Josh Makower

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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Dual signals in global medtech innovation: FDA clears first at‑home brain stimulation device and AI smart dialysis manufacturing wins regulatory nod — a tectonic shift in therapeutic tech This week’s Medtech headlines spotlight regulatory validation of distributed therapeutic devices and AI‑enabled hardware moving toward scale. The U.S. FDA approved Flow Neuroscience’s FL‑100 — the first at‑home neurostimulation device for adults with moderate‑to‑severe depression — based on a mid‑stage study showing ~58% remission at 10 weeks, underscoring a broader shift of regulated therapy outside clinic walls. Simultaneously, Lords Mark Industries’ Renalyx AI‑based smart haemodialysis machines secured a national licence in India and CE marking, signaling global market access for AI‑driven critical care devices.   #MedTech #RegulatoryNews #AIinHealthcare #Innovation https://lnkd.in/gimCRHFf

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Med and AI Tech in Focus   Smart Bandage Detects Inflammation and Infection Researchers at California Institute of Technology have developed a smart bandage called iCares that continuously monitors fluids in wound sites in real time to assess inflammation and infection. The bandage is equipped with three different microfluidic components. One removes moisture from the wound to help with healing. Another detects nitric oxide and other molecules that indicate wound inflammation. A third component detects hydrogen peroxide, which is another biomarker of infection which occurs one to three days before patients experience symptoms. The iCares bandage was designed for patients with chronic wounds that are slow to heal, because of diabetes or poor blood flow at the wound site. iCares is composed of a flexible strip that can be 3-d printed and incorporates a disposable biomarker sensor array together with reusable circuit board that handles signal processing and wireless data transmission. A machine learning algorithm is used to classify and monitor any changes in patients’ wounds in real-time and can send a signal and data to a Smartphone. VC Investors are always adjusting their "Play Book" with a variety of options for investing. Mikal Ventures is one of those alternatives, offering curated solutions to real world problems. Reach out if you have questions on how we can be of assistance and bookmark https://mikalventures.com/ for additional insights and information.

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Search Engines and LLMs have value because they are the origin point of the query. If you don’t have to manually enter the query though typing or voice the starting line for who gets to keep the finders fee moves. First to consciencess thought and eventually to subconscious preawareness. All queries are a cry for help to reduce “suffering”, an attempt to augment our domain over reality QUICKER. First principles: recognition and context in brains and AIs always precedes query.

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AI is transforming how we manage surgical backlogs. A new system from C2-Ai uses real-world data to identify high-risk patients and provide personalized “prehabilitation,” reducing complications and hospital readmissions. This is another powerful example of how healthcare AI is not just a vision—it’s improving outcomes today. Andrew Ng Lin Fei Demis Hassabis Cassie Kozyrkov Pascal BORNET #AIinHealthcare #HealthTech #DigitalHealth #ArtificialIntelligence #PatientCare #SurgicalInnovation #HealthcareInnovation #NHS #MedTech #Prehabilitation

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Emerging company profile in BioCentury Inc. on Brandon Capital company ENA Respiratory. Phase 2 Virus-agnostic prophylaxis to prevent respiratory infections.

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For most of modern medical history, the “default human” in research was a 160 pound white man. Women were routinely excluded from clinical trials until the early 1990s. Even after policy changes, much of medicine — from cardiovascular research to sleep science — continued to rely on male-dominant data sets. The downstream effect? Gaps in understanding women’s physiology and health needs that we’re still working to close today. That’s why this announcement from Tom Hale and ŌURA matters so much. Today, ŌURA introduced its first proprietary large language model — purpose-built for health, and designed specifically to advance and empower women’s health insights. This isn’t a generic AI layer. It’s grounded in peer-reviewed clinical research and powered by the longitudinal biometric data Oura has been building for nearly a decade. Women’s bodies are dynamic — hormonal cycles influence temperature, sleep, recovery, cardiovascular strain. Personalized health requires context and pattern recognition over time, not one-size-fits-all advice. And just as important: privacy. As AI becomes a first stop for health questions, we Forerunner believe trust IS the product. Building a private, secure model reflects a commitment to responsible AI and long-term stewardship of deeply personal data. I’m especially proud that Oura is partnering with webAI — another Forerunner portfolio company I’m fortunate to be involved with — on this ground breaking initiative. Bringing together biometric intelligence, secure AI infrastructure, and a mission to advance women’s health is exactly the kind of ecosystem thinking that moves markets forward. As an investor and board member at Oura, I couldn’t be more inspired about this meaningful step forward towards what the future of healthcare can and should look be for us all. Congratulations to Tom Hale, Dorothy Kilroy, Ricky Bloomfield, Holly Shelton, Shyamal Patel and the entire ŌURA team. Onward and upwards!

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Honored to join this panel at LSI USA 2026 alongside medical device leaders from Boston Scientific, Abbott, and Edwards Lifesciences 🎯 The topic — engaging physicians early in company development — sits at the heart of PhyCap Fund's investment thesis: clinical operators don't just validate products, they unlock superior deal flow and identify scalable business models that traditional VCs often miss 💡 When physicians move from the sidelines to decision-making roles in healthcare innovation, everyone wins: ✅ Founders get better clinical insights ✅ Investors access higher-quality opportunities ✅ Patients benefit from solutions built by those who understand care delivery Looking forward to sharing perspectives on what effective physician engagement actually looks like — and why it matters more than ever in healthcare venture 🏥 See you in Dana Point, March 16-20 🌊 Scott PantelHenry PeckKelly WilliamsPhyCap Fund #LSI2026 #HealthTech #MedTech #HealthcareVC #PhysicianLeadership #MedicalDevices #HealthcareInnovation

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OpenAI makes new healthcare push with new ChatGPT Health. MedTech Innovator LSI American Heart Association Heart Rhythm Society HRX HeartX Accelerator Y Combinator Techstars Health Wildcatters Company Ventures MedTech World Ai ChatGPT Healthcare Microsoft

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Check out the latest from Limbic - their breakthrough study in Nature Portfolio, shows how Limbic turns frontier language models into behavioral health specialists. In their pre-registered, double-blind randomized trial they showed that: 1️⃣ Adding the Limbic Layer improves AI-led therapy performance by 43% 2️⃣ Clinicians preferred Limbic over general-purpose LLMs 83% of the time 3️⃣ 74% of Limbic's AI sessions ranked among the top 10% of therapists 4️⃣ Patients rate the Limbic experience as comparable to clinician-led sessions Amazing stuff from Ross Harper and Sebastiaan de Vries - delighted to have them in the Entrepreneurs First portfolio.

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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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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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Great interview with @mHUB's Monica Vajani and Spencer Jones on the Medtech Innovation podcast discussing hot #technology areas for early-stage medical device #startups, #venturecapital, alternative forms of early capital, leveraging #data, and more. mHUB mHUB Ventures #hardtech #innovation #Chicago

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🧬 Austin Bio & Health Roundup: Neurotech patients, shifting health benefits, the possible emergence of an Austin Bio & Health Blvd, & new national AI infrastructure all touch the city this week. 🧬 🚀 Launches, Expansions, Milestones & Wins Phantom Neuro formally opened its patient registry to connect people with upper-limb amputations to clinical studies and early access programs for its minimally invasive Phantom X neural interface platform. 🤝 Partnerships & M&A Thatch, the health benefits platform and marketplace, signed a new partnership with Deel so small businesses can use ICHRAs to give employees monthly budgets for individual coverage while the two companies handle compliance and administration behind the scenes. 🏗️ Infrastructure & Policy The Department of Energy launched the Genesis Mission, a national AI-powered discovery platform that will connect supercomputers, labs, AI systems, and unique data sets to double the productivity and impact of American research and innovation within a decade. Austin is showing up with AMD, Dell Technologies, and Bio & Health company Emerald Cloud Lab all initial partners. UT Austin signaled it may move the planned $2.5B University of Texas Medical Center from the former Frank Erwin Center site downtown to a larger site near The Domain in Northwest Austin. With the Domain area’s recent life sciences–oriented zoning changes, are we seeing a gravity toward a Bio & Health physical cluster? What’s Next? 🤠 🚀 🦾 🧬

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After more than two decades of investing in healthcare, I've learned three things: be patient, resist trend-chasing, and wait until timing makes sense. With experience on dozens of boards, witnessing thousands of pitches, navigating frothy portfolio activity, and surviving the dud markets while waiting on good ones to return, I know that time and timing is key for success in healthcare investing. The challenge is, how do I convince LPs that the wait will be worth it? Peek at Relentless Venture Fund diversity of companies that span regenerative medicine to software-as-a-medical-device (SaMD), includes a repeat entrepreneur who practiced medicine, to technical founders who figured out IP rights in a way that only newbies to the industry would contemplate. The beauty of diversified portfolio construction, regulatory and risk balance. Deep bets take time. That's the opportunity in healthcare investing. BC has structural advantages that make deep bets work. World-class science from The University of British Columbia, Simon Fraser University, University of Victoria, BCCA and our research hospitals. Clinical trial facilities such as the new Phase 1 Clinical Trial Unit at Providence Health Care. Provincial commitment to the innovation ecosystem such as the government's participation in Aspect Biosystems' $200M, multi-year project to ensure a world class team thrives in a world class facility in our province. What would further amplify our potential? Procurement strategies that let BC companies prove themselves locally before going global. As a member of DIGITAL's investment committee, I evaluate and advance private/public partnerships that derisk technology and accelerate commercial adoption in BC and across Canada. These collaborations are shortening the path from lab to market. Timelines for liquidity in healthcare may be longer than other venture sectors, but the wins are foreshadowed years ahead. Canary Medical Inc. locked in a commercial partnership with Zimmer Biomet before regulatory approval. Aspect secured a $2.6B partnership with Novo Nordisk on pre-clinical data. Two BC founded, Relentless portfolio companies. It will be approximately one decade from our original investment in Aspect to their first human clinical trial. I am not fussed by the timeline. Each strategic partnership and validation of data by customers sets the stage for a high value exit. The beauty of investing in healthcare innovation is regulatory timelines are getting shorter and costs are dropping; innovation is expediting discovery, diagnosis, treatment and care options never imagined when I started my VC career. I know deep science takes time, and patient capital wins. And when they do, BC has an opportunity to capture value that historically flowed south. With the right policy support and patient capital aligned, we can continue to build category defining healthcare companies that scale from our province, not just launch here and relocate. Life Sciences BC

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Avantor Surges As Activist Investor Takes Aim At 'Self-Inflicted' Issues Note in second paragraph below the qualifications for Engine Capital's director candidates. When are public company boards going to wakeup and realize that they are not box ticking, compliance focused consensus oriented bodies but are instead engaged in an actual business with products and/or services and that they are responsible to the shareholders for that business's performance? It is beyond time for radical change. "But Avantor stock has underperformed its peers, Engine Capital said in a letter to the company's board, specifically calling out better growth from Thermo Fisher Scientific (TMO). The investor outlined a series of problems, including cost control and turnover issues, as well as poor capital allocation and succession planning. "Engine Capital says Avantor's issues are "self-inflicted." The investor wants to add new board members with experience in health care distribution, capital allocation and leadership at relevant companies. It sees a path to 100% upside in share price by the end of 2027." #corporategovernance #boardsofdirectors #governance #shareholdervalue #shareholderactivism #performance #governancearbitrage https://lnkd.in/g3t3e77p

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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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Healthcare is entering a new era. For decades the healthcare system has been built around treating disease after symptoms appear. But advances in diagnostics, metabolic medicine, wearable monitoring, and longevity science are beginning to shift the model toward preventive health systems. Instead of episodic treatment, individuals are beginning to manage health continuously. I’ve been exploring this transformation through a new publication called Science Is Health, where I’m mapping what I call the Preventive Health Economy. This article introduces the framework. Where do you see the biggest opportunities emerging in preventive healthcare?

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