ZKELETON
// Payer-side infrastructure

Your data. Your environment. Your terms.

Zkeleton builds a private environment inside your own VPC where your data finally works for you. Raw PHI never leaves. Core systems are never touched.

Runtime //AWS VPCAzure VNetGCP VPCOn-Prem
Host environment//Live architecture
Zkeleton host environment diagram, compact viewPayer VPC boundary with the Zkeleton bubble at center, value returning upward to your teams, and four logged gates where external flows cross the boundary. The legend below lists each party and what crosses.PAYER VPCYour teamsZKELETONvalue returns.1.2.3.4
.1 Existing vendors: governed export out
.2 Evidence studies: queries in, aggregates out
.3 Resident workloads: compute in, results out
.4 Device + digital health: consented data in, proof out
value returns to Your teams

// CMS-0057 Context

Receiving the data is not the same as using it.

The Payer-to-Payer Data Exchange mandate requires every US payer to receive five years of member clinical history by January 1, 2027. Most payers will build pipes to ingest this data for compliance. The data itself remains unstructured, unmatched, and unmerged with claims or authorization context.

2027
// CMS-0057 enforcement date

// How it works

A parallel flow in your own VPC.

YOUR VPCCMS-0057clinical exchangeCompliance pipeyour existing build→ adjudication, MLR, auditZKELETON BUBBLENormalize → Match → Merge+ claims + member + auth historyvalue returnsIntelligencepayer teamszero new connections
.01

Ingest from compliance

Zkeleton attaches to your existing CMS-0057 data stream. No new external connections. No new data rights.

.02

Normalize and match

Raw clinical data is normalized against a common schema and probabilistically matched to your member records.

.03

Unify with history

Matched clinical data merges with your claims and prior authorization history into a single dataset inside the bubble.

.04

Payer-owned analysis

The unified data lives inside a bubble in your VPC. Your teams use it for their own analytics. Intelligence leaves the bubble. Raw clinical data does not.

.05

The environment opens

Once the dataset exists, the bubble becomes a place others connect to, on your terms.

The environment opensConnection docks appear around the Zkeleton bubbleZKELETON

// Inside the bubble

What unified clinical data unlocks.

// FRAUD & WASTE

Full clinical context on every claim

Match procedure codes against clinical evidence. Surface billed services without corresponding clinical documentation.

// RISK ADJUSTMENT

Accurate HCC capture from source records

Identify chronic conditions from clinical data, not just claims. Close the gap between what was documented and what was coded.

// CARE GAPS

HEDIS measures against unified member data

Cross-reference clinical history with claims to catch missing screenings, uncontrolled chronic conditions, and follow-up lapses before the measure closes.

// PRIOR AUTH

Context-aware authorization review

Reviewers see the full longitudinal clinical picture, not just the faxed prior-auth request. Faster approvals where clinical justification is clear.

// AI ENABLEMENT

Payer-owned models on unified data

Run your models against the merged dataset inside the bubble. No data leaves. No vendor cloud retention. Payer policies govern every query.

// EXTENSIBLE

Use cases expand with the dataset. Anything a payer can build on a unified clinical and claims view.


// The environment

What your environment can host.

Once the bubble exists, it becomes the place others come to work, on your terms, at your pace, with every byte logged.

What your environment can host, simplified viewThe Zkeleton environment sits inside a gated boundary with audit ticks at every port. Below it, four relationships: existing vendors receive a governed export, resident workloads bring compute in and send results out, evidence studies send queries in and receive aggregates out, coverage proof brings consented data in and proof out.YOUR ENVIRONMENTZKELETONgoverned exportcompute inresults// EXISTINGVENDORS// RESIDENTWORKLOADSqueriesaggregatesconsented dataproof// EVIDENCESTUDIES// COVERAGEPROOF
// EXISTING VENDORS

Opaque extracts become governed exports. Your current stack performs better on higher-fidelity data, and you finally see what leaves.

// RESIDENT WORKLOADS

Vendors bring their compute inside the bubble. Results leave. Data never does.

// EVIDENCE STUDIES

Real-world-evidence work runs against your full-fidelity data inside your walls, instead of a broker's copy of it.

// COVERAGE PROOF

Device and digital-health makers contribute member-consented data and prove outcomes on your own population before you cover them.


// Architectural principles

Four asymmetric choices.

Payer-owned data

The unified dataset is your asset. It resides in your infrastructure under your control. Zkeleton operates on it. Zkeleton does not hold it.

Payer-owned VPC

The entire system runs inside your virtual private cloud. Zkeleton is a guest in your infrastructure, not a landlord holding your data in our cloud.

Payer does nothing new

We operate on the data flow you are already mandated to build. No new operational lift. No changes to adjudication, MLR reporting, or audit trails.

One-sided upside

Upside accrues to the payer: fraud catch, risk accuracy, AI enablement. Transformation cost and architectural burden stay with Zkeleton. The bubble runs beside adjudication, not through it. No critical-systems rewrite at pilot.


We are not building an exchange network. Exchange networks aggregate clinical data through shared pipes in a vendor cloud. Zkeleton runs inside each payer's own VPC. No shared pipes. No vendor cloud. No data leaving payer control.

Full-fidelity merged data is why this works and why it cannot be copied: every alternative architecture pushes complete data into shared or core systems, which is exactly what payers are right to refuse.