By Mohar Mishra, CTO, Inovaare
The healthcare payers landscape has become increasingly complex, with regulatory requirements, operational inefficiencies, and data fragmentation presenting formidable challenges. Conventional compliance and operational models are no longer sufficient to meet the changing needs of CMS, Medicaid, and commercial plans.
At Inovaare, we have taken the lead in this evolution, shifting from payer-specific Software as a Service (SaaS) solutions to a scalable, microservices-based Platform as a Service (PaaS) that unifies compliance, operations, and data intelligence. However, our journey does not end here.
The next logical step is Agentic PaaS – popularly known as Agents as a Service (AaaS) – that will utilize autonomous AI-powered agents to transform the way healthcare payers deal with compliance, data, and decision-making processes.
This blog outlines the journey that has brought us to this critical juncture, the technical underpinnings of this evolution, and the potential implications for Inovaare’s AI-first health cloud platform.
The SaaS Era: Solving Specific Healthcare Payer Challenges
SaaS-based point solutions have formed the backbone of healthcare compliance, allowing health plans to efficiently handle audits, appeals and grievances, provider disputes, and regulatory oversight. Inovaare’s SaaS solutions were carefully crafted to streamline these workflows, thus ensuring compliance with CMS and state-level regulations while optimizing operational efficiency.
However, as regulatory landscapes became increasingly complex and data silos persisted, health plans needed more than just standalone SaaS applications. They needed scalability, configurability, and deeper integrations with their legacy systems. This realization led us to shift from a SaaS-only model to a microservices-driven, scalable PaaS architecture.
The Evolution of Inovaare’s PaaS: A Unified Industry Cloud for Healthcare
With our scalable, HITRUST-certified health cloud platform, we moved from fragmented applications to a fully integrated compliance and operations hub. This shift allowed health plans to:
- Leverage modular solutions – Compliance, delegation oversight, risk management, and data scrubbing were no longer isolated applications but interlinked services.
- Enable interoperability – Seamless API integrations with core admin systems, claims platforms, and external compliance bodies.
- Unlock real-time insights – AI-powered analytics and monitoring dashboards transformed data from passive records into proactive compliance intelligence.
- Adopt low-code/no-code configurability – Allowing health plans to customize workflows without deep technical expertise.
This evolution redefined how healthcare payers approached compliance and operations, but we soon recognized another bottleneck: decision-making speed and intelligence. And, that was our Aha moment!
Agentic PaaS (AaaS): The Future of Intelligent Healthcare Operations
Agentic PaaS is the logical next step in this journey. At its core, it enables AI-driven autonomous agents to operate within our PaaS environment, not just assisting but acting—transforming compliance, audit, and operations from reactive processes into self-governing ecosystems.
What Makes AaaS Different?
- Autonomous Decision-Making: Agentic systems are not like traditional AI-supported workflows. They work autonomously within established compliance and operating parameters. An agent doesn’t simply alert an issue—it fixes it by running workflows, communicating with stakeholders, and following regulations.
- Cross-System Intelligence: AI agents will function across applications. They will handle tasks between compliance, claims, provider management, and customer experience systems—eliminating data silos.
- Self-Learning Compliance: With federated learning models, AI agents will update compliance frameworks in real-time based on real-time regulatory updates, so automated compliance is maintained with the most current CMS, Medicaid, and state regulations.
- Conversational AI as Operational Assistants: With Usher powering our AI-based compliance and operations copilot, agents will engage with users contextually—responding to questions, summarizing audit results, or initiating corrective action without human involvement.
- Event-Driven Automation: In an AaaS environment, agents are event-driven, not user-driven. That means real-time compliance violations, operational inefficiencies, or data inconsistencies will automatically be corrected before they become serious issues.
The Technical Architecture of Inovaare’s AaaS Model
Building an Agentic PaaS that can operate autonomously and intelligently within healthcare payer ecosystems requires an intricate interplay of technologies. Traditional platforms rely on static rules and predefined workflows, limiting their ability to adapt to the fast-evolving regulatory landscape. In contrast, Inovaare’s AaaS model is architected specifically to be dynamic, event-driven, and self-learning.
At its core, our platform harnesses AI, automation, and microservices to create an interconnected ecosystem where compliance, operations, and decision-making occur in real-time. The architecture supports AI agents being able to learn and adapt to process enormous volumes of structured and unstructured data, initiate automated responses, and learn continuously from regulatory changes and operational patterns.
This is achieved through a multi-layered AI-driven architecture that brings together modularity, interoperability, and scalability.
At a high level, Agentic PaaS is built on a multi-layered AI-driven architecture:
- Microservices Backbone: Ensuring modularity, interoperability, and horizontal scalability.
- LLM-Infused AI Models: Powering decision-making agents that process structured and unstructured data.
- Federated Compliance Learning: Securely training AI models on regulatory changes while maintaining data privacy.
- Event-Driven API Mesh: Enabling real-time, AI-triggered automation across compliance, claims, and provider management systems.
- Hybrid AI Agents: Combining rule-based governance with adaptive ML for dynamic, risk-aware decision-making.
What This Means for Healthcare Payers
The shift to AaaS is not optional—it’s inevitable. The regulatory environment is becoming more stringent, operational complexities are rising, and payers cannot afford inefficiencies.
For compliance, IT, and operational leaders, AaaS is not just an efficiency play—it’s a fundamental shift in how healthcare technology operates. Here’s why this matters:
- Healthcare payers can finally move from managing compliance to enforcing it autonomously.
- IT teams can reduce operational overhead by integrating intelligent, event-driven agents instead of manual interventions.
- Operational leaders can gain real-time insights, with AI-driven actions improving CMS audit readiness and reducing penalties.
Those who adopt early will not just keep up; they will define the future standards of compliance and operations. Healthcare payers that integrate autonomous agents now will establish benchmarks for compliance automation, cost reduction, and operational agility. Organizations must begin integrating AaaS capabilities into their ecosystem before regulatory and market pressures force abrupt changes.
By transitioning to Agentic PaaS, healthcare payers will transform compliance into a proactive, AI-managed function, reduce operational risk, and achieve a level of efficiency that legacy systems simply cannot match.
The Road Ahead
At Inovaare, our vision is towards the development of intelligent automation, with compliance-first AI leading us to a future where healthcare organizations can be proactively compliant, autonomously decided, and governed by AI. We are already implementing early-stage Automation as a Service (AaaS) frameworks in our audit management and regulatory compliance solutions, and the next two to three years will see the mass adoption of agentic intelligence on our platform.
Future healthcare technology is defined by agentic capabilities—and at Inovaare, we are building the foundation to make this vision a reality. Healthcare payers are facing unprecedented complexity, and the conventional ways of managing compliance and operations are no longer sufficient. The future frontier is Agentic AI Platform as a Service (AaaS), where AI-driven agents will not just augment workflows but will run them autonomously. Welcome to the era of Agentic PaaS.
About the Author:
Mohar Mishra is the Chief Technology Officer at Inovaare, driving the company’s innovation in AI, compliance automation, and next-gen healthcare technology. With expertise in scalable platforms, microservices, and agentic AI, he is at the forefront of transforming healthcare payers’ operational landscapes.