PwC & Zyter team up on healthcare workflow overhaul

PwC and Zyter have agreed to collaborate on programmes for healthcare payers and providers aimed at improving outcomes while reducing the total cost of care.

The partnership combines PwC's healthcare transformation, analytics, operations and programme execution capabilities with Zyter's AI-based workflow software and clinical services. It is designed to support utilisation management, care management, appeals and grievances, and related clinical and administrative work.

Healthcare organisations in the US are facing mounting pressure from rising medical costs, staff shortages, administrative burdens and fragmented data systems. In response, consulting firms and software providers have been promoting tools that promise tighter coordination between clinical teams, health plans and back-office functions.

Under the collaboration, PwC will provide transformation, implementation, change management and programme execution services. Zyter will contribute its platform, orchestration tools and clinical teams, targeting clients that want to redesign operational processes rather than simply replace legacy systems.

The work will begin with assessments of existing operations, followed by outcome-based transformation plans and the introduction of AI-enabled workflows. Those workflows are intended to run across existing systems through modular architecture, application programming interfaces and interoperability features, while incorporating governance, audit trails and controls.

Operational focus

The collaboration centres on healthcare administrative functions that involve high volumes of repeat tasks and strict clinical or policy rules. In utilisation management and care management, insurers and providers often have to move information across multiple systems, review cases against policy requirements and coordinate decisions across teams, making the work slow and labour-intensive.

Zyter said its software is already used by more than 45 health plans and supports more than 44 million covered lives. The company has been expanding in care management, utilisation review and clinical operations, where health plans and providers are under pressure to deliver measurable improvements in both cost and patient outcomes.

For PwC, the alliance extends its healthcare consulting work into a more structured technology partnership at a time when advisory firms are increasingly pairing implementation teams with specialist software vendors. It also reflects broader demand from healthcare clients for projects tied more closely to financial and operational results.

Thom Bales, National Health Services Advisory Leader at PwC US, outlined the rationale for the move.

"Healthcare organizations are under intense pressure to improve outcomes while reducing total cost of care, and that requires more than technology implementation," said Thom Bales, National Health Services Advisory Leader at PwC US.

"Working with Zyter|TruCare, we can help health organizations redesign operating models, embed governed AI into clinical and administrative workflows, and turn transformation programs into measurable performance improvement," Bales said.

Workflow changes

The companies are focused on changing how work is carried out across departments and systems, not just digitising existing processes. That includes directing tasks between staff, applying policy and clinical guidance consistently, and tracking decisions for compliance and review.

In practice, that could include automating parts of case intake, routing files to the right teams, coordinating information between care managers and clinicians, and reducing the manual effort involved in administrative transactions. The approach is also intended to improve provider experience and member engagement while lowering the cost per transaction in targeted workflows.

That emphasis on governance may matter to buyers in a heavily regulated sector, where AI systems are being scrutinised not just for speed and cost reduction but also for oversight and accountability. Health plans and providers have been cautious about adopting automation in areas that affect care decisions, reimbursement and patient communication.

Sundar Subramanian, Chief Executive Officer at Zyter, said the opportunity lies in changing operating models rather than simply deploying new software.

"The real opportunity is not just to implement new technology; it is to transform how healthcare work gets done," said Sundar Subramanian, Chief Executive Officer at Zyter.

"By combining PwC's transformation capabilities with Zyter|TruCare's AI execution platform, we can help payers and providers coordinate work across systems, enforce clinical and policy guidance, and deliver more affordable, equitable, and outcome-driven care," Subramanian said.

The collaboration comes as healthcare organisations continue to look for ways to contain costs without adding strain to clinical and administrative staff, with utilisation management, care management and appeals among the functions most exposed to inefficiency and duplication.