San Diego, CA–April 3, 2025–The United States healthcare system has broken under the weight of its own complexity. We spend about $5 trillion dollars on healthcare, or 17.6% of GDP, an outlier among all nations, with minimal compelling healthcare outcomes to show for it. Patients are lost, frustrated and forced into passive participation in their own healthcare journey. It’s not a poorly designed system, it’s a system that was never designed.
So we took the best and brightest minds across the healthcare industry and designed a new way forward.
How did we get here?
It was compounded piece by piece: the creation of employer-sponsored healthcare during World War II, the creation of Medicare and Medicaid, new billing codes, HIPAA rules, Meaningful Use requirements, and the Affordable Care Act. All well-meaning, but designed without consideration for the entire ecosystem. As a result, we have Medicare, Medicaid, Tricare, and private insurance all running on different systems, with different rules for billing, approvals, and benefits—a chain of unnecessarily complex steps to accomplish straightforward tasks at exponentially rising costs.
But there’s hope. We’ve solved similarly complex, far-reaching problems before. Banks share common transaction standards through federal clearinghouses. Mortgage lenders simplified their agreements through Fannie Mae and Freddie Mac. Even other countries with private healthcare, like Germany, have successfully standardized health plan designs and clinical policies across their entire system.
So we took the best and brightest minds across the healthcare industry and designed a new way forward. The PATIENTS Framework (Publicly Accountable Transparent Interoperable Efficient Nonproprietary Transaction Standard) is our blueprint for healthcare administrative reform and a thoughtfully-designed system that centers the patient in the healthcare transaction.
Patients deserve better
Incentive misalignment between business stakeholders in healthcare has resulted in an inadequate patient (and consumer) experience, lack of competition, outdated transaction processes, and dysfunctional payer-provider relationships. The numbers tell a stark story: 30% of all healthcare spending is wasted on administrative costs. This makes administrative complexity the single biggest component of excess US spending.
We believe the key to cutting administrative costs is replacing the patchwork of old, proprietary systems between health plans, providers, and middle men with a system that is simple, standardized, transparent, and most of all, patient-centered.
A truly patient-centered system is one that makes the complex simple; the fragmented, standardized; the opaque, transparent; the proprietary, open license; and most importantly, (we really can’t say it enough) the business-centered, patient centered.
When we get this right, healthcare works better for everyone:
Patients know exactly what their care will cost—and what quality to expect
Doctors and insurance companies work from the same, transparent playbook
Insurance plans use standardized benefit and network designs
Providers adopt standard processes for billing and patient payments
Everyone understands each step and can precisely predict their financial responsibility
How it works
We started by asking a fundamental question: In today’s world, what’s the simplest way to handle healthcare payments while ensuring excellent patient care?
From there, we developed the core tenets of an efficient transaction:
Consider the patient first
Strive for a perfectly efficient, payer-provider integrated transaction
Ensure backwards compatibility to existing transaction rails and payment systems
Set open license standards for interoperability
Create transparent documentation that anyone can understand
Then, we took a look at the status quo. Today, all healthcare transactions follow the Revenue Cycle: a 10+ step, months-long process that begins with scheduling an appointment and ends with patient collections and reporting. The PATIENTS framework condenses the healthcare transaction into fewer, more transparent steps—most of which are completed prior to the patient receiving care.
To see this in action, the framework includes these essential pieces:
Standard Modular Provider <> Group Purchaser Contract
Open Payment, Grouping and Pricing System
Universal Clinical Coverage Library
Standard Plan Design and Benefits Mapping
Open and Patient-Facing Transaction Rails
With new technology and a shared desire for change, we can move past the old ways of doing things that came before smartphones, AI, and the internet. We’re inviting forward-thinking leaders to join us in rebuilding healthcare administration into something that truly serves patient care.