Payer AI at HLTH 2025: From Efficiency Trials to Scaled Effectiveness - Partially There

This IDC Perspective describes how there's no shortage of AI enthusiasm, but most of what's being built today still focuses on administrative efficiency. The leap into true clinical decision support is coming, but it's clear that the payer industry is taking a cautious, stepwise approach in an environment where they are managing rising medical loss ratios and utilization while contending with heightened scrutiny around risk adjustment."Payers remain 'AI-curious' still in piloting and experimentation mode, focusing on administrative efficiency," says Jeff Rivkin, research director of Payer IT Strategies, IDC. "Payers claim AI hesitation around PHI and PII and member-facing applications, but we all know it is the conservative lawyers meting out disruptive technology with a thimble".