Deep Dive: Healthcare x Fintech
In this edition of Fintech Wrap Up, we dive deep into Healthcare x Fintech — a space that’s ripe for disruption as financial inefficiencies continue to plague the $4 trillion healthcare industry.
TL;DR:
In this edition of Fintech Wrap Up, we dive deep into Healthcare x Fintech — a space that’s ripe for disruption as financial inefficiencies continue to plague the $4 trillion healthcare industry. Our deep dive explores these opportunities through the lens of a16z a venture capital firm that is drawing insights from emerging trends and the evolving fintech landscape. Imagine running a business where you don’t know how much you’ll get paid, when the money will arrive, or whether it’s even the correct amount. That’s the financial reality for most healthcare providers today. Unlike other industries, healthcare lacks a true financial operating system, leaving providers scrambling to track revenue, reconcile payments, and manage cash flow manually. The result? A system rife with inefficiencies, surprise payment gaps, and even insolvency risks.
The good news? Fintech is stepping in to fill the gap. From revenue cycle management to AI-powered financial forecasting, the race is on to build the Financial OS for Healthcare — a real-time, action-driven financial backbone that integrates with EHRs, billing systems, and banking tools to give providers better control over their cash flow. And let’s not forget the rise of Consumers as a New Class of Payor. With out-of-pocket healthcare spending reaching $471 billion, fintech startups are reimagining health payments — think BNPL for medical bills, tax-advantaged spending accounts, and even marketplaces for cash-pay procedures.
We also break down the Unbundling of Payvidors — the massive insurance-and-care giants like UnitedHealth, Anthem, and Aetna that dominate healthcare finances. While these firms control the ecosystem, fintech upstarts are chipping away at their dominance with modern, user-friendly alternatives in areas like insurance, platform services, and provider payments. The next era of healthcare fintech will be shaped by those who can move fast, integrate financial services directly into care delivery, and build consumer-first payment solutions that make navigating healthcare as seamless as booking a flight.
The bottom line? Fintech has the power to bring transparency, predictability, and innovation to healthcare finances — and the companies solving these pain points today are positioned to define the future of healthcare payments.
The Financial Operating System for Healthcare
Consider this: most healthcare providers are flying blind when it comes to their finances.
Once a medical provider treats patients, they don’t really know how much they’ll get paid, when they’ll get paid, and if that payment is more or less than they’re owed. In many cases, providers lack insight into whether they will be able to make payroll based on the expected inflows of cash from insurance and patients. This is true for the majority of independent medical practices, and even many larger hospital systems.
This is particularly tragic after what was arguably one of the toughest years in recent history for providers in terms of financial performance. In 2022, even the most prestigious hospitals were severely unprofitable, and overall visit volumes and payment rates exhibited volatility that has been detrimental to the majority of traditional medical practices.
For healthcare providers, the electronic health records (EHR) system serves as the clinical source of truth, but a financial source of truth doesn’t yet exist. Most industries (let alone $4 trillion industries) do not work this way!
Why is this the case in healthcare? It has to do with the flow of funds, and the lack of healthcare-specific systems for accounting and financial planning that track that flow of funds. Here’s a typical example of how money moves when a patient visits a provider:
A patient visits a healthcare provider. They’re asked to share their insurance information and, according to that, they’ll pay their copay and — if the provider runs an eligibility check — the portion of the bill insurance does not cover. Or, the patient will pay out-of-pocket or be sent a direct bill if not using insurance.
Then, the provider delivers care and sends a summary of that care to an internal or external medical biller. That person converts that documentation to billing codes (known as “CPT codes” and “ICD codes”) and figures out how to format the claim to be accepted by the insurance company. Each insurance company and plan product may have slightly different forms and submission requirements.
Credits: Credits: This article was originally authored by Andreessen Horowitz’s team and published on their website.
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