New industry research surfaces trends and perceptions of healthcare finance

Zelis, a leading provider of healthcare technology solutions, today released a comprehensive industry study, The State of the Healthcare Financial Experience, revealing what factors employers and consumers believe will improve care outcomes and experiences.

The study, commissioned by Zelis and conducted by Datos Insights, reveals several notable trends that can help shape healthcare payers’ strategies and offerings. Employers want partners who can help them achieve multiple strategic objectives—controlling costs, expanding choice, and improving the overall benefits experience. Members are seeking digital tools that can help them navigate their care needs while providing greater transparency into costs.

“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,” says Amanda Eisel, Chief Executive Officer at Zelis. “At the same time, there’s recognition that progress is possible. 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 research reveals several key themes:

Digital Tools, Price Transparency and Digital Payments are the Future of Care

Digital transformation is reshaping how organizations manage benefits. Employers investing in digital tools report gains in employee satisfaction, cost control, and decision-making.

Price transparency tools are the most widely adopted digital solution, offered by 59% of employers. While these tools lead in deployment, adoption remains modest—suggesting that many employers are still looking for solutions that are easier to use, more insightful, and better integrated into the benefits experience.

Employers are increasingly feeling pressure from their employees to offer these types of tools. The research finds that 70% of members are willing to pay an incremental $10/month for access to price transparency, online scheduling and low-cost medication search tools. Forty percent of consumers believe price transparency is a top improvement area when dealing with providers and insurance.

Additionally, the study finds that members are increasingly seeking simplification and digital payments as part of their benefits offerings. Members report that the top three most valuable medical payment capabilities are consolidated billing, mobile payment options, and easier HSA/FSA integration.

Care and Benefits Experience Drive More Investment

Cost is no longer an employer’s sole decision-making factor when selecting health plan partners. The research finds that employee satisfaction and retention are equally important as financial metrics. Organizations increasingly recognize that benefits are a powerful lever for attracting and keeping top talent, especially in today’s competitive employment market.

Technology is playing a key role here, too. Faster claims processing, transparent communication, and digital tools are now essential for delivering the experience employees expect and deserve. Employers are leveraging digital capabilities to create benefits programs that control expenses, drive engagement and loyalty.

Over a third of employers report being likely or very likely to switch their primary insurance carrier in the next year, with mid-sized employers showing the highest propensity to make a change. This marks a clear shift from relationship-based selection to performance-based decision-making, where measurable results and value outrank legacy connections. The data shows that 51% of employers are considering changing carriers or vendors.

Growing Interest in the Use of AI

AI is no longer viewed as experimental, but a future value driver. Employers are particularly bullish: As of the survey’s completion, 80% believe AI will improve healthcare benefits administration in the next two years, with 39% expecting significant improvements. The top perceived benefits of AI are faster claims processing (47%), improved accuracy in benefits administration (45%) and better predictive analytics for cost management (45%).​ The majority of employers (67%) are either actively using or piloting AI in benefits administration, with larger employers further along in implementation.

Consumer sentiment shows they’re ready for AI-enabled processes and services. Seventy percent are comfortable with AI processing claims, 81% are comfortable with AI supporting appointment scheduling and 63% use AI-enabled tools in daily life. That level of familiarity opens the door for member-facing AI solutions that are intuitive and trustworthy.

Despite the interest in AI, there is equal focus on preserving the human connection that defines healthcare. Members want to know that AI won’t replace empathy, and when something goes wrong, they can still interact with a human who can help them navigate their care situation.

Optimism for the Future

While the healthcare industry faces challenges, there is growing belief that transformation is within reach—with trust, technology and transparency as the levers for change.

Employers are optimistic—71% expect quality improvements and 85% believe transformation is achievable. Nearly half of consumers say access to care is improving, with 48% expecting better care quality. What’s more, 61% of consumers believe healthcare quality and their insurance benefits have improved over the last three years.

The State of Healthcare Financial Experience Series

Over the coming months, Zelis will release a series of in-depth reports informed by proprietary research exploring key themes from the study. Topics will include cost and transparency, AI, employer and consumer perspectives, and future trends.

To access the executive summary and subscribe for future reports, visit https://www.zelis.com/healthcare-financial-experience.

Survey Methodology

Analysis is based on proprietary research conducted by Datos Insights in April 2025 across three key stakeholder groups in the U.S. healthcare market: payers, employers, and consumers and reflects attitudes and sentiment at that time. The multi-source approach provides a comprehensive view of the trends shaping cost management, transparency, and digital transformation in healthcare.

About Zelis

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

Learn more at Zelis.com and follow us on LinkedIn to get the latest news.

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