Jonathan Muñoz

Investing in companies that fill needs for health systems is a growth opportunity for both delivery organizations and start ups. Some systems are jumping in on their own, while others are partnering with like minded systems or with established VC firms. While this is a relatively new trend for systems, health plans have been making similar bets for many years. The benefits of becoming a health system portfolio company can be significant. Data, access to beta populations and real world coaching can be extremely beneficial. Start ups get mentoring and systems have to ability to leverage outside resources to solve relevant business problems. I predict a booming business!

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Healthcare's $1 trillion problem is hiding in plain sight. It's not drug prices or insurance premiums. It's the humble phone call. Here's why: I've seen first-hand how physicians and their staff spend hours a day on the phone. Sometimes, it's for something as simple as a prior authorization request. But it adds up. Healthcare providers complete ~45 prior authorization requests per physician per week. That amounts to 14 hours (almost two business days!) completing those requests EACH WEEK. [1] So it’s not surprising our healthcare system is struggling with: 1. Staff burnout and attrition from repetitive, mind-numbing work 2. Skyrocketing costs 3. Patient outcomes that lag far behind other OECD countries What's maddening to me is that we are living at a point in history when AI can transform healthcare from reactive to proactive. Yet we're clinging to inefficient, error-prone, mind-numbingly boring methods. Phone call automation with AI can drive serious ROI: 1. Freeing clinicians to spend more time with patients 2. Reducing time-to-care and driving better health outcomes 3. Higher revenues from more efficient claim processing and a greater volume of patient encounters The future of healthcare isn't in a pill or a policy. It's transforming how we communicate. What's the biggest communication bottleneck in your healthcare organization? Is there an opportunity for AI to improve it?

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Here’s your recap of last week’s health IT news 🗞️ 👇 🤖 AI Clinician Assistant • Commure announced it will acquire Augmedix in a take-private deal. • Suki announced a partnership with Federally Qualified Health Centers and Community Health Centers, including Utah Navajo Health System, Inc., CenterPlace Health , and Access Health Louisiana. • OneHealth is partnering with healthPrecision / Medical Brain to support the former’s Modern Primary Care platform. 📈 Data & Analytics • Huma announced a $80M Series D that included pharma investors AstraZeneca and Leaps by Bayer, as well as the launch of its Huma Cloud Platform, a service that promises to help digital health products scale and launch their products more efficiently. • Intermountain Health partnered with NeuroFlow to better understand its Colorado patients’ behavioral health risks. 🔁 RCM • Medmetrix acquired HRSI - Healthcare Receivable Specialists Inc., accelerating development of its end-to-end solutions. • Thoughtful AI launched new “human-capable” AI agents for claims processing, patient eligibility verification, and payment posting and announced a $20M Series A. 📋 Patient Administration • XO Health Inc. is partnering with Kyruus Health to integrate its price transparency and directory tools. 💼 Provider and Practice Administration • West Tennessee Healthcare is implementing Qventus, Inc. 📱 Patient Support and Communications • Vizient, Inc has contracted with Mytonomy on behalf of its hospital and health system customers. • Tendo added FlyteHealth to its marketplace. • Epic offers a new integration with United Language Group allowing providers to dial-in an interpreter directly from the patient care workflow. ⚙️ Clinical Operations • Wolters Kluwer Health released an update to its UpToDate Pro software designed to support PCPs in prescribing, switching, and titrating antidepressant prescriptions. • Fullscript released two new studies demonstrating higher engagement and improved patient labs. 🍎 VBC • Guidehealth is now offering Story Health to its partner health systems. • Astrana Health is partnering with Elation Health to offer its EHR platform and billing technology to its customers. • Thyme Care closed a $95M series C, including healthcare funds such as CVS Health Ventures, Concord Health Partners, and more. 🧠 Food For Thought • A recent study found that Chat GPT-written patient portal messages were comparable in quality (and better on measures of empathy and communication style) to those drafted by healthcare professionals, according to PCP reviewers. We’re always interested to see physicians’ responses to GenAI solutions, as the tide turns toward greater acceptance of the technology. https://lnkd.in/gMX7ATX2 --- Want the latest healthcare tech news delivered to your inbox each week? Sign up here 📬 👉 https://lnkd.in/e2UJ3ckP

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Sometimes, the best way to describe what Caresyntax does is through real results. We don't just talk about optimizing healthcare – we deliver. This case study dives deep into how we partnered with a Southeastern health system to optimize their complex ventral hernia repair program. The results are staggering: - Annual cost reduction of $700,000 - Service line net margin improvement of $15,000 per patient - 54% decrease in post-surgical opioid use (safer, happier patients) - 33% reduction in length of stay (patients recover faster) Here's the secret sauce: We go beyond traditional data analysis. Our unique approach connects all the dots – patient factors, treatment details, costs, and reimbursements. This allows us to identify hidden opportunities for improvement. Read this case study to see how we did it. https://lnkd.in/gtebkRU7 #DataDrivenSurgery

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Here's another fundraising roundup spotted in the healthcare wilds 👀 🍃 ✅ Sword Health raised $130M (new valuation: $3B). ✅ Better Health raised $14M to deploy expanded payer partnerships. ✅ Alzheon, Inc. | Preserving Future Memories raised $100M Series E to advance development & commercialization of its Alzheimer’s treatment. ✅ CinRx Pharma raised $73M to continue its ‘Hub and Spoke’ model of startup formation. ✅ Eko Health raised $41M to scale AI-driven heart and lung disease detection. ✅ Anterior (formerly Co:Helm) secured a $20M Series A to unlock admin efficiencies for healthcare payers. ✅ SamaCare raised a $17M Series B to scale specialty drug prior authorization platform. ✅ Plenful secured a $17M Series A to streamline pharmacy operations with AI-powered workflow automation. ✅ Grayce raised a $10.4M Series A led by Maveron amid a caregiving crisis. ✅ Stitch Employment Services Inc PEO raised $8.75M in seed to support independent medical practices. ✅ Posterity Health secured $6M to fund expansion and technology acceleration. ✅ Sware raised $6M to accelerate life sciences innovation by automating FDA-mandated software validation. ✅ Keragon raised $3M, as announced in @Conno Christou’s LinkedIn post. As always, if I missed you, let me know! Each week I'm spotlighting an innovative healthcare startup. I just ask for a bit more transparency. All submissions are confidential; submit yours here 👇 https://lnkd.in/gF4DrAvJ Looking for more fundraising roundups, alongside healthcare industry news and analysis? Subscribe to Hospitalogy, my 2x/week newsletter. Join 33K+ other investors, executives, and healthcare professionals: https://lnkd.in/g-nfRqW6

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We had an incredible time at the Northwest Pharmacy Convention 2024! Some key learnings and discussions from the conference as the MedMe Health (YC W21) team spent a few enlightening days in Coeur d’Alene, Idaho:: 🩺 Standard of Care Model for Autonomous Prescribing Jennifer Adams highlighted the continuum of pharmacist prescribing authority, from most restrictive to least restrictive across all the states, starting from: 1) Collaborative Prescribing: Patient-Specific CPAs 2) Collaborative Prescribing: Population-Specific CPAs 3) Autonomous Prescribing: Government Protocols 4) Autonomous Prescribing: Standard of Care States like Idaho on the Standard of Care model are leading the charge with the more standard and sustainable way for pharmacists to prescribe, rather than more restrictive and highly-specific models that make it difficult for even patients to know what pharmacists can and cannot do. 🌐 Diverse Approaches to Clinical Services We observed a wide range of progress among pharmacies in their clinical services journey - from those just beginning to implement clinical services to those with fully established systems, multiple consultation rooms, and dedicated clinical staff such as Alexandra (Sasha) Heyneman, PharmD, MS, ANP and Scott Herzog doing services like compounding, prescribing, PrEP, Travel, Hormone Therapy, etc. 💊 Emergence of Cash Pay Pharmacies Innovative models like cash pay pharmacies, where patients pay a fixed monthly fee for unlimited healthcare access, are gaining traction. There was an interesting case we heard where a pharmacy was able to retain 50% of their patients after transitioning Caremark patients to this model. This approach is particularly valuable for patients caught between Medicare and Medicaid or those with high deductibles and copays, making out-of-pocket payments more affordable. Extremely grateful for all the insights from other leaders as well including Alex Barker, PharmD, Chris Schaffner, Pharm.D., Mylinh Nguyen, Pam Eaton, and many more! #pharmacy #healthtech #NWPharmacistConference2024 #digitalhealth

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I’m worried about the state of venture capital and direct-to-consumer (DTC) healthcare startups. Hims & Hers is the poster child for DTC healthcare at $1.2B proj 2024 revenue and a $3.6B valuation. By most accounts, they have been an outlier success for DTC since bottoming out in May 2022. So why is this bad news for DTC healthcare? Because the market leader (Hims) trades at a 3x forward revenue multiple. And the category leader typically gets a higher valuation multiple than smaller startups. We see this phenomenon in private equity. They “roll up” smaller companies within the same category at a lower multiples just to create one larger platform that trades at higher multiples. Now back to DTC healthcare startups. If Hims commands a 3x revenue multiple, it’s not unrealistic that smaller, unprofitable startups may be valued 1-2x revenue at exit. At 2x revenue, a startup must generate $500M to produce a $1B exit in today’s market (depending on growth and profitability). Series A/B venture capitalists must see a pathway to $1B outcomes. And if the growth-stage investors with billions under management are less interested in DTC healthcare, the future funding rounds necessary for fueling growth are not guaranteed. Juxtapose this against 2017-2022 where DTC could raise Series B-E funding. Let’s take a DTC startup doing $25M after 3-4 years of operations and has already raised a Series A. By most accounts, it would be a phenomenal accomplishment. But today, investors will question the chances of that same company scaling from $25M to $500M revenue in the next 3-4 years with unknown future funding sources from Series B and beyond. You're stuck in VC-funding purgatory. Some of these companies will shut down. Some may sell for 1-3x revenue. And some may try to transition to profitable, cash-flowing businesses. All of which are certainly not the venture-backed goal the founders, investors, and employees often had in mind when first taking capital. I say this all with friends working at or starting DTC healthcare companies, I feel bad for them. I also feel bad for the patients who enjoy those products or services. To caveat (b/c I know people will object), there will be other DTC brands that exit for $1B+ (i.e., Ro). However, they were forged and scaled during a different time period where seemingly endless venture capital was available for DTC healthcare. Now we're in a different time with no end in sight. Thoughts?

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The median patient adoption for our Digital Health tool is 75%. Our best health systems achieve 90% adoption. Here’s what those getting 90% patient adoption are doing differently👇 1. Go true multichannel: make it available beyond just their patient portal and digital front door. Some patients prefer a native mobile app, an SMS or email + web app experience. 2. Entire interprofessional care team (physicians, nurses, pharmacists, OT/PT, allied health, etc.) all involved in the customization and implementation process. That’s how you build a sense of team-wide ownership of the Digital Health tool. 3. Clinicians actively promote it to patients as standard of care. It’s not an afterthought that just the office staff barely mention. 4. The leadership team is bought in and cares. When everyone knows it’s a real organizational priority, magically the numbers go up. Who would’ve guessed? 5. If possible, actually monitor patient health data (e.g. symptoms) and act on it when patients fall off track (e.g. early signs of deterioration). When patients have log a symptom and a care team member calls them about it, it has a magical effect: patients stay engaged. 6. Automate patient enrollment via an EHR integration BUT still educating patients on the tool. You can’t just “set it and forget it”. Patients still have to know WHY they should use this tool they get an electronic notification about. 7. Reinforce use of the Digital Health tool at multiple points in the patient journey - at the clinic, in the hospital, at follow up, etc. 8. Support multiple languages based on the local demographics. No AI isn’t safe enough to real-time translate clinical information with no oversight. But, LLMs are now often good enough to do a “first draft” of the translation which lowers time and cost to review. 9. Review your patient adoption and engagement data regularly (at minimum quarterly, but ideally monthly). Share it with your executives and key champions. Dig into the data where it’s weak and ask WHY. Use the tips in this post to improve the dta. 10. Provide actual scripts and train staff on best practice talk tracks for how to introduce the Digital Health tool to patients and families. Don’t just leave it up to staff to make up what to say. Systematize the communication. 11. Design for health literacy: all clinical content at the Gr. 6 reading level, in plain language, using adult learning principles. 12. Meet digital accessibility guidelines, such as WCAG 2.0 level AA. E.g. make sure it’s colorblind and contrast-tested, screen reader friendly, etc. 13. Allow caregivers and family members to be enrolled in the Digital Health tool so they can monitor the patient’s progress and nudge them to stay on track. Motivation from family members is HUGE. P.S. SeamlessMD enables health systems to digitize patient care journeys with reminders, education and symptom monitoring. If you’re looking for help on how to make 90%+ adoption happen for you… give us a shout!

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A whirlwind of activity last week at the America's Physician Groups conference. Lots of solid insights shared by health system leaders. Some notable thoughts: +++ Artificial intelligence is intelligent in different ways: By now, we all know ai has a diverse set of use cases, incorporated in different applications and tools. But there are fundamental differences in how the intelligence itself is brought to life. Examples include: - Predictive AI, used to forecast future outcomes by leveraging historical data. Shout out to UCLA’s CKD/ESRD early intervention protocol (Joycee Berin) and Diagnostic Robotics’ intelligence care post-dicharge journeys (Kira Radinsky) - Protocolized AI, used to automating a user’s administrative load by using a set of detailed, pre-defined rule sets. Thanks to ARC for sharing their experience using Elaborate 's automated outpatient lab summaries (Manish Naik) - Generative AI, used to create new content. Great overview of ambient documentation at MGB as well as Cedars’ Sinai talking through its medical ontology model powering acute triage (Caroline Goldzweig) Across system leaders and experts, there was clear agreement that the first step to implementing intelligence intelligently is defining the ‘jobs to be done’. That way, internal and external stakeholders are clear on what they're solving for when they architect the solution.  +++ Scaling AI takes time and rigorous observation: Market leaders describe a phased pilot approach that allows clinicians to build confidence and system leaders to measure ROI before deploying systemwide. Loved hearing Rebecca Mishuris outline MGB’s novel approach of piloting two solutions against one another, to pressure test implementation, workflow, and value creation. +++ Proving ROI continues to be challenging: Lots of vendors using lots of different metrics to prove value, but the majority of leaders agreed that estimating the ROI of these new tools today is part science, part art. Demonstrating the ROI of the “soft” metrics around provider burnout and retention seemed to be a big opportunity, especially for investment in more efficient primary care and PCP wellbeing. After all, PCPs drive referrals to specialty-level care (and higher reimbursements) for health systems. Appreciated Anurang Revri's overview of how working team setup can also impact ROI estimates. +++ Value-based care = tools + humanity: VBC will require not only implementing tools to support clinical documentation, risk capture, upcoding, etc, but also humanizing interactions to engage patients. Countless examples, but one that made me smile was a depression focused chat bot responding in the following interaction: - Context: post-discharge check in Bot: Hi Freida, how are you feeling today after your surgery?  Patient: I’m having a tough time, am in a lot of pain.  Bot: Well, it can’t be that bad, I’m sure it will get better with a positive mindset!    🤣 🤣 🤣 Can't wait for next go-around!

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Today’s healthcare policymakers are focused on their favorite boogeymen: physician compensation, biopharma, and new medical technologies. The real villains are ‘benefit managers’ and administrators’ who lurk in the shadows extracting 25 cents of every healthcare dollar. The reality is, in fact, in plain view if you look: administrators have grown 3200% while physicians have grown 200% over the last two decades; physician compensation is down, net of inflation. Admin comp is up, way up. PBM (pharmacy ‘benefit’ ‘management’) revenue has outstripped Pharma revenue growth in the last 20 years. Pharma extends life and improves quality of life, and extends working lives of taxpayers. PBMs - who knows… People grasp onto things they understand like doctors and drug companies. ‘Administrators’, ACOs, VBC, VBC, PBMs, spread pricing are more challenging to grasp and are allowed to obsfucate people about what they do from the shadows. America’s healthcare landscape is burdened by ‘administrators’ and ‘managers’ who extract rents from an otherwise highly innovative system. https://lnkd.in/gK3mCme4 https://lnkd.in/gPC9vKB9 DocVader puts it aptly: ‘thoughts and prayers’ https://lnkd.in/gUfnSXGV Technology is one answer. Physician and nurse leaders are another. If your company is about literally decimating administrative costs in the back office or front office of healthcare, I applaud you. As Americans we need this. Return care to the people and shrink administration and management bloat across the system. Medicare deserves this and so do the commercially ‘insured’.

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The healthcare industry is averaging two cyber attacks per week at a staggering cost of $900k per day down. Considering that the average downtime is 4-6 weeks, the impact can cripple even the best run revenue cycle.

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There is a misconception emerging that AI agents will lead to immediate reductions in healthcare labor costs. While AI agents can automate end-to-end workflows such as booking appointments, answering basic patient questions, and performing form completion for prior authorizations, automating a single task is not equivalent to automating an entire job. Nurses are a prime example. Certain nursing tasks, such as care coordination and patient documentation, are highly automatable by AI agents; however, there is a tremendous amount of work nurses perform on the ground that cannot be fully automated with current technologies such as direct patient care, physical examinations, medication administration, wound care, patient support, and clinical assessments. These nuances make full role elimination less likely with current technologies. When articulating the ROI of an AI agent, we need to be both precise and accurate. Automating a task is more often not automating an entire profession. For roles that encompass many functions, such as nursing, AI agents can be invaluable tools for unburdening staff, increasing efficiency, and boosting throughput—benefits that are particularly valuable given current healthcare staffing and resource shortages. The most promising job candidates for full role elimination through AI remain positions with monolithic task structures, of which there are relatively few in healthcare today—scribes, medical coders, and data entry specialists for example. It is therefore unsurprising then that the most progress has been made in these categories.

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Health system adoption of your Health Tech Innovation moves at the Speed of Trust they have in your company 👇 Patient care is high stakes. Not innovating is relatively low risk. It’s not like all your patients will go elsewhere simply because your health system is slow to innovate (at least not in the near term). Innovating - and potentially hurting patient care - is high risk. So the more you earn the Trust of health systems, the faster they will adopt your innovation. Here are 5 factors that can increase ⬆️ Trust if you excel at them… or  ⬇️ Trust if you’re lacking in them: 1️⃣ Company brand: has our team heard of your company before? No one gets fired for picking Microsoft today. 2️⃣ Social proof: do peers I trust rave about your innovation? They will almost certainly call their peers about you, whether they tell you or not. 3️⃣ Clinical evidence: what data do you have that shows your innovation actually works? Data builds confidence and de-risks. 4️⃣ Delivering value: after Go-Live, are we achieving our goals? The relationship has to be earned year after year. Results are the best way to do that. 5️⃣ Reliability: do you do what you say you’re going to do? How responsive are you to our needs? You’d be surprised at how often people either don’t deliver on their promises (big or small) or do so very slowly. Of course if you’re an early stage startup you’re going to have gaps at many of these. No one will have ever heard of you. You may have next to no social proof. And no evidence to show for it. BUT you can still earn Trust by delivering on the things you can control. E.g. You can be more responsive and reliable than even the largest incumbents who may have grown complacent. And certain health systems will choose you just because of that. So the hard part is holding a high bar for earning Trust in the company culture as you scale. To ensure you still aim for high reliability and value creation, even though your growing brand, social proof and evidence may start to carry you. Because as quickly as Trust can be earned… it can just as quickly be lost. What would you add?

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Is that really a death sentence for smaller startups? I don't think so. Alright, let's take a step back and look at this DTC healthcare situation from a different angle… Sure, the market is tough right now, and big players like Hims are trading at lower multiples than we'd like. But here's the thing: tough times are GOOD. Tough times are when the real innovation happens. It sucks in the moment, but it forces you to get creative and build something sustainable. The same goes for DTC healthcare startups. Instead of relying on endless rounds of VC funding to fuel growth at any cost, these companies now have to focus on the fundamentals — just like every other medical practice and healthcare system out there. All things must eventually survive without huge churn. They have to figure out how to; acquire new customers efficiently, retain them for the long haul, and actually turn a profit. 👆 Crazy concept, right? Some startups might not make it through this rough patch. I’m not one to sugarcoat that. But the ones that do will come out stronger and better equipped to tackle the real challenges in healthcare. With proven business models, loyal customers, and the grit to keep pushing forward even when the going gets tough. Before Side Health I was aggregating, building, and running ENT practices. There was no VC money coming to save the day. Build a proper business plan or die. The same principles apply to DTC health tech. If the current market conditions lead to more startups actually delivering on the promise to make healthcare better for patients while reducing costs, that’s fantastic. So to all my friends out there grinding away at DTC healthcare startups, don't lose hope. Keep putting one foot in front of the other, keep listening to your customers, and keep believing in the power of innovation. The world needs what you're building, even if the valuations don't always reflect it. And to the VCs who are suddenly getting cold feet about DTC healthcare, I have just one thing to say: you're missing out. The startups that emerge from this crucible will be the ones that reshape the industry and deliver outsized returns.

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"Liam why did nobody ever tell me this f*****g stuff 👇" (#healthtech #founder) At some point with clients I get that frustrated meeting where a company that has been on 3 accelerators and around half of the ecosystem, gets frustrated when I lay out pretty fundamental 101 stuff about how the NHS works. I share their frustration, it frustrates me too. My conclusion is this: The NHS either can't or won't acknowledge that it's a messy, imperfect, irrational, risk averse, political, silo-compromised, factional, and culturally complex system that needs to be treated that way. So it tells you how to engage with a rational system that makes decisions solely based on evidence and compliance. It makes working with the NHS sound like a well executed Gantt chart where you'll get in if you tick the right boxes. Most companies who hang around for a while find out the truth, and once they see the system for what it is, they work out how to navigate it. Well, I felt it was about time that someone did a more honest and candid job of preparing healthtech companies, and giving them the information they need to get in, and it IS NOT about ticking boxes (although some need to be ticked!). So look, yes, I'm plugging 🔌, but if you're building a solution for the NHS, and fancy skipping the wild goose chase, and instead getting down to the real work, then take my course - it's not even that expensive. https://lnkd.in/ew6N8psC

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Digital health investors pulled back, but there are rays of hope... It's a similar story with startups across the gamut - things got a bit crazy there for a while, and discipline is ramping up - profitable growth is in. At MedCity News INVEST, Shawn Ellis put it well - much-needed practicality has been injected into the funding environment "Founders are paying more attention to unit economics, contribution margin, thinking critically about the milestones in their business and the KPIs they need to show all the way." Good news is that many investors want to be more than cash machines - Fatima Husain cites the Better Health example, where her healthcare connections helped the company achieve traction with major health systems. All this to say, rocky times are still ahead for #digitalhealth as things reset. But reasons to be optimistic and keep at the mission. #healthcare #innovation

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Welcome to the Healthcare Entrepreneurship Series #6 - Revenue Models You've got funding. Now, how do you make money? Let's break it down. Two main options: 1. One-time fee 2. Subscription model 1️⃣One-time fee: Good for: Hardware, wearables, assessment tools ✔️Pros: Big upfront cash ❌Cons: No recurring revenue 2️⃣Subscription model: Good for: Cloud solutions, software ✔️Pros: Steady income, easier on customers ❌Cons: Slower growth Which to choose? Depends on your product. Hardware? Go one-time. Software? Think subscription. But don't stop there. Get creative: ↪️Freemium: Basic free, charge for premium ↪️Pay-per-use: Charge only when used ↪️Hybrid: Mix it up Bonus tips: ✨Keep it simple for your customers ✨Align with your costs ✨Think long-term growth Your model can change. Start simple. Adjust as you grow. Most important? Deliver value. Solve real problems. The money will follow. P.S. - New here? Check comments for previous posts. ♻️Repost to help an aspiring healthcare founder. #Healthcarestartup #revenuemodel #entrepreneurship #linkedin

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