5 Technology Trends Shaping Payer Strategy

By Stephanie Ngo, Managing Director, Payer  

As 2026 comes into focus, health plans are accelerating innovation. Vendors are focused on modernizing tools, platforms, and processes to enhance transparency, collaboration, and experiences. Whether starting small or pursuing enterprise-wide transformation, payers are seeing more options—and more urgency—than ever.  

Here are five key trends impacting payer strategy, based on what we’re seeing in the market and hearing from health plan leaders: 

1. Platform-Based Transformation Gains Traction and Depth 

More health plans are choosing platforms and partners that can support everything from care management to claims processing. Some begin with targeted rollouts, while others are going all-in with enterprise implementations that include provider data management, portals, and interoperability. To support this shift, technology vendors are actively expanding their offerings to make comprehensive implementations more feasible for health plans.

2. New Functionality Elevate Compliance, Experience, and Insight 

Functionality is evolving across the board to meet payer needs. Some of the most compelling developments include: 

• Quality collaboration between payers and providers to measure and manage cost and quality. 

• Provider directory tools that connect members with providers. 

• Employer and broker portals with integrated payment and reporting capabilities. 

• Interoperability (interop) enhancements supporting compliance with CMS-0057 data exchange requirements. 

• Price transparency capabilities to meet regulatory requirements and empower members’ decision-making. 

• Member experience upgrades offering digital self-service and omnichannel options to unify call center, mobile, and digital engagement.   

• Operational dashboards that offer real-time benchmarking and insights into key functions and performance metrics. 

• Provider data management solutions that clean and maintain critical provider information. 

• Advanced intake tools that use OCR (optical character recognition) to eliminate manual processes.  

These enhancements represent a meaningful shift toward payer functionality that’s more agile, member-centered, and compliance-ready. 

3. AI Takes Center Stage  

AI continues to dominate conversations around payer transformation. Across the industry, organizations are exploring how AI can reduce friction, unlock insights, and improve both speed and accuracy. Flexible pricing models and bundled solutions are making AI more accessible, encouraging phased adoption that aligns with organizational readiness. 

4. Tools Must Deliver Real-World Value for Payers 

While AI often feels like hype, we’re seeing real, value-generating applications across key payer workflows: 

• AI for prior authorization workflows to ease the submission process for providers, speeding decisions for payers while increasing transparency and reducing administrative burden for everyone. 

• Risk adjustment that surfaces accurate and comprehensive risk capture supported by clinical documentation that is shared between payer and provider. 

• Advanced analytics and reporting tools empowering end users to easily turn raw data into strategic insight via generative AI. 

• AI for claims processing that automates high-volume tasks to improve speed and accuracy. 

These tools are designed not just for experimentation but for real-world operational improvement. And as they mature, we expect them to become integral to how modern health plans work. 

5. Flexible, Modular Strategies Are Winning 

As payer strategy evolves, vendors are ready to meet payers where they are. The path to implementation doesn’t have to be all or nothing—many plans are pursuing a phased approach, starting with targeted use cases or a limited tech stack and expanding over time. 

Bottom Line 

As health plans navigate a complex and fast-changing landscape, technology decisions are becoming more critical. Organizations that embrace flexibility, interoperability, and intelligent automation are better positioned to reduce costs, satisfy members, and meet regulatory demands. 

Whether you’re exploring CRM, utilization management modernization, or full-stack platform consolidation, these trends offer a roadmap for what’s possible—and what’s next.