning, and agentic orchestration to analyze and improve inpatient care and support comprehensive quality, mortality, peer, and utilization reviews.
Jason Minor, EvaluCare Executive Director
Network Director Continuous Systems Improvement Jeffords Institute for Quality UVM Health
Board Chair Vermont Program for Quality in Health Care Inc.,
Vice Chair Northwestern Counseling & Support Services, Inc
Lecturer UVM College of Nursing & Health Sciences
Quality Peer Reviewer Vermont Care Partners: Centers of Excellence
