If you’re new here or got forwarded this post, hi, I’m Vadim. I lead a digital health growth fund called Mighty Middle Ventures and organize high impact digital health events workshops in NYC under the Healing Healthtech banner.

I’ve been sending out this monthly events newsletter for years and will continue to do so for a long time to come.

Please take a minute to subscribe or forward to someone new to NYC or digital health who you believe would get value.

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📈 How to Raise Your First Priced Round

• Tue, Oct 27, 1–5 PM · NoMad, address on approval · Free, approval required

  • Raising your first priced round is a completely different beast than stacking SAFEs. I’ve come together with Qapita, Gunderson Dettmer, and Mercury to create a half-day bootcamp that will teach you everything you need to know.

  • Event is free and open to the public. Although my jam is healthcare, the topics apply to founders raising in any domain.

  • Four sessions in one afternoon: data room and cap table hygiene, finding and closing your first institutional investor, term sheet language, then a VC panel with Mat Kaliski (Acronym Venture Capital), Brian Laung Aoaeh (REFASHIOND Ventures) and Owen Willis (Opal Ventures). Presented with Qapita, Gunderson Dettmer and Mercury. Ten founders get picked to stay for a private session afterward.

⚡ This Week: Oct 8–11

🤖 Agents on Call: Live AI Agents in Healthcare Ops

• Thu, Oct 8, 6–8 PM · NYC, address after registration · Free, approval required

  • Pepper’s AI Week session on agents doing prior auth, intake, scheduling, eligibility and denials work in production. Operators who have shipped, not demo reels.

🍁 Autumn After Hours

• Thu, Oct 8, 6–9 PM · Park Place, 1218 Jericho Tpke, New Hyde Park · $35

  • nycthehive’s evening for clinicians, administrators and health system leaders, just over the Queens line on Long Island. Hosts include Tiffany Lam, Alex Tang, Gurdeep S Sareen, Carlos Navas and Dr. Silpa Saladi. A room of the people who run hospitals and practices, not other founders.

🌍 Global Health Congress 2026

• Fri–Sun, Oct 9–11 · The Yale Club, 50 Vanderbilt Ave · $800 single day, $1,500 conference, $2,500 VIP

  • Clinical leaders, pharma and payer executives and investors under one roof for a weekend. Tickets support a nonprofit.

🔥 Week of Oct 12

📊 Quantified Self NYC: Show&Tell and Gary Wolf Book Launch

• Tue, Oct 13, 6:30–8:30 PM · Civic Hall, address to registrants · $15–$48, capped at 60

  • Quantified Self’s first NYC Show&Tell since March 2017: self-tracking talks, tool demos, and the launch of Gary Wolf’s book The Quantified Self: Learning to Observe. Hosted by Steven Dean. Wearables and digital biomarker founders get a room of the people who track themselves most seriously.

🔗 2026 Healthix Conference

• Wed, Oct 14, 8:30 AM–4:30 PM · Museum of Jewish Heritage, 36 Battery Pl · $39–$402 on Eventbrite

  • New York’s largest health information exchange, run with City & State NY. Interoperability vendors meet the people who steward the data and buy the integrations.

⏳ New York Health Innovation Night: Is Longevity Becoming Real Medicine?

• Wed, Oct 14, 5:30–8:30 PM · The Globe Bar, 158 E 23rd St · $22–$27 on Eventbrite

  • Hosted by Alex Fair (MedStartr), James Hueston (AgeTech NYC) and Steven Wardell (DigitalHealth InvestorTalk). Hillary Lin, MD, CEO of CareCore, speaks. Longevity founders and the investors deciding whether it is a category.

🦠 Gut Feelings: A Panel on the Gut-Brain Connection

• Wed, Oct 14, 6–8 PM · Parsley Health, 126 5th Ave, 2nd Floor · Free

  • Our Kind Therapy and Parsley Health put a functional medicine clinician and a therapist on one panel. Useful for anyone building integrated behavioral and physical care.

🎯 Great Products Don’t Speak for Themselves: A Fireside with Turquoise Leadership

• Wed, Oct 14, 5:30–8:30 PM · NYC, address on approval · Free, approval required, sold out with a waitlist

  • Women in Healthtech hosts Turquoise Health’s VP of Product, Ariela Simerman, and VP of Marketing, Faye Leong, on running product vision and its story at the same time at a fast-growing company. Organized by Oriana Fuentes and Sydney Clark. The page says waitlisted guests usually get in.

💉 An UNMUTED Debate: Peptide Freedom vs Proof First

• Thu, Oct 15, doors 6:30 PM, debate at 7, ends 8:30 · NYC, address to registrants · $20–$45

  • Should consumers be able to buy peptides, exosomes and other regenerative therapies before trials prove they work? Julius Ritter (California Peptide Club) argues for access plus outcome data; Dr. Tiana Woolridge (Hospital for Special Surgery sports medicine) argues for evidence first. Hosted by UNMUTED with Pepper NYC and the Peptide Club of NYC.

🔬 Nucleate NY Activator Info Session

• Thu, Oct 15, 12–1:30 PM · NYU Langone, address on approval · Free, approval required, lunch served

  • For postdocs, PhDs, MDs, MBAs and JDs thinking about a life sciences company. Covers Nucleate’s Activator program and NYU’s Technology Opportunities & Ventures office.

🧬 9th Annual NY Metro Life Science Symposium

• Thu, Oct 15, 8 AM–3:30 PM, reception after · Union League Club, 38 E 37th St · $399 members and academics, $499 standard

  • Builds Bio+’s regional life sciences day. Therapeutics and diagnostics founders, their investors and the service providers around them.

🍷 Fall 2026 Healthcare Happy Hour

• Thu, Oct 15, 5:30–7:30 PM · Moquette, 11 Boniface Cir, Scarsdale · Free

  • Sixth Borough Health’s first quarterly happy hour for Westchester digital health leaders. Walkable from the Scarsdale station.

🩺 Healthcare Expertise, Scaled

• Thu, Oct 15, 6–8 PM · NYC, address on approval · Free, approval required

  • Forum Ventures and One Health Collective on turning clinical and operator expertise into B2B companies. Panel: Alice Bator Krenitski (Forum Ventures), Margaret Davidson (Company Ventures), Ethan Fischer (Nourish), Greg Fitzgerald (Doctronic) and Nima Roohi Sefidmazgi (Blooming Health).

🤰 It Takes Two: Preconception, Vitamins & Fertility

• Thu, Oct 15, 6–8 PM · Materna Health, 130 7th Ave S · Free

  • Materna’s clinical team and Bird&Be on preconception testing and male fertility. Patient-facing, so it is a chance to watch how a maternal health practice talks to its customers.

🌎 Ugly Talk: Latino Founders Building Between Latin America and the U.S.

• Thu, Oct 15, 6:30–8:30 PM · Venue not on page · $10–$15, approval required

  • Founder-CEOs including Christopher Saravia of Carebox on the false starts behind building across two health and consumer markets.

🏅 Medical Innovation Olympics: Live Finals

• Fri, Oct 16 · Rockefeller Center, plus hybrid on Swapcard · Time and price not on page

  • Finals of a global early-stage health innovation competition that held qualifying rounds in June and September.

🌸 Claude & Longevity Health

• Sun, Oct 18, 2–5 PM · Everything’s Jake, 54 E 13th St · Free, approval required

  • A World Menopause Day gathering on femtech, midlife care gaps and where language models help or hurt clinical communication.

🔥 Week of Oct 19

🩻 i2i Workshop: from Innovation to Implementation in Imaging

• Wed–Thu, Oct 21–22 · NYU Langone Health, 550 1st Ave · Free to $250

  • NYU’s Center for Advanced Imaging Innovation and Research on getting new imaging methods into clinical use. Relevant to anyone selling AI or device tools into radiology.

🧠 Make-With-Data Hackathon: Mapping Mental Health

• Wed, Oct 21, 4:30–7:30 PM · Pier 57, 25 11th Ave · Free

  • A three-hour data hackathon on mental health. Good for meeting technical people interested in behavioral health problems.

🧪 ASRC CAT x HarlemBiospace x J.P. Morgan Innovators Social

• Wed, Oct 21, 4–6 PM · NYC, address on approval · Free, approval required

  • Monthly science founder social. This edition features Dr. Norma Padrón of J.P. Morgan’s Innovation Economy team.

🥂 NewYorkBIO Life Sciences Innovators Mixer

• Wed, Oct 21, 4:30–7 PM · Deloitte, 330 Hudson St · Price not on page, approval required

  • NewYorkBIO and Deloitte. Members get priority, so apply early if you are not one.

🦿 Robots That Care Summit

• Wed, Oct 21, 6–9 PM · Brooklyn Navy Yard, address to registrants · Free

  • The first of a quarterly series on care robots taking protocol-driven clinical work under licensed staff. Alexandre Winter (Norbert Health), Matthieu Masselin (Wandercraft) and Hyo Won Lee, Ph.D. (ARPA-H) speak, then a panel moderated by Ahmad Gaber and live robot demos. Co-hosted with Newlab Brooklyn.

🏛️ HLNY’s 10th Annual Mini Congress

• Thu, Oct 22, 8 AM–4 PM · New York Academy of Medicine, 1216 Fifth Ave · $53–$263

  • Healthcare Leaders of New York’s annual day on policy, people and payments. A room of health system administrators, which is where most digital health sales start.

🚀 Health2Tech NYC, October

• Thu, Oct 22, 5:30–8:30 PM · NYC, address to registrants · Free, approval required

  • Bailey Morgan and Alex Koshykov’s monthly. Marissa Fayer, CEO of DeepLook Medical, and Bailey Morgan talk “Women’s Health: Undervalued to Unavoidable,” then networking until 8:30.

🥼 MED Connect Healthcare

• Thu, Oct 22, 6–10 PM · Virgin Hotels New York City, 1227 Broadway · $33–$43

  • A networking night for doctors and medical professionals, run by RED AWARDS. Useful if you are recruiting clinicians or advisors.

🔥 Week of Oct 26

💊 BioFuture

• Tue, Oct 27 · 345 Park Ave S · Time and price not on page

  • Demy-Colton’s convening across biopharma, digital medicine and AI, with partnering meetings and a seed showcase.

🏥 Skilled Nursing Executive Outlook

• Wed, Oct 28, 8 AM–3 PM · DoubleTree LaGuardia, 104-04 Ditmars Blvd, Queens · From $215

  • The New York State Health Facilities Association’s strategy day for SNF operators. Post-acute founders get the operators’ own view of their constraints.

📡 ConV2X: Smart Technology Transformation in Healthcare

• Thu–Fri, Oct 29–30 · ILR Conference Center, 570 Lexington Ave, 12th Floor · Price not on page

  • Telehealth and Medicine Today’s symposium on AI and telehealth. Clinicians, vendors and journal editors.

⚖️ Responsible Tech Summit 2026

• Thu, Oct 29, 10 AM–7:30 PM · The Times Center, 242 W 41st St · $150–$700 in person, free virtual, approval required

  • All Tech Is Human’s curated summit for 375 people on AI accountability. Useful for health AI teams thinking about governance before regulators make them.

🍸 bconnected NYC: Biotech & Life Sciences Networking

• Thu, Oct 29, 6:30–8:30 PM · Vanderbilt Market, 230 Park Ave · $42–$82

  • Scientists, founders and investors from NYC biotech, in a food hall by Grand Central.

🍂 November

🦾 Health2Tech NYC, November

• Thu, Nov 5, 5:30–8:30 PM · NYC, address to registrants · Free, approval required

  • A medtech edition. Priority goes to device founders, bioengineers, clinicians and specialist investors, and there are live demo slots for physical products.

💼 NewYorkBIO’s 2026 Finance Networking Reception

• Thu, Nov 5, 5–7 PM · RSM, 151 W 42nd St, 19th Floor · Complimentary

  • Life sciences founders with the bankers, accountants and investors who finance them.

🔌 NYBCI26: The New York Brain-Computer Interface Symposium

• Thu–Fri, Nov 5–6 · New York Academy of Medicine, 1216 Fifth Ave · Paid, price on nybci.com

  • Mount Sinai BioDesign’s neurotech meeting. nybci.com lists 8 AM–5 PM both days, a Nov 5 evening reception and a Nov 4 pre-event mixer.

☕ November Healthcare Coffee Meet Up

• Fri, Nov 6, 8:30–10 AM · Hastings Tea & Coffee, 235 Main St, White Plains · Free

  • Sixth Borough Health’s monthly coffee and co-working morning for Westchester digital health people.

🎤 NewYorkBIO’s November 9th Mini-Pitch Day

• Mon, Nov 9, 1–6:30 PM · Cooley LLP, 55 Hudson Yards · Price not on page

  • Early-stage life sciences companies pitch from 1 to 5, reception after. This edition is in Manhattan; NewYorkBIO’s September pitch day was in Buffalo.

🫀 Rewriting Women’s Health

• Tue, Nov 10, 1–6 PM · Oppenheimer & Co., 666 3rd Ave · $35

  • An inaugural summit on cardiovascular, autoimmune and neurological conditions that hit women differently, hosted by Reba Auslander and Sandy Polu, PhD (Alysia Health). Panels with Suzanne Steinbaum, MD (Heart-Tech Health) and Shruti Naik, PhD (Colton Center for Autoimmunity), plus startup pitches with feedback from investors including me.

🌳 Treehub Pitch Night NYC

• Wed, Nov 18, 5:30–9 PM · Upper East Side, address on approval · Free, approval required

  • Early-stage AI and health startups pitch to Treehub, a Silicon Valley investor that runs a six-month founder residency in Los Altos, with Coleman Family Ventures. Pitches at 6, dinner provided at 7. Pitch slots are assigned separately from registration; judges not yet announced.

🍽️ AI in Healthcare: From Pilot to Production, An Executive Dinner

• Tue, Nov 17, 6:30–9 PM · Kyma, 15 W 18th St · Free, approval required, 12 seats

  • Will Naylor (Sentro IT) seats health system and payer CIOs across from the CTOs building for them. Build versus buy, Epic integration, pilot purgatory. Off the record.

Trying a new format this month. Two amazing bits of digital health builder alpha for you.

1. How to Raise a Priced Round Panel / Workshop

   1. 

   2. Raising a priced round is a completely different beast than stacking SAFEs. I’ve condensed some of the highest value workshops that we ran in my former accelerator into a single afternoon sponsored by Mercury, Qapita, and Gunderson Dettmer.

      1. Session 1: Data room contents and hygiene.

      2. Session 2: Negotiating Terms in Your First Priced Raise

      3. Session 3: How to find, pitch, and close priced round investors.

      4. Session 4: First Round Panel with NYC VC Partners.

         1. Owen Willis - GP Opal Ventures / VP Primary Venture Partners

         2. Brian Launch Aoaeh, GP REFASHIOND Ventures

         3. Mat Kaliski, Partner Acronym Venture Capital

      5. Event will be the afternoon of 10/27 in Gunderson Dettmer’s NOMAD, NYC Office.

      6. Register Here or forward to a founder you know raising in the next 12 months. The content will be industry agnostic - not just healthcare.

2. How to Sell into Medicare Medicaid

   1. 

   2. Selling national scale contracts into managed Medicare and Medicaid is something that exceptionally few founders have done ever, and far fewer have done well.

   3. Two weeks ago, I had a breathtaking conversation that was my "Only New Mistakes" thesis in action. A deeply experienced operators who has built and operated billions of dollars of programs in both Medicare and Medicaid sat with one of my portfolio founders and laid out his framework for designing, pitching, and executing on care programs at national scale.

   4. With both of their permission, I’ve stripped out company identifiers and shared the conversation here.

The complete October / November NYC events calendar will go out Thursday AM.

Thanks everyone!

-Vadim

Last week, I had a call with a portfolio founder that was my “only new mistakes” thesis in action.

A deeply experienced executive and operator, who has sold and executed years-long, population-scale programs into multiple national plans, sat with a portfolio founder seeking to do the same. Both have dedicated this leg of their careers towards meaningfully bettering the human condition.

The conversation was extraordinarily valuable to anyone building for and selling into managed Medicare and Medicaid, and with their joint permission I’m sharing it here stripped of identifiers.

The founder is under a year into building care coordination for a vulnerable Medicaid population, working toward outcomes the system has long sought and rarely reached. She sells to critical access hospitals and FQHCs today and knows the company only scales through health plans.

The operator spent years contracting a care model for a high-cost chronic population with Medicaid plans at full risk on total cost of care representing millions of member lives and billions of dollars of medical expenses.

What follows is his playbook, organized in the order a founder would run it, with my own commentary where I disagree or where I have seen the same pattern elsewhere.

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TLDR

• Price against the plan’s three revenue lines, not against your own cost.

• Medical expense savings, rate-cell timing, and the state quality withhold (0.5% to 5% of premium) each land on a different executive’s scorecard.

• Contract as a provider through a professional corporation and bill one bundled monthly code.

• Provider spend counts toward the plan’s medical loss ratio; vendor spend comes out of administrative margin, and the CFO treats the two differently.

• Skip the white paper and bake the published evidence for your care model into the pro forma as the baseline.

• The operator behind this piece closed total-cost-of-care deals without one; the single system that demanded one was the deal he lost.

• Hire a chief medical officer who opens payer doors, and pay in equity if cash is short.

• A former MCO CMO or state Medicaid director should outperform any deck; 0.25% to 3% is the range depending on startup stage and CMO time commitment, and the sales cycles they shorten a lot yet still run 18 months to five years.

• Start with the national MCOs rather than the regionals.

• National value-based contracting teams have the staff to move; regional plans want to be nimble and mostly are not.

• Sell the health system now and parlay it into the system’s affiliated plan.

• The first plan contract comes from a provider customer that owns lives, and the plan will deliberate long enough for you to build whatever is missing.

Contents

1. What a Medicaid plan is buying.

• Map your program to the plan’s three revenue lines before you set a price.

• Pull the state’s quality withhold methodology and the plan’s measure-level NCQA scores before the first meeting.

2. Size the value from public data, then let an actuary argue with you.

• Build a five-year pro forma from the plan’s own website and public enrollment data.

• Pre-empt the regression-to-the-mean objection by triangulating the population you are accountable for.

3. Turn a cluster of clinical problems into a top-five line item.

• Name a construct that bundles your conditions into one budget owner’s problem.

4. Do not write the white paper.

• Anchor outcomes in the published evidence for your care model; keep your proprietary data to engagement and retention.

5. Sell at the top, and hire the person who gets you there.

• Target theCMO, and the state plan president who missed their numbers.

• Structure the first deal so a named person inside the plan gets promoted on it.

6. Nationals move faster than regionals.

• Sequence plans by whether they field a national value-based contracting team.

• Check whose carve-out you are leapfrogging before you pitch full risk.

7. Be the provider, not the vendor.

• Form the professional corporation, bill a single monthly code at a negotiated rate, and land inside the medical loss ratio.

8. Sequence the motion: health system now, plan next, build while they deliberate.

• Convert a provider customer with at-risk lives into the first plan contract.

• Write missing certifications into the contract with a cure period instead of waiting to be ready.

1. What a Medicaid plan is buying

[001] The founder’s question was the one every founder asks at this stage: what do plans care about, how do I price, and how much data do I need before they take me seriously. Her company ran its first clinical pilot at the start of the year, went to market this summer, and closes health-system contracts in the low six figures. She has a pilot pending at a large health system’s two highest-Medicaid sites, traction in a half dozen states, and retention above 70% across the full episode of care. What she does not have is a payer contract or a model for pricing one.

[002] The operator’s first move was to refuse the word “payers.” Medicaid plans differ by state, and within a state the MCOs differ from one another; an MCO in the Northeast does not buy the way a Blue plan in a midwestern state does. Every one of them does ask the same two questions, though: how much value are you creating for us, and how much of it are you asking to capture back. Founders answer the first question with medical expense savings and stop there. His point is that medical expense is one of three revenue lines the plan is looking at, and the other two are frequently larger.

[003] The second line is the rate cell. A Medicaid plan’s capitation is a spreadsheet of cells, and a member whose status qualifies for a higher-acuity cell earns the plan a higher monthly rate than the same member did the month before. Identify the qualifying status two months earlier and the plan collects the higher rate for two more months. Eligibility windows change the arithmetic further. A state that lengthens coverage for this population from two months to twelve extends the window over which a plan collects premium on the member, observes your program working, and attributes the savings to you, from two months to a year. A founder who keeps a member enrolled and on the plan through that window is protecting revenue the plan is otherwise entitled to and does not collect.

[004] The third line is the quality withhold. States hold back a slice of premium, 0.5% in California and up to 5% in the strictest states, pending the plan’s performance on the state’s own quality measures. The methodology sits in a long PDF on the Medicaid agency’s website next to the rural strategy. Take a plan with a billion dollars of annual premium: the difference between zero withheld and five percent withheld is $50M. In a specialty, let’s say five of the fifteen measures in a typical state touch a population, so if a cohort moved those measures at the population level a high-impact solution can be the difference between the plan keeping that withhold money and losing it. NCQA publishes the plan’s rating measure by measure, zero to five stars, about two years stale but directional. In commercial a four-star rating is decorative. In Medicaid it is cash.

[005] Before the first meeting, pull the state’s quality withhold strategy/methodology and the plan’s NCQA measure-level scores, and mark which measures your program moves and which of those carry withhold dollars. Bring that list to the first meeting. Enter the conversation with a thesis about which measures your solution can impact the most and which of those the prospective customer needs the most help with. Ask them where they might want the most support with their quality measures over the next 5 years.

2. Size the value from public data, then let an actuary argue with you

[006] The operator did not have outcomes data when he got in the door. He had a national plan as an anchor customer, which he calls an unfair advantage, and he had a spreadsheet built from sources anyone can reach. The plan’s website lists its Medicaid enrollment, by county if the plan cares about rural versus urban. If the age breakdown is missing, assume each year of age is about 1% of the population. Split the book into TANF, ABD, and expansion, since the cost profiles differ. Where the plan discloses nothing useful, take statewide Medicaid enrollment and multiply by the plan’s market share. He did this state by state, and the numbers were close enough to price against.

[007] The pro forma follows from that top line. Population at the top, the share you expect to engage, the value you deliver per member per month, five years out. Cost of this population without you, cost with you, with the reductions lined up by event: ED visits, avoidable admissions, courses of treatment for the complications your program heads off, and the catastrophic stays that run to a million dollars each. Work the math out in front of the plan rather than jumping to a number; the CFO wants to see which cells you touched. A regional Blue plan’s Medicaid director had already handed the founder the storyline: half her state’s counties have no local access to the relevant care, members skip the visits that would catch problems early, the catastrophic admissions follow, and then the member churns off the plan before it can realize the next year’s risk adjustment. Even a small improvement in keeping members engaged through the episode was, in that director’s words, a meaningful conversation.

[008] The pushback will be regression to the mean. A high-cost cohort gets cheaper on its own, and the CFO will ask how much of your savings is that. The operator’s answer is triangulation across three questions. Who is the most expensive population for the problem you solve? Where does your program deliver the most value? And how do you demonstrate accountability for that value, so the plan gets its share, you get yours, and the quality measures move? The uncomfortable part of the triangulation is the second question. A program that enrolls everyone it feels right to help will not save money on most of them; a program that names the high-cost slice it is accountable for will.

[009] Then bring in an actuary, and do not assume you cannot afford one. The operator’s chief actuary came from the anchor plan’s Medicaid business, where he had underwritten the operator’s own deal from the plan’s side of the table. An investor recruited him to work fractionally across two portfolio companies, which is how a seed-stage company paid for a chief actuary. He now runs a fractional practice, and he is not the only plan-side actuary who does. Build the five-year pro forma yourself from public data first, so the actuary is refining a model rather than inventing one, and so the back-and-forth with the plan’s own actuaries is between peers.

3. Turn a cluster of clinical problems into a top-five line item

[010] Point solutions lose on the plan’s cost ranking. In his specialty, each clinical condition that a center of excellence targeted showed up as the plan’s problem number nine, or twelve, or twenty. The operator’s company bundled the whole cluster into one named construct and taught plans an acronym they had not been using. That construct is now a category with a dozen companies in it. At the time it was a reframing of a clinical cluster into a single business problem large enough for a plan CEO/president to care about.

[011] The founder’s version writes itself. The handful of complications her program prevents, and the missed visit that precedes all of them, are each too small to be anyone’s line item. Bundled into one named construct and sliced across the plan’s members in this population, they are a top-five concern with a dollar figure attached. The pitch he ran, and the one I would run here, is chief medical officer to chief medical officer: an evidence-based care model that delivers a few hundred dollars of value per member net of fees, which across your population is double-digit millions a year at maturity. Name the construct before the first meeting, then find the slicing that makes it one budget owner’s problem instead of five clinical committees’ problems.

4. Do not write the white paper

[012] The operator refused to produce one, and he lost exactly one deal for it. Every company he had watched publish a white paper found it was never enough. The sample was too small, the paper was not peer-reviewed, the analysis was in process, and the plan’s team tore it apart because tearing it apart was their job. His response was to decline the genre. His company was tech-enabling models of care with decades of published evidence behind them. Why would a plan need a white paper to show it what the literature already shows? He baked the literature’s baseline outcomes into the financial model, positioned his company as likely to outperform the baseline, and priced the reduction in high-cost events at what the care model was already known to deliver. UPMC called that a non-starter and walked. Everyone else accepted it.

[013] His chief medical officer carried the rest of the burden. When the plan asked whether the model worked, the CMO could say that he had done this work before, and the plan did not press on whether “before” meant inside the company or during his years running a state Medicaid program. That is what a credentialed CMO buys you in a room where you have no outcomes data of your own.

[014] The founder’s situation differs in one useful way. She has engagement and retention numbers, and those are exactly what the Blue plan director asked her to start tracking. Retention through the episode is her proprietary data; the outcomes case belongs to the published literature for her care model. Keep the two separate in the pitch. Your data proves the plan’s members will stay enrolled; the literature proves what happens to cost when they do.

5. Sell at the top, and hire the person who gets you there

[015] I asked which title owns NCQA scoring for the founder’s outcomes at a plan. His answer was that no single person does, and if accountability had to roll up to one desk it would be the plan CFO, who does not know the measures. The people he sold to were the plan president, and, easiest to reach and most influential on the decision, the chief medical officer. At the national MCOs you might work one level up: the regional CEOs of the national plan’s Medicaid business can point to the state-level plan CEOs/presidents, with a question that does the sales qualification for you. Who missed their numbers by the widest margin this year and needs a Hail Mary? www.healthmanagement.com paid subscriptions give access to MCO P&L data, Medicaid enrollment data, RFP updates, and more.

[016] The hire that can make CMOe meetings happen is the startup CMO, a physician who had run a state Medicaid program and held a prominent public-facing post. The intro email wrote itself. Would the CMO at the plan like to meet our CMO, who wants to bring you up to speed on an evidence-based model that should move the dial on your book? The founder has a stacked medical advisory board and no CMO, and the operator said that was good, because the common mistake is hiring someone clinically excellent who is not the celebrity in the specialty. The person you want is a distribution power player who opens doors, and if you cannot pay them, pay in equity: a quarter of a percent to three percent depending on how full-time they are, and do not go to three unless you must. Payer cycles run 18 months to five years, so you want that person at the table for years, not for a launch.

[017] The second lesson is about the people below the CMO. Once one national plan’s specialty subsidiary saw his model working, it repriced the model internally on top of his chassis, added a markup, and took credit for the revenue. His counterparts got promoted on the margin. The founder’s reaction was that this came at his expense, and it did, up front. My reaction is that it made the renewal resilient. Slightly fewer dollars in year one bought a set of people inside the plan whose careers were now attached to the contract. He described the halo that follows: once a plan sees a two-to-one return and millions flowing through the system because of you, everyone in the building stops treating you as a startup risk and starts being friendly. Structure the first deal so a named person inside the plan wins on it, and accept the discount that costs.

6. Nationals move faster than regionals

[018] One might assume regional Medicaid plans would be nimbler, when regional Commercial plans are often nimbler. The opposite held. The people who are best at executing value-based contracts, and the MCOs that field national value-based contracting teams, sit at the big plans, and the big plans move faster because they have the staff to move. You might want the regionals to step up and compete, and if anyone has examples of this happening, please let me know.

[019] His favorites, for what one operator’s experience is worth: two of the national MCOs and the specialty arm of a third, where his counterparts were excellent. The regional plans he liked had not reached the scale he needed.. Sequence plans by whether they have a national VBC team, and before you pitch full risk, find out whose carve-out you would be jumping.

7. Be the provider, not the vendor

[020] The question that changed the call was structural. The operator asked whether the founder operated as a professional corporation with an MSO, and whether she was a vendor or a provider. She is a vendor to health systems, has no clinicians, and never drops a code; the platform coordinates the interactions between patients and the providers they already have. His answer was that for payers she should consider becoming a provider anyway, and the reason is the medical loss ratio.

[021] A plan must spend a set share of premium on medical care. Spend that counts as medical expense is money the plan was going to spend regardless; spend that counts as administrative comes out of the plan’s operating budget and, in effect, out of profit. A vendor is administrative. A provider is medical. The same dollars, routed through a provider services agreement instead of a vendor contract, land on the side of the plan’s accounting where the CFO is indifferent to them rather than hostile. The founder had heard a version of this from the Blue plan director, who told her that if she could bill CPT codes as a provider rather than hit the plan’s P&L, the conversation changed. It did not click until the operator laid out the mechanism.

[022] The chassis is a professional corporation. You bill as a provider on a monthly case rate, deliver something minimally clinical through the PC, an annual well visit through a remote provider will do, and run all of your services through that entity. You send the plan one bundled monthly code for everything you do, and you are not bound to the fee schedule for that code; the rate is negotiated against the work. The operator pointed to a care coordination company in California that did exactly this under the state’s enhanced care management program, becoming a provider without trying to replace the providers its members already had. Tele911’s ED-diversion contracts look to me like the same shape, though I have not asked Ramon Lizardo to confirm it.

[023] Form the PC before the payer conversation, so that when a plan asks how it would contract with you the answer is “as a provider,” and the paper is a provider services agreement they already have a template for.

8. Sequence the motion: health system now, plan next, build while they deliberate

[024] Health-system contracts in the low six figures and payer contracts in the millions are different businesses, and the operator’s advice was to use the first to reach the second. Some health systems carry Medicaid lives at risk, and some own a plan. Sell to those systems with the motion that already works, do the work, and parlay the relationship into the affiliated plan. The first plan contract comes from a provider customer that owns lives, not from a cold pitch to a plan president. The founder’s traction with critical access hospitals and FQHCs, where she is not hearing many no’s, is the asset here; the growth is slower than she wants, and it is the bridge.

[025] I asked when in the arc she should build the enterprise pieces a plan will require. His answer was now, because plans move so slowly, whether you want them to or not, that you will have time to build anything you need. The one long pole is security certification. The rest of the paper is standard: a data use agreement, a business associate agreement, and the provider services agreement from section 7.

[026] He started engaging payers six months before his first funding, which sounds early until you remember he = had payer relationships. The founder was worried plans would see an eight-month-old company as a toddler. They will, and it does not matter, because a cycle that runs 18 months to five years means the company that starts the conversation now is the one that is three years old when the contract signs. Better to know the timeline than to be surprised by it.

[027] The checklist, in the order the operator would run it. Pull the state’s withhold methodology and the plan’s measure-level scores. Build the five-year pro forma from public enrollment data and get a fractional actuary to argue with it. Name the construct that makes your conditions a top-five line item. Anchor outcomes in the published evidence and keep your own data to engagement and retention. Recruit the CMO who opens doors and pay in equity. Start with the plans that have a national VBC team, and find out whose carve-out you are jumping. Form the professional corporation and bill one monthly code at a negotiated rate. Sell the health system that owns lives, and write the missing certifications into the contract with a cure period. None of this requires outcomes data you do not have. Start before you feel ready.

Vadim Gordin writes Healing Healthtech, on the companies, founders, and capital quietly fixing what’s broken. Subscribe for a twice-monthly dispatch of free and paid field guides, and forward this to a founder who is about to send a plan a white paper.

First, let’s define sociopathy, at least for the purposes of this conversation: an absence of empathy—or simply an absence of giving a damn—about the human consequences of your actions.

I wish that were hyperbole or a joke.

The story I’m about to share happened months ago. Unfortunately, its parameters are something that I’ve seen repeated over the years. I’ve wrestled with whether to make it public, and how much to disclose. The Pulley implosion this week made up my mind.

This spring, I was pitched an angel investment in a platform serving a vulnerable population: families caring for people with disabilities.

The company helped families navigate the byzantine financial and compliance rules required to preserve eligibility for disability benefits. There was one important wrinkle: to use the platform, families placed financial assets associated with their disabled loved one into the platform’s custody.

Eight thousand families had done so.

My first diligence step after receiving the deck was to send it to a longtime friend who runs a rehabilitation clinic in NYC helping newly disabled spinal-cord-injury survivors re-enter everyday life.

He is normally demure about the startup projects I send him. He is understandably protective of his tribe and access to them.

This time, he was ecstatic.

Was this something he could start sharing with patients immediately? His social worker spends enormous amounts of time helping families navigate exactly this kind of paperwork. If the platform actually worked, it could remove a major ongoing burden from both his staff and the families they served.

I asked the founder for data-room access. I also sent the company to my friend and fellow angel investor, who I knew would be similarly excited about backing something built to help people with disabilities.

Then we started digging.

I’m not going to disclose everything he and I found. But four things matter:

• The business model would not be profitable at any scale.

• The apparent plan was to keep raising successive venture rounds to finance growth in enrolled families and a relatively small pool of assets under management. The handwavy hope was that those pooled families and assets would eventually be worth an acquisition by a fintech or bank.

• The company had three months of runway remaining.

• There was no contingency plan for supporting those 8,000 families if the company shut down.

Our enthusiasm turned to simmering rage.

This wasn’t a dating app or a B2B workflow tool. These were vulnerable people whose ability to retain disability benefits depended on financial and administrative arrangements they had entrusted to this company.

And the central problem wasn’t some unforeseeable black swan. The basic mismatch between the business model, the capital requirements, and the responsibility the company was assuming for its users was knowable at the whiteboard stage.

So we asked the CEO what his plan for any of the above was.

And somehow, the story got worse.

The CEO was a recent graduate student who had effectively been handed this mess two months prior. The original founders—the people who had designed the model, raised the first tranche of money, and enrolled thousands of vulnerable families into it—were no longer involved.

He seemed genuinely surprised that we would ask questions as silly as “what happens to these families if you shut down?” Rather than digging in on his slide deck full of charts going up and to the right.

Here’s the thing I want founders to take away from this.

If you develop a platform or service that becomes essential to someone’s healthcare or well-being, you are likely replacing supports that were already in place.

Someone stops doing something because you now do it. A social worker stops helping with the paperwork. A family stops managing something themselves. A clinician starts relying on your system.

That’s what we want our companies to do. We want people to depend on the things we build.

But if you choose not to design for viability, or you choose to run the company without sufficient runway, then you absolutely have to consider what happens when the services you’ve put in place get withdrawn.

Not when you’re down to three months of cash. Not when the next round falls apart.

When you design the damn thing.

Please, please, please don’t be a sociopath.

This is basic math. These are real humans and real lives.

If you choose to build something people come to depend on, you have a responsibility to do the work to understand what happens to them if it goes away.

P.S. The company’s website is still up. There are no current team members that I can find. The CEO is still the CEO but now lists a different full-time job.

I have no idea what happened to the 8,000 families who were using the platform to manage assets for their disabled loved ones.

- Oura sells to people who chose to wear a ring. Most health hardware founders sell into employers, health systems and plans, where the wearer, the operator and the payer are three different people.

- Kinetic co-founder Haytham Elhawary put a belt-worn sensor on warehouse workers, fought churn driven by the prevention paradox, then rebuilt the company as a workers’ comp MGA writing more than $100M in premium this year.

- The operator lessons: design for the involuntary wearer, close the loop at the device, contract for the counterfactual, and stop trying to convince actuaries.

Oura’s IPO will set the terms of the wearables conversation for the rest of the year. Founders will screenshot the S-1, investors will reprice their comps, and every seed deck with a sensor in it will add an Oura logo to the market slide.

For most people building health hardware, that is the wrong comparable. Oura’s buyer is the wearer. They chose the ring, they pay for the subscription, and they open the app because they want to. Almost nobody reading this sells that way. You sell to an employer, a health system or a plan. The person wearing your device was told to wear it, the person watching the dashboard has twenty other priorities, and the person paying for it will never see either of them.

Kinetic built a business in that second world, and Haytham Elhawary, its co-founder and former CEO, has made most of the mistakes available there. We sat down to go through them.

Kinetic in brief

Haytham’s mother is a nurse who was injured on the job more than once. That stayed with him, and roughly twelve years ago he co-founded Kinetic to reduce musculoskeletal injuries at work. The device clips to a worker’s belt, detects a high-risk lift and vibrates so the worker corrects their form. Kinetic sold it to large self-insured employers, the UPS and DHL tier, for years.

In late 2021 it launched an insurance business: a managing general agent selling workers’ comp on Nationwide’s capacity, with the wearables given away free. It sold its first policy about a day after launch. Haytham says Kinetic will write more than $100M in premium this year on roughly $30M of venture capital. He left the company in January.

Design for the wearer who didn’t volunteer

Kinetic’s first device looked like a gun belt, and workers nicknamed it “the bra.” The next version went into a back brace, which got sweaty and was abandoned. The design that stuck clipped to a belt and looked like a pager. Even then, workers wanted to know whether it had a microphone and whether they would be fired for not lifting enough. Kinetic had to standardize how it explained the product on the floor, and still fought every morning over whether people remembered to pick the device up.

So I asked Haytham whether he would put a new device on workers if he started today.

His exceptions are useful. A device the job requires, such as one that clocks you in, gets worn. A sensor on something already mandatory, like a safety vest, gets worn. A new device that nothing depends on gets left in the locker. The question for any B2B hardware founder is what happens the day the wearer leaves your device at home. If the answer is nothing, your adherence curve is already set.

Close the loop at the device

Kinetic built dashboards for managers showing how many high-risk movements workers made and how far that number had fallen. Managers rarely looked. The injury reduction came from the vibration on the belt at the moment of the lift, which pulled workers out of habits they didn’t know they had. Every handoff between detecting a problem and someone acting on it is a place for value to leak. RPM and ambient-sensing founders should map their own handoffs with that in mind.

Contract for the counterfactual

Success created the hardest problem Kinetic had.

Once injuries fall and stay down, buyers stop crediting the device for injuries that no longer happen. Haytham saw churn spike after a year or two, from customers convinced their workers now moved perfectly. The budget structure makes it worse. Actuaries set the injury reserve, the CFO books it with medical inflation, and the safety manager championing your device cannot move that number. A physical therapy product can show a claim that used to cost $50,000 now costs $30,000. Prevention asks a CFO to pay for a claim that never arrived.

DPP, fall-prevention and MSK founders are up against the same wall. Put the baseline and the attribution method in the contract before signing, or move toward the entity that books the savings.

Stop trying to convince actuaries

Kinetic moved toward the savings, and it did so without winning the actuarial argument.

It compared workers who wore the device with workers at the same sites who didn’t, and had an actuarial firm turn the difference into frequency and severity. Then it took the results to business-minded partners. Nationwide, an early investor that had watched the results for years, became its capacity partner.

The policy design removed the need for anyone to believe the device worked. Kinetic priced policies the usual way, gave the devices away and paid customers a dividend at the end of the term when injuries fell. The actuaries were comfortable because pricing assumed nothing. Nationwide was comfortable because the devices cost it nothing. And because Kinetic operates as an MGA, it earns commission without holding the risk.

That also answers the slide every hardware deck carries: “insurers will pay for our data.” Haytham’s experience is that insurers have a pricing method, and new data doesn’t fit into it. The value came from a structure that put the devices inside Nationwide’s distribution, not from licensing a data feed.

Prevention wins the meeting; claims win the renewal

Once Kinetic was in insurance, the change-management problem followed it to smaller customers. Haytham also found that companies switch carriers because of bad claims experiences, not because of prevention. Kinetic now puts much of its investment into claims management: dashboards showing each customer’s loss ratio, next-best actions on open claims, and AI agents that turned a growing data-entry team’s work into pre-filled underwriting files.

What to take from it

Oura will teach founders a lot about consumer subscription hardware. If your wearer, operator and payer are different people, Kinetic’s twelve years are the better syllabus. Before your next pilot, answer four questions. Would the wearer notice if they left your device at home? Does your product act at the moment of detection, or does it produce a report? Who books the savings, and is that person in the room? And what structure would let a partner adopt your product without first believing your outcome data?

The full conversation with Haytham is below.

Read more

Author’s note

Once or twice a year, an economic development entity I am connected to asks me whether they should fund an accelerator, accept a pitch from a national network, or build something themselves. The answer is rarely the one the loudest voice in the room is selling. This is the field guide I wish I could hand them at the beginning of that conversation instead of explaining it from scratch each time.

The vantage for what follows: I ran the Catalyst and Innovention Accelerators at NYU Tandon Future Labs for four years, and Steve Kuyan, now my venture partner at Mighty Middle Ventures, ran them for eleven before me. We supported 300+ teams who went on to raise $2.7B and produce 44 exits (a 15% outcome rate). That work was funded in part by city and state grants from NYC EDC and NY ESD who consistently required us to report outcome metrics as a requirement of our grant(s). I also spent years as a founder in Louisville, where a local government entity lit $250K on fire for a strategic study whose conclusion was that they should hire the study’s author to run their accelerator. Both vantages inform what follows.

My goal with this field guide is to put the measured data on regional accelerator outcomes next to a working case study (Cintrifuse in Cincinnati and Renaissance Venture Capital in Michigan), so that an EDC operator weighing a real proposal can model the expected lift against their specific ecosystem rather than against the marketing deck’s national average.

This piece was built with support from Claude Cowork with a custom skill stack. My use of generative AI is loud and proud. The thesis and the judgment calls are mine.

Contents

1. What the literature says.

   1. The regional bump, the comet distribution, and leverage as the success metric.

2. Distinguishing Startup Activity from Startup Progress

   1. What is it that startups (and accelerators) actually do?

3. The Renaissance VC and Cintrifuse model.

   1. Understand the fund-of-funds plus LP-to-VC channel mechanism that actually works.

4. Anti-patterns: the global accelerator network pitch.

   1. Spot the franchise-licensing pitch and walk.

5. Empathy demands that we reject mediocre accelerators.

   1. Brad Feld’s framework, the founder-runway argument, and the community failure of protecting mediocre programs.

6. Three pieces of advice for the operator weighing a proposal.

   1. Model the lift, commission an independent study, study what is already working.

7. The decision rule: build, license, or walk.

   1. Tie it all together before signing the bill.

1. What the literature says

The strongest empirical finding for an EDC operator: when an accelerator opens in a metro area, seed and early-stage venture deal volume rises across the region, including for companies that never enrolled [1]. The effect is metro-level, not just treatment-on-the-treated; accelerators spawn local investor groups, attract outside investors, and produce peer effects beyond the cohort. That spillover is the public-investment case. The lift is conditional on existing capital base, though: a 2026 meta-analysis finds smaller effects in developed economies than in capital-poor markets [2]. A quality accelerator in a region with no existing seed activity produces more uplift than the fifth one in a metro with thirty active angels.

The lift is also conditional on program quality. Hallen, Cohen, and Bingham used an accepted-versus-almost-accepted design at a set of top US programs and found heterogeneous effects: top-tier programs produced large gains, second-tier programs delivered beneficial learning without the sorting and signaling premium, and one of the studied programs actively inhibited venture development [3].

If even a verified strong-end program can run net-negative, an unverified program in your region is more likely to drain regional value than create it. A bad accelerator does not produce a smaller version of the regional bump; it produces inhibition for the founders it touches, misallocation of public capital, and a credibility hit subsequent regional programs must overcome. Site selection is the question, and the verification standard for a public investment should be at least as high as a sophisticated founder’s standard for giving up equity.

Startups at the idea stage are fragile, not yet resilient. The founder is running on a finite reservoir of personal runway — savings, spousal tolerance, the patience of friends-and-family backers, the months a day-job exit will sustain. A bad accelerator burns that runway against milestones that do not move the venture forward. When the year ends and there is nothing to show for it, the founder’s loss is also the community’s: a venture that might have worked, did not, because the program took the wrong months.

2. Distinguishing Startup Activity from Startup Progress

A startup has two functions

1. To ship product to customers

2. To transact with customers on the basis of that product

3. (bonus) Not die while executing iterative loops of (1) and (2)

That’s it.

Every single thing that a founder or accelerator does needs to be viewed critically through the lens of whether they advance (1) or (2).

Startup and Accelerator activities like fundraising, pitch days, workshops, networking events, happy hours, demo days, etc. all either support or detract from those primary objectives.

Those objectives also need to be what instruments and distinguishes a successful accelerator from one that is likely wasting founders’ time.

The goal here is attributable outcomes from the most recent cohort.

What percentage of alumni founders can point to discrete customers, product elements, or closed investments that are attributable to their accelerator activities?

If you come across an accelerator operator that either doesn’t currently measure these for their cohorts and/or is unwilling to do so in the future, you should move on and find someone who is.

On a metro investment level, the correct metric to instrument a regional accelerator against is fund-of-funds leverage: the ratio of follow-on venture capital flowing into local startups per dollar of regional capital committed. Not the count of new companies formed. No one benefits when a bunch of new companies get formed and then die on the vine for lack of follow-on capital. Section 3 develops the metric.

3. The Renaissance VC and Cintrifuse model

The strongest example is Cintrifuse in Cincinnati. Cintrifuse launched in 2012 from a McKinsey strategic study commissioned by the Cincinnati Business Committee Regional Innovation Task Force [4]. The fund-of-funds architecture was adapted from Michigan’s Renaissance Venture Capital, which was founded in 2008 under the Business Leaders for Michigan umbrella [5]. The McKinsey study’s final recommendation states the mechanism explicitly: form a regional fund of funds that invests in national VC funds, then use the resulting LP relationship to channel investor attention back to local startups.

The mechanism is worth unpacking step by step:

• The region’s pillar companies (in Cincinnati’s case: P&G, Kroger, Cincinnati Children’s Hospital, GE Aviation, Western & Southern, Fifth Third Bank, and others) invest into a regional fund-of-funds vehicle (Cintrifuse Capital).

• That regional fund-of-funds becomes an LP in top-tier national venture capital funds.

• The thesis is structural: a national VC will always take a call from one of its LPs asking for an investor introduction for a local company. The LP relationship purchases warm-intro rights that local startups cannot buy on their own.

• A smaller slice of the fund’s capital runs the local programs: in Cintrifuse’s case, a direct-investment vehicle, the Venture Velocity Program, the Emerging Founder Residency, and the StartupCincy community coalition.

Three properties follow from this design:

• The pillar companies are investors expecting returns, not philanthropists writing off the cost. The fund-of-funds invests in market-rate venture funds. The corporate LPs receive normal venture returns on their commitment, which makes the participation sustainable across CEO transitions and budget cycles.

• The program is calibrated to the parameters of the local ecosystem, not benchmarked against a national average. Cincinnati’s pillars are consumer goods, research hospitals, aviation, and retail. The program’s pillar relationships, mentor bench, and corporate-partner pipeline reflect that, not a Silicon Valley template.

• Local startups get a structural fundraising advantage. The LP-to-VC channel converts pillar-corporate capital into warm intros that local startups cannot generate on their own. This is the mechanism that should drive your regional ROI expectations, not the cohort programming.

The lifetime outcomes data on both programs is consistent with the model. Cintrifuse and Renaissance calculate the leverage ratio on slightly different bases. Cintrifuse measures on recent direct-investment dollars into specific local startups; Renaissance measures on cumulative fund-of-funds commitments across its full Michigan portfolio chain. The conceptual measure is the same: how much outside venture capital does each regional dollar attract.

Caveats: Cincinnati’s ecosystem growth cannot be cleanly attributed to Cintrifuse alone; other regional actors contributed. The 12x leverage ratio reflects recent direct-investment activity and may not generalize. Neither Cintrifuse nor Renaissance publishes a complete enumeration of follow-on capital raised by portfolio companies. Use these numbers as directionally indicative, not as forecasts.

The leverage figures measure the bottom of Cintrifuse’s funnel: dollars deployed directly into local startups and the follow-on capital those companies attracted. The broader work that feeds the funnel does not appear in the ratio and is just as valuable. Cintrifuse runs coaching and mentorship programs, operates the Union Hall coworking space, and anchors the StartupCincy community coalition, all of which touch hundreds of startups and founders each year.

Leverage is the bottom-of-funnel financial output; programming reach is the top of the funnel that sustains it. An EDC operator should expect both: a credible leverage target and a credible plan for the programming work that feeds it.

For comparison. Three national benchmarks help the reader decide whether these numbers represent meaningful performance:

• State fund-of-funds leverage. Published leverage ratios for comparable US state-backed FoFs (Ohio Third Frontier, Illinois Growth and Innovation Fund, Indiana Next Level Fund, Texas Emerging Technology Fund, and similar) vary widely by program and methodology, but commonly fall in the 3–10x range over full fund life [10]. Renaissance’s reported $13:$1 cumulative leverage and Cintrifuse’s $12:$1 leverage on recent direct-investment dollars both sit at the upper end of the published range for state-backed regional FoF peers.

• Seed-funded startup outcomes. The CB Insights Venture Capital Funnel reports that ~48% of US seed-funded startups raise at least one follow-on institutional round, ~30% achieve any exit (M&A or IPO), and ~67% stall without follow-on or exit over the full funnel horizon [11]. Direct comparison to Cintrifuse and Renaissance portfolios is imperfect because both programs report on “pipeline” and “fund chain” rather than clean treated-cohort outcomes, but the funnel rates set the yardstick for what a typical seed-funded company experiences nationally.

Cincinnati and Michigan are both regions where the national seed funnel applies under conditions of structural capital scarcity. The Renaissance and Cintrifuse models do not erase the funnel; they widen the top of it for their regions.

3. Anti-patterns: the global accelerator network pitch

The most common bad proposal is the global accelerator network. The pattern is consistent across cities. A national branded network sends a business development team to a regional EDC or municipal innovation office. They propose a strategic study, often funded by the entity, whose conclusion will recommend that the entity build an accelerator under the network’s brand and pay them annually to run it. The licensing royalty is typically seven figures per year on top of whatever the study cost.

When I was a founder living in Louisville, one of the local government entities paid $250K to a “global accelerator network” for exactly that whitepaper. The study’s conclusion was, predictably, that the entity should build an accelerator under that network’s brand and pay them seven figures annually to run it. The $250K was a waste. Reasonable voices eventually prevailed on the larger decision: the recommended accelerator was not built. The dollars that ended up supporting the region’s actual entrepreneur infrastructure came from different sources and went to a home-grown network of solutions that has been doing well since.

At NYU, I saw the same pattern from the supply side. A steady stream of consultants knocked on our door asking to stamp “NYU Future Labs” branding on the acceleration programs they were pitching to municipalities all over the world in exchange for a licensing royalty. We declined 100% of these external pitches.

The structural feature of these pitches is that the entity doing the strategic diagnosis is the same entity proposing to run the resulting program. There is no version of this where the diagnosis is honest. The work is structurally compromised before it begins. What gets built is innovation theater dressed as economic development.

4. Empathy demands that we reject mediocre accelerators

Brad Feld’s Startup Communities lays the cornerstone for how regional ecosystems work: entrepreneurs lead, feeders (universities, government, investors, service providers) support, and the community’s long-term health depends on resisting feeder-led programs that misallocate founder time and credibility [12]. Feld’s “give first” ethos functions as a normative filter; actors who extract more than they contribute should not become central or leading figures in the ecosystem. Even if Feld does not say it in those words, bad-actor accelerators need to be identified and marked accordingly. A community that protects its mediocre programs out of misplaced civility is failing its founders.

Back to the founder-runway point above. Personal runway is finite. Spousal tolerance is finite. The patience of friends-and-family backers is finite. A mediocre accelerator that absorbs three to four months of that finite resource does damage that does not show up in the program’s own metrics: the founder still finished demo day, still got the certificate, still appears in the alumni count. What is missing from the alumni count is the venture that might have raised, sold, or pivoted in those same months.

I learned this myself. As a young founder I was considering a nationally known healthtech accelerator network, since thankfully shuttered. Before applying, I called alums. About nine in ten told me their time there had been a complete waste, and I did not apply. The information was already in the community; it was just sitting in the peer network rather than in the marketing copy. The community knew. The community had no way to say so to the next founder.

The kinder posture is the harder one. Empathy for founders requires the community to tell them when a program is mediocre, even when the program is run by people you know. The alternative — letting friends-of-friends absorb founder runway in the name of being supportive — is a failure of empathy dressed as collegiality.

5. Three pieces of advice for the operator weighing a proposal

1. Model the lift against your specific baseline, not a national average. The economic lift of a local accelerator is similar to the therapeutic effect of exercise: the result depends on both the intervention and the baseline.

• A quality accelerator that is the first or second in a region will have more impact than one that is the fifth.

• A program in a region with healthy capital throughput will lift less than one in a region with none.

Before you sign the bill, model the expected lift against your specific baseline, not against the marketing deck’s national averages.

2. Commission an independent local study before deciding to spend. Research outcomes at comparable locations. COI hygiene dictates that the entity doing the study cannot be the one running the eventual accelerator. The “global accelerator network” pitching you a whitepaper whose conclusion is that you should hire them is not running an honest process. The McKinsey study that produced Cintrifuse is the counterexample worth modeling: McKinsey produced the diagnostic and stepped away. They did not pitch themselves to run the resulting program. That separation is the operative test for any consultancy you bring in.

3. Study what is already working. The Renaissance VC and Cintrifuse model is the cleanest available template for a region-scale accelerator platform. The key design choice is the LP-to-VC channel: pillar companies invest into a regional fund-of-funds that becomes an LP in national VC funds, and that LP relationship converts into warm-intro rights for local startups.

The programming layer (cohort accelerator, community coalition, founder residency) is built around the fund-of-funds, not the other way around. Most failed regional accelerators have the order inverted: they build programming first, then attempt to bolt on a capital strategy. The Renaissance and Cintrifuse track records suggest the capital architecture should come first.

Read the original McKinsey study that produced Cintrifuse [4]. The full strategic logic is in that document: a seven-recommendation framework, an inventory of Cincinnati’s specific ecosystem assets, the dollar-and-timeline math behind the fund-of-funds case, and the explicit cross-reference to Michigan’s Renaissance model. It is the cleanest single document on how a region can think through the question you are weighing, and it is short enough to read in an afternoon.

6. The decision rule: build, license, or walk

The closing decision rule. Fund an accelerator when the regional capital base is undercapitalized enough for the spillover effect to clear your bar, when the operator would pass arms-length diligence on their own merits, when the structure puts a fund-of-funds with pillar-company capital ahead of the programming layer, when the program commits to leverage as its primary success metric, and when the consultancy doing your strategic diagnosis has no stake in running the resulting program.

Walk from any proposal where one entity pitches both the diagnostic and the operating role, where the licensing royalty exceeds what the brand brings to your specific region, where success is measured in new-venture count rather than leverage, or where the projected lift is benchmarked against a national average rather than your baseline.

The regional bump is a public good when the program is real and a liability when it is not.

References

[1] Fehder, D. C., & Hochberg, Y. V. (2014). Accelerators and the regional supply of venture capital investment. SSRN. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2518668. Synthesized in Hochberg, Y. V. (2016). Accelerating entrepreneurs and ecosystems: The seed accelerator model. Innovation Policy and the Economy, 16, 25–51. https://doi.org/10.1086/684985

[2] Seitz, N., Buratti, M., Lehmann, E. E., & Kurrle, J. (2026). A meta-analysis towards the effectiveness of startup accelerators. Journal of Technology Transfer, 51(1), 373–413. https://doi.org/10.1007/s10961-025-10218-6

[3] Hallen, B. L., Cohen, S. L., & Bingham, C. B. (2020). Do accelerators work? If so, how? Organization Science, 31(2), 378–414. https://doi.org/10.1287/orsc.2019.1304

[4] McKinsey & Company (c. 2011). Accelerating the development of an innovation economy in Cincinnati. Strategic report prepared for the Cincinnati Business Committee Regional Innovation Task Force. https://cintrifuse.com/wp-content/uploads/2022/03/McKinsey-Report.pdf

[5] Renaissance Venture Capital Fund (founded 2008). Business Leaders for Michigan. Current portfolio (per Renaissance’s own Impact page, accessed 2026): 60+ venture capital funds and 800+ active portfolio companies. https://renvcf.com/impact/ and https://renvcf.com/about/.

[6] Cintrifuse. (2024). Powering our innovation economy: 2022–2023 Impact Report. Cintrifuse Fund Management LLC reported $175M regulatory AUM across three funds as of 2023. https://cintrifuse.com/wp-content/uploads/2024/01/Cintrifuse_ImpactReport2023.pdf

[7] Cincinnati Business Courier / Inno (2025). Reporting on Cintrifuse Capital’s direct-investment activity through late 2024: $6.1M deployed into 17 local Cincinnati companies attracting $72M in outside capital; Greater Cincinnati venture-style funding tracked by Cincy Inno’s startup funding database grew from $114M (2023) to $250M (2024), a 117% YoY increase. (Broader Cincinnati startup funding including angel and growth-stage rounds was reported separately at ~$260M for 2023 in a June 2024 Courier piece, reflecting different methodologies.) https://www.bizjournals.com/cincinnati/inno/stories/news/2025/01/09/cintrifuse-capital-venture-dollars-startups-funds.html

[8] Cintrifuse (2019). First impact report. Reported nearly $100M committed into venture capital funds, 700+ startups in pipeline with ~1/3 attracting seed-or-later capital, and Cincinnati regional risk capital growth from $25M (2011) to $176M (2018). https://cintrifuse.com/cintrifuse-releases-first-ever-impact-report/

[9] Renaissance Venture Capital (2021). Renaissance closes $77.5M Fourth Fund. PR Newswire press release reporting cumulative $280M+ raised across four funds since 2008, with $2B+ in capital attracted to Michigan startups (approximately $13:$1 leverage). https://www.prnewswire.com/news-releases/renaissance-venture-capital-closes-77-5m-fourth-fund-301337309.html. See also Silicon Prairie News (2018), https://siliconprairienews.com/2018/05/renaissance-venture-fund-closes-fund-iii-with-81m-of-new-capital/.

[10] State fund-of-funds leverage range synthesized from program-level evaluations and reports of Ohio Third Frontier, Illinois Growth and Innovation Fund, Indiana Next Level Fund, Texas Emerging Technology Fund, and similar programs. Published leverage ratios vary widely by program and methodology; commonly cited figures fall in the 3–10x range over full fund life. No single consolidated national report exists; figures reflect the range that recurs across individual state program audits and legislative reports.

[11] CB Insights. The Venture Capital Funnel. ~48% of seed-funded US startups raise at least one follow-on institutional round; ~30% achieve any exit (M&A or IPO); ~67% stall without follow-on or exit over the full funnel horizon. https://www.cbinsights.com/research/venture-capital-funnel-2/. See also Carta cohort analysis (~30–35% of seed-funded startups fail within seven years; ~15% reach Series B within seven years), summarized at https://www.saastr.com/carta-of-seed-funded-start-ups-fail-and-1-3-become-unicorns/.

[12] Feld, B. (2012). Startup Communities: Building an Entrepreneurial Ecosystem in Your City. Wiley. The “Boulder Thesis” distinguishes entrepreneurs (who must lead the community) from “feeders” (universities, government, investors, service providers — who support but should not lead). The “give first” ethos functions as a normative filter on community participants; actors who extract more than they contribute should not become central or leading figures. The “warning label” extension is mine; the underlying framework is Feld’s. See Startup Communities chapters 1, 2, and 6, and Feld’s blog at https://feld.com/categories/startup-communities/.

• Andrea Ippolito of SimpliFed: Lactation Support at Population Scale.

• Otto Sipe of Photon Pharmacy: Building Prescription Routing in the face of a 95% market share incumbent.
  

Every founder in this series has had to convince enterprise healthcare to pay for something it wasn’t built to buy. Jake Rothstein has done it twice. At Papa, he turned companionship for older adults into a Medicare Advantage benefit and rode a 2019 rule change from zero to a hundred million dollars of ARR in several years. At Upside, he is doing it with housing, a messier social need than food or transportation. The product isn’t immediately apparent as medical: it’s an apartment, a lease, a care guide, and a landlord.

Last month Upside closed a $20 million Series A led by Aqualine, with Flare Capital participating. It works across ten states with more than seventeen regional health plans and four of the largest national payers.

Healthcare has named housing the top social determinant for fifteen years and funded little of it. This conversation gets into the payment, measurement, and design choices Upside used to change that. Four moments are open below; the full interview is under the paywall.

The attribution problem when working with SDoH

Ask a plan why it won't fund a social intervention and you'll hear that outcomes can't be attributed to any one vendor. Jake reads attribution differently: it is the reason plans give when a problem is too small to be worth solving. He reframed housing as the biggest unturned stone in social determinants, on the logic that a member without stable housing can't reliably eat well, get to appointments, or take delivery of medication. With that framing, attribution came up less.

Getting paid for outcomes, not activity

The social-needs category is full of companies reporting referrals made and resources connected. Those are activity metrics, and Upside was built to be paid on something else: enrollment, stabilization inside ninety days, and measurable movement toward stable housing. Jake draws a working line between a leading indicator a payer will underwrite and an activity it will discount.

"I can't house that person"

Hand Upside a member with no income living under a bridge and the honest answer is that they can't house that person yet. Housing is a continuum, not a binary of housed and unhoused. Getting someone from the street into a shelter is a measurable step with its own ROI, as is the move from a shelter to a group home. Upside builds its contracts around the rungs of that ladder rather than a single end state.

The advice for founders who are early.

His counsel to anyone selling the not-yet-reimbursable: stay lean, keep the business alive, and be there when the problem grows too big for the buyer to ignore. And some luck.

Why this matters if you’re building

If you’re selling something healthcare wasn’t set up to buy, four decisions in this interview are worth borrowing.

Speak the buyer’s language, from the buyer’s seat. Upside hired its own actuaries out of the health plans, former Optum and UHC people, and built its ROI model to the standard a plan’s actuary would apply. It then stripped HEDIS and star ratings out of that model, because plans discount the soft metrics and weigh medical cost savings, ED reduction, and length of stay. Offering to be judged on the hard numbers reads as credible to the person on the other side of the table.

Find the dollars before you find the demand. The channel wasn’t a better pitch. It was getting written into states’ Medicaid managed-care RFPs as a scalable housing-stability benefit, then taking the full contract when the plan won the bid. The money for a new benefit often already exists, mislabeled and underused; the work is locating the flexible dollar rather than inventing a budget line.

Pick your wheelhouse and hand off the edges. Housing touches employment, credit, documentation, and behavioral health in a way food and transportation don’t. Upside got repeatable at the housing-specific components, became the coordination layer around them, and routed everything else back to plan case managers and community organizations. That focus is part of why they hold an engagement rate most Medicaid programs don’t.

Pressure-test the moat you’ll have in three years, not today. Jake will tell you technology is commoditizing. What compounds is the matchmaking data: which member profile fits which unit, fastest, learned over thousands of placements, sitting on a two-sided marketplace where volume in a market earns better landlord relationships.

None of these were timing alone. They were design choices that made a non-medical product legible to a medical buyer, one decision at a time.

🔒 The full conversation is below for subscribers.

We get into the hypotheses Upside got wrong, why they were afraid of Medicaid and got pulled in anyway, how they shut down a working direct-to-consumer business in 2023 to focus on payers, and how they hold an eighty-five to ninety percent engagement rate in a Medicaid population.

Read more

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The Healing Healthtech Mini Accelerator - The Consult - was absolutely incredible. Thrilled to be doing the next ones with Scrub Capital in SF in December and Paulo Machado in Chicago this Spring. I’ll have application links shortly.

I’m going to be experimenting with a bunch of new event formats this year. My theme overall is to distill the most interesting and highest value elements of accelerator programs and community events into high impact, deeply engaging meetups.

If you’ve got an event format that you’d like to experiment with or are interested in volunteering, providing space, or sponsoring a get-together, reach out to me via DM here on Substack.

I’m not the only one cooking though. NYC digital health peers communities Pepper, Health2Tech, OneHealth and many others have a bunch going on these next two months. 40 events total.

-Vadim

🏠 My September and October events

🎧 Just Listen: A zero talking event

• Thu, Sep 10, 6–8 PM · Dumbo, Brooklyn · Free, 20 seats by lottery

  • After two days of intense communication at The Consult, my next event will be the exact opposite.

  • My passion project this summer was to restore a pair of vintage large format Urei studio monitors (big loudspeakers used in recording studio)

  • October 10th, I’ll be setting them up in an acoustically treated space with comfy couches.

  • Zero talking, zero screens allowed.

  • Two surprise albums will be played end-to-end.

  • Bring takeout, bring a book, or just sit.

  • Twenty attendees will be drawn at random from applicants.

🍷 Medicare + Medicaid Founders and Funders Dinner

• Thu, Oct 1, 6–9 PM · Personal penthouse of a 3x IPO’d super-angel, NYC · Approval required

  • Building for the social safety net brings its own challenges, economic, operational, and clinical realities and struggles. Connect with founders and investors building and thriving in that space.

  • Twelve founders and twelve investors will be accepted to participate.

  • Part one will be a mixer-style dinner with a gorgeous view of the city.

  • Part two will bid farewell to the investors and be a group office hours for founders led by an exited YC CEO where we help one another work through our respective hurdles.

  • The founder side is open to any company that has not yet raised a priced seed and serves a predominantly Medicare or Medicaid population.

  • Investor side is open to VCs and angels who have written at least two checks into Medicare or Medicaid-focused value props in the past 24 months.

🗣️ Negotiation for Non-Lawyers

• Thu, Oct 15, Cct 22, 6–9 PM · Tribeca NYC · capped at 25 participants

  • Learn strategies and tactics to become effective at driving negotiations

  • A two-part workshop on the skill most operators assume is innate. I’m proof that it can in-fact be learned.

  • Each evening runs two short didactic sections and two peer role-plays built from real digital health and venture scenarios.

  • I’ve spent years developing and teaching this workshop and have previously taught it to rave reviews at NYU, the SOSA International Accelerator, and many others.

  • This will sell out quickly.

  • $350 per attendee

📑 Priced Round Bootcamp

• Tue, Oct 27, 1–5 PM · Flatiron, NYC · Approval required

  • Raising your first priced round is a completely different beast than stacking SAFEs.

  • Four part afternoon workshop will cover

    • Cap table and data room hygiene

    • Finding, pitching, and closing your first institutional investors

    • Words that matter in a term sheet and deal docs

    • Panel / Q&A with 4 active VCs working at priced seed

  • This workshop / bootcamp is a distillation of the best parts of multiple different programs I’ve run previously to support founders’ first institutional raise.

  • This one is domain agnostic - not just digital health.

Peer community events in NYC Digital Health

⚡ This Week: Sept 1–6

☕ September Healthcare Coffee Meet Up

• Fri, Sep 4, 8:30–10 AM · Laughing Horse Coffee & Tea Co., Harrison · Free

  • One for those in Westchester!

  • Sixth Borough Health’s monthly coffee and co-working session for digital health leaders, run by Julia Bernstein, COO of Brightside Health.

🔥 Week of Sept 7

🍽️ Seed2Table: Pitch + Dinner for Health Tech & AI Investors

• Tue, Sep 8, 5–10 PM · NYC, address on approval · Ticketed, tiers vary

  • A seated pitch dinner with Tower Capital, presented by KPMG.

🏦 The Ecosystem Behind Innovation: The Neion Bio Journey

• Tue, Sep 8, 5:30–8:30 PM · NYC, address on approval · Free, approval required

  • The Ford Center Incubator at Rockefeller University with J.P. Morgan, tracing Neion Bio from stealth to a Series A.

  • The founders, their Caffeinated Capital investor, and Rockefeller leadership on the table, moderated by J.P. Morgan.

  • Networking after.

🧬 From Bench to Boardroom: James Rothman on Cellular Logistics

• Tue, Sep 8, 6 PM · NYC, address on approval · Free, approval required

  • SOSV brings the Nobel laureate whose vesicle-trafficking work underwrites a generation of nanobiology companies.

  • Conversation with Sean O’Sullivan on what actually converts bench science into a fundable company.

🩺 Health2Tech NYC

• Thu, Sep 10, 5:30–8:30 PM · NYC, address on approval · Free, approval required

  • Bailey Morgan, Perrin Joel, and Alex Koshykov’s recurring digital health evening.

  • Investor Panel will include Margette Davidson of Company Ventures, Michelle Wang of Wavemaker 360, and Jesse Gentil of Health Enterprise Partners

🌶️ Pepper NYC Healthtech Founder Meetup

• Thu, Sep 10, 6–8:30 PM · Tap Haus 33, 14 E 33rd St · Free, approval required

  • Founders and operators building in healthcare, drinks and bites covered by Lemma.

🏃 NYC September Run: Bio-Health Athletic Club

• Sat, Sep 12, 10–11:30 AM · Pier 46, Hudson River Park · Free

  • Conversational pace, biotech and healthtech talk, drinks after. All levels.

🔥 Week of Sept 14

🌇 Health Tech Founders & Funders: Rooftop Happy Hour

• Tue, Sep 15, 5–7 PM · NYC, address on approval · Free, approval required

  • Distributed Ventures, Inflect Capital, and Wilson Sonsini putting founders and funders on a roof together.

  • Inflect writes $250K to $2.5M and is backed by a physician group of 8,000 clinicians across 500 sites;

  • Distributed does seed and Series A across health, wealth, and insurance.

  • Curated guest list rather than open door.

⚛️ No Free Lunches: Why Physics Still Matters in an AI-Driven Drug Discovery World

• Wed, Sep 16, 6–8 PM · NYU Silver Building, Rm 32, Waverly Pl · Free

  • The New York Area Group for Informatics and Modeling on where physics-based methods still beat learned ones in drug discovery. Technical room.

🗽 Digital Health NY Summit

• Thu, Sep 17 · Quorum by Convene, 1221 Sixth Ave · Registration by application

  • DHNY’s annual summit.

⚓ Ship It: A Healthcare Software Engineering Conference

• Thu–Fri, Sep 17–18 · NYC · $950, invite-only

  • Out-Of-Pocket’s engineering summit.

  • 80 curated guests,

  • 12 workshops,

  • hands-on sessions on FHIR, HIPAA, and AI. Debates and breakouts rather than hour-long keynotes.

🧠 Materna Mind Series: Managing Anxiety in Pregnancy and Postpartum

• Thu, Sep 17, 6:30–8 PM · Materna Health, 130 7th Ave S

  • Lillian Rishty, LCSW, PMH-C on the 3am spiral and the worry that asking too many questions makes you a difficult patient.

🌍 Project Dandelion: Health is the Headline

• Sun, Sep 20, 2 PM · NYC, address on approval · Approval required

  • Women, climate, and health as one problem rather than three.

  • Opens the Climate Week stretch.

🔥 Week of Sept 21

Climate Week NYC runs Sep 20–27.

🎓 From Lab to Market: Adaptation and Resilience Tech from Universities

• Tue, Sep 22, 8:30 AM–12 PM · Cisco Systems, 1 Penn Plaza · Approval required

  • Tailwind Futures on commercializing university-originated research.

🏛️ The State of Play: How Global Governance Reform Will Reshape Health and Climate

• Tue, Sep 22, 10:30 AM–12 PM · The Sidebar, 134 W 29th St · Private event

  • The global health architecture is currently undergoing significant institutional change, with several parallel reform initiatives underway, including UN80, the WHO Joint Process, and other financing processes, set against a broader backdrop of shifting multilateralism and geopolitics.

  • This is the session that maps them against each other.

🚑 When the Road to Healthcare Is the Barrier

• Tue, Sep 22, 11 AM–12:30 PM · The Sidebar, 134 W 29th St

  • The event looks at SDOH elements of distance, travel time, and unreliable transport as the determinant nobody funds towards healthcare outcomes.

  • Emergency obstetric care and immunization completion will be the worked examples for the conversation.

⚖️ States Under Pressure: Resisting Federal Climate Rollbacks

• Tue, Sep 22, 11:30 AM–12:30 PM · 113 W 60th St · Free

  • ​As the federal government moves to accelerate fossil fuel infrastructure and roll back environmental protections, states, local governments, Tribal nations, and communities are confronting a fundamental question:

  • Who gets to decide what is built, where it is built, and whose health and environment are put at risk?

🌱 From Climate Commitments to Health Impact

• Tue, Sep 22, 4:30–6 PM · The Sidebar, 134 W 29th St

  • The implementation gap between a pledge and a health system that can absorb it.

  • Panel representing academia, government, philanthropy, and industry discuss the path forward.

💪 The Core Truth: Movement, Pelvic Floor, and Birth Prep

• Tue, Sep 22, 6:30–8 PM · Materna Health, 130 7th Ave S

  • Jenny Hoofnagle of Freya Movement Studio on diastasis, prenatal strength, and postpartum recovery.

📰 Newsweek AI Health Summit

• Wed, Sep 23, 7 AM · Newsweek HQ, 1 WTC 72nd Fl · $799

  • Jennifer Cunningham and Alexis Kayser convene hospital leaders on moving AI past isolated pilots.

⚡ AEG NYC Health, Energy & Resilience Action Challenge

• Wed, Sep 23, 11:30 AM–4:30 PM · WSP USA, 250 W 34th St · $295–$2,544, some passes free

  • Advanced Energy Group’s working session with WSP and the NYC Department of Health’s Air Quality program.

  • Gov and nonprofit passes are comped.

🌾 Scaling Resilience through Whole-System Innovation

• Wed, Sep 23, 2–3:15 PM · NYC, address on approval · Approval required

  • REGEN HOUSE on regenerative agriculture inside planetary boundaries.

  • Food-as-health adjacent.

🔀 Shifting Power in Climate and Health

• Thu, Sep 24, 8:30–10 AM · The Sidebar, 134 W 29th St

  • A small working conversation on who decides what gets funded when the expertise sits in the countries bearing the risk and the capital does not.

👵 HITLAB September Digital Health Symposium

• Thu, Sep 24, 11 AM–2 PM · NYC · Registration open

  • Healthy aging, longevity, and caregiver technology.

  • RPM and AI applied to the population that actually generates the spend.

🧘 Mental Health in a Disastrous Climate

• Fri, Sep 25, 11 AM–1 PM · The Climate Imaginarium, Governors Island · $10 suggested, nobody turned away

  • Climate Cafe NYC on converting climate grief into action. Governors Island in late September is its own argument.

🔥 Week of Sept 28

🧫 NewYorkBIO Innovation Summit

• Wed, Sep 30, 8:30 AM–6 PM · Cure, 345 Park Ave S · $99-$800

  • New York’s life science advocacy body running its annual innovation day at Deerfield’s Cure.

🩻 Klinikum+: How AI is Reshaping Medicine

• Wed, Sep 30, 7–9 PM · Manhattan, exact venue to registrants

  • Part two of the Klinikum+ series.

🍂 October

🫂 The Check In: Men’s Mental Health

• Thu, Oct 1, 7–9 PM · Harlem, address on registration

  • Dre Steinberg’s monthly peer circle. Every first Wednesday normally; this one runs Thursday.

👶 The Future of Fertility

• Tue, Oct 6, 9 AM–12 PM · 115 Broadway, FiDi

  • Five experts on where fertility care, law, and coverage are heading. Hosted by IVF Law Group, so the regulatory angle will be sharper than the usual femtech panel.

🧪 Biolabs@NYU Langone Investor & Innovator Exchange

• Tue, Oct 6, 12–7 PM · Hunters Point, Queens, address on approval · Approval required

  • Seven hours of founders and investors in the room at NYU Langone’s incubator. The Sep 15 pitch practice session feeds this.

🍴 AI in Healthcare: From Pilot to Production, An Executive Dinner

• Wed, Oct 7, 6:30–9 PM · Kyma, 15 W 18th St · Free, approval required, 12 seats

  • CIOs and technology executives from regional health systems and payers seated with the CTOs building for them. No slides, no recording, off the record. Will Naylor of Sentro IT hosts.

🤝 Agents on Call: Live AI Agents in Healthcare Ops

• Thu, Oct 8 · Venue TBD · #AIWeekNY

  • Prior auths, intake, and the rest of the operational surface where agents either work or quietly don’t.

🌐 Global Health Congress 2026

• Fri–Sun, Oct 9–11 · The Yale Club, 50 Vanderbilt Ave · $1,500–$2,500

  • Three days of clinical leaders, innovators, and capital. Priced for institutions.

🔗 2026 Healthix Conference

• Wed, Oct 14, 8:30 AM–4:30 PM · Museum of Jewish Heritage, 36 Battery Pl · Ticketed

  • City & State NY convenes New York’s largest health information exchange. If your product touches interoperability in this state, the buyers and the data stewards are both here.

🦠 Gut Feelings: A Panel on the Mind-Body-Belly Connection

• Wed, Oct 14, 6–8 PM · Parsley Health, 126 5th Ave · Registration required

  • Our Kind Therapy and Parsley on the gut-brain axis and the patient whose labs come back normal.

🔬 NY Metro Builds Bio+ 9th Annual Symposium for Life Science Innovation

• Thu, Oct 15, 8 AM · Union League Club, 38 E 37th St · $349

  • The tri-state life sciences economy, including eastern New Jersey and southern Connecticut, treated as one market. Science, real estate, and capital in the same program.

🍸 Fall 2026 Healthcare Happy Hour

• Thu, Oct 15, 5:30–7:30 PM · Moquette, Scarsdale · Free

  • Sixth Borough Health’s first quarterly happy hour. Julia Bernstein again, this time north of the city.

🏆 Medical Innovation Olympics: Live Finals

• Fri, Oct 16 · Rockefeller Center · Attendee $500 early, $650 regular

  • Finals and closing ceremony for the competition whose Sep 18 trials are listed above. Hybrid.

♀️ Claude & Longevity Health

• Sun, Oct 18, 2–5 PM · Everything’s Jake, 54 E 13th St · Free

  • World Menopause Day, framed around femtech, AI, and longevity as a women’s health question. 31 going.

🩺 Health2Tech NYC

• Thu, Oct 22, 5:30–8:30 PM · NYC, address to registrants · Free, approval required

🏥 Smart Technology Transformation in Healthcare (ConV2X)

• Thu, Oct 29, 9 AM · NYC Conference Center at Cornell ILR, 570 Lexington Ave

  • Partners in Digital Health’s summit on smart tech, clinical practice, and policy.

⚙️ Responsible Tech Summit 2026: From Principles to Power

• Thu, Oct 29, 10:30 AM–7:30 PM · The Times Center, 242 W 41st St · $150–$300, approval required

  • All Tech Is Human on moving AI accountability from principle to enforcement. University and nonprofit rate available.

Hi, I’m Vadim.

Healthtech venture is hard, a fact I’ve learned firsthand as an operator, accelerator director, and investor. I’ve watched too many good teams repeat avoidable mistakes others have already paid for. I write Healing Healthtech to distill research and the experiences of top-tier operators into actionable tactics and frameworks, so we can all aim to make only new mistakes.

Subscribe for a twice-monthly dispatch of free and paid field guides meant to help you build more deliberately toward something better in human health. And if it’s useful, please forward it to other healthtech builders in your network.

Subscribe now

TLDR

• Coach your funnel to two bars: one in three from qualified lead to conversation, one in five from conversation to wired check.

  • The conversation bar sits at the corpus median; clearing both is where you stop tinkering and add volume.

• Read Carta and AngelList for how rounds end; read founder narratives for how raises run.

  • Cap tables record price, dilution, and instrument. Names contacted, per-step conversion, and wire slippage never reach them.

• Plan one qualified investor name per $5-10K of target round.

  • Cold lists convert at 3-4% contact-to-check; a $750K round wants 80-120 names, not 30.

• Budget the calendar for the build and the wire tail; the active raise is the short middle.

  • Both DocSend’s survey and the corpus put roughly three raises in ten past six months.

• Respect the direct-check ceiling of 10-40 yeses per round; go wider only through a pooled vehicle.

  • Syndicates, RUVs, and crowdfunding are the only rounds in the corpus that broke it.

• Track committed and wired as separate columns from the first yes.

  • The founders who measured slippage counted only wires; verbal commitments evaporated without ever being reported as no’s.

Author’s note

This piece is the data companion to Raising Angel and Preseed Funding for Digital Health [2]. The dataset ships with it: the comparison grid, the per-source verification ledger, and a primary-source link for every account.

This piece was built in Claude Cowork with a custom skill stack that I developed. Claude was my primary collaborator; Gemini, ChatGPT, and Perplexity served as red-team research associates. My use of generative AI is loud and proud, and in this piece it is also the method: Claude agents swept the open web for founder accounts and tabulated them, and every number they extracted was verified against its primary source before it entered the grid. The thesis and the judgment calls are mine.

Contents

1. The numbers that trace back to nobody.

   • Stop planning your raise on funnel folklore.

2. What Carta and AngelList see, and what they can’t.

   • Match each dataset to the decision it can support.

3. How the dataset was built.

   • Judge the verification standard before trusting any figure, mine included.

4. What the data shows.

   • Calibrate your funnel, calendar, check count, and clock against measured raises.

5. What founders should do with it.

   • Run five decision rules in your CRM from the first outreach.

6. What investors should take from it.

   • Read process discipline as a diligence signal; pace angel rounds on angel math.

7. Contribute your raise.

   • Add your account to the corpus, or correct your row.

1. The numbers that trace back to nobody

[001]When Jon Lee was raising Pickle’s pre-seed, I read his funnel every week, the way I read every founder’s I coach: qualified leads into conversations, conversations into checks. The week the two rates turned healthy, I told him to stop worrying about the raise, stop tinkering with the pitch and the targeting, and put 20-30 new investors into the top of the funnel every week; the round would close in three months. It closed three months later, almost to the day, and Jon came into my office bewildered at the precision of the forecast. No magic was involved. Healthy conversion against known weekly volume is arithmetic.

[002]The arithmetic came from a vantage almost nobody gets. For fifteen years my venture partner and I led the Future Labs at NYU, where we supported 300+ teams to $2.7B in capital raised and 44 exits. Watching that many raises run side by side is what taught me what healthy conversion looks like, when to stop tinkering with a venture’s design, pitch, and investor targeting, and how to forecast a close. The discipline works at cohort scale: 80% of my final cohort at Catalyst, NYU Tandon’s public-facing pre-seed-to-seed accelerator, closed a round within three months of graduation, and conversion-driven coaching is how we achieved that. 99% of founders will never sit inside a network like that, and the public record is no substitute: the conversion figures circulating in accelerator curricula and fundraising posts trace back to nobody (the deck cites a talk that cites a post that cites nothing), and no measured aggregate of per-step angel-round conversion had ever been published. I built this dataset to put the thing the Future Labs dataflow gave me into anyone’s hands, with sources attached.

[003]The gap it fills is concrete. How many investor names does a $750K round need? How many weeks will the raise take, and which weeks do what? What does a healthy funnel convert at each step, and when does a quiet one mean the pitch is broken rather than early? The advisory tradition answers with first-person judgment. Alex Iskold, Paul Graham, Charlie O’Donnell, Elizabeth Yin, and Mark Suster have shared theirs generously for years, and it is woven through the parent guide [2]. But judgment can’t be audited, and when two advisors disagree, the founder has no way to adjudicate.

[004]The Founder Narratives dataset is fifty verified first-person accounts of angel and pre-seed raises, published between 2008 and 2025, each reduced to the same operating row. Across the fifty, founders worked roughly 4,500 investor names, held some 2,000 first conversations, closed several hundred checks, and banked more than $150M across three continents [1].

Figure 1. Active weeks against dollars raised; bubble area is names contacted. Source: HH Founder Narratives [1].

If you read Part II, you have seen this chart; it opens the process guide as a promise and a warning. Every bubble is a real raise from a named founder, and no existing dataset could have produced it. The promise comes first: angel rounds close at every size, on both clocks, and on three continents. The supply side backs the promise up. The US alone counted 422,000 active angels in 2023, funding 55,000 ventures with $18.6B; Europe’s formal networks add 45,000 more, and that census misses the informal majority [8]. Roughly 500,000 angels will write checks into some 60,000 companies around the world this year. Your angels exist. What separates the founders who find them is process, and process is learnable.

2. What Carta and AngelList see, and what they can’t

Carta operates the largest cap-table dataset in the industry, roughly 500,000 signed SAFEs and notes since 2018 and more than 10,000 seed rounds from 2021 through late 2025, and Peter Walker has spent years cutting it against most of the consequential questions a founder faces: round sizes, valuations, dilution by instrument, cofounder splits, founder salaries, time between rounds [3]. AngelList’s deal flow has given its data science team, Abe Othman’s work in particular, a comparable vantage over the syndicate market [4]. DocSend’s index adds deck behavior: read time by intro type, slide order, survey-recalled fundraising duration [5]. Parts I and II lean on all three.

Each instrument records an ending. A cap table is a record of how a raise finished: who owns what, at what price, on which instrument. Platform deal flow records the transactions that reached the platform. Deck telemetry records what happened after the deck arrived. None of them can see how the raise ran: how many names the founder contacted, what fraction became conversations, how long she calibrated before opening the round, how many verbal yeses never wired. Those numbers live in the founder’s CRM, or in her head, and they never touch the systems the industry aggregates. No platform’s data exhaust contains them, so no platform could have published them.

A selection problem sits on top of the measurement problem. Cap-table and platform data are conditioned on completion: a round appears in Carta because it closed, and on AngelList because it transacted there. The raise that stalled at week ten and the funnel that leaked at the conversation step leave no record at all. The Narratives corpus carries its own selection bias, which section 3 takes seriously; the point is that the two biases run in different directions, and a founder planning a process needs the process-level view even when it is noisier.

The missing data was sitting in public the whole time. Founders have been writing detailed post-mortems of their raises for fifteen years, on Medium, Substack, LinkedIn, and company blogs, some with complete funnel tables: Niels Hoven published the anatomy of Mentava’s 50-angel round, Obum Egbuna the 300-name outreach behind Chezie’s $780K, Williams the 99-contact, 36-check funnel behind Urban Jungle’s £1M [1]. Each was read as a story and cited as an anecdote. Fifty of them, held to one schema and verified against their sources, become a dataset. That aggregation is the entire contribution.

3. How the dataset was built

Claude agents swept Substack, Medium, LinkedIn, and the open web for first-person accounts of angel and pre-seed raises, with three admission criteria: a named founder, a first-person telling, and specific process numbers rather than a victory lap. Each candidate account was fetched in full and its figures checked against the primary source. Accounts that couldn’t be fetched (login walls, deleted posts, audio-only) were held as pending and excluded from every aggregate. A per-source verification ledger records what was checked, when, and to what standard [1].

From every account we extracted the same operating row: names contacted, first conversations, checks closed, and the conversion at each step; calibration time versus active raise time; check sizes and dollars raised per name; the instrument and cap-table container; what the anchor check changed; and whether committed money failed to wire. Blanks are data: where an account doesn’t report a field, the cell stays empty and nothing is imputed. Derived values (currency conversions, midpoints, floors under “50+” claims) are flagged as derived, with the basis recorded in the grid.

Where the public record ran out, I reached out to the founders directly on LinkedIn, and many happily responded, filling in data points missing from every published account. Williams confirmed that his 36 closed checks exclude two or three verbal yeses that never signed or wired, which he quietly reclassified as no’s; published yes-counts likely absorb their dropouts the same way. Egbuna confirmed zero commit-to-wire slippage on Chezie’s RUV round. Three of the six fully documented funnels in Part II are founder-confirmed by direct correspondence [1].

Fifty self-published accounts are a self-selected sample: founders who closed, and who chose to write about it, skew more transparent and more successful than the population. Market regimes aren’t comparable; a 2021 yes-rate and a 2023 yes-rate describe different worlds. UK tax relief inflates British angel yes-rates against American ones. And accounts define “contacted” differently (emailed, listed, met), so the grid tracks each account’s denominator and refuses cross-denominator averages. The corpus argues from named raises and recurring clusters, and holds its aggregates more loosely than one would hold Carta-grade data. The claim standard is pattern recurrence: when the same structure appears across founders who never read each other, it is worth planning around.

4. What the data shows

A healthy funnel is one in three, then one in five.

The corpus’s central numbers: a healthy angel raise converts about one in three qualified leads into a real conversation, and about one in five conversations into a wired check. Compounded, roughly one qualified lead in fifteen becomes a check. The two fully documented under-networked funnels ran below that bar, at 3-4% lead-to-check on cold lists, and still closed; the lean funnel bought a longer raise. Warmth moves every number. Own-network founders ran 14-36% lead-to-check, and the relationship-rich skipped the funnel entirely: the shortest raise in the corpus closed $555K on a single ask, twenty-one days, no deck, seventeen years of earned trust [1].

Figure 2. Per-step conversion for six fully documented funnels. The drawn ~1 in 3 bar applies to the contact-to-meeting step; the conversation-to-check bar is ~1 in 5 (Figure 3). Source: HH Founder Narratives [1].

The location of the leak names the problem. Leads that never become conversations are a targeting or story problem: you aren’t earning the meeting. Conversations that never become checks are a proof, anchor, or close-date problem: you aren’t closing it. The two send you to different fixes, and adding leads multiplies the conversion you already have. The rates are not readable until you have pitched about twenty check-writing strangers; friendly meetings and practice pitches do not count, and a thinner sample is tuition rather than a verdict. Expect roughly half the healthy rates until the first meaningful check lands; account after account shows the anchor changing the psychology of every meeting that follows [1].

Be precise about what each bar asks. Across the ten documented funnels, the median conversation-to-check is about one in five: two checks from ten real conversations is the middle of the corpus, with warm and inbound raises above one in two and cold institutional funnels below one in ten. The conversation-to-check coaching bar sits at that median. The top step runs higher; documented funnels cluster around one in three lead-to-conversation, and that is the bar there. A funnel clearing both is healthy: stop tinkering with the pitch and the targeting, feed the funnel on a weekly schedule, and let the arithmetic run.

Figure 3. Conversation-to-check for the ten documented funnels, with 95% intervals; the coaching bar sits at the corpus median. Source: HH Founder Narratives [1].

Table 1. Median 22%; the 30% mean is pulled up by the warm and inbound rows. Per-row caveats (institutional-only counts, inbound funnels, denominator definitions) are in the chart data tabs [1].

The active raise is the short middle

Ask a founder how long a raise took and you get one number; decompose the reported timelines and you get three. The build (sharpening the pitch, assembling the list, accumulating proof) and the wire tail (collecting money already committed) surround a short active window. Hoven spent four months iterating Mentava’s pitch, four weeks raising full-time, and roughly three more chasing wires from an oversubscribed round [1]. The pattern holds down the chart: the part that looks like fundraising is the shortest part, and the calendar mistake founders make is budgeting for the middle while the build and the tail spend the runway.

Figure 4. Build, active raise, and wire tail, in reported order. Source: HH Founder Narratives [1].

On total duration, DocSend’s seed survey and the corpus agree where it matters: roughly three raises in ten run past six months, so the marathon is a third of the market rather than a failure case [5][1]. They disagree at the short end (35% of corpus raises ran six active weeks or fewer, against 15% in DocSend’s recall) because they measure different quantities: DocSend records survey-recalled total fundraising time, the Narratives measure documented active raise time. Plan your calendar on the decomposition, not on a single recalled number.

Figure 5. Survey recall versus documented founder accounts. Sources: DocSend seed survey [5]; HH Founder Narratives, n = 26 [1].

Direct checks have a ceiling

Plot average check size against round size and the direct-check rounds cluster between the 10-check and 40-check diagonals: rounds built from individually signed checks top out at roughly 10-40 yeses, because every signature is a relationship, a paperwork packet, and a cap-table line. The rounds that broke the ceiling pooled their long tail into a container: a syndicate, an RUV, or crowdfunding. Egbuna’s RUV took checks from $1,000 by debit card and landed fifty investors on one cap-table line [1]. Part II’s $10K floor on direct checks falls straight out of this chart: below the floor, take the believer’s money through a container or not at all.

Figure 6. Average check versus round size, log-log; dashed diagonals mark a constant number of checks. Source: HH Founder Narratives, n = 17 verified raises [1].

The clock is a demand reading

The corpus documents two pacing patterns and almost nothing between them. The sprint piles up intros during a calibration period, then lands every meeting in one dense window with a close date every investor can see. The marathon keeps the round open while proof accrues, with a deadline set investor by investor. The meetings in the two diagrams below are identical; the only thing that changes is when they happen, and that timing is the entire difference in leverage [9].

Figure 7. The Sprint: conversations accumulate early; decisions land together. Concept after Daniel Olmedo’s meeting-density diagram [9].

Figure 8. The Marathon: each conversation starts before the last one resolves, on the same 12-week skeleton. Concept after Daniel Olmedo’s meeting-density diagram [9].

In the corpus, sprints closed materially larger rounds than marathons, and the causal arrow points backward: founders don’t raise more because they sprint, they get to sprint because demand is strong [1]. That makes the clock a reading the market takes of you, and one you re-check as the raise runs. A planned sprint still raising at week ten is the market answering the demand question; the response is to resize the round, reset each investor’s deadline, and re-declare the mode as a decision, because a sprint that decays into an undeclared marathon reads, from the investor’s side, like a deal that has been shopping for months.

Committed money fails to wire at a measurable rate: Riesen’s pipeline carried four investors in the closed stage who never wired, and Williams filed his two or three silent yeses as no’s [1]. The founders who could report their slippage precisely were the ones who had tracked committed and wired as separate columns. The gap between those columns is a real funnel stage with its own loss rate, and no published yes-count includes it.

5. What founders should do with it

Five decision rules, runnable in a CRM from the first outreach.

• Size the list to the round: one qualified name per $5-10K of target. A $750K round wants 80-120 named angels, operator-angels, and micro-VCs that write at angel sizes. At healthy conversion, every check sits on ten qualified names; on a cold list, contact-to-check runs 3-4%, so 30 names is a rehearsal, not a fundraise [1].

• Instrument two conversion columns from day one. Lead-to-conversation and conversation-to-check, read against the bars (one in three, one in five) once about twenty check-writing strangers have heard the pitch. Fix the leaking stage before adding volume; a bigger list multiplies the conversion you already have. Once both steps clear the bar, stop tinkering and feed the funnel on a weekly schedule; healthy conversion against known volume is a close date you can put on a calendar.

• Pick your clock in writing, and re-read it at week ten. Sprint or marathon, declared, with every conversation carrying its own deadline. The marathon is a legitimate third of the market; the undeclared marathon is a shopped deal.

• Set a $10K floor on direct checks, and stand up a container below it. The 10-40-yes ceiling is structural. An RUV or syndicate turns the long tail of small believers into one cap-table line instead of thirty signature chases [1].

• Collect every yes the day it lands, and track committed versus wired. A SAFE binds one investor at a time; nothing rewards waiting, and the corpus’s slippage data says a verbal yes is a pipeline stage, not money [1].

The founders who struggle most with this, in my coaching, have been the clinicians, engineers, and scientists coming to venture for the first time; the open-endedness of a raise sits badly with people whose day jobs run on protocols and proofs. They are also the founders best built for it. Each of those professions trains its people to make informed decisions with limited knowledge: a treatment plan from an incomplete picture, a design margin against loads nobody can fully model, an experiment that pays for itself in information either way. Conversion-driven fundraising is the same discipline pointed at capital: instrument the funnel, read it once twenty strangers have heard the pitch, act on the leak it names. That reframe is what has gotten my most uncertainty-averse founders over the hump for years, and sharing it beyond the founders I can coach in person is half of why this dataset exists.

None of this is fundraising exotica. A named list, weekly stage transitions, conversion read at each step, leaks fixed rather than worked around: this is the same discipline your company will need for sales, partnerships, and hiring. The raise is a trial run for the business-development function, and the corpus founders who closed on the timeline they planned ran it that way [1].

6. What investors should take from it

The same numbers read differently from the other side of the table.

• Process discipline is a diligence signal. A founder who can tell you her two step rates, her denominator definition, and where the funnel is leaking is showing you the sales motion her company will run after the round. The corpus founders who closed on plan all kept named lists and weekly reviews; the improvisers drifted past the runway they intended [1].

• Pace angel rounds on angel math. An angel round needs fifteen to forty separate yeses; an institutional raise ends at one or two term sheets. Judging an angel raise’s week-eight state against fund-raise pacing misreads it, in either direction. The comparator funnels (Right Side Capital’s institutional model, the Gompers 100-to-1 VC funnel) describe a different process; Part II works both [2][6].

• Your pass is data the founder can use. The angels who engaged seriously and passed hold the most useful read on a round, precisely because they have no position. When a founder asks for ten minutes to understand where the process is losing people, take the call; the corpus says the disciplined ones act on it [1][2].

• Pooled vehicles moved the floor. A $1,000 debit-card check through an RUV is now ordinary infrastructure. Expect more rounds shaped as a handful of direct anchor checks plus a pooled tail, and price the cap-table cleanliness accordingly [1].

• Mind what the corpus can’t say. It is conditioned on closing: it shows what closing looked like, not the odds of closing. The base rates sit elsewhere: healthcare-focused VCs fund roughly 1% of what they see, and angel groups fund 3-5% of applications [6][7].

7. Contribute your raise

Fifty accounts is a start. Sixty thousand companies will close an angel round this year [8], and the process data behind those raises should not have to be folklore. If you have raised an angel or pre-seed round and written a first-person account with numbers in it, or are willing to write one, send it to me and I’ll add it to the grid with full credit and a primary-source link. And if your raise is already a row and I have something wrong, tell me: every figure carries its source, and corrections are cheaper than myths. The strategy this data underpins lives in Parts I and II.

References

1. Vadim Gordin, HH Founder Narratives dataset: 50 verified first-person founder accounts of angel and pre-seed raises (2008-2025), comparison grid, chart data tabs with confidence intervals, and per-source verification ledger. Ships with this piece; every founder cited above (Hoven, Egbuna, Williams, Riesen, Zuo, Chalmer, Gillenwater, Olmedo) is keyed to a primary-source link in the grid.

2. Vadim Gordin, Venture Funding for Fun and Profit: “Part I, The Narrative” (https://healinghealthtech.substack.com/p/raising-angel-and-preseed-funding) and “Part II, The Process” (https://healinghealthtech.substack.com/p/raising-angel-and-pre-seed-funding), Healing Healthtech, June 15, 2026. The guide this dataset was built for.

3. Carta, State of Pre-Seed and State of Private Markets series; Peter Walker, Head of Insights. Cap-table data: ~500,000 signed SAFEs and notes since 2018; 10,000+ seed rounds 2021-Q3 2025. https://carta.com/data/

4. AngelList data science analyses of platform deal flow (Abe Othman). Referenced as context for what platform datasets cover; no figures in this piece are drawn from AngelList data.

5. DocSend Startup Index (Dropbox). Deck read-time by intro type and survey-recalled fundraising duration. https://www.docsend.com/index/

6. Paul Gompers, William Gornall, Steven N. Kaplan, and Ilya A. Strebulaev, “How Do Venture Capitalists Make Decisions?” Journal of Financial Economics 135(1), 2020. Median VC funnel ~100 opportunities considered per investment closed; ~78 in the healthcare subsample.

7. Angel Capital Association, “Trends in Funding Rates,” Dealum platform data, 2022-2024. Application-to-funded: pre-seed 3.0%, seed 4.5%.

8. Center for Venture Research (Jeffrey Sohl), The Angel Market in 2023, University of New Hampshire, 2024 (422,350 active US angels; 54,735 ventures; $18.6B); EBAN Statistics Compendium 2023. The rounded global claim is conservative.

9. Daniel Olmedo, “Funding Rounds’ Cheat Sheet 2026,” Fundraising Journey (Substack), Dec 2025. Meeting density as the lever that converts volume into leverage; the sprint and marathon diagrams follow his meeting-density concept.

Read more

Way off topic today and written from a lake house in the Poconos.

First, the healthcare:

I’m running a free mentorship bootcamp and mini-accelerator in late August with some of my favorite digital health friends and mentors.

Each accepted team get 16 matched 1:1 mentorship sessions with folks who have already been down the road you’re on.

If you’re interested in mentoring or sponsoring, please reach out directly.

Click here to apply.

Applications due 5pm EST on August 6th.

This is my braintrust.

The folks volunteering to mentor have worked with patients, built, raised, sold, and exited in almost every corner of enterprise scale healthcare.

Free for startups.
Accepted teams are welcome to participate one or both days.

👇 A sample of who’s mentoring:

🚑 Ramon Lizardo, MD, MBA CEO Tele911 (ED diversion, 9.5M+ lives, 150 health plans)
🏆 Ron Goldman, two exits: Wisdo (to Talkspace) and Kognito (to Blackstone)
📈 Ansgar Lange, scaled home care delivery $0 to $250M; ex-COO of Nostos (exited)
📡 Alexandre Winter, serial founder; Placemeter (exited), now CEO of Norbert Health
🤖 Margaux Benoit, healthcare AI go-to-market at Nabla
💊 Owen Willis, operator turned investor; ex-COO of Osmosis (acquired), now GP Opal Ventures
🏘️ Moshe Bellows, 3rd generation LTC operator. Seed-stage healthtech investor at Maccabee Ventures.
🏥 Neil Carpenter, health system executive. Former chief strategy officer at NantHealth
🩺 Alex Tang, built, scaled, and operated primary care ACOs at the 6k provider level. Former ops leadership at CityMD and Rendr. Currently a GP at PhyCap Fund.
📱 Rachel Trobman, co-founder and CEO of Upside Health (RTM/RPM/CCM)
🎧 Nyamitse-Calvin Mahinda, ex-Cityblock, now founder and CEO of Vital Audio
🫁 John Joshua, RRT, MHA, healthcare operations, former Northwell Exec. Current strategy leader
🚀 Christine Lu Hong, repeat healthtech founder. Formerly program lead at Techstars NYC


Then a perfect cup of coffee:

Most folks who know me know that I’ve gone way way way down the coffee geekery rabbit hole.

Here’s my no-fuss daily driver method - learned from a Japanese world brewer cup champion’s Youtube channel two years ago.

How to Brew a Spectacularly Good Cup of Coffee at Home.

Enjoy the sunshine!

-V

Way off-topic for a Sunday moment.

Thanks to pathological levels of ADHD and Can’t-Leave-Well-Enough-Alone-Itis, I have gone all the way down the coffee geekery rabbit hole. I roast my own beans on my rooftop once a week and have for five years, sourcing green coffee from around the world in cycles, chasing whatever is in season wherever it grows. I pull espresso on a hand-powered lever machine. I am, by any reasonable measure, too far gone.

I also have 3 kids who need to get ready for school in the same time it takes me to make everyone breakfast and get my wife and I out the door, so I need to balance the universe of flavor and texture possibilities with a realistic weekday workflow.

So believe me when I tell you that almost none of it is necessary. The single thing I wish more people knew about coffee is how accessible a world-class cup is: a championship-level brew is within reach of conventional, low-cost tools.

The method I’m about to describe has been my daily driver for the last 2 years. It is no fuss, takes less than 5 minutes end to end, and draws out deep, nuanced flavor and mouthfeel far better than finicky pour-over methods or my beloved espresso workflow, both of which impose themselves on the cup in ways this one refuses to. Unlike espresso and pour over, this method also needs no calibration for different beans. It gives exceptional results for syrupy African and Brazilian natural and honey process beans in the exact same way it conveys the clarity and fruit notes of Central American or Indonesian washed varietals.

The method comes from Tetsu Kasuya, the 2016 World Brewers Cup champion (Youtube link below). He called it the God recipe, then thought better of it and renamed it the Devil. His original runs on a contrarian move: partway through, you drop the water temperature, so the back half of the brew steeps cooler than it started.

My everyday version keeps his ratio but changes three things:

• A simpler pour structure: one bloom and one steep instead of staged pours.

• A gentler temperature drop.

• No second kettle or cold-water step to fuss with.

Kasuya has no kids and can stage a championship pour in peace. I have three who need tending while the coffee happens, so I traded his finesse for something I can run one-handed and still get a cup worth drinking.

What you need

• A Hario Switch (about $30). A cone with a valve at the bottom: open, it drains like a pour-over; closed, it steeps like a French press. One tool, two brews.

• 20 g of coffee, ground slightly finer than usual French press or pour over.

• A kettle, and a way to hit two temperatures: 205°F / 96°C for the bloom and 192°F / 89°C for the steep (just off the boil, then rested a couple of minutes).

• A measuring cup or scale to hit the pour weights.

• (optional) A 600ml glass coffee server for decanting ($15)

The cleverness is in the sequence.

The Method for a Hot Cup

The method has two phases.

• A hot bloom that drains all the way through.

  • This grabs the bright floral notes from your beans.

• Followed by a longer, slightly cooler 3 minute immersion.

  • The slightly cooler, longer immersion is similar to a French press in that it will draw out mouthfeel and rounder chocolate and caramel flavors. The lower temperature protects you from the more acidic and astringent notes that can turn a cup harsh and require milk or sugar to cover up.

Total water is 280 g to 20 g of coffee, Kasuya’s 1:14 ratio, split one-third for the bloom and two-thirds for the steep.

1. Grind. Grind 20 g a little finer than you would for a standard pour-over.

2. Rinse. Seat the paper filter in the Switch, rinse with hot water, discard the rinse.

   

3. Bloom, 205°F / 96°C, valve open. Pour about 93 g, a third of the total, over the grounds. Let it drain all the way through and stop.

4. Steep, 192°F / 89°C, valve closed. Close the valve and pour the remaining water to 280 g total. Let it steep, submerged, for 3 minutes. If you’re feeling sassy, give the slurry a gentle stir.

5. Open and drain. Open the valve and let it draw down. If it drains slowly, grind coarser next time; if it races through, go finer. Drawdown should take about 60 seconds.

   

6. Pour from height (Optional but strongly recommended). Decant from a foot up, the way mint tea is poured in Morocco (image below). This last bit aerates your coffee in the same way similar processes open up and round out the flavors in the same way it does for wine or Moroccan tea.

7. Enjoy. You’ll likely find that you need no milk or sugar if these are things that you add regularly.

A first note on temperature. If you don’t have a temperature controlled kettle, just do both steps at 200F and time your kettle. When I was in law school 15 years ago, I knew that my simple electric kettle dropped to 200F right at 4 minutes after having come to a boil if I took the lid off. I used that knowledge together with the microwave kitchen timer to make delicious French Press without having to ever re-measure temperature. If you’re doing this experiment, also figure out the time it takes to drop to 180F - the ideal for most green teas.

A second note on temperature: my drop from 205 to 192°F is lighter, about 13°F. Kasuya’s original plunges much further, toward 70°C / 158°F across multiple pours. This is my flavor and process preference. If you want the more dramatic effect closer to his Devil Pour as published, cool the steep water further.

The Method for Iced Coffee

Keep the same coffee-to-final-liquid ratio, but let ice in the server supply part of the water instead of the kettle. As a starting point, aim for the ice to supply about 40% of the finished drink.

In practice that means 20 g coffee : 170 g hot water through the brewer (the same bloom-then-steep structure as the hot cup, just to a lower total), dropped onto 150 g of ice waiting in the server. Two things make the exact final ratio fuzzy, and both push the drink stronger than the nominal numbers suggest:

• Bed retention. The grounds hold roughly 1.5 to 2 g of water per gram of dry coffee, so 30 to 40 g of your 170 g never reaches the server.

• Variable melt. How much ice melts depends on cube size, starting temperature, server mass, brew temperature, room temperature and how long you swirl.

So the served drink may land closer to 230–250 g than 280, and stronger than 1:14. Chilling also changes perception: it suppresses aroma release and shifts the balance of acidity, bitterness and sweetness, so a chemically identical brew can read as less expressive: quieter, though no weaker in concentration.

If you want to get fancy, you can also replace the coffee server with a cocktail shaker and get a result that has a mouthfeel similar to a Guiness.

1. Load the server. Put 150 g of ice in the Hario server, and set the Switch on top. The brew will fall straight onto the ice.

   

2. Grind and rinse. Grind 20 g a little fine. Seat the paper filter, rinse with hot water, discard the rinse.

3. Bloom, 205°F / 96°C, valve open. Pour about 57 g, a third of the 170, over the grounds and let it drain through. Hotter water up front favors the bright aromatics, and since chilling mutes acidity, you want that brightness.

4. Steep, 192°F / 89°C, valve closed. Close the valve and pour the rest to 170 g total. Steep 3 minutes.

5. Open and drain onto the ice. Open the valve and let the brew draw down into the iced server. Swirl to melt the ice evenly and chill the drink.

6. Pour off into a glass. Once cold, decant into a separate glass, leaving the surviving ice behind in the server. If using a cocktail shaker, cap it and give your drink a vigorous shake before filtering into a glass. This stops further melting so the cup holds its strength instead of watering down. Add fresh ice to the glass if you want it colder.

Why the order matters

Coffee gives up its compounds in a loose sequence, and that sequence is the lever this method leans on. Acids go early, small and highly soluble; one study notes plainly that most acids in coffee extract quickly. [1] Soluble carbohydrates and the caramel-and-nut compounds follow, and the heavier, more bitter material comes later and slower.

That is a teaching model; the real chemistry is messier:

• Acids, carbohydrates, caffeine, volatiles, melanoidins and bitter compounds all extract concurrently rather than in orderly waves.

• “Bitterness” is a sensory output of several compounds rather than a single late fraction; some chlorogenic acids suppress bitterness rather than cause it. [13]

• Roast level and origin can shift the whole system more than the temperature profile does.

Temperature sets the pace. Higher water raises both the rate and ceiling of extraction; an infusion study measured caffeine climbing steadily across 80, 85, and 90°C (176, 185, 194°F), following first-order kinetics. [2] Cooler water slows extraction, and slows it most for the slowest, least-soluble material. A cooler steep should ease the back half down and limit the rise of harsh, bitter notes while the cup keeps building. In my everyday version the drop is small (205 to 192°F, about 13°F), so this is a light lever; Kasuya’s deeper plunge toward 70°C / 158°F leans on it harder.

A caveat runs the other way. Some controlled drip work found that once brew strength and extraction yield are held constant, temperature itself has little independent sensory effect. [14] Temperature may matter mainly because it changes extraction rate and final yield rather than because cooler water selectively refuses bitter molecules. In this recipe temperature, contact mode and extraction trajectory all change together, so none of them is cleanly the cause; in my low-gradient version, the long three-minute immersion and the fully-drained bloom do most of the work.

One more point the recipe depends on: these are kettle temperatures, not slurry temperatures. The bed is cooled by wet grounds, the dripper, retained brew, and the air; the coffee itself follows a smoother, lower curve than the numbers suggest, and the shift from bloom to steep is a transient rather than a clean step.

Why not brew cool the whole way? You would lose the top of the cup; hotter water extracts and releases aroma-active compounds faster, and brings out a brighter aromatic profile. The Devil spends its hottest water where heat helps and switches to cool before the back half turns harsh. The one study that brewed coffee under deliberate temperature gradients points the same way: Salamanca and colleagues found the temperature path measurably changed which compounds reached the cup and could highlight or hide sensory attributes. [3] That was espresso with a smaller gradient, so it points the way without proving it; the principle is the one Kasuya found by taste.

Where the body comes from

The Devil’s cup is thick and round, and the temptation is to credit the temperature trick. Body is mostly physics: suspended fines, emulsified oils, colloidal material, all set by method and grind rather than by the temperature curve. A 2025 review catalogs body, viscosity, and lipid content as properties of the brewing technique itself. [4] The recipe’s finer grind means more fines in suspension; the long immersion keeps oils mobilized. If your cup is thin, grind finer or steep longer. The thermometer is the wrong lever for body.

Freshness: the window before you brew

TLDR: In my experience, coffee tastes best between day 5 and 15 after roasting. This is the biggest reason I roast weekly: so that my coffee at home is always in the tastiest part of the flavor curve.

The best method cannot rescue beans brewed at the wrong moment in their life, and “fresh” is more complicated than it sounds. Coffee straight off the roaster is not at its best. Roasting traps carbon dioxide in the bean, and for the first few days that gas fights your extraction: it repels water, destabilizes the pour, and throws a sharp, slightly carbonic edge over the cup while muting sweetness. The bean needs to rest and off-gas before it brews cleanly. But wait too long and the opposite problem takes over: oxygen stales the coffee, lipids oxidize, and the aromatic compounds that make it worth drinking quietly leave.

The window you want sits between those two time-driven processes.

Most better roasters across the country will print their roasted-on date right on the package. This is the one that matters.

The high pour

The last move has the least published science under it, but the clearest result at my own table.

Poured from height, the stream breaks turbulent and folds in air, and to my nose the cup arrives with a lift of aroma off the surface. The physics is understood, if not specifically for coffee: aroma reaches your nose only when volatiles leave the liquid, and agitation drives that transfer. It has been measured directly: in a model liquid, a higher stirring rate increased volatile release into the headspace, while thickening the liquid slowed it. [10] Agitation is itself a studied variable in flavor science. [11] Disturb and spread the liquid and more volatiles go airborne, the same reason wine is swirled.

I could find no study that isolates pour height itself in coffee. What I have instead is a result from my own table and palate that you can reproduce at home to see what you prefer.

A note on why this, of all things

My uncle, a materials scientist, has a theory about why so many scientists, engineers, and physicians end up obsessive about cooking. The work spans precision and art at once: it rewards measurement and technique, but the result is sensory, and you cannot fully specify it in advance. It is intensely tactile in a way most of our professional lives are not. And it pays out on a timescale our actual work almost never offers, a result you can hold and taste in minutes or hours rather than quarters or years.

The Devil, it turns out, is in the timing.

Recipe: Tetsu Kasuya’s “Devil” recipe for the Hario Switch (2024 version). A later “Super Hybrid” evolution followed in January 2025; the principles apply to both.

References

1. Fuller, M. & Rao, N.Z. (2017). Scientific Reports 7:17979. Open access, verified from full text. Cold-brew study; cited for extraction order and acid solubility, not hot-brew magnitudes.

2. Taip, F.S., Abdul Ghani, N.H. & Othman, N. (2025). Food Research 9(2):32–39. Verified from full text. Infusion at 80/85/90°C (176/185/194°F); caffeine rose with temperature, first-order kinetics.

3. Salamanca, C.A. et al. (2017). “Extraction of espresso coffee by using gradient of temperature.” Food Chemistry. Rising vs. falling vs. fixed profiles. Paywalled; claim from abstract and secondary review, full figures not retrieved.

4. Baiano, A. (2025). Beverages 11(5):125. Open-access review; body, viscosity, lipid content as method-dependent. Cited from abstract.

5. Mechanism per the diterpene-filtration literature (note 9): the paper filter’s principal function is retaining the fine particles that carry compounds out of the brew, the same particles responsible for grit.

6. Established finding that paper filters retain cafestol and kahweol while metal, nylon, and mesh filters do not.

7. Controlled studies: regular unfiltered (boiled) coffee raises serum cholesterol; filtered does not. Reflected in the 2023 Nordic Nutrition Recommendations.

8. Iggman, D. et al. (2025). Nutrition, Metabolism and Cardiovascular Diseases (S0939-4753(25)00087-0). LC-MS: paper-filtered home coffee ~12 mg/L cafestol, ~8 mg/L kahweol; French press and percolator ~90 / ~70 mg/L. Verified from abstract across PubMed and journal.

9. Most cafestol is retained on grounds and fine particles rather than the paper itself; the paper’s principal role is blocking the particles carrying the compound. Per nutrition-science summary of the primary studies.

10. “Dynamic Release of Diacetyl from Liquid Gelatin in the Headspace,” J. Agric. Food Chem. (1998). Higher stirring rate increased volatile release; higher viscosity decreased it. Model liquid, not coffee; cited for the agitation→release mechanism.

11. Weterings, M. et al. (2022). “The influence of agitation on aroma release.” Innovative Food Science & Emerging Technologies 75:102610. Topic reference; cited from indexing.

12. Cocktail/dispense guidance advising slow pours and minimal agitation to limit volatile loss. Trade source, non-peer-reviewed; practitioner corroboration, not primary evidence.

13. “Identification of coffee compounds that suppress bitterness of brew,” PubMed (2021). Some chlorogenic-acid-derived compounds suppress, not cause, perceived bitterness, complicating any clean “late bitter fraction” model.

14. Cotter, A.R. et al. (2023). “A new Coffee Brewing Control Chart relating sensory properties and consumer liking to brew strength, extraction yield, and brew ratio,” PubMed. In drip brewing, much of temperature’s apparent sensory effect diminished once strength and extraction yield were held constant. Cited as the counterweight to a temperature-as-dominant-lever reading.

15. Cotter, A.R. & Hopfer, H. (Penn State, 2018/2019). Headspace GC-MS study of six roast levels finding that freezing beans at −20°C, particularly dark roasts, preserved aroma comparably to or better than room-temperature storage. Same lead author as the brewing control chart in note 14. Reported via Penn State / phys.org.

16. Coffee staling work showing that even in low-oxygen sealed pouches kept frozen, coffee still loses some volatile aroma compounds over time. Freezing slows staling rather than stopping it.

17. Hendon, C. et al., “The effect of bean origin and temperature on grinding roasted coffee,” Scientific Reports (2016): colder beans grind to a finer, narrower particle distribution. Practical note: coarsen the grinder a notch when grinding from frozen.

18. James Hoffmann, “Resting Coffee — How Long Should You Wait After Roasting?” (video). Recommends ~4–5 days for medium-roast filter, up to ~10 days for very light roasts; for espresso, ~10 days for light roasts down to ~2 days for dark. Practitioner taste-testing, not controlled study.

19. Scott Rao, “Resting Roasts: Is Fresher Better?” (scottrao.com, 2023). Argues there is no universal resting period: classic-drum coffee rarely benefits beyond a day or two, air-roasted coffee may want one to four weeks depending on development and machine, dark oily roasts should be drunk within about a day. Also the source for the espresso back-pressure mechanism, the bloom-as-readiness tell, and the note that vacuum-sealed freezing slows aging to months or years. Practitioner experience.

Fifteen NYC events between this weekend and the end of August: happy hours, hackathons, summits, and a picnic. July 30 triple-books you: a mental health summit at NYU Langone by day, then the Central Park picnic or the Out-Of-Pocket happy hour by night.

Subscribe for a twice-monthly dispatch of field guides for healthtech builders, and forward this to anyone who just moved to the city.

Warmly, Vadim

Only new mistakes.

📣 Mine First

🩺 The Consult - Free Mentorship for NYC Healthtech Founders

🗓️ Wed–Thu, Aug 26–27 · NYC · ⏰ Applications due July 30

Intensive mini accelerator for digital health founders who have raised less than $250k and done less than $500k of revenue.

Mentors are some of the best digital health operators and investors in NYC.

Two afternoons of 1:1 mentorship for 30 curated NYC healthcare founders: 18 mentor sessions per team, 40+ operator mentors, six tactical workshops, happy hours to close each day. $0 cost, sponsored by Rho.

🎙️ Right to Exist, Ep. 2: Otto Sipe of Photon Health

30 Minute listen.

Otto Sipe and Photon are building and executing against an incumbent with >95% market share.

Otto watched SureScripts’ closed network block the product his Thirty Madison team wanted to build, so Photon inverts the rail: the prescription goes to the patient, who picks the pharmacy with price, stock, and delivery in view.

In the interview we dig into the strategies and tactics through which Otto found their wedge, moat, and drove their Right to Exist.

📗 How to Own Risk Without Getting Pwned (Part 2 of 2)

20 Minute Read. Part II of my essay and recipe for owning risk.

Part I followed Kinetic Insurance and its story arc living the VC healthtech dream. Kinetic creating and now dominates a new category where it owns risk and drives economic and human outcomes.

Part II uses that framework to look at how 4 very different companies found commercial success with upside and downside risk in pregnancy (Fetal Pillow, Maven Clinic, Pomelo Care, Ouma + MedArrive),

Part II closes with a nine-question diligence memo for scoring any healthtech company in thirty minutes.

⚡ This Week: July 19–24

🎛️ Sound and Movement Hackathon

Sun, Jul 19 · Fractal Tech, Brooklyn · Free

Music Community Lab’s day of building music through gesture and dance: artist talks, workshop, open presentations at 7:30 PM.

🎤 Pitch Your Way Into the Hacker House

Mon, Jul 20 · Brown Rudnick, NYC · Free, pitching invite-only

~5 curated pre-seed frontier-AI founders, 3-minute pitches with live VC Q&A, and a fast track into the OnlyExit Seattle hacker house cohort.

💼 My Worst Day as a CFO

Tue, Jul 21 · NYC · Finance leaders only

The NY Tech CFO Group’s panel with the CFOs of Public.com and Lerer Hippeau on the misses and crises that shaped how they lead. Four spots remained when I saved the page.

🍹 Multi-School Summer Mixer

Wed, Jul 22 · Rooftop, NYC · Waitlist

Alumni clubs of Berkeley, Brown, Dartmouth, Georgetown, Oxford, Stanford, UChicago, and more on one rooftop. 500 going.

💄 AI-Native Women: Beauty, Health, Wellness

Wed, Jul 22 · G-Gallery, NYC · Free / $15 guaranteed spot

Build a Claude Projects brand assistant live in the room, then a panel on AI in trend intelligence, sales enablement, and GTM.

🦷 Convergence Health Summit NYC

Fri, Jul 24 · AIC Wall Street, NYC · $250

An all-day summit judging innovation on implementation readiness, reimbursement alignment, and adoption feasibility, with dentistry and oral-systemic health at the center of the room.

🔥 Week of July 26

🛠️ Builders NYC Demo Day: Roast & Roast

Sun, Jul 26 · Fractal Tech, Brooklyn · Free

A morning demo day where builders present real projects and half-baked ideas, then take 3-5 minutes of honest feedback and lighthearted roasting over coffee.

📄 Papers We Love Brooklyn: DeepSeek-R1

Wed, Jul 29 · Mindspace Williamsburg, Brooklyn · Free

Espresso AI’s Edwin Jain walks through the DeepSeek-R1 paper on reinforcement-learned reasoning, for engineers who like their LLM claims with methods sections.

🙏 5th Annual Faith Summit: Mental Health is Physical Health

Thu, Jul 30, 8 AM–3:30 PM · NYU Langone, 550 1st Ave · Few tickets left

The Institute for Excellence in Health Equity’s day-long summit bringing community members, clinicians, and faith leaders together on mental health stigma, access, and support.

🌳 NY’s Healthcare & Lifesci Central Park Social

Thu, Jul 30, 5–8 PM · Central Park · BYO blankets & beverages

One Health Collective’s fourth annual Central Park edition of its ~250-person quarterly ecosystem gathering: clinicians, startups, pharma, payers, investors.

🍻 Out-Of-Pocket x Bunkerhill Health Happy Hour

Thu, Jul 30, 5:30–8:30 PM · Location TBD · Approval required

A small, curated group of FDEs, product people, and consultants building in healthcare, from Nikhil Krishnan’s Out-Of-Pocket crew and Bunkerhill Health.

☀️ August

🤖 Build with Gemma NYC: On-Device AI for Healthcare

Sat, Aug 1, 10 AM–6 PM · NYC · Free, $2,000 prize pool

Bond AI’s one-day hackathon on Google’s Gemma 4 models, built for healthcare’s privacy constraints: voice for care, agentic admin copilots, fully offline patient-data tools. Beginners welcome.

🚀 NYC HealthTech Launchathon

Sat–Sun, Aug 1–2, 9 AM–6 PM · NYC · $50 early bird by application, $250 regular

MedStartr’s two-day launchathon hosted by Alex Fair: form teams and find a problem worth solving on day one, build on day two, then every project continues into a MedStartr.ai showcase and a Founder’s Day with investors.

🧬 Biotech Happy Hour with 2048 Ventures × Rho

Wed, Aug 5, 5:30–7:30 PM · Brown Rudnick, NYC

A mid-summer break for the NY biotech community. No slides, no agenda; drinks sponsored by Rho.

🩺 Health2Tech NYC

Thu, Aug 20, 5:30–8:30 PM · NYC · Approval required

An investor panel (”Beyond Borders”) and two hours of networking, hosted by Bailey Morgan, Christopher Martinez, and Alex Koshykov with Orrick as partner.

🗺️ Make-With-Data: Mapping Mental Health

Thu, Aug 27, 5:30–7:30 PM · Pier 57, 25 11th Ave · Donation-based

Edenas Children’s workshop teaching mapping and data-science skills in service of community mental-health challenges.

The arc of success digital health startups is a thoughtfully crafted wedge grows to become your moat, which then defines your right to exist and ability to have human impact at population scale.

Otto Sipe built Photon Pharmacy into a national scale infrastructure for moving prescriptions and patients from clinicians to pharmacies. He and his team did so in the face of SureScripts owning 95% of the prescription routing volume in the US.

In this interview, he walks us through how they designed their wedge, how the think about traction and defensibility in the face of GenAI and Vibe Coding, and what it means to solve hard problems in digital health.

Clip 1: Why Hundreds of Thousands of Faxes per day Was the Right Architecture Choice.

Clip 2 What Does it Mean When Claude Code Can Build Your Interface in 5 Minutes?

Clip 3: Moats are something you worry about on the way down.

In the full episode:

• Why GLP-1 insurance edge cases turned out to be the training ground for selling into health systems

• The price-transparency bet Otto admits Photon got wrong, and why the fix is commercial, not technical

• How retail pharmacies went from blocking Photon to integrating with it directly

• “Tips and tricks from the monopolies that came before us” on scaling a fax operation

• The agentic prescribing future: what collapses when an AI can navigate benefits faster than any human party

• Otto’s advice for founders staring down a dominant incumbent in a regulated market

Read more

Part 1 walked Kinetic from concept to the VC healthcare promised land - owning risk and dominating a category that it had created.

This essay - Part 2 - will use 4 very different companies that found success owning risk supporting mothers during difficult pregnancies.

Before that thought, let’s dig into what we established.

We used Kinetic…

Read more

The arc of success digital health startups is a thoughtfully crafted wedge grows to become your moat, which then defines your right to exist and ability to have human impact at population scale.

Andrea Ippolito has built Simplifed into a national scale telehealth platform delivering lactation and post-partem support in all 50 states. She has contracts with all of the major payers and just raised a $10M series A. When she started Simplifed 6 years ago, the ACA Lactation mandate was almost a decade old, but fewer than 15 percent of lactation consultants billed insurance and less than 5% of those claims got paid. In this interview she shares the steps that she took to get here.

Clip #1 Building for Understaffed Healthcare Mandates.

One reason that I asked Andrea to be my first guest on Right to Exist is that lactation support is structurally similar to many other spaces, pediatric asthma, osteoporosis, menopause, hormone replacement therapy, and others.

What does it take to build for a population or condition that is understaffed or under-resourced by conventional enterprise healthcare?

Clip #2: Integration Friction vs. Product Perfection

One of the common questions that founders have at pre-seed and seed is how much to invest in integration rails with existing healthcare infrastructure.

In Andrea’s case, the signal from OBGYNs was that smooth integration with care flows, and more importantly, feedback loops about how referrals had been handled, would be the driver for adoption.

Clip #3 When Lactation Support Drives more than Lactation Outcomes

Part of the secret sauce for Andrea, was the realization that Simplifed’s contact area with patients was much broader than that of the intermittent visits to OBGYNs who drove the initial referrals.

This meant that they were able to catch things like post-partem depression, preeclampsia, and gestational diabetes and route the patients in need of additional care back to the clinic.

Subscribe below to watch the entire 30 minute conversation.

Read more

Right to Exist: Episode 1, Lactation Support at Population Scale

• Andrea Ippolito - Simplifed

• 30 Minute Video / Podcast

• The most common category error made by founders, investors, and operators in digital health is believing that GTM, venture design, and stakeholder alignment are distinct disciplines. The best operators execute these as an integrated whole.

• Right to Exist is a new interview series on how founders earn their project’s right to exist, from the wedge to the moat to the human impact they aspire to.

• The ACA in 2010 required health plans to cover lactation support at no cost. Despite this, when Andrea started Simplifed in 2019, fewer than 15% of lactation consultants billed insurance, and only 4% of those claims got paid. Andrea built the 50 state clinical practice to deliver a mandated benefit new moms desperately needed that almost nobody was serving.

• We get into why interoperability became her moat, the five-body problem of enterprise healthcare adoption, what she would sequence differently if she were building today, and her advice for other orphaned and understaffed clinical domains like peds asthma, osteoporosis, HRT, and others.

How to Own Risk Without Getting Pwned (Part 1 of 2)

• 20 Minute Read

• Start-ups love to put “owning risk” into their roadmaps.

• Bright Health went public at $11.2B and wound down its insurance business two years later on a 101.3% medical cost ratio.

• Meanwhile, Kinetic, an NYC wearables company, started with a buzzer on a warehouse worker’s belt and is now living the VC startup dream.

• It created a new multi-billion dollar category that it now dominates.

• Same phrase, “taking risk,” two outcomes that could not be further apart. This guide separates the four distinct things people call risk, then hands you a five element framework to determine how and when to take risk, the failure modes and the multi-billion dollar startups that fell into them, and four diagnostic instruments to place any company on the map.

• In Part 2 (live July 15th), we’ll use live examples of 4 very different companies tackling high risk pregnancy outcomes and close with a nine-question diligence memo to evaluate both your own work and that of your portcos.

Venture Funding for Fun and Profit: Part II, The Process

• 40 minute read

• What does it actually take to raise a 6/7 figure angel or pre-seed round?

  • Where do you find angels?

  • What does a first e-mail or call look like?

  • How should the overall process run?

• I provide the framework that I’ve taught for years along with detailed instructions on how to execute, measure, and course correct a raise that isn’t going as planned.

• I’ve also done original research here to help you manage both expectations and execution on your fundraise - especially if you’re outside of NYC or SF. Tabulated and scored lessons from 50 verified first-person raises, roughly 4,500 investor names worked, more than $150M closed across three continents.

• This is the seven-phase process built from it, from filing your 83(b)s to chasing the last wire that won’t land, written for founders who don’t have the network the standard advice quietly assumes.

All three are behind the paywall for premium subscribers. As I continue to experiment with the Substack format, my goal is both provide free actionable content and give folks who a taste of how electric our in-person events these past years have been.

If you know a founder, operator, or investor who would use any of these, forward it their way.

Share

Only New Mistakes.

— Vadim

Contents

1. How Kinetic created and then won a category — the worked example before the framework.

2. The framework for effectively owning risk — five conditions, three stages, five failure modes, four diagnostic instruments.

3. Value-based care economics are often bad. Yours do not have to be — owned-loss economics vs. savings-share economics.

4. Three failures, three modes triggered — Bright, Cano, Babylon.

5. CareBridge — a narrow-population exit consistent with the framework.

Part 2 ships July 15: maternity through four different concepts of risk and venture design (Fetal Pillow, Maven, Pomelo, Ouma + MedArrive), a nine-question diligence memo for evaluating risk-bearing projects, and the venture-scale path through the framework.

TLDR: Take responsibility only for losses you can define, measure, materially influence, price with credible data, and survive when the model is wrong.

1. How Kinetic created and then won a category

My favorite startup example of a both wearables and owning risk is almost never discussed in the healthtech startup ecosystem.

Kinetic Insurance is an NYC company living the VC-funded dream. It created a new multi-billion dollar category that it now dominates. It did so by providing ground truth capable of dramatically beating the relevant actuarial tables and an effector arm for delivery both human and economic impact at scale. Most healthtech companies that announce a path to risk-bearing never even come close to reaching those destinations.

The Kinetic Reflex sensor detects high-risk lifting and bending postures among warehouse workers. When it sees one, it provides haptic feedback to the worker in real time. The accompanying software shows managers where risk is clustering by department, job type, and time of day, creating something employers rarely have: ground truth about how work is being performed. The employer value proposition is therefore twofold: fewer injuries and lost workdays, plus a usable map of the behaviors likely to produce the next injury. The product is not merely a warning buzzer; it is a sensor-to-coaching-to-management system aimed at a specific workers’ compensation loss.

Kinetic launched in 2014 as a workplace-safety wearable. By November 2021 it had launched Kinetic Insurance, a workers’ compensation program sold and serviced by Kinetic, with Nationwide’s excess-and-surplus and specialty organization underwriting the policies. Unsurprisingly, Nationwide Ventures has been involved with Kinetic since its 2020 series A.

Most healthtech companies that claim a path to “taking risk” never leave the much lower-margin strata of vendor economics. Some reach outcomes-priced contracts where a performance fee can be lost while the payer still owns the medical claim. Some accept capitation and bear delegated medical-cost downside. A much smaller group administers an insurance product. “Taking risk” collapses these into one sentence; this field guide separates them.

What Kinetic did is still the rare thing: it satisfied the operating and evidentiary prerequisites in sequence, in public, before moving into a delegated insurance role. The sequence is applicable and deeply instructive even when the strategic endpoint differs.

The loss event Kinetic addressed (strain and sprain claims in industrial work) is unusually well-suited to risk-bearing: a compensable injury is observable, maps to the policy and employer, settles inside the policy period, has decades of workers’-comp actuarial baseline, and posture, lift technique, repetition, and workstation design are operationally addressable.

In Section 2, we’ll work through these properties as the five conditions for a successful risk program, how Kinetic’s venture design passes each, and what new lessons new teams can apply to their own work.

Read more

Read more

Healthtech venture is hard, a fact I’ve learned firsthand as an operator, accelerator director, and investor. I’ve watched too many good teams repeat avoidable mistakes others have already paid for. I write Healing Healthtech to distill research and the experiences of top-tier operators into actionable tactics and frameworks, so we can all aim to make only new mistakes.

• Part 1 covers what I published this month on Substack.

• Part 2 covers NYC Healthtech events that I’m hosting.

• Parts 3 covers the most impactful and informative things that I read in the past month.

• Part 4 covers other NYC healthtech events worth a spot on your calendar.

Subscribe now

Subscribe for a twice-monthly dispatch of free and paid field guides meant to help you build more deliberately toward something better in human health. And if it’s useful, please forward it to other healthtech builders in your network.

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Warmly,
Vadim
Only new mistakes.

✍️ Part 1 — What I Wrote This Month

• 🎬 Venture Funding for Fun and Profit - Part 1 The Narrative — Free — 20 minutes

  • The heart of this video is how to build a successful pitch deck for raising angel and preseed funding.

  • More broadly, its a workshop that I’ve given many times focusing on the meta narrative that creates a fundable company.

  • My approach to pitch decks and narrative works - 80% of my final 12-team accelerator cohort raised follow-on funding within 3 months of graduation. One got into YC and another has already exited. Historically, we had 300+ teams raise 2.7B into 44 exits.

• 📊 Join an Accelerator or Nah? — Free — 10 minute read

  • When a program is worth the equity and when it isn’t; the comet distribution of accelerator outcomes, the hedging-accelerator model, two diligence checks for founder, and my advice from getting the most out of a program that you decide to participate in.

• 💰 Venture Funding for Fun and Profit - Part 2 The Process — Paid — 45 minute read

  • Deep dive into the process of running an effective raise.

  • How to find, qualify, engage with, and close angels and early funds.

  • How to measure and re-calibrate your raise against benchmarks as you go.

  • I combine my own anecdotal experiences, data from Docsend, Carta, and Angellist, along with the writings of the best venture investors of the past 20 years into a deeply actionable and practical field guide.

• 📱 SMS vs. Apps for Effective Digital Health Interventions — Paid — ~30 min

  • A field guide on when to reach for SMS versus an app in chronic care, built from 75+ clinical trials and operators who delivered at population scale.

• 🏛️ Anthropic’s Future Looks More Like Oracle Than Google — Free — ~15 min

  • Argues open weights are compressing frontier API margins, with OpenAI on a Cisco path and Anthropic on an Oracle one, and what that means for healthtech builders.

• ⚖️ Will My SMS Architecture Survive Scrutiny or Create Liability? — Free — ~5 min

  • The free, abbreviated edition of the SMS field guide: the four regulatory regimes governing healthcare SMS and six tripwires that turn a compliant program into a class action.

📅 Part 2 — My Events This Month

• 🍽️ Self-Funded Employer Founders & Funders Dinner | Tribeca, New York City

  • If you’re building or investing in angel or pre-seed self-funded employer healthcare, please apply to attend. Sponsored by Rho.

  • Historically, 70%+ of the founders at my F&F dinners have follow-on meetings after the event with 1 or 2 checks resulting.

  • 🗓️ Tuesday, July 7, 2026

• ⌚ HealthTech Watch Club | TIME+TIDE Watches NYC, 460 Broome St, New York City

  • One Health Collective x MarkOne Health x Time+Tide gather NYC’s healthcare-ecosystem watch enthusiasts for horology, no pitches. Wear your most interesting mechanical, automatic, or quartz piece (no smartwatches).

  • 🗓️ Thursday, June 25, 2026

✍️ Part 3 — The Best Things I Read in Healthtech This Month

• 📉 340B Wasn’t Stolen From Rural Hospitals. It Was Built On Their Graves. — — ~15 min

  • Follows where the 340B spread actually landed, naming five publicly traded chains and PBMs rather than the safety-net communities Congress wrote the program for, plus the dual-classification loophole that let urban hospitals qualify as rural.

• 🐄 How Farmers are Smarter than Doctors — — ~3 min

  • Uses livestock veterinary practice to show how far human medicine lags on women’s reproductive and vaginal health.

  • This one really isn’t as off-color as it might seem. A founding patriarch of reproductive endocrinology once gleefully walked me through how both the devices and procedures in his field owe more to animal husbandry than human medicine.

  • Lara is a heck of a clinician scientist and well worth the follow and read.

• 🏗️ It’s time to build (in Medicaid) — — ~13 min

  • Makes the operator case for building inside an $880B program most founders avoid, with field notes on navigating the bureaucracy.

  • Youssef isn’t an idle bystander. As healthtech investment principal at AlleyCorp, he led investments into several current rocket ships in the portfolio that work with Medicaid-heavy panels, including Altitude, Birches, and Stepful.

• 🧠 Mental Health AI Is Operating Without Clinically-Informed Safety Standards. That Should Alarm Us — — ~15 min

  • Proposes a seven-part architecture of enforceable safety standards for mental health AI, grounded in documented patient deaths and existing clinical frameworks like ASL-MH.

• 🩺 The Dangerous Practitioner: on miscalibrated confidence in medicine — Graham Walker MD — ~10 min

  • Defines the “dangerous” clinician as one whose confidence outruns competence with no outward signal of the gap, and shows why medicine’s safety systems (consults, escalation, supervision) all depend on someone recognizing where their competence ends. The calibration frame maps directly onto the question of when to trust a confident AI.

  • I’m placing this Scott and Graham’s piece above right next to Byron’s piece on purpose, as a counterpoint: the case for caution right before the case for urgency.

• 💊 Our Penicillin Moment — — ~7 min

  • Argues the evidence for medical AI’s benefit is now strong enough that continued delay carries its own moral cost.

  • Byron is CMO of Doctronic, which runs the first state-approved autonomous AI prescription program in the U.S., currently limited to prescription renewals in Utah under a graduated-autonomy model.

• 🎓 The Old World Is Dying — — ~12 min

  • Career advice for the class of 2026 entering an AI-disrupted job market, useful for anyone weighing where durable work comes from.

  • I graduated during the last recession and now teach digital health venture design to graduate students pursuing MPA, MHA, and MPH degrees. Like many, I’ve been struggling with what to advise new alums in the face of AI emergence. This piece reached me by way of Youssef (above).

• 💸 How much I’ve made angel investing — an update — — ~5 min

  • Publishes a full deal-by-deal angel track record (0.89x cash returned on $2.9M across 53 investments) and benchmarks it against Carta fund data, a rare unvarnished look at returns.

  • Halle is easily the best-connected US healthtech angel of the past 25 years, and her openness about portfolio performance (or lack thereof) is badass.

  • Get her book.

📅 Part 4 — NYC Healthtech Community Events

• 🤖 Healthcare in the Age of AI | New York City

  • UJA’s Healthcare Division hosts a panel on how AI is reshaping care across clinical, technical, and business functions.

  • 🗓️ Monday, June 15, 2026

• 🏛️ Civic Health Forum 2026 | Civic Hall, New York City

  • A half-day convening of providers, policymakers, investors, and founders built around one question: how do we keep people healthy before they enter the healthcare system? Co-hosted by Fedcap, Digital Health Hub Foundation, and StartUp Health.

  • 🗓️ Tuesday, June 16, 2026

• 🍹 NY–IL Digital Health Community Happy Hour | New York City

  • An evening bringing together Israelis and allies building healthcare software, with rapid-fire startup pitches alongside the drinks and networking.

  • 🗓️ Wednesday, June 17, 2026

• ❤️ An Evening of Courage, Connection & Purpose (KuraHealth) | New York City

  • An intimate talk on grief and resilience at the residence of economist Nouriel Roubini, featuring Kevin Hines, one of the few to survive a jump from the Golden Gate Bridge.

  • 🗓️ Thursday, June 18, 2026

• 🎨 Art in the Education Lab: “The Shape of Memory” by Maya Ciarrocchi | New York City

  • The unveiling of the 2026 Art in the Education Lab commission by artist Maya Ciarrocchi.

  • 🗓️ Thursday, June 18, 2026

• 🥂 The Art of emPOWERment: Ultimate FO Happy Hour | New York City

  • The 13th event in the Art of Empowerment series, a curated family-office happy hour where founders, allocators, and investors discuss where they put capital and energy to work. Hosted with EisnerAmper.

  • 🗓️ Thursday, June 18, 2026

• 😎 Summer Chill (HIVE) | New York City

  • A HIVE healthcare networking evening for clinicians, administrators, and healthcare leaders built around intentional conversation and connection.

  • 🗓️ Thursday, June 18, 2026

• 🧠 BrainHealth: VC Panel + GTM Bootcamp | FINN Partners, 1675 Broadway, Midtown NYC

  • A practical session on go-to-market strategy for brain-health innovation, with lessons from CEOs and institutional BrainHealth VCs. Moderated by Richard Hatzfeld of FINN Partners.

  • 🗓️ Monday, June 22, 2026

• 🚀 AI Engineers Presents: Founders to Follow | New York City

  • Intimate conversations with NYC startup founders about their journeys, including Tyler Johnson (Tennr) and Aditya Maru (Blacksmith).

  • 🗓️ Wednesday, June 24, 2026

• ⚖️ Digital Health Market NYC Symposium | Nixon Peabody, 55 W 46th St, New York City

  • A CTeL and Nixon Peabody roundtable bringing together digital health leaders, investors, and policymakers on the regulatory, data, and AI deployment dynamics shaping market growth and M&A.

  • 🗓️ Thursday, June 25, 2026

• 🌇 Pepper Community Hang: Vessel Sunset Walk + Tapas | Vessel, Hudson Yards, New York City

  • A golden-hour walk around the Vessel followed by tapas and drinks, hosted by Pepper NYC’s health/tech community.

  • 🗓️ Thursday, June 25, 2026

• 💻 Healthcare x AI Hackathon | NYC | New York City

  • A 1.5-day hands-on hackathon to build real AI tools and agents for healthcare, for engineers, PMs, and founders working in regulated spaces. Partners include Baseten, Lovable, ElevenLabs, Upfront Ventures, Frist Cressey Ventures, and Aegis Ventures.

  • 🗓️ Friday–Saturday, June 26–27, 2026

• 🏙️ Health Tech Startup Networking Rooftop Happy Hour | New York City

  • Rooftop networking for health tech startup professionals over drinks and skyline views.

  • 🗓️ Tuesday, June 30, 2026

• 🧬 NeuroNYC GP/LP Happy Hour | New York City

  • A curated evening for GPs and LPs active in or exploring neurotech, mental health, brain-computer interface, and neurodegenerative disease, held the night before the NeuroTech Summit.

  • 🗓️ Wednesday, July 15, 2026

• 🌟 Health2Tech NYC | New York City

  • An exclusive digital health gathering hosted by Bailey Morgan, with a guest talk and extended networking.

  • 🗓️ Thursday, July 16, 2026

• ⚓ Ship It 2026 (Healthcare Software Engineering Conference) | New York City

  • An invite-only Out-Of-Pocket summit for software engineers in healthcare: 80 curated guests, 12 hands-on workshops, and tactical talks over panels. Two-plus years of healthcare experience expected.

  • 🗓️ Thursday–Friday, September 17–18, 2026

  • ⏰ Deadline to apply: July 1, 2026