Inside the Foundry and Factory model that’s helping payers drive efficient operations, consistent decisions, and better care.
Behind every healthcare claim, authorization, and member interaction lies a dense web of rules and workflows that payers must navigate every day. Over time, those layers of complexity have made it increasingly difficult for health plans to move quickly, ensure consistency, and maintain transparency across their operations.
Boost Health AI, a venture launched by Chicago-based healthcare digital consultancy Productive Edge, is working to change that. Instead of layering on new tools, the company helps payers modernize from within, transforming operational complexity into intelligence that improves efficiency, outcomes, and overall quality of care.
Transforming the Payer Operating Model
Health plans have invested heavily in data and technology over the past decade, yet many still struggle to connect strategy to execution. Rules sit in documents and policy manuals; data lives in multiple systems; institutional knowledge resides in people’s heads. The result is a fragmented operating environment where even small process changes require disproportionate effort.
“Every payer we meet is managing enormous complexity,” says Raheel Retiwalla, Chief Product Officer of Boost Health AI. “The underlying logic is there, it’s just scattered. We built Boost to unify that logic and make it actionable, consistent, and efficient.”
At the center of that effort is the Boost Health AI Foundry, a library of reusable building blocks for healthcare-trained AI. Inside the Foundry are Agents, Solution Blueprints, and Decision Packs that work together to turn complex payer policies, contracts, and guidelines into structured, explainable intelligence that organizations can own and control. The Foundry enables payers to “build once and reuse everywhere,” ensuring consistent, compliant decision logic across care management, utilization management, claims, and other operational workflows.
The Foundry + Factory Model
Boost’s model pairs the Foundry with what it calls the Healthcare AI Factory, Productive Edge’s delivery organization that implements and activates these capabilities inside payer environments.
“The Foundry defines what can be built,” Retiwalla explains. “The Factory builds it, using our healthcare experts and engineering teams to bring those frameworks to life quickly and responsibly.”
Together, they form a closed loop between innovation and execution. The Foundry establishes the standards, governance, and shared infrastructure for intelligent operations, while the Factory ensures those designs deliver measurable outcomes in production.
This combination allows payers to scale AI safely, not as isolated pilots or vendor experiments, but as a managed capability that spans departments and evolves over time.
Efficiency, Clarity, and Control
For many health plans, efficiency gains have historically come at the cost of transparency. Automation and outsourcing can streamline work but often create black boxes in the process. Boost’s model takes the opposite approach: it emphasizes explainability and control.
“Efficiency without clarity eventually creates risk,” Retiwalla says. “Our goal is to make efficiency and clarity work together so payers can see how every decision is made and continuously improve it.”
Each capability built through the Foundry is governed, documented, and auditable. The result is automation that leaders can trust—a system that not only accelerates processes but also strengthens compliance and oversight.
Owning the AI Future
The philosophy behind Boost reflects a broader shift happening across industries: organizations want to own their AI capabilities, not just rent them. Instead of depending on proprietary vendor platforms, Boost enables payers to license and extend its frameworks, building a foundation they control and can adapt over time.
“We believe payers should have sovereignty over their intelligence,” Retiwalla says. “When you own the framework, you can evolve it as technology changes. You’re not waiting on someone else’s roadmap.”
That sense of ownership is increasingly important in an era when AI models, regulations, and risks evolve at a rapid pace. By maintaining control of their data, logic, and infrastructure, payers can respond to change faster and with greater confidence.
Early Impact
Boost Health AI’s first implementations have focused on care management and utilization management, areas where administrative complexity directly affects member outcomes and provider experience. Early projects have shown measurable improvements in turnaround times, data accuracy, and coordination between clinical and operational teams.
“What’s powerful isn’t just automation,” Retiwalla says. “It’s alignment. When every function works from the same intelligent foundation, people spend less time reconciling systems and more time improving care.”
Looking Ahead
The company’s ambitions reach beyond efficiency. Boost and Productive Edge see an opportunity to help health plans establish a lasting foundation for responsible, auditable AI—one that balances innovation with governance and ties operational improvement back to its ultimate purpose: better care delivery and member outcomes.
Retiwalla summarizes the vision simply: “Payers don’t need another application. They need an operating system for intelligence that helps their existing systems work together cohesively.”
As healthcare organizations face growing cost pressures and rising expectations for transparency, that operating-system mindset could mark a turning point. By transforming administrative complexity into intelligence that improves outcomes, efficiency, and care, Boost Health AI is redefining what operational excellence can look like in the modern healthcare enterprise.
At a time when AI often promises disruption without accountability, Boost Health AI’s Foundry offers a more grounded path forward—one built on clarity, efficiency, ownership, and trust.
