Healthcare IT Investing Advisory Services

Health care payers face many challenges that are shaping strategic priorities — from cost containment to IT spending to member engagement. They have experienced higher than expected medical costs over the last two years, driven by rising demand for health care services that were deferred during the COVID-19 pandemic. Commercial payers see their business model affected as an increasing number of employers move to a self-funded model. Meanwhile, increased health care utilization has been a double whammy for Medicare payers, as the Center for Medicare and Medicaid Services (CMS) announced a lower rate increase compared to prior years (~3% in 2024 vs. ~5% in the prior three years). Likewise, Managed Medicaid plans face about a 15 million drop in member enrollment with the end of the redetermination waiver period. At the same time, payer business models are being disrupted by provider incumbents that are taking on risk and typical payer health care. Combined, these macroeconomic forces and industry trends are putting pressures on payer margins, forcing them to reevaluate their cost models and growth options. With these trends in mind, EY-Parthenon professionals and KLAS Research interviewed and surveyed executives across a diverse mix of payer types, sizes and line of business (LoB) coverage to understand their overall strategic priorities, the impact on spend for HCIT variety of players in the health care ecosystem. Investors: What are the key trends in payer HCIT? Which areas are ripe for increased investment? What are key investment considerations in the payer tech and tech-enabled services market? HCIT vendors: What do payers want from their HCIT vendors? How do payers make decisions? What could be potential solutions to cross-sell (or not)? Payers: How are your competitors dealing with market forces? Where are your competitors making investments? How can you up your HCIT game?

Representing the feedback of 139 healthcare professionals from 131 provider organizations, this report examines the healthcare IT (HCIT) vendors and market segments that are top of mind for healthcare organizations today as well as which technologies are likely to be the target of future investment. Though the COVID-19 pandemic has slowed capital spending for a time, patient engagement, artificial intelligence/machine learning, telehealth, and other remote care solutions continue to attract attention. In total, this report indexes nearly 100 emerging vendors in these and other high-interest markets.