To the operators and friends of this firm,
This is the first one of these, so let me start with why the firm exists at all.
I’ve spent twenty years inside post-acute care. Field leadership, turnarounds, the executive seat. And the whole time I kept running into the same thing: the people with the money had never sat at a kitchen table with a family at 2am, and the people who had were begging for capital and running on software from 2009. Two rooms, and the door between them stayed shut. The Culture Group is me deciding to stop complaining about the door. We don’t invest in post-acute care from the outside. We operate in it, and we invest where we operate. And we build the software we run it on.
The model fits in one breath. HealthView, founded in 1967, was the first use case, where we built the culture and the operating system with our own clinicians. Now we buy clean, small home health, hospice and palliative care agencies we know how to fix, and we fold them into it. We raise the quality, and we never sell. Not in five years, and not when somebody calls with a number.
The model fits in one breath
We raise the quality,
and we never sell.
That sounds strange to anyone who has spent time around private equity. Most of what’s broken in this industry traces back to owners who plan the exit on the day they buy. They manage for the next buyer, they turn their people over every year, and nobody trusts anybody. When people trust each other you need fewer rules, and fewer rules is speed. You can’t build that kind of trust on a five-year clock.
Here’s what that produced this year, with numbers you can check.
HealthView, the company we’ve led since 2022, came in ninety-seventh on the Inc. 5000, the fastest-growing home health and hospice company in the country. Fortune ranked us sixteenth among the Best Small Workplaces in America, up from twenty-third. Team satisfaction hit ninety-eight percent, up from ninety-five. I put the culture numbers next to the growth number on purpose. The growth is what happens when clinicians stay, and clinicians stay because of how the place feels on a Tuesday.
It was also the hardest year we’ve had. As a compliant provider in Los Angeles County, we got swept up in the federal crackdown on home care fraud. Payments were held while we proved eligibility, chart by chart, and the banks got careful with us. We kept everyone paid because we built the reserves before we needed them. And when agencies around us closed, their clinicians started calling. We added ride-alongs to our interviews just to keep up.
We also started publishing this year, which surprised people who expected a capital firm to buy ads instead. The Culture Lab is where I write my field notes, in text and audio, with the sources attached and predictions I put dates on so you can score me later. I don’t trust a firm that won’t show its thinking in public, so I wasn’t going to run one.
01What we built.
We don’t buy our software. We build it. People ask about that part of the firm more than any other, so here’s the honest version.
CultureAI is our own platform. One API, one database, one sign-in, and every app we run sits on top of it. We built two this year. The OKR app keeps every goal, 1:1 and promise current, finds the number that’s stuck, drafts the work that moves it, and waits for a person to say yes. Navigator answers questions only from a site’s own pages and shows you the passage behind every answer. On hvhh.ai it answers families in nine languages and gets them to a person. You can ask this firm anything the same way, on our home page. The apps our teams already live in, like Microsoft Teams, plug into ours, not the other way around.
The Culture System is how every company we operate is run, written down. Its first chapter is The Culture OKR Playbook, and CultureAI is the software that keeps it. The Culture Studio is the team that built hvhh.ai, cultureai.com and this site, AI-native on the web and on the phone, for our own companies first and then for healthcare companies like them. The Culture Lab is where the lessons get published.
I don’t know of another home health, hospice and palliative care operator that builds its own AI-native platform, its own apps and its own web and mobile sites. I could be wrong, and if I am I’d like to meet them. Either way, as software gets cheaper and faster to build, the operator who already writes its own gets faster with it. Everybody else waits on a vendor’s roadmap.
Added October 31, 2026, after the recording. The audio doesn’t include it yet.
Chapters 02 to 04 · about 6 min
How we invest.
Our AI-native software goes in on day one, and the hours it frees go to patients.
03How we actually run things.
Every requirement in our companies has to have a person’s name on it. Not a department. A name. You’d be amazed how many requirements go quiet when you ask whose it is. Those get deleted. Then we simplify whatever survived, then we speed it up, and we automate last, only the stuff that earned it. I got this order wrong earlier in my career. I automated things that shouldn’t have existed, and I paid to make bad processes faster. Once was enough.
That order matters more now that we build our own platform and our own apps. The point of the software is to give a nurse back an hour. That hour goes into a visit, a family call or a raise. It never goes into cutting the people at the bedside.
There’s one ratio I keep in front of me. Our raw material is a clinician hour. Our finished product is a paid, clean thirty-day period of care. When the distance between those two gets wide, the problem is almost never the people. It’s the process, and the fastest way to find it is to skip the org chart and ask the nurse in the driveway, because the reports always come back cleaner than the driveway does.
Before anything we can’t undo, we write down how it fails before we write down how it wins, and we name what every party at the table is actually incentivized to do. Including us. Decisions we can reverse get made fast and fixed in daylight. Decisions we can’t reverse get patience. And being wrong is fine here. I’ve been wrong plenty. Being confident and wrong is the expensive one, which is the whole reason the predictions get dates.
The biggest structural choice we made isn’t a process, it’s who’s in the room. Our clinical team is the executive team. The nurse is the real engineer of this industry, so clinical leadership sits inside the finance and technology decisions, not down the hall from them. Half the receipts in this letter are theirs.
04 · Where we’re aimed
The middle of healthcare is dying. It always dies.
Where we’re aimed.
The middle of healthcare is dying. It always dies. The consolidators are building towers on one end, and we picked the other end on purpose: the home, and small residential buildings where the operator knows every resident by name. When risk models finally get honest about total cost, the kitchen table wins. We plan to be standing next to it.
The goal is to be the highest quality home health and hospice provider in California by 2031, and the largest alternative to the corporate chains, the one clinicians actually want to work for. If we get the quality right, the size follows. We don’t plan to chase it.
We also build early, during the gated years, before the flood shows up. I learned that one the hard way. I was 22, in a spare bedroom, betting the professional internet was about to change with a digital business card built a year before the iPhone existed. I was right about the change and wrong about the clock, and it took me years to understand which part was the mistake. The receipt is still on the public internet: our pitch video has 294 views after seventeen years, and I published the whole story, screenshots and all, in the field notes. That’s the tuition this firm runs on. Healthcare AI’s gate opened this September, and what we built behind it was designed for the flood, for a nurse in a driveway and a family at a table, not for the early crowd. And we do it in California first, on purpose, because it’s the hardest state, and whatever survives here travels.
One more thing, and it’s the part I’d keep if I had to cut everything else. I run a hospice company, which means my teams are in the room at the end of more lives in a month than most people stand near in a lifetime. I’ve come to think of that room as the most honest first-principles review that exists. At the end, every requirement gets questioned and every ornament falls away, and what survives the audit is the same, family after family: people, by name. Time that was fully attended. Whether there was kindness in the room. Nobody closes on their title. So this firm works backwards from that room. It’s why we underwrite the environment clinicians walk out of instead of the square footage they walk into, and it’s where my conviction about extending healthy years comes from. If healthcare gets good enough at that to shrink demand for some of what we sell, then good. I mean it. The mission outranks the market, and I’d rather build backwards from a hospice living room than forward from any thesis I could put in a deck.
The most honest review that exists
Nobody closes
on their title.
One prediction, dated, so this letter gets graded like everything else we publish. By the time I write Letter 002, most new capital coming into post-acute care will still be underwriting real estate and census. Ours will be underwriting culture and clinician retention. I expect the gap between those two bets to be visible enough to name by then, and if I’m wrong, you’ll read it here first.
If you operate in this industry and believe the culture is the asset, my door is one email away. If you’re thinking about selling, call me first. And if you run a healthcare company and want a site or an app built the way we build ours, the Studio’s door is the same one.
Steven F. GonzalezFounder, The Culture GroupNewport Beach, California · October 2026
Letter 002 · September 2027 · 328 days away
Graded against this one.
The prediction above gets scored in the next letter, in public, whichever way it lands.
The conversation
No comment box here on purpose. The discussion lives on LinkedIn, in public, with names attached.