Rob Coppedge

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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It had to be said! 🎯 Epic's stranglehold on healthcare IT has stifled innovation for too long and the writing is on the wall. The consolidation myth needs to die already. We were promised efficiency and lower costs, but what we got was bloated bureaucracies that prioritize profits over patients. The data doesn't lie: smaller, agile providers consistently outperform these healthcare monopolies on both outcomes and patient satisfaction. Time for a major reset in how we think about healthcare delivery.

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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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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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More data in health care does not always mean better outcomes. Most consumer data only appeals to the worried well, without considering the downstream impact on the health system. Real change requires real ROI - justified reimbursement, workflow changes, and overall cost reduction. Data is only valuable when it changes behavior, not just for patients, but for payers and providers too. The founders who win will connect consumer insight to system economics, where the real leverage lives.

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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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Longevity isn’t about living longer at any cost, it’s about living better for longer. Yet, the gap between healthspan and lifespan in the US is the highest in the world and has grown to over 12 years. This gap is 29% higher than the global average and means that, in general, we are living over a decade of life in a diseased state. I spend a lot of time thinking about how this shift from reactive to proactive care is evolving and what emerging strategies from the elite performance world can be applied to accelerate this transition. The focus becomes less about how long can we live, and more on how long can we maintain strength, cognition, metabolic health, and independence? I’m really looking forward to this conversation with three outstanding people operating in this space. Hope you can join us live, but if not, be sure to register to receive a recording of our conversation. Registration link in comments.

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At Acumen America, we see the challenges many rural communities face in accessing quality care. But we also see huge opportunity to innovate, close these access gaps, and transform rural health. This report from our colleague Veenu Aulakh at the Medicaid Innovation Collaborative and the amazing team at the Center for Health Care Strategies lays out some promising models to tackle these issues, and highlights the fantastic work of Acumen America portfolio companies Reema Health, Arc Health, Sonara Health, and Boulder Care. Check it out!

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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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