Not Every Telehealth Company Is a Healthcare Company
What the Medvi story revealed about who's actually building care, and who's just selling it.
For a while now I’ve been saying something on calls I keep circling back to. The rapidly evolving telehealth corner of consumer health — TRT, GLP-1s, peptides, ED meds. Verbatim, from a recent Granola transcript: “there are moments navigating the telehealth landscape that increasingly feels like the wild Wild West to me. There are moments where these telehealth doctors feel like digital substitute teachers, paid assassins doing 7-minute online consults and slinging powerful molecules to the uninformed.”
Then the New York Times called Medvi one of the most interesting companies in America. A $1.8 billion operation. Two employees. AI-powered. The piece hit a lot of notes for the healthcare and AI crowd, and I became privy that a lot of aspiring builders took the leap that it was now entirely feasible to build the next Medvi in their basement because they just upgraded to Claude Pro.
Then the story behind the story got more... dynamic. Fake doctors. Deepfaked patient photos. Fabricated press coverage. An FDA warning letter. A RICO lawsuit. A spam operation so prolific the litigation landed on the wrong company.
Medvi wasn’t really a healthcare company. It was a marketing company that happened to sell prescriptions.
The clinical infrastructure wasn’t Medvi’s. A company called OpenLoop runs what amounts to a telehealth franchise kit: landing page templates, a prescribing pipeline, pharmacy fulfillment, payment routing. You supply the brand name and the ad budget. They handle the doctors and the drugs. The storefronts don’t hold any inventory, any pharmacy licensure, or any clinical infrastructure of their own. Prebuilt, labeled, ready to ship. You put your logo on the door and call it healthcare.
Medvi was the biggest brand running on that backend. There were at least a dozen others. After the Times piece dropped, we immediately started seeing pitch decks from founders citing Medvi as proof of concept. The distance between running a performance marketing operation and being a telehealth company is now about 90 days and a Shopify-adjacent stack.
Here’s the part that doesn’t get said out loud enough.
The same infrastructure that made Medvi possible also make real care more possible than it’s ever been. It’s never been easier to build a sophisticated marketing operation. It’s also never been easier to build actual clinical infrastructure: protocol design, credentialed clinicians, supervised prescribing, real follow-up, data captured over time. Both got cheaper at the same time.
What telehealth has made possible is real. The guy who hasn’t seen a doctor in 11 years finally getting his testosterone levels checked is a good outcome. The peri-menopausal woman who was told her hormones are "within normal range" by her PCP, finding a telehealth platform that solely focus on gender-specific care, is a good outcome too. That's the form factor doing meaningful work.
The caution is in how the access argument gets used. A lot of what's getting pitched out there is framed as expanded access, and we need to be careful that doesn't get conflated with fewer guardrails dressed up in better marketing.
The bigger structural shift here - the disappearing PCP and the personal care stack taking its place - is a separate piece…one that we think represents an even bigger global shift in healthcare as we know it today. Stay tuned for that.
In our view, this is even more prevalent because the traditional PCP + Patient relationship has been slowly disappearing. The industry has innovated faster than primary care can keep up.
The consumer is the one worth watching.
They’ve already left the system in meaningful ways. They’re paying out of pocket for bloodwork, peptides, hormone panels, longevity clinics, and telehealth subscriptions. They’re reading. They’re comparing. They’re figuring out what actually works and telling their friends.
And they’re getting sharper. The first wave of consumer telehealth trained them to expect convenience and low friction. The next wave is training them to ask harder questions. Who designed these protocols? What’s the follow-up actually look like? Am I being cared for, or processed? The brands that assume the consumer stays passive are going to be surprised by how quickly that changes.
The companies that come out of the correction will be chosen on transparency, efficacy, and trust. That’s where the decisions will get made.
What we’re looking for - and what we’d tell any founder building in this space - is someone who understands both sides of the new math.
Marketing skill and clinical DNA. Either one without the other breaks. Marketing without clinical becomes Medvi in slow motion. Clinical without marketing stays small and invisible. The brands worth building are the ones where both are real, both are visible to the customer, and the founder can explain how they think about each with equal specificity.
The Wild West phase is certainly here. The correction is coming. What comes through the other side is either a lot of marketing companies getting regulated out of existence, or a new category of consumer health brand that actually earns the relationship it’s been handed.
The second version is the one worth building. And investing in.