Keaton Bedell is the Co-Founder and CEO of Bridge, a health insurance infrastructure platform. Rebecca Mitchell, MD, is the Managing Partner and Co-Founder of early-stage venture firm Scrub Capital.
The virtual care junkyard is full of companies that built great care models, but never found a sustainable business model. It’s still such a new category that entrepreneurs are writing the playbooks in real time.
There’s lots of flavors of direct-to-consumer healthcare. One potential playbook we’re seeing these days involves leveraging insurance, versus cash pay. Instead of trying to influence behavior as tech or service vendors, these companies are stepping into the role of care delivery itself. They borrow the acquisition playbooks from cash-pay leaders like Hims & Hers, Ro, and Hone Health, but layer in insurance to expand access and (in some cases) affordability.
At Bridge, we’ve seen hundreds of companies pursuing this model and now power dozens of them. At Scrub Capital and Second Opinion, Chrissy and Rebecca have spent time with many of the category’s defining founders, including Jake Cooper, CEO of Grow Therapy, which recently reached a $3B valuation, and $1B women’s health unicorn Midi Health.
This model first took shape with companies like Grow Therapy, Headway, and Talkiatry, who benefited from the surge during the pandemic. Dietician-focused platforms like Nourish and Berry Street followed soon after. As barriers to entry have continued to fall, we’re now seeing a Cambrian explosion of companies across specialties: Midi Health (menopause), Found (obesity), Allara (PCOS), Neura Health (neurology), Birches (gambling addiction), Eddii Health (endocrinology), and many more.
In this piece, we break down the four stages of this model to give builders a practical playbook. Not every company will follow this exact path, but many will benefit from thinking in phases like this.
We are calling it:
The Four Stages of Building a Care Delivery Services Business in 2026*
*because this is also the era of AI
Most digital health companies that struggle don’t fail because of bad technology or bad clinical operations. They fail because they never figured out if anyone would actually pay for what they built — or they figured it out too late.
Here's the framework we use when thinking about how care delivery companies get built — and where they tend to get stuck.
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This week on Lifers!
Christina Farr speaks with Josh Tauber, multi-time COO and founder, and Keaton Bedell, co-founder and CEO of Bridge, about Medvi, a cash-pay GLP-1 company valued at $1.8 billion. The founders discuss the end of the software-as-a-service moat and how to build a sustainable business focused on patient care.
Stage 1: The cash test
Before anything else, it’s valid to test willingness to pay out-of-pocket. Not because cash-pay must be the long-term business model, but because it's the fastest and most honest signal you can get.
Insurance won't save a product that no one will pay for directly. If you can't find a cohort of patients willing to pull out a credit card, you might not have market pull for the product yet, which justifies the next three steps. The cash phase is where you test the hypothesis without the noise.
The TAM here is tiny—that 1% willing to pay cash. But that's exactly the point. You're not trying to scale yet. You're trying to learn.