Payment integrity is becoming an increasingly important lever for health plans as medical costs rise, avoidable spend persists, and the vendor ecosystem continues to expand. Within this broader PI agenda, pre-pay is quickly moving to the forefront as plans increase investment, broaden use cases, and look to shift more intervention upstream. Yet the path forward is becoming more complex: health plans are largely retaining multiple pre-pay partners and expanding scope, even as gaps remain around ROI, error identification, reporting, and commercial flexibility. At the same time, AI and analytics are becoming central to payer strategies, while adoption of GenAI and agentic AI varies by use case and delivery model. Commercial expectations are also evolving, with growing interest in hybrid pricing alongside traditional contingency structures.
- How should health plan leaders navigate this expanding ecosystem, determine where vendors are delivering value, and position their pre-pay programs for the next phase of growth?
- How the outsourced PI landscape is evolving as health plans increase pre-pay investment, broaden priorities, and expand scope with existing partners
- How vendor performance is tracking against health plan expectations, and where AI, analytics, and automation are changing what plans want from their partners
- How health plans are rethinking commercial models and which emerging trends are likely to shape the next phase of pre-pay PI
Ankur Verma
Ankur Verma is a member of the Business Process Services team and assists clients on topics related to optimizing business process service delivery models, with an emphasis on Healthcare (payers and providers) and Life Sciences. Ankur’s responsibilities include assisting in managing Everest Group’s Healthcare and Life Sciences Outsourcing subscription offerings and providing outsourcing advisory services to clients on an ad hoc basis.
Prior to joining Everest Group, Ankur was a Senior Analyst with The Smartcube. He holds a bachelor’s degree in technology from Netaji Subhas Institute of Technology, Delhi.
