Jia Jia Ye

FORCING CHANGE IN SITE OF CARE McKinsey & Company's recent paper on the forces pressuring healthcare, including the possibility of margin compression of up to 13 percentage points for health systems, does a good job of putting numbers around what most operators already feel. Two of the biggest drivers they mention are policy shifts in reimbursement and rising utilization driven by an aging population. The cohort of 70+ year old Americans will grow the fastest over the next 5 years, and it is well established that older patients have more complex needs, more chronic disease, and more touchpoints within the healthcare system. Layer that on top of continued clinical workforce shortages, and the supply-demand gap widens further. From my perspective, optimizing for site of care is the most important lever we have to address this challenge. We can’t quickly reduce how much care older patients need, but we can change where and how services are delivered. Supporting aging patients in lower-cost settings like the home, ambulatory sites, and virtual environments is no longer just a preference or convenience, it’s a necessity. This is where the conversation around site-neutral payments becomes so relevant. CMS is moving quickly in this direction, and hospital outpatient departments (HOPDs) are squarely in the crosshairs. The shift will undoubtedly clamp down further on hospital margins, but it shouldn’t be surprising. We’ve been talking about the demise of HOPD reimbursement for years, and the health systems that will fare best are the ones who are working towards aligning their approach with where patients can be treated safely, efficiently, and at lower cost, rather than relying on legacy reimbursement structures to fill the gap. And just like it doesn’t make sense to try to replicate a hospital or nursing home environment in a patient’s home, we also shouldn’t try to carry the same clinical staffing model into every care setting. Yes, there are non-negotiables when it comes to patient safety and clinical expertise, but there’s also a meaningful opportunity to rethink how teams are built. That means clinicians at every level working at the top of their licenses, thoughtfully involving family members and community resources, and using technology to surround these sites of care with non-clinical operational support. From my health system days, I understand why rising costs, margin pressure, and site-neutral payments feel like threats. While painful, I’m hopeful they can also serve as a positive forcing function, pushing us toward care models that are better aligned with our aging population and the realities of today’s workforce.

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Say you know me without saying it ... "Hey, let's improve healthcare purchasing!" Durable goods, every day disposables, every part of purchasing in healthcare products continues to be broken. Natan Wise and team Conduit Health are improving the spend process for consumers, healthcare providers. This moves $100b in annual spend, but also improves people's lives. You can read our deeper take at XYZ here: https://lnkd.in/gEhfACtB Thrilled to have more money to run with the Drive Capital partnership! And Maybe you want to improve people's everyday lives? Live in NYC? You probably want to work here: https://lnkd.in/gtGEB8Ku

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Nice quote from one of our Partners Andrew Brackin in TechCrunch: “This was one of the biggest use cases of ChatGPT,” Andrew Brackin, a partner at Gradient who invests in health tech, told TechCrunch. “So it makes a lot of sense that they would want to build a more kind of private, secure, optimized version of ChatGPT for these healthcare questions.” https://lnkd.in/gY3TV5VD

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I’m excited to share that Angle Health, founded by former Palantir Technologies execs Tylon (Ty) W. and Anirban Gangopadhyay, has announced an oversubscribed Series B bringing total funding to nearly $200M. I’m proud to be an early investor and to have led this competitive round with the amazing team at Portage. Why we keep leaning in: - 26x revenue growth since the Series A - Serving 3,000+ employers across 44 states - 80%+ renewal rates Angle Health is rebuilding the healthcare benefits infrastructure for SMBs, who employ nearly half of America’s workforce but have historically been shut out of enterprise-grade coverage. Their AI-native platform helps predict risk and deliver better care at a sustainable cost. This is exactly the kind of product-driven, AI-native company we’re proud to support at Mighty Capital.

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Transforming healthcare with AI requires industry. Industry requires capital investment. Capital investment requires return. Return requires revenue. Revenue requires reimbursement. Medicare (and transitively private insurance) reimbursement policy for clinical AI will define the incentives for the technologies we build and deploy over the next decade. Our existing fee for service codes are what the military would call cost-plus contracting. We pay for every nail, screw, and hour of labor and don't care if that was a good and efficient way to build the tank or not. Our CMS Innovation Center director, Abe Sutton, believes cost-plus is the wrong path for the future of American healthcare. ACCESS and VBC models pay for outcomes. When we have AI that can manage heart failure can we link payment to making people healthier? Doing so would unleash the might of American techno-capitalism on exactly the thing we care about in society, but there are devils in the details.

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Bret Anderson has spent 20 years working with hospitals and health systems on the economics of care delivery. His read on IVF was straight-forward on the Inside Reproductive Health podcast with Griffin Jones: "Over the last decade or so, there has probably been a greater focus on the revenue side and less so on the cost side. I think that the next five to ten years are going to be much more focused on the economics of the operating model," Anderson said. That's exactly what we found building the activity-based costing framework published in the Journal of Assisted Reproduction and Genetics last December. The revenue side of IVF is well understood. Coverage mandates are expanding. Managed care is rising. What isn't well understood is what it actually costs to deliver a cycle — down to the activity level, by procedure type, by egg count, by lab scale. The payers are going to figure this out. The question is whether clinic operators figure it out first? Full paper and episode link in comments. #IVFEconomics #FertilityBusiness #ActivityBasedCosting #JARG Conceivable Life Sciences

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Matt Holt, former New Mountain Capital executive, is exploring a $30 billion deal to combine five health tech startups into a single platform called Thoreau. The venture would set out to simplify and integrate services across payers, providers and data — and if completed, it would rank among the largest private equity-backed health tech companies ever. Time will tell if this massive consolidation ever gets completed or translates into real value — or if it's just another bet on scale.

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“This is validation for the movement we’re leading to provide women better healthcare,” - Joanna Strober, co-founder and chief executive of Midi Health. Women's telehealth company Midi Health has raised $100 million in a Series D funding round, valuing the women’s telehealth company at more than $1 billion and cementing its status as a unicorn. The round was led by Goodwater Capital, with new backing from Foresite Capital and Serena Ventures, alongside existing investors including GV (Google Ventures), @Emerson Collective, McKesson Ventures, Felicis Ventures, AVP | Advance Venture Partners and SemperVirens VC. The funding marks one of the largest recent raises in women’s digital health. https://lnkd.in/eiUaVJai

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Introducing the Health Innovation Strategy Framework After two decades of building health startups, advising Fortune 500 life sciences firms, and designing care delivery programs at scale—I've distilled what works (and what fails) in transforming healthcare. 💡 That’s why I created the Health Innovation Strategy Framework—a blueprint to help healthcare leaders and organizations move beyond the buzzwords and into measurable outcomes. This framework is designed for: Health tech founders navigating go-to-market chaos Provider groups launching digital-first services Employers, payers & PBMs aiming to improve access, cost & experience Investors evaluating scalable models in a complex care ecosystem Organizations looking for the next best health innovation to partner, adopt or acquire 📊 Core pillars: •Innovation Culture and Infrastructure •Partnership Readiness •Product-Market Fit in Healthcare •Regulatory & Payer Navigation •Clinical Workflow Alignment •Patient Engagement •Sustainable Growth Strategy Here’s a quick look ⬇️ I’ll be diving into each of these in subsequent posts. 🔍 Want to see how this applies to your organization? 📬 DM me or contact me directly for a custom Innovation Readiness Assessment. Let’s build smarter, faster, and with real impact. #HealthcareInnovation #HealthTech #PartnershipStrategy #DigitalHealth #GoToMarket #ValueBasedCare #HealthEquity #LifeSciences #StrategicGrowth #HealthStrategy

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I’m so proud that Hyphen Capital has been a backer of Tim Hwang and Jonathan Chen since the beginning of Nitra. They had big ambitions to modernize the archaic back office of healthcare practices from fax machines to AI. It’s been amazing to see their growth from processing zero transactions to over a billion dollars and they’re just getting started.

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