Health plans stand at a pivotal juncture. While SaaS has successfully addressed specific operational requirements and delivered rule-based static automation, the future seems more dynamic, integrated and intelligent. Gartner's report on the Top 10 Strategic Technology Trends for 2025 highlights the emergence of Agentic AI—autonomous AI agents embedded within platforms (Agentic PaaS)—as a transformative force. By 2028, 33% of enterprise software will incorporate these agentic capabilities, a significant leap from less than 1% today. Adopting such intelligent and autonomous platforms is no longer a luxury but a necessity for health plans struggling with escalating care costs, demanding consumers and relentless regulatory changes. These platforms will serve as catalysts, enabling the development of new capabilities at scale and enhancing operational efficiency.
SaaS to Agentic PaaS: The journey of possibilities
Although it may look like the rise of agentic PaaS is also the fall of SaaS, that is far from the truth. SaaS is evolving rather than becoming obsolete. The backbone of many health plan operations is SaaS applications, which are enveloped in the larger agentic ecosystem. These ecosystems integrate disparate SaaS applications and fuse them with multiple AI agents as peers, enabling them to function more intelligently and streamline complex healthcare processes (claims adjudication, prior authorization, benefit configuration and care management) with human-like understanding and machine-like precision.
Agentic PaaS tends to complement current health plan systems with proactive workflow handling by independent or multiple collaborative agents. These AI agents autonomously assess context, initiate tasks, navigate situations, proactively learn, and deliver their objectives with little or no manual intervention. Consider the transformation in claims processing, which traditionally involves multi-system interactions and large manual handoffs between various functions for edits, checks, validation, data extraction, routing, etc. Multiple AI agents can now coordinate inputs and execute specific tasks across various SaaS tools, such as policy verification, member validation, service eligibility checks and provider network validation. They also handle fee schedule lookups, medical necessity checks, COB validation, pricing, payment posting, duplicate claims, payment integrity checks and EOB generation. This orchestration transforms complex, fragmented workflows into a unified and efficient ecosystem. Such autonomous action will bring more speed, scale and accuracy. Moreover, this autonomous action equips health plans with a digital workforce, freeing their subject matter experts (SMEs) to focus on more creative and strategic work that only human talent can accomplish.
Path to adoption
The transition to Agentic PaaS is not disruptive but evolutionary. This thoughtful execution will bridge both technological and operational chasms. Although still in its initial stages, the Agentic PaaS model is poised to catch up soon. Adoption will be an incremental process rather than an overnight event. Small, targeted deployments will accumulate to create transformative value. Health plans should start by identifying and prioritizing the most suitable use cases (processes or functions that are high volume, manually intensive and of high business impact, such as appeals and grievances, prior authorization reviews, compliance monitoring and claims management). They should prepare for change management and training to ensure a successful transition with fewer talent-to-task fitting conflicts. Additionally, they must adopt the proper governance and controls to uphold responsible AI guardrails, safeguarding the organization’s reputation while strengthening the foundational data ecosystem to confidently undertake this new technology journey.
Conclusion:
The SaaS to Agentic PaaS transition is not a replacement story but one of advancement. This evolution is structured and strategic, positioning health plans at the forefront of intelligence, agility and resilience. Those who embrace this change first will lead the charge into a new era. Now is the time for deliberate actions: strategic investments, organizational preparations and focusing on long-term impact. The future is not about choosing between SaaS or Agentic PaaS but integrating the two into a cohesive, intelligent whole. Today's investments in this transition will shape how effectively health plans navigate their future.
References:
How Intelligent Agents in AI Can Work Alone | Gartner
Gartner: How Agentic AI is Shaping Business Decision-Making | Technology Magazine
A guide to healthcare payer digital transformation | McKinsey
Explore Gartner's Top 10 Strategic Technology Trends for 2025
