Generative AI in Payer and Provider IT Transformation Research Report 2024-2029 Featuring Hexaware, Codoxo, Microsoft, Wolters Kluwer, Cipher, InterSystems, Salesforce, Palo Alto Networks, AKASA - ResearchAndMarkets.com

The "Generative AI in Payer and Provider IT Transformation, Global, 2024-2029" report has been added to ResearchAndMarkets.com's offering.

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.

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.

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.

Growth Opportunity Universe in the Use of LLMs for Payer and Provider IT Transformation

• Promote Clinical Decision Support System (CDSS) at Point-of-care for Personalized Care
• Reduce Administrative Burden Associated with Prior Authorization
• Improve Healthcare Data Interoperability
• Optimize Resources for Expansion of the Hospital at Home (HaH) Model
• Enhance Patient and Member Engagement

Key Topics Covered:

Scope and Segmentation

• Scope of Analysis
• Segmentation

Growth Environment: Transformation in Generative AI in Payer and Provider IT Transformation

• Why Is It Increasingly Difficult to Grow?
• The Strategic Imperative
• The Impact of the Top 3 Strategic Imperatives on the Use of Gen AI in the Payer and Provider IT Transformation Industry

Ecosystem in Generative AI in Payer and Provider IT Transformation

• 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
• 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 Generator in Generative AI in Payer and Provider IT Transformation

• Growth Metrics
• Growth Drivers
• Growth Restraints
• Forecast Considerations
• Forecast Methodology
• Revenue Forecast
• Revenue Forecast by Industry Vertical
• Revenue Forecast by Region
• Revenue Forecast Analysis
• Pricing Trends and Forecast Analysis
• Competitive Market Structure
• Revenue Share Analysis

Growth Generator: Payer IT Transformation

• 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 Generator: Provider IT Transformation

• 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 Generator: Horizontal Solutions

• Growth Metrics
• Revenue Forecast
• Revenue Forecast by Application
• Revenue Forecast by Region
• Forecast Analysis
• Role of Gen AI: Interoperability
• Role of Gen AI: Cybersecurity

Next Steps

• Benefits and Impacts of Growth Opportunities
• Next Steps

For more information about this report visit https://www.researchandmarkets.com/r/ehmc73

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