This report identifies key demand-side trends in the healthcare payor industry that can help enterprises fine-tune their digital strategies. It also provides an overview of enterprise challenges in this space based on Avasant’s assessment.

Why read this Market Insights?

Healthcare payors are rapidly accelerating digital transformation in response to rising costs, regulatory pressures, talent shortages, and the industry’s shift toward value-based care. Central to this transformation is the adoption of AI, automation, and advanced analytics, which streamline administrative workflows, reduce operational costs, and enhance organizational agility. To meet growing interoperability mandates, payors are implementing API-driven architectures and adopting Fast Healthcare Interoperability Resources (FHIR) standards. These efforts are supported by advanced data integration platforms that ensure secure, seamless access to health data across systems. Digital tools are also improving member engagement through AI-powered chatbots, mobile apps, and unified digital portals that deliver personalized experiences and real-time support. Internally, these technologies enable workforce upskilling and foster collaboration, contributing to a more agile, future-ready organization. Meanwhile, collaboration with providers is deepening through the codesign of alternative payment models that align incentives, improve care outcomes, and share financial risk. Together, these digital strategies position payors to thrive in a more connected, value-driven healthcare ecosystem.

The Healthcare Payor Digital Services 2025 Market Insights™ helps enterprises in this sector identify important market trends and challenges for any digital project they participate in.

Methodology

The industry insights presented in this report are based on our ongoing interactions with enterprise CXOs and other key executives; targeted discussions with service providers, subject matter experts, and Avasant Fellows; analyst insights from primary and secondary research; and lessons learned from consulting engagements.

Table of contents

About the report (Page 3)

Executive summary (Pages 4–7)

• • Scope of coverage
  • Key market drivers and enterprise response
  • Avasant recognizes 22 top-tier service providers supporting the healthcare payor industry in digital transformation

Demand-side trends (Pages 8–13)

• • Payors are leveraging AI, automation, and advanced analytics to streamline administrative workflows, reduce waste, and deliver value-driven care, cutting costs and preserving margins in a tightening landscape.
  • Payors are using data analytics and AI to support value-based care, aligning incentives with patient health; they are also tracking outcomes, predicting risk, and collaborating with providers on models that reward quality and share financial risk.
  • To boost member engagement and satisfaction, payors are using AI-powered chatbots, mobile apps, and real-time data to streamline communication and deliver personalized experiences across all touchpoints.
  • Regulatory pressures and CMS mandates are pushing payors to adopt API-driven architectures and FHIR standards, enabling secure, real-time data sharing and seamless member access to health information.
  • Facing talent shortages and rapid digital innovation, payors are deploying AI and automation to streamline operations and free staff for higher-value work while adopting digital tools for upskilling and collaboration to build an agile, future-ready workforce.

Key contacts (Page 14)

Read the Research Byte based on this report. Please refer to Avasant’s Healthcare Payor Digital Services 2025 RadarView™ for detailed insights on the service providers and supply-side trends.