Three decades. Nine companies. One repeating pattern — turn a napkin sketch into a real business, then turn that business into real growth.
From napkin sketch to $25M trajectory. Repeat.
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.
Monthly 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.
For the first time, pharmaceutical digital ad spending is projected to exceed linear TV in 2026, hitting $24.77 billion (up 13.3% YoY). Connected TV and social are surging as brands swap reach for targeted, data-driven channels. The crossover isn't a blip — it's the new floor.
Nearly half of Gen Z and over a third of Millennials now use TikTok and Instagram as primary tools for health research — vs. just 10% of Boomers. Reddit has emerged as the high-trust environment where patients prep for doctor visits.
OPDP issued at least nine enforcement letters in the first 10 weeks of 2026 — already nearly double 2024's total-year output. The pace puts the office on track to exceed 50 letters this year. The September 2025 crackdown that everyone wrote off as theater is now operational reality.
Enforcement is expanding beyond TV. Recent letters cite HCP websites, corporate pages, influencer content, earned media, and patient testimonials. The "adequate provision" rulemaking is still alive — and if it lands, broadcast DTC becomes effectively impractical.
On April 9, Eli Lilly rolled out Foundayo (oral orforglipron) directly to patients via LillyDirect, Amazon Pharmacy, GoodRx, Ro, and Weight Watchers — bypassing the PBM layer entirely. Self-pay starts at $149/month. Commercial insurance with savings card: as low as $25.
Hims & Hers added the full FDA-approved GLP-1 lineup (Wegovy, Ozempic, Zepbound, Mounjaro, Foundayo) in late March. Novo Nordisk launched a discounted Wegovy subscription. The DTP playbook — pharma → telehealth → doorstep — is now the default obesity treatment path.
The Advancing Chronic Care with Effective, Coordinated, and Substantive Solutions (ACCESS) Model — a 10-year voluntary outcome-focused payment model — goes live July 5, 2026. First cohort applications closed April 1; subsequent cohorts open quarterly through 2033.
The signal: CMMI killed four primary-care-leaning models in February (Maryland TCOC, Primary Care First, Making Care Primary, ETC) — projected $750M savings — while preserving ACO REACH and launching ACCESS. Outcome-based and tech-enabled wins. Pure primary care attribution loses.
Digital pharma ad spend hits $24.77 billion in 2026, up 13.3% YoY — the first year it exceeds linear TV. Connected TV and social are the surge channels. Nearly half of Gen Z and over a third of Millennials use TikTok and Instagram as primary tools for health research; just 10% of Boomers do.
CVS Health holds 24.5% U.S. prescription share vs. Walgreens' 14.6%, and is opening 60+ new stores in 2026 after acquiring 63 former Rite Aid/Bartell locations. Health Services and Pharmacy & Consumer Wellness segments are doing the lifting. Walgreens, now privately held under Sycamore Partners, is in turnaround mode — 1,200 store closures planned (500 this year), 628 corporate cuts, a Houston distribution hub shuttered.
In March, FDA granted marketing authorization to the first no-prescription, at-home diagnostic test for chlamydia, gonorrhea, and trichomoniasis. Results in ~30 minutes. Approved via the de novo pathway — explicitly opening the 510(k) door for follow-on home STI tests.
Translation for DTP operators: the regulatory ceiling on consumer-grade molecular diagnostics keeps getting raised. Cervical HPV self-collection cleared in 2025. STI at-home in 2026. The "go see your doctor" gate is being dismantled one test at a time.
Major compounding labs (ProRx, BPI Labs) ceased GLP-1 production in early 2026. The September 2025 FDA letters to 55+ online sellers, combined with Novo Nordisk's escalating litigation against Hims, are systematically narrowing the gray-market lane.
TrumpRx launched February 5 advertising lower-cost FDA-approved GLP-1 access directly to patients. Hims pivoted with a compounded semaglutide tablet launch the same day — and is now the named defendant in Novo's most aggressive suit yet.
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.
Diasorin's Liaison Nes platform received FDA clearance and CLIA waiver for a four-in-one Flu A/B + RSV + SARS-CoV-2 assay — 15 minutes, no lab tech needed. UK-based Lex Diagnostics submitted its rapid point-of-care PCR system to FDA for 510(k) clearance and CLIA waiver in parallel. This turns retail pharmacy locations into mini-clinics.
40% of medical appointments are booked outside standard business hours. Voice AI agents deployed for 24/7 booking are producing 15-25% lifts in appointment volume — pure recovered demand that used to die at voicemail.
Notable Health reports an 80% pre-registration rate (up from 40%) at North Kansas City Hospital and 90% reduction in check-in time. Vocalize, Retell AI, Bland AI, and Cognigy are all in production at scale. The $150B "no-show" problem is being chipped at from the top of the funnel.
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.
Pharma companies spend ~25% of total budget on advertising, and a significant portion targets patients directly. With the FDA crackdown holding and consumers demanding simpler risk disclosure, the dollars are migrating from "promotional" to "patient services" — onboarding, adherence, end-to-end care coordination.
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.
Three forces locked in this quarter: (1) Pharma proved DTC works without TV — Lilly Direct and NovoCare are the templates. (2) FDA proved it will enforce against legacy DTC at scale — broadcast economics broke. (3) AI agents and at-home diagnostics proved the patient front door moved out of the doctor's office. The operators who built infrastructure in 2024-25 are now compounding. The ones who waited are buying it.
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 crossed $3.75B in 2025 and is still accelerating. Home-testing kits alone hit $19.24B in 2025. Every brand can now offer lab-analyzed diagnostics in a parallel system being assembled piece by piece — pharmacy distribution, telehealth interpretation, CLIA-waived rapid molecular at the point of care.
Device companies are spending 20%+ of new-launch revenue shifting decisively toward digital and direct-to-patient pathways. The pharma DTP playbook — direct-to-patient awareness, verified intake, telehealth confirmation, in-network delivery — is now being adopted wholesale by device manufacturers.
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 monthly. Free.
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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
Built for clinical research and commercial therapy programs.
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.