You Own the Capacity. Who Owns the Demand?

On October 29, Business Insider reported that Ro, a direct-to-patient healthcare company, launched Robin, an AI health agent. But CEO Zachariah Reitano described a much larger ambition of making Ro a central coordinator of healthcare.

That frames up a big question healthcare strategists should consider as we build future scenarios:

What if healthcare’s greatest competitive advantage shifts from owning clinical capacity to earning the patient’s trust to decide where and how to access it?

I spent the past 35+ years helping hospitals, health systems, and physician enterprises grow through physician recruitment, practice acquisitions, and clinical expansion. I’ve also watched successive waves of innovation promise to transform healthcare, sometimes successfully and sometimes at enormous expense.

What interests me about Zachariah Reitano’s vision for Ro isn’t the AI technology. It’s the possibility of a fundamentally different business model in which a company creates and captures value by connecting patients who need care with the physicians and facilities that provide it.

What if the next great healthcare enterprise makes the market rather than delivers the care?

The Market-Maker Opportunity

There are signals from other industries.

Consider Expedia, a $33 billion enterprise that built its business connecting travelers with airlines, hotels, and rental car companies without owning those underlying assets. Its value comes from organizing demand, making supply accessible, and facilitating transactions. Expedia captures a share of the economic value of those transactions.

Healthcare presents a similar opportunity, although the stakes and complexity are considerably greater.

Imagine patients trusting an independent intermediary to understand their needs, identify appropriate providers, navigate insurance requirements, locate available appointments, and complete the connection. Physicians and hospitals would still deliver the care, but the intermediary would increasingly influence where patients go and who gets their business.

For healthcare executives, the strategic threat isn’t that Ro will replace their physicians or facilities. It’s that someone else could own the relationship that determines where patients receive care.

That possibility has significant implications for health system executives.

We have invested billions in clinical capacity, brand development, and digital front doors to attract patients into our organizations. But if another company becomes the trusted intermediary between patient demand and clinical supply, those investments may increasingly position us as suppliers in a marketplace someone else influences.

We would still carry the cost of operating the assets while another enterprise gains leverage over the demand that makes them economically viable.

A Signal or Just Market Noise?

Futurist Amy Webb, in her 2016 book The Signals Are Talking: Why Today’s Fringe Is Tomorrow’s Mainstream, challenges executives to distinguish emerging structural change from the noise surrounding new technologies.

In the abstract, Ro’s announcement is far more strategy aspiration than proven performance.

But consider the convergence of AI capable of navigating increasingly complex transactions, healthcare delivery spreading across more settings, and technology platforms making clinical services easier to find and access.

On October 28, Zocdoc announced that it was opening its scheduling infrastructure to outside AI agents, allowing them to identify providers, verify insurance participation, and book appointments with patient consent.

Ro aspires to coordinate care. Zocdoc is building infrastructure to connect AI agents with available clinical services. Neither is evidence that a new market-making business model has succeeded. Ro itself delivers healthcare services, so it isn’t a pure marketplace business.

But together, these developments suggest that the next major healthcare innovation may not be another way to deliver care, but a better way to make the market for care work.

What Would Have to Be True?

I have some personal experience with this challenge. In 2004, my son Michael Alden Eaton and I built an interoperable healthcare marketplace, brought it to market, raised capital through several financing rounds, and eventually achieved a profitable exit.

That experience taught me that connecting healthcare demand and supply is considerably harder than building the technology.

Physicians aren’t interchangeable suppliers. Clinical appropriateness, continuity, insurance coverage, and accountability matter. Patients must trust the intermediary, providers must participate, and someone must be willing to pay for the service.

Most importantly, the business model must reward appropriate care connections rather than simply generating transactions or directing patients toward the highest-paying providers.

AI may make some of these challenges easier to solve, but it does not eliminate them.

Two Questions for Healthcare Executives

Ro’s announcement about Robin, and its CEO’s vision to position the company as a market-maker, should be looked at as a signal that strategists need to think about as we make future plans. There are two questions worth considering:

• If an independent company becomes the trusted marketplace connecting patients with healthcare services, what happens to the competitive advantage we’ve built through owning physicians, facilities, and clinical capacity?
• Are we investing in technology to bring more patients into our own healthcare system, or are we prepared to compete in a market where patients can find and access appropriate care regardless of who owns it?

I don’t know whether Ro will become healthcare’s next market-maker. Its strategy may evolve into something quite different. But having spent decades helping healthcare organizations build clinical capacity, and having personally built a healthcare marketplace, I believe the possibility deserves serious attention.

We know how to build the supply side of healthcare. The strategic question is who will earn the patient’s trust to organize the demand and capture the value of making the match.