🏥 Reimagine Care and the Future of Oncology

The current state of oncology and market forces at play

Happy Tuesday Hospitalogists,   I’ve got 3 incredible essays headed your way this week on different parts of the healthcare ecosystem - the first is a recap of the state of oncology and innovation with Dan Nardi and Ben Freeberg, stemming from our podcast. The second will be an overview of Photon Health, and the third will dive into VBC and health system economics with Pearl Health.   Let’s dive into the wide world of oncology today! Was this email forwarded to you? Subscribe Here GET EXCITED My team and I have been working on something for months, and we are announcing it in Thursday’s newsletter. But I’m not really into secrets, so I’ll just tell you now. This November, we are hosting the first ever Hospitalogy AI Retreat. It’s an immersive 3-day experience at a resort with 2 championship golf courses. And we’re covering your flight, hotel room, and ticket. Applications open Thursday, and we're limiting this to 100 attendees. Use this link to mark your calendar and get early access to apply. See you on the green. The State of Innovation in Oncology - Executive Summary 1,700 Americans die of cancer every day, and over half of those deaths are preventable with care, data, and workflows we already have. Ben Freeberg (Oncology Ventures) makes the case that the moonshot isn't another CAR-T molecule. It's fixing the 97% of the cancer journey that happens outside the infusion chair. Reimagine Care's Remy AI platform is resolving 52% of patient interactions autonomously and driving a 67% reduction in ED visits. Average resolution time drops from 24-48 hours to 30-60 minutes, and that's before the personalization layer even kicks in. Cancer has been the top driver of employer healthcare costs for 4 straight years, now growing at 3x the rate of other disease states and eclipsing $220B in annual spend. This is the cost problem no benefits consultant can talk around anymore. Keytruda, man. Outpatient cell and gene therapy is the next oncology wave. With the REMS changes last June, CAR-T and bispecifics are moving out of 60-day inpatient stays and into the home, and whoever owns the remote monitoring layer (spoiler: Dan thinks it's Reimagine) captures the next decade of oncology care delivery. Dan and Ben both forecast real digital oncology consolidation over the next 3 years. Point solution fatigue is biting, budgets are tightening, and the platforms that can't show attributable ROI in real time aren't getting renewed. The roll-up is coming. Listen to my conversation with Dan Nardi and Ben Freeberg HERE Cancer's $220B Problem (And the 97% Nobody's Building For) Cancer has now been the top driver of employer healthcare costs for 4 straight years, growing at roughly 3x the rate of every other disease category and eating up north of $220B in annual U.S. spend. 2025 was the first year the country crossed 2M newly diagnosed patients in a 12-month window, and that number is going up, not down. There isn't a Fortune 500 CFO alive who can squint at that trendline and pretend it's reverting to the mean. Every benefits consultant in the country has stopped trying to spin it.   Now compare that financial picture to where innovation dollars are actually flowing. Cell and gene therapies. ADCs. Bispecifics. Six-figure infusions. Drug pipelines that command 9-figure board attention. Don’t get me wrong, I'm not knocking the molecule story. Investing in new drugs and pipeline is real and the science is moving faster than any other corner of medicine. But here's the huge asymmetry, though: roughly 1,700 Americans die of cancer every day, and about 1,000 of those deaths are preventable using care models, data, and workflows that already exist. Earlier detection. Better symptom triage between visits. Boring infrastructure work that, by Dan Nardi's count at Reimagine Care, addresses the 97% of the cancer journey that happens outside the infusion chair.   Almost none of the venture capital chasing oncology is aimed at that 97%. That asymmetry is the whole investment thesis. It's also the reason a company like Reimagine Care matters more than its press release count would suggest. Two Operators With Real Skin in the Game I always appreciate when healthcare operators have skin in the game, and these guys both do.   Ben started his career in banking and VC, then was diagnosed with cancer almost 8 years ago. He talks about it with the dry matter-of-factness you only get from someone who has genuinely sat in the chair. One of the moments in our conversation that hit hardest for me was his description of being neutropenic mid-treatment, dehydrated, with a headache, calling his cancer center, and being told, "why don't you come into the emergency room?" So off he went. In a cab. 30 minutes. Into a waiting room full of other immunocompromised patients. That's the default pathway in oncology today. Anyone who has walked a family member through it can confirm.   Ben launched Oncology Ventures a little over 3 years ago, and by the time this episode drops, Fund II will be formally announced. Worth a shoutout: Ben's monthly Substack is one of the more transparent VC thesis documents I've seen in the space, and it ends with a standup comedy bit every time. I told him on the pod that my own readership responds to the personal stuff (golf, my 2-year-old) more than the analysis, and he confirmed the same dynamic. More people respond to the jokes than the cancer. I thought that was a pretty telling detail about how newsletters actually work in 2026.   Dan, for his part, is on his third startup and has been CEO of Reimagine Care for 3 years. He came in after the company had already pivoted once, and he's the one who turned a noble-but-hard-to-commercialize chemotherapy-at-home vision into the virtual cancer center Reimagine operates today. His ‘why’ is simple - more and more of us, every year, are touched by cancer personally. He wanted to be working on something that deeply matters at its core.   Two guys, two deeply personal reasons for being in the seat. Really this is what building and investing in healthcare is all about. From Chemo-at-Home to Virtual Cancer Center Reimagine Care was founded in late 2020 out of Martin Ventures by Devin Carty (shout out to Devin, prolific), after a close friend died not from his late-stage colorectal cancer but from an infection picked up at a routine in-clinic follow-up that could have been done remotely. His original thesis was chemotherapy-in-the-home. Beautiful idea, but it ran headfirst into a wall of regulatory friction, reimbursement chaos, and tough provider economics that don't love the idea of moving J-code revenue off-site.   Dan Nardi came in as CEO 3 years ago, and the company pivoted into what it actually scaled - infrastructure: a virtual cancer center built around an AI assistant called Remi, backstopped by a remote care team of oncology-trained MAs, RNs, and APPs. Today, Remi resolves 52% of patient interactions autonomously. For the other 48%, handoff to a human clinician happens within roughly 12 minutes from the initial text. Average resolution time for a patient symptom or question drops from the 24-48 hours that's standard at most oncology clinics — anyone who has shepherded a family member through chemo will confirm that number is generous — to 30-60 minutes.   When a neutropenic patient 4 days post-infusion notices swelling at 8pm on a Friday, the difference between a 30-minute response and a 36-hour response is the difference between a text exchange and an ED admission. Reimagine reports a 67% reduction in ED visits, a 10% lift in new patient volume in year one (because freed-up clinic capacity absorbs more consults), and 9-of-10 patient satisfaction. Those are CFO-deck numbers, not poster-session numbers. Why Remi's Architecture Matters A lot of digital health vendors are wrestling with how much LLM work to own versus outsource. Reimagine made the call most healthcare AI companies should make and most won't: don't build your own foundation model. Build on top of Anthropic, OpenAI, and whoever else is at the frontier this quarter, and put the engineering hours into prompt design, context engineering, and orchestration instead. Remi is a multi-agent system — enrollment, triage, an evaluation layer running QA on 100% of interactions, and a routing layer that escalates to humans when acuity warrants. Because the underlying model is interchangeable, Reimagine can rotate as the frontier moves and never get caught long on a model the market repriced overnight.   This is the right architecture for vertical AI in healthcare, full stop. Companies that try to compete with the foundation labs on raw model capability are setting venture capital on fire. Companies that own the workflow, the proprietary context, and the domain data layer are the ones that compound.   And the data layer at Reimagine is where this gets genuinely interesting. After 3 years across roughly 30 health systems, the company is sitting on a quarter-million patient interactions, every one of them tied to diagnosis, treatment regimen, and timing within the treatment arc. Translation: they can normalize every triple-negative breast cancer patient on a given protocol to day zero of treatment and start predicting which symptoms will surface on day 3 of cycle 2. Ben Freeberg of Oncology Ventures, who has been through the chair himself and now invests across this category, made the case that this is the v2 business model investors should actually care about. Forget the symptom-management SaaS sold to a hospital. The real prize is the personalized orchestration layer you can only build after years of live deployment. He's right. That's the moat. That's how a company moves from "vendor on the implementation list" to embedded infrastructure on the cancer service line. Same Platform, Different P&L One of the cleaner pieces of commercial thinking I've heard in digital health this year is how Reimagine segments its customer base. Community oncology, comprehensive cancer centers, and integrated health systems all run the identical Remi platform. Based on the kind of operator you are, Remi’s value proposition shifts. For a community practice in a rural market that can't recruit enough oncology RNs, Remi is a staffing bridge. For a comprehensive cancer center, it's a patient experience and leakage play, with 59% of patients saying they'd switch providers over a broken communication experience Where Reimagine got it right, is FFS versus VBC. Same platform, different P&L line item. For an FFS oncology practice, the value is the 10% volume lift; freed-up clinic capacity converts into more billable consults. For a VBC contract or an at-risk ACO, the value is the 67% ED reduction, because the ED is now a cost center instead of a revenue center. Either way, Reimagine ships one product. Different math. Why Home Infusion Stalled Here's where the conversation gets a little edgier. Drug-distributor consolidation across community oncology — McKesson's roll-up through US Oncology, Cencora's ION/OneOncology footprint, Cardinal's Navista — has quietly made the Big 3 distributors among the largest practical owners of community oncology in America. Their economics depend on owning the J-code spend. Buy-and-bill margin is the entire model. Any care delivery innovation that pulls infusion revenue out of the clinic and into the home structurally threatens the unit economics of the practices the distributors just bought.   Dan was honest about this in a way most operators won't be on the record about: incentives in cancer care are misaligned, the drug is the revenue source for most providers, and that's exactly why chemotherapy-at-home as a primary thesis ran into brick walls. VBC is a step in the realignment direction. We need more.   Home infusion as a scaled care model is going to remain niche until somebody figures out how to detach the oncologist's economic engine from the J-code. As long as the buy-and-bill spread is baked into practice primary margin, distributors will keep shelling out blank checks for the economics. Which is why Reimagine's pivot was the smart pivot. Don't fight the J-code. Go around it. Sell into the workflow layer where everybody — oncologist, patient, payer, employer — has aligned interests in fewer ED visits and faster symptom resolution. Cell and Gene Goes Outpatient If there's a single inflection point across healthcare but also in oncology delivery over the next 24 months, it's the migration of cell and gene therapy out of the inpatient setting. Historically, only 18-20% of patients who could clinically benefit from CAR-T or bispecifics were actually getting them, because the inpatient monitoring footprint required a FACT-accredited center and a 60-day window. REMS changes from June removed a meaningful chunk of that constraint, and every academic and community-affiliated cancer program is now racing to stand up an outpatient CAR-T pathway. Bispecifics are right behind.   Reimagine is positioning what they call advanced therapy management as exactly that layer: crawl into symptom management, walk into RPM device integration (CMS's RPM and the newer PIN codes are creating real reimbursement here for the first time), run into full outpatient cell-and-gene monitoring across the patient arc.   Whoever owns that remote monitoring layer captures one of the most consequential delivery shifts in modern oncology. Reimagine has a real shot at owning it. And there are maybe 3 companies positioned to do this well today. M&A Is Coming for Digital Oncology Consolidation is not only happening among community oncology groups but also among the digital health ecosystem supporting those providers. COVID-era venture capital funded a generation of oncology point solutions — symptom trackers, financial navigation, survivorship apps, behavioral health bolt-ons, second-opinion services, distress screeners. Outcome data on most of them is thin. Hospital CIOs and CMIOs are tired of evaluating 10 vendors for 10 slivers of the same patient journey. Budgets are tightening. Renewal conversations are getting brutal.   Over the next 3 years, M&A activity in digital oncology is going to accelerate hard. Platforms that can show attributable ROI in real time will roll up the ones that can't. Best-of-suite displaces best-of-breed when the buyer is exhausted, and oncology buyers are exhausted. Reimagine's pitch to become the orchestration layer — warm-handing patients off to behavioral health, transportation, financial assistance, and survivorship partners — is the right pitch for the environment we're walking into.   Ben's Fund II thesis at Oncology Ventures is the same idea from the cap-table side. Traditional digital oncology budgets at health systems are finite. Companies that generate Fund II-level returns will be the ones finding adjacent buyers — life insurance carriers underwriting risk on diagnosed members, employers running benefits-led oncology programs, JV structures between startups, distributors, and health systems on outpatient CAR-T builds. He's putting capital behind that thesis directly with investments like NextCure alongside RA Capital and Cencora.   Funders want consolidation. Buyers are exhausted from vendor evaluations. Operators are signaling it openly. Only the marketing teams at the point-solution vendors are pretending it isn't coming, and they're pretending because they know they're on the wrong side of it. Who wins in oncology infrastructure Whoever closes the gap between the infusion chair and the kitchen table at 9pm on a Friday wins the next decade of oncology. That's the 97% Dan keeps pointing at, and it’s also the $220B line item every employer has been staring at for 4 straight years.   Reimagine Care is one of a small number of companies actually building infrastructure in that gap. Whether they're the platform that consolidates this category or one of the platforms that gets consolidated into something bigger probably comes down to the next 18 months of go-to-market execution and how the cell-and-gene wave breaks. Oncology Ventures invests in commercially-validated start-ups transforming the future of cancer care.  Investment Theses, Cancer Facts and Comedy via Our Substack. Ben & team also just announced an oversubscribed Fund II - Check out the details here.   Dan Nardi is the CEO of Reimagine Care, the nation’s leading provider of cancer care services in the home. Dan is a proven leader and has over 23 years of experience with rapidly growing companies in the digital health space. Prior to joining Reimagine Care, Dan was the Chief Operating Officer of Carrum Health, a company focused on value-based care, where he had responsibilities over operations, care delivery, and growth, among other areas. Prior to Carrum Health, he helped grow and scale Livongo, as Vice President of Operations, from 13 employees to the IPO. Dan brings significant leadership and operational expertise; having been successful in building high-performing teams and converting aspiring company vision & mission into reality. MISCELLANEOUS MADDENINGS I recently played a golf round with my buddy at Pecan Hollow up in north DFW, and we got paired with two fine fellas who were probably 15 handicaps. But one of them (who was maybe even more of a 20) pulled out the hole of his life on the 9th hole, which is a straightaway par 5. Out of nowhere, this guy rips his driver down the right side of the fairway, then stuffs a 3 hybrid to 10 feet pin high. He has a quick left to right putt for eagle…and absolutely drains it. Hole of the day by far, his first eagle, and those moments are what keeps us golfers chasing the dream and coming back to the golf course. Godspeed, Hospitalogists. Thanks for the read! Let me know what you thought by replying back to this email.   — Blake   🏥 Hospitalogy Membership I'm building a community of leaders in strategy, finance, and ops at hospitals and health systems to help us connect, learn, and grow together. Apply for free membership here. 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