Historically, the healthcare industry has been slower to adopt new digital solutions compared to other markets. But in recent years, health plan leaders are showing fewer signs of risk-aversion. To contend with regulatory shifts and ongoing cost pressures, payers are increasingly willing to adopt integrated digital solutions and tools driven by artificial intelligence (AI). 

In the report, “Gartner® Predicts 2026: U.S. Healthcare Payers Bet Big on Agentic Workforce,” industry analysts share key research findings about the applications of AI tools and recommendations for payers looking to implement agentic AI solutions. 

“Agentic AI is a standout area of investment, with all payer respondents indicating they have already implemented or will deploy agentic AI by 2028. Agentic AI has long-term transformational potential due to its ability to autonomously execute tasks and workflows, particularly for repeatable processes that have access to AI-ready data (see “Agentic AI — A Bet U.S. Healthcare Payers Are Willing to Take”).1 

Data silos can prevent health plans from harnessing the full power of their clinical and administrative information. Agentic AI tools help seamlessly connect incompatible legacy systems and modern platforms. This seamless integration ensures health plans have access to accurate, AI-ready data for superior decision-making. 

“Administrative processes like adjudicating claims are well-suited for agentic AI workflows, though data quality, inconsistent outcomes and lack of trust between payers and providers present barriers to adoption. Vendors like Codoxo, HealthEdge, Machinify, Sagility and Zelis have payment integrity products that use AI agents.”¹ 

Manual processes like eligibility verification and claims adjudication are costly and inefficient. By deploying agentic AI, health plans can automate these repeatable tasks and dramatically lower your operational expenses.

According to the report, "By 2028, 80% of all ambulatory claims will be processed through AI-enabled real-time adjudication processes, resulting in a quantifiable reduction in manual processing costs.” ¹ 

Implementing autonomous systems requires a strong foundation of data privacy and security. Intelligent health platforms help payers maintain high regulatory compliance scores while building trust with members and providers. Health plans get transparent, accurate outputs that enhance the overall member experience. 

“For example, build or partner with vendors that fulfill specific payer-provider workflow solutions, such as payment integrity, service centers, provider contracting and prior authorizations (see AI Agents: Use-Case Examples for Health Insurers). Additionally, seek vendors that will partner to incrementally help build or implement for multiple agentic AI use cases.”¹