The Future of Healthcare Looks Like Cloud Computing

Healthcare has long been the graveyard of startups. The stats don't lie—success rates are 80% lower than other sectors, regulation moves at glacial speed, and incumbents control both distribution and trust. Most smart entrepreneurs take one look and run.

AI is changing that. It’s turning “boring” admin tools like scheduling, booking, and EMRs into gateways to patient relationships, structured data, and defensibility at scale.

In Brazil, the scale of the opportunity is explosive: a ~R$900 billion market (~ US$180 billion), millions of new doctors entering the system, and consumers demanding digital-first experiences from a healthcare stack still stuck in the past. The question is no longer whether the sector is ripe for transformation — it clearly is. The real question is which startups can turn this moment into models that compound over time.

That’s the bet Claudio Mifano made with Livance. His model is simple but powerful: treat doctors as entrepreneurs, give them the core tools to run a practice — spaces, scheduling, payments, and back-office support — and flip fixed costs into variable ones so profitability starts with the very first patient. By combining flexible spaces with SaaS and community, Livance offers doctors elastic infrastructure, without the burden of ownership. From there, scale, data, and network effects take over.

To unpack this shift, I sat down with Claudio for a wide-ranging conversation on building in one of the hardest markets there is — from applying trading psychology to founder decision-making, to analyzing market structure, to understanding winner-takes-most dynamics in regulated industries. Adapted and edited for the J Curve Insider newsletter format.

Let’s get into it.

NO ONE WHO GOES TO STANFORD GOES BACK TO FINANCE

Olga Maslikhova: Let’s start from the beginning. What was the single most formative experience before Livance that shaped how you operate as a founder today?

Claudio Mifano: Two actually.

The first was in undergrad, when I launched an investment club with two classmates. We each put in 5,000 reais (~ $1,000) and eventually raised 1 million reais — $200,000 at the time. We called it Lince, after the animal. For a while, I thought that would be my life: running a fund with close friends.

But the real turning point was Stanford. I had spent 13 years in finance — hedge funds and wealth management, living in spreadsheets, skeptical of everything. At Stanford, I went all-in on entrepreneurship: startup garage, VC classes, technology. You breathe the Silicon Valley air and suddenly it feels possible. The Dropbox founder walked into class. Brian Chesky from Airbnb spoke to us. And I’ll never forget a Stanford alum we visited in China telling us: “No one who goes to Stanford goes back to finance.” That mindset shift — from managing capital to creating something from scratch — completely transformed how I operate today.

YOU DON’T NEED TO BE RIGHT ALL THE TIME TO WIN

OM: What's one lesson from finance that founders often miss?

CM: First, mistakes are normal. As a trader, if you’re right 50% of the time, you’re great. That means you’re also wrong 50% of the time. Federer — maybe the greatest tennis player ever — won only 55% of the points he played. Nobody wins 100% of the time. The same applies to running a company: you’ll make constant mistakes. The real skill is developing thick skin, moving on, and focusing on the decisions that truly shape the outcome.

Second, speaking the language of investors. Too many founders underestimate how important it is to understand dilution, fund math, and how investors think. If you know how to engage, when to push, and what to emphasize, you build trust faster and avoid costly mistakes.

THE WINNER-TAKES-MOST REALITY OF BRAZILIAN HEALTHCARE

OM: For an investor new to Brazil, how would you explain the healthcare services market?

CM: The best way is to break it down into a few core dynamics:

• Doctors value independence. Unlike the U.S., where consolidation has been driven by private equity and big hospital systems, Brazilian doctors dream of owning their own practice, seeing their own patients, and building reputation under their own name. That independence creates fragmentation at scale.

• Large addressable market. Healthcare is ~10% of Brazil’s GDP, about 900 billion reais. The private sector accounts for ~500 billion and the public system ~400 billion. Only ~25% of Brazilians have private insurance — even though it’s the number one aspiration. The rest rely on the public system or pay out of pocket.

• Fragmentation is extreme. Brazil has ~1.3 million healthcare professionals today, heading toward 1.8 million in the coming years. Infrastructure, technology, and trust are unevenly distributed. Healthtech success rates are much lower than in other verticals. Doctors are skeptical of innovation, insurers lack the profit pools of banks, and regulators are cautious because healthcare is politically sensitive.

• Winner-takes-most dynamics. Healthcare is tough, but that’s what makes it valuable. The few players who build trust with doctors, insurers, and patients will be positioned to expand into adjacencies and capture disproportionate share.

OM: And within that broader system, how big is Livance’s addressable market?

CM:  Our current TAM is about R$30 billion (~US$6 billion), tied to the professional healthcare segment. If we capture even 20% of that, it represents close to US$1 billion in revenue potential in Brazil alone.

OM: How do you think about unit economics in healthcare?

CM: Healthcare is not SaaS. You have more operational costs, more paperwork, more physical overhead. Unit economics usually start weaker than in software — but they improve dramatically with scale. The bigger your network, the more you can spread fixed costs, digitize processes, and expand margins. Scale is the strategy.

THE OLD STACK VS. THE NEW EXPECTATIONS

OM: What are the biggest tailwinds shaping Brazil’s healthcare space?

CM: Two big ones. The first one is the surge in medical professionals. A decade ago Brazil had about 10,000 new medical graduates a year — today it’s 40,000 and soon it will reach 50,000. This growth came from government incentives, big education groups moving aggressively into medical schools, and broader access to scholarships. Twenty years ago, most doctors came from wealthy families; now many are first-generation. That shift means doctors can’t rely on scarcity — they have to build reputation, brand, and practice. The level of professionalism and competition has gone up.

The second is the digital gap. In many respects, healthcare in Brazil still operates the way it did fifty years ago — patients pick up the phone to book appointments, calendars and records aren’t integrated, and the same tests are often repeated because results don’t flow between providers. At the same time, consumers now expect everything to be digital, seamless, and mobile-first. Layer on top the rapid adoption of SaaS and the rise of AI, and you get powerful forces pushing the sector toward long-overdue transformation.

The combination of rapid supply growth and pent-up demand for modernization makes healthcare one of Brazil’s most dynamic — and challenging — markets to build in.

SHOPIFY, BUF FOR DOCTORS

OM: How would you explain what Livance is to someone outside the market?

CM: Think of Shopify for small businesses — they give entrepreneurs the tools to become full businesses with logistics, payments, websites, and marketing. We do the same for independent healthcare professionals.

Doctors are entrepreneurs, but medical school doesn’t teach them finance, marketing, or technology. Livance provides the full stack: spaces, scheduling, payments, back-office, and patient experience. We flip fixed costs into variable ones — like cloud computing — so they pay a small SaaS fee plus usage of offices.

It’s also a kind of BPO: we take care of the admin so they can focus on patients. And because it’s white-label, what the patient sees is their doctor’s practice, not a Livance clinic. Most importantly, their practice is profitable from the very first patient.

OM: What's the bad doctor profile for Livance?

CM: Someone who wants complete customization — their wall a different color, very specific layouts, or permanent heavy equipment on-site. Many equipment needs can be rented by the day, but if a doctor wants everything fully customized and permanently theirs, our model isn’t the best fit.

ICE TO ESKIMOS, AND OTHER SALES PRINCIPLES

OM: What’s been the strongest driver of growth on the doctor side?

CM: Referrals. Doctors talk to doctors, they marry doctors — we even see father–son, mother–daughter, and couples working at Livance. Having a friend in the network makes your practice stronger: you can share patients, lean on each other, or simply have someone to grab lunch with. Roughly half of our growth comes organically from this community effect. Partnerships, on the other hand, haven’t been a big driver.

OM: What are the ultimate elements of being a good salesman?

CM: First, remember you have two ears and one mouth — that’s not by accident. The best salespeople listen more than they talk. One phrase I live by is: “While you’re speaking, you’re not learning anything.”

Second, be intentional with your words. I’m obsessive about this — even in meetings, I notice when someone misunderstands because phrasing wasn’t precise. How you say things matters as much as what you say.

That instinct came from my father. People used to say he could sell ice to Eskimos. He took me to meetings as a teenager so I could watch how he operated, and he made me read constantly. Our house was filled with newspapers and magazines, and I devoured them. Having context on many topics makes you more interesting — and ultimately, more persuasive.

THE NATURAL NEXT CHAPTER

OM: You’ve mentioned that healthcare is a winner-takes-most market. Where do you see Livance expanding next?

CM: We see two major opportunities. The first is with insurers. By bundling our doctors into trusted, ready-made networks, we can deliver immediate value for payors who need quality, consistency, and scale. The second is the out-of-pocket segment. Only about 25% of Brazilians — roughly 52 million people — have private health insurance. The rest depend on the public system or pay cash. Within that 160 million, tens of millions are reachable through more affordable access models such as health cards or memberships. It’s a massive but fragmented market, and one that’s waiting to be organized.

THE FUTURE IS DOCTORS + AI

OM: How is AI changing the way Livance operates and builds products?

CM: Our moat has always been about three things: scale, brand trust, and data. AI is what takes that data advantage to the next level. It’s changing both how we run the business and what we can deliver as a product.

On the operations side, we already use AI agents for scheduling, booking, and customer support. Internally, they help us organize data, surface insights, and connect the dots across the revenue stream — from marketing to sales to customer success.

On the product side, AI is transforming what an EMR can be. Until recently, building one wasn’t exciting. But now we can record consultations, structure the data, and turn it into something actionable. That opens the door to better care delivery, integrated records, and smarter data sharing across the system.

OM: And how will the doctor experience look in five years with full AI integration?

CM: It will evolve from back-office automation into a true co-pilot — even a partner that makes doctors 10x better. Efficiency, accuracy, and care delivery will all improve. That’s the future: not replacement, but the combination of human expertise with AI assistance.

RAPID FIRE

OM: What’s the most valuable thing an investor has done for you post-check?

CM: Pattern recognition. They’ve seen the same mistakes play out across dozens of companies — some a year ahead, some five.That kind of blended cross-industry intelligence is underrated. Every market is different, but there are always parallels if you’re open to hearing them.

OM: What’s one piece of startup advice you think is wrong or misleading?

CM: The way MVP is often interpreted. In healthcare, you can’t launch something half-baked. Sometimes you need a strong product from day one.

OM: What’s one emerging trend in Brazil founders should pay more attention to?

CM: The speed of demographic change. Brazil is getting old while not getting richer, which puts pressure on the working population.

OM: If you had to rebuild your leadership team from scratch, what roles would you hire first?

CM: Marketing and technology. I think people often overlook the power of brand, and I’m not a technical founder, so having that strength early would make a big difference.

OM: What's your favorite restaurant in São Paulo? 

CM: Tres Cuatro Ocho - the Argentinian steakhouse.

THE J CURVE HALL OF FAME

Since you made it this far, you might want to check out our episode featuring Marcelo Lombardo, founder and CEO of Omie — fresh off raising the largest round in Latin America this year, a $150M deal made up mostly of secondaries.

This episode unpacks how Omie built a billion-dollar SaaS + fintech platform in Brazil by mastering B2B sales playbooks, leveraging accountants as a distribution engine, navigating one of the world’s toughest tax systems, and using M&A as a growth accelerant:

Want the raw, hard-earned founder lessons — here’s what stood out in my conversation with Marcelo in TJC Insider format.

Thanks for reading,

Olga 

 P.S. If this issue was valuable to you please share it with a founder who needs to hear it. Let’s build LATAM’s next tech leaders—together

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