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Home » Payers and providers increase investments in AI
AI in Finance

Payers and providers increase investments in AI

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More than half of health system and insurance executives consider artificial intelligence an “immediate priority,” and 73% of organizations said they are increasing their financial commitments to the technology, according to a new study . investigation“Within the C-Suite, payer and provider leaders share their vision for AI.”

The survey from Define Ventures, a venture capital firm focused on health technology companies, found that 73% of organizations have established governance structures, which can align AI incentives with organizational values .

The main focus areas of these governance committees include identifying and prioritizing use cases (91%), establishing ethics and security guidelines (87%), and defining data policies (84%).

WHAT IS THE IMPACT

Payers and providers both view AI as a transformative force in healthcare, with 54% expressing confidence in its potential to reshape the patient and clinician experience over the next few years. years.

Thirty-three percent think it will reduce health care costs, 9% think it will improve the quality of care, and 4% think it will improve access. This partly explains why 76% are implementing AI pilot programs, focusing on small-scale projects to validate their impact before committing to broader adoption. 71% of them are in the process of identifying specific use cases, indicating that while AI shows potential, executives are still considering its implementation.

According to the survey, organizations are taking a portfolio approach to AI, focusing more on long-term ROI rather than immediate gains. Sixty-eight percent of payers see an opportunity to improve their member experience, but largely through improvements in operational efficiency. Call center optimizations, for example, represent a common use case that enables short-term gains and solves what the survey calls a critical problem for members.

The majority of executives (64%) cite establishing a clear ROI as one of the biggest integration challenges, while 40% say their technical teams are scattered between competing priorities, making it difficult to devote the necessary attention to the integration of AI solutions. This is confirmed by 38% of executives citing the onboarding process itself as one of the biggest obstacles.

For vendors, the same factors that proved challenging – ROI for their chosen use case (45%), workflow integration (38%), and data security and compliance (38%) %) – are the main considerations when evaluating AI providers. Among payers, 86% cite data security and compliance, followed by 38% for data access and ownership and 38% for ROI for the specific use case.

“As regulatory pressures increase and patient expectations evolve, payers are increasingly focused on solutions that improve operational efficiencies without compromising data integrity or compliance,” the authors write.

Sixty-three payer and provider executives participated in the survey, representing 10 of the top 20 providers, five of the top 10 payers.

THE BIGGEST TREND

Three-quarters of U.S. healthcare providers and payers increased their IT spending last year, with artificial intelligence, cybersecurity and IT infrastructure among the top areas of investment, according to a study. study by Bain & Company and KLAS Research.

AI adoption is gaining traction, with 15% of providers and 25% of payers reporting having an established AI strategy in 2024, the report said.

Jeff Lagasse is editor-in-chief of Healthcare Finance News.
E-mail: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.

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A list of the fastest expanding fintech startups in South Africa.

May 14, 2025

Fortunesamaya AI secures $43.5 million in new funding from Fundingnea, with contributions from notable figures including former Google CEO Eric Schmidt, Meta AI’s Yann Lecun, Two Sigma’s David Siegel, and Sixth Street’s Marty Chavez.

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