# Healthcare Payors * **Definition:** Organizations that finance or reimburse the cost of health services, such as insurance companies, which benefit from improved health outcomes and savings. * **Taxonomy:** Sectors / Healthcare Payors ## News * Selected news on the topic of **Healthcare Payors**, for healthcare technology leaders * 9.1K news items are in the system for this topic * Posts have been filtered for tech-related keywords | Date | Title | Source | | --- | --- | --- | | 5/30/2025 | [**The Growing Importance Of AI In Provider Data Management**](https://www.forbes.com/councils/forbestechcouncil/2025/05/30/the-growing-importance-of-ai-in-provider-data-management/) | [[Forbes]] | | 4/23/2025 | [**Why Healthcare Publishers Need An Exclusive Ad Management Platform**](https://hitconsultant.net/2025/04/24/why-healthcare-publishers-need-an-exclusive-ad-management-platform/) | [[HIT Consultant]] | | 1/7/2025 | [**ActiGraph Accelerates Clinical Trial Modernization with Transformational Acquisition of Biofourmis Life Science Business**](https://www.prnewswire.com/news-releases/actigraph-accelerates-clinical-trial-modernization-with-transformational-acquisition-of-biofourmis-life-science-business-302344216.html) | [[PR Newswire]] | | 1/7/2025 | [**6 Ways Integrated Platforms are Transforming Provider Data for Payors**](https://hitconsultant.net/2025/01/08/6-ways-integrated-platforms-are-revolutionizing-provider-data-for-payors/) | [[HIT Consultant]] | | 1/2/2025 | [**Patient Experience - 2025 Health IT Predictions**](https://www.healthcareittoday.com/2025/01/02/patient-experience-2025-health-it-predictions/) | [[Healthcare IT Today]] | | 12/31/2024 | [**Verisma Acquires Olah, Streamlining Patient Data Management for Hospitals and ...**](https://www.healthcareittoday.com/2024/12/31/verisma-acquires-olah-streamlining-patient-data-management-for-hospitals-and-healthcare-facilities-nationwide/) | [[Healthcare IT Today]] | | 12/31/2024 | [**Precision Medicine Software Market Focused Insights 2024-2029, with Key Player Profiles of Syapse, AccessDX Laboratory, Fabric Genomics, Foundation Medicine, Intel and IBM - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241231013633/en/Precision-Medicine-Software-Market-Focused-Insights-2024-2029-with-Key-Player-Profiles-of-Syapse-AccessDX-Laboratory-Fabric-Genomics-Foundation-Medicine-Intel-and-IBM---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-Q-tiwWZwkcswR1UZtV7eGe24xL9TZOyQUMS3J72mJlQ7fxFuNFTHSunhvli30RlBNXya2izy9YOgHlBiZQk2LOzmn6JePCpHPCiYGaEx4DL1Rq8pNwkf3AarimpDzQGuQ==) | [[Business Wire]] | | 12/31/2024 | [**Precision Medicine Software Market Focused Insights 2024-2029, with Key Player Profiles of Syapse, AccessDX Laboratory, Fabric Genomics, Foundation Medicine, Intel and IBM - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241231013633/en/Precision-Medicine-Software-Market-Focused-Insights-2024-2029-with-Key-Player-Profiles-of-Syapse-AccessDX-Laboratory-Fabric-Genomics-Foundation-Medicine-Intel-and-IBM---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-RLXHJgazfQJNuOVHefdHP-D8R-QU5o2AvY8bhI9uvWSD8DYIYv4TIC1g1u0AKcacnnViVjtb72bOP4-4nHK5ieT3WxPE8m_kWI77F87CseT) | [[Business Wire]] | | 12/30/2024 | [**Ensuring Patient Privacy in Healthcare Data Analytics - HIT Consultant**](https://hitconsultant.net/2024/12/30/hipaa-compliance-in-the-age-of-big-data-ensuring-patient-privacy-in-healthcare-data-analytics/) | [[HIT Consultant]] | | 12/23/2024 | [**How Medicare Advantage Programs Can Address Social Risk and Improve Health Outcomes**](https://hitconsultant.net/2024/12/23/how-medicare-advantage-programs-can-address-social-risk/) | [[HIT Consultant]] | | 12/21/2024 | [**Industry Revenue Insights and Market Worth with a Projected CAGR of 8.7or 2024 to 2031**](https://www.linkedin.com/pulse/exploring-medical-saas-system-market-industry-revenue-insights-zmsxf) | [[Linkedin]] | | 12/20/2024 | [**Future Market Revenue for Healthcare Artificial Intelligence Projected at 13.1AGR from ...**](https://www.linkedin.com/pulse/future-market-revenue-healthcare-artificial-intelligence-9ndyc) | [[Linkedin]] | | 12/19/2024 | [**Artificial Intelligence in Healthcare Market to Hit US$ 164.16 Billion by 2030 with 49.1AGR - MarketsandMarkets™**](https://www.prnewswire.com/news-releases/artificial-intelligence-in-healthcare-market-to-hit-us-164-16-billion-by-2030-with-49-1-cagr--marketsandmarkets-302335998.html) | [[PR Newswire]] | | 12/18/2024 | [**Three for 2025: What you need to know about agentic AI, cancer informatics and data ...**](https://www.healthcareitnews.com/news/three-2025-what-you-need-know-about-agentic-ai-cancer-informatics-and-data-security-imperatives) | [[Healthcare IT News]] | | 12/11/2024 | [**Healthcare Consulting Services Market to Reach USD 59.75 Billion by 2032, Driven by ...**](https://finance.yahoo.com/news/healthcare-consulting-services-market-reach-130000602.html) | [[Yahoo Finance]] | | 12/10/2024 | [**Smart Healthcare Market to Grow by USD 125.7 Billion (2023-2028), Segmented by Channel, Solution, and Geography, with AI Impacting Market Trends - Technavio**](https://www.prnewswire.com/news-releases/smart-healthcare-market-to-grow-by-usd-125-7-billion-2023-2028-segmented-by-channel-solution-and-geography-with-ai-impacting-market-trends---technavio-302326632.html) | [[PR Newswire]] | | 12/3/2024 | [**Cotiviti Welcomes Seasoned Technology Executive Suvajit Gupta as Chief Technology Officer**](https://www.businesswire.com/news/home/20241203139499/en/Cotiviti-Welcomes-Seasoned-Technology-Executive-Suvajit-Gupta-as-Chief-Technology-Officer) | [[Business Wire]] | | 12/3/2024 | [**Cotiviti Welcomes Seasoned Technology Executive Suvajit Gupta as Chief Technology Officer**](https://www.businesswire.com/news/beverlyhillschamber/20241203139499/en/Cotiviti-Welcomes-Seasoned-Technology-Executive-Suvajit-Gupta-as-Chief-Technology-Officer) | [[Business Wire]] | | 11/30/2024 | [**Robust Growth Anticipated in the Healthcare Cloud Computing Software Market, with a ... - LinkedIn**](https://www.linkedin.com/pulse/robust-growth-anticipated-healthcare-cloud-computing-software-plywf) | [[Linkedin]] | | 11/30/2024 | [**Forecasts for the Cloud Computing in Healthcare market with an anticipated 7.5AGR from 2024**](https://www.linkedin.com/pulse/forecasts-cloud-computing-healthcare-market-anticipated-75-cagr-528xe) | [[Linkedin]] | | 11/22/2024 | [**The Patient Access Solutions Market Report 2024-2031: Evaluating Growth Prospects and a ...**](https://www.linkedin.com/pulse/patient-access-solutions-market-report-2024-2031-evaluating-growth-7g92e) | [[Linkedin]] | | 11/13/2024 | [**AI in Healthcare Market to Grow by USD 20.34 Billion (2024-2028), Driven by ... - PR Newswire**](https://www.prnewswire.com/news-releases/ai-in-healthcare-market-to-grow-by-usd-20-34-billion-2024-2028-driven-by-healthcare-digitization-ai-powered-report-highlights-market-transformation---technavio-302304148.html) | [[PR Newswire]] | | 7/11/2024 | [**Swift Medical among the latest #CDNtech companies to appoint new leaders as industry ... - BetaKit**](https://betakit.com/swift-medical-among-the-latest-cdntech-companies-to-appoint-new-leaders-as-industry-executive-turnover-continues/) | betakit.com | | 7/9/2024 | [**The Pharma CCO Market to clock a double-digit growth rate by 2027 - Daily Investor Hub**](https://dailyinvestorhub.com/the-pharma-cco-market-to-clock-a-double-digit-growth-rate-by-2027/) | dailyinvestorhub.com | | 7/3/2024 | [**Healthcare IT Market Poised for Explosive Growth, Projected to Reach $1.83 Trillion by 2031**](https://www.whatech.com/og/markets-research/medical/851706-healthcare-it-market-poised-for-explosive-growth-projected-to-reach-1-83-trillion-by-2031) | whatech.com | ## Sector Overview (Some LLM-derived content — please confirm with above primary sources) ### Key Players - **MultiPlan**: A healthcare payor that offers network optimization and analytics services to improve cost and quality for payors. - **MultiPlan Corporation**: A healthcare technology firm that provides transparency and affordability solutions to over 700 healthcare payors. - **CVS Health**: A major health insurance payor implementing innovative reimbursement models to enhance transparency and reduce costs. - **Santéch**: Provider of automated provider data management platforms aimed at improving data accuracy and operational efficiency for payors. - **Cotiviti**: A technology company focused on delivering innovative solutions to healthcare payors and retailers through advanced analytics. - **XiFin, Inc.**: A company that offers healthcare analytics and financial health solutions, including the Payor Rate Transparency Monitor. - **AssureCare**: Provider of the MedCompass platform, which enhances efficiency for healthcare providers by ensuring compliance with CMS interoperability and prior authorization rules. - **Health Commons Project**: A healthcare organization focused on improving data interoperability and care coordination through strategic acquisitions. - **mPulse**: A digital health engagement company recognized by Gartner for its capabilities in Health Navigation Solutions, Social Determinants of Health Resource Management, and Provider/Partner Network Management Platforms. - **1upHealth**: A leader in FHIR-based interoperability, focusing on improving patient health outcomes through data connectivity. - **Ontrak, Inc.**: A company focused on improving behavioral health outcomes through personalized care coaching and customized care pathways, utilizing AI and predictive analytics. - **VSee Health, Inc.**: A telehealth technology provider that offers teleradiology services and aims to enhance healthcare access and reduce physician burnout. - **Medicare Advantage (MA)**: A program that provides healthcare coverage to Medicare beneficiaries, often with stricter policies impacting patient care. - **Adena Health**: Recognized for its commitment to innovative technology in patient care, achieving high levels of digital health integration. - **Hippocratic AI**: A company specializing in healthcare-focused large language models for non-diagnostic clinical tasks. ### Partnerships and Collaborations - **MultiPlan and J2 Health**: A strategic agreement to enhance network optimization and improve decision-making efficiency for healthcare payors. - **AssureCare and Clinigence Health**: AssureCare acquired Clinigence Health to enhance its capabilities in population health management and value-based care software. - **Health Commons Project and OneHealthPort**: Acquisition aimed at enhancing healthcare access and quality through improved data interoperability. - **Ontrak and a regional health plan**: Ontrak expanded its partnership with a large regional health plan to enhance behavioral healthcare services using its Ontrak Quality solution. - **Ontrak and Regional Health Plan**: Ontrak has expanded its partnership with a large regional health plan in the Northeast to enhance behavioral health metrics through its Ontrak Quality solution. - **Orlando Health Network and InnovAge**: A joint venture to enhance community access to primary care and supportive resources for seniors. - **Plethy and Viscogliosi Brothers Watermark Holdings**: Collaboration to innovate musculoskeletal healthcare through personalized, data-driven solutions. - **VSee Health and Tele911**: Collaboration to address emergency room overcrowding by utilizing telehealth solutions for low acuity 911 calls. - **eMerge Americas and Jackson Health System/UHealth**: Partnership to enhance health technology offerings at the Healthtech Innovation Hub. - **Bayer and Google Cloud**: Collaboration to develop AI-powered medical imaging applications. - **Vitalic and VNS Health**: Vitalic collaborated with VNS Health to develop a specialized geriatric behavioral health care platform. - **NTT Data and Amelia**: Partnership to enhance patient engagement through AI solutions. - **ActiGraph and Biofourmis**: Acquisition aimed at enhancing digital health technology offerings for clinical research and development. - **Cognizant and Google Cloud**: Partnership to streamline administrative tasks using large language models. ### Innovations, Trends, and Initiatives - **AI-Driven Solutions**: Healthcare payors are increasingly adopting AI technologies for fraud detection, payment error prevention, and improving patient outcomes. - **CMS Interoperability Rule**: Healthcare payors are required to implement specific FHIR APIs by January 2027 to improve data exchange and streamline prior authorization processes. - **Payor Rate Transparency Monitor**: XiFin enhanced its monitor to provide healthcare organizations with improved insights into in-network contracted rates. - **AI Adoption**: Healthcare providers and payors are increasingly investing in AI technologies, with 15% of providers and 25% of payors reporting established AI strategies for 2024. - **Healthcare Cloud Computing**: Dynamic growth in cloud solutions for healthcare, focusing on data security, interoperability, and scalability. - **Patient Access Solutions Market**: Projected to grow significantly, driven by advancements in digital technologies and patient engagement strategies. - **Automated Provider Data Management**: Platforms like Santéch's I-Network are streamlining onboarding and improving efficiencies through automation. - **Medicare Advantage (MA) Plans**: Expected growth despite challenges in data utilization and service delivery for vulnerable populations. - **CostVantage Model by CVS**: A new reimbursement model pricing prescriptions based on underlying costs to enhance transparency. - **CMS Interoperability Compliance**: AssureCare's MedCompass platform is now compliant with CMS regulations, allowing real-time prior authorization requests directly from EHRs. - **Generative AI in Healthcare**: Transforming patient care and operational efficiency by creating and analyzing data for improved diagnostics and treatment. - **Healthcare AI Agent App Store**: Hippocratic AI launched a platform allowing clinicians to create AI agents for patient care, emphasizing safety and collaboration. - **Cloud Infrastructure Migration**: MultiPlan's migration to Oracle Cloud Infrastructure to enhance scalability and improve client support in the healthcare sector. - **Digital Therapeutics (DTx)**: Expected to gain traction in addressing unmet healthcare needs, particularly in mental health and chronic disease management. - **Telemedicine Growth**: The demand for telehealth services is rising, driven by consumer needs and regulatory support, enhancing convenience and cost-effectiveness. - **AI and Predictive Analytics**: Ontrak utilizes AI and predictive analytics to enhance member health and optimize healthcare system utilization. - **AI Integration**: The use of AI and machine learning in healthcare is driving advancements in predictive analytics, claims automation, and personalized care. - **HITRUST Certification**: Ontrak achieved HITRUST Risk-based certification, demonstrating its commitment to data security and regulatory compliance. ### Challenges and Concerns - **Legacy Technology**: Healthcare payors face significant barriers due to outdated systems, prompting a need for modernization to improve member support and care coordination. - **Interoperability Issues**: Despite advancements, inconsistent implementation of interoperability standards remains a challenge for healthcare payors. - **Cybersecurity Risks**: The recent cyber-attack on Change Healthcare highlights the need for robust cybersecurity measures among healthcare payors and their vendors. - **Inaccurate Provider Directories**: 81% of payor directories contain inaccuracies, costing the healthcare industry approximately $3 billion annually. - **Compliance with New Regulations**: Payors must adapt to new regulatory requirements, necessitating increased operational capacity or advanced technology adoption. - **Medicare Advantage Underperformance**: Predictions indicate turnover at major payors due to underperformance in Medicare Advantage plans. - **Cybersecurity in Healthcare BPO**: Data security remains a critical challenge, necessitating robust measures to protect patient confidentiality. - **Prior Authorization Confusion**: Patients experience confusion regarding prior authorizations and pricing information, highlighting the need for improved communication in the healthcare system. - **Prior Authorization Delays**: Stricter MA policies lead to delays in patient care, with 62% of patients experiencing care delays due to insurance issues. - **Data Privacy and Security**: As healthcare organizations adopt AI and digital solutions, maintaining data security and compliance with regulations like HIPAA is critical. - **Healthcare Cost and Access**: Concerns regarding the cost-effectiveness and access to GLP-1 medications, with expectations of increasing rebates and data clarifying their value. - **Data Security and Compliance**: The need for rigorous data security standards, as highlighted by KBrax's HITRUST certification for its Care Coordination Platform. - **Administrative Burden**: Healthcare professionals face significant administrative burdens, contributing to burnout and staffing shortages. - **Data Privacy and Integration Issues**: Challenges in managing big data and ensuring compliance with privacy regulations like HIPAA. - **Resistance to AI Adoption**: Healthcare practitioners may resist adopting AI solutions due to high implementation costs and concerns over data privacy. - **Data Integrity in MA Plans**: Poor data integrity complicates the identification of social risks and tailored interventions for beneficiaries. - **Regulatory Concerns**: The adoption of AI in healthcare is hindered by regulatory challenges and accuracy issues, impacting the effectiveness of AI strategies. - **AI Risks**: Potential risks to patient safety if AI systems are not properly managed, including biases and misleading results. ## Related Topics [[Healthcare Payers]]; [[Healthcare Payer Services]]; [[AI for Healthcare Payors]]; [[Healthcare Providers]]