Agentic and Generative AI Efforts Fall Short Without Unified Data Foundation, Report Finds
About 85% of health plans have yet to centralize data across their systems, missing key opportunities to leverage artificial intelligence effectively. A recent report from healthcare data platform Arcadia highlights a growing gap between payers’ existing data capabilities and the tools and infrastructure they still need. Without a unified data foundation—built around complete member profiles—initiatives involving agentic or generative AI risk underperforming, falling short of the cost savings and improved member experiences these technologies promise.
The report also outlines how leading health plans are advancing with data-driven strategies that enhance outcomes, control costs, and improve provider performance.
Current Data Challenges and Their Impact
While 66% of payers rate their ability to share data externally as “very good” or “excellent,” only 57% feel confident about integrating data from external sources. Most notably, 85% have yet to consolidate all available data into a centralized analytics platform. This fragmentation limits their capacity to generate comprehensive and actionable insights.
Less than 20% of health plans currently use AI to develop care plans, summarize records, or boost member engagement—tools that could significantly improve operational efficiency and accelerate performance gains.
Cost-containment remains the top priority, with 54% focusing on improving risk adjustment and 50% optimizing network performance, while only 45% emphasize revenue growth strategies like expanding membership.
Although 96% of payers maintain longitudinal member profiles, many struggle with data aggregation and interoperability. The report reveals that:
- 76% of payers aren’t fully leveraging social determinants of health (SDoH) data.
- 87% do not use episodes of care data.
- Only 10% actively apply pharmacy data in their analytics.
Michael Meucci, president and CEO of Arcadia, points out, “Too often, payers believe they have a complete picture of the member, but significant gaps remain in the data they actually use. This means missed chances for better risk adjustment, personalized care, and cost savings.”
He emphasizes that a true 360-degree member profile must integrate timely, complete information across claims, clinical encounters, SDoH, episodes of care, and pharmacy data. When payers unify and strategically apply this data, they can improve outcomes, reduce costs, and collaborate more effectively with providers.
The Path Forward: Unified Data Platforms Drive Better Results
Bridging the divide between fragmented data and actionable insights requires more than superficial integration. The report finds that leading health plans prioritize platforms that unify clinical, claims, behavioral, and social data. This approach enables real-time intelligence sharing across care teams and turns data from a static resource into a strategic asset.
Dr. Luke Hansen, chief medical officer of Arcadia, summarizes the findings: “The payer organizations that invest in centralized analytics platforms, empower providers with shared insights, and apply data to personalize care will lead the pack. Working from a common data foundation makes it possible to manage risk, optimize utilization, and enhance physician performance effectively.”
For finance and healthcare professionals, the message is clear: without a unified data foundation, AI initiatives risk falling short. Prioritizing data integration and strategic analytics platforms is essential to unlocking AI’s potential to improve care quality and control costs.
To learn more about AI tools and training that can support improved data strategies and healthcare finance initiatives, visit Complete AI Training.
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