Leveraging Digital Tools to Power Value-based Care and Shared-risk Models

Healthcare payors are rapidly accelerating digital transformation in response to rising costs, regulatory pressures, talent shortage, 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 co-design 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.

Both demand-side and supply-side trends are covered in our Healthcare Payor Digital Services 2025 Market Insights™ and Healthcare Payor Digital Services 2025 RadarView™, respectively. These reports present a comprehensive study of digital service providers in the healthcare payor industry, including top trends, analysis, and recommendations. It takes a close look at the leaders, innovators, disruptors, and challengers in this market.

We evaluated 41 service providers across three dimensions: practice maturity, partner ecosystem, and investments and innovation. Of the 41 providers, we recognized 22 that have brought the most value to the market over the past 12 months.

The reports recognize service providers across four categories:

• • Leaders: Accenture, Cognizant, HCLTech, Infosys, Optum, and Wipro
  • Innovators: Capgemini, Infinite Computer Solutions, NT DATA, TCS, and Tech Mahindra
  • Disruptors: Atos, IBM, LTIMindtree, Persistent Systems, UST, and Virtusa
  • Challengers: DXC Technology, Exela Technologies, Genpact, and Mphasis

Figure 1 below from the full report illustrates these categories:

“Regulatory pressures and CMS mandates on interoperability and data transparency are transforming healthcare. Through API-driven systems, FHIR standards, and data integration, payors are ensuring compliance while improving efficiency, data access, and member outcomes,” said Nishant Verma, managing partner at Avasant.

Matthew Barlow, partner at Avasant, added, “Alternate payment models and value-based care are redefining payor-provider collaboration. Leveraging AI and data integration, payors are creating smarter reimbursement models, tracking outcomes more precisely, and aligning incentives around quality, driving a more efficient healthcare ecosystem.”

The reports provide several findings, including the following:

• • A need for greater operational efficiency, cost control, and agility is driving strong demand for technology modernization.
  • A shift toward improving patient health outcomes and incentives, instead of service volume, has become vital as rising costs reduce value and push premiums higher.
  • 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 Centers for Medicare & Medicaid Services (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.
  • Faced with talent shortage and rapid digital innovation, payors are deploying AI and automation to streamline operations and free staff for higher-value work. They are also adopting digital tools for upskilling and collaboration to build an agile, future-ready workforce.

“By embracing AI, automation, and interoperable data platforms, payors are streamlining operations and elevating member engagement,” said Eratha Poongkuntran, associate director at Avasant. “They are also deepening collaboration with providers to advance a more connected healthcare ecosystem.”

The RadarView™ also features detailed profiles of 22 service providers, along with their solutions, offerings, and experience in assisting healthcare payor enterprises in their digital transformation journeys.

This Research Byte provides a brief overview of Avasant’s Healthcare Payor Digital Services 2025 Market Insights™ and Healthcare Payor Digital Services 2025 RadarView™ (click for pricing).