Original analysis from Erik Abel and OneAnother Health on payer mechanics, market access, and product commercialization. Working notes from the intersections most healthcare strategy actually lives in, written for operators and investors who need the picture, not the slogan.
The metrics regulators want versus the metrics that move clinical alignment.
Technology enhancements are real, but the bigger picture is being missed. Prior auth and UM have created burdens of national merit. Sunlight and transparency are sanitizers. Right now significant regulatory and data transparency gaps exist in moving the needle to align clinically led, justified coverage frameworks across payer lines of business.
Read the analysis →An interactive walkthrough of payer architecture, regulation, and emergent behavior.
Many recognize the complexities of health systems and care delivery. Few recognize the complexities behind the walls of health plans, their operations, and their regulations. This brings that forward illustratively.
See the framework →A market on the verge of disruption if services and products align for innovation.
Price transparency has been pursued to expose consumerized paths for shoppable services. The dental space is an adjacent market with greater disruption potential. It already runs more like concierge care, and dental insurance approaches to delivering value have grown stale. This tells the story of a market on the verge of disruption if services and products align for business innovation.
Read the whitepaper →PQA has payer reach no clinical organization can match. The opportunity is to accelerate evidence activation across professional societies.
Twenty years in, the Pharmacy Quality Alliance sits at a structural position nobody else holds: direct CMS connectivity, Star Ratings influence, and operational payer reach. The opportunity ahead is to use that leverage as a bridge, becoming the connective tissue between clinical guideline development and operational quality measurement across pharmacy and medication management.
Read the analysis →Workforce clinical risk is an enterprise issue, not a benefits expense.
Corporate strategy is built around predictable risks, yet workforce clinical risk is largely absent from the conversation. Commercial populations are pre-Medicare populations, and average tenure of three to five years gives employers a strategic horizon that insurers and Medicaid plans structurally lack. This piece reframes population health as a longitudinal risk management function with board-level implications.
Read the analysis →Two-thirds of plan sponsors lack a lowest net cost biosimilar strategy. But the metric itself is incomplete.
Net cost optimization without total cost accounting creates selection incentives that increase downstream medical spend. This piece builds the framework plan sponsors need to evaluate biosimilar strategy beyond the formulary negotiation.
Read the analysis →Not all non-medical biosimilar switches carry the same risk. A stratified clinical reference across 13 scenarios.
Risk stratification from treatment-naive initiation to high-stakes neurologic disease, drawing on RCT data, registry studies, and clinical society guidance across rheumatology, gastroenterology, and oncology.
View the reference →The infrastructure gap three decades of advocacy has failed to close.
Why provider status remains unresolved despite strong clinical evidence, and how the MSO-PC operating model closes the gap between clinical capability and reimbursement infrastructure.
Read the analysis →Why value stops at the health system and rarely reaches the physician
Only 9% of primary care and 5% of specialist pay is tied to value metrics. The structural gap between payer VBC contracts and physician employment agreements explains most of what stalls value-based care at the point of care.
Read the analysis →Advanced imaging has a ceiling. The floor is missing.
The debate about Midjourney Medical’s scanner asks whether ultrasonic CT is as good as MRI. The right question is what happens in the gap before patients reach advanced imaging at all, and what the incumbent imaging industry chose not to build. A commercial and clinical case for patient-centered longitudinal imaging infrastructure.
Read the analysis →The payer harmonization gap across CKM and beyond.
Three major 2025–2026 guidelines now anchor cardiovascular treatment thresholds to a PREVENT score that clinicians can compute and the payer adjudicating the claim cannot. The data infrastructure gap is structural, and the stakes just got higher.
Read the analysis →The upstream patients coding and risk adjustment cannot represent.
The 2022 guideline redefined Stage B as pre-HF and asked clinicians to catch structural disease before decompensation. The ICD-10 vocabulary still traces to 2013. The at-risk patient maps to no risk weight, and the only codes that earn weight assert a heart failure these patients do not yet have.
Read the analysis →Who actually owns each of the 15 requirements to deliver imaging at scale. An interactive supplement.
Follow a patient from population risk to population health and see where the imaging industry shows up and where it disappears. Companion to The Pathway Illusion analysis.
Explore the matrix →Why imaging vendors cannot orchestrate what they were never built to coordinate.
The sector has converged on care pathway language. The structural foundation to deliver it was never built into the OEM model. This piece maps the infrastructure gaps, the organizational fault line, and the platform participant role that creates defensible value instead.
Read the analysis →