Senior healthcare AI and data leadership, on a fractional basis.
Architecture decisions, team development, vendor evaluation, clinical AI governance, and investor-ready technical narratives. Designed for healthtech founders pre and post product-market fit, health systems and ACOs building an internal AI practice, and boutique healthcare consultancies that need senior subcontracting capacity on specific engagements.
When a fractional CTO outperforms a full-time hire
Most early healthtech companies, mid-stage health systems, and boutique consultancies do not need a full-time CTO. They need senior judgment on a recurring cadence: weekly architecture review, monthly vendor evaluation, quarterly board prep, and the occasional critical-path moment that benefits from outside depth. Hiring full-time for that pattern overshoots the need by a factor of four and recruits against a candidate pool that is shallow, expensive, and slow.
Fractional engagements align cost with actual value created. They also bring a wider lens, because a fractional CTO has visibility into 8 to 15 contemporaneous engagements and knows which patterns are working in the market right now. The full-time CTO you hire today knows the industry as of their last role, which may be 12 or 24 months stale by the time their offer-to-onboarding cycle completes.
What the engagement actually looks like
Four pillars, sized to the engagement. We do all four for most clients, weighted to where the leverage is highest at the time.
Architecture and technology decisions
Recurring architecture review. Vendor evaluation. Build versus buy framing. AI model and platform selection. Healthcare data architecture decisions specifically (FHIR, PHI governance, lakehouse, clinical AI evaluation). Decisions documented for the team and for future leadership.
Team development and hiring
Senior engineering hiring loop participation. Technical mentorship for your senior engineers. Capability building specifically around healthcare data, FHIR, clinical AI, and Microsoft cloud. Helping you grow the engineer who will eventually take the full-time CTO role.
Investor and board preparation
Investor-ready technical narrative. Due-diligence preparation for Series A through C. Board-deck technical sections. Roadmap credibility review. We have sat in due diligence sessions and can shape the narrative ahead of time.
Clinical AI governance and compliance
Clinical AI evaluation frameworks, model risk management, HIPAA-aligned operations, RADV-defensibility for risk adjustment workflows, payer audit preparation. The governance layer that healthcare buyers and regulators expect, packaged in a way your team can operate.
How we deliver
Embedded enough to be useful, lightweight enough to scale. Every engagement starts with a defined scope and an exit plan.
- 01
Discovery and engagement scoping (1 to 2 weeks)
Understand the company shape, current technical state, the next 12 months of pressure, and the gap a fractional CTO is filling. Output: scoped engagement (cadence, scope, retainer, exit conditions) plus a 90-day plan with decision points your team and our team both commit to.
- 02
First 30 days, embed and stabilize
Recurring cadence established (typically a weekly working session, biweekly architecture review, monthly board or leadership sync). Top three immediate decisions identified and worked through. Team meets and starts building working relationships. Communication channels in place.
- 03
Days 31 to 90, the leverage period
The critical decisions and capability builds happen here. Vendor selection if applicable. First-round architecture decisions documented. Hiring loop adjustments. Initial board or investor prep. By day 90 the engagement has produced concrete outputs your leadership can point to.
- 04
Months 4 to 12, sustained operating cadence
Ongoing recurring cadence. Vendor and capability evaluations as they come. Board cycles supported. Continuous mentorship for your senior engineering staff. The work compounds because the relationships compound.
- 05
Exit or transition
Every engagement has a defined exit. Either a full-time CTO is hired (we help in the loop and transition), the engagement winds down to lighter advisory, or it sustains at current cadence by mutual agreement. Knowledge transfer documented before exit.
What you get
- Senior healthcare AI and data leadership at fractional cost
- Recurring working cadence (weekly, biweekly, or monthly)
- Architecture decisions documented for team and leadership
- Vendor evaluations with defensible build-versus-buy framing
- Investor and board preparation for healthtech founders
- Hiring loop participation for senior engineering roles
- Mentorship for your senior engineers (the future CTO bench)
- Clinical AI governance and compliance posture documentation
- FHIR, EHR, and Microsoft cloud architecture depth
- Defined engagement scope, retainer pricing, and exit plan
When to engage us
You are a healthtech founder pre or post Series A
Product-market fit is forming, the architecture decisions you make this year compound for three years, and the full-time CTO hire is 12 to 18 months away. Fractional bridges that gap and de-risks the eventual hire.
You are a health system or ACO building AI capacity
Internal AI practice in stand-up mode. Need senior depth during the first 12 to 24 months while you recruit or develop permanent leadership. Fractional reduces the cost of getting the architecture right the first time.
You are a boutique healthcare consultancy
You won an engagement that requires senior healthcare-AI capacity you do not have on bench. Subcontract us for the engagement. White-label or co-branded as your scope dictates.
You are between full-time CTOs
Gap-filling between hires. Continuity for the engineering team. Defensible technical posture for the board during the transition. Hand-off to the new CTO when they arrive.
Pitfalls we see in fractional CTO engagements gone sideways
- Treating fractional as full-time at a discount. A fractional CTO is not a part-time engineering manager. Define the leverage points up front or you get neither operating value nor cost savings.
- No exit plan. Engagements that drift end up resented on both sides. Quarterly review of fit and a stated exit plan keeps the relationship clean.
- Skipping the engineering-leader buy-in. If your existing engineering leader is not bought in, the fractional CTO is a friction point. Get the buy-in first or redesign the engagement.
- Generic advisor versus operator. Healthcare AI requires operating depth (FHIR, clinical AI, HIPAA, payer dynamics). A general fractional CTO without that depth will spend the engagement learning instead of leveraging.
- No documentation discipline. Decisions and architecture not documented during the engagement walk out the door at exit. Documentation cadence is part of the engagement, not optional.
Related reading
FHIR integration consulting
FHIR architecture decisions are some of the most consequential a healthtech CTO makes. We bring depth to that conversation.
ACO data platform consulting
Health systems and ACOs building an internal data practice often start with an architecture review under fractional advisory.
GenAI and AI agents in healthcare
Generative AI strategy and clinical evaluation frameworks are increasingly part of the fractional CTO scope.
Frequently asked questions
Who is a fractional CTO actually for?
Three patterns. Healthtech founders who have product-market fit but cannot yet justify a $400k all-in full-time CTO compensation package. Health systems and ACOs building an AI practice that needs senior leadership during the first 12 to 24 months while permanent leadership is recruited or developed. Boutique healthcare consultancies that win an engagement requiring senior healthcare-AI capacity they do not have on bench. We work in all three modes and tailor the engagement shape accordingly.
How much time do you actually commit, and how is it priced?
Engagements range from one day per week (lightweight advisory, board prep, vendor evaluation) to three days per week (deep operating involvement). Pricing is monthly retainer based on the committed scope, not hourly billing. Healthtech engagements typically run 6 to 18 months. Health-system engagements typically run 12 to 24 months. Consultancy subcontract engagements are scoped per project.
Will you write code or run a team?
We do not full-time-manage your engineers. We do code-review, architect, mentor your senior staff, run technical decision meetings, drive vendor evaluations, and step in on critical path work where senior judgement matters more than headcount. The team management line stays with your full-time leadership or with the senior engineer we help develop into the role.
Can a fractional CTO sign off on technical decisions for funding rounds or due diligence?
Yes, and this is one of the more common reasons healthtech founders engage us. Investor-ready technical narrative, due-diligence preparation, architecture defensibility, AI strategy and governance positioning, and roadmap credibility are all standard scope. We have sat in due diligence sessions for Series A through C healthtech raises.
How does this work alongside our existing engineering leadership?
Cleanly. The framing matters. Your engineering leader stays accountable for delivery and team. We bring senior healthcare AI and data depth where they do not have it, run the architecture decisions that benefit from a wider lens, and provide a peer relationship that compresses learning curves. The healthiest engagements have your engineering leader as the primary working partner.
What about non-compete and conflicts of interest?
We do not take on engagements with directly competing healthtech products or directly competing ACO operators. We do work with multiple clients in adjacent spaces (e.g. an ACO and a healthtech vendor that sells to ACOs) where conflict is structural rather than direct, and we are transparent about adjacencies up front. Conflict-of-interest review is part of every engagement scope.
Let's talk about your value-based care project.
Working on a value-based care contract, ACCESS Model application, EHR integration, or AI-enabled clinical workflow project? Book a 20-minute discovery call or email [email protected].