Payers are looking to stand out in a difficult market. : An interesting trend is emerging in the health care world: Startups are starting to target insurers, or payers, as their first choice of partners. This was unthinkable eight years ago, when a wave of startups formed after the passage of the Affordable Care Act (ACA). But today, startups providing end-to-end health services to insurers are becoming an essential component of our care delivery system.