Administrative Burden
Prior authorization, utilization management, care management, and provider operations create manual work that slows care and consumes operating capacity.
Transformation & program recovery
Find out where your transformation is actually failing.
Todd Kovalsky is an independent transformation and program recovery advisor for healthcare and regulated operations. He has led delivery and modernization inside Fortune 5 healthcare, Apollo, and Goldman Sachs and JPMorgan asset management. He finds where large initiatives are actually failing, who carries the risk, and what to fix first, backed by evidence you can inspect.
Strategy
Define the executive decision and the operating problem it must resolve.
Operating Model
Design how decisions, ownership, and work should actually run.
Product
Build the AI-enabled systems the operating model requires.
Implementation
Put it into production with human control and measurable adoption.
20+ years in regulated operations
- Apollo Global Management, Leveraged loan and REIT operations through the post-2008 cycle
- Sapient, Platform transformation for Goldman Sachs AM and JPMorgan AM
- FolioDynamix, Wealth platform product ownership through Envestnet acquisition
- ELLKAY, CMS Cures Act / FHIR interoperability platform for payers
- Cognizant, Fortune 5 healthcare transformation, AI & analytics
- Full career record
The Operating Problem
Complex operations don't fail from bad strategy. They fail between strategy and execution.
The gap usually lives in the handoff from executive decision to operating model to system to daily work. That is where capacity disappears, customers wait, revenue leaks, and leaders lose the ability to act with confidence.
- Operational bottlenecks
- Slow or unclear decisions
- Key-person dependency
- Revenue and capacity leakage
- Transformation spend without operational improvement
Transformation Recovery
Modernization programs can report progress while dependency risk, decision latency, and adoption gaps accumulate between teams.
Key-Person Dependency
Critical knowledge lives in a few key people. When they are overloaded, unavailable, or leave, execution slows down.
Operational Visibility Gaps
Reports show activity and status, but they do not show where work is stuck, who owns the next decision, or which risk needs attention.
Workflow Friction
Teams spend time reconciling status, chasing handoffs, and managing work instead of advancing work.
AI Without Operational Control
AI can summarize or draft, but it does not become trusted healthcare execution unless human approval, workflow fit, and decision rights are designed in.
Anonymized enterprise proof
Prior Authorization Workflow Modernization
Administrative review burden persisted because workflow, decision rights, compliance, and human review tiers were not redesigned together.
Evidence scope: Healthcare operating experience across prior authorization, utilization management, compliance logic, and payer/provider workflow complexity.
View selected workAnonymized enterprise proof
Enterprise Program Recovery
A large modernization program risked execution failure because dependency complexity and executive visibility gaps were not fully exposed.
Evidence scope: Program scope spanned claims, care management, eligibility, provider operations, and clinical workflow dependencies across a multi-workstream enterprise portfolio.
View selected workHow TKO works
Assessment first, then only the work the evidence supports.
TKO diagnoses where the initiative is failing before recommending a fix. When deeper work is warranted it runs across four stages, strategy, operating model, product, and implementation, but the default first step is a bounded assessment, not a full program.
01
Strategy
Name the executive decision and the operating problem it has to resolve.
02
Operating Model
Define decision rights, ownership, escalation, and how work should actually run.
03
Product
Build the AI-enabled systems the operating model requires, not a generic platform.
04
Implementation
Put it into production with human control, adoption, and measurable results.
Method & Evidence Proof
RachelOS: proof the evidence method holds in production.
RachelOS is the reference implementation of how TKO works, not the product TKO sells. It is a live system, built and audited in public, where every capability is graded implemented, activated, validated, or unvalidated. It shows the same evidence discipline TKO brings to a transformation or program assessment. What transfers is the method and its governance, not the software.
Review the RachelOS evidenceWhy this matters outside real estate
Healthcare Background
The same failure pattern appears wherever executive strategy crosses teams.
Healthcare transformation, complex service delivery, and enterprise operations all expose the same problem: strategy is set, but the operating model, product, and implementation needed to carry it out never fully arrive.
Advisory background
Healthcare Transformation
Prior authorization redesign, care-management modernization, and interoperability work show why the same operating pattern matters where administrative burden, exception handling, auditability, and multi-team dependencies are real constraints.
Operating lesson: Identify the dependency, make the decision path explicit, and build only after the operating truth is visible.
Review the proof registryWhy TKO
Most programs do not fail for lack of a plan. They fail where the work crosses teams.
Status reports show green while risk accumulates between workstreams. TKO finds where the work is actually stuck, who owns the next decision, and what to fix before more budget is committed.
AI matters only when it improves a real workflow with clear ownership and human accountability. It is one tool among several, never the reason to engage TKO.
Engagement Path
Engagement starts small and sequential: assessment first, build only when the case is clear.
Every engagement begins with a fixed-scope assessment of the operating problem and the decision it is blocking. Deeper work follows only when the evidence supports it.
Step 1 · Assessment
Operational Recovery Assessment
- Duration
- 1 week
- Investment
- $5K-$8K
A focused assessment for leaders who need to find the bottleneck, business exposure, and highest-leverage next move before committing to a larger solution.
Outcome: Evidence-based view of the top places work stalls.
View assessmentStep 2 · Diagnostic
Operational Truth Diagnostic
- Duration
- 2-3 weeks
- Investment
- $15K-$30K
A focused diagnostic for leaders who need to understand what is reducing performance before committing to a larger transformation or technology investment.
Outcome: Clear view of where work stalls, why decisions slow down, and what friction is costing the team.
View diagnosticStep 3 · Build
Operating System Build Sprint
- Duration
- 6-12 weeks
- Investment
- $45K-$150K
Design and implementation support for the operating system that turns fragmented work into clear priorities, accountable action, and measurable improvement.
Outcome: Working operating system for one or two high-value workflow areas.
View buildStep 4 · Advisory
Fractional Operational Intelligence Advisor
- Duration
- 3-6 months
- Investment
- $12K-$25K / month
Ongoing operating support for leadership teams that need to improve execution, remove constraints, and keep transformation tied to business results.
Outcome: Leadership has a trusted operating view of priorities, risks, and required decisions.
View advisory
Executive operating review
Bring the initiative that is not landing.
Describe the transformation, program, or workflow under pressure. TKO will help determine where execution is breaking down and what deserves action first.