Execution Isn’t a Commodity: Rethinking Services in Health Tech
Even in an AI-obsessed world, people still drive the outcomes that matter.
There’s a bias in health tech: if it’s not a software platform, it’s not scalable.
You hear it in every pitch critique and investor Q&A. “What’s the product?” “How automated is it?” “Can you remove the services over time?” The assumption is that platforms scale and services don’t.
But in payor enablement, where outcomes are measured in risk scores, Stars bonuses, and care gap closure, services aren’t the bottleneck. They’re the delivery system.
Whether you’re working with Medicare Advantage, Medicaid, or D-SNP populations and trying to drive performance on risk adjustment, HEDIS, CAHPS, or Stars, software alone doesn’t move the needle. The actual work gets done by service teams.
And the best companies in this space? They build around that reality, not in spite of it.
This piece walks through the dynamics from three angles:
How health plans actually buy and rely on services
How great vendors scale services without losing margin or control
And how savvy investors are starting to see what others dismiss
The point isn’t to defend services. It’s to show where the real leverage lies and why some of the strongest, most defensible businesses in health tech aren’t software companies.
What Health Plans Actually Need
Health plans don’t need another dashboard. They need execution. And when it comes to the work that actually drives Stars bonuses, risk-adjusted revenue, and CAHPS scores, they’re often unequipped to do it in-house.
Simply put, it’s a matter of capability. Plans don’t have scalable field teams. They don’t have certified coders or in-home nurses sitting idle. They’re workforce and processes are not built to manage surge work, last-mile logistics, or one-to-one member outreach. So when deadlines hit or performance lags, they don’t turn to software.
They turn to vendors who can act. Not just as a one-off, but as an ongoing operating model.
What that looks like:
A national MA plan flags anomalies in a provider group’s coding data and initiates a focused audit. They bring in a coding vendor to review 2,000 charts in under three weeks because spinning up that kind of capacity internally isn’t just slow, it’s not even possible.
A D-SNP plan with lagging CAHPS results hires an outreach vendor with bilingual agents, trained to rebuild trust with members who won’t answer calls from the health plan.
A Medicaid plan with care gap deadlines contracts a field team to complete in-home assessments across rural counties where the plan has zero local staff and no ability to recruit.
This isn’t “boots on the ground” as a throwaway phrase. It’s boots that know where to land, when, and why.
Plans don’t just need insights and analytics. They need partners who can turn strategy and data into action, quickly, reliably, and at scale. The vendors who can do that aren’t nice to have, they’re deep-seated partners.
What the Best Vendors Actually Build
The best services businesses in healthcare aren’t simply scaling by adding headcount. They’re scaling by building systems around their people - standardizing what works, automating where it makes sense, and delivering consistently across markets, contracts, and teams.
They aren’t staffing shops. They’re execution engines.
What sets them apart isn’t just what they do. It’s how they’ve built repeatable, accountable systems around it. Delivery isn’t left to chance. It’s managed, measured, and continuously refined.
What that looks like:
A member support vendor provides in-home and virtual companion visits to seniors, helping address loneliness, food insecurity, and care coordination gaps. Visits are scheduled and routed using predictive models that prioritize members based on their isolation risk, plan performance goals, and social needs, turning what feels like a human connection into measurable Stars impact.
A call center vendor provides post-discharge outreach to members with chronic conditions, assisting them in scheduling follow-ups, understanding new benefits, and preventing unnecessary readmissions. Outreach is prioritized using claims triggers, hospital partner feeds, and member-level risk data, turning a call queue into a clinical recovery system.
A DRE vendor runs a mobile initiative for Stars and HEDIS, deploying nurses to in-home visits and pop-up clinics. Scheduling and staffing are optimized using software that accounts for member eligibility, clinical opportunity, geography, and visit capacity, ensuring the highest yield with minimal waste.
These companies scale not by avoiding services, but by designing them to deliver with consistency, speed, and control. They build around the moments where humans matter most and use technology to amplify, not replace, that execution.
What Smart Investors Are Starting to See
Most investors have a mental filter. They hear "services" and assume low-margin, hard to scale, or too dependent on people. They’re trained to look for product, automation, and ARR. But that filter doesn’t work in payor enablement.
Because the companies that health plans rely on most?
They’re not selling tools. They’re delivering outcomes.
These vendors may not fit the classic SaaS pattern. But they’re embedded inside Stars programs, risk workflows, supplemental benefit strategies, and care gap operations, often more deeply than any platform will ever be.
They win renewals because they drive outcomes. They grow because health plan strategies are built around them.
And increasingly, they’re not just service vendors. They’re hybrid operators that combine structured delivery with proprietary tools, internal data, and playbooks that scale. Real infrastructure, purpose-built.
They’re addressing the part of the Quaintuple Aim that most vendors struggle with: improving the patient experience. CAHPS. Retention. Activation. Navigation. The human connection work that’s hard to fake and even harder to scale.
And for investors who know what they’re looking at, these businesses offer a different kind of upside:
They sit inside core operating budgets tied to Stars, HEDIS, risk adjustment, and member experience, not pilots or innovation funds
Their renewal rates are driven by outcomes, not usage metrics, which means expansion is based on need
Their delivery systems can extend or embed into existing tech platforms, creating composite solutions that are more valuable than either alone
They often win deals that software companies can’t touch, especially with underserved or high-friction populations
Their business model naturally creates proprietary data and process IP, giving them a long-term edge few competitors recognize
In my experience, I’ve found it to be much more successful to bolt SaaS onto the chassis of a great services business than to layer services onto a product company that has never touched operations.
That’s not just execution, it’s a competitive moat hiding in plain sight.
Final Thought
The services vs. software debate misses the point.
The companies winning in payor enablement don’t fit cleanly into one bucket. They scale not because they avoided services, but because they’ve built them with discipline, purpose, and integration.
For investors and operators alike, the opportunity isn’t to pick a side. It’s to understand what plans actually buy, where execution meets leverage, and how the next category-defining companies might not look like the last ones.
Some of the best businesses in this space are already built.
We just need to adjust our lens to see them.
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About the Author
Ryan Peterson writes Upward Growth, where he shares practical insights on selling health tech into the payor market. With 15+ years in healthcare growth leadership, he focuses on helping vendors translate their value into traction with health plans.
🟦 Connect with him on LinkedIn.