Digital Health Is Overstaffed and Under-Architected: The Real Reason Companies Fail at Payer Contracting

**There is a structural truth in digital health almost no one is willing to say out loud:

Companies are massively overstaffed — yet missing the one function that actually drives revenue.**

In the last two years, digital health companies expanded headcount across:

• commercial

• sales

• market access

• implementation

• outcomes

• clinical ops

• enablement

• customer success

• “pilot teams”

• 
  

Yet the outcomes are identical:

**Payer contracts remain slow.

MA expansion stalls. Employer budgets freeze. Pilots don’t convert.**

This isn’t a sales problem. It’s not a pipeline problem. It’s not a product problem.

It’s an architecture problem.

New research across CMS, Mercer, JAMA, and Epic reveals why digital health fails to commercialize — and why sales teams can’t fix it.

CMS MA 2026 Changes

MA plans are eliminating low-value programs and demanding cost-trajectory proof, not clinical outcomes.

Mercer’s 2025–2026 Employer Data

Employers plan material reductions in discretionary benefits, requiring vendors to show validated cost displacement.

JAMA’s Attribution Findings

Under mixed-care environments, most interventions cannot prove attribution, destroying ROI narratives.

Epic’s Workflow Burden Release

Clinician workflow burden is at historic highs, killing adoption for any solution that adds friction.

These aren’t problems you solve with more AEs or more pilots. They’re evidence that the commercial engine itself is mis-structured.

Digital health companies hire for motion, not architecture — and it’s the reason they can’t scale.

Most organizations are built around:

❌ Outcome storytelling, not economic clarity

❌ Pilots, not commercial inevitability

❌ Headcount, not contracting architecture

❌ Volume, not attribution stability

❌ Functional silos, not revenue systems

❌ Workflow additions, not workflow removal

The industry keeps hiring more people…while the structural causes of commercial failure stay untouched.

The commercial engine is missing the middle layer — the Commercialization Architect.

This is the function that unifies:

• clinical evidence

• actuarial logic

• attribution stability

• payer economics

• MA benefit structure

• employer budget mechanics

• workflow physics

• contracting design

• value stack sequencing

• revenue architecture

  
  

This is not sales. Not “market access.” Not outcomes. Not finance. Not strategy.

**It is a specialized discipline:

Commercialization Architecture.**

It’s the role that transforms:

• outcomes → economics

• economics → contracting power

• contracting power → predictable revenue

• predictable revenue → scale

  
  

Without it, organizations remain overstaffed and under-architected.

2026 will be the Great Commercial Reset — and the Great Organizational Reset.

The companies that fail next year will fail for one reason:

They built teams before they built architecture.

The companies that win will win for the opposite reason:

They built architecture before they built teams.

What winners already have in place:

• Structural Friction Audit

• attribution + actuarial logic

• a payer-ready economic clarity model

• MA/state-level contracting structure

• employer benefit alignment

• a defensible value stack

• episode- and utilization-aligned pricing

• Commercialization Architect function

• a unified revenue system

• a commercial cockpit that scales

  
  

This is what buyers respond to.

This is what CFOs approve.

This is what drives enterprise contracts.

If you lead Behavioral Health, Metabolic Care, MSK/Pain, Wearables, or MA/Employer Commercial Strategy — 2026 demands a different engine.

Axis Growth Partners supports organizations in:

• building Economic Clarity from clinical evidence

• designing MA and regional payer expansion strategy

• creating attribution + actuarial models that withstand scrutiny

• developing multi-segment revenue architecture

• aligning with employer benefits economics

• designing contracting blueprints that accelerate cycles

• reducing workflow friction to unlock adoption

• building the Commercialization Architect function

• operating a Commercial Cockpit for predictable scale

  
  

2026 will reward companies who are structured for economic inevitability — and eliminate those who aren’t.

Let’s architect the engine that wins the next cycle.

Tom Riley, Founder & Commercialization Architect | Axis Growth Partners tomriley@axisgrowthpartners.co | axisgrowthpartners.co