As healthcare costs surge and administrative waste drives premiums higher, one solution keeps coming up again and again: artificial intelligence. But is AI actually moving the needle when it comes to improving health plan operations? That’s the question we set out to answer in our new report based on a nationwide survey of 100 health plan executives.
The findings? Let’s just say there’s a gap between enthusiasm and execution.
Payers See the Potential…
An overwhelming majority of executives surveyed—86%—said they’re eager to bring AI into their organizations. Even more (94%) believe a good chunk of their day-to-day responsibilities could be automated, freeing them up for more strategic work. That’s not surprising, given that over three-quarters of respondents said they feel overwhelmed by the volume and repetitiveness of their current workloads.
Executives also reported a growing level of trust in AI tools. More than 80% said they have at least a moderate level of trust that AI can effectively support them in tasks ranging from claims processing to billing rule enforcement.
…But Adoption Remains Stubbornly Low
Despite the optimism, only 12% of respondents said their organizations have implemented AI. Nearly 9 in 10 health plans are still operating without it.
Why the lag? The reasons vary—but licensing costs, training demands, and perceived technical immaturity are high on the list. Many executives worry their organizations aren’t quite ready to support AI at scale, especially when it comes to creating feedback loops that allow AI systems to continuously improve.
And, while AI vendors often pitch the technology as a silver bullet for everything from prior auth to member engagement, the report points out that success starts with high-value use cases. For payers, that means focusing on things like claims adjudication and policy enforcement—areas where AI can deliver fast, measurable ROI.
What the Future Holds
Here’s the kicker: even with all these barriers, 79% of executives expect their companies to adopt AI within the next two years.
That means we’re on the cusp of a major shift in payer operations. But it also means health plans need to act fast to get the right infrastructure in place—data, tooling, governance, and training—before AI can really start pulling its weight.
The full report is packed with insights, including:
- Which payer functions execs think are best suited for AI
- Why executives aren’t afraid of job loss—but are worried about ethics
- How to lay the groundwork for successful AI implementation
- And what AI adoption really means for cost reduction and care quality
Want to know where your peers stand on AI—and what it’ll take to catch up?
Download the full report to see the complete findings and get ahead of what’s coming next in health plan AI adoption.
