Stephen Grinich

Independent clinicians want autonomy, but the insurance system only works if you have the resources of a scaled group. That’s why MSO-PC "practice-in-a-box" platforms (Headway, Nourish, Grow, and what we’re building with HealthSpark) have taken off. We centralize the admin work that no clinician can realistically do alone (credentialing, contracting, billing ops, compliance, appeals) so they can thrive with insurance while remaining independent. AI pushes this further. No individual clinician can track the full complexity of the insurance system, but an AI-native platform can. For the first time, every little guy can have the equivalent of a fully staffed back-office fighting through the maze on their behalf.

Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies. They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight. Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient. This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country

Last night was a full-circle moment. I went back to Cal’s campus for the first time since doing YC, speaking at the Haas Healthcare Speaker Series to MBAs, PhDs, MEng, and MTM students about my journey building HealthSpark. Just a few years ago, I was a grad student at Berkeley sitting in those same seats, listening to alumni share their stories, dreaming of building my own digital health startup. Crazy how much can change in such a short time.

We lost a real one today. RIP Claude 🤍 sfgate.com/local/article/…

Back at the mothership for YC alumni demo day

Stripe had 50 users two years in. When you’re building infrastructure in a regulated space, early feels slow. But it lays the foundation for something massive. "If you're working on a startup that's a bad idea, it's going to feel like slow going. If you're working on a startup that's a good idea, it may feel like slow going too." youtu.be/9DUQ7_7Pj_c?t=…

HealthSpark shows up on YC’s list of 100 top healthcare startups. Cool ycombinator.com/companies/indu…

@meksikanpijja “Startups are like building a plane while you’re flying it” The flight in question:

i don't think i ever stopped to consider how *tall* hurricanes are beautiful and terrifying

Want to find your next startup idea? Don’t underestimate Facebook groups. I found groups with tens of thousands of PTs asking how to accept insurance, stay compliant, and run their own practice. When everyone in the community is struggling with the same thing, there’s your opportunity.

Takeaway from office hours this week: when something works, double down. Don’t waste momentum solving problems that don’t exist yet. It’s good to keep sight of the long-term foundation you’re building and stay aware of what might break in the future. Just don’t let it slow the compounding. Keep the long-term vision in mind, but execute in the present.

@lillysharples If you’re trying to get even crazier allow me to introduce bay to breakers swim edition

Sunrise swim across the SF bay has got to be the craziest thing I’ve ever done

@Jo_Minimis Occasionally track Wednesdays!

@stephengrinich Will you be there?

I went to Strava HQ seeking a partnership and they called the cops on me 1 like = 1 prayer that they forgive my transgressions

@alexcooldev Makes total sense. We have a virtual PT clinic and we're now layering in an AI physical therapist on top of it. See real PTs covered by insurance over video + AI coaching and accountability between sessions for 24/7 support

Building a startup? Focus on timeless problems, the kind people always care about: - Fitness → AI calorie tracker - Studying → AI tutor, flashcards generator - Productivity → AI planner, habit tracker - Money → AI dropshipping or finance assistant - Beauty → AI skincare or makeup coach - Memory → AI note-taker or summarizer - Mental health → AI sleep or mood coach - Photography → AI photo editor, caption writer - Food → AI meal or grocery planner - Relationships → AI dating coach or conversation guide - Health → AI symptom checker, rehab or fitness guide - Travel → AI trip planner or itinerary builder These categories never die. People always pay for what solves real, everyday needs.

At the doctor’s office in SF today, hearing an older boomer absolutely ripping into their new AI receptionist. The front desk responds almost on script: “thanks for the feedback, this helps us at the front desk, we’ve received mixed results.” This is Voice AI in the wild

There’s bipartisan support to keep telehealth. I’m confident it will become permanent. But it should never get this close. The uncertainty is bad for the industry, bad for providers, and bad for patients

I run a startup delivering in-person & virtual PT to Medicare patients. Tomorrow, Medicare stops covering virtual PT — even though HHS itself says: "physical therapy services through telehealth can be an effective, convenient, lower-cost mode of care for you and your patients" telehealth.hhs.gov/providers/best…

The government shutdown tonight puts Medicare telehealth on the cliff. COVID flexibilities that opened telehealth at home, phone checkups & virtual therapy to tens of millions are set to expire. Without action, most seniors will again need to travel to a clinic for care