Top Payer IT Consulting Priorities for 2025-2026: Health Plans Intensify Focus on AI, Value-Based Care, Compliance, and Digital Transformation
WASHINGTON, D.C., 3683 / / July 13, 2025 / A new survey of 1,202 executives from national, regional, and specialty health plans reveals surging demand for expert consulting services as payers face unprecedented digital, financial, and regulatory transformation. The Q2 2025 Black Book Research study ranks the top-performing advisory firms in each priority area, based on client satisfaction, outcomes, ROI, and 18 proprietary key performance indicators.
Strategic Priorities: Survey Highlights
For 2025-2026, health plans cite value-based reimbursement, artificial intelligence, digital integration, compliance, and consumer engagement as their top areas for advisory firm engagement. Ninety-two percent of executives expressed a preference for independent, vendor-neutral consultants to ensure actionable, unbiased guidance.
Top-Ranked Payer IT Advisory Firms
Value-Based Care & Reimbursement OptimizationRanked by performance in provider alignment, financial impact, and contract innovation
CareAllies: (#1 for eight consecutive years): Highest scores for payer-provider collaboration, MA contract model transformation, and value-based enablement.
Lumeris: Top-rated for accountable care strategy, operationalizing value-based initiatives, and STAR ratings improvement.
Milliman: Leader in financial modeling, risk adjustment methodology, and payment analytics for VBC.
___________
AI & Advanced Analytics ConsultingRanked by outcomes in automation, forecasting, and operational ROI
SAS Institute - Health & Life Sciences: Highest for actuarial forecasting, claims automation, and predictive fraud detection tools.
Optum Advisory Services: Client satisfaction leader for second year in AI-powered modeling, analytics deployment, and clinical data use.
Fractal Analytics: Recognized for intelligent automation, AI maturity frameworks, and operationalization of analytics.
__________
Digital Health Strategy & Ecosystem IntegrationRated for digital platform enablement, virtual care, and infrastructure modernization
Chartis Group: #1 for virtual care strategy, digital health transformation, and infrastructure integration.
PwC Health Industries Advisory: Rated for comprehensive digital planning, interoperability, and patient/member engagement strategies.
Huron Consulting Group: Top client marks for readiness assessments, digital ops alignment, and IT modernization support.
__________
Regulatory Compliance & CMS Audit ReadinessEvaluated on compliance outcomes, risk mitigation, and audit performance
Deloitte: Highest client scores in regulatory tech implementation and CMS audit response readiness.
Inovalon Consulting & Analytics: Leader in audit risk reduction through analytics and compliance advisory.
Guidehouse: Top marks for proven success in RADV audits, risk adjustment, and regulatory readiness.
__________
Pricing Transparency & Consumer EngagementAssessed by transparency tool effectiveness, consumer experience, and enrollment optimization
Softheon: #1 in ACA enrollment, member-facing quoting platforms, and transparency integration.
ZS Associates: Strong client outcomes in benefit pricing, segmentation, and digital experience design.
EY-Parthenon: Trusted for journey mapping, behavioral economics, and consumer digital strategy.
_________
Key Trends Driving 2026 Advisory Demand
Survey respondents identified four primary trends fueling the need for external consulting partners:
Generative AI in claims and prior authorization.
Predictive analytics for cost, quality, and patient/member engagement.
ROI-based digital health evaluations to ensure investments deliver measurable returns.
CMS compliance and audit preparedness as oversight expands.
"Health plans are navigating the most complex transformation period in recent memory," said Doug Brown, President of Black Book Research. "Executives are choosing external advisory partners for their track record of measurable outcomes, unbiased insight, and proven client satisfaction-especially as value-based care, AI, and digital health become the foundation of payer strategy."
About the SurveyThe Q2 2025 Black Book Research survey gathered responses from 1,202 validated health plan, PBM, Medicaid, Medicare Advantage, and commercial payer executives. Advisory firms were evaluated and ranked on 18 KPIs, including outcomes, ROI, responsiveness, innovation, strategic alignment, and client satisfaction. Contact: research@healthplaninsights.com | 800-863-7590 | www.blackbookmarketresearch.com
Contact Information
Press Office research@blackbookmarketresearch.com8008637590
SOURCE: Black Book Research
View the original press release on ACCESS Newswire
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