With all of our focus on AI, we figured it was time to take a deeper look at AI's potential impact in healthcare payments. We are delighted to welcome our fellow traveler Rajil Vohra this issue to offer his thoughts on this topic. We hope you find his commentary helpful - we plan to include more perspectives from guest authors in future issues.
We'll be attending HIMSS in Las Vegas from March 9-12 - drop us a line here if you'd like to set up time to meet in person, or during Fintech Meetup from March 30-31. We do so much of our work remotely - we always look forward to spending time in person with clients, colleagues and friends!
If you haven't yet, we invite you to download our Demystifying Healthcare Payments white paper here. You can reach out here to schedule time if you'd like to take a deeper dive.
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FEATURE ARTICLE
Agentic AI in Healthcare Billing & Payments: Reducing Friction Where It Matters Most
By Rajil Vohra, Founder & CEO, Rasonance
Healthcare billing and payments remain one of the most complex and frustrating parts of the patient experience. For providers, payers, and patients alike, the process is slow, opaque, and burdened with manual coordination across disconnected systems.
Despite years of digitization, much of healthcare’s financial workflow still relies on people acting as intermediaries — checking eligibility, reconciling claims, responding to denials, following up on balances, and explaining outcomes to patients. The challenge is not a lack of intelligence in the system; it is a lack of coordination.
This is where Agentic AI presents a meaningful opportunity.
From Automation to Coordination
Traditional automation in healthcare billing has focused on task-level efficiency: generating claims, validating codes, or flagging exceptions. While helpful, these systems tend to operate in silos and require constant human oversight to move work from one step to the next.
Agentic AI shifts the focus from isolated tasks to end-to-end workflow coordination.
An agentic system does not simply analyze data or respond to prompts. It observes processes, understands context, applies rules and policies, and takes action across systems — escalating to humans only when judgment or intervention is required.
In healthcare billing and payments, this distinction matters.
Where Agentic AI Can Make a Difference
Billing and payment workflows span multiple stages and stakeholders: eligibility checks, prior authorizations, claim submissions, payer responses, patient billing, collections, and reconciliation. Each step introduces opportunities for delay, error, and confusion.
Agentic AI can help by monitoring the full lifecycle of a claim or patient balance rather than individual events; detecting exceptions early; reconciling payer responses against contractual and policy rules; coordinating follow-ups automatically instead of relying on manual queues; and presenting clear, explainable outcomes.
Importantly, these systems do not replace clinical or financial judgment. They absorb the repetitive coordination work that currently consumes time and creates friction.
Trust, Policy, and Accountability are Non-Negotiable
Healthcare is a regulated, trust-sensitive environment. Any agentic system operating in billing and payments must be designed with strong guardrails.
Agentic AI in this context must operate within clearly defined policies, permissions, and escalation paths. Every action needs to be traceable. Every decision needs to be explainable. Human-in-the-loop design is not optional; it is essential.
The goal is not autonomy for its own sake, but reliable execution within defined boundaries.
Start Small, Prove Value
One of the most common mistakes organizations make with AI initiatives is trying to transform everything at once. Agentic adoption in healthcare payments works best when it starts narrowly: one workflow, one bottleneck, one measurable outcome.
For example, reducing claim rework in a specific service line, accelerating denial resolution, or improving patient billing transparency. Success builds confidence, and confidence enables expansion.
Improving the Patient Experience
While much of the operational value accrues behind the scenes, the patient ultimately benefits. Faster resolution, clearer billing explanations, fewer surprises, and more responsive communication all contribute to trust and satisfaction — areas where healthcare payments have historically struggled.
Agentic AI does not eliminate complexity in healthcare billing, but it can manage that complexity more effectively.
By shifting the burden of coordination from people to systems, healthcare organizations can reduce friction, improve cash flow, and deliver a better experience for patients — without sacrificing control or compliance.
INDUSTRY TRENDS
McKinsey report has healthcare IT growing >10%
McKinsey's most recent look at near/ medium-term healthcare trends shows a number of segments under pressure over the next 3+ years. Overall healthcare EBITDA is expected to grow annually at 5% from 2024-2027. Healthcare software and platforms EBITDA, however, should grow more than 10% a year all the way through 2029.
According to McKinsey, "Healthcare services and technology (HST) is expected to continue as the fastest growing segment in healthcare. Software platforms have a growing role within the healthcare ecosystem, enabling providers and payers to become more efficient in an increasingly complex environment. Technological innovation (for example, gen AI and machine learning) is creating opportunities for stakeholders across segments by automating workflows, promoting data connectivity and interoperability, and generating actionable insights."
Read summary and full report "What to expect in US healthcare in 2026 and beyond" here
U.S. healthcare spending increased 7.2% in 2024
Health Affairs recently published its review of 2024 U.S. healthcare spending, based on CMS's National Health Expenditure data. Total healthcare spending was $5.3 trillion in 2024, or $15,474 per person. This represented 7.2% growth over 2023, and the second consecutive year that healthcare cost growth exceeded 7% (2023 grew 7.4% over 2022). The Health Affairs team attributes the growth in 2023 and 2024 to "increased demand for care and changes in the composition of the health care goods and services consumed" (e.g., average annual growth in personal health care spending of 8.9%, which is "the highest average growth rate for two consecutive years since 1991–92").
Luan Cox and her team stood out to us several years back when we were evaluating fintech players in the Point of Sale financing space. FinMkt impressed us as they innovated in a crowded field, focusing on waterfalls, lending ladders, and other decisioning frameworks. The FinMkt platform combines technical sophistication with a deep understanding of credit, risk, and user experience, making it applicable to patient financing. We're excited to welcome Luan in our latest CEO Chat.
Click here for Luan's thoughts on why FinMkt was founded, its right to win, and the company's key goals for the next 12 months.
AI IN HEALTHCARE
Anthropic is Winning by Trying to Lose. How treating AI like plutonium became the best enterprise strategy in tech. A great look at how Anthropic is on track to deliver $70 billion of revenue by 2028, while creating existential dread for CEO Dario Amodei. (Fintech Brainfood)
How Bank of America's Erica does the work of 11,000 people. Bank of America deployed Erica seven years ago, and today is used by 42 million consumers and 40,000 business customers who use a version built into the bank's CashPro digital banking platform. In total, Erica handles 20 million regular users and two million interactions a day. The bank is aiming to have 80% of its clients actively engaged with Erica. Healthcare would do well to learn from Bank of America's experience. (American Banker)
DEAL NEWS
Tenet reassumes full ownership of Conifer
Dallas-based hospital company Tenet (NYSE: THC) announced that it has reached agreement with CommonSpirit Health to take over full ownership of revenue cycle company Conifer Health Solutions. CommonSpirit will make payments totaling $1.9 billion to Tenet over the next three years to unwind its Conifer partnership, while Conifer will pay CommonSpirit $540 million in exchange for CommonSpirit's 23.8% equity stake in Conifer. Conifer has provided revenue cycle services to CommonSpirit since 2012. CommonSpirit will continue to work with Conifer through the end of 2026, as it prepares to insource its revenue cycle operations.
Sheridan Capital Partners in announced in January that it has finalized its investment in ICANotes, a Baltimore, MD-based behavioral health EMR. ICANotes as founded in 1999, and offers a cloud-based EMR platform for mental health professionals, including psychiatrists, therapists, counselors, social workers, and nurse practitioners. Terms were not disclosed.
Franklin, TN-based EnableComp, known for Complex Revenue Cycle Management services, has acquired Metuchen, NJ-based Health Resources Optimization (H/ROI). H/ROI offers clinical denials and revenue recovery services primarily to health systems in the Northeast U.S. EnableComp recovers $3 billion annually for over 1,000 hospitals by improving claims accuracy, identifying underpayments earlier, and resolving complex claims, denials, and revenue recovery issues more quickly.
Santander will merge with Webster Bank in $12.3B deal
Spain's Banco Santander (NYSE: SAN) announced in early February that it is buying Stamford, CT-based Webster Bank in a deal worth $12.3 billion. This deal will make Santander a top 10 U.S. retail and commercial bank by assets (approximately $327 billion post deal), and a top 5 deposit franchise in key Northeastern states. This deal is significant from a healthcare standpoint, as Webster's HSA Bank unit is currently the largest bank-based HSA administrator and custodian in the U.S., with over 3 million accounts and more than $10 billion in assets as of late 2025.
Mindbody, ClassPass parent merges with EGYM in $7.5B deal
San Luis Obispo, CA‑based Playlist, the parent of Mindbody, ClassPass and Booker, is merging with Munich, Germany-based EGYM. The deal, backed by Affinity Partners, Vista, Temasek, and L Catterton, is valued at $7.5 billion. The investors are putting up an additional $785 million in new funding, to help connect software and hardware, and support the combined company’s consumer booking and workplace well-being focus. When it comes to payments, Stripe will surely be paying attention, since Mindbody is one of Stripe’s largest global healthcare and wellness customers, generating payment volume from millions of monthly transactions across 40 countries..
Leader in healthcare agentic AI announces $55M Series B
New York-based Alaffia Health announced a $55 million Series B financing led by Transformation Capital, with participation from insiders including FirstMark Capital, Tau Ventures, and Twine Ventures. With this round, the company has raised a total of $73 million to date. Alaffia has an agentic AI solution for health plan claims operations. The company was founded in 2020 and calculates it has saved health plans more than $100 million in medical costs by pairing expert clinicians with AI that evaluates claims against the complete patient medical record.
Agentic Commerce is a $0 Billion Market. Autonomous agentic commerce isn’t solving a problem consumers want solved...the far more significant shift underway is how consumers discover and purchase products, with AI platforms becoming the new starting point for many commerce journeys. (FinTech Frontlines from Commerce Ventures)
2026 Priorities. A deep dive on ten predictions and priorities for banking and fintech in 2026. (Alex Johnson - Fintech Takes)
Takeaways From the J.P. Morgan Healthcare Conference. The 2026 J.P. Morgan Healthcare Conference opened with quiet confidence after a turbulent 2025, with attendees looking for proof that innovation tailwinds are translating into real execution. (Pitchbook)
We'd love to say hello! Click here to schedule time to meet with us at the upcoming HIMSS conference in Las Vegas.
Conference List. Rolling twelve month look ahead at conferences and other events covering healthcare payments, revenue cycle, fintech and related areas. Updated through November 2026.
FMP Blog. Thoughts from healthcare payments CEOs and investors on their right to win and goals for the year ahead, as well as data and perspectives on healthcare payments.
Newsletter Archive. News, trends, and insights from the healthcare payments industry compiled in our bi-weekly newsletter. Last six months of newsletters.
Epic MyChart. Excel sheet with full listing of all Epic MyChart instances as of May 2024, categorized by state, provider type and specialty.
All of these resources can also be accessed at the FinMed Partners Insights page.
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FinMed Partners is a management consulting and advisory business focusing at the intersection of payments/ fintech and healthcare. Our founders have developed deep expertise from decades of experience with health IT companies, healthcare providers and many players within the payments ecosystem. Investors, boards and executive teams work with us to maximize business value through strategic input and tactical execution.
FinMed Partners LLC, 34 Long Avenue, Belmont, MA 02478, United States
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