It’s no secret that one of AI’s greatest use cases has been to streamline internal operations and administrative tasks at healthcare organizations. But, for some payers and their parent companies, these technologies are going even further, now serving as a basis for new revenue streams.
As large payers have grown more comfortable with AI, they’ve begun seeking ways to monetize their hefty investments. Internal tools are going external, and business models have evolved from paying claims to building out software, blurring the line between payer and vendor.
UnitedHealth Group is not shy about this strategy. Last year, Craig Kurtzweil, chief data and analytics officer for UnitedHealthcare’s commercial business, told Becker’s, “At our core, we’re a data company.” During this year’s first-quarter earnings call, Optum Insight CEO Sandeep Dadlani said his division is facing a “transition of business models into an AI-first software and services firm,” adding that one-third of UnitedHealth’s overall $1.5 billion AI spend is going toward this transformation.
In 2025, health services business Optum rolled out a variety of offerings rooted in AI, several focused on the provider side of the healthcare equation. In June, the company introduced its AI marketplace, a platform sharing curated AI tools with healthcare providers, payers and developers. One month earlier, in May, it launched Optum Integrity One, an AI-powered revenue cycle management platform.
CVS Health has also hopped on the trend. Earlier this year, in partnership with Google Cloud, CVS Health shared plans for its health technology services subsidiary, Health100, “an integrated healthcare engagement platform for consumers, regardless of which pharmacy, care provider, medical insurance company, pharmacy benefits manager and digital health solution providers they use.” Health100 will use AI to form its real-time interface, relying on Gemini AI models, Cloud Healthcare API and BigQuery. The platform will integrate data across healthcare sources to assist with clinical and administrative workflows.
As part of Elevance’s $1 billion AI investment, the company’s Health OS platform serves as one pillar of its strategy. The platform streamlines prior authorization and clinical decisions, linking patient data, lab results and pharmacy information.
While healthcare behemoths have been leaning into this software focus, younger payers have also leveraged technology as a cornerstone of their businesses. In 2024, Medicare Advantage payer Clover Health took its internal clinical decision support tool, Clover Assistant, and expanded it externally, branded as Counterpart Assistant.
“We are beginning to see early traction within Counterpart, with growing provider adoption in markets where we do not currently operate plans,” Clover’s interim CFO, Clay Thornton, said on a May earnings call. “We expect to expand that footprint further over time.”
Payers and their parent companies are using AI to unlock revenue beyond their core insurance businesses, but the products could interact with the very AI tools and algorithms that payers deploy themselves. AI in prior authorization, for example, has been under intensified scrutiny as states pitch legislation to limit these tools’ authority.
“Explain to me why insurance companies and PBMs have departments of people and AI to find new ways to downcode, add fees, mark up, deny, underpay and more,” Cost Plus Drugs’ Mark Cuban said on LinkedIn this month. “Hospitals and providers have RCM that they pay up to 10% of revenues to combat what the carriers do.”
He argued that employers are left without the resources to audit what they are actually paying. Payers, meanwhile, are standing behind these platforms. Elevance has said Health OS has reduced denials stemming from a lack of information by nearly 70%.
Whether these AI-powered platforms ultimately serve providers and members, or just serve as a revenue stream that adds noise to an often confusing healthcare landscape, could be a defining question as payers continue to lean into the advancements.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
