Healthcare AI investment focusing on hard-dollar returns and clinical workflows amid shift from pilots to widespread production--Bain & Company and KLAS Research

• Providers remain capacity-constrained, prioritizing revenue cycle management and solutions with demonstrable returns on investment
• AI-powered tools gain traction among providers – ambient documentation adoption furthest along
• Payers face higher medical loss ratios, utilization rates, and risk-adjustment scrutiny while bracing for enrollment pressures.
• Payer IT dollars take aim at care coordination and utilization management, with increased spending in pockets of high-ROI value-based care.

NEW YORK and SALT LAKE CITY, Oct. 9, 2025 /PRNewswire/ -- US healthcare providers and payers are ramping up the AI investments most likely to improve profit margins as they focus on an imperative of harnessing tech to bolster returns, a new study from Bain & Company and KLAS Research reveals today.

The prioritization of technology solutions that deliver greatest impact to bottom lines comes as the healthcare sector's deployment of AI moves from a previous phase of broad exploration to focused execution to capture financial benefits, Bain and KLAS report in their 2025 Healthcare IT Spending study. 70% of providers and 80% of payers now have an AI strategy in place or in development – significantly up from 60% for both groups in last year's Bain/KLAS survey.  

The 2025 Bain/KLAS survey of some 228 US healthcare provider and payer executives finds that revenue cycle management (RCM) and clinical workflow are providers' key priorities while payers emphasize utilization and network management. Providers remain capacity-constrained, prioritizing solutions with demonstrable return on investment (ROI). Payers face higher medical loss ratios, utilization rates, and risk-adjustment scrutiny while they brace for enrollment pressures. 

"Healthcare AI is moving out of the pilot stage and being leveraged to meet profitability needs of both providers and payers," said Aaron Feinberg, partner in Bain & Company's Healthcare & Life Sciences and Private Equity practice. "Executives want quickly scalable solutions that address key business challenges and pay for themselves with tangible results and short time-to-value windows. This is all about the bottom line now."

"AI in healthcare is here to stay, and providers and payers are wisely moving from exploration to execution," said Adam Gale, CEO of KLAS Research. "While results are encouraging, it will take time to fully understand the financial impact. What's clear is the strong intent to scale thoughtfully—focusing on use cases that improve experiences for patients, members, and clinicians."

Where providers are investing

In the latest Bain/KLAS survey findings this year, RCM returns to primacy among providers, having been supplanted last year by IT infrastructure and cybersecurity spending in the wake of the Change Healthcare data breach. RCM offers hard-dollar ROI through accurate documentation and coding – resulting in cleaner claims and fewer denials and leading to measurable gains on both the revenue and expense lines.

The repetitive, rules-based nature of RCM makes this function a natural proving ground for automation and for generative AI, Bain and KLAS note. RCM represents the four most common AI use cases currently: ambient documentation, clinical documentation improvement, coding, and prior authorization. Ambient documentation is furthest along, with roughly one-in-five providers at full rollout and another two-in-five in pilot.

Providers are also continuing to invest in clinical workflow optimization tools that improve throughput, support care quality goals, and reduce clinician burnout. Because labor remains scarce, improvements in clinician experience and productivity are an urgent priority, the survey results indicate.

Where payers are investing

Care coordination and utilization management remain the top IT priorities for payers for the second straight year in the survey results, Bain and KLAS find. Plans seek to manage medical cost and close care gaps through prior authorization automation, improvements to care management workflows, and population-level data aggregation and analytics. Network optimization and plan design is the fastest-rising category. Payers have leaned into tools that help them assess provider performance and steer members toward high-quality care, which is critical to Medicare Advantage STAR performance.

Spending on value-based care enablement is accelerating, particularly around risk and quality applications. Roughly three-quarters of plan respondents expect spending in this category to grow faster than other IT priorities over the next three years. AI adoption in payer operations is concentrating first in contact centers, member engagement and follow up, and underwriting and pricing. These domains benefit from personalization at scale by doing so, create meaningful value in member experience, enable better outcomes, and reduce administrative expense.

The outlook for AI

Bain and KLAS report that provider results from AI deployments are encouraging. While many providers say that it is still early to quantify precise financial returns, the qualitative read from them on AI implementations is positive. Fewer than 5% of providers surveyed indicate that the technology was not meeting expectations for categories in which AI solutions have been introduced; most are excited or very excited to scale up AI in those areas.

AI's ROI outcomes have generally been positive on the payer side, too, although there are more instances of payers saying AI use cases have not met expectations, likely owing to the scale of internal IT and other operating resources available to assess the impact of AI. Still, payers appear excited to scale up generative AI use cases – notably for various forms of member/care navigation, in which they see an opportunity to engage members at a scale and level of operations previously unimaginable.  

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For more information, questions, or to request an interview, please contact:

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About Bain & Company
Bain & Company is a global consultancy that helps the world's most ambitious change makers define the future.  

Across 65 cities in 40 countries, we work alongside our clients as one team with a shared ambition to achieve extraordinary results, outperform the competition, and redefine industries. We complement our tailored, integrated expertise with a vibrant ecosystem of digital innovators to deliver better, faster, and more enduring outcomes. Our 10-year commitment to invest more than $1 billion in pro bono services brings our talent, expertise, and insight to organizations tackling today's urgent challenges in education, racial equity, social justice, economic development, and the environment. We earned a platinum rating from EcoVadis, the leading platform for environmental, social, and ethical performance ratings for global supply chains, putting us in the top 1% of all companies. Since our founding in 1973, we have measured our success by the success of our clients, and we proudly maintain the highest level of client advocacy in the industry.  

About KLAS
KLAS is a research and insights firm on a global mission to improve healthcare delivery by amplifying the provider's voice. Working with thousands of healthcare professionals and clinicians, KLAS gathers data and insights on software, services, and medical equipment to deliver timely reports, trends and statistical overviews. The research directly represents the provider voice and acts as a catalyst for improving vendor performance. Learn more at klasresearch.com.

SOURCE Bain & Company