The Hidden Economics of Healthcare: The 7 Cost Signatures™ That Determine Every Payer Decision

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

Introduction

Every payer decision — every contract, every reimbursement, every benefit approval — is driven by a set of hidden cost signatures.

And almost no digital health company understands them.

For decades, health-tech has obsessed over:

• outcomes

• engagement

• design

• adoption

• UX

• adherence

• clinical credibility

  
  

But none of those determine whether a plan will contract with you.

Every payer, MA plan, employer, and IDN makes decisions based on one thing:

Cost Signatures™ — the economic fingerprints that determine where money flows, where it gets stuck, and where it can be saved.

Digital health companies talk about:

• better health

• improved outcomes

• fewer symptoms

• better experiences

  
  

Payers talk about:

• unit cost

• utilization variance

• risk score volatility

• episode leakage

• cost-trajectory pressure

  
  

If you do not speak the language of Cost Signatures, you are not speaking to the buyer.

This article reveals the 7 Cost Signatures™ that control every payer decision — and how digital health companies can align to them to win 2026–2030.

What Is a Cost Signature™?

A Cost Signature™ is the economic identity of a care problem:

• where cost originates

• how it accelerates

• what drives variance

• which cohorts produce the majority of spend

• which utilization events can be prevented

• what benefit structure governs it

• which interventions reliably displace cost

  
  

Every clinical condition — metabolic, MSK, behavioral, cardiometabolic — has a unique Cost Signature™.

Plans contract only when a vendor can prove they influence it.

Most vendors don’t even know this concept exists.

THE 7 COST SIGNATURES™ EVERY BUYER USES (BUT NO VENDOR MENTIONS)

Here are the real economic systems shaping every payer contracting decision in the United States.

Cost Signature #1:

High-Risk Cohort Concentration™

5–10% of members drive 50–70% of cost.

Payers don’t care about averages. They care about the tail risk.

Digital health vendors often claim:

• 15% reduction in HbA1c

• 20% decrease in pain

• 30% improvement in symptoms

• 90% engagement

  
  

None of that matters unless it affects the expensive tail of the population.

High-Risk Cohort Concentration™ determines:

• if your ROI is real

• if it scales

• if it matters

• if it can be priced

• if the actuarial team listens

  
  

If you cannot explain how you influence the top 5–10% of spend,you cannot win contracts.

Cost Signature #2:

Utilization Pathway Physics™

Costs follow predictable mechanical pathways — and buyers only fund interventions that change them.

Every high-cost cohort follows a utilization “physics model”:

• ED → admission → imaging → surgery

• PCP → specialist → specialty pharmacy → escalation

• triage → care navigation → fragmentation → re-entry

• comorbidity stacking → volatility → crisis cycles

  
  

You must show:

• which pathways you disrupt

• how often

• for which cohorts

• with what predictability

• under which benefit design

  
  

If you can't map utilization displacement, no buyer will believe your ROI.

Cost Signature #3:

Benefit-Structure Economics™

Your ROI doesn’t matter unless it aligns to the employer’s benefit structure or the payer’s cost center.

Most vendors have never studied:

• HSA vs HRA

• carved-in vs carved-out

• pharmacy vs medical benefit alignment

• stop-loss thresholds

• incentive design

• utilization caps

• benefit exclusions

• CPT/HCPCS localization

  
  

Your outcomes are irrelevant unless they move dollars inside the benefit structure the buyer actually manages.

This is where 80% of digital health vendors fail.

Cost Signature #4:

Comorbidity Cost Stacking™

The cost crisis in the U.S. isn’t single conditions — it’s the stacking of multiple ones.

Plans don’t buy:

• diabetes solutions

• MSK solutions

• behavioral solutions

• cardiometabolic solutions

  
  

They buy solutions that affect 3–5 conditions simultaneously.

If you cannot model:

• layered cost displacement

• multi-condition ROI

• multi-pathway savings

• stacking scenarios

• clinical interdependence

  
  

…your pricing will never survive CFO review.

Cost Signature #5:

State-Level Cost Trajectory™

The cost curve varies dramatically across states — and 2030 MA contracting will be state-first, not national.

A vendor who improves outcomes in:

• Arizona

• Illinois

• New York

• Georgia

• Michigan

• Florida

  
  

…will show completely different economic impact in each.

This signature explains:

• regional care variation

• local cost structures

• state-specific utilization patterns

• local provider-to-plan dynamics

• MA risk score behaviors

• price dispersion

  
  

If your model is national, it is meaningless.

Cost Signature #6:

Workflow Friction Load™

Products that add friction add cost — not value — even if outcomes improve.

Providers are operating under:

• historic burnout

• 28% higher workflow burden

• documentation debt

• alert fatigue

• multi-system fatigue

• staffing shortages

  
  

Workflow Friction Load™ dictates:

• whether clinicians adopt

• whether employers activate

• whether IDNs integrate

• whether MA plans trust implementation

  
  

Workflow friction kills ROI, which kills contracting.

Cost Signature #7:

Predictability Bands™(The Most Important Signature of All)

Payers and CFOs do not buy outcomes — they buy predictable cost trajectories.

Every buyer wants to know:

• How predictable is your impact?

• How tight are the scenario bands?

• How stable are results across regions?

• How consistent are they across population segments?

• What happens in high variance cohorts?

  
  

Predictability Bands™ are the single most important factor in a payer’s decision to contract.

Because buyers don’t buy improvement.They buy reliability.

Why Cost Signatures™ Matter:

Because They Determine Who Wins 2026–2030

The digital health companies that win will be those who can:

• diagnose cost signatures

• influence cost signatures

• model cost signatures

• price to cost signatures

• contract based on cost signatures

• align attribution to cost signatures

• articulate cost signatures to CFOs

  
  

This becomes the defining commercial capability of the next decade.

This is why the Economic Clarity Framework™, the Attribution Engine™, and Economic Clarity Pricing™ are now mandatory.

How Axis Growth Partners Uses Cost Signatures™ to Build Commercial Engines

Axis Growth Partners architects:

• Cost Signature Mapping

• Attribution Engines™

• Economic Clarity Frameworks™

• Economic Clarity Pricing™

• Structural Friction Audits™

• Multi-Segment Revenue Architecture

• MA State-Level Contract Models

• Employer Benefit Displacement Strategy

• Commercial Proof Rows™

• Commercialization Architect Functions

  
  

This is the commercial architecture required to survive — and dominate — the 2026–2030 cycle.

Conclusion

If you don’t understand Cost Signatures™, you cannot understand payer decisions — and you cannot commercialize in the next decade.

Digital health’s next evolution is not:

• better apps

• better UX

• better engagement

• better outcomes

  
  

It is:

• better economics

• better attribution

• better ROI

• better predictability

• better alignment to the hidden logic buyers use

  
  

The companies that learn to read, model, and influence Cost Signatures™will win every contract.

The companies that ignore them will be eliminated.

Axis Growth Partners exists to build the engines that align digital health solutions to Cost Signatures™ — and create commercialization inevitability.

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