Jared White

At Venture Investors Health Fund we have experienced the impact that funds of funds (FoF) can have on capital availability. Our first experience was with the Venture Michigan Funds, two state sponsored funds of $95M and $120M. That’s big enough to make a large enough commitment to justify opening an office in the state (at least $15M). The idea was to attract experienced firms from out of state and their syndication networks. The commitment couldn’t be more than 25% of a fund and the funds had to invest at least that amount in Michigan. It worked. They stopped collecting data in 2018, but by that time, the funds had invested $264M in 56 Michigan companies. Through syndication, total invested was $1.71B (6.45x). VMF 1 returned 1x by 2018, and VMF 2 was 3x. Annual economic impact had grown to $303M. That data was before HistoSonics, Inc. got FDA approval triggering its meteoric rise. The company may have never gotten off the ground without VMF. Series A had 5 funds, 4 from Michigan, 3 of which opened a MI office because of VMF. Badger Fund is also State funded, but the first fund was only $25M, so they pursued a different strategy of helping launch first time funds, resulting in new funds across the state. We need that too, and it has impacted the number of funds and companies able to get VC backing. NVNG Investment Advisors, LLC is a private effort targeting corporate investors. We need more participants in the asset class, but small institutions and companies can’t always make the scale of investment to get diversification or hire the in house expertise for fund selection. A FoF like NVNG provides that. All different, all playing important roles. To be an Exempt Reporting Advisor, 80% of investments need to be directly into companies, precluding FoFs. The DEAL Act would lower the threshold to 50%, so a FoF that did 50% direct co-invest could qualify, lowering the barrier to formation. Ask Congress to make that happen.

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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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Check out our most recent discussion on the quickly shifting payer AI landscape and a sample of our 2026 investment themes here at Flare - it was a privilege to sit with Matt Parker at Cohere Health to hit a few of the most important questions shaping this market - trust, implementation hurdles, and the stickiest GTM motion. If only we had more time!

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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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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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“We are not afraid of regulation.” I recently spoke with Bill M. at Private Funds CFO for an article on the regulatory policies impacting private investment in healthcare under consideration in statehouses across the country. I argue that now is the time for the industry to engage in thoughtful conversation. “Healthcare is a very human issue,” ARHI CEO Parker says. “It impacts everybody, every day, all the time, for the rest of our lives. When something goes wrong, it’s devastating.” “We believe in holding bad actors accountable. What we’re advocating for is a more thoughtful conversation about how we can engage lawmakers to ensure that those regulations don’t impact things like innovation, access and affordability for patients, and ultimately come up with a stronger framework, so that we can move forward and help invest in some of these communities where it’s needed most.” Read the full article here: https://lnkd.in/g2AtpemP

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Jonathan Norris and his team always do a great job tracking how healthcare private market trends are shifting. This 1H 2025 report highlights how healthcare investing evolved from Q1 to Q2 amid a challenging macro backdrop. Worth a look.

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