Healthcare domain depth + systems thinking
Healthcare Can't Be Disrupted Wholesale — and That's the Point
Healthcare is a collaborative system. Collaborative systems move at the speed of their slowest partner.
At Abacus Insights, I was building an all-in-one data platform for health plans. Payers liked what we built and were ready to move. Their partners still sent data by fax. Without those partners, the data was incomplete.
At Audacious Inquiry, we built a state-wide notification service tracking patients in emergency rooms. The service relied on the fields every partner reliably sent: admission, discharge, transfer, and timestamp. Anything beyond that varied too much across partners to depend on. Master data management became a core part of the service to normalize what arrived. The reliable field ceiling was the use case ceiling.
One slow partner sets the ceiling.
Disruption requires a 10x improvement that makes the old way obsolete. In healthcare, the old way can’t become obsolete until all independent partners upgrade simultaneously. Vertical integration has consolidated ownership in insurance, analytics, and PBMs. Provider and pharmacy data streams remain fragmented. The gaps don’t consolidate with the ownership. Government programs can incentivize the upgrade financially. The pace of adoption still lags what disruption requires.
What’s left are seams. The gaps between players where coordination fails are where real companies get built. The ones that have broken through recently share a pattern: they helped patients get what they wanted immediately, outside the incumbent system. Direct pharmacies for medications patients couldn’t easily ask their doctor for. Compound pharmacies for GLP-1s when brand supply ran short. Those are real businesses, structurally capped by the gap they fill. Seam companies grow in the gaps. Incumbents hold the structure: Epic, UnitedHealth, load-bearing nodes with golden records. They control the data and the dollars. You build around them.
The seams are permanent. Manual processes could paper over them: a care manager printed the CSV, an account manager called the partner still sending faxes. Agents can navigate systems connected by APIs and services. Most healthcare coordination still runs on manual processes and contractual agreements that require human verification — agent navigation at the seam is slow enough to be impractical. You’ll see manual interventions added back in at exactly those points as AI gets adopted. Humans inserted to compensate for coordination walls the technology can’t yet navigate at speed. Two steps forward, one step back.
The opportunity in healthcare is the seam.
The seam is always the same: a buyer ready to move, blocked by a partner they don’t control. That gap is where the product belongs.
Agentic AI will surface those gaps faster than any discovery process that came before. The structure doesn’t change. The seams just become visible sooner.
The PM who spots that pattern builds something real.