Health insurance companies process millions of decisions every year: claims, authorizations, coverage reviews. Most of that work still runs on rules buried in documents no computer can easily read. Boost Health AI, a Chicago-based company that launched in October 2025, thinks it has found a smarter path through that mess. It starts with a question the industry has largely ignored: who actually owns the AI?
The Control Problem Nobody Talks About
Most health plans that adopt AI today do so by subscribing to a vendor’s platform. The vendor hosts the technology, sets the update schedule, and holds the underlying logic. When the contract ends or the vendor pivots, the health plan starts over. That dependency has quietly accumulated across the industry for years, and it is now colliding with a moment when AI sits inside prior authorization workflows, claims adjudication, and care management decisions affecting real patients.
Boost CEO Wyatt Kapastin built the company’s model around rejecting that dependency. Rather than selling access to a hosted platform, Boost licenses its technology as perpetual, extensible IP. The health plan owns it, runs it in its own environment, and can modify it independently. No ongoing subscription fees. No waiting on a vendor’s release cycle.
“We believe payers should have sovereignty over their intelligence,” said Raheel Retiwalla, the company’s Chief Product Officer. “When you own the framework, you can evolve it as technology changes. You’re not waiting on someone else’s roadmap.”
Rules That Machines Can Finally Read
The deeper problem Boost targets is less about ownership and more about legibility. Every coverage decision a health plan makes traces back to a rule: a policy clause, a contract term, a clinical guideline. Those rules are real and specific. They are also written for humans, stored in PDFs, and interpreted differently by different staff members across different departments. The result is inconsistency at scale, where the same request gets handled two ways, by two teams, on the same day.
Boost’s core product, the AI Foundry, converts those documents into what the company calls machine-readable, auditable intelligence. AI Agents extract the logic from policies and contracts. That logic feeds into pre-built workflow templates covering claims processing, utilization management, and compliance validation. Each decision the system produces carries citations, versioning, and a traceable audit trail.
That audit trail matters more than it might appear. A 2024 Senate investigation found that Medicare Advantage insurers used algorithmic tools to deny patients post-acute care at troubling rates. Health plans that cannot explain how a denial was reached face growing legal and reputational exposure as regulators sharpen their scrutiny of AI in coverage decisions.
A Seven-Month-Old Company Entering a $46 Billion Race
Boost is early-stage by any measure. The company has not disclosed named clients, funding, or revenue. Its first live deployments targeted care management and utilization management, two areas where administrative friction directly slows patient care. Early results, according to the company, include faster turnaround times and improved coordination between clinical and operational teams. Independent verification of those claims is not yet publicly available.
The market it has entered is moving fast regardless. The global AI for healthcare payer market is projected to grow from $5.7 billion in 2025 to $46.67 billion by 2035. Competitors include Oracle Health, Microsoft Nuance, and a growing field of well-funded startups. Boost’s differentiator, perpetual IP ownership over subscription dependency, is a coherent argument. Whether large health plans, long accustomed to managed SaaS relationships, will embrace the operational responsibility that true ownership requires is the question the next few years will answer.
“Payers don’t need another application,” Retiwalla said. “They need an operating system for intelligence that helps their existing systems work together cohesively.”
That framing, infrastructure over application, ownership over access, is either ahead of its time or precisely on time. The payer AI market, under regulatory pressure and financial strain, may be ready to find out.
