Where the Operators Lead

There's a common pattern in health system venture investing: a fund identifies a promising company, writes a check, and hopes the portfolio company eventually finds traction in the organization. The thought is that even if operations is not in love with the idea now, eventually they will see the light. I was not immune to this approach over the past decade.

We're going to do it differently at Ballad Health. Going forward, we'll start with the problems our operators are actually trying to solve - and then find the companies who can help.

Why operator priorities will come first

Health systems are complex organizations. Even the most promising technology will stall if it doesn't have executive sponsorship, clinical champions, and operational bandwidth to support implementation.

We've seen this happen. When something isn't a genuine priority for leaders, it simply won't get the time and attention an early-stage company needs to succeed. No amount of enthusiasm from the venture team can substitute for authentic pull from the business.

So we're reversing course. Before we seriously evaluate company, we'll work with Ballad Health leadership to identify the stubborn, persistent problems they're trying to solve. Workforce shortages. Access gaps in rural communities. Administrative burden that pulls clinicians away from patients. These will become our investment themes — not because they're trendy, but because our operators see them as necessary to move their part of the organization forward.

Partnership, not just capital

Our new fund will focus on pre-seed through Series A companies for a reason. At these stages, products are still taking shape. Business models are still being tested. That's exactly where a health system partner can add the most value.

We don't see ourselves as passive investors. We see ourselves as co-developers. When we invest, we're committing time and resources to work alongside founders - testing products in real clinical environments, providing honest feedback, and helping build something that actually works for health systems like ours.

This means the "problem to solve" must be meaningful to our leadership. If our operators aren't willing to roll up their sleeves and engage, we're not the right partner for that company. But when the fit is right, founders will get something far more valuable than capital: a health system that's genuinely invested in their success.

We don't want to invest alone

Here's what we've noticed: the problems that keep our leaders up at night tend to be the same problems facing health systems across the country.

That's why we'll actively seek out other health systems who share our challenges and invite them to co-invest. This will give portfolio companies access to multiple health system partners, broader pilot opportunities, and a clearer path to scale.

It also keeps us humble. We're one health system in Appalachia. We don't have all the answers. But when several systems see the same problem and believe in the same solution, that's a meaningful signal.

From investment to implementation

We'd like every investment to lead to a commercial relationship with Ballad Health. That's the goal in at least 80% of our portfolio. Not because we'll require it, but because it should be the natural outcome when we've done our job well: we invested in a solution to a problem our operators actually have, and the company delivered.

When that happens, everyone wins. The startup gets a real customer. Our health system gets a solution that works. And our region gets better care.

What comes next

In the coming weeks and months, we'll be posting specific problems to solve and challenges that our leadership has identified. These posts will describe what we're looking for in concrete terms - the pain points, the context, and the outcomes we need.

If you're building a solution that addresses one of those specific challenges, we want to hear from you. That's the best way to start a conversation with us: show us how you solve a problem we've already said matters.

Our areas of focus

Our investment themes will be guided by what our health system needs most:

• Leadership-Identified Needs - solutions to stubborn problems our executives are actively working to solve. This is where every investment conversation starts.
• Workforce Leverage & Capacity Expansion - technologies that extend clinical, operational, and administrative capacity
• Digital Care & Distributed Care Models - solutions that deliver care beyond traditional physical and geographic constraints
• Consumer Needs - companies that make Ballad Health the first choice for health in our region
• Personalization + Precision - tools that make care more precise while respecting each person's unique characteristics