Healthcare innovation in the US is advancing rapidly, but long‑term impact depends on more than technological promise. In this article, Dr. Gregory Grunberg, Head of Healthcare & Life Sciences (North America and EMEA), Temasek Global Investments, explains why rigorous validation is critical to determining which care models can scale sustainably and deliver durable outcomes.
The challenge: the structural cost of metabolic disease
Today, healthcare is at a tipping point. We are moving from an era where pharmaceuticals, like insulin, turned a fatal disease into a chronic illness. Our system is burdened by the cost of chronic care management, and our patients want more than survival—they want to be healthy, and they want the healthcare system to provide them with solutions they can easily adopt.
Metabolic disease is one of the most consequential challenges facing the American healthcare system. According to the CDC's 2026 National Diabetes Statistics Report, 40.1 million Americans are living with diabetes, while a further 115.2 million adults have prediabetes1. These figures alone represent more than 150 million people across the metabolic spectrum, before accounting for the additional burden of obesity, non-alcoholic fatty liver disease, and metabolic syndrome.
The costs are substantial. According to the American Diabetes Association's most recent Economic Costs of Diabetes report, the total annual cost of diagnosed diabetes in the United States reached $412.9 billion in 2022: $306.6 billion in direct medical costs and $106.3 billion in indirect costs, including lost productivity, absenteeism, and premature mortality2. When the broader metabolic cluster is considered, the aggregate toll on employers, payers, and health systems is considerably larger and largely absorbed without the tools to address it at its root.
Unique solutions that protect and save lives
The achievements of modern medicine should not be understated. A century ago, the leading killers were diarrheal disease, pneumonia, and tuberculosis — Cancer, heart disease and type 1 diabetes, once death sentences, are now conditions people live with for decades. Hundreds of millions of lives have been protected and saved.
Today’s healthcare and pharmaceutical infrastructure was built to deliver chronic care management. Now, we need a new care paradigm. Today’s most challenging conditions are shaped simultaneously by food, behavior, biology, and environment. Medication alone rarely resolves them.
The current generation of AI is changing what is possible with digital twin systems, continuous biometric inputs, and real-time decision support. The opportunity is not to work harder within the current model; it is to realign how evidence and incentives are structured around emerging models of care that demonstrate long-term outcomes. For long-horizon healthcare investors, advancing that evidence base and scaling the tools best supported by robust clinical evidence is the central investment opportunity of our time.
Temasek’s approach: evidence as a driver of long‑term value
Across our U.S. healthcare portfolio, the innovations most likely to scale sustainably are those that integrate into existing care pathways and demonstrate outcomes through rigorous clinical and economic evidence.
That informs how Temasek approaches long-term capital deployment in healthcare: with an emphasis on evidence-based care models that improve outcomes, strengthen system resilience, and contribute to affordability. In practice, this means identifying promising solutions at an earlier stage of market maturity while maintaining a clear focus on validation that supports durable, real-world impact.
To sharpen that discipline, Temasek participates in the Duke‑Margolis Institute for Health Policy’s Capital Impact Council—a group of experienced investors committed to developing evidence frameworks and best practices that help ensure healthcare investments deliver genuine health value alongside financial returns. Solutions that genuinely improve outcomes are, in our experience, the ones that earn durable adoption within care delivery and reimbursement structures, and that is ultimately what supports sustainable returns.
In February 2026, Duke-Margolis Capital Impact Council issued a new evidence quality framework for private investment that improves healthcare3.
Temasek sees this framework as an essential lens through which to evaluate investments and on which to focus our portfolio companies.
Twin Health and evidence‑based metabolic care
Twin Health is a Temasek‑invested care platform that combines AI Digital Twin technology with human clinical care, focused on cardiometabolic disease. Their Digital Twin Care Platform combines the power of AI Digital Twin with human clinical care (doctors, nurses, and coaches) to deliver continuous, daily guidance tailored to each individual’s biology and preferences, rather than averaging across populations. It is available to members through employer- and health-plan-sponsored benefits programs across the U.S.
Their AI Digital Twin integrates data from connected devices, laboratory results, and daily behavior input to build a real-time picture of an individual's biology and behaviors—allowing the care team to address underlying biological drivers in a hyperpersonalized way and reverse disease at the root cause rather than just manage symptoms with medications, integrated with existing clinical care pathways rather than in parallel to them.
In a randomized clinical trial conducted at the Cleveland Clinic4, 71% of participants using Twin reached an A1C below 6.5% at twelve months while reducing or eliminating most blood sugar-lowering medications. 85% eliminated a glucagon-like peptide-1 (GLP-1s) and 96% eliminated a sodium glucose cotransporter-2 (SGLT-2) inhibitors. In the standard-care group, only 2.4% reached the same endpoint. Reductions in acute-care events and hospitalizations were also reported.
For employers and health plans, the economic case has followed the clinical one. Twin Health has reported more than $9,000 in annualized per-member savings, primarily through medication elimination and avoided acute-care utilization. Twin’s economic model is also distinctive: payment is tied to outcomes rather than utilization. Results of this magnitude suggest more than incremental gains—they point to a structural shift in what managed cardiometabolic care can deliver when the model is designed for resolution rather than ongoing management.
Linking clinical evidence to healthcare valuation
To ground its evidence‑based investment approach, Temasek draws on the Health Value Evidence Quality framework.
Twin Health illustrates this approach in practice. The Cleveland Clinic RCT is an important step in demonstrating clinical efficacy. Effective care delivery establishes system fit. Real-world employer and health plan data show sustained outcomes at scale. The value creation is clear: fewer high-cost medications, fewer avoidable clinical events, and lower total cost of care, alongside reduced indirect costs from absenteeism and disability.
The same discipline applies to other parts of Temasek's U.S. healthcare portfolio, from senior care to value-based services. WelbeHealth, another Temasek investment, delivers coordinated evidence-based care for seniors through the PACE model, an integrated payer-provider model also cited within the Duke-Margolis Capital Impact Council’s Health Value Return on Investment Framework5. The population and care model differ; the investment thesis is the same. Care models that deliver better outcomes and lower cost at scale align with value creation through invested capital.
These examples point to a principle that shapes how Temasek approaches healthcare investment: evidence is not merely a criterion of diligence. It is what allows innovation to earn sustainable adoption within a system that has become increasingly selective about what it integrates at scale.
Looking ahead: raising the bar for healthcare investment
As evidence-backed digital health and precision care models continue to mature, their ability to address chronic metabolic conditions at scale will depend on real-world clinical and economic validation—not proof-of-concept studies, but evidence robust enough to move benefit design, reimbursement policy, and capital allocation.
For employers, this means a focus on approaches that modify behavior and support disease resolution. For payers, rigorous evidence offers a defensible basis for coverage and reimbursement models that align payments with sustained outcomes.
As investors, we must commit our companies to generating evidence that improves the standard of care, and investments should be rewarded on that basis. There have been too many cycles of technologies that generated investment returns on promise and that ultimately failed. This has eroded trust in private capital. Today, the bar is, and should be, higher.
For Temasek, these dynamics affirm a long-held conviction: that disciplined, evidence-based capital allocation in healthcare creates the conditions for returns that are both durable and meaningful. That shift from promise to proof is where durable investment value is being built—and where doing well and doing right point in the same direction. That is where Temasek intends to keep investing.
