[{"data":1,"prerenderedAt":541},["ShallowReactive",2],{"content:home":3,"content:resume":35,"content:post:value-based-care-the-future-of-healthtech-in-2026":256},{"id":4,"extension":5,"facts":6,"footer":19,"lede":20,"meta":21,"now":22,"quotes":23,"stem":26,"tagline":27,"terminal":28,"__hash__":34},"home\u002Fsite\u002Fhome.yml","yml",[7,10,13,16],{"key":8,"value":9},"now","vp engineering · aledade",{"key":11,"value":12},"prev","curia.ai · foundry.ai · ghost creative",{"key":14,"value":15},"edu","johns hopkins · bs ee, ms cs",{"key":17,"value":18},"loc","washington, dc","Working on something interesting? Say hi.","I build products, platforms, and teams that turn technically hard ideas into useful things. Right now that's AI at Aledade, where I'm VP of Engineering.",{},"At Aledade, I lead teams across applied AI research, AI platform engineering, and AI enablement. We work on turning advances in AI into things people can rely on: the shared foundations teams use to build and run AI applications, the evaluation and controls that make them measurable, and the tools that help our own people put AI to work. Some of that lands inside the systems primary care practices already use every day.",[24,25],"Building is fun, but impact is the point.","Chase interesting problems and good people. The rest tends to follow.","site\u002Fhome","Engineering leader, founder, and builder.",{"suggestions":29,"disclosure":33},[30,31,32],"what does he work on now?","how did curia.ai end up at aledade?","what's gerner ventures?","Questions are logged to improve answers.","P8O1DTDujRo48foUHlV7Z2TrL_AKrxbXh44W68jQJrY",{"id":36,"basics":37,"education":43,"experience":53,"extension":5,"meta":185,"skills":186,"stem":211,"timeline":212,"__hash__":255},"resume\u002Fresume.yml",{"name":38,"location":39,"email":40,"linkedin":41,"github":42},"Nick Gerner","Washington, DC","hello@njgerner.com","https:\u002F\u002Flinkedin.com\u002Fin\u002Fnjgerner","https:\u002F\u002Fgithub.com\u002Fnjgerner",[44,49],{"degree":45,"institution":46,"period":47,"notes":48},"M.S. in Computer Science","Johns Hopkins University","2014 – 2016","Specialization in Distributed Systems, Cloud Computing, and Machine Learning",{"degree":50,"institution":46,"period":51,"notes":52},"B.S. in Electrical Engineering","2009 – 2013","Involved in Hopkins Undergraduate Engineering Society, Pi Kappa Alpha, Pre-Law Society, Varsity Track & Field",[54,67,74,84,93,103,112,120,128,138,148,156,166,174],{"id":55,"company":56,"title":57,"start":58,"end":59,"summary":60,"bullets":61},"aledade-vp","Aledade, Inc.","Vice President of Engineering","2025-03",null,"Lead teams across applied AI research, AI platform engineering, and AI enablement, connecting advances in AI with the practical work of value-based primary care.",[62,63,64,65,66],"Lead the shared foundations teams use to build and operate AI applications: access to models, information, and tools, plus evaluation, observability, and operational controls.","Bring AI capabilities into the systems and workflows primary care practices already use, including electronic health records.","Lead the engineering that helps Aledade's own teams use AI in their daily work and build their own tools.","Partner with Product, Clinical, Data, and Security\u002FCompliance to deliver outcomes that improve care quality and reduce administrative burden.","Drive engineering operating processes: hiring and org design, technical strategy, delivery predictability, reliability, and cost-aware scaling.",{"id":68,"company":69,"title":70,"start":71,"end":59,"bullets":72},"fig-advisor","Fig – Food Is Good","Advisor","2024-03",[73],"I am an advisor to the company.",{"id":75,"company":56,"title":76,"start":77,"end":58,"bullets":78},"aledade-senior-director","Senior Director of Engineering","2023-01",[79,80,81,82,83],"Oversaw engineering activities and strategies following the acquisition of Curia.ai by Aledade in January 2023.","Collaborated with cross-functional teams to ensure the seamless integration of Curia.ai's technology and talent.","Guided the development of AI-driven healthcare solutions that support Aledade's mission to improve patient outcomes and reduce healthcare costs.","Led the Point of Care (POC) organization, focusing on AI-driven EHR integrations.","Spearheaded the launch of the EHR Overlay into production.",{"id":85,"company":86,"title":70,"start":87,"end":88,"bullets":89},"invisory-advisor","InVisory","2022-10","2025-11",[90,91,92],"Providing strategic guidance on technology development and growth initiatives.","Offering insights on industry trends, technical feasibility, and product-market fit.","Assisting with the development of effective go-to-market strategies and partnership opportunities.",{"id":94,"company":95,"title":96,"start":97,"end":77,"bullets":98},"curia-vp","Foundry.ai \u002F Curia.ai","VP of Engineering","2022-02",[99,100,101,102],"Led engineering at Curia.ai, an AI Healthcare startup that built a full-service machine learning platform to help healthcare companies deliver better outcomes and reduce the cost of care.","Developed custom machine learning models for targeting patient populations, improving diagnosis accuracy, and optimizing treatment plans.","Managed a team of engineers, data scientists, and product managers, ensuring on-time delivery of high-quality software solutions.","Collaborated with key stakeholders to define product roadmap, set priorities, and allocate resources.",{"id":104,"company":105,"title":106,"start":107,"end":97,"bullets":108},"foundry-principal","Foundry.ai","Principal Software Engineer","2020-02",[109,110,111],"Contributed to the development of AI software companies using data science, machine learning, and software engineering principles.","Designed and implemented scalable, high-performance software systems for various applications, including the energy, healthcare, and sales industries.","Mentored junior engineers and fostered a culture of continuous learning and innovation.",{"id":113,"company":105,"title":114,"start":115,"end":107,"bullets":116},"foundry-lead","Lead Software Engineer","2018-09",[117,118,119],"Led software engineering projects, including the design, development, testing, and deployment of applications and systems.","Mentored junior engineers, providing technical guidance and support to foster professional growth.","Ensured adherence to best practices and maintained high quality standards across all projects.",{"id":121,"company":105,"title":122,"start":123,"end":115,"bullets":124},"foundry-senior","Senior Software Engineer","2016-04",[125,126,127],"Developed scalable software solutions using Docker, Terraform, Spark ML, Hadoop, Node.js, Vue.js\u002FReact, Elasticsearch, Redis, MySQL, and Python on AWS.","Worked closely with data scientists to integrate machine learning algorithms into software applications.","Collaborated with product managers and stakeholders to define requirements, design solutions, and ensure alignment with business objectives.",{"id":129,"company":130,"title":131,"start":132,"end":133,"bullets":134},"ghost-creative","Ghost Creative","Managing Partner","2015-10","2018-04",[135,136,137],"Co-founded a software development company specializing in modern technology solutions for small businesses in the healthcare industry.","Managed client relationships, project timelines, and resource allocation.","Oversaw the design and development of custom practice and patient management platforms, ensuring security, scalability, and usability.",{"id":139,"company":140,"title":141,"start":142,"end":143,"bullets":144},"bizy","Bizy","Software Engineer","2015-04","2016-03",[145,146,147],"Led full stack and mobile engineering teams in the development of a team collaboration and productivity application.","Developed and maintained application features, including real-time messaging, task management, and file sharing.","Collaborated with UX designers to create intuitive, user-friendly interfaces and optimized user experience.",{"id":149,"company":150,"title":141,"start":151,"end":142,"bullets":152},"hippo-health","Hippo Health","2015-01",[153,154,155],"Developed web and mobile applications using Angular, Express, and Node.js.","Collaborated with the product team to define requirements and implement features.","Participated in code reviews and testing to ensure high-quality software delivery.",{"id":157,"company":158,"title":159,"start":160,"end":161,"bullets":162},"accenture-senior","Accenture","Senior Consulting Analyst","2014-04","2014-12",[163,164,165],"Developed full stack web applications using PHP and PL\u002FSQL Oracle.","Assisted clients in defining project requirements and translating them into technical specifications.","Worked closely with team members to ensure timely delivery of software solutions and provided ongoing support.",{"id":167,"company":158,"title":168,"start":169,"end":160,"bullets":170},"accenture-analyst","Consulting Analyst","2013-05",[171,172,173],"Assisted with software development projects and provided technology consulting services.","Conducted research on emerging technologies and provided recommendations to clients for technology adoption.","Supported project management activities, including planning, resource allocation, and progress tracking.",{"id":175,"company":176,"title":177,"start":178,"end":179,"bullets":180},"united-airlines-intern","United Airlines","Avionics Engineering Intern","2012-05","2012-09",[181,182,183,184],"Performed maintenance and overhaul of aircraft avionics systems and components.","Supervised and instructed electrical technicians in avionics systems, ensuring compliance with industry standards and regulations.","Conducted quality control inspections to identify and address potential issues.","Collaborated with cross-functional teams to ensure operational efficiency and minimize downtime.",{},[187,195,203],{"group":188,"items":189},"Technical",[190,191,192,193,194],"Machine Learning","Artificial Intelligence","Cloud Architecture","Distributed Systems","Database Technologies",{"group":196,"items":197},"Programming",[198,199,200,201,202],"Python","JavaScript","API Design","Node.js","SQL",{"group":204,"items":205},"Leadership",[206,207,208,209,210],"Team Management","Product Management","Agile Methodologies","Strategic Planning","Mentorship","resume",{"early":213,"thread":220,"alongside":250},[214,217],{"name":158,"from":215,"line":216},[167,157],"Learned the craft on enterprise software.",{"name":130,"from":218,"line":219},[129],"Co-founded a studio building healthcare practice software.",{"header":221,"steps":222},"One thread: a venture studio, the company it built, and the company that acquired it",[223,229,236,243],{"name":105,"from":224,"line":225,"link":226},[121,113,104],"Helped build AI companies inside a venture studio.",{"href":227,"text":228},"\u002Fwork#foundry","story →",{"name":230,"rel":231,"from":232,"line":233,"link":234},"Curia.ai","spun out",[94],"Led engineering for its healthcare ML platform.",{"href":235,"text":228},"\u002Fwork#curia",{"name":237,"rel":238,"from":239,"line":240,"link":241},"Aledade","acquired",[75],"Brought AI into EHR workflows for primary care.",{"href":242,"text":228},"\u002Fwork#aledade",{"name":244,"from":245,"line":246,"link":247},"AI at Aledade",[55],"Leading AI research, platforms, and enablement.",{"href":248,"text":249},"#now","what I do now ↓",{"label":251,"name":252,"text":253,"url":254},"alongside","Gerner Ventures","independent experiments on my own time","https:\u002F\u002Fgernerventures.com","8y4oIg071CfkLkaNG5NFeuzWon5ZeDrXBJS5pD0Cb9M",{"id":257,"title":258,"body":259,"description":520,"extension":521,"image":522,"meta":527,"navigation":528,"ogImage":529,"path":530,"publishDate":531,"readingTime":532,"seo":533,"seoDescription":534,"stem":535,"tags":536,"__hash__":540},"blog\u002Fblog\u002Fvalue-based-care-the-future-of-healthtech-in-2026.md","Notes From the Messy Middle",{"type":260,"value":261,"toc":501},"minimark",[262,266,269,272,275,280,283,286,303,306,310,313,316,330,338,341,345,348,351,354,362,365,375,379,384,387,390,393,397,400,403,406,409,413,416,419,422,425,429,432,436,439,442,445,449,452,458,462,465,473,476,480,483,486,489,492,495],[263,264,265],"p",{},"As 2025 closes, I’ve felt a growing urge to write more. I spend my days building technology around value-based primary care, and I keep seeing the same pattern: the biggest constraint isn’t ambition, or even ideas. It’s the missing infrastructure that turns fragmented data into coordinated action inside real workflows.",[263,267,268],{},"In 2026, I’m going to write about that layer.",[263,270,271],{},"I am a part of engineering at Aledade, working alongside independent primary care practices that are taking on value-based accountability. That vantage point shapes how I see the world. You can debate which model should win, which policies will stick, and which vendors will capture share. But on the ground, the bottleneck is surprisingly consistent: coordination is still expensive, brittle, and labor-intensive.",[263,273,274],{},"If you zoom out, 2025 looked like a year of convergence. Three forces that used to move independently started to line up.",[276,277,279],"h2",{"id":278},"_1-value-based-care-stopped-feeling-optional","1) Value-based care stopped feeling optional",[263,281,282],{},"The story of value-based care is often told as an aspiration. In 2025, it increasingly read like an economic inevitability.",[263,284,285],{},"When providers are accountable for outcomes and total cost of care, the math changes. Preventable admissions and avoidable ED visits are not just clinical failures. They are margin destroyers. Prevention and chronic care management stop being “nice to have” and become the only coherent strategy.",[263,287,288,289,296,297,302],{},"We have seen this direction for years, but the footprint keeps expanding. CMS has publicly highlighted continued savings and quality performance in Medicare accountable care programs, including the Medicare Shared Savings Program’s net savings in recent performance years. (",[290,291,295],"a",{"href":292,"rel":293},"https:\u002F\u002Fwww.cms.gov\u002Fnewsroom\u002Fpress-releases\u002Fmedicare-shared-savings-program-continues-deliver-meaningful-savings-and-high-quality-health-care?utm_source=njgerner.com",[294],"nofollow","Centers for Medicare & Medicaid Services",") And across the industry, estimates suggest tens of millions of lives are now in some form of accountable care arrangement across payers. (",[290,298,301],{"href":299,"rel":300},"https:\u002F\u002Fwww.unitedhealthgroup.com\u002Fcontent\u002Fdam\u002FUHG\u002FPDF\u002F2025\u002F2025-10-value-based-care.pdf?utm_source=njgerner.com",[294],"UnitedHealth Group",")",[263,304,305],{},"The more this footprint grows, the more the same constraint shows up: you cannot run proactive, population-level care on workflows that still depend on delayed data, manual reconciliation, and heroic effort.",[276,307,309],{"id":308},"_2-interoperability-became-less-theoretical-and-more-operational","2) Interoperability became less theoretical and more operational",[263,311,312],{},"Interoperability in healthcare has been a long series of “almost” moments. Standards existed. Networks existed. Policy existed. But getting the right record to the right workflow at the right time was still inconsistent.",[263,314,315],{},"What felt different heading into 2026 is that the substrate is starting to look more like an actual exchange layer, not just a set of standards and good intentions.",[263,317,318,319,324,325,302],{},"TEFCA is a useful marker here. The Recognized Coordinating Entity (RCE) has reported rapid growth in the number of organizations live on TEFCA and the volume of documents exchanged since go-live in late 2023. (",[290,320,323],{"href":321,"rel":322},"https:\u002F\u002Frce.sequoiaproject.org\u002Ftefca?utm_source=njgerner.com",[294],"ASTP TEFCA RCE",") And the number of designated QHINs has continued to climb through 2025. (",[290,326,329],{"href":327,"rel":328},"https:\u002F\u002Fwww.healthcaredive.com\u002Fnews\u002Foracle-health-qhin-designation-tefca\u002F806217\u002F?utm_source=njgerner.com",[294],"Healthcare Dive",[263,331,332,333,302],{},"At the same time, the era of “closed gardens by default” is getting harder to defend. HHS has signaled increased enforcement posture around information blocking. (",[290,334,337],{"href":335,"rel":336},"https:\u002F\u002Fwww.hhs.gov\u002Fpress-room\u002Fhhs-crackdown-health-data-blocking.html?utm_source=njgerner.com",[294],"HHS",[263,339,340],{},"None of this means “data is solved.” Anyone building real clinical workflows knows it’s still messy. But it does mean the question is changing from “can data move?” to “can we operationalize it safely, consistently, and cheaply enough to matter?”",[276,342,344],{"id":343},"_3-ai-moved-closer-to-workflow-and-closer-to-the-line-of-accountability","3) AI moved closer to workflow, and closer to the line of accountability",[263,346,347],{},"2025 was full of AI activity, but the most important shift was not model capability. It was placement.",[263,349,350],{},"AI is steadily moving from standalone experiences into embedded workflow, and that matters because embedded AI inherits the responsibilities of the workflow it touches.",[263,352,353],{},"In documentation, that looks like ambient and assistive tools that reduce clerical burden and help clinicians stay present. In operations, it increasingly looks like automation of repetitive, rules-heavy processes like prior authorization and utilization management, where the stakes are real and delays can cause harm.",[263,355,356,357,302],{},"You can see this shift reflected in policy experiments and pilots that explicitly blend technology with administrative gatekeeping and payment incentives heading into 2026. (",[290,358,361],{"href":359,"rel":360},"https:\u002F\u002Fwww.marketwatch.com\u002Fstory\u002Fover-6-million-americans-on-medicare-will-now-need-to-get-prior-authorization-from-ai-for-these-17-procedures-0cf605a2?utm_source=njgerner.com",[294],"MarketWatch",[263,363,364],{},"This is where the world view and my day-to-day perspective collide:",[366,367,368,372],"ul",{},[369,370,371],"li",{},"AI is getting easier to access. But healthcare is not a domain where access equals readiness.",[369,373,374],{},"In 2026, the winning teams will not be the ones with the best model. They will be the ones that can make trust rational.",[276,376,378],{"id":377},"the-three-beliefs-i-updated-in-2025","The three beliefs I updated in 2025",[380,381,383],"h3",{"id":382},"belief-1-interoperability-is-necessary-but-not-sufficient","Belief 1: Interoperability is necessary, but not sufficient",[263,385,386],{},"Interoperability is a prerequisite. It is not an operating model.",[263,388,389],{},"Even when data is technically available, you still have to solve: identity, consent, normalization, provenance, routing, and accountability. “FHIR exists” is not the same thing as “the right context shows up for the right person at the right time.”",[263,391,392],{},"2025 reinforced for me that healthcare does not have an innovation problem. It has a translation problem.",[380,394,396],{"id":395},"belief-2-primary-care-is-the-coordination-layer-but-it-has-not-been-given-coordination-infrastructure","Belief 2: Primary care is the coordination layer, but it has not been given coordination infrastructure",[263,398,399],{},"We keep asking primary care to manage the longitudinal journey: prevention, chronic disease, behavioral health, referrals, transitions, end-of-life planning. That only works if primary care has leverage.",[263,401,402],{},"Independent practices rarely have the technical staff or spare operational bandwidth to stitch together portals, labs, claims, and hospital feeds, then prove outcomes, then redo it every time a new tool arrives.",[263,404,405],{},"What they need is a platform, not another dashboard.",[263,407,408],{},"A platform that makes coordination cheaper than fragmentation. A platform that turns “we should” into “we can” without burning out the people doing the work.",[380,410,412],{"id":411},"belief-3-governance-cannot-be-a-committee-it-has-to-be-a-product","Belief 3: Governance cannot be a committee. It has to be a product",[263,414,415],{},"Healthcare governance that only exists as a quarterly review is governance that fails daily.",[263,417,418],{},"The only scalable path is to treat governance as product. Encode the rules. Automate the guardrails. Make the compliant path the path of least resistance.",[263,420,421],{},"This is the heart of “earned AI.”",[263,423,424],{},"If you cannot explain, audit, monitor, and safely degrade an AI-driven recommendation inside the workflow, then you have not built a clinical capability. You have built a liability.",[276,426,428],{"id":427},"what-i-think-2026-will-reveal","What I think 2026 will reveal",[263,430,431],{},"Here’s my world view bet for 2026, shaped by what I saw in 2025.",[380,433,435],{"id":434},"_1-ai-everywhere-will-meet-the-reality-of-accountability","1) “AI everywhere” will meet the reality of accountability",[263,437,438],{},"AI will continue to spread through EHRs and operational tooling. But the center of gravity will move from novelty to evidence.",[263,440,441],{},"Where does it demonstrably reduce burden? Where does it demonstrably improve quality or outcomes? Where does it introduce risk, bias, or delays? Who is responsible when it fails?",[263,443,444],{},"The loudest conversations will not be about prompt quality. They will be about governance, measurement, and rollback.",[380,446,448],{"id":447},"_2-the-administrative-layer-will-be-an-early-battleground","2) The administrative layer will be an early battleground",[263,450,451],{},"Prior auth, claims workflows, and utilization management are tempting targets for automation because they are repetitive and rules-driven. They are also a place where automation can create invisible harm if it is wrong or if it shifts friction onto clinicians and patients.",[263,453,454,455,302],{},"The most important question is not “can AI do it?” It is “can AI do it with transparency, appeal paths, and safety guarantees that preserve trust?” (",[290,456,361],{"href":359,"rel":457},[294],[380,459,461],{"id":460},"_3-rural-and-independent-care-settings-will-matter-more-than-ever","3) Rural and independent care settings will matter more than ever",[263,463,464],{},"If you care about outcomes and equity, the long tail is the point. Rural and independent practices are where a huge amount of longitudinal care happens, and they are often the least resourced to adopt bespoke tooling.",[263,466,467,468,302],{},"Recent federal and state-level initiatives heading into 2026 underscore that rural capacity and transformation are front-of-mind, even if the politics and implementation details are contested. (",[290,469,472],{"href":470,"rel":471},"https:\u002F\u002Fwww.reuters.com\u002Fbusiness\u002Fhealthcare-pharmaceuticals\u002Fus-allots-least-147-million-per-state-rural-health-2026-2025-12-29\u002F?utm_source=njgerner.com",[294],"Reuters",[263,474,475],{},"If healthcare is going to improve at scale, infrastructure has to work for the long tail, not just flagship systems.",[380,477,479],{"id":478},"_4-the-next-differentiation-will-be-utility-layers-not-point-solutions","4) The next differentiation will be utility layers, not point solutions",[263,481,482],{},"The last decade produced many valuable point solutions. The next decade will reward shared utility layers: identity, consent, data normalization, auditability, workflow routing, evaluation, monitoring.",[263,484,485],{},"When those layers exist, innovation compounds. When they do not, innovation resets to zero every time you change an integration, a policy, or a workflow.",[487,488],"hr",{},[263,490,491],{},"If you are building in this space, I would love the pushback. What is the most important thing that needs to become invisible? What part of the workflow feels most broken? Where do you think the industry is overconfident?",[263,493,494],{},"I’m going to write toward the messy middle, because that is where the work actually is.",[263,496,497],{},[498,499,500],"em",{},"Disclosure: I work at Aledade. Views are my own.",{"title":502,"searchDepth":503,"depth":503,"links":504},"",2,[505,506,507,508,514],{"id":278,"depth":503,"text":279},{"id":308,"depth":503,"text":309},{"id":343,"depth":503,"text":344},{"id":377,"depth":503,"text":378,"children":509},[510,512,513],{"id":382,"depth":511,"text":383},3,{"id":395,"depth":511,"text":396},{"id":411,"depth":511,"text":412},{"id":427,"depth":503,"text":428,"children":515},[516,517,518,519],{"id":434,"depth":511,"text":435},{"id":447,"depth":511,"text":448},{"id":460,"depth":511,"text":461},{"id":478,"depth":511,"text":479},"A 2025→2026 reflection on why value-based care is becoming inevitable, interoperability is turning operational, and AI is moving into workflow — making governance and infrastructure the real differentiators.","md",{"src":523,"width":524,"height":525,"alt":526},"\u002Fimages\u002Fblog\u002Fvbc-2026.webp",1600,873,"Illustration of a person at a desk sketching how data silos, EMR, claims, and labs feed into a primary care coordination platform",{},true,"\u002Fimages\u002Fblog\u002Fvbc-2026-og.jpg","\u002Fblog\u002Fvalue-based-care-the-future-of-healthtech-in-2026","2026-01-01",7,{"title":258,"description":520},"Why value-based care is becoming inevitable, interoperability is turning operational, and AI is moving into workflow.","blog\u002Fvalue-based-care-the-future-of-healthtech-in-2026",[537,538,539],"value-based-care","AI-in-healthcare","primary-care","tCWP99aKFnn-yZpwDhPqt-v3Hb5RUWTtDn3lFyO9chU",1791043008899]