He described something that happens every day in the U.S.: despite having insurance, a patient receives a confusing surprise bill months after receiving care and is forced to navigate between the provider and the insurer to resolve the issue by themself.
Delinsky also reminded the audience that the country spends about $950 billion a year on healthcare administration — a staggering inefficiency due in large part to an outdated administrative technology infrastructure
“The transactional chassis that we use to adjudicate healthcare in this country was chartered and created by the Balanced Budget Act of 1997, where we came live with a series of ANSI standard transactions for claims, eligibility, prior authorization and payment. And it is now 2025, and we’re running on the same transactions. They got upgraded once to accommodate ICD-10 codes. It’s absurd,” he explained.
On top of that, rising labor costs and the shift from traditional Medicare to Medicare Advantage — which pays less and is harder to bill — are eroding provider margins, Delinsky added.
How a New PE-Backed RCM Company Plans to Fix the ‘Transactional Bowels of US Healthcare’
Additionally, denial rates have nearly doubled in the past five years as payers increasingly use AI to scrutinize claims, often asking providers to submit additional medical records to determine medical necessity, he stated. He noted that payers also “have a whole series of AI tools that have been deployed to claw back claims that have already been paid.”
Despite widespread adoption of EHRs over the past couple of decades, the infrastructure to support seamless data exchange is lacking, with delays and claim holds remaining all too common, Delinsky said.
“When you add all that up, I can’t think of a better use case for the application of AI than the transactional bowels of U.S. healthcare,” he declared.
In his view, the U.S. doesn’t just need another healthcare revenue cycle management company — it needs one that is more cost-efficient. Most revenue cycle management vendors charge their providers a fee that represents 5–9% of collections — but Smarter Technologies aims for 1–1.5%, Delinsky remarked.
The company is able to provide this affordable model due to its AI agents operating across payer portals and billing systems, as well as its low-cost, scalable offshore BPO, he said.
Delinsky added that Smarter Technologies’ agents are trained not to make mistakes.
How a New PE-Backed RCM Company Plans to Fix the ‘Transactional Bowels of US Healthcare’
“[BPOs] say, we’ll do a 5% quality audit and we’ll guarantee you a 95% quality score. That means that an extraordinary number of mistakes are getting through, and those are [surprise] bills or authorizations that weren’t completed for a visit,” he explained.
He said Smarter Technologies’ agents don’t make those same mistakes because they follow strict procedures, reason when necessary and escalate edge cases to a human-in-the-loop team so they can be resolved appropriately.
Plenty of companies have promised to fix healthcare’s broken revenue cycle before — but Delinsky believes Smarter Technologies will stand out by its ability to deliver on both accuracy and affordability.
The company currently serves more than 200 customers, including more than 60 health systems.