Clinical
Recognition
PharmD and cardiothoracic critical care. I know what medicine can now identify, and why it matters earlier than the system acts on it.
Erik Abel, PharmD, MBA
Medicine keeps learning to see more. The system that pays for it cannot recognize most of it.
I work in that gap. Clinical science advances faster than the coding, payment, and delivery infrastructure meant to represent it. Guidelines move and vocabularies do not. Capability exists and reimbursement infrastructure does not. Contracts change upstream and the incentive never reaches the point of care.
Two decades on multiple sides of that gap, as a clinician, inside a health plan, and as the executive who built the operating model that carried an AI-guided diagnostic service to national scale and an acquisition.
20+
Years across provider, payer, and MedTech
44
States reached, scaled from 11 in two years
5.6M
Members in the payer enterprise transformed
1
Series B exit, Caption Health to GE HealthCare
The recognition gap
A 2022 guideline redefined Stage B heart failure and asked clinicians to catch structural disease before decompensation. The vocabulary they document it in still traces to 2013. The at-risk patient maps to no risk weight, and the codes that do carry weight assert a heart failure the patient does not yet have.
That pattern repeats everywhere once you know to look for it. It is why value contracts stall before reaching a physician, why cleared products never reach a patient, and why an entire sector can adopt care pathway language without building the coordination that language implies.
The system cannot pay for what it cannot recognize. Naming that gap is the easy half. Creating the path to close it is what I bring.
Three things, usually held by three different people
The seams between them are where most healthcare strategy fails.
Commercial
System fluency
Utilization management, coverage policy, and payer economics inside a plan covering millions. I know what the payment layer can actually represent, and why it says no.
Product
Built correction
An MSO-PC operating model that turned a cleared device into a commercially offered clinical service, scaled nationally, carried through an acquisition.
Where the thinking gets pressure-tested
A growing body of independent analysis, written for operators and investors who need the picture rather than the slogan. Three clusters carry most of it.
Imaging and diagnostics
Why the outpatient imaging floor was never built, why vendors cannot orchestrate a pathway they were not designed to coordinate, and who actually owns delivery.
Explore →Cardiovascular and coding
Risk scores clinicians can compute and payers cannot adjudicate. Pre-heart-failure patients the code set cannot represent. Guideline science outrunning claims infrastructure.
Explore →Payer mechanics and access
Prior authorization transparency, health plans as complex adaptive systems, biosimilar total cost, and where value contracts stop reaching the clinician.
Explore →Speaking and media
Keynotes, executive briefings, webinars, and accelerator sessions for clinicians, health plans, ACOs, investors, and founders. Recent work covers heart failure detection, AI in clinical workflow, and the payer economics that decide whether any of it reaches a patient.
Advisory work
Client engagements run through OneAnother Health, an independent advisory practice serving MedTech, digital health, biopharma, and value-based care organizations on reimbursement strategy, evidence architecture, and commercialization.
This site is where the thinking lives. That one is where the work gets scoped.
Working on something in the gap?
I take a small number of advisory engagements, board seats, and speaking invitations each year.
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