Yoni Rechtman

Forward Health Is Gone But The Dream Lives On

Vertical integration in healthcare is just really hard

Bending the healthcare cost/outcomes curve is not just a massive commercial opportunity it’s one of the most important things for any person to work on. If you can deliver better care, more efficiently you will literally save lives.

So while it’s easy to gravedance when a healthcare company with an ambitious mission like Forward shuts down, it’s shitty. Much better to try to unpack why this was so hard, learn from it, and get ready to try again.

The key lessons here is that 1) vertical integration is hard and 2) everything is always harder in healthcare.

Going fully vertical in healthcare means needing to build five companies at once. You need to 1) find patients, 2) contract with plans and employers, 3) recruit and manage doctors at scale, 4) do the admin, and 5) build technology that makes everything work better/more profitably. And the more ambitious you are, the more levers (like hardware) you add.

That is, you need to build a large, fully functioning healthcare business before you even know if the technology really works. And you need to do it on a venture timeline to stay alive. ~You’re building and flying a plane at the same time, in the real world, with huge capital needs, and terrible consequences~ if you make a mistake.

This is why we’re focused on private practice enablement. Instead of backing a healthcare providers directly, we’re deep believers in fixing private practice/medical entrepreneurship because healthcare works better when doctors are in charge, not PE funds or hospital execs.

We’re looking to power doctors to own their own practices whether through generational transition, new practice formation, or improving economics/viability of existing practices. Obviously this extends far beyond simple software companies and into complex, integrated approaches.

But the key is to limit how many things need to go right at once and how many things YOU need to be excellent at. For example, we would gladly back a franchised approach to tech-enabled care because it takes the operational burden off the company and puts doctors in charge locally.

So Forward is gone but I hope others will be inspired to try. Technology has lots of work to do to improve healthcare and save lives. And we’re all counting on it to work.

If you do go vertical, best to go slow and validate rigorously before scaling. Nailing the true/false on “better” matters much more than just doing “more”