Healthcare has never been an easy place to build. But in 2026, the landscape looks fundamentally different than it did even a few years ago: more equipped, more competitive, and in many ways, more demanding. That's the terrain Alyssa Jaffee of 7wire Ventures navigates every day as a partner at one of digital health's most founder-focused firms.

Jaffee recently joined StartUp Health CEO & Co-founder Steven Krein and members of the StartUp Health community for an in-depth, hour-long AMA-style event, fielding questions on everything from fundraising strategy and AI adoption to what she still isn't seeing enough founders tackle. The conversation was candid, substantive, and full of the kind of insight that only comes from someone who has been both inside the operator trenches and at the investment table.

7wire's thesis, which the firm calls the "informed connected health consumer," centers on helping people become better stewards of their own health. But when Jaffee talks about what she looks for in founders, she keeps returning to something that no technology shift has altered: founder market fit.

"We talk a lot about product market fit," she said, "but founder market fit – why are you and your team the best people to solve this problem – will never go away. It's just too hard in healthcare to try to build something for the monetary value of it alone. You have to have some kind of mission or passion. You have to have some kind of connection, some kind of understanding of the population you're serving."

That bar hasn't changed in seven years at 7wire. What has changed is the environment founders are entering. When Jaffee joined the firm, much of the digital health market was still being defined. Self-funded employer contracting barely existed as a category. Today, there are actual buyers who understand how to contract against what you're building – and many more entrants competing for their attention.

The positive news is that the market is maturing. The challenging news is that maturity comes with higher expectations. Jaffee put a name to the moment we're in: the evidence era.

"The evidence era is no longer about saying, 'oh, this will save employees some time,'" she said. "It's really about: what are your outcomes?" Patient-reported outcomes, clinical validation, real proof points – these aren't nice-to-haves anymore. They're table stakes for getting a serious look from buyers and investors alike.

That shift tracks with what 7wire sees across the portfolio. Founders who arrive with a clear sense of who holds the pain point, what the data shows, and how the business unlocks payer dollars are simply better positioned. In Jaffee's view, the path to a multi-billion dollar health tech business runs directly through the payers. "Whether you like it or not," she said, "the keys to the kingdom are held with the payers. Unlocking those dollars is what makes you a multi-billion dollar business."

On AI, Jaffee was precise where others tend to be sweeping. 7wire's thesis is clear: AI is a provider enabler, not a provider replacement. That distinction matters enormously for how founders should be positioning their companies and how investors are evaluating them.

Every company raising external capital needs an AI story right now, she acknowledged. But that's different from needing to be an AI-native business. What investors want to see is that you're using new technologies to be more effective and efficient – not just that you've bolted the word "AI" onto a pitch deck.

She also flagged the valuation risk lurking in the current hype cycle. Some AI-native companies are carrying what she described as unsustainable valuations, given the traction they'll eventually need to justify them. Meanwhile, building a business has in some ways become more accessible – lower headcount, lower burn, faster iteration. But the funding market has bifurcated sharply between the haves and the have-nots, and founders should be clear-eyed about which side of that divide they're on.

One of the most valuable parts of the conversation was Jaffee's willingness to talk founders out of taking VC money at all. Or at least, into taking it more deliberately.

"The drug of other people's money is very addicting," she said. "But venture capital often creates misaligned incentives. What we look for in terms of outcomes may be very different from what you look for in terms of outcomes." She framed the investor relationship not as a transaction but as a decade-long marriage – and urged every founder to ask themselves honestly whether the person they're taking a term sheet from is someone they want calling them every day for the next ten to fifteen years.

That candor extends to the firm's broader philosophy. 7wire believes it has to help far more people than just its own portfolio companies to be successful. Jaffee described showing up for founders regardless of whether an investment ultimately happens – because the mission is healthcare transformation, not just deal flow.

Asked where she still sees too few founders building, Jaffee pointed to the breadth of women's health that remains unaddressed. Maternal health and fertility have seen real investment. But cardiac health, oncology, clinical trial design for underrepresented populations, and access for vulnerable communities are still wide open. Whole-person care – actually treating the full complexity of a person rather than taking on individual conditions in isolation – remains one of healthcare's most stubborn unsolved problems.

These are not small opportunities. They are, in Jaffee's framing, exactly the kind of mission-driven challenges that attract the founders worth backing.