AI fills almost every Medicare Advantage conversation right now. Risk adjustment teams test it on documentation gaps. Stars teams point it at member outreach. Utilization management runs it through prior authorization. Vendors arrive with promises of speed, accuracy, and savings.
Here is what we keep coming back to. We are not sure anyone has a clear, MA-specific read on how the sector is putting AI to work.
The data we have is not quite the data we need
There is no shortage of AI surveys in healthcare. They tell us what hospitals, health systems, and broad payer groups are doing. They rarely zoom in on Medicare Advantage, and they seldom speak to the work your teams own every day: risk adjustment, Stars, compliance, utilization management, member experience.
So many decisions end up resting on borrowed numbers. A statistic drawn from hospital IT departments tells you little about RADV exposure or a Stars cut point. A general payer figure blurs the difference between a plan testing one pilot and a plan with AI woven into core operations. Without a picture built for Medicare Advantage, the questions your board keeps asking stay open. Are we ahead or behind our peers? Where are other plans seeing real return? Which use cases deliver, and which quietly stall?
If those answers feel out of reach, you are in good company. Most of the industry is working from the same incomplete map.
Why keeping pace still matters
The stakes keep climbing. Regulators tightened prior authorization timelines and drew clearer lines around AI in coverage decisions. CMS is piloting AI-driven prior authorization in traditional Medicare. Members, providers, and auditors all watch how plans use these tools. Lean too cautious and you risk falling behind on efficiency and member experience. Lean too hard without evidence and you open the door to denials, appeals, and compliance questions.
Waiting carries its own quiet risk. The plans finding their footing are not the loudest about AI. They are the ones who know where they stand, watch outcomes rather than activity, and adjust with confidence. Getting there takes a clear view of the field, and a shared view does not seem to exist for Medicare Advantage yet.
Benchmarking turns guesswork into footing
A good benchmark shifts the whole conversation. Instead of wondering whether AI is worth pursuing, you see where you sit among plans like yours and where the real value lands. Instead of weighing vendor claims on instinct, you compare your maturity to the market. Instead of defending a strategy on a hunch, you ground it in peer experience. RISE is here to build a benchmark together with you.
Help shape the first MA AI benchmark
RISE created the first-ever Medicare Advantage AI benchmarking survey to trade borrowed numbers for answers built for your world. The survey captures how plans and provider organizations use AI, where they see results, and where ambition runs ahead of execution. Your responses shape the picture, and the more leaders who join in, the clearer it grows for everyone.
The survey takes only a few minutes & you will receive a $5 Starbucks gift card immediately following completion as a thank you for participating.
The findings debut at RISE West in the exclusive general session, Winning with AI in Medicare Advantage: Benchmarking Results and Leader Insights. RaeAnn Grossman, CEO of HLTHWorks, moderates. Jonathan Burow, VP of Customer Experience and Digital Transformation at Independent Health, joins a panel of industry leaders reacting to the data. Together they explore how AI works in practice, where value shows up, where challenges persist, and what helps an organization move from experimentation to real impact.
If you have wondered how your AI strategy compares to the rest of Medicare Advantage, this is the room where those answers come together. Add your data to the benchmark, then join us at RISE West to see where you stand.