Prabhjot Singh, MD, PhD, is Co-Founder & CEO of Altitude, an early-stage startup building the system for clinical performance. Primary care is facing a staffing crisis, and Altitude is building a solution leveraging artificial intelligence to supercharge nurse practitioners to deliver optimal care. The company recently raised $5.4 million in funding, led by Lerer Hippeau and AlleyCorp, to continue building its technology and expand beyond the six practices that it currently supports. Before co-founding Altitude alongside Abhishek Gupta, Prabhjot has experience at Oak Street Health and the Peterson Health Technology Institute, where he currently serves as a senior advisor evaluating the evidence-based outcomes of new digital health technologies. Learn more at joinaltitude.com.

Prabhjot Singh, MD, PhD, Co-Founder & CEO of Altitude

The Pulse: Could you tell us about your background, and how that led you to founding Altitude?

Prabhjot Singh: My childhood was in Kenya, and I saw a very different kind of healthcare landscape. You don’t have enough physicians. You, definitionally, are going to have a lot of folks that are non-physicians taking care of people, and that formed a lot of my interest in both healthcare and who can actually deliver care. I ended up training as a doctor and getting a PhD in New York City. I then did some work in economic development globally, where we looked at how do you invest in rural healthcare infrastructure with technology and decision support, and how do you drive population health impacts for child and maternal health, especially with non-physicians.

Over the last 15 years, I have spent more time on chronic condition management in the U.S., which is really important because our rates of chronic conditions across America are increasing over time. Some 60 to 80% of Americans have chronic conditions, and at the same time, the size of the workforce of people that manage them—primary care doctors like myself—are shrinking. One data point that recently struck me is that the generation of physicians before us practiced 50% more hours per week than my generation does. At the same time, the people that are stepping up to the plate are people like nurse practitioners and physician assistants, and this growth has skyrocketed.

Because of this, I worked on setting up with my wife, Manmeet Kaur, who has a business and operations background, a risk-bearing provider group in New York City that focused on chronic conditions. We ran this group during COVID which was an incredibly challenging, important experience for us, and we worked on converting the whole infrastructure from fee-for-service to value-based care. We ultimately ended up selling the group to Oak Street Health/CVS, where I then spent a year post-acquisition. Upon working at Oak Street, I saw really well-run processes, but with the same sort of issues that we had had: for instance, it’s really hard to onboard new clinicians, and specifically to teach folks how to expertly manage the six to eight chronic conditions that represent most of the health challenges that Americans face. The environments of care themselves are being flooded with technologies, and the same clinicians who struggle with knowing what to do are also struggling with information overload. This brings us to Altitude, which I will come back to.

Along the way, because of my background in economics and health globally, I began working on domestic, macroeconomic questions with the Peterson Center on Healthcare, where we ultimately built a Health Technology Institute which produces deep-dive assessments of how digital health and technology companies are working and operating. With this experience, I have looked at 60 companies in incredibly great detail, understanding what works, is it worth it, and for whom, which has deeply informed how I think about the challenges that we’re working on at Altitude.

The Pulse: What specific trends from the past few years on the “people” side of healthcare made you believe that it was the right time to build a company like Altitude?

PS: What I found staggering is that, especially during COVID and post-COVID, the rate of production of nurse practitioners has gone up 5-10x, while the rate of production of doctors has gone flat, and the share going into primary care is actually diminishing. When I was training, maybe 10% of visits across the country were done by nurse practitioners, but by the early 2030s, it will be about 50%. Who delivers care in America is changing. So we need to ask, are we building systems that can both adapt to the changes in the workforce and at the same time take advantage of the new trends in technology, AI, and workflow support to actually make this a good news story of how we became better at delivering care?

The Pulse: Altitude is an AI-native solution designed to elevate clinician performance. Could you tell us a bit more about what the company does and what its goals are for the future?

PS: If you take a big step back, Altitude works with care delivery organizations that are taking even small amounts of risk—that can be in quality bonuses, or STARS, or up- or downside risk. The reason why that matters is because these organizations are interested in the longitudinal health of their patients. Altitude works with these organizations to look across all of their patients and ask: How well do patients in your system progress or get stalled on their journey towards chronic condition control? Which clinicians are really good at managing these conditions, which ones struggle, and how? If you know that, you can then start engaging with clinicians and giving them insight into where they are: “You’re really excellent with moving forward your patients with simple hypertension. You struggle to move forward patients with complex hypertension, because you don’t know how to add a second or third class of medications.” Once you have that diagnosis, Altitude can then support you in building the skills of managing complex hypertension, and in an AI-native way, provide support for specific actions like making sure patients are picking up their medications, or that their next visits are being scheduled proactively.

You can think about Altitude as being a motivational supervisor, helping to build new skills for clinicians, while also executing directly on follow-ups and proactively moving patients towards control. If you’re an expert clinician, you can actually leverage delegation to Altitude to get more things done, manage your patients with more focus, or increase your panel sizes. That is why we call Altitude a care performance system.

The Pulse: From its founding, Altitude has been committed to building AI-native tools that directly work with and support clinicians, as opposed to replacing them. How did you and the team develop your philosophy on AI, and how do you see it evolving as the company grows?

PS: We have a unique team, because we have folks that have really excellent clinical operational experience. They know how organizations operate, and they have a really strong point of view on how they should operate. At the same time, we have an incredible, first-amongst-equals group of AI engineers, folks that are keeping up with agentic systems, context graphs, state changes, and more. We also have a clinical group that understands what motivates clinicians. If you add all that up, our general belief is that we equip clinicians to gain the most leverage out of AI systems, including when they should and should not delegate more autonomy to them. We believe there needs to be more shades of gray in how people utilize AI. In the process, our general belief is that people gain not only a sense of trust, but a sense of how they want to best leverage these tools, just like how you and I have learned over the past year or two how to best leverage Open AI and Claude. Our vision is that these tools and people co-evolve together.

Put a different way, we have at Altitude levels of clinicians — levels 1, 2, 3, 4 — with four being an incredibly consistent, “always gets everything right” clinician. There is this idea of a level five clinician, who is actually really good at supervising a lot of consistent systems, and knows when they should use their time and effort. Level five only works if you co-evolve with these tools. We’re really excited about the future of the workforce, not just because we have people that are yoked to scribes and building systems, but because there’s an incredible creative, generative mix that comes out of people that really know how to best leverage these tools.

The Pulse: Rightly so, clinicians are often hesitant to introduce another technology layer to their workflow. How have clinicians responded to bringing Altitude into their practices?

PS: I think of it like a two-by-two matrix: you have new clinicians and you have tenured clinicians, then you have clinicians who want to learn new capabilities and others who want tasks taken off their plate. New clinicians are generally trying to learn their way into new environments and pick up the habits for effective practice, where tenured clinicians have a point of view on how they want to run their day. Then you have to consider, are you taking away work for me? Are you increasing my capability, reducing my burden, or are you trying to help me do my job better? In that latter quadrant, think about a tenured clinician: if you say I want to help you do your job better, then you’re going to hit a bit of friction on that front. If you say to that tenured clinician, “Look, we want to take a bunch of the stuff that you don’t like out of your workflow”, then that’s going to be a better way to engage them. Because we know clinicians, we have a very good way of engaging them and understanding how to equip them to succeed with the right mix of tools that makes them better while increasing their capability in ways that reflect their preference. Over time, there is a lot of convergence in how people ultimately end up using these tools, but the path to getting there might be different.

The Pulse: This year’s conference theme is Healthcare 2030: Preparing Systems, Policy, and People for the Next Decade. What do you think are the most important measures to focus on today to ensure success in the evolving healthcare landscape?

PS: I’ll take a step back and give three things that I think are critical to focus on. One is that our workforce is changing. I mentioned that by 2030, 50% of visits will be driven by non-physicians. That is remarkable, and a huge shift. The second is that chronic condition burden is increasing. GLPs, for instance, have been incredible, but the sticking utilization rates of them are actually much lower than people think. We are going to need a different clinician workforce to be able to effectively handle the most common conditions that affect Americans. Third, technology can either make our systems more expensive and less scalable, or more affordable and more efficient. However you are building, whatever you are trying to solve, you have to remember that who is delivering care is changing. Americans are still getting sicker, and we need to make core progress on that.

We all have a choice as we head out into the world to build companies about whether we fundamentally think that we should be increasing the cost of healthcare with technology or refactoring it as we go. If you crunch those three points together, you have an incredibly exciting opportunity to remix how we deliver care. I feel very hopeful after a bit of a sluggish and sideways decade, that we will start to get our heads together and turn the corner in the 2030s on these issues.