Jamie Kiggen

The healthcare workforce is one of four themes we are betting on at Terrarium, where we think technology and AI will catalyze massive changes to the status quo, driving outsized impact on the industry as a whole. We published a white paper today on why building for the future of the healthcare workforce is prime ground for startups, and where we think returns are going to concentrate: https://lnkd.in/e6hsR2VA. Why are we betting on workforce solutions? Simply put, the opportunity is massive. There are not enough healthcare workers across all licensed roles to meet demand, a shortage crisis that will only get worse if nothing is done. Meanwhile, the cost of labor post-Covid--driven primarily by surging contract staffing fees--has become untenable for employers. Labor increased from 50% of hospital OpEx (2011-2019) to 60%+ of hospital OpEx in 2023. These costs are no longer predictable and are eating away at already razor-thin margins in most cases. We have heard from large health systems that contract staffing fees account for over half of recruitment costs, and that total costs of labor shortages are estimated into the hundreds of millions of dollars when accounting for lost revenues alongside direct costs of attrition and replacement. 💸 Healthcare is also the most licensed industry in America, and structural barriers to education and licensure that slow the entry of new professionals into the workforce are a major hurdle to innovation at the top of the talent funnel. We think this hurdle can also act as a defensible moat, however, for companies that do successfully gain traction in this space. 🎓 All to say, we are focused on building and investing in solutions that don't just treat the symptoms, but aim to fix the root cause of the problem: 🌱 Solutions that GROW the workforce, and 🤖 Solutions that OPTIMIZE the work itself If our POV resonates with you, please reach out! We are looking for EIRs to incubate new companies in this space alongside us, and we also write checks to pre-seed and seed teams already on their way. Special thanks for the insights to: Mark Rosenblum, Yaniv Sadka, Austin Dirks, Stephen R. Saine, Hank Capps, MD FAAFP, Laura P. Dannels, PhD, MBA, SPHR, Gabriel Szaszko, Wellstar Health System, Cleveland Clinic, Northwell Health, Mount Sinai Health System, Carl Madi, Lee Hudson Teslik, Alexi Nazem, James Hueston, Rachel Parlier, Raquel Scott, MBA, Zachary Fleitman, Grace Dhanraj, Tanya Beja, Tara Sullivan, Brittany Wadhwani and many others! Company Ventures Terrarium

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AI in life sciences isn’t new — but the pace, ambition, and real-world impact have all shifted into another gear. Last week, David Berry of Averin Capital hosted a fireside chat with three leaders shaping what comes next: 🔹 Andrew Hopkins (XYME / Exscientia) 🔹 Jared Saul, MD (AWS) 🔹 Andrey Doronichev (Optic) From generative molecule design and synthetic biology to autonomous lab systems and agentic AI. What stood out was how quickly we’re moving from prediction to decision-making systems that reason, act, and even write their own code. If you’re interested in where AI is truly transforming healthcare and biotech — not just in theory, but in practice — this is worth a read. 🔗 https://lnkd.in/eKTDZ59r

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FORCING CHANGE IN SITE OF CARE McKinsey & Company's recent paper on the forces pressuring healthcare, including the possibility of margin compression of up to 13 percentage points for health systems, does a good job of putting numbers around what most operators already feel. Two of the biggest drivers they mention are policy shifts in reimbursement and rising utilization driven by an aging population. The cohort of 70+ year old Americans will grow the fastest over the next 5 years, and it is well established that older patients have more complex needs, more chronic disease, and more touchpoints within the healthcare system. Layer that on top of continued clinical workforce shortages, and the supply-demand gap widens further. From my perspective, optimizing for site of care is the most important lever we have to address this challenge. We can’t quickly reduce how much care older patients need, but we can change where and how services are delivered. Supporting aging patients in lower-cost settings like the home, ambulatory sites, and virtual environments is no longer just a preference or convenience, it’s a necessity. This is where the conversation around site-neutral payments becomes so relevant. CMS is moving quickly in this direction, and hospital outpatient departments (HOPDs) are squarely in the crosshairs. The shift will undoubtedly clamp down further on hospital margins, but it shouldn’t be surprising. We’ve been talking about the demise of HOPD reimbursement for years, and the health systems that will fare best are the ones who are working towards aligning their approach with where patients can be treated safely, efficiently, and at lower cost, rather than relying on legacy reimbursement structures to fill the gap. And just like it doesn’t make sense to try to replicate a hospital or nursing home environment in a patient’s home, we also shouldn’t try to carry the same clinical staffing model into every care setting. Yes, there are non-negotiables when it comes to patient safety and clinical expertise, but there’s also a meaningful opportunity to rethink how teams are built. That means clinicians at every level working at the top of their licenses, thoughtfully involving family members and community resources, and using technology to surround these sites of care with non-clinical operational support. From my health system days, I understand why rising costs, margin pressure, and site-neutral payments feel like threats. While painful, I’m hopeful they can also serve as a positive forcing function, pushing us toward care models that are better aligned with our aging population and the realities of today’s workforce.

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Over the weekend, alongside Sam Ulin of ClearView Healthcare Partners, I discussed how the rise of integrated direct-to-consumer (DTC) models marks a foundational shift for pharma, streamlining access, empowering patients, and redefining how treatments are promoted, prescribed, and delivered.   What started in obesity care is now expanding across therapeutic areas. The momentum is clear that patient-first models aren't just better for patients, they enable faster access and greater innovation.    Read the piece in BioCentury Inc.: https://lnkd.in/ejqJbhJh   #DTC #Innovation #Obesity #Healthcare #PatientFirst

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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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Exciting news at Sixth Street Growth portfolio company MasterControl as we announce the acquisition today of Qualer, bringing additional enterprise asset and maintenance management capabilities for life sciences and med device manufacturing companies globally! https://lnkd.in/guuWgeWh

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