CareTalk: Healthcare. Unfiltered.
Can Healthcare Claims Be Adjudicated in Real-Time? W/ Don Peterson, Founder & CEO, PIM Health
Why It Matters
Accelerating payments reshapes the financial stability of independent practices, freeing up capital that is currently tied up in months‑long reimbursement cycles. By cutting administrative waste and simplifying prior authorizations, the approach supports the shift toward value‑based care and could save billions of dollars across the healthcare system, making it a timely solution as new CMS initiatives launch.
Key Takeaways
- •Real-time claim adjudication could pay providers within seconds.
- •PIM aims to clear 70% of routine claims instantly.
- •Insurers earn billions from float by delaying payments.
- •Eliminating prior authorizations reduces administrative waste dramatically.
- •Coders shift to scheduling, accelerating revenue cycle efficiency.
Pulse Analysis
Hospitals now spend roughly two dollars on administration for every dollar of direct patient care, creating a $5 trillion industry where insurers profit from delayed payments. This "float"—the time insurers hold premium funds before reimbursing providers—generates billions in interest revenue, while providers wait 30‑40 days for cash, often borrowing against personal assets to fund drug purchases. The inefficiency fuels administrative waste, inflates costs, and hampers the shift toward value‑based care that CMS will accelerate with its 2027 programs.
PIM Health proposes a real‑time claim adjudication platform that processes routine episodes—about 70% of visits—in seconds, mirroring credit‑card settlements. By routing the claim through a clearinghouse at checkout, the system delivers immediate remittance advice, allowing patients to settle balances before leaving the office. The model also eliminates most prior authorizations; physicians attest to medical necessity, and the platform validates it instantly, reserving manual review for true exceptions. This deterministic approach removes denials, appeals, and post‑episode negotiations, dramatically cutting administrative overhead.
If adopted, the solution reshapes provider revenue cycles, reduces reliance on large billing teams, and reassigns coders to front‑desk scheduling, accelerating intake and coding accuracy. Insurers would lose the lucrative float but gain transparency and lower operational costs, aligning incentives with the upcoming CMS value‑based care frameworks. For independent practices, near‑instant cash flow improves fiscal stability, while employers and employees benefit from clearer pricing and faster claim resolution. The industry-wide shift could reclaim billions in wasted spend, positioning real‑time adjudication as a cornerstone of the next generation of healthcare finance.
Episode Description
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American hospitals now spend nearly $2 on administrative overhead for every dollar that touches direct patient care. Insurers earn billions in float by sitting on claims for weeks, providers borrow money just to stay liquid, and patients open bills for visits they barely remember.
Don Peterson, Founder and CEO of PIM Health, joins host David E. Williams to discuss why healthcare's payment system is working exactly as it was designed to work, and how real-time claims adjudication at the point of care could eliminate prior authorization as it currently exists, cut administrative overhead from 12 to 15 percent down to 2 to 3 percent, and return hundreds of billions of dollars in waste back to patients, providers, and plan sponsors.
🎙️⚕️ABOUT DON PETERSON
Don Peterson is a healthcare entrepreneur and technology executive with over 30 years of experience building and scaling companies across technology and healthcare. He held senior roles at AMD during the semiconductor boom, founded DeskStation Technology in 1990 (acquired by Samsung), and in 2012 founded IVX Health, building the operating model for ambulatory infusion centers from the ground up. Under subsequent leadership, IVX Health scaled to 150+ locations nationally and completed a change-of-control transaction in 2024 at a valuation exceeding one billion dollars. Peterson also launched and operationalized ambulatory infusion clinics in Saudi Arabia from 2020 to 2024.
He is currently the founder of PIM Health Corp., a healthcare technology company developing real-time claims adjudication and payment infrastructure designed to replace the batch-processing architecture that has defined healthcare payment settlement for decades. Peterson publishes healthcare policy analysis and industry commentary on Substack and hosts the podcast Divided Attention, covering healthcare, technology, and policy.
🎙️⚕️ABOUT PIM HEALTH
PIM Health is a healthcare technology company building real-time claims adjudication and payment infrastructure designed to replace the batch-processing architecture that has defined healthcare payment settlement for decades. Founded by Don Peterson, whose experience scaling IVX Health to a billion-dollar acquisition gave him a firsthand view of how broken healthcare payment actually is, PIM is built around a simple insight: providers who get paid in 24 hours instead of 90 days, members who never receive a surprise bill, and self-insured employers who can see real-time claims activity will drive demand faster than any direct sales effort. The infrastructure investment by payers follows that demand, not the other way around.
At PIM Health, we’re building real-time payment infrastructure where providers don’t wait weeks to get paid, patients don’t leave without knowing exactly what they owe, and employers stop flying blind on their own plan spend. AR burden, gone. Surprise bills, gone. Prior auth delays, gone. Denials and appeals, gone. Learn what we’re building at pim.health
🎙️⚕️ABOUT CARETALK
CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy.
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⚙️CareTalk: Healthcare. Unfiltered. is produced by Grippi Media Digital Marketing Consulting.
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