There's more than a trillion dollars of waste sitting inside U.S. healthcare administration.
That number isn't controversial. Ask anyone. A consultant might box it slightly higher or slightly lower, but the order of magnitude holds. What is controversial is why it won't go away. We've spent a decade throwing data platforms, point solutions, and "AI-powered" everything at it, and the curve keeps bending the wrong way.
Ric Sinclair, about 100 days into running Cotiviti, has a diagnosis for why. And it's the most interesting thing he said in our entire conversation:
Our business doesn't think there's a data problem. We don't think there's a technology problem. We believe at the core of it all that there is this underlying coordination problem and challenge in healthcare.
Sit with that for a second, because it changes everything about what a solution is even supposed to look like.
The reframe
If healthcare's problem is a data problem, you build a bigger, cleaner database.
If it's a technology problem, you ship better software.
But if it's a coordination problem, if the trillion dollars is leaking out of the gaps between the players and not inside any one of them, then no database and no app fixes it. The only thing that does is infrastructure. A neutral layer that sits between payers, providers, pharma, and patients and gets all four operating off the same source of truth.
That's the bet Ric inherited, and it's the one he's now doubling down on: turning a decade of Cotiviti acquisitions into what he calls "the first infrastructure layer that healthcare in this country has ever seen."
It's a big claim. "Infrastructure" might be the single most overused word in health tech. So the real question is what separates a genuine infrastructure play from a pile of data assets wearing the label.
What it actually runs on
Ric's version isn't abstract. He described a platform already touching most of the administrative surface area of U.S. healthcare:
Financial integrity. Thousands of clinical nurses, content experts, and MDs working alongside human-in-the-loop AI to make sure every claim and procedure is paid fairly, and to predict problems before they happen.
Interoperability. Clinical records and administrative transactions moving cleanly between insurers and providers of every size.
Value-based care. Population analytics, risk adjustment, and the patient communication and engagement layer that shapes how people actually interact with their health plan.
The thread connecting all of it is his network thesis: each solution feeds what he calls the Cotiviti network, and the network effects make every other product better, which drives cost down and efficiency up across the system. Whether that compounding actually materializes is the thing to watch over the next few years. But the logic is coherent, and it's a sharper articulation of "infrastructure" than most companies using the word can offer.
The hard part isn't the tech. It's trust.
Here's the catch Cotiviti's whole strategy hinges on: to sit in the middle, you have to be trusted by two sides that famously don't trust each other.
Payers and providers spend an enormous amount of energy in tension. How do you build something both sides believe is fair?
Ric's answer started somewhere I didn't expect: with values, not architecture. One of the four he and his leadership team recast is "people obsessed," and he tied it directly to the trust problem:
Every single financial transaction that we talk about or that we see moving through a healthcare network, that's a person, just like you and me. That's a patient, that's an individual that's receiving care.
The second part of his answer is more structural, and more interesting: with a trillion dollars of waste on the table, there's enough room for everyone to win. You don't have to pick a side when the inefficiency itself is the adversary.
With a trillion dollars of waste, there is an ample amount of opportunity... to drive costs down and drive real ROI for every single constituent in healthcare without any side feeling like we're taking a side.
He's an optimist by nature (he'll tell you that himself), and he's betting that the willingness across payers, providers, and pharma to actually collaborate is real right now in a way it hasn't been before.
One framework worth stealing
A quick aside that's too good to leave out, because it travels well beyond healthcare.
Every leader is quietly running the same math right now: if AI makes my team 5x more productive, how many people can I cut? Ric thinks that instinct is backwards.
A certain type of leader would say, if you have AI, you only need two people to achieve the same. I say, no, no, no, take all 10 and go five to one. And now with your 10 team members... that are world-class experts using the right technology, you can now accomplish what 50 could before.
In a business built on human-in-the-loop AI, that's not a feel-good line. It's the moat. The whole model only works if you keep the humans and point the leverage at output instead of subtraction.
Why it matters
Strip away the jargon and Ric's bet comes down to a single image he kept returning to: a family of five at a dinner table who, for once, aren't arguing about a medical bill, because they actually understand what they owe and have a health-centric conversation instead.
For the businesses Cotiviti serves, he expects the same shift to show up as higher member engagement, less provider abrasion, and healthier P&Ls. Do good qualitatively for patients and providers while doing good financially for plans, and you've got the win-win that bends the waste curve.
The cost of healthcare as a share of GDP has kept climbing for years. That's a macro trend that won't reverse on a 100-day timeline. But the reframe is the part worth carrying with you: most of the players trying to fix healthcare are solving the wrong problem. If Ric is right that it's coordination, not data and not tech, then the winners of the next five years won't be whoever has the most assets. It'll be whoever earns the right to sit in the middle.
🎧 Listen to the full conversation with Ric Sinclair on Slice of Healthcare, Episode 534, including how a former Nashville drummer ended up running one of healthcare's biggest infrastructure plays, and what music taught him about leading without needing the spotlight.
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Episode 534 is presented by Sage Growth Partners - "Value-focused strategy and marketing for growth-driven healthcare organizations."
