Smart Health Infrastructure Alliance
Ending the $1 Trillion Administrative Crisis
Building the Foundation for Healthcare's Digital Future
American healthcare still runs on 9 billion faxes a year - wasting over $1 trillion on administrative expenses - while families reel from $27,000 annual premiums and rural hospitals close at record rates.
The Smart Health Infrastructure Alliance is a public-private partnership that enables states to deploy proven digital infrastructure to transform this crisis into lasting advantage. By connecting providers, payers, and patients through neutral, shared utility infrastructure, states can eliminate administrative waste and simultaneously create the secure foundation for AI, precision medicine, and the next generation of healthcare innovation.
Imagine If...
Prior authorization took 3 seconds
No more waiting weeks for approvals. Instant decisions at the point of care.
Your records followed you seamlessly
Medical data owned by you, not trapped in incompatible systems.
Healthcare ran like the internet
Open, instant, and universally accessible infrastructure for all.
$1 trillion went to actual care
Eliminating waste from paperwork and administrative burden.
AI learned from real patient experiences
Preventing disease through insights, not just processing billing codes.
This is no longer hypothetical - it is possible today with shared, open infrastructure.
The $1 Trillion Problem
Healthcare remains frozen in 1980s infrastructure, costing the system and patients dearly:
9 billion faxes annually
Slowing down critical decisions
45% of physician time
Wasted on paperwork instead of patient care
$27,000 annual premiums
Families drowning in healthcare costs
700+ incompatible systems
Each extracting layers of fees
Fragile, brittle infrastructure
System-wide outages from single vendor failures
Research advances slowed
Data trapped in silos, preventing breakthroughs

"We waste half a million dollars a year faxing insurance companies. That's three nurses' salaries. That's our margin. That's the difference between staying open and shutting down." - Rural Hospital CEO
CMS didn't mince words in launching its Interoperability Framework:
"America's healthcare system is plagued by complexity, high costs, and fragmentation - placing strain on patients, providers, and our national budget. Outdated infrastructure and disconnected data have made it harder—not easier - to get quality care and achieve positive long-term outcomes."
The Root Cause: Three Digital Islands That Don't Connect
Clinical Data
Trapped in Electronic Health Records (EHRs) that don't communicate
Payment Systems
Built on fragile 1980s technology that can't see medical context
Patient Access
Locked out of their own information, treated as afterthoughts

The Absurd Result: "Hey Doc, we'd love to approve your prior authorization. Can you fax us the clinical notes?"
The Solution: A Three-Way Digital Hub Connecting Providers, Payers AND Patients
Connect once and reach everyone.
Every other major industry has already transformed through shared infrastructure:
Payments
From paper checks → VISA/Mastercard → instant global commerce
Travel
From travel agents → Expedia/Kayak → book anything instantly
Banking
From paper ledgers → ACH/SWIFT → instant transfers
Each transformation delivered 90%+ efficiency gains. Healthcare is the last holdout.
Just as VISA created a neutral network connecting banks, merchants, and consumers, healthcare needs neutral infrastructure connecting providers, payers, and patients.
Benefits for Everyone
For Providers
  • Prior authorizations in minutes , not days
  • Claims adjudicated in seconds, not weeks
  • Up to 70% reductions in administrative burden
For Payers
  • 90% reduction in manual processes
  • Instant coordination of benefits
  • Real-time fraud and abuse detection
  • Automated quality measurement
For Patients
  • See all your health data in one place
  • Track every authorization and claim
  • Manage your healthcare proactively
  • No more playing telephone between doctors and insurers
Meet Maria
Maria needs an MRI for persistent back pain.
Today: three weeks of phone calls, faxes, and uncertainty while her pain continues.
With Smart Health Infrastructure: approved in 30 seconds with transparent pricing, scheduled that afternoon.
Modern Secure Infrastructure Proven at Scale
68M+
Lives Connected
across multiple states
99.93%
Claims Success
in under 5 seconds
$3.36-$5.75
Provider Savings
per claim
$0.57-$1.65
Payer Savings
per claim
These aren't projections, they're documented results from leading health systems and health plans.

Sustained through a simple utility fee with proven ROI:
  • 0.05% of revenues for payers & providers
  • Free for patients forever
Building on the HIE Foundation
In many states, Health Information Exchanges provide the connectivity backbone for clinical data sharing. The Alliance completes this infrastructure by adding three critical components:
Administrative Transactions
HIEs move clinical documents. The Alliance adds business transactions—claims, prior authorizations, eligibility - creating complete infrastructure.
Patient Access
Traditional HIEs serve providers and payers. The Alliance includes patients as active participants with full visibility into their health data and transactions.
Sustainable Revenue
The simple utility fee sustains both new infrastructure and existing HIE capacity, reducing reliance on cyclical grants.
The model leverages existing investments while ensuring permanent sustainability.
State Leadership
States are the only entities with the authority to convene all stakeholders - public and private - into shared infrastructure.
Healthcare transformation requires every stakeholder at the table. Providers need sustainable operations. Insurers need efficient processes. Employers need predictable costs. Patients need access and transparency. Governors can bring together these diverse interests - from rural hospitals to urban health systems, from Medicaid to commercial insurers - to adopt shared, open infrastructure that benefits everyone.
When States Unite Their Healthcare Ecosystem:
  • Rural hospitals survive: Administrative savings become operating margins
  • Physicians practice medicine: Less paperwork, more patient care
  • Businesses compete: Predictable healthcare costs attract and retain workforce
  • Families breathe easier: Efficient systems stabilize premiums
  • Communities flourish: Healthcare infrastructure drives economic vitality
A Platform for Innovation: Where AI and Prevention Finally Work
This infrastructure doesn't just cut costs - it becomes the platform for healthcare's future. When data flows seamlessly through neutral, open infrastructure:
AI can actually deliver
Machine learning needs comprehensive data to predict health risks and personalize care. Without infrastructure, AI is blind.
Prevention becomes possible
Track patterns across populations, identify at-risk patients, intervene before crisis - but only if systems connect.
Innovation explodes
Startups can plug into one infrastructure instead of building connections to thousands of separate systems.
Value-based care succeeds
Finally measure outcomes across the full care journey, not fragments.
The same infrastructure that saves rural hospitals today enables the breakthroughs of tomorrow.
Governance Built for Perpetual Independence, Neutrality & Sustainability
The Neutral Operator
Smart Health Network operates as a Public Benefit Corporation - legally required to balance public mission with sustainability. The "No Raw Data" Rule prohibits accessing or monetizing patient data.
The Mission Guardian
An independent Benefit Trust governs the PBC, ensuring it remains true to its public mission. The Trust holds "Golden Share" rights preventing any sale or merger, keeping the network as a permanent public utility.
Multi-Stakeholder Governance
Governance is structured to ensure representation across all sectors of healthcare:
Members' Council
patients and families
Provider Council
physicians, nurses, clinicians
Care Delivery Organizations Council
health systems, medical groups, FQHCs
Payer Council
insurers, employers, government payers
Public Health Council
health departments, community health
Research Council
academic centers, researchers
Technology & Innovation Council
digital health, EHRs, cloud & AI platforms
State Advisory Councils
local stakeholder input and compliance oversight
This structure ensures the infrastructure serves everyone equally - permanently.
The Moment of Decision
Three forces converging:
Skyrocketing health costs demanding action
Historic federal RHTP investment
Proven, deployable infrastructure ready at scale
States can continue operating in isolation - watching rural hospitals close while families drown in premium increases and doctors flee the profession. Or states can work together, building shared infrastructure that connects across state lines while preserving state sovereignty.
Every other industry transformed by building shared, open digital infrastructure. Healthcare's time has come.
The Fax Machine Era is Over.
Join the Alliance
Ready to transform healthcare in your state?
The Smart Health Infrastructure Alliance invites state leaders, healthcare organizations, and all stakeholders committed to a more efficient, equitable, and innovative healthcare future to connect with us. We are building a permanent public utility for health information – a shared, open infrastructure that benefits everyone.
Email: info@smartpbc.net
Contact Us
© Smart Health Network PBC 2025