Build, Buy, or Tune: The Economics Behind Every Health System AI Decision

The AI conversation inside health systems has moved from governance and validation to return on investment. The problem is that the ROI case usually gets built on top of work that was never finished. Local validation, ongoing monitoring, and performance across the populations a system actually serves are still underfunded in most organizations, and the bill comes due quietly.

Midori Kondo has worked both sides of this, from clinical pharmacy to enterprise applications leadership, and she is second author on published work in the Journal of Medical Internet Research laying out what each AI pathway actually costs and who gets priced out of the safer ones. In this conversation she makes the case that access and validation are not the soft side of the AI agenda. They are the part of the financial model most systems skipped.

We also get into the newer problem. Patients are adopting consumer AI faster than health systems are deploying enterprise AI, and no CIO approved it.

If you are defending an AI budget, sitting on a governance committee, or trying to explain to a CFO why the cheapest pathway is not the cheapest, this one is for you.

Midori Kondo, Pharm.D., MHA, Vice President of Applications, UCSF Health

Megan Antonelli, CEO, HealthIMPACT Live

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