PwC and Zyter have formed a collaboration to help healthcare payers and providers reduce the total cost of care using AI. The partnership combines PwC's healthcare transformation and analytics experience with Zyter|TruCare's agentic AI orchestration platform to redesign clinical and administrative workflows.
The collaboration targets utilization management, care management, and appeals and grievances. The goal is to move beyond basic technology modernization by embedding governed AI into core healthcare processes and tying transformation programs to measurable operational and clinical outcomes.
Healthcare organizations are dealing with rising medical expenses, administrative complexity, staffing constraints, and fragmented data across multiple systems. For professionals in this environment, understanding how to apply AI for Healthcare to these specific pain points is becoming essential. PwC and Zyter plan to help clients assess their current operating environments, establish outcome-based transformation roadmaps, and deploy AI-enabled workflows across clinical and administrative functions.
The companies will support these programs with modular architecture, API-based integrations, healthcare interoperability, governance, auditability, and operational controls. By applying AI for Operations principles, the initiative aims to reduce the cost of individual transactions across utilization management, care management, and related administrative operations.
Redesigning clinical workflows
Zyter's platform automates high-volume work, coordinates tasks across healthcare systems and care teams, and enforces clinical and policy guidance within operational workflows. PwC will provide transformation strategy, implementation, change management, and program execution services.
Potential applications include:
- Automating repetitive administrative processes.
- Improving care coordination and strengthening member engagement.
- Making it easier for healthcare providers to manage payer requirements.
Platform scale and credentials
Zyter's platform currently supports more than 44 million covered lives across over 45 health plans. The company provides care management, utilization review, and clinical operations technology that is NCQA pre-certified, HITRUST certified, and compliant with SOC 2 requirements.
Why this matters for healthcare professionals
"Healthcare organizations are under intense pressure to improve outcomes while reducing total cost of care, and that requires more than technology implementation," said Thom Bales, National Health Services Advisory Leader at PwC US. "Working with Zyter|TruCare, we can help health organizations redesign operating models, embed governed AI into clinical and administrative workflows, and turn transformation programs into measurable performance improvement."
Sundar Subramanian, CEO of Zyter, said the real opportunity is to transform how healthcare work gets done. "By combining PwC's transformation capabilities with Zyter|TruCare's AI execution platform, we can help payers and providers coordinate work across systems, enforce clinical and policy guidance, and deliver more affordable, equitable and outcome-driven care."
The collaboration is focused on shifting healthcare organizations from fragmented processes toward coordinated, outcome-driven care delivery. For healthcare professionals, this signals a concrete push to reduce avoidable medical expenses and ease the administrative burden of managing payer requirements.
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