BOSTON, Mass. — Zelis, a leading provider of healthcare technology solutions, has released a new industry study, The State of the Healthcare Financial Experience, showing that both employers and consumers believe artificial intelligence, price transparency, and digital tools will play a critical role in improving healthcare outcomes and experiences. The research, conducted by Datos Insights on behalf of Zelis, highlights how expectations around healthcare benefits and payer performance are rapidly evolving.
According to the study, employers want partners who can help them balance multiple priorities such as controlling costs, expanding choice, and enhancing the overall benefits experience. At the same time, consumers are seeking user-friendly digital tools that offer clearer insight into care costs and simplify the healthcare process.
“The study underscores that healthcare is at an inflection point and there are opportunities for payers to create meaningful impact and foster deeper levels of trust with employer groups and the members that depend on them,” said Amanda Eisel, Chief Executive Officer at Zelis. “At Zelis, we’re building solutions that connect the dots—streamlining payments, clarifying pricing, and reducing administrative burden—so healthcare can finally work the way it should.”
The findings show that digital transformation is already reshaping how organizations manage benefits. Fifty-nine percent of employers offer price transparency tools, but usage remains moderate, suggesting a need for simpler, more integrated solutions. Seventy percent of members said they would pay an additional $10 per month for access to transparency, scheduling, and low-cost medication search tools. The top digital payment features valued by members include consolidated billing, mobile payment options, and improved HSA/FSA integration.
Employers are also shifting their focus from cost alone to overall employee experience. Many now see benefits as a vital tool for attracting and retaining talent, with more than one-third saying they are likely to switch carriers in the next year and 51 percent considering a change. This marks a shift toward performance-based relationships where measurable results outweigh legacy connections.
The study also highlights a growing belief in the potential of artificial intelligence to transform healthcare. Eighty percent of employers believe AI will improve benefits administration within two years, with 39 percent expecting significant gains. The top anticipated advantages include faster claims processing, greater accuracy, and more predictive analytics for cost management. Two-thirds of employers are already using or piloting AI tools, particularly larger organizations. Consumers are also increasingly comfortable with AI, with 70 percent trusting it to process claims, 81 percent comfortable with AI appointment scheduling, and 63 percent already using AI-enabled tools in everyday life. Still, members emphasized that human empathy and support must remain central to care.
Despite ongoing challenges, optimism is rising across the industry. Seventy-one percent of employers expect care quality to improve, and 85 percent believe meaningful transformation is achievable. Nearly half of consumers report that access to care is getting better, while 61 percent believe healthcare quality and insurance benefits have improved in the past three years.
Zelis plans to publish a series of follow-up reports over the coming months exploring major themes from the study, including AI adoption, cost transparency, and the future of healthcare experience.
