US Healthcare Administration 📞 Book a 1:1

Where does the dollar go in US Healthcare?

I spent my post-Anterior sabbatical reflecting on everything I'd picked up about this industry, and used Claude to help me compile it and keep me honest. This is a complete 175 page dump of my understanding on how care gets authorized, coded, billed, paid, managed and regulated; with a specific founder's-eye view of where it breaks and where AI wins. I hope my work can play a small part in your important role to build Healthcare for our future.

Start with the 90-second model → Unlock all 127 + 48 premium pages for $399
175pages
48in-depth premium pages
Fact-checkedprimary sources
Operator POVa founder's lens

I founded Anterior in 2022 to take on the spiralling healthcare administration crisis by building AI to automate the clinical and administrative work behind prior authorization and utilization management. I've spent years shipping software inside the plumbing of US healthcare — the claims, the codes, the criteria, the denials.

Zahid built ChatGPT for doctors and nurses before ChatGPT was an idea in Sam Altman's head. Now when you go to New York you don't need to wait in the emergency room; they see you right away. Next time you have any pains you should catch a flight out there and try it.

— how my mum describes me to her friends

During my time at Anterior I made meticulous notes and maps about US healthcare as I tried to wrap my head around this monster. At every turn there is a new rabbit hole to dive deep into, and I believe so much of this industry is yet to be uncovered and solved. With the help of Claude, I have spent some of my sabbatical typing, writing and dictating my thoughts, insight and understanding into a comprehensive operator's guide. Nikhil's Out Of Pocket Health helped me a lot in the early days, so I hope my material might specifically help founders navigating this space too.

There is a better way to do healthcare out there on the horizon. Don't chase the future. Build it.

New to the map? These three, in order.

01The 90-Second Mental ModelThe whole system in one sitting — how a decision and a dollar move through US healthcare. 02How to Use This MapHow the 175 pages fit together, and how to read the callouts. 03The StakeholdersWho's who — payers, providers, members, regulators, and the middlemen.

Otherwise, jump to the thread that fits you.

You're new to US healthcare

Get the mental model and the money before anything else.

You're a founder building in health-IT

Where the dysfunction pays, and who has the right to win it.

You work in prior auth or UM

The review machine, why it jams, and where it is heading.

You invest or operate

The size of the prize and where the returns actually sit.

You're here for the AI angle

What is automatable, who is building it, and how the arms race plays out.

Or if you know what you're looking for, jump directly to it.

01
The StakeholdersWho pays, who provides, who oversees — and the middlemen between them.
2302
How Money FlowsPremiums, claims, fee schedules, and where the dollars actually land.
1703
Coverage & BenefitsWhat is covered, what needs approval, and how benefits are designed.
1104
Utilization ManagementPrior auth, medical necessity, and the review machine that gates care.
2805
Care Management & Population HealthManaging the sickest members and the health of the whole population.
1206
Clinical Data, Coding & InteroperabilityCodes, records, and the standards that move them between systems.
1107
Payment & Program IntegrityCatching — and preventing — the wrong dollar going out the door.
1008
Pharmacy & PBMsDrugs, rebates, and the most opaque supply chain in healthcare.
1009
Value-Based Care & RiskCapitation, bundles, and getting paid for outcomes instead of volume.
710
Regulation & PolicyThe rules of the game: CMS, ERISA, HIPAA, and the reform wave.
1711
The Vendor LandscapeWho sells what — and where the health-IT software money is.
1312
Where It Breaks & Where AI WinsThe thesis layer: the dysfunction, the opportunity, and who wins.
12

Reference: Glossary & Acronyms · How to Use This Map · start with the 90-second model.

127 pages are free to access. I've gated the deeper dives.

The free map covers every corner of US healthcare administration as I understand it. The premium layer (48 pages), plus my take on every page and a downloadable AI pack, goes deeper into how it actually works: how determinations really get made, the 90/10 economics, and who has the right to win. It's my own synthesis — public sources, primary documents, and an operator's read of how the pieces fit.

Unlock everything for $399

After payment you'll receive your unlock code by email within a few minutes. Not there? Email zahid@theadminlayer.com and I'll resend it.

For unlocked readers

Want to go deeper? Book a 1:1.

If you've unlocked the map and want to talk through your market, your wedge, or your go-to-market in US healthcare admin, book a call with me — $1,499. After payment you'll get a link to schedule right away (or email zahid@theadminlayer.com).

Book a 1:1 — $1,499