Author name: John Engerholm

The U.S. Medicare Advantage (MA) market is booming. With over 30 million enrollees in 2024 (more than 50% of all Medicare beneficiaries), the MA program continues to outpace traditional Medicare in growth. The Congressional Budget Office projects MA enrollment to surpass 60% by 2030, fueled by demographic trends, greater member flexibility, and increasing payer investment in value-based care models.

But here’s the challenge: more members mean more complexity—claims, regulatory compliance, provider interactions, member services, and care coordination all demand scalable, intelligent infrastructure.

Private equity is re-engaging with healthcare in a big way, with a dual focus on physician practice management (PPM) platforms and hospital systems. The common thread? A strategy centered on value-based care (VBC) transformation and the intelligent deployment of artificial intelligence (AI) to drive financial and clinical performance.

When we talk about AI in healthcare, it’s easy to think of large systems like Mayo Clinic or CVS Health. But here’s the reality: midsize healthcare providers and regional health plans are now leading the way in AI adoption — and doing so with agility, focus, and measurable ROI.

If you’re “waiting and watching,” you’re not just behind — you’re at risk of being outpaced by your peers.