Engineering healthcare abundance

Abundant healthcare

Abundant intelligence is rapidly transforming almost every part of society, yet if you've touched the American healthcare system recently, none of that abundance has reached you.

Today's systems underlying care delivery — fax-based referrals, manual intake queues and scheduling, fragmented coordination across providers, clinical documentation that takes longer than the visit itself, compliance workflows built for auditors rather than patients — cannot keep up with the demand they already have. The most acute 5% of patients account for over half of all healthcare spend, exacerbated by gaps between disconnected systems and siloed providers causing patients to slip through the cracks. Two out of every five patients prescribed acute nursing care in their homes never actually receive it, causing conditions to worsen and net care spend to increase. The operating systems that care is delivered on were never built for this volume, and they are breaking under it.

This gap is widening: by 2034, for the first time in American history, there will be more people over 65 than under 18. Nearly one in five dollars of American GDP already flows through care delivery and the demand for more care is effectively infinite.

Healthcare is singularly supply-constrained in this way. Every marginal unit of efficiency isn't just applied to eliminate a need or reduce an expense, it means unlocking access and enabling another patient to receive care they weren't going to get. It requires rebuilding the operating systems that care runs on so that abundance actually reaches patients. We believe this is among the most meaningful problems to solve, because the need on the other side is empathetically human, physical, and practically limitless.

We started Adaptive Innovations to close the gap. Today, Adaptive is delivering on this thesis as an AI-native provider, starting in skilled home health. We're already one of the largest home health providers in Texas, delivering tens of thousands of visits per month, and actively planting flags to launch new states.

Why Home Health

Home health doesn't get the attention it deserves. Created by CMS in 1965 as part of the original Medicare program, Home Health is one of the oldest value-based care sectors and pulls costs out of the net healthcare system at scale. Every dollar spent on home health saves two downstream by keeping patients out of the emergency room and other facilities. It's a one-of-a-kind win-win-win-win. Nurses win the flexibility to focus on what they care about most, treating acute-needs patients. Health systems and health insurers both win by delivering higher quality outcomes at reduced costs. And patients win by receiving the life-altering care they need in the familiar comfort of their own homes. For these reasons, Home Health is one of the fastest-growing outpatient sectors in the country and on pace to nearly double over the next five to six years as the demographic pyramid inversion continues.

It's also deeply, structurally broken. Traditional agencies are bogged down in 40+% administrative overheads, resulting in strained economics and stranded patients turned away due to costs. In an industry providing $100B of care annually, an estimated $40B in additional referrals are rejected every year.

Today the market is heavily fragmented, with 10,000+ mom-and-pop agencies making up the vast majority of the industry, running on legacy systems and manual workflows, each disparately solving their own overlapping local coordination problems. Delivering skilled care is logistically complex, and coupled with a low tolerance for error, these long-tail agencies are fundamentally shackled in their ability to grow.

Home health is a massive clinical coordination problem begging to be solved, and we believe Adaptive is the best positioned to execute on it.

AI-Native Care

At Adaptive, we run care end-to-end: in-home visits, intake, eligibility, scheduling, charting, coding, QA, billing, collections, clinician experience, patient experience. All on a single agent-native platform. We've engineered the whole ecosystem: harnesses, evals, skills, and domain models, so that every operator, manager, or clinician can rapidly prototype and deploy production agents to solve their own scaling problems. Models will continue to improve, and we are exceptionally focused on building the agentic systems that will compound as abundant intelligence progresses.

But for today, better software alone is necessary but insufficient. Taking full advantage of AI today requires real operational transformation. Traditional SaaS vendors can only offer tools and hope for adoption, and can't actually enact the operational changes required to drive real value change. By owning the end-to-end operation, we have the privilege of rapidly reorganizing our work around AI, adapting our processes in real time as we react to capability increases, and fully realizing the value throughout our platform.

This gives us alpha on growth rates as well. Our AI-native cost structure gives us a unique growth vector that no traditional agency can replicate: we can push towards universal patient acceptance and profitably serve those nearly 40% of referrals no one else will touch. By accepting almost every referral, we improve our relationships with health systems, clinics, and facilities by providing a fundamentally better product experience. Discharge planners and physicians don't want to call ten agencies in the hopes of patient acceptance; they want one partner who will reliably take everyone. By being that partner, we stop competing for referrals and start consolidating them. We have the privilege to grow with tangible social impact by expanding patient care access itself.

Our expanding access drives physical network effects which in turn fuels durable growth. More patients leads to more patient density, reducing drive time, which raises clinician productivity and total take-home compensation, which improves recruiting, which drives more density. Referral depth and universal acceptance builds trust with hospitals, which grows volume, which deepens our operational and relational wedges with health systems. And as our patient reach grows, we develop unique data moats that enable us to thoughtfully partner with payers on innovative contracting models that align with our ability to shift outcomes at the population level. Each region becomes its own flywheel, and each flywheel reinforces the next.

Team & Mission

We've assembled what we believe is the strongest team in health tech: ex-founders, quants, researchers, engineers, PE operators, and clinicians. People with the pick of any company, increasingly asking the harder question: what is actually worth building and meaningful to dedicate our lives to? For us, that's fixing healthcare.

Nurses should only have to focus on what they do best: delivering life-changing care to patients in their homes. Everything else, that burden of administrative and logistical friction, should be an ambient consequence of great care already happening. That's the system we're building. Intelligence is abundant. Care doesn't have to be scarce.

If any of this resonates and you're an engineer, operator, or clinician who wants to build something that matters at the intersection of AI and physical care, we're hiring across every function and we'd love to meet you.