AI Governance and Digital Access at Mount Sinai Health System with Girish N. Nadkarni and Dr. Nicholas Gavin

Summary

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Podcast Summary: AI Governance and Digital Access at Mount Sinai Health System

Podcast: Becker’s Healthcare Podcast
Episode Date: February 22, 2026
Guests:

• Girish N. Nadkarni, Chair of the Windreich Department of Artificial Intelligence and Human Health, Director of the Hasso Plattner Institute for Digital Health, Chief AI Officer, Mount Sinai
• Dr. Nicholas Gavin, Vice President and Chief Clinical Innovation Officer, Mount Sinai
  Host: Laura Dardel

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Episode Overview

This episode centers on Mount Sinai Health System’s leadership in responsible AI governance and digital health innovation, with a deep dive into their expanding digital front door, asynchronous care models, and the challenges and opportunities in healthcare access for 2026. Girish Nadkarni and Dr. Nicholas Gavin share insights on leveraging technology to transform patient care, how they’re creating robust oversight for AI deployment, and the system’s ambitions to become the most consumer-oriented and learning-focused health system in New York City.

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Guest Introductions

[01:02]

• Girish Nadkarni: Clinician (internist and nephrologist), clinical informaticist, with extensive experience in AI implementation and deployment. Leads Mount Sinai’s AI initiatives.
• Dr. Nicholas Gavin: Emergency physician, inaugural Chief Clinical Innovation Officer, and clinical informaticist. Overseeing innovation across Mount Sinai’s eight acute care hospitals and hundreds of clinics.

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Key Discussion Points & Insights

1. Expansion of Asynchronous Care

[02:24] Dr. Nicholas Gavin

• Mount Sinai is prioritizing the expansion of asynchronous care to improve patient access and convenience:
  • Definition: Patients interact with providers on their own schedule—via surveys, wearables, or messaging—instead of synchronous video or in-person visits.
  • Use Cases:
    • Acute care: E.g., young women with urinary tract infections can be treated efficiently without in-person or video visits.
    • Preventive care: Focused on HIV PrEP medication management.
    • Chronic care: Includes insulin and GLP1 titration management.
  • Quote:

    "Asynchronous care today is where telemedicine was in 2017." (Dr. Gavin, 03:38)

  • This innovation addresses access challenges for patients and streamlines care delivery for clinicians.

2. AI Governance and Assurance

[04:54] Girish Nadkarni

• Unified Governance: Mount Sinai created streamlined AI and digital health governance structures to enable rapid, responsible decision-making at the executive level.
  • Governance is categorized by personas: patient, clinician, workforce, researcher.
• AI Assurance Lab:
  • Established to ensure AI tools used in care are safe, effective, unbiased, and avoid "hallucinations."
  • Quote:

    "We set up also an AI assurance lab in order to make sure that AI is safe, effective, responsible." (Girish Nadkarni, 05:12)

• The overall goal is to ensure that AI empowers rather than obstructs clinical innovation.

3. Headwinds and Priorities for 2026

[06:28] Dr. Nicholas Gavin & [07:04] Girish Nadkarni

• Chief Concern: Loss of insurance coverage for many due to federal Medicaid rollbacks and ACA program changes.
• The health system is actively working to help patients maintain coverage and continuity of care.
• Quote:

  "The biggest headwind that we'll face going into this year." (Dr. Nicholas Gavin, 06:54)

4. Driving Access and Precision Matching

[07:52] Dr. Nicholas Gavin

• Access is the "holy grail" for Mount Sinai: More precise patient-provider matching via data and technology.
• Aiming to optimize specialty clinic utilization and align resources efficiently.
• Considering generative AI for identifying care gaps and optimizing matching.

5. Generative AI for Patient Interaction and Automation

[08:57] Girish Nadkarni

• Opportunities:
  • Patient-facing chatbots to proactively augment care at scale.
  • Automating routine admin tasks—preauthorization, insurance checks—to improve experience.
  • Quote:

    "...shift care from reactive to proactive at a scale that has never been done before." (Girish Nadkarni, 09:04)

6. Organizational Focus and Execution

[10:05] Dr. Nicholas Gavin

• Biggest Challenge:
  • Prioritizing execution on core organizational problems amidst a barrage of "shiny object" solutions from industry.
  • Staying focused on scalable, patient-centered initiatives rather than narrow point solutions.
  • Quote:

    "It's really, really important to focus on execution and focus on execution around core problems for the organization..." (Dr. Gavin, 10:13)

• [10:32] Girish Nadkarni:
  • Echoes importance of purpose-driven innovation: “Start with the why... keep the patients at the center of all of this.”

7. Organizational Growth and the Consumer-Driven Model

[11:28] Dr. Nicholas Gavin

• Mount Sinai aims to become the "most convenient health system" in New York City.
• Sees opportunity to lead as a truly consumer-oriented system, meeting patients on their terms—drawing on lessons from other industries.
• Quote:

  "No one has really stepped forward to say we are going to own being the most consumer oriented health system in New York City." (Dr. Gavin, 11:39)

8. Becoming a Learning Health System

[12:29] Girish Nadkarni

• Mount Sinai is leveraging data and continuous feedback to create a "virtuous cycle of learning, acting, doing, and further learning."
• Integration of consumer-orientation with learning from patient experiences to improve outcomes and experience.
• Quote:

  "The consumer oriented piece and the learning health system goes hand in hand because ultimately it's all about learning what we should do next and listening to patients and improving the experience." (Girish Nadkarni, 12:53)

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Notable Quotes & Memorable Moments

• Dr. Nicholas Gavin [03:38]:
  "Asynchronous care today is where telemedicine was in 2017. The incentives aren't necessarily there yet, but we're starting to see patients adopt this type of care."
• Girish Nadkarni [05:12]:
  "We set up also an AI assurance lab in order to make sure that AI is safe, effective, responsible so that anything that gets deployed into clinical care is assured and made sure that we... There's no bias, there's no hallucinations, etc."
• Dr. Nicholas Gavin [10:13]:
  "It's really, really important to focus on execution and focus on execution around core problems for the organization as opposed to getting distracted by, by shiny objects in the periphery. That's going to be our challenge over the next year."
• Girish Nadkarni [12:53]:
  "The consumer oriented piece and the learning health system goes hand in hand because ultimately it's all about learning what we should do next and listening to patients and improving the experience."

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Timestamps for Important Segments

• [01:14] – Guest introductions
• [02:24] – Expansion of asynchronous care
• [04:54] – AI and digital health governance structures, AI assurance lab
• [06:28] – Challenges with Medicaid and ACA policy shifts
• [07:52] – Leveraging data and technology to improve access and matching
• [08:57] – Role of generative AI in augmenting care and automating workflow
• [10:05] – Strategic focus: Prioritization and execution challenges
• [11:28] – Growth aspirations: Becoming consumer-oriented and a learning health system

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Conclusion

Mount Sinai Health System is proactively confronting the dual challenges of digital transformation and rapidly changing healthcare policy. By expanding asynchronous care, implementing rigorous AI governance, and shifting toward a more consumer- and data-driven organizational mindset, Mount Sinai aims to deliver safer, more responsive, and accessible care. The conversation emphasizes the necessity of purposeful innovation and continuous learning to navigate industry disruption and better meet patient needs in the years ahead.

Transcript

[Becker's Healthcare Announcer]

This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.

[Laura Dardel]

This is Laura Dardel with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Girish Nadkarni, Chair of the Windreich Department of Artificial Intelligence and Human Health, as well as director of the Hasso Plattner Institute for Digital health and chief AI officer at Mount Sinai Health System, and Dr. Nicholas Gavin, vice President and Chief Clinical Innovation Officer at Mount Sinai, to talk about some of the great things that they're doing in AI technology and more. So, Girish, Dr. Gavin, thank you so much for being here today.

[Dr. Nicholas Gavin]

Thanks for having us.

[Girish Nadkarni]

Thanks for having us.

[Laura Dardel]

Excellent. Well, I'm excited for our conversation, but before we dive in, we'd love to have you both just briefly tell us a little bit about yourselves, your background, maybe, you know, 20 seconds or so. Girish, can we start with you?

[Girish Nadkarni]

Yeah, sure. My name is Girish. I'm a clinician, clinical informaticist. I'm the chair of the Department of AI and the Windreich Department of AI and Human Health. As one of the chief AI officers, My background I'm a clinician, internist, nephrologist, but also have a lot of experience in clinical informatics, AI implementation and deployment.

[Laura Dardel]

Fantastic. So glad to have that perspective.

[Dr. Nicholas Gavin]

And Dr. Gavin, I'm Nick Gavin. I'm the Health Systems inaugural Chief Clinical Innovation Officer by training. I'm an emergency physician and clinical informaticist. We're both representing Mount Sinai Health System in New York, which is a large academic health system serving mostly New York City, but some presence in Westchester, Long island and New Jersey. We have eight acute care hospitals, hundreds of clinics and run many multi specialty group practices.

[Laura Dardel]

Fantastic. Given the breadth and depth that you oversee, I can imagine there's a lot going on at any given time, but when you think about the last year or so, can you tell me about a project or initiative that you led and have been working? What did you do and what were the results?

[Girish Nadkarni]

Sure.

[Dr. Nicholas Gavin]

So I'll start. We have been really thinking about our digital front door in the health system and one of the projects that we led over the last year was really Expanding our access to asynchronous care. This is a care modality that some health systems have leveraged. Kaiser on the West Coast, Baylor, Scott and White in Texas. And this is a care modality that I think is in its infancy in terms of how it can be leveraged. What do we mean by asynchronous care? Asynchronous care basically says we aren't dependent on a model where a patient has to find time to get on a video visit or go to a clinic in order to receive care. They can respond to a survey, they can provide wearable data, they can answer questions that we may have of them asynchronously. And ultimately we give them anticipatory guidance, prescription medications, and really provide continuous care, not requiring an in office visit or even a video visit. We've seen a lot of our world shift in this direction and people want to be able to, to do things from the palm of their hand. And we've started to experiment with this at Mount Sinai. So we've expanded our asynchronous care offerings. I really think asynchronous care today is where telemedicine was in 2017. The incentives aren't necessarily there yet, but we're starting to see patients adopt this type of care. We're expanding on this in three different areas. One is in acute care. So young women with urinary tract infection, for instance, do they need to have a video visit or an in person visit? Or can we shift this care to the most efficient, most and most cost effective way of delivering that type of care? We were also experimenting with this around preventive care, particularly Prep medications for HIV prevention and then chronic condition management. So insulin regimen, GLP1 titration. We're really interested in shifting that care out of the practice and into the digital space. This is one way we're trying to alleviate our huge, huge access challenge within a large academic health system.

[Girish Nadkarni]

The one thing that we also focused on over the last year was setting up appropriate governance structures for AI and digital health. Now, AI and digital health are so intertwined with each other that we sort of harmonized and streamline all of the governance structures in order to make sure that it becomes more of an enabler and a force multiplier blocker. So we divided it up by sort of Personas in terms of whether it's patient facing, clinician facing, workforce facing, researcher facing, and all of that gets rolled up into an executive committee where the highest echelons of our health system sit in order to make decision with rapid speed. So one of the things that we accomplished over the last year was to get the governance and guard rails up. The other thing that we set up also was sort of an AI assurance lab in order to make sure that AI is safe, effective, responsible so that anything that gets deployed into clinical care is assured and made sure that we. There's no bias, there's no hallucinations, etc. Etc. So I think that was one thing that we were very proud of last year.

[Laura Dardel]

That's amazing to hear and I know that is no small task to set up those governance structures and then for the asynchronous care too, what a great benefits of the community. But again, it takes change management, it takes a good amount of effort on the technology and people side to bring that about and get it done in an efficient and effective way.

[Girish Nadkarni]

Possible.

[Laura Dardel]

I'm curious, when you look ahead to the next year or so, what are some of the big priorities and headwinds that you're focused on for 2026?

[Dr. Nicholas Gavin]

Obviously, a lot of the headwinds that our health system, among many others across the country, are facing is all of the people who will be uninsured secondary to federal policy shifting people off of Medicaid rolls and reducing coverage through ACA coverage programs. So we're doing everything we can to support patients in staying active on, on their Medicaid and making sure that people have continuity of care. But that's the biggest headwind that we'll face going into this year.

[Girish Nadkarni]

Yeah, I completely agree with Nick. The regulatory and reimbursement changes are all the biggest headwinds that we face this year. And sort of it's our role as a leading health system in order to make sure that the community and our patients are well cared.

[Laura Dardel]

That makes a lot of sense, you know, is a huge challenge and concern, I know, for many hospitals and systems across the country as they're looking at what it will mean already with some of the ACA changes and then into Medicaid for next year. And so, you know, when you're looking at the ways that you're preparing today or how you know you're, you're getting ready for that type of reality, what does it look like from a technology perspective? Are there things that you have been able to put in place or are planning to start digging into deeper as access to care and those kinds of things I can imagine are going to be a really big focus in the next couple of years?

[Dr. Nicholas Gavin]

Yeah, I think what we're trying to do on the access front Which I think has to be our holy grail. Right now we're in a hyper competitive market. We need to start leveraging our data to be really precise about matching patient needs with the supply of the physicians and providers that we have. We've left it up to patients a lot of the time. And I think there's more of a role that we need to play actively in getting patients matched to the right resource, making sure that those patients that are getting seen in our specialty clinics in particular really need to be seen in those practices. The efficient use of specialty time, real estate energy should be a real singular focus for us. And we're thinking about how to leverage technology, particularly generative artificial intelligence, to really highlight where our opportunities are and where our gaps are.

[Girish Nadkarni]

So I'd like to just add on to that. I think generative AI, I mean patient facing chatbot, provide a unique opportunity in order to augment care and improve access and provide shift care from reactive to proactive at a scale that has never been done before. Now obviously this needs to be safe and effective and responsible. But I think that, you know, just two advancing trends of generative AI capabilities improving as well as the access issues that we are running into. Provide a unique opportunity in order to understand patient preferences, match them to the correct care, escalate if need be, but also think about augmenting and maybe automating some of the routine administrative work that patients go through, the pre authorization, insurance checking, et cetera, et cetera, in order to make the patient experience much better.

[Laura Dardel]

That makes a lot of sense and it's really helpful to understand how you're thinking through all of those things and changing dynamics on an executive level. Now, what do you think the hardest thing you'll have to do in the coming year will be?

[Dr. Nicholas Gavin]

The constant challenge of the next year is going to be where to prioritize and where to focus. We are being pitched different solutions every single day and I think it's really, really important to focus on execution and focus on execution around core problems for the organization as opposed to getting distracted by, by shiny objects in the periphery. That's going to be our challenge over the next year.

[Girish Nadkarni]

Yeah, I completely agree with that. And important to start with the why we are doing this other than find a point solution that solves a very niche, very narrow niche case and also sort of keep the patients at the center of all of this and figure out what's the best, most scalable way to help them safely and effectively. That would be the, the most important challenge coming in 2026, because technology sort of keeps on improving, but we need to, like, focus and like, make sure that we are helping patients rather than just being building technology for technology's sake.

[Laura Dardel]

That makes a lot of sense. And I think, you know, it's always a helpful reminder. It seems like it should be easy, but I know it never is, especially as you said, when there's, you know, every single day new companies coming at you and new pitches coming forward. And speaking of looking into the future, I'm curious, how are you thinking about organizational growth in the next couple years or so? What does that look like, especially given some of the different factors and dynamics we talked about today.

[Dr. Nicholas Gavin]

So I feel strongly that we have an opportunity to step into the space of being the most convenient health system in our, in our market. No one has really stepped forward to say we are going to own being the most consumer oriented health system in New York City. And that's something that we're trying to advance internally as a concept. Patients are increasingly demanding about their healthcare services and want it to be on their terms in their time. And we need to really meet people where they're at, just as other industries have done. We've been a laggard in this arena and we really, really have the opportunity with the assets that we have within the health system to leap ahead. So that's something I'm hoping for, to be part of our growth strategy in the year ahead.

[Girish Nadkarni]

Yeah, and completely agree with Nick. And to add to that, I think we also have the unique opportunity of being a learning health system, which we learn from experiences, we learn from data, and we learn from our own actions in order to improve the next iteration of what we're doing and what that helps us do. Sort of create a virtu cycle of learning, acting, doing, and then further learning in order to improve patient experience, improve outcomes. And sort of the consumer oriented piece in the learning health system goes in hand in hand because ultimately it's all about learning what we should do next and listening to patients and improving the experience.

[Laura Dardel]

I love that that's such a clear way to really add a ton of value to the organization overall. But then improving the care, improving the experience, and really growing the reputation of everything that you're doing at Mount Sinai. So I really appreciate your time today. Thank you so much, Girish and Nick, it's been a pleasure speaking with you both and I look forward to seeing you as well at our annual meeting in April. I know we'll be speaking on panels with us and so that'll be a ton of fun to keep this conversation going.

[Girish Nadkarni]

Thank you. Thank you.