NexusHealth

The Global Health Operating System

Displacing Epic, IQVIA & Veeva by 2056

The Problem

Healthcare is fragmented because the incumbents profit from fragmentation.

42%
Epic Systems
Owns care delivery but research workflows are afterthoughts. Slow, closed, expensive.
89K
IQVIA
Employs 89,000 doing manual work that should be automated. $16B revenue from fragmentation.
High
Veeva Systems
Locks sponsors into document vaults. Weak at point-of-care. High switching costs by design.

Result: 6-12 month study startup, manual coordination, duplicate data entry, no longitudinal patient view.

Why Now

🤖
LLMs make ambient capture viable
Abridge ($5.3B valuation), Ambience ($243M Series C), and Epic's native AI scribe validated the market. Documentation is solved—workflow automation is next.
📊
FHIR + TEFCA enable interoperability
Standards-based data exchange is finally real. National Academy of Medicine called for "fully interoperable national health data architecture" in March 2026.
💰
Capital flows to AI healthcare infra
OpenEvidence raised $250M at $12B valuation in Jan 2026. 54% of digital health funding went to AI companies in 2025. Buyers understand the category.
🤝
Incumbents admit fragmentation
IQVIA + Veeva formed strategic partnership in Aug 2025 because neither can unify the stack alone. This validates our thesis.

Our Solution

One unified platform connecting care delivery, research operations, and sponsor execution.

Clinical Operating Layer
  • • AI-native specialty EHR (oncology, cardiology, behavioral health)
  • • Real-time trial matching from structured + unstructured data
  • • Longitudinal subject timeline from pre-screen to follow-up
  • • Ambient documentation with specialty-specific templates
Research Execution Layer
  • • Study startup automation: CTA/budget routing, IRB prep
  • • eConsent with version control and revocation tracking
  • • EHR-to-EDC eSource (FHIR-based, CDISC-compliant)
  • • Unified CTMS for sites + sponsor workspaces
Agentic Services Layer
  • • AI does feasibility, site selection, protocol mapping
  • • Automated SDV, coding, safety signal monitoring
  • • Contract negotiation and amendment management
  • • Replaces $500K/study manual IQVIA labor
Longitudinal Data Layer
  • • One unified patient-study-outcome graph
  • • Consent-aware data governance and sharing
  • • Real-world evidence for regulatory submissions
  • • Patient-sovereign health passports (future)

The 30-Year Vision

Wave 1
2026-2033: Own the Clinical-Research Interface

500 sites, $500M ARR, 100K active subjects. Replace Epic's research workflows, IQVIA's manual coordination, Veeva's site tools.

Wave 2
2033-2043: Become the Health Data Backbone

100M patients with sovereign health passports. Embedded pragmatic trials in routine care. Epic becomes billing ledger, IQVIA's CRO model collapses.

Wave 3
2043-2056: Planetary-Scale Precision Medicine

1B patients, AI-first drug development, Veeva's document vaults obsolete, universal health access, median lifespan +10 years.

Why We Win

Network Effects Cascade
100
sites → sponsors require us for faster startup
1K
sites → Epic loses research differentiation
10K
sites → largest clinical-research dataset
100M
patients → pharma bypasses IQVIA entirely
1B
patients → global health operating system
Data Moat
✓ Unified patient-study-outcome graph
✓ 20-year longitudinal journeys (irreplaceable)
✓ Patient sovereignty creates trust moat
✓ Standards-based but proprietary linkage
✓ More data → better AI → better outcomes
Technical Moat
✓ Multi-EHR integration (12-18 months to build)
✓ FHIR-to-CDISC mapping and eSource automation
✓ Consent-aware data governance
✓ Agentic workflow orchestration
✓ Real-time pragmatic trial infrastructure
Economic Forcing Function
✓ Embedded trials: 1/10th cost, 5x faster
✓ Pharma can't afford $1B Phase III when competitors use us at $100M
✓ Health systems can't afford Epic at $50M when we deliver better for $5M

Business Model

Phase 1 (Yrs 1-7)
SaaS + Services
  • • Site: $1-2.5K per provider/year
  • • Sponsor: $50-500K per study
  • • Implementation services
  • • Outcome-based fees
LTV/CAC: 10x | Margin: 80%+
Phase 2 (Yrs 8-17)
Platform + Data
  • • Enterprise: $100M+ contracts
  • • RWE licensing to pharma
  • • Embedded trials: per-subject + outcomes
  • • Public health: govt contracts
LTV/CAC: 25x | Margin: 85%+
Phase 3 (Yrs 18-30)
Operating System
  • • Global health OS subscriptions
  • • AI-designed trial execution
  • • Precision medicine guidance
  • • Longevity outcomes-based
Network pricing power | Margin: 90%+
$500M
ARR by Year 7
$5B
ARR by Year 12
$50B
ARR by Year 20
10x
Unit economics

Go-to-Market Strategy

Beachhead: Specialty Ambulatory
Start where Epic is weakest and pain is highest
  • ✓ Behavioral health (Epic workflows are generic and broken)
  • ✓ Oncology (complex regimens, trial-rich, high ROI)
  • ✓ Cardiology (specialty protocols, device integration)
  • ✓ Independent groups + PE-backed MSOs (faster decisions)
Sales Motion
Land with one workflow, expand by module
  • ✓ Sell to CFO/COO/service-line leaders (not just CMIO)
  • ✓ ROI story: more research revenue, less coordinator burden
  • ✓ 3-6 month sales cycles (not 2+ years like Epic)
  • ✓ Pricing: transparent, per-provider annual contracts
Expansion Path
From ambulatory wedge to hospital integration
  • 1. Land 50 specialty groups (year 1-2)
  • 2. Sign first health system for specialty service lines (year 2-3)
  • 3. Become sponsor-required platform (year 3-4)
  • 4. Offer Epic integration → then Epic replacement (year 4-7)
Two-Sided Network
Sites + sponsors create lock-in
  • ✓ Sites choose us: reduce workload 70%
  • ✓ Sponsors choose us: 10x faster startup
  • ✓ Both sides on platform → switching cost = ∞
  • ✓ Network effects compound with every new site

18-Month Roadmap

Months 1-6: Specialty MVP
Q2-Q3 2026
Pick one specialty (behavioral health), build ambient documentation + specialty templates + trial matching + scheduling
Target: 5-10 design partner practices, proof of 10x study startup acceleration
Months 7-12: Multi-Specialty + Epic Sync
Q4 2026-Q1 2027
Expand to 2-3 more specialties, build FHIR-based Epic integration for patient data pull, add CDI and coding intelligence
Target: 30+ sites, $500K ARR, first sponsor workspace pilot
Months 13-18: Clinical Intelligence Platform
Q2-Q3 2027
Build predictive workflow engine, launch bidirectional Epic write-back, add hospital pilot program for specialty service lines
Target: $2M ARR, 100 sites, first health system beachhead proof
10
Design partners
100
Sites by Month 18
$2M
ARR by Month 18
10x
Startup speed vs. industry

The Ask

$10-15M Seed Round
To build the 6-month MVP and sign 10 design partners
Use of Funds
  • • Product development: $5M
  • • Design partner pilots: $2M
  • • Team (15 people): $2M
  • • Legal/regulatory: $1M
18-Month Milestones
  • • 10 design partners signed
  • • 100 sites live
  • • 50 active research subjects
  • • Proof of 10x study startup acceleration
Pilots
Academic health systems, specialty networks, MSOs
Talent
Healthcare operator intros, regulatory expertise
Network
Pharma sponsor intros, IRB relationships

Founding Team (To Be Recruited)

CEO
Healthcare operator with clinical + business background. Ideally MD/MBA who built and sold a health tech company. Must have Epic implementation experience.
CTO
Ex-FAANG with healthcare data infrastructure experience. Prior FHIR, EHR integrations, and security/compliance at scale.
CPO
Clinical informaticist who understands provider workflows and research operations. Prior CTMS or clinical research software experience.
Chief Medical Officer
Practicing physician-researcher who can recruit design partners and champion clinical adoption. Academic medical center credibility essential.

YC would accelerate team assembly, design partner intros, and regulatory/compliance navigation.

One Patient, One Graph

Continuous learning, universal access, AI-first execution, patient sovereignty at the center

Epic, IQVIA, and Veeva profit from fragmentation. We win by making fragmentation obsolete.

In 30 years: 1 billion patients with sovereign health identities, clinical trials embedded in routine care, AI-first drug development, and healthcare costs declining as % of GDP for the first time in 70 years.

That's the future we're building.

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