First came a period of experimentation by corporate customers. They tried out AI in a limited way—infusing some of their internal tools with the nascent technology to see what worked and what didn’t. Then, more recently, companies started getting more serious and confident. They invested more heavily in AI and made it more central to their operations. 

“2023 was really a year of industry and businesses wrapping their heads around AI,” says James Dyett, head of platform sales of OpenAI. “2024 is the year we’re starting to see real-scale deployments of our technology.”

On Wednesday, Fortune released its second annual Fortune 50 AI Innovators list, highlighting the AI companies that are leading in this new phase of the technology’s adoption. They’re the vendors that have gained the most traction, such as funding or customers, and whose AI is considered to be among the best of class. 

In addition to OpenAI, the Big Tech companies on the list include Microsoft, chipmaker Nvidia, business software firm Salesforce, and Chinese e-commerce juggernaut Alibaba. Among the startups are voice cloning tech company ElevenLabs, French AI chatbot upstart Mistral, China-based AI company ModelBest, and biotechnology company Xaira Therapeutics—all of which are less than three years old.

Of course, it’s still early days in AI, and the industry’s pecking order is still very fluid. Companies on top today face many challenges, including the high cost of training models and the difficulty of landing  enough paying customers to turn a profit. At the same time, the industry has a glut of startups doing the same thing, often with little difference between the products they sell. A winnowing, by all accounts, is inevitable. 

From AI basics to dreaming big 

So far, businesses adopting AI have focused on improving employee productivity, like helping software developers write code or tackling customer service questions, thereby reducing the number of calls a customer support desk must jockey. 

Such tweaks can marginally improve business operations. But Eric Boyd, corporate vice president of Microsoft’s Azure AI platform, says executives should dream bigger.

“You are probably missing an opportunity,” warns Boyd, saying corporate customers should consider entirely changing how they do business. 

Microsoft is, of course, one of the biggest beneficiaries of the AI boom. Its AI-related revenue will soon reach a $10 billion annual run rate, making the business segment the fastest in the company’s history to achieve that milestone.

In general, corporate partnerships between AI vendors and corporate customers have exploded in 2024, including OpenAI’s pacts with biotechnology company Moderna and financial giant Morgan Stanley. Similar deals have helped to lift OpenAI’s valuation to $157 billion, most recently raising $6.6 billion in a huge funding round in October, nearly doubling the company’s valuation from nine months earlier.

Over the past year, new large AI models have been unveiled at a steady clip including the preview release of o1, which is touted by OpenAI for its stronger “reasoning” capabilities. Meanwhile, Meta has introduced three versions of the company’s open-source language model in 2024, up from two the prior year. Uptake for many such foundational models is growing rapidly. 

“We’ve hit 500 million downloads, that’s 10-times the same time as last year,” says Ahmad Al-Dahle, Meta’s vice president and head of genAI. “We’ve seen incredible adoption in the Fortune 500 companies leveraging Llama for their internal use cases,” citing the name of Meta’s large language model. 

Can AI help treat health care’s symptoms? 

Health care is among the sectors especially poised to benefit from AI, especially considering its reputation for high costs, administrative complexity, staffing shortages and clinician burnout. AI could create $370 billion in value for health care by accelerating drug discovery and development and more accurately matching patients with potential treatments, according to consulting firm McKinsey.

Xaira Therapeutics is among the AI-focused drug development startups that’s made a splash. In April, it emerged with $1 billion in funding and has since started its first effort to come up with new drug treatments, set up an office in South San Francisco, and made key appointments including hiring a chief scientific officer.

The startup intends to apply generative AI to drug discovery, production, and clinical trials, aiming to improve the entire drug development process and get more effective treatments to market faster. 

“We believe that AI will enable us to transform how we do all three steps and be much more successful,” says Marc Tessier-Lavigne, CEO of Xaira Therapeutics.

Abridge, which helps doctors save time by automatically transcribing and organizing their discussions with patients, in February announced a $150 million Series C investment. It has also disclosed a steady pace of new contracts with the likes of Yale New Haven Health System and The University of Vermont Health Network.

“Our opportunity is to really unburden clinicians and help them focus on the most important person in the room…the patient,” says Shiv Rao, CEO and founder of Abridge, and also a practicing cardiologist. 

He cites surveys showing physicians are overwhelmed and that many are even considering exiting the field entirely. Rural hospitals, already at risk of closing due to financial constraints, would be particularly impacted by such an exodus.

Rao says Abridge’s value is that it’s a sector-specific AI application—trained specifically on medical and patient data—and that it’s meant to address multiple markets, ranging from large academic medical centers to private practices, and across different parts of the health care system including cardiology, primary care, and the emergency room. This year, Abridge alongside the Mayo Clinic and software provider Epic, unveiled an AI documentation product specifically targeted to nurses.

To score deals, Rao says he must make a successful pitch to three executives: the chief medical information officer, chief information officer, and chief financial officer. “We need all three of them to believe that this creates ROI for their clinicians,” says Rao.

AI is both Hollywood’s new star and villian

The creative industry also presents fresh opportunities with AI, but also thorny questions about copyright protection, the potential threat to artists’ livelihoods, and big changes to the art, films, design, and advertising. The pitch from AI video company Runway, which in June released its newest model that can create 10 second video clips from text prompts, says AI can help speed up video projects and give creators more time.

“Cinema is an art form because of technology,” says Cristobal Valenzuela, Runway’s CEO and cofounder. “These are just tools.”

Runway works with major film studios, including Lionsgate, following a partnership they signed in September. The deal involves two creating and training a new AI model that is customized on the entertainment company’s proprietary catalog, which includes The Hunger Games and Saw film series.

Meanwhile, Adobe’s Firefly AI image-generating tool has been used by its customers to create over 13 billion images. Clients have used the technology, for example, to create images for Barbie packaging and for customizable bottles sold by Gatorade.

“We’re excited about actually seeing these enterprises not only using gen AI to make the lives of their creative departments easier, but in some cases, enable their customers to personalize and change the engagement with the brand,” says Alexandru Costin, vice president of generative AI at Adobe. 

Adobe has recently unveiled a generative AI video tool, and a feature that lets artists draw a shape that Adobe Illustrator then fills with an image via a text prompt. Adobe stresses that its generative AI is trained only on data that the company has a right to use or that is in the public domain and therefore does not violate copyright laws. 

Overall, Meta says use cases that felt impossible before the current AI boom are now becoming a reality as AI models get smarter. Some customers using Llama today include Accenture, which built a custom LLM to more efficiently produce ESG reports for the consulting firm’s clients, while telecommunications giant AT&T used fine-tuned versions of Llama models to help speed up response times for customer inquiries.

Microsoft’s Boyd says that while more than 60,000 customers are using Azure AI today, many C-suite leaders are still thinking through the responsible and ethical use of AI, how to manage their data, and the hunt for ROI. “Where we’ve been focused is, how do we help our customers take advantage of this new technology that’s really touching every facet of their business?,” asks Boyd.

OpenAI’s Dyett says it’s unclear what the next big thing is in AI now that the basics are largely taken care of. But whoever does take the technology to the next level will have to take some risks. Said Dyett, “It’ll be a company that goes out on a limb and experiments with something that hasn’t been done before, starts to see some really positive results, and that gets the rest of the market going.”