By the third day of HLTH in Las Vegas, I realized something that’s hard to admit out loud. Payers aren’t allergic to innovation. They’ve just outgrown the hype. In my conversations with leaders from Humana, UPMC, Avalon, and HealthWorks, the tone felt different from the scripted, panel-stage optimism that fills the expo hall. Gone were the catchphrases about “meeting members where they are” or “harnessing the power of AI.” Behind closed doors, the tone was sharper, more disc

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

By Akros Advisory in collaboration with HTEC Group The New Frontier for Payers At HLTH 2025, Akros Advisory and HTEC Group convened two closed-door lunches for payer, provider, and technology leaders. One explored Pain Points to Performance ; the other unpacked AI, Quality, and Care Management. Across both rooms, the message was clear: Payers are no longer just financial intermediaries. They are becoming system designers. This shift requires a new mindset. Technology isn’t ju

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

Successful HealthTech commercialization requires more than developing a strong product. This workshop connects reimbursement, market access, product strategy, and commercial execution to show founders how to prepare for launch, understand healthcare buyer requirements, and build a practical path from coverage to sustainable revenue.

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

A startup's go-to-market strategy can have a direct impact on its future exit opportunities. This workshop explores common healthcare exit paths, what strategic and financial buyers value, and how founders can strengthen revenue, assets, operations, leadership, and positioning to build a more attractive business.

One of the most important (and most uncomfortable) questions a healthcare founder can ask is this: Are we a services company using tech to scale, or a tech company that’s lightly supported by people? The difference might sound subtle. It’s not. It’s a strategic fork in the road, and you can’t keep one foot on each path. Why This Question Matters Too many early-stage companies try to do both. They build a tech platform and provide done-for-you services. They pitch Sa

We all want leverage. We’re all looking for the next tool, the next integration, the next AI plugin that’s finally going to unlock scale. But here’s the truth that founders in healthcare need to hear (and probably don’t want to): You can’t automate your way out of dysfunction. Let Me Explain I've seen founders spend thousands—sometimes tens of thousands—on building or buying tech tools that promise efficiency. NLP-based coding tools. Pre-visit planning platforms. Real-ti

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 I joined my first startup accelerator, I thought I was getting a blueprint for success—access to top investors, world-class mentorship, and a step-by-step plan to take my company from idea to scale. But here’s the truth: Not all accelerators are created equal. Yes, I got a polished pitch deck. Yes, I met a few investors. But when the program ended, I was left with more questions than answers: How do I actually close my first enterprise contract? How do I price my pr

In today's evolving landscape, non-profits are increasingly recognizing the value of incorporating for-profit structures into their operations. Whether through mission-driven revenue generation or strategic expansion, spinning off a for-profit entity can unlock new opportunities, reduce dependency on grants, and create long-term sustainability. However, this decision must be carefully structured to align with the non-profit’s mission, regulatory guidelines, and operational st

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