AI in Healthcare: Payers Invest to Enhance Patient Outcomes and Streamline Operations

In a rapidly evolving healthcare landscape, technology is increasingly seen as a key driver of better patient outcomes and more efficient operations. Two recent developments highlight how payers are leveraging artificial intelligence (AI) to address critical challenges in the industry: Evernorth’s $100 million investment in Pharmacy Forward and Zelis’s AI solution for streamlining dispute resolution under the No Surprises Act.

Evernorth, a leading health solutions company, is making a significant commitment to AI with its $100 million investment through 2028 in Pharmacy Forward. This program aims to enhance specialty pharmacy operations and improve patient care by leveraging advanced AI technologies. Specialty pharmacies deal with complex, often life-saving medications for conditions like cancer, multiple sclerosis, and rheumatoid arthritis. By integrating AI, Evernorth hopes to optimize medication management, reduce errors, and provide more personalized care.

Zelis, a healthcare technology company, is also stepping up its AI game. They have introduced an innovative solution designed to streamline the Independent Dispute Resolution (IDR) process mandated by the No Surprises Act. This federal law aims to protect patients from surprise medical bills, but it has created complex administrative challenges for insurers and providers. Zelis’s AI-driven platform automates key aspects of the IDR process, making it faster, more transparent, and less burdensome for all parties involved.

Enhancing Patient Care and Operational Efficiency

The investments by Evernorth and Zelis reflect a broader trend in healthcare: the growing adoption of AI to tackle longstanding issues. According to a recent study, 22% of healthcare organizations have implemented AI solutions, marking a significant 7x increase over just one year. In 2025 alone, $1.4 billion was invested in AI for healthcare, underscoring the sector’s commitment to technological advancement.

Sanford Health, a leading health system, is another example of an organization embracing AI. They are set to highlight best practices for AI adoption at a national leadership conference. Sanford’s experience highlights the potential benefits of AI, including improved diagnostic accuracy, personalized treatment plans, and enhanced patient engagement. However, the journey to AI integration is not without challenges. Organizations must navigate issues such as data privacy, ethical considerations, and the need for robust training programs for healthcare professionals.

The use of federated networks in conjunction with AI is another promising development. Federated networks allow multiple organizations to share data while maintaining control over their own datasets. This approach can lead to more comprehensive insights and better-informed decision-making without compromising patient privacy. The i2b2 symposium, an annual event focused on informatics, will explore how federated networks and AI are bridging the gap between bedside care and broader public health initiatives.

Why It Matters

The investments by Evernorth and Zelis in AI-driven solutions have far-reaching implications for patients, healthcare providers, and insurers. For patients, these technologies promise more personalized and efficient care, reducing the likelihood of medication errors and improving treatment outcomes. For healthcare providers, AI can streamline administrative tasks, freeing up time to focus on patient care. And for insurers, AI offers a way to manage costs while ensuring compliance with regulatory requirements.

However, the benefits of AI in healthcare are not without risks. Issues such as data privacy, algorithmic bias, and the need for ongoing training must be addressed to ensure that these technologies truly serve the best interests of patients. As the healthcare industry continues to evolve, it is crucial that stakeholders work together to develop ethical, transparent, and patient-centered AI solutions.

The path forward is clear: AI has the potential to transform healthcare, but its success will depend on a collaborative approach that prioritizes transparency, ethics, and the well-being of all involved.