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 — accelerated by surgical robotics, minimally invasive techniques,
and advanced anesthesia.
No. I
The migration is real, and accelerating.
80%+ of U.S. surgeries already happen outpatient. The highest-acuity cases are moving fastest — cardiology procedures in ASCs are up 230% since 2018, spine +200%, orthopedics +31%. CMS added 560 more procedures to the list in 2026 alone.
No. II
The opportunity is $148B and growing.
$148B in annual U.S. savings are achievable today from site-of-care shifts — and the opportunity grows to $303.2B over the next 7–10 years as enabling technology matures. Acute-care-at-home alone could shift another $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%. Coordination, eligibility, care-transition, and AI-driven workflows are what unlocks the next tranche. The founders who build them will define the next decade of digital health.
Sources: CMS National Health Expenditure Accounts · MedPAC (2025) · Sahni, Cutler et al., JAMA Network Open (2024) · ASC Association · Vizient (2025) · McKinsey home-care analysis.