Collaboration Opportunity "*" indicates required fields First Name* Last Name* Email* Opportunity Name*i.e. Cancer Patient Navigation Pilot Company Name:* Company Funding Stage:* Seed Stage Series A Series B Series C+ Public External Point of Contact:Last Name* First Name* Title* Email* Phone*Opportunity Proposed*Problem being addressed:*Strategic Theme:* Business Service & Infrastructure Clinical Tools Consumer-Centric Healthcare Population Health Engagement Potential:* Pilot Opportunity Product Co-development Strategic partnership Investment or co-investment The Opportunity has the following:* Team Technology Traction Does the opportunity involve a product?* Yes No If Yes, what is the product's status? Conceptual Prototype Active pilots In market for different use case In market for same or similar use case What is the estimated financial impact to UH:* Less than $1M $1M-$10M Greater than $10M Not sure Type of impact and value:* New new revenue Labor productivity cost savings Cost avoidance Supply unit cost saving Employee/patient engagement Competitive advantage Recovery of revenue leakage Mission or community related In what ways does this opportunity align with UH's system goals?* Better Patient experience Operational Efficiencies Better staff Engagement Streamlined Throughput Reduces Readmissions Decreases Mortality Promotes Culture of Safety Reduces Patient Harm Please list or describe any current or past activities/relationships with University Hospitals.* I certify that I (i) have the authority to disclose this information, (ii) that the information disclosed is not subject to obligations of confidentiality, (iii) and that this disclosure does not violate any agreement in place with a third party relating to the information. PhoneThis field is for validation purposes and should be left unchanged.
