Rainshadow is Oregon's statewide convener for health technology, built on the pattern New Mexico proved: a care led pilot and learning network, backed by state and philanthropic money, with Builders VC as the incubator rather than the owner.
The organisation is set up and incubated by Builders VC. The Oregon organisations named further down are counterparts to approach, not partners.
Rainshadow is incubated by Builders VC, the firm behind the New Mexico programme this is built on. The incubator carries the setup cost and the early staffing so the convener does not have to raise before it can be useful to anyone.
Where that stops is written down rather than assumed. Builders VC has no ownership of the convener, no right to see applications before anyone else and no preference in any cohort. A Builders company that applies is reviewed on the same terms as a company the firm has never met, and the clinical counterpart deciding a pilot is never told which is which.
We do not build product, we do not resell it and we do not take a placement fee or equity in the companies we review. The moment any of those is true the review stops being worth anything to an Oregon care organization, which is the only asset this thing has.
Priorities come from Oregon care organizations first and the search for technology follows. We never open a cohort because a company is interesting, and that single rule is the difference between this and an accelerator.
A convener that meets in Portland and pilots in Portland would be a Portland programme. The frontier counties are in the design from the first cohort, and a rural delivery footprint exists so that participating is not conditional on having spare staff.
Every evaluation produces a short public write up. Negative results are published on the same terms as positive ones. That is the part that compounds, and it is also the part that gets quietly dropped in most programmes of this kind.
The organisation is deliberately small. Three operating seats and an advisory council drawn from Oregon care, policy and research, with at least two seats held for rural and tribal health leadership.
Operating seat
Owns the relationships: health systems, coordinated care organizations, tribal health programs, funders, policymakers and founders. Brings partners to the table and keeps them coming back once the novelty wears off.
Operating seat
Runs the Health ACCORD Challenge end to end. The national call, the vetting, the sessions, the pilot scoping and the write ups. The seat that makes or breaks whether a cohort actually ships.
Operating seat
A senior Oregon clinical or health plan operator who decides what is feasible in a real setting, designs the evaluations and says no to the ones that are not ready. Part time is fine. Credibility is not optional.
Advisory council
Held for a leader operating in the frontier counties, so rural reality is in every conversation rather than represented in one slide.
Advisory council
Held for tribal health leadership, on terms set by them, including whether and how tribal priorities enter the programme at all.
Advisory council
Four further seats: a CCO operator, a state health policy voice, a health services researcher and an investor who sees national deal flow and can tell the council what is real.
Named individuals are not listed here by design. The seats are published before the people so the structure can be argued with on its merits.
The New Mexico programme launched with state economic development money and area foundations, alongside the state's academic health centre. These are the Oregon counterparts to approach. None has been approached and none has agreed to anything.
Business Oregon is the counterpart to the agency that put the first money behind the New Mexico programme. It already co funds the application support that helps Oregon health startups chase federal small business grants, so the thesis that health technology is economic development is one it already holds.
Oregon Health & Science University, and specifically the Oregon Office of Rural Health, which holds the state's rural and frontier designations and the data this whole programme reasons from. OHSU's own commercialisation and translational research programmes are the obvious research counterpart.
The Oregon Health Authority holds the Rural Health Transformation award and runs the coordinated care system. A convener that is useful to OHA is a convener that gets used.
Oregon has serious rural focused philanthropic capital, including foundations whose entire remit is rural communities outside the Willamette Valley. One foundation anchoring the capacity building work is the pattern that funded the New Mexico bootcamp.
Waystation Health, through its Milepost programme, as the place a rural pilot physically runs when a participating organisation has the interest but not the staffing. Waystation is a delivery partner, not an owner, and takes no part in deciding which companies are reviewed.
The third pillar, and the one with the longest payback. A pilot network is only as good as the people on the care side who can run a pilot.
Cohort programme
A cohort built with a community college partner and aimed at real roles: health data, interoperability and implementation. Deliberately recruited outside the Portland metro, because the jobs this creates should land where the need is.
Working curriculum
Short, practical sessions for care organization staff: scoping an evaluation, choosing a measure, reading a vendor claim, negotiating a data agreement, and knowing when to stop. Free to network participants.
Shared record
Every evaluation written up and kept in one place, so the fourteenth organisation to consider a product starts from thirteen real answers instead of a sales deck.
When it works here, it is a model for every state with the same geography and the same clock.
Care organizations, coordinated care organizations, tribal health leadership, state partners, foundations and researchers. The table is being set now and the first participants shape what it is for.