Creating a Culture of Innovation to Accelerate AI Adoption

Artificial Intelligence (AI) is transforming healthcare by helping payers streamline operations, reduce costs, and enhance experiences for staff, members, and providers. However, health plans must look beyond technology to fully realize AI’s potential. They must address the cultural shifts needed within their organizations to support adoption—like recognizing the benefits for all stakeholders, and building trust in the responsible, sustainable use of AI.

The Importance of AI in Healthcare

AI has the potential to revolutionize how health plans operate. It can increase automation, reduce training times, lower costs, and improve staff efficiency. Embracing AI is critical for health plans who want to stay competitive and meet the evolving needs of members and providers.

According to McKinsey & Company, health plans that embrace digital and AI transformation stand to achieve significant financial and operational gains — it could save health plans up to $1.2 billion and grow revenue by another $1.2 billion for every $10 billion in revenue. In addition, Gartner predicts AI will help reduce health plan administrative costs by up to 30% by 2027, and nearly all health plans are expected to adopt AI solutions by 2026.

Why Adopting Healthcare AI Is More Than Just the Technology

Adopting AI is not just about deploying new software or automating workflows. Implementing AI-powered solutions requires rethinking manual processes for staff and establishing trust in new experiences for members and providers. Health plans must cultivate a culture of innovation and adaptability to fully benefit from AI tools. This includes helping staff see AI not as a threat to their roles but as a tool to amplify their impact.

Understanding Cultural Resistance to Adopting AI Tools

AI adoption can encounter resistance rooted in organizational culture. Common challenges include:

• Skepticism about AI’s potential. Staff may question AI’s potential benefits and may resist its adoption due to concerns over its ability to improve productivity, solve complex problems, and enhance decision-making processes.
• Fear for job security. Many people fear that AI will result in job loss and are resistant to its adoption for this reason. It is important to address this concern by highlighting the potential for AI to create new jobs and improve existing ones.
• Reluctance to change workflows. Some people may resist AI adoption due to a reluctance to change established workflows and processes. It is important to provide ongoing training and support to help people adapt to new technologies and ways of working.

Acknowledging and proactively addressing these concerns is essential. Through our own experience accelerating AI innovation and close collaboration with health plans, HealthEdge® has identified change management best practices that every health plan should consider.

3 Best Practices to Accelerate AI Adoption at Health Plans  

1. Conducting Ongoing Workshops and Training Sessions

Education is one of the most effective ways to address resistance and increase engagement. Hosting AI workshops and training sessions can give staff clarity on the long-term plan for AI solutions, how the new technologies will benefit them, and the opportunity to explore use cases, see the technology in action, and ask questions.

Successful training sessions often include:

• Role-based walkthroughs of AI-driven workflows.
• Peer-to-peer Q&A.
• Clear guidance on how AI will enhance their daily responsibilities.
• Compelling communication and examples of how AI will benefit members and improve outcomes.

This engagement clarifies AI’s benefits and establishes a foundation of trust.

2. Sharing Success Stories Within the Organization

Sharing early success stories from champions and pilot projects reinforces the benefits of AI and makes the value feel more real.

For example, demonstrating how a care manager streamlined their workflow using AI-generated member summaries or how claims staff reduced turnaround time with automated validations provides peers with concrete examples of AI’s potential.

Peer validation is a powerful tool. When staff hear directly from colleagues about improvements in accuracy, efficiency, or member experience they are more likely to embrace the change.

3. Setting Clear and Achievable Goals

Setting clear, achievable AI goals helps focus teams and creates accountability.

The goals should be:

• Aligned with key priorities such as reducing claim rework, improving HEDIS scores, or boosting member satisfaction.
• Measurable and time-bound.
• Communicated frequently to reinforce purpose and progress.

A strong goal framework clarifies the AI strategy for staff and helps them feel part of the “why” to accelerate AI adoption and integration.

Realizing Operational Value: Communicating the Vision

Once a health plan establishes cultural readiness, it can focus on realizing its broader AI vision. For example, HealthEdge defines its AI vision as creating value for health plans in three key areas:

• Intelligent Claims Operations.  Automate every aspect of adjudication with AI, including contract management, adjudication, fraud detection, and improved financial accuracy.
• Proactive & Integrated Care. Improve care and cost outcomes while driving care team quality and efficiency through predictive insights, automation, and tailored care support.
• Elevated Member & Provider Experience. Enable personalized experiences at scale to meet member and provider needs across intelligent content, workflows, and data.

Each health plan should convey an outcome-focused vision that aligns with its organizational goals. This establishes a framework for clear communication that flows through new capabilities, reimagined workflows, and enhanced experiences. 

Key Takeaways for Health Plans: AI Readiness Checklist

Successful AI adoption requires more than next-generation, AI-powered capabilities. Based on HealthEdge’s journey with AI, we see that it requires:

• Cultural readiness and open communication
• Strong change management and leadership support
• Ongoing training and employee engagement
• Clear alignment between AI and business priorities and goals

When these elements are in place, health plans can confidently advance their AI strategy and deliver measurable improvements in healthcare and financial outcomes.

Innovate with a Partner That Understands Healthcare Digital Transformation

HealthEdge understands that adopting AI isn’t just about deploying new technology. It’s about enabling strategic, sustainable transformation centered on the needs of your organization, your teams, and the members you serve.

From identifying the highest-impact use cases to implementing AI responsibly and supporting long-term change management, we’re here to help health plans move forward confidently. Our approach combines deep healthcare expertise, proven technology, and a commitment to transparency and trust.

Contact us to discover how HealthEdge solutions leverage AI to help transform operations and outcomes for healthcare payers.

Not ready for a discussion? Discover how the HealthRules® Payer solution helped Medica health plan transform claims operations through strategic automation. Read the case study.

Gartner, Predicts 2025: AI Reshapes How U.S. Healthcare Payer CIOs Do Business, 16 January 2025

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