Executive Summary
Health care costs are climbing faster than payers can keep pace.
The traditional approach to cost containment (i.e., pay the claim, then chase recoveries) isn’t enough anymore. The next era of payment coordination is already taking shape, driven by two major trends: shifting left and artificial intelligence (AI) with an expert in the loop.
Shifting left
For years, payment integrity has moved upstream in areas like coordination of benefits and risk adjustment. Subrogation is next. By identifying and resolving cases earlier in the claims lifecycle, payers can prevent erroneous spend before dollars go out the door. The benefits compound: faster payments, fewer denials, more savings, and a better experience for providers and members.
AI with an expert in the loop
AI has become the industry’s favorite box to check, but most applications fall short of their promise. Without oversight, AI can hallucinate, create bias, and erode member trust. The real value comes when AI amplifies human expertise: detecting complex fraud patterns, automating routine reviews, and freeing investigators to focus on the toughest cases. Technology delivers scale, but humans ensure accountability.
Key Takeaways
Being proactive pays
Shift left to create earlier,
faster savings.
Technology isn’t enough
AI only delivers when
guided by experts.
The future is already here
Leaders who act now
will safeguard resources
others continue to lose.
The next era of payment coordination is here. Download the full report to better understand the trends and how to stay ahead.