The product works. The health plan pipeline doesn't.
You've proven the model with employers or consumers, and plan deals keep stalling in procurement, pilots that never convert, or a buyer who can't fund it this year.
Medicare Advantage go-to-marketEmerging Technology Partners advises the companies building healthcare technology, the investors backing them, and the health plans and health systems buying it. Every engagement is led by a partner who has run product inside healthcare companies.
Andy Kumar, Founder and Managing Partner.
Former CPTO at Cleo and CPO at Datavant / Ciox Health.
- Medicare Advantage go-to-market
- Product and technology diligence
- AI product strategy
- Vendor selection and ROI
- Value-based care strategy
- Prior authorization modernization
- Risk adjustment and quality
- Interoperability and FHIR
- Digital health launch readiness
- Interim product leadership
25+Years of combined experience in value-based care
$100M+New revenue from value-based care solutions
$30M+Operational savings delivered
10+Zero-to-one products and services launched
5+M&A deals and exits
Leaders call us when the decision is expensive and the answer has to be right.
Most of our work starts with one of four situations.
The M&A deal looks good. Nobody has checked the technology.
The management deck describes a platform. Before you sign, you need to know what's built, what it will cost to reach the plan in the model, and whether this team can deliver it.
Product and technology diligenceYour customers expect AI. The roadmap doesn't say where to start.
You need to find the customer problems AI can solve, decide what to build yourself and how to build it, and know where a partner gets you to market faster than your own team can.
AI product strategyTen vendors say they solve the same problem. You have to pick one.
Health plans and health systems are flooded with near-identical pitches. You need to know which vendor fits your problem, which can operationalize and scale inside your organization, and which will deliver the ROI it promises.
Vendor selection and value realizationCapabilities
Nine practice areas, all drawn from work we have done as operators. Each engagement has a written scope, a fixed fee, and a deliverable your team can act on.
Medicare Advantage go-to-market
For digital health companies that need health plan contracts. We pick the right plans, build the value case they expect, and structure pilots that convert.
Representative services
- Plan segmentation and target list
- Stars, CAHPS, and HEDIS value case
- Pilot design and pricing
- Broker and channel strategy
- RFP and procurement support
- Government programs sales hiring
Product and technology diligence
For VC and PE firms and strategic acquirers. An operator's read on product, platform, and team, timed to your deal process and written for an investment committee.
Representative services
- Product and roadmap assessment
- Architecture and scalability review
- Data and interoperability review
- Engineering team assessment
- Ranked risks with cost to fix
- First-year value creation plan
AI product strategy
For healthcare technology vendors, and for plans and systems building their own tools. We identify the problems AI can solve for your customers, decide what to build and how, and find the partners that speed up the build.
Representative services
- AI opportunity and use-case mapping
- Build, buy, or partner analysis
- Partner and model evaluation
- Prior authorization and UM automation
- Governance and clinical oversight
- AI roadmap and board brief
Vendor selection and value realization
For health plans and health systems choosing among vendors that all claim to solve the same problem. We define the problem, test the claims, and stay through implementation until the ROI shows up.
Representative services
- Problem definition and requirements
- Market scan and shortlist
- Vendor diligence and reference checks
- Pilot design and success measures
- Performance-based contract terms
- Implementation and scale-up oversight
Value-based care product strategy
For health systems taking on risk and the companies building for them. We connect the product roadmap to how money moves in value-based contracts.
Representative services
- Market and buyer mapping
- Pricing and at-risk contract models
- Outcomes and ROI measurement
- Roadmap prioritization
- Member and patient engagement design
- Partnership strategy
Risk adjustment and quality product strategy
For vendors and risk-bearing organizations building the tools that drive accurate risk capture, Stars performance, and quality reporting as CMS tightens the rules.
Representative services
- Risk adjustment product vision
- Payer and provider workflow design
- Stars and HEDIS product alignment
- CMS rule impact assessment
- Engagement and adoption strategy
- Competitive positioning
Interoperability and health data strategy
For organizations turning data-sharing requirements into product advantage, informed by product leadership at a national health data network and a statewide health information exchange.
Representative services
- CMS interoperability rule readiness
- FHIR API product strategy
- Clinical data acquisition
- Health information exchange strategy
- Privacy and consent design
- Data product commercialization
Digital health launch and regulatory readiness
For founders taking a clinical or direct-to-consumer product to market. We map the regulatory exposure, choose the infrastructure, and design the care model before launch money is spent.
Representative services
- FDA and FTC marketing risk review
- Telehealth platform selection
- Provider group and MSO structure
- Clinical care model design
- Product requirements and flows
- Launch plan and unit economics
Interim leadership and product operations
For boards and chief executives who need a senior product leader in the seat now, or a product organization that ships on time and explains itself clearly to customers and the board.
Representative services
- Interim CPO or CPTO
- Product organization design
- Concept-to-launch process
- Roadmap and portfolio governance
- Executive hiring and onboarding
- Board and investor reporting
In Medicare Advantage, timing decides more deals than product does.
Plans run on three federal clocks at once: bids and rates, Stars and quality, and risk adjustment. Each one opens and closes budgets at different times. This is the calendar we plan every go-to-market engagement around.
Swipe sideways to see the full year.
Vendor buying window
Bids and rates
Advance notice
Final rates
Bids due
Stars and quality
HEDIS submission
Star Ratings published
Risk adjustment
Final sweep
Mid-year sweep
Initial sweep
Service cutoff, Dec 31
Window open
January to March
- Bids and quality
- New plan year starts January 1. HEDIS chart retrieval and CAHPS surveys get under way.
- Risk adjustment
- The final sweep closes at the end of January and the mid-year sweep in early March. Plans budget the year's prospective and retrieval programs.
- What it means
- The best quarter to open a conversation. Plans choose retrieval, coding, and in-home assessment partners now.
Window closing
April to June
- Bids and quality
- Final rates arrive in early April. Bids are due the first Monday in June, and HEDIS results are submitted mid-June.
- Risk adjustment
- Prospective season ramps up: wellness visits, in-home assessments, and provider engagement campaigns.
- What it means
- Vendor decisions lock with the bid. Risk adjustment vendors need to be contracted and live by now.
Contract and implement
July to September
- Bids and quality
- Contracting, security review, and implementation for January go-lives.
- Risk adjustment
- Retrospective chart retrieval and coding projects launch. The initial sweep closes in early September.
- What it means
- Good for scoping pilots with plans that already said yes. Retrieval and coding capacity is what plans buy late.
Heads down
October to December
- Bids and quality
- Star Ratings publish in October. Annual enrollment runs October 15 to December 7.
- Risk adjustment
- Retrieval and coding hit peak volume. December 31 is the last date of service that counts toward next year's payment.
- What it means
- Plans are focused on enrollment and gap closure. Study the new Star Ratings and build the January target list.
This shows the standard CMS annual cycle. CMS sets exact sweep and bid dates each year, and individual plans vary.
Who we work with
Digital health companies
Series A to C teams with a working product and a growth target that depends on health plan or health system contracts.
VC and PE firms
Deal teams and operating partners evaluating, buying, or growing healthcare technology companies.
Health plans
Medicare Advantage and government programs leaders modernizing utilization management, quality, and member experience.
Health systems
Provider organizations taking on risk, fixing prior authorization and data exchange, and choosing which digital health and AI vendors to bring in.
We have built products in every part of the market we advise on.
Between them, our partners have held product leadership roles across six segments of healthcare. That is why our recommendations account for how the other side of the table thinks.
Medicare Advantage and member engagement
Product, technology, and health plan sales leadership for a member engagement platform serving Medicare Advantage plans: multimodal outreach across email, text, automated and live calls, and mail, sequenced by each member's behavior and channel preference, with AI-enabled outreach that decides who to contact, when, and with what message to close care gaps.
Value-based care and risk adjustment
Multi-year product vision and strategy for risk adjustment tools used by payers and providers, including the move from retrospective chart review to prospective risk capture: pre-visit suspecting, annual wellness and in-home assessments, and point-of-care tools that help clinicians document conditions during the visit, where the record holds up to audit.
Utilization management and clinical decision support
Product management and AI product strategy for evidence-based guidelines, prior authorization, and utilization review.
Health data and interoperability
Product leadership at a national health data network and at a statewide health information exchange.
Care navigation and care coordination
Health plan go-to-market, pilot design, and sales leadership hiring for a care navigation platform, and product work on the coordination workflows that connect members, caregivers, and care teams.
Risk and quality analytics
Analytics products that show plans and provider groups where risk scores, Star measures, and care gaps stand today, where they are heading, and which members and providers to act on first.
Representative work
A sample of our partners' recent work, as advisors and as operators. Client names are withheld.
Care navigation company, post-acquisition
Carried a Medicare Advantage pipeline through the fall selling season
Led health plan go-to-market during a change of ownership: managed plan and broker relationships, scoped fourth-quarter pilots, and recruited and onboarded a head of government programs sales.
- Medicare Advantage
- Pilot design
- Sales leadership hiring
Clinical decision support company
Product strategy for an AI prior authorization and utilization review platform
Produced the strategy brief, executive summary, and leadership presentation covering market position, product concept, and build sequence for an AI-powered platform.
- AI strategy
- Prior authorization
- Board materials
Value-based care enablement company
Multi-year product vision for a risk adjustment platform
Set product vision and strategy for risk adjustment tools serving both payer and provider customers, and raised product engagement among the clinicians and coders who use them.
- Risk adjustment
- Product strategy
- User adoption
Statewide health information exchange
Took data products from concept to launch
Led cross-functional teams through market research, product definition, and launch, and tightened the development and release process so products shipped on schedule.
- Health data exchange
- Product launch
- Product operations
Physician-supervised telehealth startup
Regulatory risk map and platform selection for a direct-to-consumer launch
Reviewed five years of FDA enforcement to map marketing and formulary risk, evaluated more than 20 telehealth infrastructure vendors, and designed the clinical care model and product requirements.
- Regulatory strategy
- Vendor selection
- Zero-to-one launch
Medicare Advantage member engagement company
Led product and technology as CPTO
Owned product, engineering, and the technical side of health plan sales for a member engagement platform serving Medicare Advantage plans.
- Product leadership
- Engineering
- Health plan sales
Our partners
You work with the people on this page. We don't hand engagements to a junior team.
Andy Kumar
Founder and Managing Partner
Andy has spent more than 18 years building healthcare technology and selling it to the organizations that pay for care.
He has served as Chief Product and Technology Officer at Cleo and as Chief Product Officer at Datavant / Ciox Health. Across his career he has launched more than 10 digital health products and services, generated more than $70 million in new revenue, and delivered more than $20 million in operational savings. He has helped evaluate and close four M&A deals and guided three startups from inception to acquisition.
He leads the firm's Medicare Advantage go-to-market, diligence, and AI strategy work.
- Chief Product and Technology Officer, Cleo
- Medicare Advantage member engagement
- Chief Product Officer, Datavant / Ciox Health
- Health data exchange and interoperability
- Track record
- 10+ products launched, $70M+ new revenue, $20M+ savings, 4 M&A deals, 3 startups to acquisition
- Focus areas
- Medicare Advantage, value-based care, AI strategy, deal diligence
Stephanie Miller
Partner
Stephanie is a healthcare product leader who works where strategy meets delivery: deciding what to build, then getting it shipped and adopted.
She has led product for utilization management and clinical decision support, for risk adjustment tools used by payers and providers, and for a statewide health information exchange. Colleagues know her for turning complicated material into clear decisions for executives, engineers, and customers alike.
She leads the firm's risk adjustment and quality, interoperability, and product operations work. Stephanie studied at Northwestern University's Kellogg School of Management.
- Product management leadership
- Utilization management and clinical decision support
- Principal product management
- Risk adjustment for value-based care
- Focus areas
- Risk adjustment, quality, health data exchange, product operations
How we engage
No open-ended hours. You know the questions, the deliverables, the timeline, and the fee before work starts.
Intro call
Thirty minutes on what you need to decide and by when. If we aren't the right fit, we'll say so and point you to someone who is.
Written scope
Within a few days you get a short proposal with the questions to answer, the deliverables, the timeline, and a fixed fee.
Focused sprint
Senior-led work with weekly check-ins. You see findings as they form, so the final readout holds no surprises.
Handoff
You finish with documents your team can act on, a readout for your leadership or board, and the option of ongoing advisory.
Strategy sprint
4 to 8 weeksMarket entry, AI strategy, and value-based care product work. Fixed scope and fee.
Deal diligence
2 to 3 weeksProduct and technology diligence timed to your process, with an investment committee summary.
Advisory retainer
MonthlyA defined number of senior days each month for leadership teams and boards that want continuity after a sprint.
Interim leadership
3 to 9 monthsA part-time or interim CPO or CPTO seat, with a plan to hire and hand off to a permanent leader.
What we tell every client
A health plan funds what it can write into its bid.
If you can't say which Star measure, which cost category, or which supplemental benefit you move, the buyer can't fund you, however much they like the demo.
Technology diligence should price the next 18 months of delivery.
Every platform has debt. What matters is whether this team can ship the roadmap the model depends on, and what it will cost when they can't.
Risk adjustment is moving from retrospective to prospective.
From 2027, CMS stops counting diagnoses from chart reviews that aren't tied to a visit. Conditions documented during care are what gets paid, and what holds up in a RADV audit.
Let's talk about the decision in front of you.
Whether it's a Medicare Advantage launch, a deal in diligence, or an AI plan your board is waiting on, tell us what you're dealing with and we'll tell you how we can help.
Reach us directly
- Emailandy@etpartners.io
- LinkedInMessage Andy Kumar, Managing Partner
- XFollow for commentary on Medicare Advantage and health tech
- SubstackSubscribe for longer analysis
San Francisco Bay Area, serving clients nationwide.