I have spent 20 years building and scaling multiple technology-enabled services businesses. I have watched many technology trends come and go. Much of my last experience was spent inside healthcare providers where I watched capable organizations wrestle with the promise of modernization: the optimism, the investment, and too often, the disappointment.
The discussion around AI has changed the conversation once again. But this time, I am more optimistic than ever about the healthcare industry. AI on its own solves nothing, but it changes the economics of building. For twenty years the only real path to modernization ran through a rip-and-replace program with a 10-year installation cycle. That is no longer true. A health plan can now build on the core platforms it already operates, get more throughput out of the team it already has, and close the gap between what it spends and what it gets back. That shift is not tied to a single deadline or a single year. It is the new baseline, and it is why we started i2 Health Advisors.
Health Plans Are Running Out of Ways to Absorb the Work
American health plans are under real financial pressure. Industry profit margins have compressed from 3.8% in 2020 to 0.4% in 2025. Medical loss ratios are climbing across every line of business. And the regulatory work never stops arriving: HIPAA 5010, ICD-10, the No Surprises Act, and now CMS-0057-F, which requires every covered health plan to have production-grade FHIR APIs for prior authorization live by January 1, 2027. The specific mandate changes every few years, but the pattern does not. Each one lands on the same team that was already behind, on a Monday morning backlog that is longer than the week.
The workforce gap is real, it is widening, and hiring alone will not close it. McKinsey put it plainly:
“Pressure on payers to accelerate their digital transformations is intensifying because cost pressures may be addressable only with automation, especially in the United States, where government reimbursement rates have not kept pace with rising healthcare costs.”
McKinsey & Company, “Rewiring Healthcare Payers: A Guide to Digital and AI Transformation”, 2025
The key words are only with automation. The answer is not more hiring or a bigger capital program. It is workflows built in and around the workforce a health plan already has, running on the systems it already owns.
AI Is the Enabler, Not the Solution
For two decades, healthcare technology consistently promised more than it delivered. Electronic health records were going to eliminate administrative burden. Predictive analytics were going to prevent hospitalizations. Each wave arrived with conviction and left behind expensive implementations and a system that looked much like it did before, with the paperwork simply moved onto a screen.
AI is a real shift, and it will play out over decades. But technology by itself has never been the answer to process improvement, and it is not the answer now. What it actually does is let you ask a different set of questions and build a different set of workflows. Even with the capabilities of today’s models, a workflow that holds up inside a regulated health plan still requires human judgment, domain expertise, and someone accountable for the decision. AI is the enabler, not the solution on its own.
The i2 Health Mission
Our mission is to transform healthcare administration by eliminating complexity, accelerating decision-making, and delivering value for payers and the members they serve.
We are a solutions partner for health plans that want results, not just roadmaps. We extend the investments you have already made in platforms like Snowflake, UiPath, and Salesforce into AI-powered infrastructure that modernizes operational workflows. We are an Anthropic partner, and we stay fluent across the leading platforms rather than beholden to any one of them.
We meet customers where they are. Sometimes that’s an AI readiness assessment, sometimes it’s building a full production workflow, and sometimes it’s operating that workflow as a managed service. We help with data management, and particularly the deluge of clinical data now available to health plans, along with claims processing and member experience. We do not implement and leave. We build it, we prove it, and we run it.
I am building i2 Health alongside Pete Biagioni, Chief Growth Officer; Brian Anderson, Chief Technology Officer; and Stephanie Ngo, Vice President of Service Delivery. We are a team of growth-oriented operators and technologists who have spent decades in the industry. And we can’t wait to make a difference for our customers.
Who We Want to Help
i2 Health is built for health plans running Facets, QNXT, TriZetto, or other claims management systems that want value today, not a multi-year core replacement program. We like to work with organizations that want to invest in partnering: provider-owned plans, regional plans, Blues Plans, and other risk-bearing organizations. Groups where there is real financial pressure, a regulatory calendar that never clears, and interest in partnering with people who know payer operations.
If you are working toward the January 2027 deadline, trying to get more out of a platform you already own, or simply want to explore AI-powered automation, let’s talk.
Frequently Asked Questions
Q: What does i2 Health Advisors do for health plans?
We build AI-powered workflows on the platforms a health plan already runs, and then we operate them. That covers utilization management, claims, member experience, and provider data. The distinction that matters is the second half. Most firms implement a system and hand it over. We stay and run it as a managed service.
Q: Does working with i2 Health require replacing our core admin system?
No. The model is built the other way around. Facets, QNXT, and TriZetto stay exactly where they are as the system of record. We layer workflows on top, connecting through APIs and data services, so the work can start without waiting to finish a multi-year migration.
Q: What does CMS-0057-F require by January 2027?
Every covered health plan needs production-grade FHIR APIs for prior authorization live by January 1, 2027. That means a Prior Authorization API, plus patient, provider, and payer-to-payer access. The date is fixed and there are no extensions, which is why plans are re-architecting utilization management now.
