Outcomes-as-a-Service makes a lot of sense, but do people understand the concept, and what’s the hardest part of positioning this as a viable delivery option?

While it’s still a relatively new model, Outcomes-as-a-Service provides a much better deal for healthcare providers than traditional SaaS. The problem is that "better" doesn't necessarily translate to "easier to sell." As an experienced marketer, I’ve found that it makes the go-to-market function harder, causing us to evolve our sales and messaging approach. Research varies, but the industry speaks broadly to 850 million claims denied annually. This results in close to $20 billion in administrative appeals costs, and 41% of providers report denial rates above 10% in 2025, with some payers dealing with excess of 30%.

But those numbers don't capture the real problem inside provider organizations, and that's where our messaging is evolving. Revenue Cycle Management teams aren't wondering why no one has built a better dashboard. They already know where the problem is. What they're dealing with is a capacity challenge that’s usually been dealt with as a technology issue. Billing specialists are manually chasing denial codes. They have to triage, not in the operating room, but financially, and decide which claims are worth pursuing and which must be written off. Not because those claims are unrecoverable, but because there aren't enough hours to chase them all.

This means providers are knowingly leaving legitimately earned revenue on the table every day. And most have accepted it as the reality of operating in this environment.  As a result, how we go to market is challenging even though we offer something completely different.  From all our client data and analysis, we know exactly what's being lost and hear the same thing – providers just don't have the capacity to do anything about it. Leveraging AI and machine learning, Red Sky Health solves the capacity problem, not just the visibility problem, and that is the true distinction.

It appears as if the SaaS playbook is being challenged. What is the new narrative now?

Having spent the better part of two decades selling and marketing SaaS to solve operational enterprise problems, this is a major strategic change. We can no longer focus on licensing the platform, integrating it, training the team, and hope that value follows. That model has a flaw that the industry has been slow to accept, as here the execution risk lies solely on the buyer. Putting it simply, the vendor delivers capability, and the customer is responsible for turning that capability into outcomes – in this case, remediated insurance claims. For healthcare providers, teams are understaffed and managing high volumes of claims, and that gap is where SaaS technology investment quietly disappears.

Can you provide an example of how this is different?

Sure. Imagine the organization buys and deploys a denial analytics platform. It comes with great new dashboards, and insights are delivered. But a few months later, the denial recovery rate hasn't changed because the provider’s billing specialists still don’t have the bandwidth to act on what the platform is showing them. The software worked, but the outcome didn't change. Red Sky Health is designed to address that issue, but this leads to a different challenge. We're not selling a different product; we're selling a different model of accountability. And buyers, especially in healthcare and based on experience, are skeptical of that model.

How has this changed your GTM strategy? Does it require a tweak to older messaging, or does it require a different market mindsight altogether?

Outcomes-as-a-Service is a better model as it aligns incentives, risk mitigation, and outcomes to deliver measurable results. The benefits to the user are clear, so you would think it would be easy to sell, right?

When Red Sky Health meets with providers about their claims denial process and tells them, "We only get paid when your revenue goes up," we’re asking buyers to evaluate something their process wasn't meant to assess. We’re challenging a framework designed for buying software, not outcomes. Healthcare technology buyers know how to evaluate platforms. Their procurement processes are built around feature comparisons, integration requirements, and reference checks. This is the central positioning problem we need to solve for go-to-market success.

What does the path forward look like, and how are you adapting?

First, we need to lead with demonstrating the cost of inaction. In a traditional SaaS sale, ROI is a late-stage justification conversation. That sequence doesn't work for Red Sky Health. For us to succeed, we are leading with the economic case, talking to the denied claims going untouched, smaller claims written off, and the recoverable revenue providers are accepting as cost of business challenges. As we get buyers to realize and internalize the value available, Red Sky Health's model becomes very clear. This is why we are building our messaging around the problem cost first, AI model second, product last. It changes the story.

Then, we need to reframe the evaluation criteria. We're not going to change the procurement process, but we can change the questions buyers ask before they get there. The goal is getting decision-makers to walk into evaluations asking: "What happens to our denial rate in six months, and who's accountable if it doesn't move?" That shifts the conversation from feature comparison to performance accountability, which is exactly where Red Sky Health wins.

Next, we need to build the internal champion narrative, as someone inside the provider’s buying organization has to carry this story to finance, operations, and clinical leadership. That person needs language they can actually use. We need to enable our prospects to say, "We're writing off recoverable revenue quarterly because we don't have the capacity to chase it. Red Sky Health pursues it for us, takes a share of recovery, and it costs us nothing if it doesn't work." This approach enables the CFO to hear the story very differently than a feature-to-feature comparison.

Lastly, we need to promote proof to gain trust. Here, we let Red Sky Health's performance data lead the conversation. When we say, "We'll recover your denied revenue and only charge you when we do," we need to show proof points, recovery rates, and outcomes data from similar providers. For us, the proof is the product story. Our positioning isn't "why are we better than the competition?" It's outcome and collaboratively focused, where we state, “We help you hold payers accountable because your revenue matters now.”

When we talk to providers who recognize this revenue and operations pain, they generally move fastest. Buyers who've accepted denial write-offs as a cost of doing business need a different conversation, where we challenge that assumption before Red Sky Health ever enters the picture. Our content and campaign planning has to reflect both. Put simply, if you get the accountability and outcome story right, everything else will follow.