As regulatory mandates tighten and cost pressures rise, health plans are accelerating their investments in AI, not as an experiment, but as a strategic necessity.

From CMS-0057-F (Interoperability and Prior Authorization Final Rule) to the proposed CMS-0062-P, the shift toward faster decisions, greater transparency, and improved member outcomes is pushing payers to rethink how they operate. At the same time, advances in generative and agentic AI are opening new possibilities to automate workflows, enhance clinical decision-making, and reduce administrative burden at scale.

In this webinar, we’ll explore how leading health plans are navigating this transformation, where AI is delivering real impact today across prior authorization, clinical management, and cost containment, and what it takes to build a future-ready AI strategy.

We’ll also discuss the critical role of foundational data platforms, the build vs. buy debate in the era of OpenAI, Copilot, and Claude, and how agentic AI is poised to redefine productivity across payer operations.

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• AI is shifting from experimentation to mandate in the payer market, driven by rising cost pressures and regulatory catalysts like CMS-0057-F and CMS-0062-P, which are accelerating the need for faster, more transparent, and automated decision-making.
• Health plans are already seeing tangible impact from AI across prior authorization, clinical management, and cost optimization, moving from manual, fragmented workflows to more proactive and intelligent operations.
• A successful AI strategy depends on getting the foundation right, particularly unified data and a clear build vs. buy approach, ensuring that investments in tools like OpenAI, Copilot, or Claude translate into scalable, enterprise-wide value.
• Agentic AI represents the next evolution, enabling payers to deploy intelligent agents that can autonomously execute tasks such as chart review, coding, and care gap closure, significantly improving productivity while maintaining human oversight.

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