The pressure shows up most visibly on exits, where the numbers tell a consistent story: Capital is harder to return and harder to raise.¹ Investment committees now want conviction in how growth happens—not just that it will.¹ The new EBITDA growth bar can’t be cleared by adjacency expansion alone. It requires specific levers: commercial execution, pricing discipline and operating rigor.

The widened bid-ask gap is the most common breaking point on failed deals, per the StepStone/Bain Private Equity GP Survey—driven primarily by seller expectations that haven’t caught up to the new math. Pipelines remain full, but the bar to enter a formal process is higher.

The advantage is in the workflow, not the feature

One of the biggest debates in Nashville was how operators are now evaluating AI. Three years into healthcare’s AI cycle, the operator’s question has changed. It’s no longer whether AI works—pilots have proven it does in narrow conditions. It's whether a given tool can survive integration into an EHR, a claims system or a clinical workflow that wasn't designed to accommodate it. The vendor landscape has matured and so has the bar.

That’s where the conversation is splitting. On one side: point solutions evaluated on capability. On the other: AI built into the workflow itself—the documentation pipeline, the prior authorization process, the revenue cycle—where it stops being a tool that the user opens and becomes a layer the user no longer thinks about. The forum surfaced the distinction sharply.

Speakers from both the technology and investor side described the same gap in different ways.

Syed Mohiuddin, head of healthcare at Anthropic, explained that a demo can show anything. “Run that same test a thousand times with slight variation,” he said, “and it almost always falls apart because you don’t have the piping.” Annie Lamont of Oak HC/FT made the corollary point on durable advantage: Data is “incredibly important,” she said, but embedded workflow is the moat. Companies that win become integral to how work gets done. Features commoditize.

Two operator examples make the point concrete. Carda Health’s Harry DiFrancesco noted that roughly 80% of patient questions don’t require a provider response—making them well-suited to be answered by AI agents and freeing clinicians’ time for higher-value care.² Ensemble has deployed AI inside utilization management—the insurer-driven process requiring rapid notification and clinical justification for inpatient admissions—and is working to deliver measurable reductions in nurse time, friction and cost.

In healthcare, AI accrues durable value when it’s embedded deep enough in the workflow that ripping it out would mean rebuilding the workflow itself. Tools that sit on top of a workflow get reviewed, repriced and replaced. Tools that are the workflow tend to stay.

One relationship, every stage of the capital structure

Across operator conversations, companies described navigating multiple banking relationships as they scaled.

Healthcare companies don’t grow in a straight line. They move across the capital structure as they scale—operating accounts, lending, M&A advisory and capital markets. Most banks can meet a company at a few stages. Few can meet it at all of them.

Curtis Reed, who leads Government, Healthcare, Higher Education and Nonprofits Banking at J.P. Morgan, framed what that requires on the bank’s side:

Reed's example—connecting a hospital’s underused real estate to affordable housing developer relationships to address nurse shortages downstream—points to a broader pattern. A relationship that scales with a company does more than meet it at every stage of the capital structure. It brings the rest of the firm along when the company’s needs extend past banking.

Spear Physical Therapy is one example of what that arc looks like. Founded in 1999 as a single Manhattan location with a model built around one-on-one patient care, Spear now operates over 80 locations across the New York metro and is on a path to 90-plus in the coming year.³ The company has banked with J.P. Morgan for over a decade starting in Business Banking, graduating into Commercial Banking as scale grew, then through a 2024 recapitalization with J.P. Morgan as lead debt provider. The firm is now supporting M&A advisory as Spear evaluates inorganic growth. CFO Paul Solomon described what the relationship has come to mean operationally: When his team flagged that they had no business development function solely dedicated to tuck-in acquisitions, J.P. Morgan surfaced opportunities through middle-market resources at no additional cost.

SonderMind's mental health footprint of 19,000 therapists and psychiatric providers operates in all 50 states and works with all major commercial and government health plans, as well as serves as the largest outpatient mental health provider for veterans in the country.⁴ In early 2026, the company completed a debt-funded acquisition supported by a J.P. Morgan term loan. CEO Mark Frank described the value as a single coordinated team across Commercial Banking, Investment Banking and Credit—without the handoffs that typically fragment a banking relationship as a company scales.

Stepful, which builds internal pathways to train healthcare workers—medical assistants, nurses and allied health professionals—for some of the largest US healthcare systems scaled from Series A to Series C with J.P. Morgan through a period of regional bank volatility, when a treasury relationship became, briefly, an existential question. CEO Carl Madi described the firm’s responsiveness in moving capital quickly during the disruption as the moment the relationship proved itself.

The healthcare bench at J.P. Morgan spans Commercial Banking, Investment Banking, Payments and Capital Markets to meet healthcare companies at every stage of the arc—with bankers, credit and treasury teams dedicated to healthcare

Subsector specialization is the difference

Conversations across subsectors—from provider groups to payments—underscored how unevenly complexity is distributed in healthcare.

Healthcare isn’t an industry. It's more than two dozen distinct subsectors, and the operational reality of each is different enough that generalist coverage misses the picture. Tim Moffet, head of Healthcare Services at J.P. Morgan Commercial Banking, put it concretely:

That complexity compounds across Medicare, Medicaid and commercial reimbursement—which is why expertise must live at the subsector level.

Dan Blum, CEO of ENT and Allergy Associates—the largest provider of ear, nose and throat care in the U.S.—explained that the depth presents itself in unexpected places.⁵ When monitoring tools from J.P. Morgan picked up a ransomware attempt against ENTA on the dark web, the firm was the first and only business counterparty to alert the company. ENTA did not experience a breach. The same depth showed up in the firm's support for ENTA’s electronic health records migration—including the integration work needed to make revenue cycle management run cleanly on a new platform.

The takeaway

Taken together, the conversations in Nashville point to a clear separation forming.

Healthcare’s next phase is being shaped by the gap between operators who are clearing the new bar and operators still finding their footing. The forum surfaced where the market is moving—and what kind of execution it’s now asking for. The reset is real, but the conditions for healthcare leaders building durable companies are unusually favorable: Capital is available, AI is maturing and the bar for execution is producing meaningful separation.

Clearing that bar is a financing and execution challenge first. It calls for a banking relationship that can move with a company across the capital structure as it scales, and sector expertise deep enough to know how a specific subsector operates.