AI, Equity, and the Future of Care: A Conversation with Dr. Jesse Ehrenfeld

In a new episode of Digital Health Interviews, host Alex Koshykov sits down with Dr. Jesse Ehrenfeld, anesthesiologist, informaticist, and the 178th President of the American Medical Association. A physician and veteran with nearly two decades of experience in digital health and policy, Ehrenfeld has spent his career at the intersection of patient care, technology, and systemic reform. In this conversation, he opens up about the realities of value-based care, the promise and pitfalls of clinical AI, and why the physician–patient connection remains his anchor despite holding some of the most influential leadership roles in American healthcare.

Medicine as Anchor: Why He Still Practices

Despite his deep involvement in health policy and digital transformation, Ehrenfeld insists that clinical practice is what grounds him. “I tell people it’s the easiest part of my job because I know what to do,” he says. On a recent Monday, he operated on an elderly refugee from Ukraine - a moment he describes as humbling and deeply rewarding. That patient’s story reminded him why the physician–patient bond is “foundational” and why he has no plans to step away from practicing medicine.

The Evidence Gap: Why Reliable Systems Matter

Ehrenfeld argues that while the principles of evidence-based medicine remain unchanged, implementation lags. Preventive screenings, vaccinations, and chronic disease management occur only about 80% of the time in the U.S., leaving a significant reliability gap. “We have a whole bunch of unreliable disconnected systems that are siloed,” he explains. For him, digital medicine and AI aren’t about replacing physicians but about closing that reliability gap: ensuring that every patient gets the right care at the right time, regardless of the hour or the clinician’s fatigue.

Preventing Bankruptcy from a Hospital Bed

The paradox of U.S. healthcare is striking: one of the wealthiest nations in the world still sees hundreds of thousands of families bankrupted by medical debt. Ehrenfeld’s prescription for change is clear - expand access through digital tools and telemedicine, modernize outdated payment structures, and invest in prevention. “We have a sick care system,” he says bluntly. With one-third of U.S. adults living with hypertension and only half managing it effectively, the opportunity to reduce preventable strokes and heart attacks is enormous. The tragedy, he points out, is that treatment already exists - “the pills are basically free” - yet systemic barriers keep patients from receiving it.

Value-Based Care: A Bumpy Journey

Asked whether value-based care is a failed promise, Ehrenfeld doesn’t think so. “The journey has been bumpy and slow,” he admits, citing misaligned payment incentives and barriers to data interoperability. While smaller practices struggle to scale, large systems face operational hurdles in changing entrenched pathways. Yet he sees momentum building, with new White House initiatives attempting to incentivize payers and technology companies to embrace value-based contracting.

Defining Health Equity Beyond Rhetoric

For Ehrenfeld, health equity is simple: “Everybody has access to the same best possible health outcomes, regardless of who you are, where you live, what you look like, who you love, where you were born.” But the reality is far from that ideal. Rural communities in Wisconsin, where he now practices, face disproportionately poor outcomes. His work at the Medical College of Wisconsin focuses on creating models that improve access and equity, from workforce expansion to ensuring insurance coverage. “We can do better. We should be doing better,” he stresses.

AI in Healthcare: From Fax Machines to Clinical Intelligence

Ehrenfeld places today’s AI boom in the context of broader societal transformations, comparing it to the Industrial Revolution. While most current adoption in U.S. healthcare is limited to backend functions like scheduling and dictation, the potential lies in clinical AI - tools that help patients stay healthy and reduce barriers to care. Radiology is leading the charge, with thousands of hospitals now using AI for image interpretation, but broader adoption remains slow.

Part of the problem is fragmentation: “No CIO wants to incorporate 47 different tools from 30 vendors, each costing millions to deploy,” he says. The future, he argues, lies in moving from point solutions to platforms, though debates over who will own those platforms - EHR vendors or new entrants - remain unresolved.

And then there’s the cultural contrast: while Chinese health systems can deploy AI nationwide almost overnight, the U.S. faces liability and regulatory uncertainties. “What happens when an AI tool fails? Who is responsible?” he asks, pointing out that such questions still lack clear answers.

Burnout, Ambient Scribes, and Physician Wellbeing

Ehrenfeld acknowledges the hype around AI-powered scribes and clinical decision support tools. While they won’t dramatically increase physician productivity, they can alleviate burnout by reducing after-hours charting. “The satisfaction of not having to sit at home in your pajamas at night finishing your notes is an investment worth making,” he explains. The key, he emphasizes, is ensuring that new tools fit seamlessly into existing workflows rather than adding friction.

Cost vs. Price: The Transparency Challenge

Is U.S. healthcare’s issue one of cost or price? Ehrenfeld hesitates to give an economist’s answer but points to obvious market dysfunctions like opaque pricing and pharmacy benefit managers siphoning profits. He sees potential in models like Cost Plus Drugs, which introduce transparency, but admits that current consumer-facing tools are inadequate. “It’s still not like you can go online and compare prices the way you can at Walmart or Costco,” he notes.

Advice to Founders: Bring Physicians In Early

Ehrenfeld closes with a cautionary tale. After a keynote, an entrepreneur pitched him an algorithm to determine when colon surgery was necessary. When pressed, the founder admitted it was a black-box model with no clinical explainability. “What patient is going to accept a surgery decision from an algorithm I can’t explain?” he asked. His message to startups is clear: involve physicians from day one, not as a checkbox but as co-creators. “You get better products,” he says. “And we’ve all seen technology that promised a lot but didn’t deliver. That’s a way to solve it.”

Final Thoughts: Leaving Healthcare Better Than He Found It

Whether in the OR, at the AMA, or shaping AI adoption, Ehrenfeld’s vision is consistent: better access, better outcomes, lower costs, and equitable care. “I want to make sure that when all is said and done, I can look back and know that things got better because of the projects and programs I was engaged in,” he reflects. For founders, policymakers, and clinicians alike, his message is equal parts pragmatic and hopeful: embrace innovation, but never lose sight of the patient.