Siobhan Nolan Mangini is a Partner at Venrock, where she focuses on investments in healthcare technology and services. She currently serves on the Boards of SmithRx, Virta Health, Alight (NASDAQ: ALIT), Cityblock Health, and Marathon Health. Prior to joining Venrock, Siobhan was an operator passionate about transforming healthcare through building and scaling innovative companies at the intersection of healthcare and technology. She served as President and Chief Financial Officer at NGM Bio and Castlight Health. Earlier in her career, Siobhan worked in management consulting at Bain & Company and at the Kaiser Family Foundation. She holds an MBA from the Stanford Graduate School of Business, an MPA from the Harvard Kennedy School, and a BS in Economics from the Wharton School at the University of Pennsylvania.

Siobhan Nolan Mangini, Partner at Venrock

The Pulse: Tell us about your professional journey and how it shaped how you think about healthcare and investing today.

Siobhan Nolan Mangini: I’m someone who has loved healthcare since I was very young. I thought I wanted to be a doctor. I went to Wharton as an undergrad and while I was there studied finance and decision processes. I started to think about healthcare more broadly than just delivery – more so at a systems level. My first role out of Wharton was investing the endowment of the Kaiser Family Foundation, which is a health policy think tank. It gave me exposure to the delivery of healthcare and the broader insurance system within which we work. I gained an appreciation for the importance of policy in the delivery of healthcare and its role in driving innovation.

At the same time, the foundation was based on Sand Hill Road in Silicon Valley, so I had a front-row seat to venture capital and entrepreneurship. That combination pushed me to pursue graduate school at Stanford GSB and the Kennedy School of Government, because I wanted to better understand both sides, policy and building businesses.

After graduate school, I spent time at Bain working across payers, providers, life sciences, and specialty pharmacy. This was right as health tech was starting to grow following the passage of the Affordable Care Act. From there, I joined Castlight Health very early, initially in a strategy and business development role negotiating with payers and pharmacy benefit managers (PBMs). I was driven by a desire to solve the toughest problems and really ran toward the fire wherever there was one. I was very involved as the company scaled, went public, and eventually became President and CFO. It was an incredible experience, very challenging, and extremely formative for me.

After Castlight, I became really interested in pharmacy and therapeutics as pharmacy spend continued to grow as a percentage of total healthcare spend. I joined a NGM Bio , again as President and CFO. Along the way, I started doing board work across areas where I wanted to learn more about the healthcare system. That included advanced primary care, transparent PBMs, data infrastructure, diabetes reversal, and Medicaid value-based care. A number of those businesses were Venrock portfolio companies, and after years of getting to know and respect their team, Venrock asked me to join as an investor. For me, investing now feels like the highest-impact way to help build companies that can truly deliver better care at lower cost.

The Pulse: You have such breadth of experience across the value chain. How has your prior experience informed the lens with which you view investing?

SM: I would say the biggest learning is humility and curiosity. It is easy to identify problems in healthcare, and it is really hard to build solutions that actually work. Because I have been an operator, I tend to focus on where there are genuinely large opportunities. Those are big addressable markets where incentives can be aligned and something better, higher quality and lower cost, can be delivered. I also spend a lot of time looking at teams. When you have been in the seat of building and scaling companies, you know there is going to be a lot of bobbing and weaving. There are pivots, regulatory challenges, and go-to-market issues. I am really looking for the resilience and character of founders and management teams. I want to see whether they can identify opportunities, adapt as things change, and ultimately build something durable over time.

The Pulse: You recently came back from the J.P. Morgan Health Care Conference, which is an opportunity to get a pulse on the overall industry landscape. How would you characterize the current investing environment across health care, and how may it evolve in the near future?

SM: Coming out of the conference, the sentiment felt very optimistic. There is a lot of excitement around the opportunities in front of us, and it is impossible to talk about the current environment without talking about AI in healthcare.  I spend my time focused on early-stage healthcare companies, since that is where Venrock largely invests, and the excitement is palpable.

Historically, healthcare has been a laggard when it comes to technology adoption. Now we are seeing healthcare become one of the fastest adopters of AI of any sector. There is just so much low-hanging fruit. You see incumbent health systems talk openly about how they are using large language models across administrative and clinical workflows. Adoption of AI scribes has happened incredibly quickly, and payers are also testing and building new technologies, both internally and with startups.

At the same time, there is certainly some exuberance. Healthcare is still very complex to sell into, whether you are working with providers, payers, or patients. Staying clear-eyed is important. A big theme I heard last week was durability. The question is which of these technologies will really deliver sustained value, maintain pricing power, and become embedded in workflows over the long term.

One other interesting consideration coming out of the conference was an increased presence from CMS, HHS, FDA, and other regulators. Closer collaboration and involvement between those organizations and the early-stage ecosystem I believe is an emerging theme.

The Pulse: You alluded to a balance between exuberance and discipline. There seems to be an increasing concentration of capital in the early-stage landscape, with larger rounds from a smaller subset of investors. What is your perspective on this dynamic?

SM: I think there are two dynamics happening at once. One is the aggregation of very large pools of capital among a subset of venture firms, which you are also seeing in private equity. Those investors are often playing a different game with different return profiles and different levels of involvement.  At the same time, there are still investors who are highly selective, doing a couple high conviction deals a year and staying deeply involved with their companies. That contrast is becoming more pronounced.

A second derivative of this concentration in capital is what people often call “kingmaking”. Companies are raising very large rounds at very high valuations early on. From my experience as an operator, more capital and higher valuations are not always to the benefit of management teams. It gives you the ability to spend but deploying that capital responsibly can be very challenging. I think it will take years to see how this plays out.

The Pulse: Looking ahead to 2030, what do you see as the biggest priorities for the healthcare system?

SM: We have crossed roughly five trillion dollars in annual healthcare spend, which is astonishing. Warren Buffett used to talk about healthcare having a tapeworm, referring to the roughly thirty percent of spending that goes to administrative waste. We deliver some of the best healthcare in the world, but it is not delivered efficiently or equitably. At the same time, we are at a really unique moment with artificial intelligence and broader technology infrastructure. There is a real opportunity to drive efficiency, and to enable the “iron triangle” of cost, quality and access to be bent for the first time as AI makes it possible to apply clinical intelligence at scale rather than only through human labor.

Payment models are also critical. We are seeing more lives move into value-based models like Medicare Advantage and MSSP, which are increasingly showing they can deliver better care at lower cost. Recent policy initiatives are trying to marry payment reform with technology adoption. If we get this right, there is an opportunity to free up hundreds of billions of dollars and redeploy that toward delivering better care.

The Pulse: We’ve talked a lot about this idea of durability. Where do you see the most durable opportunities for AI in healthcare over the long run?

SM: We tend to believe durability comes from owning the full stack. Point solutions can be valuable, but they are often easier to commoditize. The more you can deliver an end-to-end workflow and apply AI across that entire stack, the more defensible the business becomes. We have seen this in our portfolio with Devoted Health, an integrated Medicare Advantage models that combine both insurance and care delivery, as well as SmithRx, a transparent PBM that controls the full pharmacy benefit workflow, passing all rebates through to employers and savings directly to patients. In those cases, AI enables scale and efficiency, but the real differentiation comes from how deeply embedded the solution is in healthcare workflows.

The Pulse: It is both an exciting and challenging time to be building in this space. What advice would you give entrepreneurs hoping to have an impact in healthcare? 

SM: First, think long-term. Healthcare takes time, and meaningful change does not happen overnight. If you are willing to do the hard work of solving real problems, there is an opportunity to build truly transformative companies. Second, resilience really matters. Healthcare is hard. There will be setbacks. But if you are genuinely aligning incentives around better care, lower cost, and higher quality, you can build a great business. It just requires patience, grit, and a willingness to stay in it for the long haul.