Executive Report · CFOs & Payer Underwriters

Your AI-in-UM vendor might be wrong about how it gets paid for — here's the $56.6M proof

8 payment pathways. Fully sourced against CMS, Federal Register, and CMMI text. No vendor spin.

The problem

You're probably funding AI-driven utilization management through a pathway that's weaker than your vendor told you. Two examples: NTAP looks solid in most vendor decks — but CMS has already proposed narrowing its alternative pathway starting FY2028. And the pathway vendors rarely lead with, MA/commercial value-based contracts, actually carries the highest exposure of all eight — severe risk, 4.7 composite, driven by AI-in-UM laws already active in California, Texas, and Alabama.

What's inside

• All 8 pathways, ranked by AI/UM viability and risk
• The NTAP correction most vendors still get wrong
• 3 quantified exposure scenarios — largest: $7.2M
• Full primary-source citations, zero press-release framing

Revenue-at-risk figures are modeled against a 300-bed community hospital baseline. Your organization's actual exposure will scale with bed count, payer mix, and case volume.

Who this is for

CFOs, VPs of Finance, and payer underwriters deciding what to trust before the next AI-in-UM budget cycle.

The report