On November 6th, I had the privilege of hosting a dynamic panel discussion to kick off our Harvard Payer Roundtable series to equip founders with real world insights on commercializing innovations for vulnerable populations in US healthcare. These are designed to be candid, intimate conversations with the real do-ers and decision makers that early-stage founders rarely get access to understand practical pathways for early-stage and growth-stage companies to go to market with government-funded Payers to make a meaningful impact. .
In this conversation we delved into the challenges and opportunities shaping the future of Medicaid, Medicare Advantage, and solutions for vulnerable populations. We brought together industry leaders who are all heavily operational and innovation-oriented - Sara Goscha (ex-UHC), Jenn Kaluza (ex-Elevance), Kevin Holub (Clover Health). Here are some high level takeaways from that detailed long-form discussion, tailored for founders and innovators looking to commercialize and grow solutions for low-income and senior populations.
1. Focus on Social Determinants of Health (SDOH): A Strategic Imperative
Health outcomes are shaped far more by social factors than clinical care—and payers are increasingly recognizing this. Panelists emphasized the growing importance of solutions addressing food insecurity, transportation, housing, and access to technology. Successful examples included partnerships that integrate community-based organizations directly into care delivery systems. Innovators who can demonstrate measurable ROI on these interventions will have a competitive edge.
Takeaway for Innovators: Embed SDOH considerations into your product roadmap and collaborate with payers to track the clinical and economic impact of your solution.
2. Value-Based Care: The Non-Negotiable North Star
Value-based care is no longer optional; it’s a mandate. The transition away from fee-for-service is accelerating, and payers are hungry for solutions that improve care quality while reducing costs. However, our panelists highlighted that operationalizing value-based models is still fraught with challenges—from aligning incentives, ensuring data interoperability, and even agreeing on which data from what period both parties agree on.
Takeaway for Innovators: Develop tools and services that simplify value-based arrangements for payers and providers, and prioritize data-sharing capabilities to bridge critical gaps.
3. Technology as an Enabler, Not the End Goal
Digital health is poised to transform care delivery, but our panelists underscored the importance of ensuring technology aligns with patient and provider needs. AI and predictive analytics are particularly promising for identifying at-risk populations and enabling proactive care management. However, overengineering or overlooking the end-user experience risks adoption hurdles.
Takeaway for Innovators: Build solutions that integrate seamlessly into existing workflows and focus on usability to drive adoption among providers and patients. Often the simple, unattractive bottlenecks that are non-core to the business are best opportunities to start with fixing.
4. Community Partnerships: The Unsung Hero of Scale
Scaling solutions for vulnerable populations requires more than top-down innovation; grassroots efforts and community engagement are critical. Panelists shared inspiring examples of local organizations collaborating with payers to deliver culturally competent care and enhance member engagement.
Takeaway for Innovators: Forge partnerships with community-based organizations to expand your reach and ensure your solution resonates with the populations you aim to serve. And prove it. You don’t need a peer-reviewed paper, show me evidence that you are in the community, in people’s homes, hearts and minds.
5. Equity and Inclusion: The Guiding Principle
Equity is no longer just a buzzword—it’s a business imperative. Solutions that reduce disparities in care access and outcomes are not only ethically sound but are increasingly being prioritized by payers. Cultural competence and inclusivity must be baked into product design and service delivery.
Takeaway for Innovators: Highlight how your solution promotes equity in measurable ways to resonate with payers and providers focused on improving outcomes for underserved populations. Inequity drives risk and also provides opportunities to close gaps in care.
6. The Commercialization Challenge: Getting Your Foot in the Door
One of the recurring themes was the difficulty startups face in gaining traction with large payers. Panelists advised focusing on pilot programs that demonstrate quick wins, followed by scalable growth strategies.
Takeaway for Innovators: Start small with well-defined pilot programs, but ensure scalability is built into your business model. Show early success metrics to accelerate payer buy-in. Be proactive and prepared with no additional burden put on the payer. Have the training material, operating manual, data collection and reporting templates, etc prepared and ready to review. Show the payer you know what you are doing, you don’t need hand-holding and you’re not going to embarrass them!
Final Thoughts
The Medicaid and Medicare Advantage landscape is ripe for disruption, but success requires a nuanced understanding of the populations served and the systems that support them. Innovators who can align their solutions with the priorities of payers, providers, and communities will be well-positioned to drive meaningful change while capturing significant market opportunities.
Following my own founder journey, I work tirelessly to bring together inspiring founders with mission-led industry leaders and decision makers who seek to make impact at scale for Medicaid and Medicare populations. Please don’t hesitate to reach out if you need help.
About the author
Shalen De Silva is a seasoned entrepreneur and healthcare strategist who first immersed themselves in the Harvard iLab as a graduate student (2017–2018), where he co-founded a venture-backed Medicaid health tech startup. Through the iLab's venture incubation and LLX alumni programs, Shalen built and scaled his company—eventually raising $6–7 million in funding before selling to an arm of UnitedHealthcare. Having practically “lived” at the iLab, they built their team within its walls and benefited from mentorship that helped navigate the complex intersection of healthcare, business, and policy.
Now leading his own consulting firm, Shalen focuses on helping later-stage companies commercialize Medicaid and Medicare-backed models of care with a highly commercial expert network and his own unique expertise. Shalen helps founders leverage underappreciated commercial opportunities with direct partnership with payers and mitigate avoidable risks of oft-unspoken truths surrounding the perils of poor governance, board selection, capital structure and value alignment with co-founders. He remains an active and engaged i-lab community member, sharing office hours, mentoring student founders, and organizing panels to demystify healthcare commercialization for entrepreneurs tackling social impact challenges. His passion lies in helping early-stage founders bridge the gap between mission-driven healthcare solutions and sustainable business models—ensuring the next generation of i-lab innovators can build impactful, scalable ventures.
