Nimbus Health is a technology-enabled pulmonary clinic roll-up that acquires community pulmonology practices and layers on remote monitoring and exacerbation prediction to convert episodic COPD/asthma visits into recurring, value-based revenue. The wedge is contrarian: brick-and-mortar clinics are the cheapest and fastest CAC channel to build a book of chronic-disease patients, dramatically undercutting D2C and payor-sales motions that have stalled most digital-health peers. Own the patient relationship at the specialist tier, monetize through service-line expansion (Nimbus at Home, rehab, monitoring), and compound revenue per patient at LTV/CAC ratios that a pure-tech seller cannot reach.
Validation was already visible at the Seed Extension: clinic #2 was a bona fide acquisition of a ~5,400-patient practice with the operating physician staying on, and Nimbus at Home was ramping to ~50 patient enrollments per week by Feb-2024. The Seed round was led by 2048 Ventures with 8VC and K50 also participating; StoryHouse Fund I wrote a $191,500 SAFE on the $25M post Extension with a 20% discount, sized to preserve pro-rata on a company that has since raised a Series Seed II at a $50M post priced round (2048 leading with $6M, 8VC $1M).
Respiratory care is a large, growing, chronically underserved specialty; COPD alone anchors ~35% of segment revenue and continues to compound with an aging population. The addressable slice for Nimbus is narrower — U.S. community pulmonary practices willing to sell — but each acquired practice comes with a captive multi-thousand-patient panel that can be re-underwritten into recurring monitoring and rehab revenue.
| Player | Positioning | Funding | Edge |
|---|---|---|---|
| Nimbus Health | Tech-enabled pulmonary clinic roll-up with in-home monitoring layer | ~$19.5M raised, 8 clinics live in AZ/GA/SC | — |
| Independent pulmonology practices | Fragmented, mostly single-doctor community practices — Nimbus' direct acquisition targets | Private | Nimbus offers physician liquidity + tech leverage on top of existing panel |
| Sound Physicians | Hospital-based pulmonology/critical-care staffing at scale | PE-owned | Nimbus owns outpatient patient relationship rather than shift-based hospital coverage |
| Oak Street Health (comp) | Precedent: primary-care roll-up serving Medicare panels | Acquired by CVS Health, May 2023 | Same playbook, applied to pulmonary specialty with higher acuity and lower CAC |
Moat: Owning acquired community clinics is the lowest-cost channel for building a chronic pulmonary panel; each acquired doctor's patient loyalty converts into recurring monitoring revenue that no software-only competitor can replicate at similar CAC.
The roll-up precedent is fresh and expensive: CVS Health closed its acquisition of Oak Street Health for an enterprise value of approximately $10.6B in May 2023, a payor / retail-health buyer absorbing a specialty-panel roll-up at scale. If Nimbus reaches even 50,000 enrolled patients on Clay's own $1,800/patient/year framing (note recVlfVIDMdNrBKxt), the revenue base supports a $1B+ exit and a healthy multiple on our $191.5K SAFE.
Updates from Clay
We've ironed out most of the kinks in Nimbus at Home, enrolling about 50 patients a week now.
Close to LOI for clinic #4
RAW NOTES:
8VC offered $3M on 25M post with 8% interest in a convertible note.
Clay spoke with Alex Moore last night and Alex said they could waive the 8% of the business; if he does that, than Clay could feel good about it.
Define Ventures is out; it would take too long for them to run their process; their feedback was that most seed rounds they're seeing are 30% of the business.
GC and Contrary are still in the mix — he has his 4th call with GC; he thinks they may get there but may want to put in more money; with GC he was introduced to Hemant and Reva, the partner is Chris Bishof.
Clay spoke with Will at Contrary and it has some appeal to them; Clay is doing their general IC meeting with them today at 6pm.
Contrary was the dorm room check at a vendor that Clay works with, and Will also previously worked at a healthcare co that failed.
Copy from Clay pushing back on 'non venture-backable' argumentation
Jason,
Great talking to you this morning. Adding my cofounder Sharvil for visibility.
As discussed, please see here for our dataroom. I'm also attaching the financial model for the clinic we just purchased in Phoenix; this will be more representative of our future strategy since we intend to grow via acquisition. De novo clinics take too long!
You asked whether brick and mortar clinics are venture backable. The simple answer is that we can deliver a venture return profile, as you'll see in the model. VCs back brick and mortar healthcare all the time — Oak Street, Carbon Health, and One Medical are examples, and there are many others.
The more complex answer is that although healthcare SaaS companies seem to more neatly fit the traditional venture investor pattern-match, the reality is that selling into healthcare (whether an 18 month sales cycle to a hospital or large payor, the slog of selling clinic by clinic, or a D2C marketing motion) is punishingly difficult, and therefore extremely costly to do. Notionally higher software margins don't mean much if sales are very costly or impossible, and this is why most digital health companies are struggling.
One of our key insights is that owning clinics is, counterintuitively, a much cheaper way to acquire strong patient relationships. Our clinics are vehicles to deliver our patient monitoring / exacerbation prediction technology, or, more precisely, our tech-enabled service lines. If we could see a faster or cheaper way of getting our technology to patients, we would do that, but we're sure that physical clinics are the best way to do it.
So I would encourage you to think about brick and mortar clinics from the standpoint of LTV / CAC. Buying pulmonary clinics is the lowest-cost strategy for acquiring chronic disease patients, very possibly in all of American healthcare.
This is our contrarian bet, no one else is making it.
Enjoy your weekend, Clay