Four years ago, I founded Mochi Health around a single question. Where do patients fall out of care, and how do you bring them back? I thought I understood the answer well enough to build toward it. What I didn’t know was how much running a company would keep rewriting that answer.
I want to use this anniversary to write down what actually surprised me. The parts of the last four years that changed how I think about care, about leadership, and about my own certainty.
In research, and in clinical practice before that, the unit I was trained to think in was the patient in front of me.
When I started Mochi, I assumed the job was to design a better version of that encounter. A better visit. A better prescription. A better follow-up.
What I learned quickly is that none of that holds up if the structure underneath it is broken. A patient can have a wonderful conversation with a provider and still fall out of care three months later because the pharmacy fulfillment was a black box, or because no one owned the relationship once the first prescription shipped.
That’s what pushed us toward building a three-sided marketplace instead of a nicer app: patients, providers, and independent pharmacies connected on one platform, with the patient choosing and keeping both a provider and a pharmacy rather than being assigned either.
I didn’t set out to build infrastructure. I set out to fix an encounter. It’s just that the encounter kept insisting that the infrastructure was the actual problem.
I also didn’t anticipate how much of my job would be resisting money. Healthcare capital tends to reward growth metrics that have nothing to do with whether a patient got better or stayed in treatment.
I watched how quickly those incentives can bend a mission-driven company into a metrics-driven one. A lot of the capital assumptions in this industry simply don’t lend themselves to the models that actually help patients.
So we grew Mochi to cash-flow-positive on minimal outside funding. I won’t pretend that was purely a strategic insight from day one.
Some of it was a necessity. But the discipline it forced on us, collecting revenue transparently at the point of care, building a pricing model patients could actually trust, is now the thing I’m most protective of. It’s slower. It’s also the reason no one outside this company gets a vote on whether a patient comes first.
The clearest example of what founding taught me that medicine didn’t is how I handled GLP-1s. I wasn’t initially a believer. I expected patients to resist injectable medications, and I built our early plans around that assumption.
The data said otherwise, and I had to reverse course in front of my own team, my own investors, and eventually my own patients.
Medical training rewards being right, or at least being defensible, by following the protocol. Founding a company rewards something almost opposite.
Noticing quickly that you were wrong and changing before the mistake compounds. After examining the data, I realized I was wrong and updated our approach. That reversal turned out to be one of the more important decisions in the company’s history.
I don’t think I would have made it as quickly if I had still been operating with a clinician’s instinct to defend a considered position rather than a founder’s instinct to update fast.
The part of the last four years I didn’t see coming at all was how much patients would expand the company for us.
We started around obesity and metabolic care. We didn’t plan to move into PCOS, perimenopause, fertility, dermatology, and more general primary care.
Patients asked their Mochi providers to manage more of their health, and the providers, no longer boxed into a single-condition workflow, said yes.
Looking back, that’s the clearest proof of the original thesis. If patients fall out of care in the gaps between specialists, then the fix isn’t a better weight-loss product. It’s a “primary care home,” one trusted relationship a patient can bring their whole health to, and that only reveals itself once patients start treating you like one.
I started this company to answer a research question. Four years in, I still think about it that way. What’s changed is my sense of scale.
I used to think fixing this meant fixing one patient’s care coordination. I now think it means building the connected, personalized infrastructure, integrated labs, continuous data, individualized dosing, that the next decade of healthcare is going to require whether or not the rest of the industry is ready for it.
I’m not writing this because I think we’ve finished anything. I’m writing it because four years in, the question I started with still feels like the right one, and I’d rather spend the next four building further into it than looking for a different one.
