Re-energize health consumer engagement and bridge the payer-provider divide with GenAI

It’s 2024, and the US healthcare system stands at a pivotal juncture, bookended by deteriorating health outcomes, including declining life expectancy, increasing prevalence of chronic conditions, and opioid and mental health epidemics. Concurrently, technological innovation is accelerating via the adoption of artificial intelligence (AI) at scale, innovative care models, and a resurgence of digital-health-fueled primary care. The combination of deteriorating health outcomes and technology innovations creates opportunities to move forward with the triple aim of care—reduced costs, enhanced experiences, and improved health outcomes. Due to technological innovation, we can see the beginning of a healthier America, but significant strides are required across the healthcare ecosystem.

HFS Research, in partnership with Cognizant, interacted with the CXOs of 350 US health plans (payers) and health systems (providers) to explore the impact of vertical integration and generative artificial intelligence (GenAI) on payer-provider friction and consumer experiences and engagement.

This unique study revealed six illuminating and actionable highlights for the next wave of healthcare opportunities.

A shift in funding helps address the diverse needs of health consumers Five of the six generations in the US population are in the US workforce, each with a unique set of needs. The healthcare system must address each generation’s needs appropriately, which is a growing demand the younger generations vocalize. This demand should drive seismic shifts in thinking about how health and care need to be delivered. Enrollment in self-insured employer plans is soaring at the expense of commercial insurance with the resonance of new care delivery models, such as subscription-based primary care and digital-first care services.
Vertical integration is designed to expand influence and mitigate risks Consequently, more than 50% of healthcare enterprises, including health plans and health systems, are reacting to threats, such as a loss of high-margin business and new competition, and opportunities, such as new markets and emerging technology, through a variety of acquisitions. These acquisition profiles reflect consolidation and vertical integration to expand healthcare enterprise reach.
Healthcare enterprises drive blind on health consumer needs Despite having ambitious growth aspirations through acquisition, nearly 60% of health plans and health systems admit to lacking a robust understanding of their evolving member or patient needs. Conversely, however, more than 50% of payers and providers claim they have the digital capabilities to meet consumer needs.
The payer-provider divide is wide and has dangerous implications Over 50% of health plans and providers recognize a high to very high disconnect between their respective operations that directly impact member experience and health outcomes. Ironically, there is a divergence in their belief of why the disconnect exists; while payers blame data integrity, providers blame regulations. Despite the disconnect about the drivers of the disconnect, about 70% of payers and providers assign the highest priority to addressing their operational divide.
GenAI’s expected impact spans a spectrum Payers and providers are intrigued by GenAI’s potential. However, payers appear to be convinced that GenAI is a game changer, particularly for administrative functions. In contrast, providers are more muted about the impact of GenAI but do agree it has the potential to positively impact care delivery.
The lack of GenAI vision can impact investments While over 70% of payers and providers anticipate the greatest impact of GenAI on health outcomes and member experience, only 20% have a vision for GenAI that is influencing their investment decisions. Approximately 50% plan to invest between $1 million and $10 million in GenAI, with about 70% anticipating this spending will occur within the next two years.

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Authors

Rohan Kulkarni Executive Research Leader

Saurabh Gupta President, Research and Advisory Services

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