April 21, 2025

Advancing Health Equity: How Payers Can Bridge Gaps in Care with AI & Digital Innovation

By: Amber Hull, Marketing Manager

The Growing Need for an Equity-First Approach

Health disparities continue to challenge the U.S. healthcare system, preventing many individuals from accessing quality care and achieving optimal health outcomes. As the burden of inequities grows, the role of healthcare payers—government, commercial, and private—becomes even more critical. With their end-to-end visibility into members’ health journeys, payers are uniquely positioned to address barriers, improve engagement, and drive meaningful change.

The urgency to implement equitable healthcare strategies has never been greater. Health disparities, deeply rooted in socioeconomic conditions, result in lower healthcare utilization, higher readmission rates, and increased financial strain on the system. If left unaddressed, the financial toll of these inequities could exceed $1 trillion annually by 2040. Recognizing this challenge, federal and state governments, along with the Centers for Medicare and Medicaid Services (CMS), are ramping up funding and introducing new health equity measures. In response, in 2024, 80% of healthcare C-suite executives now rank health equity as a top priority, with nearly 50% planning to increase their investments in this area.

Challenges in Achieving Health Equity

Despite this momentum, payers continue to face significant challenges in addressing health equity. One of the primary obstacles is data availability and credibility. Collecting accurate and comprehensive member data remains difficult, limiting the ability to gain insights into social determinants of health (SDOH) and design targeted interventions. Additionally, many payers struggle to engage members effectively, as traditional, one-way communication methods fail to reach the populations that need support the most. Furthermore, technology and access barriers persist, preventing underserved individuals from fully participating in their healthcare plans.

The Power of AI and Digital Innovation

To overcome these challenges, payers must adopt comprehensive, tech-enabled solutions that integrate SDOH insights, foster two-way engagement, and personalize outreach. Investing in AI-driven platforms and omnichannel communication strategies can help bridge these gaps. Solutions like TeleVox Payer Edition enable payers to enhance communication by leveraging multiple touchpoints, including Smart Agent, live chat, IVR, email, and multilingual options. This approach ensures that all members, regardless of language or digital literacy, can easily access the care and information they need.

Providing 24/7 support through bi-directional, AI-powered conversations allows members to inquire about their benefits, find providers, and address medical concerns in real time. Expanding access to educational content on preventive care, chronic conditions, and health plan benefits can improve health literacy and empower individuals to make informed decisions. Additionally, addressing logistical barriers such as transportation assistance ensures that members can attend medical appointments, reducing missed visits and improving continuity of care. A strong focus on data collection, particularly around race, ethnicity, and language preferences, can further refine payer strategies and lead to more effective, personalized interventions.

Creating a Sustainable Path Forward

By integrating these capabilities, payers can create stronger relationships with members, reduce care gaps, lower overall healthcare costs, and help individuals take control of their health. Advancing health equity requires a commitment to innovation, collaboration, and sustained engagement. With the right technology and strategic investments, payers can transform healthcare access and outcomes for all populations.