Authors: Demi Radeva, Clem Foltz Pricing healthcare technology isn’t just about covering costs or chasing growth. Beneath the spreadsheets and projections, it’s really a question of credibility. For payers and managed care organizations (MCOs), every vendor pitch is scrutinized through the lens of medical loss ratios (MLR), total cost of care, and quality outcomes. If your pricing model doesn’t align with that world, you’ll struggle to gain traction, no matter how brilliant y

In the early days of any digital health launch, there’s a question that hovers in every investor meeting and payer conversation: How will this be paid for? Traditional reimbursement pathways often don’t exist for novel solutions—no billing code, no defined payment mechanism, no clear precedent. But that doesn’t mean there’s no path forward. Increasingly, startups are plugging into payer programmatic spend : discretionary budgets allocated to priority areas like maternal healt

In healthcare, choosing between “payer” and “payor” goes beyond your preference of vowel. At first glance, they seem completely interchangeable, but in today’s healthcare world,  word choice matters . The term you use can influence clarity, professionalism, and even how well your content aligns with industry standards. What Do “Payer” and “Payor” Mean in Healthcare? Both terms refer to entities that finance healthcare services . Think insurance companies, government programs

83M Americans. A $918B Opportunity. Are You Building for It? For startups, this is a costly opportunity to deliver scalable, high-impact innovation. But to succeed, your product must be purpose-built for the unique realities of Medicaid users.  Engagement is key for tech solutions to actually have an impact. Medicaid supports over 82 million low-income Americans, about 1 in 5 Americans (down from pandemic peaks). Thanks to various policy changes, economic factors, and healthc

In today’s tough funding climate, only a handful of digital health companies are making it to the public markets. Among them, Hinge Health  and Omada Health  stand out — not just for their products or clinical outcomes, but for something even more foundational: Their ability to align with payers, and use that alignment to scale. At Akros, we’ve worked with dozens of companies navigating the road from Series B to M&A or IPO. What we see over and over is this: The most IPO-read

Since “point solution fatigue” is now the go-to excuse for rejection, startups need to proactively counter it. Read to find out how. Make Sure You’re Talking to the Right People  I’ve worked inside a payer. There are entire teams dedicated to scanning the market for innovative solutions. If someone tells you “we don’t buy point solutions,” they might not actually be in a position to make that call.  Find the business unit leaders who are responsible for Stars ratings, cost sa

When it comes to payer executive leadership, reports aren’t just about presenting data—they’re about driving decisions. Yet, many organizations struggle to produce reports that resonate with their audience. Executives need clarity, relevance, and actionability, but too often, reports are overloaded with excessive metrics, irrelevant details, and static, hard-to-interpret visuals.  At Akros, we’ve worked extensively with consulting firms, payviders, and health plans to refine

Payer executives rely on dashboards to track performance, identify issues, and drive strategic decisions in real time. Yet, many dashboards fail to meet their needs. Whether it’s cluttered interfaces, excessive metrics, or missing context, a poorly designed dashboard can lead to confusion instead of clarity.   At Akros, we specialize in building executive-friendly dashboards that simplify complex data, provide real-time insights, and align with payer decision-making prioritie

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As a digital health tech founder, understanding the complexities of market access and pricing is crucial to your product's success. The landscape is dynamic and multifaceted, requiring strategic planning and an in-depth understanding of the healthcare system. Here's a breakdown of the essential components to guide you through this journey, based on insights from Akros Advisory Services. Understanding the Digital Health Tech Landscape Digital Health Technologies (DHT) encompa

Disclaimer: The information provided in this article is proprietary and based on publicly available information. It offers independent views and analysis and is intended for informational purposes only. If anyone wishes to use or rely on this information, they should contact us for permission and further details.     Digital health technology is revolutionizing healthcare, offering a plethora of opportunities for founders in this space. Telehealth and remote monitoring are g

During 2022's HLTH conference, Demi Radeva, one of Digital Health Today’s global ambassadors, had a one-on-one with Aaron Gani, Founder and CEO at BehaVR . BehaVR translates proven science into immersive and engaging XR therapeutics for mental and behavioral health. Aaron shares his perspectives and experiences for securing reimbursement and investment in what are often labeled “squishy“ innovations. These include innovations in spaces such as behavioral, wellness, health eq