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Abstract
The premise, or why hospitals are the best worst customers
Revenue cycle and the prior auth forcing function
The CFO stack: cards, treasury, receivables, bad debt
Workforce: the agency markup is the product
Benchmarking businesses and the data network effect
The quiet operational layer
The vibe code test
How these die
Where the money actually is
Table of Contents
Thesis: health systems are terrible software buyers and phenomenal design partners, which makes them ideal incubation anchors for companies built inside their workflows rather than sold into them
Covers roughly 40 company concepts across five buckets: revenue cycle and prior auth, financial infrastructure, workforce, benchmarking and intelligence platforms, and operational tooling
Key numbers along the way: about $13B in annual PA administrative burden, roughly 13 to 16 hours per physician per week on prior auth, roughly 40 to 100 percent agency markups, 1.5 to 5 percent virtual card interchange, 2 to 4 percent systematic payer underpayment, tens of billions in hospital bad debt, and on the order of $66B plus in annual 340B discounts
Argues that roughly a third of these can be vibe coded to a credible seed demo in weeks because the pattern is structured data in, LLM reasoning in the middle, action-oriented UI out
Ends with an honest accounting of what kills these companies: sales cycles, IT governance committees, pilots that never convert, and performance pricing that sounds great until the finance team has to attribute savings
