Control Your Destiny: A Conversation with Sara Thomas, VP of Payer Solutions

Uncovering Quiet Problems with Huge Cost Implications: Q&A with Sara Thomas

Amanda Bair: You came into this role from brand and growth strategy for startups, not from the payer side. What was the hardest part about ramping into payment integrity? 

Sara Thomas: The steepest learning curve was understanding how payment integrity actually works inside a health plan — the terminology, the dependencies between people and systems, the vendor landscape.

But more than that, I realized early on that there’s a massive difference between explaining what a solution does and understanding what it takes for an organization to actually implement it successfully. I was really drawn to the people and process pieces, not just the technology.

I remember being fascinated by one of our early soundbites: we took a 47-step process down to seven steps with Pareo. Having worked with many different businesses, I knew that was more than just greater efficiency. It was a signal of significant complexity and fragmentation on one side, and dramatic transformation on the other.

While payment integrity has its own complexities, many of the underlying organizational challenges are familiar. Pressure to do more with less, disconnected information, and work that gets stuck between teams or systems. That makes the problems our customers face feel relatable.

Across the business I’ve helped build, I’ve approached growth holistically – asking how the pieces connect and how the work translates into actual value for stakeholders. That experience helps me understand the pressures a PI leader faces, ask better questions, and see dependencies that might otherwise be missed.

AB: You’re in almost every major conversation with PI leaders getting introduced to Pareo®. What’s the question you’re really hearing underneath all the noise about admin costs and med savings?

ST: The underlying question is: how do I get more value from the resources I already have? And how do I know where to focus next?

When I engage a PI leader, the conversation often starts with the result: total savings, admin cost to savings ratio, basic ROI. But then it goes deeper. It becomes about visibility. When you say you’re saving $20 million, what concept generated that? What’s actually driving those results? And what’s the level of effort involved? Not just the admin cost, but the operational complexity.

A lot of PI leaders are working across three, five, sometimes ten different systems. They need to know what’s producing their results. They need to be able to speak about it elegantly to their executives. And they need to know where the next opportunity is.
But here’s what surprised me: many leaders don’t actually know. They can tell you what the number is, but they can’t tell you why. That’s a different problem than most vendors assume.

I had an example of this recently. A PI leader was tasked with a common challenge: find additional savings without increasing admin expense. As we analyzed their program, we found they couldn’t see where their post-pay inventory was sitting at any given time. All the claims tagged for review were scattered across spreadsheets. It took a team member weeks to figure out where they stood.

That seemed like a small visibility problem. But when we dug deeper, we found $3 million in viable recoveries just sitting there waiting for approval — money they could recoup immediately. Even tougher, $10 million a year was aging out of recovery windows entirely.

The leader wasn’t surprised that the problem existed. They felt it. But they didn’t have language or quantification for it. And they definitely didn’t realize the dollar impact.

Most of these are quiet problems, not loud ones. Loud problems are angry providers or ASO customers questioning your value or executives pounding you on costs. Quiet problems sit like an iceberg underneath. You see the top, but there’s usually something massive you’re not seeing.

AB: Every vendor is claiming they have an “operating platform” now. How do you actually separate the real deal from the marketing noise?

ST: This one frustrates me. The term is so misused, it’s confusing. It’s polluting the market.

If you’re a PI leader hearing this claim from vendors, ask them to walk through a real workflow from beginning to end. Because an operating platform is fundamentally a connected process you can manage around. Then ask: what happens if there’s an exception? How configurable is this? Who uses it? Where does the outcome live? How easy is it to see?

But here’s the critical question: was this technology built for you or for them?

Different vendors have different goals associated with your relationship with them. One vendor might need you to have fast access to their inventory. Another might want you to work exclusively with them. That’s not necessarily wrong; it’s just context you need. Because it changes whether their solution actually solves your problem.

When someone says “operating platform,” follow your problem, not the solution. Do you need more access to a specific vendor’s work? Do you want to work with one vendor or multiple? Would you rather have one true operating system or three different platforms?

I use the smartphone analogy: I don’t have three smartphones. I have one. It has apps from third-party companies. That’s an operating system to me.

One caution: some vendors will say, “Yes, it’s our operating platform, but you can connect other systems or vendors to it.” Before you believe that, ask how neutral is that platform? How aligned are their business interests with yours? A connection is more than just a data feed. It’s about whether both companies actually want it to work — and whether their incentives are aligned.

AB: What surprised you most about how decisions actually get made inside health plans?

ST: How much work a buyer has to do internally to move a decision forward, even when value is clearly recognized.

One health plan described it to me as a “Shark Tank” experience. And that stuck with me.

The most successful buyers I work with do a lot of upfront diligence. They bring their teams in. They ask good questions. They set a clear vision internally. Not just “we’re adopting new technology,” but “this is one piece of a bigger initiative.” Maybe that initiative is making work meaningful. Maybe it’s right-sizing admin costs. Maybe it’s shifting the outsource-insource balance, or working with best-in-class vendors.

When that vision is clear, everyone understands why the decision matters. Then they invest time in discovery. They understand current state. They convince their team members to get behind it.

By the time they’re making the business case, they already have all the pieces. Implementation requirements. Stakeholder landscape. Expected outcomes. That part becomes easy.

What’s also critical: PI leaders sometimes underestimate how much they need to educate other parts of the business. You might be used to making cases for services vendors, but making a case for technology is different. You need to talk to provider relations. You need to talk to claims operations. You’re not just buying a third-party service anymore. You’re connecting systems and creating operational change across the organization.

The vendors who assume decisions are based purely on ROI and happen quickly are usually wrong.

AB: When compliance shifts come up — IDR, AI-assisted coding, the latest hot topic — how should PI leaders think about them differently?

ST: The first thing is to understand what changes. Does it change volume or complexity? Usually yes to both. But here’s where leaders get reactive: there’s pressure to solve it right now. There’s urgency. It feels like a fire.

But there’s a better approach. Look at the operational perspective. Does this call for a focused process or a specialized capability? Think about people, process, and technology together. Structure your response around that.

The reason this matters: if you don’t have true visibility into your operations — if you’re not already seeing trends — compliance shifts can blindside you. But if you’re operating from a platform that shows you what’s happening, you have context. You can anticipate. You’re not just reacting.

I’d advocate for upfront diligence and analysis before rushing to solutions. It takes discipline when everything feels urgent. But that’s when the best decisions get made.

Conclusion

After spending years building businesses and now watching dozens of health plans navigate payment integrity strategy, Sara Thomas understands something most vendors miss: the question behind the question isn’t about features. It’s about control. It’s about visibility. It’s about knowing where you stand compared to peers who face the same pressures you do.

The PI leaders she sees win are the ones who don’t get reactive. They ask hard questions of vendors. They do the work internally to set vision. They think operationally, not just tactically.

And they understand that in a market drowning in noise, real operating platforms are built with their interests — not the vendor’s — at the center.