Bain & Company October 9, 2025
Revenue cycle management and clinical workflow return as providers’ key priorities while payers emphasize utilization and network management.
At a Glance
- Provider environments remain capacity‑constrained, with leaders prioritizing solutions with demonstrable return on investment.
- AI-powered tools are gaining traction among providers, with ambient documentation adoption furthest along.
- Payers face higher medical loss ratios, utilization rates, and risk-adjustment scrutiny while they brace for enrollment pressures.
- Payer IT dollars take aim at care coordination and utilization management, with increased spending in pockets of high-ROI value-based care.
As 2025 unfolds, providers and payers are navigating different macro pressures, but technology leaders in these organizations share the same imperative: Deploy tech to improve profit margins.
Providers, while past...
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