Healthcare organizations face a fundamental tension: AI agents that can transform clinical workflows, analyzing patient records, identifying care gaps, predicting protein structures, consume massive volumes of tokens. But patient data governed by HIPAA and institutional policy cannot be routed through public cloud APIs without significant compliance risk. Agentic AI workloads are fundamentally different from the chatbot era. These agents don’t just answer a single prompt. They chain prompts, retrieve data, call tools, and collaborate with other agents, all on their own. A single agentic clinical workflow can consume 10,000 to 500,000+ tokens, and without guardrails, those autonomous loops can silently burn through your token budgets.