The healthcare payer industry is at a pivotal moment. As operational costs rise, consumer expectations evolve, and technology rapidly advances, payers are compelled to reassess their technology priorities to stay competitive and ensure they can scale efficiently while addressing complex regulatory and operational demands. According to the 2025 Gartner CIO and Technology Executive Survey, several key areas are emerging as top investment priorities, all aimed at boosting efficiency, enhancing patient outcomes, and optimizing operations.
In this two-part blog series, we’ll explore the top technology investments healthcare payers are focusing on in 2025. Based on Gartner’s survey of healthcare CIOs, the first part will dive into the top five areas of increased funding, which include:
- Consumer Experience Capabilities (66%)
- Core Admin Systems (50%)
- Interoperability Technologies (36%)
- Care Management Solutions (36%)
- Sales Enablement Applications (34%)
Each percentage reflects the proportion of healthcare payers that, according to Gartner’s research, are increasing investments in these areas.
Consumer Experience Capabilities
The drive to enhance consumer experience among healthcare payers stems from a need to influence member behavior, which hinges on building trust—something many payers have struggled to achieve. Unlike other sectors, where consumers can exercise choice, insurance is often non-optional, leaving payers with an added responsibility to cultivate loyalty in a constrained market. According to the Edelman Trust Barometer, trust is a critical factor for long-term brand success, especially in industries like healthcare, where skepticism can significantly impact engagement.1
While consumer expectations for personalized, tech-driven service are growing, many payers are grappling with how to meet these demands effectively. Heavy investments in technology for omnichannel engagement and AI-driven personalization indicate a push toward better consumer experiences, but many of these efforts have yet to translate into tangible gains in trust or loyalty. This illustrates the importance of strategic investments in consumer experience platforms that do more than streamline interactions—they must address deeper relational gaps to foster long-term member retention.
Why This Matters: By investing in cloud-native architectures and AI-driven personalization algorithms, healthcare payers can better align with member expectations, fostering engagement and loyalty in a market where consumer choice is limited. This approach not only enhances satisfaction but also supports long-term retention by addressing relational gaps, building trust, and creating a foundation for a competitive edge in today’s complex healthcare landscape.
Core Admin Processing Systems
Modernizing core administrative systems is another top priority for healthcare payers. A major challenge is the steady retirement of talent skilled in maintaining legacy infrastructure, which, combined with a growing demand for computing power to support AI-driven projects, is driving payers toward cloud-based, scalable solutions. These platforms streamline essential processes like claims management, enrollment, and payment processing while also enabling faster updates and integrations with third-party services.
According to a report by MarketsandMarkets, the global healthcare cloud computing market is estimated to be worth $53.8 billion in 2024, with a projected growth to $120.6 billion by 2029, representing a Compound Annual Growth Rate (CAGR) of 17.5%.2 This shift reflects the broader industry trend of moving away from on-premise infrastructure to more flexible, API-driven systems that allow for greater agility and cost savings.
Why This Matters: Cloud-based platforms allow payers to scale operations seamlessly, reduce infrastructure costs, and future-proof their systems against evolving regulatory requirements. The flexibility of these platforms also makes it easier to integrate new technologies, ensuring long-term operational efficiency.
Interoperability Technologies
As healthcare payers navigate growing regulatory demands, interoperability has become essential. Compliance with standards like FHIR® (Fast Healthcare Interoperability Resources) is now mandated, encouraging payers to adopt solutions that enable accurate, real-time data exchange. While the healthcare industry has yet to reach consensus on a universal data-sharing approach, payers continue investing in a variety of technologies to meet current demands. In the meantime, FHIR®-readiness facilitates smoother data flow with compliant providers, helping payers reduce manual processing and operational bottlenecks.
According to the 2023 CAQH Index, healthcare plans could save $18.3 billion annually by automating transactions like eligibility checks and prior authorizations.3 While compliance remains the primary driver, these savings illustrate an added benefit of interoperability investments. FHIR®’s standardized data structure further establishes a foundation for scalable, future-ready infrastructures.
Why This Matters: Investing in FHIR® and interoperability technologies is essential for healthcare payers to meet regulatory mandates and maintain compliance across a range of platforms. While potential cost savings offer additional value, these technologies support streamlined data exchange, foster stronger provider collaboration, and ensure payers stay aligned with evolving industry standards.
Care Management
With rising healthcare costs and increasing medical loss ratios (MLRs) placing pressure on healthcare payers, the need for advanced care management solutions has become critical. These systems use data-driven approaches to identify high-risk members, coordinate proactive interventions, and manage chronic diseases—ultimately reducing the cost of care and improving patient outcomes. According to a recent analysis by the Kaiser Family Foundation, MLRs have remained high across the individual, group, and Medicare Advantage markets, underscoring the urgency for payers to contain costs through effective care management.4
From a technical perspective, modern care management platforms integrate real-time analytics and predictive modeling tools, allowing payers to intervene early, avoid costly complications, and personalize care. This approach aligns with broader payer goals of implementing scalable solutions that not only drive down costs but also improve the overall quality of care for members.
Why This Matters: Investing in advanced care management platforms allows healthcare payers to manage rising costs effectively while enhancing the patient experience. By leveraging predictive analytics and personalized care pathways, payers can mitigate high-cost events, align with evolving care models, and remain competitive in an increasingly cost-sensitive market.
Sales Enablement Applications
To remain competitive, healthcare payers are increasingly investing in sales enablement tools that align marketing and sales efforts, streamline member acquisition processes, and optimize retention strategies. These tools, especially when integrated with cloud-based platforms, provide real-time insights and facilitate team collaboration, offering a model for efficiency that payers can extend to their core administrative systems.
Salesforce reports that companies using sales enablement platforms see a 15% improvement in their win rates, highlighting the strategic value of these technologies.5 By incorporating data analytics, payers can optimize their go-to-market strategies and improve member retention in an increasingly crowded marketplace.
The success stories seen with cloud-enabled sales tools demonstrate the potential for enhanced agility and scalability. By embracing cloud integration across their tech stack, healthcare payers can drive more effective member engagement while setting a foundation for operational improvements in core admin systems.
Why This Matters: Cloud-enabled sales enablement tools provide healthcare payers with actionable insights and streamlined processes that enhance competitiveness and efficiency. These tools showcase the benefits of cloud adoption, which can be extended to core administrative functions, helping payers sustain an agile, data-driven approach across their operations.
The Path Forward for Healthcare Payers: Laying the Foundation for Long-Term Success
These top five technology investments represent key areas where healthcare payers are dedicating significant resources to meet evolving challenges and seize new opportunities. By focusing on improving consumer experiences, modernizing core systems, ensuring interoperability, enhancing care management, and streamlining sales processes, payers are laying the groundwork for more efficient and effective operations in 2025 and beyond.
Incorporating these advancements not only helps payers meet regulatory and operational demands but also positions them for long-term success in a rapidly evolving healthcare market. The ability to adapt to these trends will be critical for maintaining a competitive edge while delivering better outcomes for members.
Read Part 2 to explore additional strategic investments, including data science platforms, analytics tools, and payment integrity technologies—equally crucial areas that are shaping the future of healthcare administration.
Author:
Eric Strikowski
Chief Innovation Officer
Sources:
1. 2024 Edelman Trust Barometer, Edelman
2. 17.5% CAGR Fueling $120.6B Healthcare Cloud Computing Market by 2029, MarketsandMarkets
3. The CAQH Index Report, CAQH
4. Health Insurer Financial Performance in 2023, Kaiser Family Foundation
5. Everything You Need To Know About Sales Enablement, Alore
