healthaxis

In today’s rapidly transforming healthcare landscape, health plans face mounting pressures to balance operational demands, cost efficiency, and member satisfaction. While artificial intelligence (AI) and automation offer promising solutions, many payers remain hesitant and uncertain about their practical applications and benefits. However, specific technologies like conversational AI and robotic process automation (RPA) are proving their value, creating a foundation for smarter decision-making, significant cost reductions, and deeper member engagement—all without compromising care quality.

In Part 1 of this two-part series, we examined the top five technology areas receiving increased investment from healthcare payers in 2025, according to the 2025 Gartner CIO and Technology Executive Survey. Now, we turn to the next set of high-priority investments aimed at further optimizing payer operations.

The healthcare payer industry is at a pivotal moment. As operational costs rise, consumer expectations evolve, and technology rapidly advances, payers are compelled to reassess their technology priorities to stay competitive and ensure they can scale efficiently while addressing complex regulatory and operational demands. According to the 2025 Gartner CIO and Technology Executive Survey, several key areas are emerging as top investment priorities, all aimed at boosting efficiency, enhancing patient outcomes, and optimizing operations.

As states resume verifying Medicaid beneficiaries’ eligibility post-COVID-19, health plans face the daunting task of managing large-scale redeterminations. This process has significant financial implications, from maintaining membership levels to ensuring positive outcomes on key quality measures, such as the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). The stakes are high: failure to engage eligible members could lead to a drop in retention and recruitment, directly impacting the bottom line.