AI and Interoperability Among Top Technology Investments for Healthcare Payers in 2024

Healthcare payers in the U.S. face the daunting task of prioritizing technology investments and initiatives amidst a rapidly changing regulatory landscape, evolving expectations from members and providers, and a difficult economic environment. With advanced, AI-enabled technologies offering great promise in a growing number of healthcare settings and applications, payers are feeling increased pressure to adopt transformation or get left behind.

According to a recent Gartner survey of healthcare payers in the U.S., over the next three years payer technology investments will shift away from legacy infrastructure and data center technologies, and toward transformative technologies like AI, cloud platforms, and integration technologies/APIs. In line with this shift, payers are planning to prioritize area-specific investment in core administrative processing systems (CAPS), interoperability technologies, and consumer experience (CX) capabilities.

This article looks at these planned transformative technology investments in more detail, and how they align with overall payer strategic goals.

Payer Investment Shifts Toward Transformative Technologies

The recently released 2024 Gartner CIO and Technology Executive Survey sheds light on the top technology investments U.S. healthcare payers will be making over the next three years to deliver key business outcomes (see full payer survey results in the infographic below). According to the survey, healthcare payers will be significantly shifting their investments towards transformative technologies in 2024 and beyond. Not surprisingly, AI/Machine Learning ranks as the technology most likely to be implemented by 2026. According to the survey, payers' primary business outcome goals as a result of investing in these transformative technologies include achieving customer experience (CX) excellence, improving operating margins, and increasing human capital effectiveness.

Health payer CIOs and technology executives plan to deploy five key technologies over the next three years to advance digital delivery democratization. These include AI/machine learning (ML), low-code/no-code development platforms, generative AI, distributed cloud, and multiexperience development platforms.

Funding in 2024 is expected to increase for AI and ML, cloud platforms, and integration technologies like APIs and API architecture. On the other hand, investment decreases are expected from payers in legacy infrastructure and data centers, enterprise resource planning, and the Internet of Things.

In order to best prepare for the coming technology shift, Gartner recommends CIOs and technology executives focus on scaling foundational technologies like robust APIs, seek out executive partners and business stakeholders to build on this foundation, and focus on developing AI and digital skills among business teams to accelerate time to value. 

Solution-Specific Payer Investments Leverage Transformative Technologies

 According to another recent Gartner report, Quick Answer - Top Industry-Specific Technology Investments for U.S. Healthcare Payers in 2024, payers are planning to prioritize specific solution investment in core administrative processing systems, interoperability technologies, and consumer experience capabilities.

Modernizing core administration processing systems (CAPS) can help payer organizations meet member and provider experience needs that are almost impossible with legacy systems. The investment in CAPS underscores health plans' need for flexibility, better data access, and real-time claim adjudication capabilities.

Technologies that increase interoperability also rank as a solution priority among healthcare payer executives. As the deadline for the interoperability mandate from the Centers for Medicare and Medicaid Services (CMS) approaches, and with the potential to gather more clinical data and decrease costs through contract optimization, payers are escalating their investments in this area. Clinical data sharing with partner providers is essential for processes such as prior authorization, risk adjustment, and quality measure performance — all of which significantly impact payer financial outcomes.

These findings provide valuable insights into the strategic technology decisions that health payer CIOs and executives must make in the healthcare industry in order to succeed. As we move further into the digital age, these insights offer a roadmap for navigating the future of technology and its impact on the healthcare enterprise.