Machinify hosted our inaugural OS/AI Payer Summit earlier this month in Scottsdale, bringing together health plan executives and industry experts to tackle today’s challenges, examine opportunities for innovation, and chart a stronger path forward for payment integrity.
The Perfect Storm: Why Now Matters
The timing couldn't have been more critical. As emphasized by many throughout the summit, the balance of power between payers and providers is shifting rapidly. "Providers are deploying AI at scale to optimize revenue, while payers face mounting cost pressures and vendor model disruption," CEO, David Pierre, noted, setting the stage for why industry collaboration has become essential.
The numbers tell a compelling story. According to Menlo Ventures, 75% of healthcare AI spending is happening on the provider side, with AI-generated claims volumes rising and coding sophistication increasing. Meanwhile, payers are grappling with medical cost utilization trends. Our conversations with industry leaders point to a 10-11% rise in healthcare costs over the next year, a trend many describe as increasingly unsustainable.
Andy Slavitt Sets the Tone
The summit's opening fireside chat with Andy Slavitt, former acting administrator of CMS and current healthcare policy leader, immediately established the event's candid, no-holds-barred atmosphere. Slavitt, who led the turnaround of Healthcare.gov and served as President Obama's White House senior advisor for COVID response, didn't mince words about the industry's challenges.
"If you don't have intelligence within all of your operations across all your administrative areas, you're not going to be able to win in the future," Slavitt declared, emphasizing that AI adoption isn't optional, it's survival. His insights on the current focus on program integrity and his observation that "this is the first time I've seen the healthcare sector be one of the fastest sectors to adapt new technology" set the strategic context for the entire summit.
The Keys to Transformation
One of the summit's central themes emerged from Chief Product Officer Shri Santhanam's compelling presentation on AI transformation lessons. Drawing parallels across generations and industries, Santhanam illustrated how "90% of companies who say they're working with AI are mostly stuck in proof of concepts" while the real value comes from working backwards from business impact.
His framework resonated throughout the summit:
- Start with simple impact, rethink work processes entirely
- Become an evangelist within your organization
- Pick the right transformation partners
- Establish proper governance
- Focus on data sharing
As Yvonne Hobby, SVP of Customer Success at Machinify, noted, "Payment integrity used to be cost containment, and now it's a strategic imperative."
Machinify’s Chief Technology Officer, Prasanna Ganesan, painted an even bolder vision of the future, describing AI decision coprocessors that will fundamentally reimagine how claims are processed. "We are now in an era where we have a new kind of computer," he explained, emphasizing that, for the first time, language has become computable, opening entirely new possibilities for healthcare administration.
Breaking Down the Adversarial Model
Perhaps the most powerful sessions were the provider-payer panels and roundtable discussions that addressed the elephant in the room: the traditionally adversarial relationship between payers and providers. Industry leaders spoke candidly about the need to move beyond the "arms race" mentality toward genuine collaboration.
One health plan executive captured the frustration perfectly, "We have this unconscious bias where we actually hold AI to much higher standards... but how many times do humans make mistakes that we just accept?"
The conversations repeatedly returned to the need for transparency, trust, and shared goals, particularly around improving patient outcomes and system sustainability.
Boyd Stewart, KLAS’ EVP of Engagement, shared the provider perspective, noting that while innovation is happening rapidly, "trust and credibility between providers and payers would be tough to overcome" without intentional collaboration efforts.
The Power of Intimate Dialogue
What set this summit apart was its format. Beyond the keynotes and panels, the real magic happened in the roundtable discussions where 10-12 industry leaders could speak freely about challenges like future-proofing payment integrity, scaling AI pilots, data sharing governance, and building next-generation ecosystems.
These intimate sessions, facilitated by Machinify's subject matter experts, created space for the kind of candid conversations that rarely happen in larger conference settings. Participants discussed everything from AI governance frameworks to the practical challenges of provider contract negotiations, sharing war stories and collaborative solutions.
As one participant reflected, "The conversations seem to be the same whether there's AI or no AI... but we need to get to a place where we can streamline more processes and collaborate early on."
There were many takeaways from the Summit, but one of the most notable was the shared desire to continue the dialog with small, strategic workgroups focused on solutions that cut through the complexity.
Looking Forward: A New Chapter for Healthcare
The Summit concluded with a clear consensus: the healthcare industry stands at an inflection point where collaboration is essential for survival. David Pierre's closing remarks offered a path forward.
"We want to be the trusted source not only for you, but in this industry, to really go build that future."
There is much work to be done, but Summit attendees left feeling hopeful and inspired. Together, we can do great things.
Ready to be part of the transformation? Learn more about how Machinify is building the future of AI-powered payment integrity and join the conversation about collaborative healthcare innovation.
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