10 AI Lessons from serving 21 million patient
                     Steer Health
PRODUCTION LESSONS IN HEALTHCARE AI
10 AI Lessons from 
Serving 21 Million Patient 
Lives
What millions of patient conversations taught Steer Health 
about building healthcare AI that works in production.
Sridhar Yerramreddy, Founder & CEO, Steer Health
Source: Steer Health article
THE MISSION IN ONE PATIENT CALL
The moment that explains the mission
2:47 a.m. Find the referral1 The agent locates the order.
A daughter calls for the third time that week to get her 
father a cardiology follow-up after an ER visit. The referral 
had gone nowhere. Verify coverage2
Insurance is checked in context.
Book the appointment
3
Completed in under four minutes.
“Wait, that’s it?” — that pause is why we do this.
Source: Steer Health article
LESSONS 1–3
Design around the whole journey
1. One channel is never enough.
Patients move across voice, web, chat, SMS, fax, and referrals. Around 40% Web Voice
of referrals are abandoned at the seams. Chat & SMS Luna
2. The playbook is the most powerful prior.
Codify payer, provider, location, and workflow rules so every channel reasons 
from the same map.
3. One brain is better than ten bots.
ONE REASONING LAYER
One reasoning layer prevents duplicate rules and patients repeating their 
story.
Referrals Playbook
Fax workflow Steer Studio
Source: Steer Health article
LESSON 4
Guardrails are non-negotiable
You cannot put a black box in front of a 
patient. SteerNotes: Show Your Work
Practice-specific playbooks sit above the model, not inside it. Suggested Codes
AI provides codes with supporting evidence from the 
Defined escalation paths for cases requiring human judgment. encounter.
Any system that can't explain itself has no business near a chart.
Draft Orders
Queued for physician review and approval, never automated.
AI Proposes. Clinicians Decide.
Source: Steer Health article
LESSON 5
Move from record to action
The EHR is the system of record. AI must be the 
system of action. SYSTEM OF ACTION(Agentic AI)
Healthcare software has spent a decade creating work about the 
DEEP WRITE-BACK
work. AI earns its keep by becoming the system of action that 
finishes the job.
36 EHR Integrations
via FHIR R4 & HL7 (including Epic SSO) SYSTEM OF RECORD(The EHR)
Source: Steer Health article; FHIR R4
LESSONS 6–8
Build for evaluation, speed, and trust
6. Every agent needs a critic 7. Think fast and slow 8. Governance is the product
Run two speeds in one system. A fast path 
Automated review at scale. Measure intent for real-time conversation latency and a Validation, monitoring, and defined 
resolution, booking accuracy, and slow path for heavyweight reasoning escalation paths. HIPAA is the floor, not 
escalation grace—not just answer rates. around encounters and payer rules. the ceiling. Governance is why you can put 
Catch drift before patients feel it. AI on a main line and sleep at night.
An AI system is only as good as the governance evaluating it.
Source: Steer Health article; HIPAA [8]
LESSON 9
The flywheel compounds
Every conversation makes the next one 
better. Patient Interaction
Interactions surface edge cases that refine the playbook in Steer 
Studio. This improves every channel at once, creating a 
compounding advantage that point solutions cannot match. Edge Cases
Data Feedback Surface
THE
FLYWHEEL
2.2%
Network No-Show Rate
Improve Channels Refine Playbook
Against a national average of 18–20%
Source: Steer Health article
LESSON 10
Production is the test
BASE CAMP THE SUMMIT
The Demo Real Production
Scripted pilots in controlled environments. The 2:47 a.m. call with no staff on the line.
Humans quietly cleaning up behind the scenes. The half-legible fax referral that must be processed.
Simulated situations with predictable inputs. Owning the outcome: when AI owns the contract.
“A great demo is base camp, not the summit.”
Source: Steer Health article
FUTURE OUTLOOK
The road ahead
1 2 3
Governance Becomes Standard Point Solutions Consolidate Performance-Based Pricing
The era of fragmented vendors ends as health Outcomes become the contract. Vendors 
AI governance committees will be as standard in systems demand unified rule sets and one unwilling to be measured on results will 
health systems as infection control within three reasoning layer. disappear from RFPs.
years.
“Vendors unwilling to be measured will quietly disappear.”
Source: Steer Health article
THE AI-NATIVE GROWTH PLATFORM
The front door is open
“Patient access is the reason. Growth is the output. Our ambition is a 
healthcare system where getting care feels easy, every time.”
2.6M 21M 2026 Top 20
ACTIVE PATIENTS LIVES COVERED HEARST HEALTH PRIZE KLAS EMERGING SOLUTIONS
Source: Steer Health article