Brenton Fargnoli, M.D.

There's a new question in every health tech buying cycle that didn't exist 18 months ago: "Is this already on the roadmap of our foundation model vendor?" As we discussed in our 2026 healthcare predictions, we are entering a moment where the end user, clinicians and operators included, can increasingly build software themselves using agentic coding environments. In practice, this shows up when a CIO asks whether a proposed point solution is meaningfully different from what their existing foundation model could deliver with internal prompts, guardrails, and a few weeks of engineering time. This shift is quietly reshaping the competitive calculus. Startups selling into healthcare enterprises no longer compete only with the EHR vendor’s roadmap. They also compete with what a foundation model provider can plausibly ship for that customer, often faster and at lower marginal cost. Importantly, while the moat around building software is eroding, the moat around running software in healthcare is not. Healthcare enterprises are not set up to independently handle deep workflow integration, continuous iteration, reliability at scale, and governance across clinical, legal, and regulatory dimensions. That operational gap is where durable companies are still built. We expect this dynamic to introduce real friction into buying cycles for point solutions with thin moats. At the same time, it expands opportunity for companies with defensible data assets, deep workflow entrenchment, and true platform potential. Artera and Atropos Health are two strong examples from Breyer Capital's portfolio, both highlighted in the article. Special thanks to Brian Gormley for featuring our perspective in today's The Wall Street Journal piece on OpenAI and Anthropic's entry into healthcare. Jim Breyer Daniel Breyer Andre Esteva, PhD Brigham Hyde

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With OpenAI is paving the path to a first-level triage / PCP layer + empowered patients, and Anthropic now building context-rich interoperability tools that link fragmented workflows and remove unnecessary admin….we are entering a brand new era in healthcare. Innovation can now focus on providing better care and experiences vs. solving infra problems with point solutions.

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As Jay Rughani, Jane Rhee, and Julie Yoo point out in this a16z Bio + Health piece on “Infinite Healthcare,” healthcare today looks a lot like telecom decades ago—with a cost structure that reinforces a scarcity mindset. They argue that AI can shift healthcare from a system of scarcity to one of abundance, and I could not agree more. Many of us remember when phone calls were billed by the minute—more usage meant more cost. But as networks scaled, pricing shifted to unlimited plans. Usage surged and value expanded for both customers and providers. Our industry can follow the same path, but only if we shift to a payment model that aligns with the future we are trying to create. For decades, our healthcare system has been built on limits—limited clinicians, appointments, and coordination. Those limitations have normalized waiting and suffering—and added complexity. AI has the power to radically expand our capacity to care for people, helping us shift from simply reacting to illness to proactively supporting health every day. Technology alone will not change the system, though. Abundance cannot thrive inside a payment model that rewards episodic intervention instead of ongoing health management. If we want proactive, continuous care at scale, incentives must align with preventing illness, not just treating it. Scarcity shaped my dad and our family’s experience at the end of his life. Abundance can create an entirely different future.  https://lnkd.in/gNQ4QkHi

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Looking back at 10 years of episodic care—how did it work out? Worth the read from Becker's Healthcare “No improvement in outcomes, no improvement in access, no improvement in equity, and paying out more money than the savings … it just does not seem to me to be worth it, though conceptually it makes good sense,” Karen Joynt Maddox, MD, MPH, a professor at Washington University School of Medicine in St. Louis, said. "That dynamic created a problem for academic medical centers and safety-net hospitals treating more complex patients. A University of Florida study published in 2023 found that its CJR participation saved Medicare an estimated $16.4 million over five years while dramatically improving quality. Length of stay dropped 56%, readmissions fell from 17.7% to 5.1%, and complications decreased from 6.5% to 2%. Despite those results, the hospital was penalized more than $300,000 at the end of its participation. The authors attributed the penalty to benchmark changes and the removal of healthier patients from the CJR-eligible pool as joint replacements moved to outpatient settings."

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