Flatiron Health

Overview

Industry: Healthcare IT, Real-World Evidence, Oncology EHR Founded: 2012 Headquarters: New York City, USA (233 Spring Street) Employees: 2,500+ Website: https://flatiron.com

Flatiron Health is a leading real-world evidence (RWE) and oncology-focused healthcare technology company that collects, curates, and transforms electronic health record (EHR) data into high-quality evidence for drug development and cancer research. Founded in 2012 by Nat Turner and Zach Weinberg and acquired by Roche in February 2018 for $1.9 billion, Flatiron operates as an independent affiliate within the Roche Group. The company has established itself as a critical infrastructure layer in the oncology value chain, providing both point-of-care solutions through its OncoEMR software and research-grade real-world data to support pharmaceutical development, regulatory submissions, and clinical research. With access to over 5 million de-identified patient records encompassing 1.5 billion data points from 200+ oncology practices across 1,000+ unique care sites in the US, UK, Germany, and Japan, Flatiron has become a primary partner for biopharma companies seeking real-world evidence to support clinical trials, label extensions, and Health Technology Assessment (HTA) submissions.

Products & Services

OncoEMR (Oncology Electronic Health Record)

• Description: Cloud-based, oncology-specific EHR system designed specifically for cancer centers and oncology practices. Built by oncologists for oncologists, integrating over 3,000 NCCN Order Templates, AJCC staging content, First Databank drug information, and evidence-based decision support. Features include OncoAir mobile app for on-the-go clinician access, Flatiron Insight analytics platform for customizable dashboards, and Flatiron Assist AI-powered features that surface clinical trials and treatment options at point of care.
• Target market: Academic and community oncology practices, cancer centers, healthcare systems
• Pricing model: Subscription-based software-as-a-service (SaaS); pricing not publicly disclosed

Flatiron Horizon (Real-World Evidence Platform)

• Description: Comprehensive real-world evidence generation platform that integrates Flatiron's de-identified patient database, proprietary curation methods, disease-specific machine learning models, and flexible data configurations. Supports the full lifecycle of evidence generation from clinical study design through post-market surveillance and HTA submissions. Recently expanded with LLM-extracted real-world progression at scale, AI data quality frameworks, and harmonized multinational datasets.
• Target market: Biopharma companies, government agencies, healthcare payers, academic institutions
• Pricing model: Professional services and licensing model; customized engagements

OncoCloud Suite Components

• OncoBilling: Revenue cycle management solution integrated with OncoEMR for oncology practices
• OncoAnalytics: Flexible analytics platform for tracking drug usage, patient volumes, referrals, and operational metrics
• OncoTrials: Clinical trial operations and patient identification capabilities

Market Position & Industry Dynamics

Market segment: Real-World Evidence Solutions and Oncology EHR; nested within broader healthcare IT and pharma informatics markets

Estimated market share: Among leading incumbents in RWE/oncology data, though exact share not publicly disclosed. Global real-world evidence solutions market estimated at USD 4.74 billion (2024), projected to reach USD 10.83 billion by 2030 (CAGR 14.8%)

TAM: Real-world evidence solutions global market: ~USD 10.83 billion (2030 projection) per Markets and Markets research. Oncology EHR and clinical operations software market is a significant subset within broader healthcare IT TAM of hundreds of billions.

SAM: Flatiron's serviceable addressable market is primarily biopharma (estimated global spend on clinical evidence generation >USD 50 billion annually) and oncology-specific EHR adoption across US community and academic centers (~1,500+ eligible oncology practices)

Industry Trends:

• FDA regulatory tailwind: FDA Oncology RWE program expanded acceptance of de-identified real-world data from large registries and multi-institutional datasets (December 2025 policy update). RWE now used in 23-28% of FDA drug approvals, with oncology as the leading sector at 43.6% adoption. This represents a significant regulatory de-risking for companies utilizing platforms like Flatiron.

• Data consolidation and standardization: Healthcare industry trend toward consolidating fragmented EHR data and establishing data standards for cross-institutional analysis. Flatiron's harmonized multinational datasets (UK, Germany, Japan) directly address this gap and represent meaningful competitive differentiation.

• AI/ML transformation of evidence generation: Industry shift from descriptive real-world data analysis toward predictive and prescriptive analytics using large language models (LLMs) and machine learning. Flatiron's October 2025 announcement of LLM-extracted progression data positions it at leading edge of this transformation.

• Biopharma outsourcing of evidence generation: Pharma companies increasingly outsourcing real-world evidence operations to specialized vendors rather than building internal capabilities, creating durable demand for platforms like Flatiron.

• Consolidation pressure on RWE vendors: Larger healthcare data incumbents (Optum, IQVIA, Parexel) acquiring smaller RWE providers, creating potential margin pressure and competitive consolidation in the market.

Key differentiators:

• Unmatched oncology data depth: 5+ million de-identified patient records with 1.5 billion data points from 1,000+ sites is substantially more comprehensive than most RWE competitors' oncology-specific datasets
• Embedded point-of-care platform: OncoEMR EHR integration creates a network effect—every clinical note, treatment decision, and outcome is automatically captured and enriched, versus competitors relying on claims or retrospective data integration
• Roche backing and scale: As Roche subsidiary, Flatiron has R&D resources, pharma credibility, and distribution through Roche's existing pharma relationships
• Proven publication track record: 1,000+ peer-reviewed publications using Flatiron data establishes scientific credibility and de-risks adoption by cautious pharma counterparties
• Global expansion momentum: Established presence in UK, Germany, Japan with harmonized datasets enables multinational evidence generation—valuable for global pharma

Positioning: Flatiron positions itself as the "most comprehensive oncology dataset" and evidence infrastructure partner, emphasizing depth of data, scientific rigor, and ability to move evidence generation from "what if" to "what is" to "what will be" (predictive). Targets biopharma looking for de-identified, readily usable datasets and end-to-end evidence services rather than competitors offering broader but less specialized platforms.

Leadership Team

Financials

• Revenue: Estimated USD 100-500 million annually (private company; estimates vary by source)
• Funding: Total raised: USD 314 million from Google Ventures and Roche across 4 funding rounds from 29 investors. Last venture funding round: USD 175 million (January 2016)
• Valuation: Acquisition price by Roche: USD 1.9 billion (February 2018)
• Current status: Private subsidiary of Roche Group (acquired 2018); operates as independent affiliate

Note: Post-acquisition financial reporting is proprietary to Roche. Flatiron does not separately disclose revenue or profitability metrics.

Recent News & Developments

• 2025-12: Paradigm Health acquires Flatiron's Clinical Research Business for undisclosed terms. Transaction includes 25+ academic medical centers, ~100 community oncology practices, and access to 2.4M+ patients. Multi-year strategic partnership established between Paradigm and Flatiron.

• 2025-10: Flatiron Health unveils major scientific innovations including LLM-extracted real-world progression data at unprecedented scale, AI data quality framework, and harmonized multinational datasets. Claims 5M+ patient records and 1.5B datapoints in unified dataset.

• 2025-04: Flatiron announces strategic partnership with Massive Bio to expand patient identification capabilities and improve clinical trial enrollment using Massive Bio's database of trial-eligible patients.

• 2025-03: Flatiron partners with Exact Sciences to accelerate clinical evidence generation for molecular residual disease (MRD) testing.

• 2025-03: Flatiron pioneers international patient-level data sharing across UK, Germany, and Japan via Trusted Research Environment.

• 2025-02: Partnership announced between Flatiron and Unicancer (French cancer research consortium) to accelerate generation of regulatory-grade real-world evidence.

• 2025-01: Flatiron partners with DeepScribe to integrate AI-enabled clinical documentation into OncoEMR workflow.

• 2025-01: Flatiron announces global oncology research network has tripled in size across UK, Germany, and Japan. Establishes Flatiron FORUM global consortium to advance RWE methodology.

• 2024-10: Flatiron surpasses 1,000 peer-reviewed research publications utilizing Flatiron de-identified patient data.

Competitive Landscape

Direct competitors:

• Atropos Health — Direct competitor in real-world evidence generation with generative evidence acceleration platform; focuses on on-demand analytics and works with Atropos's own 160M+ patient records and past studies library. More data-agnostic (works on customer data or Atropos global network) vs. Flatiron's proprietary oncology-focused dataset.

• Optum/Optum Intelligence — Large incumbent with broad healthcare data assets and claims data; less specialized in oncology RWE but has scale and pharma relationships. Part of UnitedHealth Group, creating distribution advantages.

• IQVIA — Global contract research organization with extensive CRO network and clinical trial capabilities; operates significant RWD platforms but less specialized in oncology-specific EHR data.

• Parexel — Integrated CRO with RWE capabilities; offers broader clinical development services but less focused on oncology-specific datasets.

• Medidata Solutions (Dassault subsidiary) — Clinical trial data management platform with RWE offerings; stronger in trial operations than real-world data depth.

• Cerner/Oracle — EHR vendor with access to broad clinical data; less specialized in oncology or RWE extraction.

• IBM Watson Health — AI/analytics applied to healthcare data; broad healthcare IT player but not specialized in oncology RWE.

• Syapse — Precision oncology platform; less focused on RWE generation, more on genomic data integration and treatment optimization.

• Aetion — Specialized RWE analytics platform; broader disease focus than Flatiron but less data depth in oncology.

• Truveta — Health system-focused RWE platform using EHR data from health systems; less pharma-oriented, more payer/provider focused.

• Citizen Health, Mango Sciences, Perci Health — Emerging competitors in healthcare data analytics (per CB Insights).

Competitive advantages:

• Unmatched depth of oncology-specific, longitudinal patient data (5M+ records vs. competitors' broader but less oncology-dense datasets)
• Embedded EHR network effect that ensures continuous data capture and quality (vs. competitors' retrospective data integration)
• 1,000+ publications and 4,000+ citations establishing scientific credibility and reducing buyer risk
• Roche backing providing pharma credibility, R&D resources, and distribution through Roche's existing pharma relationships
• Harmonized multinational datasets enabling global evidence generation
• Specialized oncology expertise and NCCN/AJCC integration

Competitive vulnerabilities:

• Recent divestiture of Clinical Research Business to Paradigm Health signals potential strategy shift or performance issues in that segment, reducing service breadth
• Declining employee sentiment (Glassdoor 3.2/5.0) and reports of layoffs/attrition may impact ability to compete on talent and execution
• Roche ownership may limit agility vs. pure-play startups; Paradigm's acquisition of Clinical Research unit suggests Flatiron may not be Roche's strategic priority
• Limited competitive differentiation in EHR market itself (OncoEMR)—primarily competing on data network effects rather than superior software
• Dependent on Roche's continued investment for R&D and market expansion; potential for deprioritization if Roche refocuses

Strategic Assessment

Strengths

• Proprietary oncology dataset at scale: 5+ million de-identified patient records with 1.5 billion data points from 1,000+ clinical sites represents the most comprehensive longitudinal oncology dataset globally. This is a defensible, hard-to-replicate moat that grows stronger with each new patient encounter. Competitors like Atropos can access large networks but lack Flatiron's depth in oncology.

• Embedded EHR network effect: OncoEMR's integration with 200+ oncology practices creates automatic, continuous data capture that is both higher quality and more current than retrospective claims or manual data extraction. This virtuous cycle (more practices → more data → better RWE → more pharma customers → more practices) is difficult for competitors to replicate.

• Roche backing and pharma credibility: Ownership by Roche and integration with Roche's global pharma R&D gives Flatiron both credibility and distribution advantages. Pharma companies view Flatiron as aligned with a trusted industry leader rather than a vendor with misaligned incentives.

• Scientific validation through 1,000+ publications: Surpassing 1,000 peer-reviewed publications using Flatiron data (October 2024) and 4,000+ citations establishes scientific rigor and de-risks adoption. Regulators and pharma view Flatiron data as validated, reducing friction in submissions.

• Harmonized multinational datasets: Establishment of datasets across UK, Germany, and Japan with harmonized standards solves a critical pain point for global pharma—generating regulatory-grade evidence across markets without manual harmonization. This is a material competitive advantage vs. regional competitors.

Weaknesses

• Declining internal workforce morale and organizational instability: Glassdoor rating of 3.2/5.0 (40% would recommend to friend) with employee complaints of "constant layoffs," "massive attrition," and "selling of entire business lines" suggests organizational dysfunction. December 2025 divestiture of Clinical Research Business to Paradigm Health confirms this trend. This impacts ability to retain talent, execute R&D, and compete on execution quality.

• Narrow product focus—largely dependent on data monetization: Flatiron's core value driver is real-world data access and curation. OncoEMR is a commodity EHR product without clear differentiation vs. Epic, Cerner, or specialized competitors. Revenue concentration in RWE services creates vulnerability if regulatory environment shifts or competitors gain access to comparable data.

• Dependent on Roche's strategic vision and funding: As a Roche subsidiary, Flatiron's growth and innovation priorities are subject to Roche's broader strategic choices. The December 2025 divestiture of Clinical Research suggests Roche may be reallocating resources or reducing commitment. No independent funding sources or ability to pursue aggressive M&A independently.

• Customer concentration risk: While not explicitly disclosed, biopharma customers likely represent majority of revenue. Loss of major pharma customers (e.g., due to competitive switching or internal capability building) could materially impact revenue.

• Data privacy and regulatory risk: Operations depend on access to patient data across multiple jurisdictions (US, UK, Germany, Japan). Changes in privacy regulations (GDPR, future US regulations) or patient consent laws could restrict data access, impact dataset breadth, or increase compliance costs.

Opportunities

• FDA regulatory tailwind for de-identified RWE: FDA's December 2025 policy update removing barriers to de-identified real-world evidence represents a major regulatory tailwind. FDA now accepts large de-identified registries and multi-institutional datasets as primary evidence without mandatory patient-level records, directly favoring Flatiron's business model. RWE already used in 23-28% of drug approvals; oncology at 43.6% adoption. This trend should drive increased pharma demand for platforms like Flatiron.

• Expansion into non-oncology therapeutic areas: Flatiron's dataset and expertise are concentrated in oncology. Adjacent therapeutic areas (hematology, immunology, gastroenterology) represent significant TAM expansion opportunities. Flatiron could leverage its oncology data curation playbook to build specialized datasets in high-value disease areas.

• HTA and real-world cost-effectiveness expansion: Health Technology Assessment bodies (NICE, G-BA, HAS) increasingly require real-world evidence for reimbursement. Flatiron could expand HTA-specific services to help pharma companies generate evidence for payers in UK, Germany, EU, and beyond. This is a high-margin service opportunity that complements existing offerings.

• AI-powered evidence acceleration: Flatiron's October 2025 announcement of LLM-extracted progression and AI data quality frameworks is early-stage. Expanding AI capabilities to enable faster, cheaper evidence generation could unlock new use cases (e.g., on-demand feasibility studies, real-time trial enrollment optimization) and reduce customer acquisition costs.

• Strategic partnerships with biopharma and CROs: Recent partnerships with Exact Sciences, Massive Bio, NRG Oncology, Unicancer, and DeepScribe signal demand for integrated evidence solutions. Flatiron could deepen partnerships or expand to adjacent service providers (genomics labs, patient advocacy groups, health systems) to create integrated value chains.

• Spin-off or strategic exit: If Roche deprioritizes Flatiron or decides to refocus on core pharma R&D, Flatiron could be a candidate for spin-off, PE buyout, or acquisition by larger healthcare tech incumbents (e.g., Optum, Amazon Healthcare, Microsoft Health). This could unlock capital and strategic focus.

Threats

• Competitive data access and commoditization: Larger healthcare data incumbents (Optum, IQVIA, Cerner/Oracle) are investing in RWE capabilities and have access to broad health system datasets. If competitors can access comparable oncology data or partner with health systems to create specialized oncology datasets, Flatiron's data moat weakens. Optum's scale in particular is a threat.

• Biopharma building internal RWE capabilities: Some pharma companies are evaluating in-house real-world evidence teams to reduce vendor dependency and accelerate time-to-evidence. If this trend accelerates, it could reduce addressable market for RWE vendors.

• Regulatory uncertainty and healthcare privacy headwinds: Future US healthcare privacy legislation (e.g., strengthened privacy rights, restrictions on health data sharing) could reduce Flatiron's ability to access or share patient data without friction. GDPR-like regulations in US markets would increase compliance burden.

• Pharma consolidation reducing RWE demand diversity: Industry consolidation among pharma companies reduces the number of independent customers and increases customer concentration risk. Consolidated pharma companies may demand lower pricing or negotiate exclusive partnerships.

• Roche strategic deprioritization or divestiture: December 2025 sale of Clinical Research Business and ongoing organizational challenges suggest Roche may be losing commitment to Flatiron as a strategic asset. Risk of full divestiture, lack of investment, or integration into broader Roche initiatives that dilute Flatiron's identity.

• Emerging competitors with AI-first approaches: New entrants (e.g., Atropos with generative evidence, startups leveraging GPT-4 for automated evidence synthesis) could disrupt traditional RWE workflows and commoditize evidence generation, reducing Flatiron's pricing power.

Public Sentiment

Overall sentiment: Mixed — Positive external reputation for data quality and scientific rigor, but negative internal sentiment due to organizational turmoil, layoffs, and divestiture.

Customer sentiment: Positive on data quality and scientific credibility (evidenced by 1,000+ publications and pharma partnerships), but limited public reviews. Comparably data shows 52/100 customer satisfaction score and 3.8/5 customer service rating. NPS ranking 2nd among oncology/healthcare tech competitors (behind Elekta, ahead of Foundation Medicine). Some concerns about pricing and vendor lock-in given data dependencies.

Employee sentiment: Negative. Glassdoor rating of 3.2/5.0 stars based on 371 reviews. Only 40% would recommend to friend; 21% believe company has positive business outlook. Compensation/benefits rated 3.4/5, work-life balance 3.7/5, culture/values 3.3/5, career opportunities 2.7/5. Employee complaints cite "constant layoffs," "massive attrition," "selling of entire business lines," "toxic management," "hiring freezes," and departures of key people. Positive feedback notes "great people," "collaborative colleagues," "no commute," "flexible hours."

Analyst sentiment: Limited formal analyst coverage in available sources. However, industry publications and analyst firms (Markets and Markets, CB Insights) position Flatiron as a leader in oncology RWE space. September 2024 Markets and Markets report projects RWE market CAGR of 14.8% through 2030, with Flatiron among top players alongside IQVIA, Optum, Parexel, Medidata. Scientific and regulatory communities view Flatiron positively based on publication track record and FDA collaboration through Oncology RWE program.

Sentiment Drivers

Growth Vectors

Stated strategy: Build "the world's most comprehensive oncology dataset" with AI-powered evidence generation capabilities; expand global reach across UK, Germany, Japan and establish international partnerships; integrate point-of-care clinical workflows (EHR) with research-grade evidence services; move from descriptive RWE ("what is") to predictive analytics ("what will be").

Existing Market Expansion

• Global geographic expansion: Expansion from US-only operations to UK, Germany, and Japan with harmonized datasets and local teams. Tripling of international network in 2025 signals momentum. TAM expansion through multinational pharma requiring global evidence.

• Therapeutic area expansion: Expansion beyond oncology into adjacent high-value disease areas (hematology, immunology, gastroenterology) leveraging Flatiron's data curation and EHR network playbook.

• Pharma motion expansion: Deepening relationships with existing pharma customers through additional services (HTA support, post-market surveillance, adaptive trial design) and cross-selling to new indications.

• Health system partnerships: Expansion of OncoEMR adoption through partnerships with major health systems (e.g., Mayo Clinic, Cleveland Clinic, UC Health) to increase network size and data depth.

New Market Opportunities

• Health Technology Assessment (HTA) services: High-margin consulting services supporting pharma in generating HTA-ready evidence for payers across EU, UK, Australia. Growing reimbursement focus on real-world evidence creates demand.

• CRO-integrated evidence solutions: Partnerships with or acquisition by major CROs (e.g., Parexel, Syneos, ICON) to bundle Flatiron's RWE capabilities with clinical trial operations and end-to-end drug development services.

• Patient-centric trial enrollment: Expansion of trial patient identification and enrollment services (similar to Massive Bio partnership) to support sponsors in accelerating trial recruitment using real-world data.

• Real-time outcomes monitoring and precision medicine: AI-driven real-time monitoring of treatment outcomes and adverse events to enable precision medicine and adaptive therapies. This positions Flatiron as a clinical decision support platform, not just a data vendor.

• Healthcare payer partnerships: Expansion beyond pharma to include payers (health plans, government agencies) seeking evidence for coverage decisions, cost-effectiveness analysis, and population health management.

Growth Vector Assessment

Discovered Entities

People

• Nat Turner | Co-founder, Current Advisor/Board | https://natsturner.com/about
• Zach Weinberg | Co-founder, Current Advisor/Board | https://www.linkedin.com/in/zachweinberg/
• Nathan Hubbard | Chief Executive Officer | LinkedIn profile available via Flatiron Health leadership pages
• Carolyn Starrett | Senior Advisor (Previous CEO 2021-2025) | LinkedIn profile available via Flatiron Health leadership pages
• Michael Bierl | Chief Business Officer | https://flatiron.com/team/
• Allison Candido | Chief Technology Officer | https://flatiron.com/team/
• Kate Estep | Chief Product Officer | https://flatiron.com/team/
• Michael Vasconcelles | Chief Medical Officer | https://flatiron.com/team/
• Cal Brouilette | Chief Financial Officer | https://flatiron.com/team/
• Julia Morton | Chief Operating Officer | https://flatiron.com/team/
• Quincy Weatherspoon | VP & GM, Point of Care Solutions | https://flatiron.com/team/
• Jaime Lopez | Chief Design & Marketing Officer | https://flatiron.com/team/
• Stephanie Reisinger | EVP Real-World Evidence Business (prior leadership) | Mentioned in January 2022 BusinessWire announcement

Competitors

• Atropos Health | Direct competitor in real-world evidence generation with generative analytics platform; operates 160M+ patient records network; on-demand evidence acceleration focus
• Optum/Optum Intelligence | Large healthcare data incumbent with broad RWD platform, claims data integration, and pharma relationships; part of UnitedHealth Group
• IQVIA | Global CRO with extensive RWE data platforms and clinical trial network; less oncology-specialized but major pharma relationships
• Parexel | Integrated CRO with RWE capabilities and clinical trial operations; broader service offering but less specialized in oncology
• Medidata Solutions | Clinical trial data management and RWE platform (Dassault subsidiary); stronger in trial operations than RWD depth
• Cerner Corporation | EHR vendor with access to broad clinical data; general healthcare IT player without oncology specialization
• IBM Watson Health | AI/analytics applied to healthcare data; broad healthcare IT platform without RWE specialization
• Syapse | Precision oncology platform focused on genomic data and treatment optimization; less RWE-focused
• Aetion | Specialized RWE analytics platform with broader disease focus than Flatiron but less oncology data depth
• Truveta | Health system-focused RWE platform using EHR data; more payer/provider-centric than pharma-centric
• Citizen Health | Emerging healthcare data analytics competitor per CB Insights
• Mango Sciences | Emerging healthcare data analytics competitor per CB Insights
• Perci Health | Emerging healthcare data analytics competitor per CB Insights
• Foundation Medicine | Oncology-focused but genomics/precision medicine focus rather than RWE/EHR
• Elekta | Healthcare IT vendor in oncology space with complementary focus (radiation therapy planning) rather than direct RWE competition