Healthcare Archives | PYMNTS.com https://www.pymnts.com/category/healthcare/ The latest global news and analysis in payments, retail, fintech, financial services and the digital economy. Mon, 18 May 2026 19:54:32 +0000 en-US hourly 1 https://wordpress.org/?v=7.0-RC5-62387 https://www.pymnts.com/wp-content/uploads/2022/11/cropped-PYMNTS-Icon-512x512-1.png?w=32 Healthcare Archives | PYMNTS.com https://www.pymnts.com/category/healthcare/ 32 32 225068944 Aumet Raises $12 Million for AI-Driven Pharmaceutical Procurement https://www.pymnts.com/healthcare/2026/aumet-raises-12-million-for-ai-driven-pharmaceutical-procurement/ Mon, 18 May 2026 19:54:32 +0000 https://www.pymnts.com/?p=3743047 Healthcare procurement startup Aumet raised $12 million in Series A funding as the company looks to expand its artificial intelligence (AI)-powered pharmaceutical supply chain platform across the Gulf Cooperation Council (GCC) region and other emerging markets. The Saudi-founded company operates a B2B healthcare marketplace and procurement platform connecting pharmacies, distributors, manufacturers and hospitals. Aumet […]

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Healthcare procurement startup Aumet raised $12 million in Series A funding as the company looks to expand its artificial intelligence (AI)-powered pharmaceutical supply chain platform across the Gulf Cooperation Council (GCC) region and other emerging markets.

The Saudi-founded company operates a B2B healthcare marketplace and procurement platform connecting pharmacies, distributors, manufacturers and hospitals.

Aumet said in a Wednesday (May 13) press release announcing the round that more than 12,000 pharmacies now operate within its network, with the platform processing more than $1 billion in gross merchandise volume.

The funding comes as healthcare systems across the Middle East accelerate investments in digitizing pharmaceutical supply chains, a sector rife with fragmented procurement workflows, manual inventory tracking and limited real-time visibility into medicine availability.

Aumet’s platform provides an infrastructure layer that drives procurement, inventory and decision-making across the healthcare ecosystem, the company said in the release. Its software ties pharmacies, hospitals, suppliers and healthcare systems into a unified network, offering real-time visibility and AI-driven decision-making across the medical supply chain.

Within the healthcare industry, AI adoption is moving beyond diagnostics and clinical workflows into operational infrastructure, particularly procurement, inventory management and supply chain coordination. Healthcare procurement has historically operated through disconnected distributor relationships, siloed purchasing systems and reactive inventory management, creating inefficiencies that became especially visible during the pandemic and subsequent global supply disruptions.

That shift mirrors a larger trend PYMNTS has been tracking across healthcare and enterprise infrastructure. As PYMNTS previously reported, healthcare providers are increasingly turning to AI and embedded finance tools to improve supplier coordination, automate procurement decisions and strengthen operational resilience as cost pressures rise across the sector.

PYMNTS recently reported that supply chains are beginning to “think and act on their own” as AI models become embedded directly into logistics, inventory management and procurement systems capable of executing decisions in real time rather than simply surfacing recommendations.

Aumet is attempting to build that type of centralized intelligence layer for pharmaceutical procurement across emerging markets, where fragmented supplier ecosystems and inconsistent infrastructure have historically made inventory visibility and purchasing coordination difficult at scale.

Aumet currently operates across Saudi Arabia, Jordan, Egypt and Oman, according to company materials.

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Moderna’s AI Could Accelerate Hantavirus Vaccine Development https://www.pymnts.com/healthcare/2026/modernas-ai-could-get-a-hantavirus-vaccine-here-faster/ Tue, 12 May 2026 17:25:37 +0000 https://www.pymnts.com/?p=3726842 Drug development has always been a slow business. A single medicine can take 10 to 15 years and cost billions before it reaches a patient. Moderna has fewer than 6,000 employees and plans to create a new product 15 times over in the next five years. That bet rests almost entirely on artificial intelligence […]

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Drug development has always been a slow business. A single medicine can take 10 to 15 years and cost billions before it reaches a patient. Moderna has fewer than 6,000 employees and plans to create a new product 15 times over in the next five years.

That bet rests almost entirely on artificial intelligence (AI). The Cambridge, Massachusetts-based biotech firm has deployed more than 750 internal AI models across scientific, regulatory and operational workflows since partnering with OpenAI in early 2023.

Hantavirus, a rare pathogen with fatality rates above 30% for some strains, is one of the diseases in its research roster. Bloomberg reported the company had been running early-stage hantavirus vaccine research with the U.S. Army Medical Research Institute of Infectious Diseases and Korea University’s Vaccine Innovation Center before a cluster of cases emerged on a cruise ship in April.

Stéphane Bancel, Moderna’s CEO, has been direct about the scale of what the company is attempting.

“If we had to do it the old biopharmaceutical ways, we might need a hundred thousand people today,” Bancel said, according to an OpenAI post highlighting their partnership. “We really believe we can maximize our impact on patients with a few thousand people, using technology and AI to scale the company.”

750 Tools in 2 Months

The foundation of Moderna’s AI strategy is a company-wide rollout of ChatGPT Enterprise. The company started in early 2023 with mChat, an internal chatbot built on OpenAI’s application programming interface (API) that reached 80% employee adoption. When ChatGPT Enterprise launched, Moderna ran a structured comparison of mChat, Microsoft Copilot, and the new platform. ChatGPT Enterprise won by a wide margin.

Brice Challamel, head of AI products and platforms at Moderna, OpenAI noted, described what followed as something the company hadn’t anticipated. “We were never here to fill a bucket, but to light a fire,” Challamel said. Within two months of adoption, Moderna had 750 GPTs built across the company, 40% of active users had created their own tools, and each employee averaged 120 conversations per week on the platform.

Moderna’s change management program ran for roughly 20 months before the ChatGPT Enterprise rollout. It included a company-wide AI prompt contest, a cohort of 100 internal AI champions, and an internal forum that now draws 2,000 active participants each week.

From Dosing Decisions to the Legal Team

Inside the clinical operation, one of those 750 GPTs is doing work that once took weeks. Dose ID, a tool built on ChatGPT Enterprise’s data analysis features, helps the clinical study team verify optimal vaccine doses. It analyzes large trial datasets, applies standard dose selection criteria and generates charts of findings for human review before a candidate advances to late-stage trials.

Meklit Workneh, director of clinical development at Moderna, said the tool lets the team analyze data from multiple angles. The legal team reached 100% adoption of ChatGPT Enterprise. Shannon Klinger, Moderna’s chief legal officer, said AI lets lawyers focus time on work “that is truly driving an impact for patients.”

Other tools handle contract summaries, internal policy questions, quarterly earnings slide preparation, and investor communications like converting technical language into plain terms for external audiences.

Moderna’s pipeline target of 15 products in five years sits against an industry backdrop where that pace has rarely been attempted, let alone achieved.

For all PYMNTS AI and digital transformation coverage, subscribe to the daily AI and Digital Transformation Newsletters.

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MDEnvoy Channels Jerry Maguire With Agents and AI for Doctors https://www.pymnts.com/healthcare/2026/mdenvoy-channels-jerry-maguire-with-agents-ai-doctors/ Tue, 05 May 2026 08:03:13 +0000 https://www.pymnts.com/?p=3703102 Watch more: Need to Know With MDEnvoy’s Dr. Michael Suk Doctors spend years mastering medicine. Nobody teaches them how to negotiate a contract. That gap is where MDEnvoy is making its case. The company is the first to combine artificial intelligence-powered analysis with dedicated human advocates to represent physicians across every major career decision, […]

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Watch more: Need to Know With MDEnvoy’s Dr. Michael Suk

Doctors spend years mastering medicine. Nobody teaches them how to negotiate a contract.

That gap is where MDEnvoy is making its case. The company is the first to combine artificial intelligence-powered analysis with dedicated human advocates to represent physicians across every major career decision, from their first job offer to long-term financial planning and everything in between.

The firm’s core argument is straightforward. Without someone in their corner, doctors are left to navigate contracts, compensation and career choices alone, often against institutions with more experience doing exactly that.

“We found that physicians are one of the very few professions… that doesn’t really have anybody representing them,” Dr. Michael Suk, CEO of MDEnvoy, told PYMNTS CEO Karen Webster.

What doctors need, in the immortal words of Jerry Maguire, is someone to show them the money. And then some.

A Market Defined by Moving Parts

Healthcare employment is complicated. Doctors don’t just negotiate with one employer. They’re navigating large health systems, independent practices and payment structures that shift constantly, often making it hard to know what a fair deal actually looks like.

Suk offered several examples. Compensation benchmarks are built from limited survey data that gets averaged across physicians at very different points in their careers, he said. That kind of broad-brush comparison can leave individual doctors significantly underpaid.

Contracts go beyond salary. Call schedules, administrative duties, productivity targets and performance expectations all affect how much a doctor earns and whether the job is sustainable long term. These details are often buried in the fine print, surfacing only after a physician has already accepted a role.

Webster also raised the factors doctors weigh that don’t show up in any offer letter, including research opportunities, work-life balance and the shape of a career over decades.

MDEnvoy’s service goes beyond contract negotiation. The firm acts as a quarterback for a doctor’s professional life, connecting physicians to vetted partners in wealth management, legal advisory and career planning, replacing the informal networks that most doctors cobble together on their own.

Borrowing From Sports, Adapting to Medicine

The Jerry Maguire reference is intentional. MDEnvoy’s structure was shaped in part by Suk’s real-world collaboration with sports agent Leigh Steinberg, whose client list inspired the film and whose approach to athlete representation informed MDEnvoy’s design. The parallel is hard to miss, as both physicians and athletes leave structured training programs and step directly into high-stakes financial negotiations, usually without anyone advocating for them.

“I’ve never seen a professional athlete go to an owner and say, ‘I’d like a little extra money, please,’” Suk said, or who just go it alone with all the people on the other side of the negotiating table.

“But if you flip that analogy around, that’s what doctors do all the time,” often to their own detriment, he added.

The analogy extends to how MDEnvoy thinks about a physician’s career, less as a series of separate job decisions and more as a long-term portfolio that needs active management. That framing applies whether the doctor is a first-year resident or a seasoned specialist.

That continuity is central to the pitch. A doctor can hire MDEnvoy for a single contract review or sign up for ongoing representation. Suk positioned the latter as the real goal: a relationship that grows with the physician rather than ending when one deal closes.

“We don’t see this as a transactional event,” he said. “We see this as a longitudinal event to follow somebody throughout their career.”

Business Model: Layered Services and Ongoing Access

MDEnvoy charges for its services in two ways. Doctors can pay for individual engagements, such as a contract review, compensation analysis or help preparing for a specific negotiation. Each is priced based on the scope of work involved.

The second option is a membership that gives doctors an assigned adviser who stays with them through multiple career stages, handling contract negotiations, financial decisions and professional development as they arise. Suk described the arrangement as a “365, 24/7” relationship built for the long haul.

The two-tier structure gives MDEnvoy a way to build a recurring revenue base while keeping the door open for doctors who aren’t ready to commit to a full membership. A physician who starts with a single contract review can grow into a longer-term client as their needs become more complex.

MDEnvoy also brings in outside specialists where needed. The firm screens and selects partners in wealth management and other advisory areas, connecting doctors to providers that fit their goals. Rather than trying to do everything in-house, MDEnvoy positions itself as the central coordinator, ensuring the different parts of a doctor’s professional life are working in the same direction.

Agentic AI and the Judgment Gap

AI plays a supporting role in the model, scanning contracts, compensation data and employment terms to surface patterns that a human advisor might miss. Suk said AI is a tool for analysis, not decision-making, helping advisers spot opportunities and flag risks but stopping short of replacing the human judgment that ultimately drives each recommendation.

“What AI is really good for is recognizing patterns and being a super specialist in a certain area,” he said. “What it’s really terrible at is taking that specialty knowledge… and seeing the human being.”

That combination of machine-scale analysis and human accountability is what MDEnvoy sees as its edge, reflecting a broader push in professional services to use AI where it excels while keeping people in charge of the decisions that really matter, he said.

Retention and Alignment

MDEnvoy also frames its value in terms that health systems can get behind. When doctors understand their contracts and feel supported in their careers, they tend to stay longer, and physician turnover is expensive. The argument is that better representation at the front end creates stability on both sides of the employment relationship.

“This isn’t just about getting doctors more money… it’s about long-term retention,” Suk said, emphasizing the importance of transparency and alignment.

Webster asked whether health system executives should “be worried or welcoming” about a model that shifts more negotiating power to physicians. Suk said hospitals should welcome it because a more transparent system benefits everyone.

A System Reworked One Contract at a Time

MDEnvoy is building its business one doctor at a time, with each engagement designed to close the gap between what a physician expects from a job and what they actually get. The firm tracks client outcomes and satisfaction as its primary measures of progress.

The bigger goal is systemic change. Over time, MDEnvoy wants to reshape how physicians and health systems negotiate and relate to each other, introducing a more structured approach to career management across the profession.

Suk pointed to that longer horizon in assessing the firm’s progress.

“MDEnvoy was not created ultimately to become the main business driver for finances,” he said. “It was really designed largely on mission to help shape the way physicians interact with the marketplace today and how we slowly move a healthcare system away from a pure transactional arrangement between physicians and employers to something more closely related to partnership.”

For all PYMNTS AI coverage, subscribe to the daily AI Newsletter.

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UnitedHealth Spends $1.5 Billion on AI and Wants Double Back https://www.pymnts.com/healthcare/2026/unitedhealths-ai-is-rebuilding-the-payment-layer-of-american-healthcare/ Tue, 21 Apr 2026 22:09:25 +0000 https://www.pymnts.com/?p=3671331 UnitedHealth Group is processing 500 million transactions this year through Optum Real, an artificial intelligence-first claims and reimbursement platform. By year end, that number is expected to hit 2.5 billion. That volume already puts Optum Real among the highest-throughput transaction platforms in American healthcare — and the platform launched only a few quarters ago. The […]

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UnitedHealth Group is processing 500 million transactions this year through Optum Real, an artificial intelligence-first claims and reimbursement platform. By year end, that number is expected to hit 2.5 billion. That volume already puts Optum Real among the highest-throughput transaction platforms in American healthcare — and the platform launched only a few quarters ago. The pace shows how fast the manual layer of healthcare payments is giving way to automated, real-time transaction processing.

The company’s first quarter 2026 earnings call made clear how far that shift has already gone. AI is now embedded in the core transaction layer across claims adjudication, prior authorization, pharmacy approvals and provider payments. Phone calls, manual reviews and multiday reimbursement cycles are being replaced by system-to-system data exchange that processes decisions in seconds.

Payments at Machine Speed

Optum Real handles claims adjudication and coverage validation and cuts manual contact costs by 76%, according to the earnings call.

Prior authorization is moving in the same direction. Nearly 95% of requests now arrive electronically. About half process in real time. More than 90% clear within one business day. Authorizations submitted through Digital Auth Complete, the company’s new prior auth platform, hit a 96% first-submission approval rate. That cuts rework and compresses payment cycles for providers waiting on reimbursement.

The pharmacy side moves faster still. PreCheck MyScript cuts prescription approval time from over eight hours to under 30 seconds. It drives a 68% reduction in denials tied to missing information, per the earnings call.

Rural providers are also in scope. UnitedHealth is increasing payment speeds by 50% for rural hospitals across all lines of business. The company is also exempting rural providers from most medical prior authorization requirements. For smaller organizations running on thin margins, both moves directly affect cash flow.

From Call Centers to Continuous Transactions

More than 80% of consumer contacts now happen through digital channels. The company logged 73 million digital visits in the first quarter, up 42% over two years. UnitedHealth just launched Avery, a generative AI assistant for UnitedHealthcare members. It handles coverage and billing questions without human intervention. It will reach more than 20 million members by year end.

The provider side is shifting just as fast. Digital transaction volumes rose 75% year over year. About 75% of in-network providers now use portal or API tools to check eligibility, verify benefits and track claims in real time. That replaces phone-based, back-and-forth outreach with continuous, system-to-system data exchange. The model looks less like traditional insurance administration and more like FinTech payment rails.

A $1.5 Billion Bet on 2-1 Returns

UnitedHealth plans to spend nearly $1.5 billion on AI in 2026. Chief Digital and Technology Officer Sandeep Dadlani broke down the allocation on the call. Roughly a third funds software products and platforms, accelerating Optum Insight’s shift to an AI-first services business. The remaining two-thirds goes across internal processes: member experience, administrative workflows, clinical operations and back-office functions including HR, finance and marketing.

“We expect a return conservatively of 2 to 1 on these programs over the next few years, many of them paying back within the next 12 to 18 months,” Dadlani said. Optum Insight’s new consulting arm, Optum AI, has already signed its first external contracts, including with Labcorp on operational AI initiatives. That’s the first signal that UnitedHealth intends to sell outside what it builds internally.

“This is not just a matter of being more productive at what we already do,” Chairman and CEO Stephen Hemsley said on the call, “but a reimagining of how we organize, operate and work going forward.”

Optum Real is on pace to close the year having processed more transactions than UnitedHealth’s entire domestic membership count more than 50 times over.

What Else Stood Out on the Call

  • Optum Insight is actively decommissioning older, non-AI products and reinvesting those resources into AI-first platforms, with the productivity benefits expected to materialize in the back half of 2026.
  • UnitedHealth announced it will exempt rural healthcare providers from most medical prior authorization requirements and is building network partnerships between rural providers and leading regional health systems.
  • The company refreshed nearly half of its top 100 leadership roles and exited all non-U.S. businesses to refocus squarely on domestic healthcare.
  • Optum Financial Services agreed to acquire Allegis Technologies, a health financial services business, in a transaction expected to be accretive in 2027.

Topline Results

Revenue reached $111.7 billion, up 2% year over year. Adjusted earnings per share came in at $7.23, ahead of expectations. The company serves 49.1 million domestic members. The medical care ratio improved to 83.9% from 84.8% a year earlier. Operating cash flow totaled $8.9 billion, or 1.4 times net income. The company raised its full-year outlook to greater than $18.25 per share. The company-initiated share repurchases and expects to deploy at least $2 billion by end of Q2.

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Neko Health Eyes US Health Markets With Full-Body Scans https://www.pymnts.com/healthcare/2026/neko-health-eyes-us-health-markets-with-full-body-scans/ Thu, 02 Apr 2026 22:29:44 +0000 https://www.pymnts.com/?p=3621775 A health-focused startup founded by Spotify Co-founder Daniel Ek plans to open its first U.S. location as soon as this spring if it gets regulatory approval, Bloomberg reported Thursday (April 2). Neko Health offers full-body health scans that include imaging, a blood test and other tests, and checks for skin cancer, heart disease, diabetes risk and other conditions, according to the […]

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A health-focused startup founded by Spotify Co-founder Daniel Ek plans to open its first U.S. location as soon as this spring if it gets regulatory approval, Bloomberg reported Thursday (April 2).

Neko Health offers full-body health scans that include imaging, a blood test and other tests, and checks for skin cancer, heart disease, diabetes risk and other conditions, according to the report.

To patients, the process appears similar to an airport scan along with a blood test, the report said.

The cost of the full-body health scans is the equivalent of about $400 in the United Kingdom but will likely be higher in the United States, per the report.

Neko Health plans to open its first U.S. location in New York City and then add more locations in the following months, CEO Hjalmar Nilsonne told Bloomberg.

Because the U.S. is the world’s largest health care market, “you can be sure we’re ambitious about serving folks there,” Nilsonne said in the report.

Neko Health was valued at about $1.8 billion in a January 2025 Series B funding round in which it raised $260 million, PYMNTS reported at the time.

Bejul Somaia, partner at Lightspeed Venture Partners, which led the round, said at the time in a press release: “Neko combines breakthrough technology with meticulous attention to detail in everything from their scanning technology to the patient experience. With a … clear path to international expansion, we believe comprehensive preventive care can be both accessible and scalable.”

When announcing its plans to open its first U.S. location in New York City this spring, Neko Health said in a January press release that it opened a U.S. waitlist and that globally, more than 300,000 people had signed up for the Neko Body Scan.

Neko Health was launched in Sweden in 2023 and now operates six locations across Sweden and the United Kingdom, according to the release.

The company attributed the number of sign-ups it had received to growing demand for healthcare that is proactive rather than reactive, and that offers earlier, more personalized health insights.

“For the first time, technology is enabling a fundamentally new healthcare experience centered on prevention,” Nilsonne said in the release.

For all PYMNTS digital transformation coverage, subscribe to the daily Digital Transformation Newsletter.

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How Healthcare CFOs Are Turning Operational Upgrades Into Financial Gains https://www.pymnts.com/healthcare/2026/how-healthcare-cfos-are-turning-operational-upgrades-into-financial-gains/ Wed, 18 Mar 2026 15:29:19 +0000 https://www.pymnts.com/?p=3572501 Healthcare CFOs today are walking a tightening wire. System and network margins are under structural pressures, policy risk is rising across the industry and clouding long-term planning, all while the revenue cycle has become a full-blown technology battlefield. It’s that last factor that has healthcare chief financial officers on their toes. The revenue cycle […]

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Healthcare CFOs today are walking a tightening wire. System and network margins are under structural pressures, policy risk is rising across the industry and clouding long-term planning, all while the revenue cycle has become a full-blown technology battlefield.

It’s that last factor that has healthcare chief financial officers on their toes. The revenue cycle today in healthcare sits at the intersection of clinical operations, payer dynamics, and digital infrastructure. Errors in eligibility verification, prior authorization or coding are no longer isolated inefficiencies; they are systemic leakages that can directly erode margins. At the same time, denial rates are rising across the industry, and reimbursement timelines are stretching, placing additional pressure on cash flow.

CFOs are increasingly recognizing that revenue cycle performance is not just a reflection of operational discipline but of technological capability. Automation, predictive analytics and real-time data integration are becoming prerequisites for maintaining financial stability in the modern macro environment.

But while the case for technology investment is compelling, execution remains a significant hurdle. Implementing new systems in a healthcare environment is inherently complex, involving multiple stakeholders, regulatory considerations and legacy infrastructure.

This puts the CFO at the center of any initiative, not just to rubber stamp the expenditure or chart the ROI, but to oversee the operationalization of what, thanks to artificial intelligence, could promise to be the next phase of healthcare technology and transformation.

See also: How Healthcare Innovation Starts With Regulation and Ends With Integration 

Why the Revenue Cycle Is No Longer a Support Function

The urgency behind technology investment is rooted in structural economics. Healthcare labor costs remain elevated, particularly in revenue cycle roles that are both specialized and difficult to retain. Meanwhile, payer mix is shifting toward government programs, which typically reimburse at lower rates and impose stricter compliance requirements.

Against this backdrop, traditional cost-cutting strategies are reaching their limits. CFOs can only reduce headcount or renegotiate contracts so far before diminishing returns set in. Technology, by contrast, offers a different lever: the ability to increase yield from existing operations.

As covered here last year, research shows that close to half of healthcare and life-sciences organizations have generative AI in production use, in many cases for documentation, administrative work and early-stage clinical summaries.

Dr. Marschall Runge, former executive vice president for Medical Affairs at the University of Michigan, dean of the Medical School and CEO of Michigan Medicine told PYMNTS that one hospital increased operating room utilization by 20% after deploying AI to observe surgical workflows and predict when patients would move from the OR to recovery.

A year ago, Dr. Runge would have described AI as a promising tool. Today, he describes it as embedded infrastructure, already woven into the operational and cognitive layers of healthcare, accelerating and not yet close to its ceiling.

Still, budget constraints, competing priorities, and the inherent complexity of implementation often lead to incremental rather than transformative investments. But the greatest risk in today’s landscape, it turns out, may not be spending too much on technology. It may be spending too little and discovering too late that the revenue cycle has moved on without you.

See more: PYMNTS’ 2025 Healthcare Coverage Followed the Money and the Friction

The Role of Data and Predictive Analytics

At the heart of modern revenue cycle transformation is data. The ability to capture, analyze, and act on data in real time is what differentiates high-performing organizations from their peers.

Still, CFOs are not only focusing their tech spend inwards. Patient management and the patient experience are also key impact areas for any transformation initiations.

Aashima Gupta, global director of healthcare strategy and solutions at Google Cloud, told PYMNTS in an October interview that ROI in healthcare is not only about efficiency but also about creating conditions for better care

Digital solutions are a first-order contributor to those conditions. The PYMNTS Intelligence report “The Digital Healthcare Gap: Streamlining the Patient Journey” found that two-thirds of consumers use patient portals, and older cohorts are not necessarily digital holdouts.

The Digital Platform Promise: What Baby Boomers and Seniors Want From Digital Healthcare Platforms” revealed that baby boomers and seniors reported high satisfaction with receiving test results online and meaningful participation in digital healthcare activities.

The tightening wire that healthcare CFOs must walk is unlikely to loosen anytime soon. Margins will remain under pressure, and policy uncertainty will persist. What can change, however, is how organizations respond to drive growth with change.

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38% of Millennials Pay Out of Pocket for Healthcare https://www.pymnts.com/healthcare/2026/38percent-millennials-pay-out-pocket-medical-care/ Wed, 18 Mar 2026 08:00:17 +0000 https://www.pymnts.com/?p=3552970 Healthcare costs are hitting the youngest adults hardest, turning even routine care into a budget decision for Americans who, on paper, should need the least medical attention. That was the central takeaway from “Healthcare on Hold: Why 1 in 4 Gen Z Consumers Skip the Doctor,” the November Generational Pulse Report from PYMNTS Intelligence […]

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Healthcare costs are hitting the youngest adults hardest, turning even routine care into a budget decision for Americans who, on paper, should need the least medical attention.

That was the central takeaway from “Healthcare on Hold: Why 1 in 4 Gen Z Consumers Skip the Doctor,” the November Generational Pulse Report from PYMNTS Intelligence based on a survey of 2,368 consumers in the United States.

Medical costs are straining household budgets across every age group, but the pressure is most acute among Generation Z, zillennials and millennials. While older consumers are more likely to use healthcare services, young adults are more likely to say those services create real financial stress, require out-of-pocket spending and lead them to delay treatment.

Key findings from the report:

  • Healthcare costs are at least somewhat of a financial burden for 80% of Gen Z consumers, versus 63% of consumers overall and 44% of baby boomers and seniors.
  • At least some out-of-pocket payment is required for 30% of healthcare visits overall, but that rises to 38% for millennials, 42% for zillennials and 35% for Gen Z. By contrast, 86% of baby boomers and seniors said their last visit was covered at least in part by insurance, compared with 70% of Gen Z.
  • Cost is also changing behavior, as 25% of Gen Z consumers delayed a doctor’s visit in the last three months because of cost, and 22% skipped a recommended treatment or test. Across all consumers, 18% delayed a visit and 14% skipped recommended care.

This is becoming a broad affordability issue, not a narrow insurance story, the report found. Premiums are rising, and many consumers with coverage still face out-of-pocket bills.

The strain shows up in specific parts of the system.

Out-of-pocket costs were reported in 57% of chiropractor visits, 42% of eye doctor visits and 39% of retail clinic visits. Mental and behavioral health was another pressure point. More than half of all mental health visits were conducted remotely, yet affordability remained a challenge as behavioral health costs climbed faster than many other forms of treatment.

There is, however, a constructive angle in the data. Young consumers were the most open to tools that could make healthcare easier to shop for and pay for. Gen Z was 32% more likely than the overall population to express interest in at least one new payment technology, and 39% said they want real-time tools to check insurance benefits, while 31% want artificial intelligence-powered cost prediction tools.

Consumers want clearer prices, better benefit visibility and fewer surprises. Simple tools could help.

At PYMNTS Intelligence, we work with businesses to uncover insights that fuel intelligent, data-driven discussions on changing customer expectations, a more connected economy and the strategic shifts necessary to achieve outcomes. With rigorous research methodologies and unwavering commitment to objective quality, we offer trusted data to grow your business. As our partner, you’ll have access to our diverse team of PhDs, researchers, data analysts, number crunchers, subject matter veterans and editorial experts.

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Algorithms Now Argue Over Your Medical Bill https://www.pymnts.com/healthcare/2026/healthcares-billing-wars-are-becoming-an-ai-vs-ai-contest/ Thu, 12 Mar 2026 21:59:42 +0000 https://www.pymnts.com/?p=3558412 Artificial intelligence is moving into the financial mechanics of healthcare payments, and the stakes are measured in billions. Hospitals are deploying the technology to maximize reimbursement, while insurers use their own AI systems to audit claims and challenge charges, turning a decades-old conflict over medical billing into an algorithm-driven contest over how care is priced […]

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Artificial intelligence is moving into the financial mechanics of healthcare payments, and the stakes are measured in billions. Hospitals are deploying the technology to maximize reimbursement, while insurers use their own AI systems to audit claims and challenge charges, turning a decades-old conflict over medical billing into an algorithm-driven contest over how care is priced and paid for.

The numbers on both sides reflect the amount at play. UnitedHealth Group projects AI could save it nearly $1 billion in 2026, while HCA Healthcare expects roughly $400 million in AI-driven cost savings, partly from automating revenue management, according to Reuters. On the other side of that ledger, Blue Cross Blue Shield has released an analysis suggesting that AI-enabled coding practices may be responsible for more than $2 billion in additional claims spending nationwide.

Hospitals Use AI to Optimize Billing

Hospitals are turning to AI to automate clinical documentation and medical coding, the process of translating care into standardized billing codes submitted to insurers. These tools use ambient listening technology to capture clinical interactions in real time, then analyze physician notes and lab reports to automatically assign billing codes, a workflow that proponents say reduces paperwork and physician burnout.

But the Blue Cross Blue Shield Association analysis of de-identified claims data found patterns that raise questions about accuracy. Researchers tracked a sharp rise in diagnoses of acute posthemorrhagic anemia at hospitals that had publicly disclosed AI adoption. In many of these cases, patients coded with the condition never received blood transfusions, a treatment typically associated with it. That diagnosis spike alone added $22 million to maternity admission costs in one year.

Looking across all facilities, the analysis attributed about $663 million in inpatient spending and at least $1.67 billion in outpatient spending to AI-powered coding practices.

Federal data shows 7 in 10 U.S. hospitals used predictive AI in 2024, with AI use for billing jumping 25% year over year, according to U.S. News and World Report.

Insurers Use Their Own Algorithms

As hospitals automate revenue capture, insurers are deploying AI to audit claims and deny coverage at scale. The share of provider claims denied more than 10% of the time has risen from 30% three years ago to 41% today, according to Experian. Insurers on Affordable Care Act marketplaces denied nearly 1 in 5 in-network claims in 2023, up from 17% in 2021, according to KFF.

UnitedHealth Group has faced scrutiny from federal lawmakers over its use of algorithms to deny care to seniors enrolled in Medicare Advantage, according to industry news site Stat. Humana and other insurers face lawsuits and regulatory investigations over similar practices, said Revenue Cycle Coding Strategies. The industry argues AI improves efficiency and reduces costs by processing high volumes of claims data that would otherwise require extensive manual review.

Patients are beginning to arm themselves with AI tools as well, according to North Carolina Health News. Startups, including Sheer Health and the nonprofit Counterforce Health, have built tools that help patients analyze denial letters, cross-reference their insurance policies and draft appeals. Historically, fewer than 1% of denied claims are appealed, and patients lose more than half of those appeals.

Consumer AI tools are designed to shift that math, though Carmel Shachar, assistant clinical professor of law and the faculty director of the Health Law and Policy Clinic at Harvard Law School, warned that it can be difficult for a layperson to understand when AI is doing good work and when it is hallucinating or giving something that isn’t quite accurate, according to North Carolina Health News.

Regulation Meets Rapidly Scaling Problem

The speed of AI deployment on both sides of the healthcare billing divide is outpacing regulatory frameworks. The site said more than a dozen states passed laws regulating AI in healthcare in 2025, with Arizona, Maryland, Nebraska and Texas among those banning AI as the sole decision-maker in prior authorization denials. Broader federal standards have not kept pace.

The concern for regulators is not simply that AI speeds up billing disputes. It is that automated systems on both sides risk optimizing for financial outcomes rather than clinical accuracy, with patients caught between competing algorithms.

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Microsoft Debuts AI Tool to Analyze Users’ Medical Records https://www.pymnts.com/healthcare/2026/microsoft-debuts-ai-tool-analyze-users-medical-records/ Thu, 12 Mar 2026 17:01:20 +0000 https://www.pymnts.com/?p=3556952 Microsoft is continuing its push into the healthcare field with its new Copilot Health offering. The service is a separate space within the company’s Copilot artificial intelligence tool that can make sense of a user’s information and offer personalized health insights, according to a Thursday (March 12) press release. “Copilot Health doesn’t replace your […]

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Microsoft is continuing its push into the healthcare field with its new Copilot Health offering.

The service is a separate space within the company’s Copilot artificial intelligence tool that can make sense of a user’s information and offer personalized health insights, according to a Thursday (March 12) press release.

“Copilot Health doesn’t replace your doctor,” the release said. “It makes every minute you have with them count more. You arrive prepared, with the right questions, the right context, and the confidence that comes from better understanding your own body.”

The tool combines users’ health records, wearable data, and health history into a single place, then employs intelligence to turn them “into a coherent story,” according to the release.

“Where the connection between your broken sleep and the reasons why become visible,” the release said. “Where you stop scrolling symptoms at midnight and start having better informed conversations.”

Copilot Health will be made available “through a careful, phased rollout,” with a waitlist for the tool opening Thursday, according to the release.

Microsoft AI CEO Mustafa Suleyman said health data imported into the feature will be encrypted and firewalled from the rest of the app to address the privacy concerns related to sharing users’ medical records with a generative AI platform, The Wall Street Journal reported Thursday.

“It’s something that Microsoft is uniquely placed to do with our scale, with our regulatory experience, with the kind of trust and confidence that people have in our security and the history that we have as a mature, stable player,” Suleyman said, per the report.

The PYMNTS Intelligence report “How AI Becomes the Place Consumers Start Everything” found that consumers are comfortable turning to AI tools for healthcare information.

AI “increasingly acts as a first step instead of a supplemental tool,” with frequent AI users saying they start tasks “inside AI platforms rather than search engines or apps … behavior spans learning, planning, financial tasks, and health-related inquiries,” PYMNTS reported Jan. 6.

This behavioral change was reflected in a report from OpenAI, which found that 55% of Americans use the company’s ChatGPT to understand symptoms, 48% to decipher medical terminology, and 44% to find out about treatment options.

“These are foundational steps in the healthcare journey, shaping how patients prepare for appointments and decide when to seek professional care,” PYMNTS reported.

For all PYMNTS AI coverage, subscribe to the daily AI Newsletter.

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Nitra Secures $187 Million to Automate Healthcare Practice Operations https://www.pymnts.com/healthcare/2026/nitra-secures-187-million-to-automate-healthcare-practice-operations/ Tue, 10 Mar 2026 11:00:15 +0000 https://www.pymnts.com/?p=3546444 Nitra announced Tuesday (March 10) that it raised $187 million for its artificial intelligence-native operating platform for healthcare practices. This total includes a $50 million Series B round, a previously unannounced $22 million Series A round completed in August, $20 million in venture debt and an expanded $95 million warehouse facility, the company said […]

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Nitra announced Tuesday (March 10) that it raised $187 million for its artificial intelligence-native operating platform for healthcare practices.

This total includes a $50 million Series B round, a previously unannounced $22 million Series A round completed in August, $20 million in venture debt and an expanded $95 million warehouse facility, the company said in a Tuesday press release emailed to PYMNTS.

The financing brings Nitra’s total capital raised to $205 million, and its total equity raised to $90 million, according to the release.

Nitra’s platform embeds AI agents into the operations of healthcare practices, providing help with financial automation, commerce, inventory and patient management, the release said.

Launched in 2024, the platform is now used by more than 700 clinics and processes over $1 billion in annualized volumes. Nitra’s annualized revenues grew from $4 million to $33 million in 2025, per the release.

With the new financing, Nitra plans to accelerate its AI development, expand its engineering team and scale its operating system to more healthcare practices across the United States, according to the release.

“Practices are running critical workflows across disconnected systems that were never designed to work together,” Nitra CEO Tim Hwang said in the release. “Nitra brings those layers together into a single AI-native operating system that helps healthcare practices run their operations more efficiently.”

Adarsh Bhatt, general partner at Comma Capital, one of the company’s investors, said in the release that Nitra has consistently added to the capabilities of its platform.

“As someone who regularly speaks with clinicians and practice owners, it’s clear there is a strong demand for modern financial and operational infrastructure purpose-built for healthcare practices,” Bhatt said. “This round positions Nitra to deepen that platform and expand the capabilities providers rely on every day.”

Nitra’s first product was a Visa Business card for physicians that the company launched in August 2022. The company said at the time that it planned to bring modern financial products, integrated medical software and supply chain solutions to practitioners and physicians in the healthcare industry.

Jonathan Chen, founder and current president of Nitra, told PYMNTS CEO Karen Webster in February 2024 that the company added a medical supply marketplace as it continued to work to streamline back-office operations for physicians.

“When you think about how you can best serve the market, one major thing is honestly just getting the best deals and having the lowest prices,” Chen said.

It was reported in December that health systems are actively embracing AI systems to save time by tackling the “grunt work” of dealing with documentation and other tasks.

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