Adam Stansell, CEO and Founder of Axle Health, bringing operational excellence to home health
Adam Stansell, CEO and Founder of Axle Health, the operating system for Home Health.
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Today, we’re excited to get to know Adam Stansell, CEO and Founder of Axle Health, the operating system for Home Health.
Before founding Axle, Adam spearheaded the launch of new markets at UberEats and built a high-growth business line at Motive, a leader in fleet logistics. With deep expertise at the intersection of operations, technology, and scale, he’s now bringing world class logistics to one of healthcare’s most overlooked frontiers: home health.
Founded in 2020, Axle is tackling the $150B+ home health industry in the US growing at 9% every year, of which most of home health still runs on old legacy software or spreadsheets. Recently announced, Axle has raised $10M in Series A led by Carl Byers and Julia McDowell at F-Prime Capital, joined by Lightbank and previous investors YC and us at Pear VC! We at Pear, especially my GP Mar Hershenson and I have been super grateful to be part of his journey since 2021.
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From Baseball Dreams to Building in Tech
Growing up, Adam dreamt of being a professional baseball player, but when that didn’t work out, he experimented with careers in sports finance and economic research.
Early internships, including a stint at a sports investment bank and a think tank, taught him what he didn’t want to do: banking and academic research.
He stumbled into tech almost by accident, landing at Uber, where he discovered his passion for operational problem-solving in high-growth environments.
Uber’s culture of handing big challenges to junior people inspired Adam, he thrived on the freedom to launch new markets and build from scratch.
That early taste of creating something new, even inside a big company, planted the seed for his entrepreneurial journey.
The Spark to Start Axle: Lessons from Uber & Motive
At Uber Eats, Adam launched new delivery markets when the product was still early, an experience that taught him how to operate in ambiguity and scale fast.
Later at Motive, he built new business lines within the fleet logistics space, solving tough operational challenges for vehicle fleets.
While these roles scratched his “builder” itch, they still came with the constraints of big-company bureaucracy, which Adam found frustrating when he wanted to move faster.
When COVID hit, Adam saw how healthcare’s old workflows clashed with rising demand for home care and a severe clinician shortage.
Realizing no one was tackling the last-mile logistics problem for in-home care, and that he had exactly the right operational toolkit, he knew it was time to build Axle.
Zero to One: Validating the Idea by Doing It
Initially, Axle didn’t start as pure software, Adam’s team built a full-stack home health services provider, running their own network of clinicians.
This hands-on approach gave them direct insight into the daily headaches of scheduling, routing, communication, and patient coordination.
By solving their own pain points as a provider, they developed the first version of Axle’s product, deeply grounded in real-world workflows.
Though the services arm eventually shut down, it served its purpose: providing invaluable context that shaped Axle’s technology into something the market truly needed.
Adam believes Axle’s current product wouldn’t exist, or be as good, without first being their own customer.
Tackling Home Healthcare’s Biggest Inefficiency
Home health clinicians today spend less than 40% of their time with patients, the rest is eaten up by driving, scheduling, and admin work.
For a sector already short on labor, that inefficiency is unsustainable, and Axle’s mission is to flip that ratio.
A major piece of the puzzle is reducing windshield time, ensuring clinicians spend more time at bedsides, not in cars.
Equally important is optimizing the behind-the-scenes coordination: matching the right clinician to each patient, handling last-minute changes, and keeping everyone in sync.
By giving both clinicians and office staff the tools to plan, adjust, and communicate in real time, Axle frees up capacity for what matters: care.
Real Impact: Case Studies and Customer Results
One example: Cityblock Health, an early Axle customer, saw a 17% boost in clinician productivity after implementing the platform.
That 17% improvement translates to huge margin lift, in low-margin sectors like home health, better utilization of clinical labor can double EBITDA.
Another customer cut missed visits by 55%, tackling a big hidden cost in home healthcare.
Unlike a clinic, a no-show in home health means wasted drive time and an unfilled slot, improving patient engagement directly unlocks capacity.
These results show why the industry is hungry for better operations: every percentage point of efficiency means more patients served and healthier margins.
Navigating Enterprise vs. SMB Sales
Selling to health systems taught Adam a key lesson: procurement cycles are real and long, it can take 12-18 months to turn early buy-in into a signed contract.
Axle balances big health system deals (longer runway, bigger ACV) with smaller home health providers who can close faster and get live sooner.
This portfolio approach ensures the company maintains momentum while pursuing larger, transformative partnerships.
Founders should understand that in healthcare, unlike SaaS, enterprise sales are measured in years, not quarters.
Adam’s advice: design your runway, fundraising plan, and team to survive and thrive on this timeline.
Founder-Led Sales: Why the CEO Must Be in the Trenches
Before Axle’s Series A, Adam was the company’s only salesperson, handling every demo, call, and contract negotiation himself.
He sees early sales not just as revenue generation, but as an irreplaceable feedback loop for refining product and pitch.
Hearing hundreds of no’s taught him how to sharpen messaging, adjust demos, and uncover real customer needs.
Founder-led sales also build trust with early customers, they know they’re talking directly to the person who can fix problems fast.
Adam’s core lesson: do not outsource sales too soon, you’ll miss insights critical to achieving real product-market fit.
Building a Culture that Attracts Top Talent
Axle’s early team has stayed together through pivots, a testament to the culture Adam has built around mission and autonomy.
He credits Uber’s “let builders build” mantra as inspiration for giving smart people big problems and freedom to solve them.
In a competitive tech market, getting great engineers to join a healthcare startup isn’t easy, but Axle’s mission attracts builders who want to tackle hard, meaningful problems.
The company is fully in-person in LA, with an ocean-view office that makes long days more enjoyable (and less like a grind).
Adam believes great culture comes from hiring people who genuinely love creating, and then staying out of their way so they can do their best work.
Axle Health is hiring!
The Future of Home Health and the Role of AI
If Axle succeeds, Adam envisions a world where clinicians do what they love, caring for patients, without drowning in coordination headaches.
Patients and families will have the same level of transparency and communication they expect from modern delivery services, think “Uber for home health.”
Adam doesn’t see AI replacing in-home clinicians, the human, emotional side of home care is irreplaceable.
Instead, AI can power behind-the-scenes logistics: smarter scheduling, patient engagement, and documentation.
For Adam, the biggest opportunity in AI is in freeing up clinical capacity, not replacing it, so healthcare can keep up with rising demand.
Quick Hits: Adam’s Personal Insights
Recharge Routine: Playing soccer is Adam’s biggest stress reliever, he plays in local leagues a few times a week to unwind.
Must-Read Resource: The Out-of-Pocket newsletter by Nikhil Krishnan, part healthcare breakdown, part humor, part memes. Adam calls it the best crash course for builders who want to really understand healthcare’s messy insides.
Favorite Self-Optimization Hack: Meditation during his daily train commute, plus tools like Sunsama for tracking where his time really goes, so he can stay focused on what matters most.
Surprising Fact: Adam once won awards as a jazz pianist, an unexpected creative outlet that taught him improvisation and structure, skills he now applies to building startups.
One Piece of Advice for Founders
Adam’s final advice for early founders: expect it to be really hard, there’s no easy road, especially in healthcare.
You have to love the day-to-day work, not just the idea of an exit or an IPO.
Founding in healthcare means running through walls, again and again, and you need passion for the problem to keep getting up and running through the next one.
If you don’t enjoy the day-to-day, you won’t stick with it long enough to win.
As Adam says: “Healthcare is for people who love getting punched in the face every day, but you save patients along the way, so it’s worth it.”
Axle Health’s story is a masterclass in how operational rigor, logistics know-how, and a mission-driven team can transform an overlooked corner of the healthcare system. For founders, Adam’s journey is proof that building from zero to one in healthcare requires resilience, firsthand problem-solving, and a deep love of the day-to-day grind.
Thanks for reading! Here’s to the builders creating the infrastructure that powers better care at home.