Rob is a Partner at Healthcare Foundry, a group developing and scaling revolutionary healthcare companies that evolve how people in need are cared for. Leaning on his successful healthcare operating experience and Healthcare Foundry’s unique approach to company building—characterized by rigorous market diligence and hands-on involvement— Rob has launched and helped finance a diverse portfolio of tech-enabled services companies across many specialties. Rob received his BA from Vanderbilt University, and his MBA from the Graduate School of Business at Stanford University.

Rob Pahlavan, Partner at Healthcare Foundry

The Pulse: Can you walk us through your journey into your role at Healthcare Foundry?

Rob Pahlavan: About 15-20 years ago, a few things came together for me. First, I managed my grandmother’s progression through chronic disease and her end-of-life decision, which deeply impacted me. Second, I’ve always had a bit of a drive to build and make things better. Lastly, it was the time when ‘Romneycare’ was evolving into ‘Obamacare,’ and we were starting to think about Medicare patients more holistically.

These experiences led me to build companies focused on complex populations. For the first 13 years, I founded and ran two companies as CEO. About four years ago, I partnered with Healthcare Foundry to build companies for complex populations in more of a venture studio or investment model. Overall, I’ve been part of the founding teams for seven companies. I ran two of them, while for the others, I played roles like co-founder, board member, or chairperson.

The common thread in my work, as it is for many in healthcare, stems from personal experiences with a problem. For me, that problem was related to higher risk Medicare patients. Over time, I found myself drawn to the challenges and hardships faced by lower-income Medicare beneficiaries, dual-eligibles, and Medicaid populations, which has become a significant focus of my work.

The Pulse: What is unique about Healthcare Foundry’s approach, and what is your decision-making framework for choosing a specific problem to solve out of the various pain points in the industry you could address?

RP: I view company building as peeling away layers of risk. There’s so much you can’t control, so the goal is to focus on what you can control and build companies around critical healthcare problems.

Our unique approach is centered on complex populations and identifying opportunities to create category-defining companies. The founder of Healthcare Foundry, Alon Krashinsky, has been a pioneer in the venture studio model. His 20+ years of experience and involvement in multi-billion-dollar exits heavily shape our approach.

We start with early idea development. This involves identifying interesting areas in healthcare and conducting rigorous market-based analyses. We develop ~100-slide decks on market dynamics and conduct in-market diligence to understand whether there’s a successful model that hasn’t been scaled. Alongside this, we pursue partnerships and contracts to establish revenue from day one, allowing us to build a sustainable multi-market model.

Before seeking funding, we ensure the business plan and unit economics are sound, both for initial deals and long-term growth. Finally, we recruit exceptional teams who deeply understand the market, are passionate about the problem, and have the skills to build a category-defining company. Many of our leaders come from clinical backgrounds, which is invaluable for creating effective, patient-centered solutions.

We typically work on two to four concepts annually. Once a business is formed, we stay heavily involved for at least a year and remain engaged as co-founders throughout its lifecycle. This bespoke and focused approach to company building sets us apart.

The Pulse: What are some common challenges that companies across the portfolio are facing in the current environment, and why?

RP: The biggest challenge is the fundraising market. The cost of capital is much higher than four to five years ago, and many investors are focused on protecting their existing portfolios. We’ve also observed a greater appetite for AI and tech-focused solutions, with less interest in tech-enabled services or capital-intensive models like four-wall businesses.

Investors are prioritizing capital efficiency, particularly in the early stages, where smaller funds can’t easily support companies through subsequent rounds. While there’s still a lot of dry powder in the market, the overall environment remains tough. Despite this, the services opportunity is very real, and I believe companies that focus on long-term impact and lasting value can succeed. It’s essential to remain mindful of funding realities, but not at the expense of building something transformative: because true transaction value is still seven to ten years out and market dynamics will shift over time.

The Pulse: Which applications of value-based care (VBC) do you think hold the most promise in the coming years?

Primary or whole-person care still represents a strong value area, especially within Medicare and dual-eligible populations. These markets are less penetrated than many people assume, leaving significant room for growth.

Specialty risk is also evolving in interesting ways in areas like musculoskeletal, cardiology, and kidney care. We’ve recently built companies in two areas that I think are slightly more nascent in terms of how they’ve evolved within VBC, which are in oncology and Behavioral Health. There are tried and true levers we’ve seen from other specialty areas, and there’s also some lessons in terms of building a more capital efficient model.

Medicaid is another area with immense potential. Although it’s less mature than Medicare, there’s a lot of opportunity to build transformational solutions for its tens of millions of beneficiaries. And because you’re building to a lower cost base, solutions developed for Medicaid could also be applied to other populations over the long run.

The Pulse: Have you been advising your care delivery companies on how to responsibly implement AI, and what has your guidance been if so?

RP: Yes, we think about this a lot and are integrating AI into several companies. However, the starting point should always be the patient problem and the company’s unit economics. AI should be applied where it can clearly deliver measurable value—both clinically and financially.

For example, with Gather Health, our primary care model for older adults with higher social and medical complexity, patients prefer to call, and so we’re intrigued by voice AI. In addition to improving patient interactions, voice AI also has the potential to reduce operational costs, such as scaling down the need for large call center teams because we can real-time answer the same inquiries that always creep up. Rather than be the hammer looking for a nail, AI should always be pragmatic with applications tied to long-term return on investment and demonstrable outcomes.

The Pulse: Can you share context on a company or two within Healthcare Foundry’s portfolio that you are most excited about?

RP: One company I’m particularly excited about is Daymark Health, a full-risk-bearing entity aimed at redefining the cancer care experience. Oncology is probably the most challenging area I’ve spent time on in terms of achieving the quintuple aim for VBC. Payers, patients, and providers aren’t happy with the status quo. Our care model involves both clinicians and community health workers to support patients through their care journey with a focus on dramatically enhancing their experience and outcomes and reducing the unrelenting growth in cost of care. Most importantly, we’re empowering patients and supporting their own oncologists; we’re collaboratively wrapping around what their oncologists are doing. The team is phenomenal with UPenn affiliated leaders like the CEO, Dr. Justin Bekelman – an oncologist and formerly the head of the Penn Center for Cancer Care Innovation at the Abramson Cancer Center, and advisors like Dr. Zeke Emanuel. Part of my own grandmother’s experience was cancer-related, and so I’m super excited for the company’s clinical launch in 2025.

Another exciting company is Overstory Health, which addresses the mid-acuity gap in behavioral health care by building partial hospitalization and intensive outpatient programs with a community reintegration layer. Behavioral health often swings between crisis-driven inpatient care and minimal outpatient support. Overstory bridges that gap, offering patients a more humanistic and consistent care pathway, helping reduce emergency department visits and giving patients a better path to their best selves. With clinical advisory from McLean Hospital and a very talented team, I’m very bullish on what the care model can do, as well as the lasting behavioral health ecosystem change it can have, as we get ready for clinical care in 2025.

Interviewed by Vikram Chari, December 4, 2025.