Don’t Just Follow the Pain. Follow the Strategy.
I've been spending less time looking at individual healthcare headlines and more time looking for the patterns underneath them (especially from earnings calls). Because one of the biggest commercialization mistakes founders can make is identifying a painful problem without asking whether that problem will still represent the same market opportunity three to five years from now.
Prior authorization is a great example. It's an enormous source of administrative burden, and a lot of startups have understandably built technology to make it faster. But UnitedHealthcare just announced it will eliminate 30% of prior authorization requirements across most of its plans beginning October 1. That doesn't make prior auth a "dead" market overnight. But if your entire value proposition is automating today's workflow, it's worth asking: are you building for a growing market or making a shrinking process more efficient?
We're seeing similar signals in our payer strategy maps. Molina's Marketplace membership fell from 655,000 at the end of 2025 to 283,000 by Q2 2026 as it concentrates more heavily around government-sponsored programs.
(Follow Akros on LinkedIn to find the rest of the strategy maps or email Demi if you want to talk through any of these!)
Follow where the resources are moving
The more interesting signal is what sits around that contraction.
Molina is emphasizing Medicaid and integrated Medicare duals, pursuing government contract growth, strengthening medical cost and rate management, and continuing to invest in administrative efficiency. Marketplace contraction isn't happening in isolation. It is part of a broader concentration of resources around businesses and capabilities Molina sees as strategically important.
For founders, that distinction matters. A payer pulling back from one market doesn't necessarily mean healthcare spending is disappearing. The budget, executive attention, and operational resources may simply be moving somewhere else.
That movement can tell you much more about the future market than the size of today's problem.
Humana, meanwhile, grew CenterWell Senior Primary Care patients 27% year-to-date while continuing to invest around Medicare Advantage, Stars, value-based care, government programs, and senior-focused delivery.
Growth creates its own market opportunities
Humana shows the other side of the picture. Growth itself creates commercialization opportunities.
Scaling an owned care delivery platform increases the importance of clinical performance, member engagement, medical cost management, workflow efficiency, data integration, and operating leverage.
The opportunity may not be "primary care." It may be solving one of the problems that becomes more important as Humana scales primary care.
That's an important distinction for founders. Following payer strategy doesn't mean copying what the payer is building. It means understanding the new needs, constraints, and priorities that emerge because of what the payer is building.
Those aren't just company updates. They're market signals.
How a payer responds matters too
There is another signal hidden in these maps: how payers choose to obtain a capability.
Are they building internally? Acquiring companies? Investing? Partnering with vendors? Consolidating existing operations?
Those choices can tell founders something TAM alone cannot. A strategically important problem can still be a difficult startup market if buyers consistently solve it internally. Conversely, repeated partnerships, acquisitions, investments, or vendor relationships can indicate that payers are willing to look outside their own walls for that capability.
Market attractiveness depends on both the importance of the problem and the buyer's willingness to buy a solution to it.
Look beyond TAM
That's why I increasingly look beyond TAM.
I want to know:
Where is the organization growing or contracting? Membership, revenue, geographic footprint, and capital allocation can reveal where the organization is concentrating resources.
Which capabilities keep receiving attention? Priorities that appear quarter after quarter can be more meaningful than a single announcement or headline.
How is the payer solving the problem? Building, buying, partnering, investing, and consolidating each send different signals about where an external company might fit.
What new problems does the strategy create? Growth in value-based care, government programs, owned care delivery, or another strategic area can create downstream clinical, financial, technological, and operational needs.
Where is attention disappearing? Exits, reductions, automation, and simplification can be just as informative as investments. They show where a payer may be trying to reduce complexity, eliminate work, or redirect resources.
Follow the strategy
For founders, the lesson is simple: don't just follow the pain. Follow the strategy.
A large problem today can still become a shrinking commercial opportunity. A smaller problem can become much more valuable when solving it directly supports something a payer is actively trying to grow, improve, or protect.
The strongest market opportunities sit at the intersection of persistent pain, strategic importance, available budget, and a buyer's willingness to look outside its own walls for a solution.
The best opportunity isn't necessarily the biggest problem today. It's a problem that is strategically important, economically sustainable, and likely to still command a buyer's attention and budget as the market evolves.
That's the difference between identifying a healthcare problem and identifying a market.
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