Becker's Roundtable: Health Plans Need AI for Future Growth

When AI is grounded in context and built to support complete workflows, it becomes a force multiplier across the enterprise. Health plans that move in this direction are not just modernizing operations. They are rebuilding the foundation of how care is delivered. #AI

The $4 trillion healthcare industry just got its biggest breakthrough in decades. And most people have no idea it's happening. Optum just launched "Optum Real" - an AI system that solves healthcare's most expensive problem: medical claims processing. Here's why this changes everything: → No more weeks-long waits for claim approvals → Patients know their costs BEFORE treatment → Real-time validation through complex payer contracts → Goodbye surprise medical bills The numbers are staggering: • Healthcare spends BILLIONS annually on administrative waste • Claims denials create endless frustration for patients and providers • The average claim takes weeks to process Optum Real processes this in real-time. UnitedHealthcare is already using it. Early tests with Allina Health processed over 5,000 visits successfully. This isn't just a tech upgrade - it's a complete paradigm shift. Imagine walking into a doctor's office and knowing exactly what you'll pay before any procedure. No surprises. No denied claims. No administrative nightmares. That's the future Optum Real is creating. The healthcare industry has been stuck in administrative quicksand for decades. This AI breakthrough might finally pull us out. What's your biggest frustration with medical billing and claims? Have you experienced the nightmare of surprise medical bills?

Health insurers are under growing pressure to prove value to plan sponsors while navigating tighter margins and rising member expectations. As this Fierce Healthcare article points out, payers can’t rely on traditional models alone - they must lean into AI, automation, and predictive intelligence to operate smarter and reduce costs without sacrificing care quality. At Vital Data Technology, we see every day how data-driven insights and intelligent automation empower payers to act faster, close gaps, and deliver measurable impact. Read more from Fierce Healthcare on why payers need to do more to demonstrate value → https://bit.ly/43NPaEf #HealthPayer #HealthPlan #AIinHealthcare

The health care industry is rallying behind a bold push to modernize Medicare reimbursement for AI-powered medical technologies. As covered in Inside Health Policy: https://lnkd.in/enMUAcHU, this effort is gaining momentum, with bipartisan support and legislative proposals on the horizon. Among the standout voices in this movement is Cybil Roehrenbeck, who says, “We need reimbursement models that match the pace of innovation,” Cybil emphasized in recent discussions. “AI isn’t the future—it’s the present. And patients deserve access now.” What are your thoughts on AI reimbursement? How can we ensure policy keeps up with technology? #MedicarePolicy #DigitalHealth #CMS # #LeadershipInAction #InnovationAdvocacy

Optum Real, led by Puneet Maheshwari, SVP and GM of Optum Real, is reshaping claims and reimbursement by creating real-time transparency between payers and providers. Optum—serving nine out of ten U.S. health systems and four out of five payers—uses AI to enable immediate data exchange at the point of care. Early pilots with multiple healthcare organizations show strong results: call volume reductions of 25% and 42%, and reimbursement submission error reductions of up to 75% for a major Minnesota health system. Optum Real integrates contract analysis, documentation prompts, coding, billing, and patient communication to build a more retail-like, seamless experience across the healthcare interaction. Our RCM team enhances revenue cycle efficiency and operational execution by aligning reimbursement processes, documentation accuracy, and workflow improvements—supporting health entities as they adopt solutions like Optum Real. We help organizations and communities build sustainable programs that reduce leakage, strengthen financial performance, and ensure clarity across payer–provider interactions. Let’s CoSource! By strategically CoSourcing parts of your processes, your practice or facility can prevent revenue leakage and strengthen financial performance. Connect with us today at 855-676-8326 to explore how much you could save! #OptumReal #HealthcareAI #RevenueCycleManagement #PayerProviderTransparency #HealthSystems #ClaimsOptimization #MedicalBilling #HealthcareInnovation #RCMExcellence #OperationalEfficiency Healthcare IT Today https://lnkd.in/eDsQNKz9

💡 When the Value of Free Is Priceless For 18 years, we’ve been quietly building something radical. Precision began as a vision: to connect consumers and patients directly to the care they actually need — not just what’s billable. After nearly two decades of technology development and eight years refining our model, we’ve built a scalable system that bridges the gap between medical necessity, documentation, and coordinated care. Today, that vision is live and proven. Five Things Only Precision Can Do — Now YOU Can Too: ✅ Since 2007, we’ve helped design the value-based compliance systems used by CMS and payers. ✅ We hold active CMS/Payer report cards with RAF scores and quality measures on over 1,061,000 providers. ✅ We currently connect 17 sectors across healthcare and consumer health. ✅ We’re the first true Generative AI workflow validating and documenting new medical necessities from prior encounters. ✅ In partnership with Milliman (50/50 JV), we’ve given consumers and patients access and control of their own health records — a first in healthcare history. ⚖️ Altruism and Capitalism in Harmony 💥For Providers: -We’re only paid on about 30% of our care coordination claims — yet we perform 100% of them. Why? -Because providers need this data even when payers won’t pay for it. It drives risk stratification, RAF scores, capitation credit, and helps close gaps in care. -Preventive visits have no copay. We remove the friction so providers can focus on outcomes, not obstacles. 💥For Consumers: Of the anticipated 100 million people accessing their health records, only 5–8% will lead to commerce. So why do we do it? Because access to your own health data isn’t a privilege — it’s a right. Our free My Health Youniverse platform gives every person control: options, pricing transparency, and the choice to use insurance or pay cash. You can download, update, and store your complete health record — just as easily as you manage your email or bank account. 💥 The Takeaway We’re proving that doing the right thing and doing good business are not opposites. They’re two sides of the same coin. The future of healthcare is not pay-for-access — it’s pay-for-outcomes. And when the value of free is priceless, everyone wins. #HealthcareInnovation #ValueBasedCare #GenerativeAI #HealthTech #DigitalHealth #PatientEmpowerment #HealthcareTransformation #Interoperability #HealthEquity #AIinHealthcare #FutureOfHealth #PrecisionVBM #HealthcareLeadership

The One Big Beautiful Bill Act (2025) marks a transformative decade for U.S. healthcare, reshaping Medicaid, Medicare, and ACA frameworks with $1.2 trillion in phased funding adjustments aimed at enhancing equity and sustainability. Our multi-source analysis identifies how these fiscal reconfigurations intersect with AI adoption and health system resilience, revealing critical executive challenges. Firstly, OBBB-driven Medicaid expansions emphasize AI-enabled predictive analytics to proactively target social determinants of health, mitigating coverage loss risks amplified by workforce shortages in rural hospitals. Data forecast a 15% reduction in avoidable hospital closures where AI-supported community health models are deployed, underscoring the strategic value of precision interventions aligned with new reimbursement models. Secondly, the Act’s workforce education investments pivot healthcare digital transformation toward sustainable, human-centered AI governance. Projected upskilling initiatives will increase adoption of ethical AI frameworks by 40%, directly addressing systemic inequities by ensuring algorithmic transparency and inclusivity across Medicare populations. In response to the executive challenge—How can healthcare leadership leverage AI to navigate OBBB’s decade-long structural shifts while safeguarding operational ROI and patient equity? Our perspective reframes this as a cross-sector imperative: deploying adaptive AI infrastructures that integrate policy, clinical workflow, and community context to stabilize care delivery under fiscal pressures and demographic complexity. We invite policy architects, system leaders, and innovation allies to engage in dialogue on calibrating AI strategies that not only anticipate OBBB’s funding realignments but also embed equity and workforce vitality at the core of sustainable healthcare transformation. #HealthcareLeadership #HealthcareAI #DigitalHealth #HealthEquity #HealthInnovation

Optum has just unveiled its new AI-powered claims processing platform, Optum Real, at HLTH 2025—marking a significant leap forward for US healthcare innovation. The platform streamlines the claims and reimbursement process in real time, connecting payers and providers to validate coverage instantly, reduce administrative errors, and cut down on costly delays and denials. By integrating artificial intelligence, #OptumReal distills complex payer contract rules into actionable data for healthcare staff, driving transparency and creating a positive ripple effect for patients and providers alike. What stands out about this launch is Optum’s broad partnering approach—bringing together multiple payers, providers, and innovative technology partners to build an inclusive digital health ecosystem. Pilots at organizations like Allina Health have already shown promising reductions in administrative errors and denials. Dave Ingham, CIO at Allina Health, says Optum Real platform gets at some of the most burdensome administrative hurdles for its teams, while patients struggle with potential delays or denials. "AI technology really has taken us to the next level, or at least given us vision of what that next level is—to get as real time as possible," Ingham said. Puneet Maheshwari, SVP &GM of Optum Real, says having partners like UnitedHealthcare and Allina on board is critical to making tech platforms like this work. UnitedHealthcare's size and scale, in particular, helps generate "an upward vortex that can create the momentum that's needed to be created in the ecosystem" around a launch like this, he said. And getting buy-in from a health system like Allina makes for a critical proof point. "When you start seeing the impact, now you have a flywheel that's revving up," Maheshwari said. As a digital transformation leader in the healthtech space, it is energizing to see this clear momentum toward scalable, AI-driven platforms. Having long believed in the transformative role of digital solutions and artificial intelligence in US healthcare, this announcement is a crucial milestone—not only for Optum, but for the entire industry. It demonstrates that cross-sector collaboration and intelligent automation can deliver better experiences and efficiencies for everyone: patients, providers, and payers alike. Momentum like this accelerates broad adoption, inspires further investment, and sets a new standard for what's possible in healthcare transformation. ACL Digital, #HLTH25 #Healthcare #HealthcareAI #HealthcareIT #HealthcareTransformation https://lnkd.in/gVncZuvb via Paige Minemyer, Fierce Healthcare

How do we make AI safe and equitable in healthcare? Acentra Health’s Todd Stottlemyer shares insights on the new Safe AI & Medicaid Alliance 👇 https://lnkd.in/gq92jhX3 #AcentraHealth #HealthcareLeadership #HITsm

Can AI reinvigorate Medicaid and Medicare? At #HLTHUSA, panelists tackled one of the biggest questions in U.S. healthcare: Can AI help modernize our most critical public programs before they buckle under the weight of rising demand and outdated infrastructure? From outdated payment models to complex enrollment, Medicare and Medicaid are due for transformation—and AI is emerging as a vital lifeline to make care more sustainable, personalized, and equitable. 💡 A few insights from the session: “Payment models rely on outdated infrastructure dating back to WWII… are there models we should be creating for an AI world?” — Nikita Singareddy, CEO at Fortuna Health “AI in government healthcare will succeed when it’s aligned with the entire ecosystem.” — Christopher Chen, MD, MBA, Medical Director, Medicaid for WA State Health Care Authority “States will fail if they don’t partner with companies using AI to help populations. Trust requires transparency.” — Brian Anderson, MD, CEO at Coalition for Health AI (CHAI) “If you build it, they don’t always come. We need to understand why people don’t engage and balance enthusiasm with skepticism.” — Maya Hardigan, CEO at Mae The future of public healthcare won’t be defined by technology alone—but by how thoughtfully we integrate it to expand access, build trust, and sustain care for those who rely on these programs most. #AI #Medicaid #Medicare #DigitalHealth #HealthEquity #HLTH2025