II. The thesis
What we believe.
The American healthcare system is reconfiguring around acuity. The largest
cost center — hospital care — is consolidating and getting more expensive.
Routine, scheduled, and chronic care is migrating to specialized outpatient
settings, where the technology is being rebuilt from scratch.
No. I
The migration is real, and accelerating.
80%+ of U.S. surgeries already happen outpatient. CMS keeps expanding the ambulatory surgery center list — 560 procedures were added for 2026 alone. Even the highest-acuity specialties are moving: cardiology procedures in ASCs are up 230% since 2018, spine +200%, orthopedics +31%. The shift is structural, not cyclical.
No. II
The opportunity is $148B and growing.
A 2024 JAMA analysis estimated $148B in annual U.S. savings from clinically appropriate site-of-care shifts — achievable today, with technology that already exists. The same researchers project AI adoption could drive an additional 5–10% in system-wide net savings. Acute-care-at-home alone could shift up to $265B of Medicare services out of facilities.
No. III
The next layer requires technology that doesn't exist yet.
Modern software penetration at independent ambulatory sites sits below 5%. The gap persists because outsiders can't underwrite a workflow they don't operate inside — and most digital-health investors still build for hospital buyers with 18-month enterprise sales cycles. Coordination, eligibility, care-transition, and AI-driven workflows are what unlocks the next tranche. They haven't been built yet.
Sources: CMS National Health Expenditure Accounts · MedPAC (2025) · Sahni, Cutler et al., JAMA Network Open (2024) · ASC Association · Vizient (2025) · McKinsey home-care analysis.