Selling Into Healthcare

Daniel Perez and Gabriel Mecklenburg met as doctoral students in the UK, and both had been through long rehabilitation after injuries (reported). The idea behind Hinge Health, founded in 2014, was economic as much as clinical. Back, knee and other joint pain are among the largest categories of US employer medical spending, and most of that spending goes not on physical therapy but on what follows when it fails or is skipped: imaging, injections, specialists, opioids and surgery. Clinical guidelines already recommended exercise therapy first. The problem was adherence. Hinge built a 12-week programme with a tablet, motion sensors, a coach and a physical therapist by video, and made three choices that stuck: it would be free to the member and paid by the employer, it would employ its own clinicians, and it would treat outcomes data as its main sales asset, because otherwise a benefits buyer could not tell it from a fitness app.

The decisive choice was the route to the buyer. Hinge sells directly to large employers, with 51 employer sales staff at the end of 2025, but most clients come through more than 60 partners: the five largest national health plans by self-insured lives, the three largest PBMs, and benefits navigators such as Accolade, Quantum Health and Teladoc (10-K). Partners take a fee and run multi-year agreements averaging about three years, and the charge usually flows through the medical claims stream, so adding Hinge looks to the employer like adding a covered benefit rather than signing a new vendor. Fees are tied to enrolled members, with milestone billing as they keep engaging and, in some contracts, performance guarantees (S-1 and 10-K; terms vary). By the end of 2025 Hinge had about 25 million contracted lives, 2,830 clients and 782,890 members. Its favourable independent evaluation in 2024 arrived just as buyers were losing faith in digital health. This chapter explains how healthcare buys, and why the route to the buyer is often harder to build than the product.