Cotiviti: Top Content of Last Year
- Healthcare payers are seeking new ways to excel in healthcare operations as 2025 progresses.
- Interoperability is now essential for improving risk adjustment and quality programs.
- Rising utilization and declining reimbursement rates put pressure on payers to manage increasing MLR while maintaining quality care.
Healthcare payers are revolutionizing operations in 2025 by prioritizing interoperability, AI, and managing medical loss ratios. This shift aims to enhance data exchange, improve payment integrity, and streamline processes. Interoperability is crucial for better risk adjustment, overcoming infrastructure roadblocks. Strategies to manage rising medical loss ratios are now key to protecting claim payment integrity. Expect artificial intelligence to drive accuracy and efficiency. News Directory 3 reports that Cotiviti is actively providing solutions and strategies for payers. Discover what’s succeeding in the current healthcare landscape and what’s in store.
Payers Focus on AI, Interoperability to Innovate Healthcare Operations
Updated June 9, 2025
Healthcare payers are seeking new ways to excel in healthcare operations as 2025 progresses. Key areas of focus include boosting interoperability, managing rising medical loss ratios (MLR), and leveraging artificial intelligence (AI).
Interoperability is now essential for improving risk adjustment and quality programs. It facilitates secure data exchange across different healthcare systems. Katie Devlin, vice president of interoperability, suggests overcoming barriers such as outdated infrastructure and ensuring vendor and stakeholder alignment.
Rising utilization and declining reimbursement rates put pressure on payers to manage increasing MLR while maintaining quality care. Michael Jablon, vice president of product management, recommends strategies to curb rising MLR in 2025 while protecting claim payment integrity.
AI is transforming how payers manage operations, creating opportunities to improve payment integrity and efficiency. Brett Arnold, senior vice president of product management, and Anandhi Periyanan, senior vice president of R&D, highlight how AI can improve accuracy, streamline operations, and reduce risks.
A large regional health plan used AI-driven chart selection to transform its clinical review program, resulting in a sixfold increase in captured payment errors within a year.
What’s next
cotiviti plans to continue offering solutions and strategies to help payers succeed. The company will provide updates on trends and insights related to payment accuracy, risk adjustment, quality enhancement, and consumer engagement.