Payors and providers are fighting different operational battles, but they’re using the same two-letter weapon to come out on top: AI, you guessed it.
A joint report from Bain & Company and KLAS found that 80% of payors and 70% of providers now have an AI strategy in place, up from just 60% last year.
- Providers are up against structural workforce shortages and rising patient volumes, while payors are contending with higher medical loss ratios and more regulatory scrutiny.
- Bain and KLAS’ survey of 228 U.S. healthcare execs suggests that all signs point to one solution, and that’s deploying tech to improve margins.
Where are payors investing? Care coordination (57%) and utilization management (55%) were the top IT investment priorities for the second straight year.
- Payors place total cost of ownership, functionality, and scalability ahead of suite convenience, so best‑of‑breed is still the default buying motion.
- Plans are leveraging AI for everything from member engagement (35%) and enrollment (26%) to risk adjustment (26%) and prior auth automation (20%).
Where are providers investing? Revenue. Cycle. Management.
- Half of providers ranked RCM among their top IT priorities, placing it above clinical workflows (34%) and EHRs (32%).
- RCM = ROI. Accurate documentation and coding results in cleaner claims and fewer denials, which directly translates to higher revenue and lower expenses.
- It’s also a match made in heaven for AI automation, and RCM currently represents the four most common AI use cases: ambient documentation (62%), clinical documentation improvement (43%), coding (30%), and prior authorization (27%).
Here’s the kicker. Providers cite EHR integration and interoperability as their biggest pain points, so most of them prioritize their EHR vendors for new solutions.
- Only 20% of providers are primarily best-of-breed buyers, and two-thirds of Epic customers would choose an Epic option that’s “good enough” over a better competing product.
The Takeaway
It’s getting pretty hard to not be bullish on AI. There’s still plenty of uncertainty, but both payors and providers now seem to agree that inaction is the riskiest action.
