Generative AI in Payer and Provider IT Transformation, Global, 2024-2029

Gen AI-based Solutions are Driving Transformational Growth across the Payer and Provider Ecosystem as Organizations Move from Identification to Implementation

The healthcare payer and provider industry is gradually adopting generative artificial intelligence (Gen AI) solutions across its value chain. Almost all organizations have shown an intent to implement Gen AI-based solutions in their products or processes, with a few already embarking on this journey. Gen AI seamlessly syncs with existing tools/IT applications and other technical solutions to enhance workflows or create new processes. Payer and provider organizations face administrative, operational, clinical (only providers) and financial challenges in delivering comprehensive and timely patient care. These issues often result in care delays and follow-ups, impacting the overall health of consumers. The industry is shifting from an identification to an implementation stage, with leading adopters using Gen AI solutions across different use cases and working with vendors to fine-tune output. This has created new ecosystems between technology vendors and end users that enable leaders to align technology adoption with an organization’s vision and values.

Given the nature of technology and healthcare data, some aspects or use cases are more strongly governed by regulators than others. This has accelerated product development and adoption in the administrative, operational and financial categories while limiting the growth of clinical solutions. With the change in the global regulatory environment to balance innovation with safety, government, regulators, technology developers, and end users will need to work together to build national and organizational governance models.

Looking at the evolving landscape of technology and regulations, this study seeks to quantify the savings that can be derived from implementing Gen AI-based solutions across some of the most pressing segments of the payer (claims management, risk adjustment, front- and back-office integration, marketing, and stakeholder management) and provider (financial, operational, CDSS, documentation, administrative, and patient engagement) value chains, including horizontal capabilities such as interoperability and cybersecurity. The report discusses technology advances made across these use cases and profiles several leading vendors optimizing their portfolios with Gen AI technology.

It covers the adoption of Gen AI-based solutions in North America (Canada and the United States), Europe, Asia-Pacific, and the rest of the world nations (Latin America and the Caribbean, Middle East, and Africa). North America dominates the market in terms of development and adoption owing to the region’s higher technology maturity, less stringent regulatory policies, and favorable start-up environment. While North America will continue to be the fastest growing and generate the bulk of savings from the adoption of Gen AI-based solutions, growth in Asia-Pacific will outpace the remaining regions and its net gains will reach the same level as Europe by the end of the forecast period.

GenAI is attracting more stakeholders into its realm. If implemented thoughtfully and in line with regulatory guidance, it has the potential to address the most pressing industry challenges and create an opportunity to generate more than $300 billion in gains across the patient journey by 2029.