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Payer AI at HLTH 2025: From Efficiency Trials to Scaled Effectiveness — Partially There

Publisher IDC
Published Dec 03, 2025
Length 8 Pages
SKU # IDC20635547

Description

This IDC Perspective describes how there's no shortage of AI enthusiasm, but most of what's being built today still focuses on administrative efficiency. The leap into true clinical decision support is coming, but it's clear that the payer industry is taking a cautious, stepwise approach in an environment where they are managing rising medical loss ratios and utilization while contending with heightened scrutiny around risk adjustment."Payers remain 'AI-curious' still in piloting and experimentation mode, focusing on administrative efficiency," says Jeff Rivkin, research director of Payer IT Strategies, IDC. "Payers claim AI hesitation around PHI and PII and member-facing applications, but we all know it is the conservative lawyers meting out disruptive technology with a thimble".

Table of Contents

8 Pages

Executive Snapshot

Situation Overview

Strategy in Place for Most Payers

Payer AI Tool Implementation Ramping Up, But Only <20% Adoption

Quotable AI for Payers

Agentic AI

Trust, Collaboration, and Suspicion

AI Regulation and Governance

ROI for AI

Other AI Payer-Related Announcements

Advice for the Technology Buyer

Learn More

Related Research

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