Shiv Mulgaonker
MBA candidate at the Stanford Graduate School of Business, Class of 2028. I've spent my career in healthcare, across strategy consulting, global health, and operating roles at early stage health-tech companies. I am excited about building a more healthy, resourced future for our most underserved populations. This site is a forum to explore ideas while I am back in school — all thoughts are my own.
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About Me
Most recently, I led strategy at Accompany Health, which delivers home-based primary, social, and behavioral care to 20,000+ Medicare and Medicaid patients. Working directly with the CEO, COO, and Chief Growth Officer on initiatives spanning operations, product, and growth, I led our relationship with a national insurer covering ~40% of our patients and owned the terms of our value-based contract — under which Accompany was paid for keeping patients healthy, rather than for each service delivered. I also led R&D projects to reach our most remote and medically complex patients: partnering with 10+ public housing complexes to engage 300+ previously unreachable patients, launching a meal and nutrition program for ~6,000 patients across Massachusetts, and building a Medicaid enrollment and community resource-navigation platform for patients and community health workers. Throughout my tenure, I supported the executive team on our AI transformation — automating work such as billing and clinical note-taking, and bringing digital health tools to our clinicians.
Before Accompany, I helped scale Firsthand Cares into the country’s largest peer support program, serving ~6,000 individuals with serious mental illness (SMI) within Medicaid. Firsthand’s community care model is anchored by peers — practitioners who have themselves recovered from serious mental illness — and centers on rebuilding the trust SMI patients have lost in traditional care settings. My role was to help make this untraditional care model work: I led the team that implemented the company-wide performance management system, coached market leaders on operations, and built tools for care teams, including an outreach-prioritization engine and an app-based triage workflow.
I began my career at McKinsey & Company, where I was seconded to Gates Ventures, Bill Gates’ private office. There, I researched exemplar primary care and digital health in low- and middle-income countries, writing policy briefs for leaders including Bill Gates, President Macron, and Prime Minister Modi.
Outside of work, I enjoy serving my community. I founded and ran Texas for Expanding Opportunity, a nonprofit mentoring underprivileged middle schoolers in Austin, where I grew up. In my free time, I play pickup basketball and spend time outdoors; I’ve completed six half marathons and a full marathon, and most recently summited Kilimanjaro.
Contact
Writing
Long form essays on all things related to health, policy, technology.
Notes
A few ideas and questions I am thinking about.
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10 Things I’m Currently Thinking About
Hi! Here is my first attempt in a monthly download of 10 ideas that I am currently excited about. The list below is a casual record of my thoughts and questions I am exploring, and are listed in no particular order. Please do reach out with any thoughts or questions!
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Preventative, community-based care x public service collaboration.
How can preventative home-based care for the most complex illnesses be delivered in collaboration with local government and services. Clinical needs for Serious mental illness, SUD individuals are often addressed by first responders. How can provider organizations collaborate with these city organizations in coordinating clinical care? Can provider organizations enter into risk-bearing contracts with cities to align incentives. For example, if providers can take care of X patients that would require Y spend from the city budget, can providers and government first responder programs share savings and align incentives for individuals to get appropriate preventive care vs expensive non-clinical responses?
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Make teaching fun again.
My Mom has been a teacher for the past 30+ years and it amazes me the amount of non-teaching activities she engages in. In my mind there are two main areas which drive considerable amount of time, energy, and coordination amongst different stakeholders (teachers, parents, school admin, etc) that are ancillary to education itself: Paperwork, Student support. I’m guessing AI solutions can help alleviate the burden of the former, on the latter I think there can be private sector collaboration. My Mom is a special educator, and she routinely has to work with a variety of external OTs, Psychiatrists, etc for her students’ needs. My Mom is excellent at her job, but often special and gen-ed educators are intervening as behavior / social support leaders with individuals students, a task that may not be core to their responsibilities. I wonder if there is a private sector collaboration mechanism that can help equip schools with wraparound support to teachers and help provide appropriate care to students through referrals and work with parents on outcomes?
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Physician autonomy vs accountability in AI era.
In the context of healthcare documentation, and AI-based judgement decisions / advice, what’s the line between accountability, and physician assistance for patient care and surveillance of healthcare workers? What autonomy should healthcare workers have?
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Does rapidly growing consumer-based health technology change the future of primary care?
As wearables, consumer-based longevity solutions, and AI creates on-demand primary care advice, what role does the family doc play? Will family medicine / PCP address more acute needs with PCP AI augmentations?
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Current Consumer-based health tech products and narratives optimizes for longevity, they are missing out on other aspects of health.
Bodega Peptides, Whoop readiness scores, Oura Sleep scores are all geared towards efficiency, output, and longevity. While meaningful, none of these interventions gauge the intervention on an important aspect of health: Quality and living a meaningful life. I think consumer-based health tech should deliver health advice holistically. If we’re optimizing our sleep and activity at the expense of social connection, a bowl of ice cream, and joys in life what is the point of living. There is quantifiable evidence on how joy also leads to improve levels of health and longevity. Is there a way to design this into these products and use data to inform action and real life decisions not only on longevity but also happiness?
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Automate the US safety net by making government technology sexy.
SSI, SSDI, Medicaid enrollment, amongst a multitude of other government programs, are means-tested. Means tested programs in US political culture often succumbs to intense levels of scrutiny. Unfortunately, this often means a higher bar to qualify, less funding, and more often than not erroneous regulation to make enrollment harder to complete, even if need is present. To remove the burden from the individual, there should be robust digital tools available which ingests policy changes and individual data to automate processes to ensure individual need is automatically evaluated. Public technology is too outdated currently to provide this role.
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The AI community health worker.
This seems technically feasible (filling out forms, callers to get status from service orgs etc - leaving only the relational stuff to humans), but what’s the distribution mechanism? are non-healthcare services willing to pay for that (e.g., Public funding)?
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If we redesign American cities to be less car centric, it would be the greatest public health intervention in American history.
Western Europe has perennially outpaced American life expectancy. Diet, culture, healthcare design and delivery are all factors, but could city design be a primary driver of this difference? Old cities reinforce social connection, physical activity, and when polled, considerable differences in individual feelings of “loneliness”. Former U.S. Surgeon General, Vivek Murthy, has proclaimed an epidemic of loneliness across America, and the literature is clear that loneliness is a significant causal driver of physical and mental health conditions. If we redesigned America to be less car centric, I believe there would be a large spillover on American health. I’m curious what this spillover estimate would be across both quality of life and length of life measures…
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We should think about US healthcare delivery through a prism of trust.
If policy and system design focused on bridging the chasms of trust that many have with the healthcare system, it would demonstrably improve care delivery.
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LLM-based triaging.
Physicians, clinics, and Medicine is often an art of directing care to the most impactful cases and interventions first. Often, there is limited resources and our system must make tradeoffs. Often, individual docs are making these tradeoff decisions, I wonder if LLM’s with some logic rules and data feeds can create a triaged workflow for physicians to help nudge folks on where to direct care, and which interventions to provide first. Naturally I also wonder, what would the logic rules be and is an AI-based intervention here correct? It would remove flawed decision making away from the individual in some instances, but there are certainly cases where logical algorithms don’t capture the real nuance in the field. And again, should physicians have autonomy to wrestle with these tradeoffs, is that / should that be part of the human component of medicine?
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Projects
Research projects I am building and tinkering on.
Personal Reflections
Longer-form personal writing — on life, not just work.
Resume
Viewable below, or download the PDF.