Three decades. Nine companies. One repeating pattern — turn a napkin sketch into a real business, then turn that business into real growth.
I'm a builder. Always have been.
Thirty years and roughly nine companies in, the pattern hasn't really changed: stare at a napkin sketch, see the business that could be there, then go build it. Concept to growth. $0 to $25 million. Repeat.
Curiosity is the fuel. I read everything, ask too many questions, and would rather hear "no" five times before lunch than sit through a meeting that ends nowhere new. I'm wired to win — but more than that, I'm wired to find out.
Healthcare is where I've spent the most time. Direct-response is the lens I see through. Standardbred racing is how I clear my head — a stable in Ohio, a love for the breed, and the people in the backstretch who make the sport go.
These days, I’m operating across multiple ventures, advising founders, writing, and laying the groundwork for the next chapter. Always building. Always learning. Always hunting for the next napkin.
Operating principles I've earned the hard way. They show up in every business I touch.
Slow decisions don't make decisions safer — they make them more expensive. Move first, learn faster, and course-correct in flight. The market doesn't wait for committee meetings.
Every dollar in this system flows from one source: a patient who needs help. Get the patient experience right and the rest of the value chain follows. Get it wrong and nothing else matters.
Revenue covers a lot of sins. It funds the next bet, buys you time, and tells you the truth. Build for it, defend it, and never confuse activity for it.
Eight rules I run by — earned in the field, tested across nine companies and three decades of building, selling, funding, and exiting.
Sometimes you have to get to no before you get to yes. Forcing an answer creates clarity — and clarity illuminates the pathway to success. The worst deal in your pipeline is the one that never closes and never dies.
Combining value, positioning, and extreme preparation inverts the power dynamic of the selling situation. When you walk in over-prepared and clear on what you're worth, the buyer stops interviewing you and starts qualifying themselves.
If they treat you like a vendor, walk away and rebuild your approach, offering, and communication strategy. Vendors get squeezed; partners get invited into the room where decisions are made. Pick your seat at the table — or don't sit down.
No one cares about your features and benefits — they care about how you make their lives better in a myriad of ways. Be the revenue, not the expense. The fastest way to get hired, kept, and paid more is to show up on the right side of the P&L.
Spend a small amount of your own money to derisk the deal for your potential partner — and to prove a key point. Nothing defines a partnership like making an investment before you've been asked to. Skin in the game changes every conversation that follows.
Nothing worse than an over-funded company in walking-dead mode, where no one wins years later. The formula is simple, and it's earned not theorized: Speed + Cash Efficiency + Relentless = Exit with smiles everywhere.
Your funders hold many. You hold one. Have very low expectations of value-add from investors and your life will be measurably better. Anything they bring is a bonus. Anything they don't is the default. Plan accordingly.
Tape them to your bathroom mirror and read them before coffee. List one: the key metrics that define your success. List two: the people who told you it couldn't be done. That's all you need — map and fuel.
Weekly intelligence for healthcare operators navigating the Direct-to-Patient revolution. Published by 36Red LLC. Read by people who'd rather know first than know later.
The FDA fired off warning letters to 30 telehealth companies in March over misleading claims about compounded semaglutide and tirzepatide. Simultaneously, Novo Nordisk cut a co-branding deal letting certified telehealth platforms prescribe FDA-approved Wegovy directly. And Walgreens launched its own "Walgreens Weight Management" digital program on Feb. 26.
The upshot for health system marketers: your weight management service line is now competing with the federal government, Big Pharma, and retail pharmacy — all going direct to your patients.
The White House launched TrumpRx.gov on Feb. 5 with 43 drugs at most-favored-nation pricing. It's a referral hub pointing patients to manufacturer DTC sites. Zepbound at $299/month, Wegovy pill at $149/month. The signal: the federal government endorsed the idea that patients should buy drugs without going through your system.
CMS's new ACCESS model launches July 5, 2026 — the first meaningful Medicare value-based pathway for digital health. 10-year program covering diabetes, hypertension, CKD, MSK pain, depression, and anxiety. The twist: patients enroll directly with participating organizations. Not through a referral. Not through their PCP. Direct.
The convergence of cookie deprecation, the Washington My Health My Data Act, expanding state privacy laws, and heightened FTC scrutiny means 2026 is the year getting patient tracking wrong carries real financial consequences. Health systems still running Meta Pixel without HIPAA-compliant wrappers are sitting on seven-figure liability.
PulsePoint's 2026 Health Marketing Trends Report confirms digital pharma ad spending will hit $26.2 billion this year while traditional channels shrink to $6.9B. The shift isn't just channel — it's intent. Pharma is targeting patients at the point of decision, not just awareness.
Despite Walgreens closing VillageMD clinics and Walmart shutting health centers in 2024, the retail health thesis is alive. CVS is doubling down on Oak Street Health's Medicare model, Amazon One Medical expanded to 44 cities, and Dollar General launched virtual care kiosks in rural markets. The new playbook isn't primary care — it's chronic disease management, mental health, and diagnostics at scale. Retail is learning from its failures faster than health systems are learning from theirs.
The Patent Trial and Appeal Board invalidated all patent claims Exact Sciences had asserted against Geneoscopy. That removes the final barrier to full commercialization of ColoSense, their FDA-approved, RNA-based, at-home colorectal cancer screening test. No prep, no sedation, no facility visit. Now in NCCN guidelines.
Teal Health expanded to all 50 states with the only FDA-authorized device for at-home cervical cancer screening — the Teal Wand. 96% detection rate matching clinician-collected samples. 94% of participants preferred it. HHS requires insurance coverage for self-collection HPV testing by January 2027.
Dexcom and Abbott are in an all-out DTC battle for the continuous glucose monitoring market. Dexcom's consumer-grade Stelo and Abbott's OTC Lingo and Libre Rio now target people without diabetes. Abbott partners with Weight Watchers and Withings. Together they control 91% of the $13.6B CGM market.
The $1.15B acquisition of Eucalyptus was the headline, but the real signal is their acquisition of YourBio Health — painless capillary blood sampling. Labs platform now offers 120+ biomarker tests. They're building the full DTP stack: marketing, consultation, testing, treatment, ongoing management.
UK-based Lex Diagnostics has submitted its rapid point-of-care PCR system to the FDA for 510(k) clearance and CLIA waiver. Lab-quality molecular diagnostics in urgent care clinics, retail pharmacies, and potentially patients' homes. The democratization of diagnostics continues.
Diasorin's Liaison Nes platform received FDA clearance and CLIA waiver for a four-in-one assay detecting Flu A/B, RSV, and SARS-CoV-2. Results in 15 minutes, operable without specialized lab personnel. This turns retail pharmacy locations into mini-clinics.
Butterfly Network's iQ3 handheld ultrasound probe now has 200+ AI-assisted clinical applications and is being deployed in retail health settings, urgent care, and even employer health clinics. When a $2,000 device connected to an iPhone can replace a $150,000 cart-based system for basic scans, the point-of-care diagnostic revolution has a new accelerant. Device companies are bypassing radiology departments entirely.
83% of healthcare consumers now prefer AI-generated search answers over traditional Google blue links. Google AI Overviews, ChatGPT, and Perplexity are giving patients direct answers — bypassing your service-line pages entirely. Answer Engine Optimization (AEO) is the new game.
The most successful systems have stopped measuring impressions and started measuring frictionless digital access — can a patient book, verify insurance, and complete intake digitally? If your "digital front door" still dumps patients into a phone queue, your $2M ad spend is leaking.
73% of healthcare consumers prefer short-form video to learn about a provider. Physician-led video outperforms polished brand content by 3-4× on engagement. The systems winning patient acquisition in 2026 are handing iPhones to their docs, not hiring video crews.
A provider listing with 120+ reviews and a 4.7-star rating dramatically outperforms one with 4 reviews and a 3.9 rating — regardless of ad spend. Every marketing dollar driving traffic to a weak profile underperforms. Reputation isn't separate from patient acquisition. It's the foundation.
67% of pharma marketers now rank condition-specific patient communities as "extremely important" to their DTC strategy — up from 41% two years ago. These are curated digital ecosystems with clinical moderators, peer support, and embedded care pathways.
OpenAI, Google, and Apple are all building AI agents that can act on behalf of patients — scheduling appointments, comparing providers, and navigating insurance verification. Early data from pilot programs shows AI-initiated bookings convert at 3.2× the rate of web form submissions. Health systems without API-accessible scheduling infrastructure will be invisible to the next generation of patient acquisition channels.
Boston Consulting Group frames Direct-to-Patient as healthcare's version of the DTC retail revolution. Three forces: regulatory tailwinds, consumer expectations imported from retail, and rapid AI adoption. BCG's message: the organizations that rethink the entire patient journey now will own the next decade.
Direct-to-consumer laboratory testing hit $3.75 billion in 2025, projected to reach $8.69 billion by 2035 (8.77% CAGR). At-home testing kits: $19.24 billion in 2026. Companies like Spot offer white-labeled platforms so any brand can offer lab-analyzed diagnostics via at-home collection. A parallel healthcare system being assembled piece by piece.
The global medical device market is projected at $595 billion in 2026 (5.6% CAGR). Device companies are spending 20%+ of revenue on marketing for new launches, shifting decisively to digital. The pharma DTC playbook — TV to digital to DTP — is now being adopted by device manufacturers.
U.S. digital health startup funding hit $14.2B in 2025 — up 35% from 2024. Mega deals ($100M+) accounted for 42%. The thesis: investors are backing companies that own the patient relationship directly. Health systems not partnering are funding their own disruption through inaction.
Nearly every major pharma company has built a DTP platform, but engagement remains low. DTP platforms in isolation fail. The ones connecting into provider workflows — integrating with EHRs, sharing data with care teams — are the ones that retain patients. Pharma needs you. But only if you build the integration layer.
Direct-to-Patient intelligence delivered weekly. Free.
Three decades operating at the intersection of direct-response marketing, healthcare commercialization, and capital strategy. Receipts below.
Nine napkins to reality. Companies that have collectively employed 500+ people and driven hundreds of millions in revenue — on funding ranging from self-funded all the way up to $11M total.
Nine startups and multiple consultative engagements have built a resume of over $2 billion in direct-to-consumer healthcare sales. The OG of Direct-to-Patient — literally wrote the book Patient Activation.
Focused track record of fast revenue growth through revenue programs built to sell from strength and reduce friction. I'd rather create a new pathway than adjust an existing one. Fast experiments. Fast results. Fast decisions.
A thoughtful, strategic approach to minimizing capital utilization through milestone metrics that create value-creation checkpoints. The thesis: fund six months → hit proof points → replicate → raise valuation → fund the next milestone. The process creates intensive effort, kills lack of focus, and maximizes every dollar's effectiveness.
Creating shareholder value is Job #1 of every CEO — no matter the size of the company. Strategy developed early focuses on what the market needs and values. Messaging to potential acquirers starts long before the deal table opens.
Three decades operating across human and veterinary health — and finding that the bridge between them is its own competitive edge. Same playbook. Different patient.
Molecule to market across med tech, diagnostics, digital health, and pharma. Built and operated DTP programs for FDA-cleared devices, telehealth platforms, RNA-based diagnostics, and rare disease therapeutics.
Cross-species expertise from canine to equine. Focus on nutrition, longevity, laboratory science, performance management, and general wellness.
Direct-response principles applied to voter activation and campaign messaging.
Capital deployment and investor partnerships via Acumenity LLC.
Operator-grade counsel for founders working through growth, capital, and exit.
Two audiences. One operator. Engagements built around what each one actually needs.
Pharma · Device · Diagnostic · Digital Health
Stuck in low gear with frustrated growth? Let’s find the FAST button. Launch planning. Messaging hierarchy. Channel sequencing. Partnership strategy. Built by an operator who’s launched, not just consulted.
Three decades of operator experience — $2 billion in healthcare patient transactions and hundreds of thousands of patients recruited into clinical research. Get patients into trials, pipelines, and therapy — at scale. Don’t rely on just the Meta-Google playbook.
Operator-grade counsel for the building years.
Napkin to reality. The hardest leg of any business is going from idea to first dollar of revenue. I’ve made that trip nine times.
Selective engagements where I can meaningfully move the needle — board seats, chairmanships, or fractional strategic counsel. Engaged on the work. Not a board collector. A working partner. Accountable to the outcome.
Both parties committed. Skin in the game on both sides.
Equity, options, or success-tied participation in the incremental value created.
Maximize value. Minimize downside. At this stage of my career, I’m not seeking billable hours — I want to help create financial winners.
No pitch decks. No qualifying questionnaires. Just a real conversation about what you’re building and whether I can help.
Four published titles across patient activation, healthcare consumerism, and personal health. Written for operators, patients, and the providers in between.
The 4 Steps Proven to Move Health Care Consumers From Awareness to Activation.
The operator’s playbook for moving patients through Locate, Educate, Navigate, and Advocate — the four-stage system refined over years of recruiting hundreds of thousands of patients into clinical research and commercial therapy programs. The framework that became the foundation of 83bar.
View on Amazon →
A viewpoint of today’s health care consumer.
What happens when you stop talking at patients and start listening to them? A direct-from-the-source look at how today’s healthcare consumer actually navigates the system — and what marketers, providers, and policymakers consistently get wrong.
View on Amazon →
Your guide to taking control.
A practical companion for the millions living with fibromyalgia and chronic fatigue. Cuts through the medical jargon and gives patients a roadmap they can actually follow — built from years of working with patient communities through 83bar.
View on Amazon →
Your guide to conquering prediabetes.
Roughly one in three American adults has prediabetes — and most don’t know it. EMPOWERED translates the science into concrete daily moves patients can use to reverse course before the diagnosis hardens into Type 2.
View on Amazon →Active ventures, exited businesses, and ongoing equity positions across healthcare, direct-response, real estate, and Standardbred racing.
The premiere patient activation company.
Dominates both clinical research and commercial patient recruitment and engagement — underpinned by a proprietary software platform and an RN-staffed nurse navigation center.
Genome intelligence, powered by Genetic Counseling.
Leading provider of genomic intelligence services with a powerful emerging data business focused on rare disease and oncology.
Knowledge beyond the dispense. In the home. For the first time ever.
Keep Labs is building the system that tells pharma what is really happening with patients at home — and what to do about it.
Next $250 million company.
Improving patient outcomes and clinical workflows in endoscopy.
Developing automation and AI tools for endoscopy. The world’s largest database is now the baseline for incredible screening automation to come.
Integration and migration without custom engineering.
Product-led platform connecting revenue systems with operational platforms like NetSuite, Greenhouse, and Sage — giving teams a unified, real-time view of their data. Trusted by thousands of companies to eliminate data silos and accelerate time to value.
Accelerating the medical device lifecycle.
Helps medical device companies virtually access the OR — to enhance education, drive sales, improve R&D, and support successful product launches.
Innovative noninvasive tests for GI disease.
Develops safe, effective, and innovative noninvasive tests that improve gastrointestinal disease detection, treatment, and monitoring.
Direct lab access for consumers.
Founded by physicians. Provides consumers direct lab access to advanced biomarkers — an enormous wealth of information.
The revenue consultancy.
Focused on rapidly increasing revenue and value of organizations.
Workforce housing syndication.
Real estate funding partnerships focused on workforce housing — across North Carolina and Michigan.
For healthier, happier horses.
Purveyors of evidence-based hair & mineral analysis. Corresponding supplement product line.
USTA Standardbred racing & breeding.
Standardbred racehorse and breeding operation competing across the Northeast and Midwest USA.
A Standardbred racing and breeding operation across five states — from county fair half-milers to mile-track flagships. The right partners. The right horses.
Harness racing is America’s original horse sport. It traces back to colonial farm roads and county fairs where local horsemen raced their best driving horses for bragging rights and small wagers. The modern Standardbred takes its name from the 2:30 mile-time standard set in 1879 — the time a horse had to beat to qualify for the registry. The entire breed descends from a single foundation sire: Hambletonian 10. His bloodline runs through every Standardbred racing today.
Standardbreds are honest horses. They’re bred for work, built for durability, and almost all of them have a second career waiting after the racetrack — saddle disciplines, mounted police, driving competitions, therapy work. They tolerate handling, accept training, and rarely surprise you with bad behavior. A good one can compete from age two through their teens. As a USTA-licensed trainer, I’ll take a Standardbred over almost any other animal in the barn.
The sport runs on three track sizes — half-mile, five-eighths, and full mile — and each one changes the math. Half-milers like Buffalo and Batavia put a premium on post position; full miles like Red Mile and the Meadowlands give horses room to make moves. Then there’s the fair circuit — county fairs across Ohio, Pennsylvania, Indiana, Kentucky, and New York where the racing is grassroots, the crowds are local, and horses cut their teeth before stepping up to pari-mutuel competition. Crazy Parrot Farm runs across all of it.
Roster shifts week-to-week with claims, sales, and retirements. Broodmares listed below.
Strong focus on meeting the needs of companion animals — the ones who don’t get to advocate for themselves.
37 years of horses & kids.
The Standardbred Retirement Foundation has been doing the work since 1989 — rescuing horses from the threat of slaughter and placing them in homes with the commitment most rescues won’t make: lifetime follow-up. Headquartered on the grounds of Walnridge Equine Clinic in Cream Ridge, New Jersey, SRF places horses across nine states. A few of them serve on the NYC Mounted Police.
For a USTA-licensed harness trainer, this work hits home. Standardbreds are honest, level-headed, and remarkably trainable horses — and after their racing careers, only some of them get the second chapter they’ve earned. SRF’s “Horses & Kids” programming pairs rescue with youth mentorship, which is the right kind of multiplier. Crazy Parrot Farm horses age out into a world where SRF exists. That matters.
Small operation. Enormous heart.
Angels Retreat sits deep in the Nantahala National Forest in Hayesville, North Carolina — a full mile from the closest neighbor. The rescue began the way the best ones often do: not by plan, but by need. The family of one disabled woman, looking for purpose, was sent five starving hunting dogs that had been abandoned in the woods. That was the origin. Everything since has followed from it.
What makes this work is the ratio. They primarily serve Clay and Macon counties in Western NC, but pull dogs from wherever they’re needed. The record adopter drove 1,007 miles one way to take a dog home. That’s the kind of bond rescue work creates when it’s done right. Companion animals don’t always get a fair start. Angels Retreat is one of the people fixing that — one dog at a time.