Single-Core Platforms Outperform Specialty Rollups
Brendan Keeler, Senior PM at Zus Health, on building infrastructure for digital health
The real bottleneck in multi specialty virtual care is not adding another condition line, it is stitching together different clinical software, care workflows, and sales motions without slowing everything down. A diabetes program, a primary care service, and a fertility business may all look like adjacent revenue on a slide, but in practice they run on different intake flows, provider operations, data models, and reimbursement paths, so integration work can eat the value the deal was supposed to create.
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Teladoc bought Livongo to raise revenue per member by pairing general telehealth with chronic care, but that kind of same plane combination is exactly where integration gets hard, because both sides touch the patient journey directly and need unified product, clinical, and employer selling motions.
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By contrast, Oak Street's RubiconMD deal fit more cleanly because e consult software could plug into primary care without replacing Oak Street's core clinic workflow. That is an easier kind of combination, one business helps the other do its job better instead of forcing a full stack merge.
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Ro shows the alternative path. It expanded into new specialties like fertility through Modern Fertility, while also buying infrastructure like Workpath and opening pieces of that infrastructure to other healthcare companies. That creates more ways to make money than just cross selling another condition to the same patient.
The next wave of winners in virtual care will look less like stitched together specialty rollups and more like platforms with one clean operating core, then carefully added services around it. The companies that keep one patient record, one care workflow, and one distribution engine while adding adjacent tools will compound faster and with less operational drag.