The Digital Health Dilemma
Digital health startups are revolutionizing how care is delivered — from virtual check-ins to chronic care management platforms. Yet, while many land pilot programs with health systems or payers, few make the leap to scalable, revenue-generating partnerships. In a healthcare landscape increasingly shaped by value-based care (VBC), startups need more than innovation — they need a roadmap to sustainable impact and profitability.
The Pilot Trap: Why Most Startups Stall
Landing a pilot feels like a major win — and it is. But the problem? Many startups remain stuck there. Here’s why:
- No clear ROI metrics tied to value-based outcomes: Health systems in VBC contracts want to see reductions in readmissions, improved adherence, and lower total cost of care — not just app downloads or engagement.
- Lack of integration with clinical workflows: Pilots often sit outside the clinician’s day-to-day, making it hard to scale.
- Unclear path to reimbursement: If the solution doesn’t support or align with risk-based contracts, payers and providers have no reason to fund expansion.
Think Like Your Buyer: What Payers and Providers Want in the VBC Era
To scale, digital health companies must reframe their value proposition around VBC goals. Ask yourself:
- Does our solution reduce avoidable utilization?
- Can we help close care gaps or improve HEDIS and Star ratings?
- Are we addressing social determinants of health (SDoH) in a measurable way?
- How does our tech fit into existing clinical or operational infrastructure?
These are the questions health plans, ACOs, and risk-bearing providers are asking.
Strategies to Break the Pilot Barrier and Scale
Here’s how to turn pilots into long-term partnerships in the value-based ecosystem:
- Build for Outcomes, Not Just Engagement
- Use data to connect your intervention to improved outcomes like lower ER visits, better medication adherence, or improved patient-reported outcomes (PROs).
- Highlight cost-savings potential in your pitch decks and case studies.
- Partner with Risk-Bearing Entities
- Align with organizations already in downside risk models (e.g., MA plans, ACOs, or DCEs).
- Offer to take on performance-based contracts or shared-risk models to show confidence in your value.
- Integrate Seamlessly
- Design your product to plug into EHRs, population health platforms, and existing care management workflows.
- Reduce the lift for providers and care teams.
- Get a Reimbursement Strategy Early
- Understand the reimbursement codes or value pathways that make your solution viable (e.g., RPM, CCM, CPT codes).
- Consider direct-to-plan models where value is proven and scalable.
- Tell the Right Story
- Frame your solution as essential to helping organizations hit quality benchmarks and reduce total cost of care.
- Share outcome-driven case studies with VBC-aligned metrics.
What Winning Looks Like
Look at companies like Cityblock Health or Devoted Health — they didn’t just build slick platforms. They aligned tightly with VBC goals: addressing vulnerable populations, integrating care delivery, and proving impact with data.
Your goal? Become indispensable to your buyer’s ability to succeed in value-based arrangements.
From Pilot to Partner
Scaling in value-based care isn’t about being the coolest tech. It’s about being the right partner for payers and providers who are betting on outcomes. If you can show clear alignment with their incentives — and make integration frictionless — you’re not just a vendor. You’re a strategic partner.
