Image: Depositphotos enhanced by CogWorld

This work is a natural follow-up to my previous book, You and AI – A Citizen’s Guide to Puzzling Together the Future of Healthcare with AI & Blockchain. That guide explores the foundations of how emerging technologies are reshaping the healthcare landscape from the ground up. In Health Plan 2042, we take the next step—translating possibility into architecture. Where You and AI offered a primer on transformation, this book lays out a blueprint for redesigning the very institutions that shape care delivery and financing.

In every era of transformative progress, a tipping point emerges—an inflection where yesterday’s impossibilities become the infrastructure of today. In healthcare, we are nearing such a moment. For decades, the health insurance industry has been hindered by administrative complexity, rising costs, and structural inertia. Despite numerous attempts at policy reform, meaningful simplification has remained elusive. But a convergence of emerging technologies—artificial intelligence, decentralized systems, and real-time data networks—is poised to change that.

We are not merely on the cusp of incremental improvement; we are approaching a fundamental redesign.

To begin making meaningful progress in the next 3 to 5 years, organizations must focus on three foundational innovations: establishing Trusted Intelligence Zones (TIZs) to enable confidential, automated claim settlements; evolving search into a personalized medical navigation engine that guides consumers from symptom to solution; and implementing a Clinical/Admin OS as the connective infrastructure that synchronizes clinical and administrative data in real time. These are not theoretical endpoints—they are achievable, measurable steps toward the broader vision of autonomous healthcare. Starting now, health plans and provider systems can lay the groundwork for a more intelligent, responsive, and radically simplified future.

At the heart of this transformation lies the creation of Trusted Intelligence Zones—secure, algorithmic mediation layers that automate healthcare settlements without requiring disclosure of proprietary terms. Inspired by financial systems like SWIFT or dark pools, TIZs allow payers and providers to negotiate and reconcile in real time, dramatically reducing administrative waste. AI agents evaluate coded claim data from both parties and propose fair settlements logged on a verifiable ledger, enabling confidentiality, trust, and efficiency at scale. Over time, these zones can evolve to handle dynamic contracts, automate appeals, and even manage population-level risk adjustments through shared intelligence.

In parallel, the evolution of search into a personalized navigation experience will redefine how consumers engage with care. Traditional search returns links—future search delivers outcomes. Intelligent agents triage symptoms, recommend high-value providers based on clinical quality and cost data, verify insurance in real time, and schedule appointments—all while preserving privacy. With architecture built on real-time data graphs and federated learning, these systems can guide individuals through care journeys with nuance and adaptability. Search becomes the front door to health, replacing friction with flow and uncertainty with empowerment.

To bring this all together, we must build a Clinical/Admin OS—the exoskeleton for a real-time healthcare economy. Unlike legacy clearinghouses or fragmented revenue cycle systems, Clinical/Admin OS is a decentralized, peer-to-peer platform that connects EMRs, claims processors, and other systems through intelligent overlays. It transforms healthcare workflows by embedding AI-driven decisioning directly into clinical and financial transactions: instant prior authorizations, point-of-care risk adjustments, claim adjudication at the time of service, and trend detection to prevent fraud or improve care delivery. As a programmable operating system, Clinical/Admin OS invites third-party innovation, enabling an ecosystem of applications from smart billing agents to digital consent tools.

The cumulative effect of these shifts is not merely operational—it is existential. The health plan of the future will be lean, intelligent, and purpose-built. Human roles will remain, but they will shift toward oversight, governance, engagement, and calibration of intelligent systems. Everything else—from billing to care coordination—will be handled by autonomous agents trained on live data and accountable to shared logic.

This is not about replacing people. It’s about liberating them. The goal is to reimagine healthcare from the ground up—eliminating redundancy, aligning incentives, and restoring focus to outcomes and relationships.

The vision of Health Plan 2042 is bold, but the path forward is clear:

Deploy TIZ pilots to demonstrate real-time, confidential settlements
Build AI-powered navigation to replace static search experiences
Implement a Clinical/Admin OS to unify the infrastructure across stakeholders

Each step is achievable. Each step reinforces the others. Together, they form the blueprint for a new kind of health system—one defined not by legacy limitations but by intelligent design.

Let’s build it—together.

Rajeev Ronanki continues to reimagine the future of healthcare by harnessing the power of AI and data to provide consumers with predictive, proactive, and personalized insights at the intersection of healthcare supply and demand. His experience spans over 25 years of innovation-driven industry and social change across healthcare and technology, and he regularly speaks on topics related to navigating the future of healthcare, harnessing data-driven insights, and delivering personalized experiences. In November 2021, Rajeev released “You and AI: A Citizen’s Guide to AI, Blockchain, and Puzzling Together the Future of Healthcare,” which has become an Amazon Best Seller.

When he served as the President of Carelon Digital Platforms, Rajeev led efforts to transform Elevance Health into a digital platform for health and wellbeing. He and his leadership team collaborated with internal and external partners to expand virtual care, create a longitudinal patient record to improve care and reduce overall administrative burden, deploy AI to increase auto-adjudication of claims and expedite manual claims review processes, modernize the provider data lifecycle into a single source of truth, and pilot innovative solutions to transform the way consumers interact within the healthcare ecosystem.

Before Elevance Health, Rajeev was a partner at Deloitte Consulting, LLP, where he established and led Deloitte’s life sciences and healthcare advanced analytics, artificial intelligence, and innovation practices. Additionally, he was instrumental in shaping Deloitte’s blockchain and cryptocurrency solutions and authored pieces on various exponential technology topics such as artificial intelligence, blockchain, and precision medicine.

Rajeev obtained a bachelor’s degree in mechanical engineering from Osmania University in India and a master’s degree in computer science from the University of Pennsylvania.

Visit Rajeev on LinkedIn

From Automation to Autonomy: Preparing for Health Plan 2042