Brand Is the Moat

Medicare Advantage plans spent an estimated $6 billion on supplemental benefits in 2024. Dental, vision, OTC allowances, fitness memberships. The stated goal is member engagement and retention. For most plans, the actual result is a benefits package that members find confusing, underuse, and don't connect to any real improvement in how they feel.

Meanwhile, Oura sends a push notification at 7am and 38 million people open it.

That gap is what I keep coming back to. Not a clinical infrastructure gap or a reimbursement gap, but a relationship gap. A trust gap between what the healthcare system thinks it's offering and what people actually want to engage with.

What consumer health is doing that the clinical world isn't

The companies winning in consumer health right now (Oura, Function Health, Levels, Whoop, and the newer entrants building around GLP-1 and metabolic health) aren't winning on clinical superiority. They're winning on brand, community, and story. They've built something people want to belong to, talk about, and come back to every day without being prompted. That's a fundamentally different asset than a care management platform, and it's one that large health corporations are structurally bad at building.

The reasons aren't hard to identify. Building a real brand requires a coherent point of view, a willingness to speak directly to a specific audience, and an acceptance that you won't appeal to everyone. Health systems and MA plans are designed to be all things to all members. They optimize for coverage breadth, network adequacy, and regulatory compliance. Brand building requires the opposite: a distinct identity, a defined person you're talking to, a reason someone would choose you over doing nothing rather than just over a competitor in a procurement spreadsheet.

Startups can do this. Large health corporations mostly can't, and that asymmetry is where the real opportunity sits.

The assumption the market keeps getting wrong

The conventional thinking in health tech is that clinical credibility comes first and consumer adoption follows. Build the evidence base, get the reimbursement codes, earn the CMS approval, then figure out how to reach patients. The coverage creates the distribution.

I think this is backwards, and AI is the reason it's becoming more backwards faster than most people realize.

AI makes it possible for a consumer health company to deliver a genuinely personalized, longitudinal health relationship at a cost structure that wasn't achievable before. Real-time wearable analysis, coaching that adapts to behavior over time, insights that are relevant to the specific person rather than the average person with their condition. The consumer health stack has crossed a threshold where it can deliver something that genuinely feels better than what the clinical system provides for the same conditions.

When that happens at scale, the coverage question inverts. CMS and MA plans don't set the terms of what patients will accept. A beneficiary who has spent two years getting real daily value from a consumer health platform isn't going to drop that relationship because their MA plan offers a competing product. The plan has to meet the patient where they already are. Coverage follows relationship, and the early evidence of this is already showing up: MA plans are starting to cover consumer devices not because they decided to innovate, but because members started asking why their plan didn't cover what they were already using.

It's not about the app

To be clear about what I mean by brand and relationship, because this is where the thinking tends to get fuzzy: building a consumer health brand isn't building a better interface on top of an RPM platform. It isn't adding a mobile app to a care management workflow or making your member portal less painful to use. Those are UI improvements on a model that's fundamentally built around compliance and documentation, and users can feel the difference.

The consumer health companies building real brand are doing something harder. They have a point of view about what health actually means to the person using the product. They create content, community, and narrative that makes someone feel like they're part of something. They build around identity rather than diagnosis: I'm someone who takes my health seriously, who understands my data, who's ahead of the curve. The product earns daily engagement because there's something genuinely worth coming back to, not because a care manager will notice if you miss a check-in.

That prior relationship is also what makes clinical engagement actually work. Patients who trust a brand share their data more completely, follow recommendations more consistently, and stay enrolled through the friction points that cause disengagement in traditional care programs. You can't build that behavioral foundation retroactively once you have a reimbursement code. It has to come first.

What this means if you're building right now

The opportunity I'm most interested in isn't a better RPM platform. It's a consumer health company with genuine clinical ambitions that's building the trust relationship first and treating coverage as the strategy, not the starting point.

In practice, that means investing in brand, community, and content as core business functions rather than marketing line items. It means building the AI layer in service of the individual user relationship, not the population analytics dashboard. It means choosing a specific person (the 45-year-old who just got a metabolic health wake-up call, the 60-year-old Medicare beneficiary who's more health-engaged than the system has ever given them credit for) and building something that earns their loyalty before asking for their clinical data.

The companies that will matter in this space in five years are building that trust layer now. The coverage will follow.

What I'm still working through

I have more conviction in the direction than in some of the specifics, so I'll say that honestly:

• Where's the real commercial bridge between consumer health engagement and MA plan contracting? I have a directional sense but want to understand the specific mechanics better: who owns the conversation, what the buyer motion looks like, where the risk sits.
• Which consumer health companies are already thinking seriously about this convergence versus which ones are focused purely on the consumer market and treating clinical as a future problem? I have some hypotheses I'd love to pressure-test.
• What does the regulatory path actually look like for a consumer brand moving into covered benefits territory? The FDA and CMS frameworks weren't designed for this transition, and I haven't found a clear answer on where the real friction points are.
• Is the brand-first thesis more true in metabolic health and GLP-1 adjacent categories than in CHF or complex behavioral health? My gut says yes, and that the category matters a lot for where this plays out first.

If you're building at this intersection, whether that's consumer health with clinical ambitions or clinical infrastructure trying to earn a genuine consumer relationship, I'd genuinely like to talk. Not as a pitch, but as someone trying to build real conviction in a space I think is underestimated relative to where it's heading.

— Andrew