Designing the future of payment integrity: Takeaways from HPRI 2026

This year’s HPRI conference made one thing abundantly clear: payment integrity (PI) is no longer just a cost containment function but a proactive strategy for driving affordability, managing risk, and strengthening enterprise performance. 

Below are the key takeaways shaping the next chapter of PI.

1. Affordability demands action

As healthcare costs continue to climb, pressure is mounting across employers, health plans, and members to deliver greater affordability and financial sustainability. That reality is elevating payment integrity from a compliance safeguard to a core strategic lever.

At the same time, while health plans have more access than ever to price transparency and claims data, many still struggle to translate that data into meaningful action. Interpreting and maintaining complex policies, accurately codifying them, and generating reports that surface true policy violations remain difficult.

The industry is recognizing that intelligence, not information, is the differentiator. When PI is integrated with operational and clinical expertise, it becomes more than an audit function; it becomes a diagnostic tool for organizational health.

2. Standardization and benchmarks are becoming essential

As organizations look to scale PI programs, there is a growing recognition that standardization matters. From definitions to performance metrics, the industry is seeking a common language and comparative benchmarks to measure success and maturity. Metrics such as PMPM performance now vary by program stage, with new programs often showing higher accrual and mature programs demonstrating realized savings.

This push for standardization is about more than reporting. Today, health plans and vendors often use different language to describe similar concepts, measure performance in different ways, and define success according to internal frameworks. The result is inconsistency and confusion. Without shared definitions and aligned metrics, it becomes incredibly difficult to answer a fundamental question: How effective is a payment integrity program?

As the industry evolves, establishing a more consistent measurement framework will be critical—not only for benchmarking but also for strategic decision-making.

3. From AI hype to human in the loop

The adoption of AI in PI continues to accelerate, particularly for complex, high-variability cases such as sepsis or other resource-intensive DRGs. Organizations are moving from manual review processes to AI-augmented workflows, where intelligent agents do the heavy lifting while coding auditors remain in control. The focus is no longer on novelty; it is on trust, consistency, and defensible outcomes.

Successful AI implementation requires a deep understanding of clinical nuance, an iterative, consultative rollout, and alignment with compliance and governance standards. Cohere Health’s clinician-led AI model reflects this shift. Our solutions are designed not merely to replicate workflows, but to enhance them—supporting earlier intervention, greater consistency, and improved accuracy across both PI and utilization management.

4. Partnership over point solutions

Complex organizations cannot solve affordability challenges on their own, and even experienced internal SMEs often face capability gaps. Health plans are seeking AI and PI partners who can deliver measurable savings while enabling long-term transformation. That includes collaboration, training, continuous improvement, and alignment across pre-pay, post-pay, authorization, UM, and population health functions.

For executive leaders, the conversation comes down to measurable savings, reduced risk, and service-level guarantees. Cohere Health is well-positioned to meet these expectations.  Our consultative approach, grounded in clinical expertise and cross-organizational data, positions us not as a vendor delivering isolated findings but as a strategic partner driving sustained operational and financial outcomes.

The future of payment integrity

HPRI 2026 made it clear that the future of PI lies at the intersection of intelligence, standardization, AI, and partnership. Cohere Health sits squarely at this intersection. By connecting clinical intelligence with utilization management and payment integrity data, and by embedding AI with governance and accountability into workflows, we help health plans identify and address problems. 

The next chapter of PI is proactive, integrated, and intelligence-driven. The organizations that embrace this shift will be the ones that meaningfully advance affordability, quality, and long-term performance across healthcare.