Payers, providers increasing investments in AI

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More than half of health system leaders and insurance executives are calling artificial intelligence an "immediate priority," and 73% of organizations said they were growing their financial commitments to the technology, according to a new survey, "Inside the C-Suite Payer & Provider Leaders Share Their Vision for AI."

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

The primary focus areas for these governance committees include identifying and prioritizing use cases (91%), establishing ethics and safety guidelines (87%), and setting data policies (84%). 

WHAT'S THE IMPACT

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

Thirty-three percent believe AI will decrease healthcare costs, 9% believe it will improve quality of care, and 4% believe it will improve access. That helps explain why 76% are establishing AI pilot programs, focusing on small-scale projects to validate its impact before committing to wider adoption. Another 71% are in the process of identifying specific use cases, indicating that while AI shows potential, leaders are still being deliberate about its implementation.

According to the survey, organizations are adopting a portfolio approach to AI, focusing more on long-term ROI rather than immediate wins. Sixty-eight percent of payers see an opportunity to improve their members' experiences, but largely through operational efficiency improvements. Call center optimizations, for example, represent a common use case that allows for near-term wins and addresses what the survey called a critical member pain point.

The majority of leaders (64%) cite establishing a clear ROI as one of the biggest integration challenges, while 40% said their technical teams are stretched thin across competing priorities, making it difficult to dedicate the necessary focus to AI solution integration. This is backed up by 38% of leaders citing the integration process itself as one of the biggest hurdles. 

For providers, the same factors that have proven challenging – ROI for the chosen use case (45%), workflow integration (38%), and data security and compliance (38%) – are top considerations when evaluating AI vendors. For 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 mount and patient expectations evolve, payers are increasingly focused on solutions that enhance operational efficiency without compromising data integrity or compliance," the authors wrote.

Sixty-three payer and provider leaders participated in the survey, representing 10 of the top 20 providers five of the top10 payers

THE LARGER TREND

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

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

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.