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Generative AI in Payer and Provider IT Transformation, Global, 2024-2029
Gen AI-based Solutions are Driving Transformational Growth across the Payer and Provider Ecosystem as Organizations Move from Identification to Implementation
27-Nov-2024
Global
Market Research
The healthcare payer and provider industry is gradually adopting generative artificial intelligence (Gen AI) solutions across its value chain. Almost all organizations have shown an intent to implement Gen AI-based solutions in their products or processes, with a few already embarking on this journey. Gen AI seamlessly syncs with existing tools/IT applications and other technical solutions to enhance workflows or create new processes. Payer and provider organizations face administrative, operational, clinical (only providers) and financial challenges in delivering comprehensive and timely patient care. These issues often result in care delays and follow-ups, impacting the overall health of consumers. The industry is shifting from an identification to an implementation stage, with leading adopters using Gen AI solutions across different use cases and working with vendors to fine-tune output. This has created new ecosystems between technology vendors and end users that enable leaders to align technology adoption with an organization’s vision and values.
Given the nature of technology and healthcare data, some aspects or use cases are more strongly governed by regulators than others. This has accelerated product development and adoption in the administrative, operational and financial categories while limiting the growth of clinical solutions. With the change in the global regulatory environment to balance innovation with safety, government, regulators, technology developers, and end users will need to work together to build national and organizational governance models.
. Looking at the evolving landscape of technology and regulations, this study seeks to quantify the savings that can be derived from implementing Gen AI-based solutions across some of the most pressing segments of the payer (claims management, risk adjustment, front- and back-office integration, marketing, and stakeholder management) and provider (financial, operational, CDSS, documentation, administrative, and patient engagement) value chains, including horizontal capabilities such as interoperability and cybersecurity. The report discusses technology advances made across these use cases and profiles several leading vendors optimizing their portfolios with Gen AI technology.
It covers the adoption of Gen AI-based solutions in North America (Canada and the United States), Europe, Asia-Pacific, and the rest of the world nations (Latin America and the Caribbean, Middle East, and Africa). North America dominates the market in terms of development and adoption owing to the region’s higher technology maturity, less stringent regulatory policies, and favorable start-up environment. While North America will continue to be the fastest growing and generate the bulk of savings from the adoption of Gen AI-based solutions, growth in Asia-Pacific will outpace the remaining regions and its net gains will reach the same level as Europe by the end of the forecast period.
GenAI is attracting more stakeholders into its realm. If implemented thoughtfully and in line with regulatory guidance, it has the potential to address the most pressing industry challenges and create an opportunity to generate more than $300 billion in gains across the patient journey by 2029.
Author: Nitin Manocha
Scope of Analysis
Segmentation
Why Is It Increasingly Difficult to Grow?
The Strategic Imperative 8™
The Impact of the Top 3 Strategic Imperatives on the Use of Gen AI in the Payer and Provider IT Transformation Industry
Healthcare Stakeholder’s Journey
Key Challenge for Providers: Managing Staff Concerns Without Compromising the Quality of Care During Digital Transformation
Key Challenge for Payers: Balancing the Cost of Care with Member Satisfaction while Staying on Top of Evolving Regulations
Impact of Key Challenges on Workflows and Stakeholders
Evolving Regulatory Landscape
Regulatory and Governance: Role of Key Players
Voice of the Customer: Gen AI Impact and Implementation
Voice of the Customer: Gen AI Impact and Implementation (continued)
Development Ecosystem to Support Technology Progress
Use Case Development and Gains
Gen AI Technology Evolution
Changes in Use Case Adoption Level
Deriving Gains from Gen AI-based Solutions
Automation Journey
Path to Technology Deployment
Gen AI: Productivity Paradigm
Redistributing Gains from Gen AI
Key Market Segmentation to Address Buying Behavior
Competitive Environment
Vendor Ecosystem
Hexaware
Codoxo
Microsoft
Wolters Kluwer Health
Cipher Health
InterSystems
Salesforce
Palo Alto Networks
AKASA
Growth Metrics
Growth Drivers
Growth Restraints
Forecast Considerations
Forecast Methodology
Revenue Forecast
Revenue Forecast by Industry Vertical
Revenue Forecast by Region
Revenue Forecast Analysis
Revenue Forecast Analysis (continued)
Pricing Trends and Forecast Analysis
Competitive Market Structure
Revenue Share Analysis
Revenue Share Analysis (continued)
Growth Metrics
Revenue Forecast
Revenue Forecast by Application
Revenue Forecast by Region
Forecast Analysis
Role of Gen AI: Risk Adjustment
Role of Gen AI: Stakeholder Management
Role of Gen AI: Payment Integrity (Part of Claims Management)
Elevance Health: Gen AI for Member Engagement
Blue Cross Blue Shield Association (BCBSA)
Growth Metrics
Revenue Forecast
Revenue Forecast by Application
Revenue Forecast by Region
Forecast Analysis
Role of Gen AI: Financial (RCM)
Role of Gen AI: Operational
Role of Gen AI: Clinical Documentation
Role of Gen AI: Clinical Decision Support
Role of Gen AI: Patient Engagement
Mayo Clinic
Kaiser Permanente and HCA Healthcare: Different Approaches to Documentation
Growth Metrics
Revenue Forecast
Revenue Forecast by Application
Revenue Forecast by Region
Forecast Analysis
Role of Gen AI: Interoperability
Role of Gen AI: Cybersecurity
Growth Opportunity 1: Promote Clinical Decision Support System (CDSS) at Point-of-care for Personalized Care
Growth Opportunity 1: Promote Clinical Decision Support System (CDSS) at Point-of-care for Personalized Care (continued)
Growth Opportunity 2: Reduce Administrative Burden Associated with Prior Authorization
Growth Opportunity 2: Reduce Administrative Burden Associated with Prior Authorization (continued)
Growth Opportunity 3: Improve Healthcare Data Interoperability
Growth Opportunity 3: Improve Healthcare Data Interoperability (continued)
Growth Opportunity 4: Optimize Resources for Expansion of the Hospital at Home (HaH) Model
Growth Opportunity 4: Optimize Resources for Expansion of the Hospital at Home (HaH) Model (continued)
Growth Opportunity 5: Enhance Patient and Member Engagement
Growth Opportunity 5: Enhance Patient and Member Engagement (continued)
Benefits and Impacts of Growth Opportunities
Next Steps
List of Exhibits
List of Exhibits (continued)
Legal Disclaimer
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| Deliverable Type | Market Research |
|---|---|
| Author | Nitin Manocha |
| Industries | Healthcare |
| No Index | No |
| Is Prebook | No |
| Podcast | No |
| Predecessor | K959-01-00-00-00 |
| WIP Number | KABD-01-00-00-00 |