As the country marks 250 years of American independence — I’ve found myself returning to one of the founding documents that shaped how our country works: James Madison’s Federalist Paper No. 10.
It’s not the document people usually think of when talking about healthcare. But the core challenge James Madison was wrestling with in 1787 – 11 years after the newly independent United States transitioned from a revolutionary coalition into a struggling confederation – is strikingly similar to the one we’re solving at Longitude Health today.
Madison’s challenge: how do you govern a nation made up of competing factions — regional interests, economic interests, local power centers — without either letting them tear the country apart, or crushing the liberty that lets them exist in the first place? His answer wasn’t to eliminate faction. It was to build a structure big enough — an “extended republic” — that no single faction could dominate, and that channeled competing interests into something more stable and productive than any one of them could achieve alone.
Healthcare in this country has a faction problem of its own. Health systems, payors, and vendor point solutions all operating in silos, each optimizing their own slice of the system, often at the expense of the whole. The result is the fragmentation patients and providers feel every day — in access to care, in administrative processes, in care coordination, and in healthcare financing. Longitude Health was created because a group of leading health systems – Memorial Hermann Health System, Baylor Scott & White Health, Providence Health, Novant Health and Michigan Medicine – decided the answer isn’t to wait for someone else to fix this from outside. It is to do what Madison argued an extended republic could do: bring enough shared purpose together that the system’s fragmentation could be governed, not just endured – in service of its communities.
Building shared infrastructure and industry-wide utilities – such as specialty pharmacy market access, national clinical trials site management, cell and gene therapy network of excellence, and agentic enterprise infrastructure solutions – isn’t about erasing health system independence. It’s about giving health systems a foundation to stand on that is built better, faster, and more economically together.
Madison’s lesson still holds: scale and shared structure, built with purposeful intention, can turn fragmentation into strength. That’s the bet our founders and Constitutional framers made to create the United States of America. It’s time to do the same for American healthcare.
Happy 4th of July!
Vishal Agrawal
CEO, Longitude Health
July 1, 2026