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Following last week’s PQA Convenes panel discussion—where AdhereHealth CEO Kempton Presley joined industry leaders to explore “AI in Practice Today: Lessons Learned and Emerging Practices”—this article takes a closer look at what’s really happening on the ground for health plans and their members.
The way people seek healthcare guidance is changing fast. With provider shortages and rising costs, more members are turning to technology for quick answers—especially when it comes to managing chronic conditions and new medications. Generative AI has quickly become a go-to resource, offering instant, confident responses that feel reassuring in moments of uncertainty. But while AI can be helpful, it introduces a new challenge: ensuring members can distinguish accurate, clinically sound guidance from information that could steer them in the wrong direction.
When AI Steps in Before a Clinician
Consider a member living with diabetes who receives a new prescription. They’re hopeful the medication will help stabilize their blood sugar, yet after a few doses they begin feeling off—dizzy, nauseated and unsure whether the symptoms are normal. They try calling their doctor, but the next appointment is weeks away.
Looking for reassurance, they turn to their computer. A quick search leads them to an AI chatbot that delivers a confident explanation of their symptoms and a recommendation for what to do next. It feels like the guidance they couldn’t get anywhere else.
But, like in many cases, the advice is wrong.
This is the new reality for members who, faced with shrinking access to human support, lean on AI for clarity—even when it fails to provide it.
The Underlying Problem: Members Need Support, but Access is Shrinking
Members managing chronic conditions need steady, reliable support—help understanding instructions, interpreting side effects, navigating refills and staying adherent through treatment changes. Yet across the healthcare system, those human touchpoints are becoming harder to reach.
Provider shortages and long wait times are making primary care and specialty appointments more difficult to access. Rising healthcare costs may also force members to delay or forgo care. Pharmacies are affected too; widespread closures and reduced counseling hours can mean many communities—especially in rural and low-income areas—have limited access to a pharmacist who can explain a new medication or address concerns in person.
As this human layer becomes less accessible, members may naturally turn to whatever feels immediate. For years, that meant Googling symptoms. Today, it often means asking AI for guidance—a tool that often sounds authoritative, but doesn’t always align with clinical reality.
AI is Filling the Void—But Not Always Accurately
This shift is measurable. Research shows one in six U.S. adults now use AI chatbots for health information, rising to one in four among younger adults. With only a few keystrokes, members can ask AI about symptoms, medications or side effects and receive what appears to be clear, confident guidance—no appointment required.
But accuracy remains a concern. One peer-reviewed study published in 2025 found that AI tools frequently provide incomplete or incorrect medication information. When researchers compared AI responses with trusted drug databases, they uncovered significant discrepancies. Even instructions for common therapies contained factual errors that could mislead members trying to understand their treatment.
The danger isn’t only in the inaccuracies—it’s in the confidence with which they’re delivered. A single AI-generated sentence that validates hesitation or minimizes a symptom can push a member to skip a dose, delay a refill or stop therapy altogether. This can put a member at risk for confusion, nonadherence or even harm.
The Human Layer: Still the Most Important Factor
At the recent 2025 PQA Convenes conference, AdhereHealth CEO Kempton Presley underscored an important truth: although AI can add efficiency to healthcare, it cannot replace human connection. AI can synthesize information, but it cannot understand the emotional, social or cultural factors shaping a member’s relationship with their medication—or adjust its approach to what that member needs in the moment.
Human connection fills those gaps. It helps members feel safe asking questions, admitting uncertainty and explaining why they haven’t refilled a prescription. But with physician shortages, pharmacy closures and fewer counseling opportunities, those person-to-person interactions are becoming harder to come by. Members are left navigating complex decisions with fewer human guides and more digital noise.
What Plans Need: A Trusted Partner to Bridge the Gap
Health plans don’t have to navigate this challenge alone. To counter the rising influence of AI and the shortage of provider support, plans need partners capable of reaching members with clinical guidance that also helps extend the reach of their doctors and pharmacists.
The most effective partners do more than answer medication questions. They help members understand side effects, prepare for provider visits and navigate life circumstances that can affect adherence. They engage through phone, text, digital outreach and mail—meeting members where they are. They reinforce provider instructions rather than replace them, creating a continuous, consistent line of support. And they do it often enough to become a trusted voice, not just another information source.
This kind of partnership extends the reach of care teams, filling gaps no technology can fully cover. It ensures members receive not just information, but understanding—helping to build trust and relationships.
Rewriting the Story Before it Goes Off Track
Ultimately, everything comes back to that member with diabetes—the one who felt unwell and turned to AI for advice in lieu of human support. Health plans have the power to change how that story ends.
By surrounding members with trusted, human-centered guidance, plans can ensure uncertainty doesn’t push people toward unsafe decisions. When members feel overwhelmed or confused, they need a real person who can listen, understand and help them move forward confidently.
When plans invest in partners who deliver that connection and strengthen treatment advice from doctors and pharmacists, they create a stronger, more supportive experience—one where members feel informed and empowered, every step of the way.
Looking for a trusted partner to engage even the hardest-to-reach members and expand provider outreach? Contact AdhereHealth to learn more!
