Earlier this month, our team gathered in Traverse City, Michigan, for an energizing retreat centered around one shared theme: Rooting Down to Rise Up. The retreat was more than a team getaway; it was a critical pause in our fast-paced journey to reflect, recalibrate, and reimagine what comes next.
David Smith, Founder & CEO, opened by reminding us that while it’s tempting to freeze time during seasons of strength and camaraderie, both people and businesses are meant to grow. And with growth comes change.
Reflecting on the journey of Third Horizon – from a single-member LLC to a 30-person firm tackling some of health care’s toughest challenges – David set the stage for the work ahead. He shared our history through three chapters:
1. The Founding Phase – A scrappy start focused on trust and partnership.
2. Strategic Growth – Building capabilities, forming alliances, and gaining hard-earned wisdom.
3. Rooting Down – Deepening our competencies and strengthening our financial foundation to remain nimble, creative, and values-driven.
The Changing Ecosystem
The core of our discussions began with understanding how the health care ecosystem is evolving. We explored an industry at a breaking point—marked by unsustainable cost structures, administrative burden, provider burnout, and growing disparities in access and outcomes.
Several key challenges emerged:
- Fragmented data systems and the lack of interoperability stall innovation and transparency at every level.
- Mental health access, while increasingly recognized, remains underfunded and fragmented from physical health, particularly for those with complex needs.
- Systemic financial instability, especially among safety net institutions, threatens to erode access to care across the entire system, particularly for the most vulnerable.
- Worsening health outcomes, due to limited access, increasing political polarization of public health funding, and structural barriers at the state and federal levels. Despite decades of knowledge on what should be done to improve health, political barriers, cultural empathy, and ineffective implementation is exacerbating outcomes rather than improving them.
These aren’t just trends – they are urgent calls to action.
Beyond Consulting: Reimaging the future of American health care
As we considered how our role must evolve in response to these shifts, one idea rang especially true: we are no longer content to call ourselves “consultants.” That word, though familiar, doesn’t fully reflect the value we are looking to bring to the system.
We are problem solvers.
We partner, embed, and build. We don’t just offer recommendations; we craft solutions at scale—often through data, methods, emerging technologies, strategic convening, and unparalleled creativity. Our work isn’t neutral or generic – it is deliberate, mission-oriented, and deeply connected to what matters most in health care today.
David Smith, CEO & Founder
David introduced a new language to capture this identity shift:
Third Horizon is a problem-solving firm reimagining the future of American health care. We focus on what’s coming and what’s possible, never settling for what is.
And with that, we identified ways that we can utilize our collective skills, experience, and expertise to address the key challenges and reimagine the future of American health care.
Illuminating Complexity with Starset Analytics
For the past three years, we’ve built and refined a platform to make Transparency in Coverage (TiC) data usable, trustworthy, and actionable. Designed as a hub-and-spoke model, Starset Analytics not only ingests massive pricing datasets but transforms them through rigorous cleaning, validation, and statistical modeling for quality assurance – offering clients a reliable lens into opaque markets. Just as “starset” marks the gradual fading of darkness into light, our work in data transparency offers hope for a more navigable and accountable system where decisions are powered by insight, not obscured by complexity.
Advancing Mental Health Equity Through Actionable Metrics
Greg Williams, Lindsay Reeves, Bo Nemelka
The growing awareness of mental health needs isn’t enough if access remains fragmented and underfunded. To close this gap, we helped launch the Mental Health Parity Index in partnership with the Kennedy Forum and the American Medical Association. This tool elevates mental health to its rightful place in care delivery by measuring parity between physical and behavioral health in network adequacy and reimbursement—finally giving advocates, policymakers, and systems the data they need to enforce equity.
We’ve also leaned into workforce challenges, supporting efforts to train, retain, and reimburse mental health and substance use disorder providers. By investing in the professionals at the heart of care, we aim to transform awareness into access—and crisis into coordinated response.
Transforming the Safety Net for Long-Term Viability
Urban safety net systems are at a breaking point—strained by rising costs, inadequate funding models, and deep-rooted inequities. We are actively convening health systems, government agencies, and community leaders to long-range strategies that integrate financial reform, service delivery innovation, and cross-sector collaboration. This isn’t a Band-Aid. It represents critical structural repair, rooted in the belief that communities deserve resilient systems, not just temporary relief.
Reclaiming Independent Practice in Medicine
Across the country, consolidation is eroding the autonomy of physicians and distancing patients from their providers. To combat this, we’re working alongside the American Medical Association to equip physicians with the skills and tools they need to return to independent practice.
This effort is a values-driven investment in restoring clinical decision-making to the hands of those who deliver care. By supporting a new generation of independent practices, we’re helping reverse a troubling trend of disempowerment, ensuring care is driven by people, not profit.
Activating Capital with Purpose: Foundations & Philanthropy
Aisha Waheed, Tym Rourke, Erica Bauer
Public funding is increasingly volatile, particularly in politically polarized environments. But capital still exists, especially in donor-advised funds, foundations, and mission-aligned investors who want to move the needle in health care but lack clear avenues to do so. We see an opportunity to act as strategic integrators, helping philanthropic capital flow toward high-impact solutions. By identifying leverage points, building credible strategies, and guiding execution, we can help funders align their dollars with lasting change.
Driving Systemic Reform for Health Equity and Resilience
The erosion of public trust, worsening health outcomes, and political polarization demand more than surface-level solutions. Our approach is threefold:
- We build cross-sector strategies that address funding, workforce, governance, and delivery systems together – embracing complexity rather than avoiding it.
- We create data-driven tools like the Mental Health Parity Index to hold systems accountable and guide investments in prevention and social drivers of health.
- We support government transformation, helping states modernize outdated infrastructures and implement reforms in ways that reflect local realities rather than just federal mandates.
These statements aren’t just theoretical. They’re backed by data, powered by partnerships, and aligned with our expertise. And they’re being pursued not just because they’re profitable – but because they’re right. We’re here to do meaningful work, partner with organizations we’re proud to support, and shape a healthier, more equitable health care future.
Rooting Down Within: Personal Mission & Development
In addition to examining external shifts, the retreat carved out intentional space for inward reflection – recognizing that organizational transformation begins with individual clarity and purpose. The individual sessions invited each team member to ask a powerful question: “How will I change in three years?” Through guided prompts and examples, we explored different approaches to crafting a personal mission statement—words that reflect not just what we do, but who we are becoming. After time for self-reflection, some team members chose to share their mission statements with the group, creating a moment of deep connection. Whether team members focused on skill-building, personal resilience, or long-term goals, the session was a grounding reminder that the future we’re building together depends not only on our shared direction, but also on how each of us shows up to shape it.
Andy Wilson, Alex Hryhorczuk
Rooting Down to Rise Up
We closed the day as we began—reflecting on the theme of Rooting Down to Rise Up. In uncertain times, it can feel like we’re caught in the middle of a storm. But storms don’t last forever. And if we root deeply—into our mission, our relationships, and our capabilities—we can weather whatever lies ahead.
That conversation is ongoing. But one thing is clear: we are not simply watching the future of health care unfold. We are building it—together.
Third Horizon Team