With technology disrupting almost every aspect of our lives, there's a trillion-dollar industry that still seems to be stuck in the past – healthcare.

But imagine if a company like Apple redesigned all of healthcare – what would that look like?

Well, this future might be on the horizon, but from a company most people haven’t heard of: Forward. And, for a relatively unknown startup, Forward has raised a staggering $500 million to “rebuild healthcare from the ground up.”

Forward recently launched their most innovative, or controversial, product – the CarePod. And yet most of the world is still unaware of Forward’s masterplan.

In this article, I’ll unpack my outsider’s take on Forward’s masterplan. Is it bold or simply delusional? Will Forward’s contrarian approach work? What can we learn from Forward? And why is this masterplan so bold and so secret?

[Seeing as CarePods are currently the hot topic, feel free to jump to that section]

Healthcare for a billion people for free

Forward’s mission is to provide “the world’s best healthcare to a billion people for free”.

That’s like saying you want to solve all healthcare problems, for everyone, for free.

Bold? I'd say so.

It'll take a crazy plan, and for a crazy plan it helps to have a crazy and brilliant founder. Adrian Aoun, formerly the Director of Special Projects at Google, is the mastermind behind Forward — and he comes with all of the contrarian ideas we've come to expect from the ‘crazy geniuses’ of Silicon Valley.

Adrian believes the secret to rebuilding healthcare is turning it from a service into a product. One built on hardware and software rails. And in doing so, create the platform to allow millions of health apps to be built on top. Instead of one primary care doctor, you would have dozens of apps monitoring your health, addressing your concerns, and preventing issues before they occur.

These contrarian beliefs allow us to piece together what looks like a masterplan.

1. Build doctors’ offices … and in the process build tooling to

2. Create CarePods … the first doctor’s office without a doctor and with the hardware & software to

3. Become a platform … by allowing anyone to build apps on top of CarePods

I’ll step through this three-part masterplan and unpack what founders, investors and operators can learn from Forward.

Step 1: Build doctors’ offices

If you’re familiar with Forward, you’ve probably encountered their apple-store-like doctors' offices, equipped with futuristic body scanners, built-in-house skin scanners, and minimalist design – all coming in at a  $149 per month price tag for unlimited visits. If you’re thinking, ‘this doesn’t seem like how you get healthcare to a billion people for free,’ then you’d be right – after all, OneMedical hasn’t grown past the US in 16 years following the same approach. But here’s the thing – Forward doesn’t care about traditional doctors' offices. Forward sees clinics as a strategic stepping stone to CarePods – doctors’ offices without a doctor.

Why? Adrian’s thinking is that healthcare’s challenges derive from its service-led nature: doctors are expensive, lag behind research, make errors, and most importantly, are in short supply. To put it in perspective, even if Forward hired every doctor on the planet, they still would not have enough doctors to serve one billion people. By contrast, product-led healthcare (i.e. tech) scales and gets better and cheaper over time.

The only problem is that turning healthcare from a service into a product is very hard in practice because of (a) technological limitations, (b) equivocal customer adoption, and (c) the lack of reimbursement.

So, what can we learn from Forward’s attempts at doing so?

Doctors need to service more people

The ‘simple’ way to make healthcare more product-like is to allow a single doctor to service more patients. This is the strategy of just about every tech-enabled services company. The idea is that gross margins increase as you improve utilization and efficiency of clinicians. Utilization increases via optimizing scheduling and supply-demand forecasting. Efficiency increases with better use of triaging, incentive design, and AI.

Nowadays, this is table stakes for a tech-enabled services company. Forward perhaps does this slightly better than other companies, but it’s hard to win on a more efficient operating model alone.

Building clinics is an art

If you’re building doctors’ clinics, the finer details matter. For Forward, floor-to-ceiling glass means the body scanner is always visible from outside – a marketing play, no doubt, which also explains why Forward situates its clinics in highly trafficked locations like shopping malls.

The exam rooms are a masterclass in space saving. The patient chair doubles as a lie-down table (normally these are separate), the physician sits on a small stool, appearing approachable, and even the monitor is designed so the doctor isn’t buried behind a computer. The design tries to merge space efficiency with an elevated patient experience.

On the software side, the product thinking of unbundling primary care into discrete apps is a great way to showcase the full suite of primary care to patients. I suspect we will increasingly see primary care become unbundled into discrete health apps.

However, you don’t win at the clinic game by building nicer clinics

A word of caution to all those who pitch, “I’m building One Medical but with a better customer experience” – in primary care, it’s typically not your customer experience that matters but your reimbursement model and operating model. One Medical succeeded because of B2B partnerships, not sexier design.

I suspect that Forward initially thought clinics were a good business before understanding the base reality of healthcare. And that’s when they pivoted to CarePods.

Productized healthcare is closer than we think but needs endpoints in the real world

3 in 4 millennials go to Google instead of their doctor and 1 billion Google searches each day are health-related. Is this already product-led healthcare? I’d say so. The ‘human touch’ of healthcare is increasingly a myth. Really, this should come as no surprise considering more than 70% of Americans feel failed by the healthcare system.

However, whilst lots of digital health companies seem to think that digital health is the be-all-end-all, Forward thankfully realizes that healthcare will always require endpoints in the real world. Enter CarePods.

Step 2: Launch CarePods

If you work backwards from trying to provide the world’s best healthcare for a billion people, it’s possible to arrive at an idea as far-fetched as CarePods. Why? To get free healthcare to a billion people, healthcare has to be zero marginal cost, which requires removing the main variable cost in healthcare: doctors.

The idea is that CarePods turn healthcare into a product that delivers care via apps (R&D) rather than doctors (COGS). CarePods provide the physical endpoint necessary to deliver care, diagnostics, blood tests, and treatments because digital health alone is insufficient.

This all sounds great in theory, but will CarePods work in practice? And what can we learn from Forward’s strategy?

What CarePods do well

Convenience drives value creation

CarePods are far more convenient than a traditional doctor’s office and convenience drives value creation – look no further than Uber, AirBnB, Doordash, and Amazon.

Imagine a world with a CarePod on every street corner, at shopping malls, train stations, and in high-rise buildings. A world where a weight loss app gets you to visit the CarePod each Monday morning for a body scan, or a cholesterol app helps you get routine blood tests at the CarePod in your office building – this is how CarePods become part of everyday life.

I still believe that investors underprice the power of convenience in driving behavior change, even beyond the world of health.

CarePods are self-marketing

The best founders think as much in terms of distribution (go to market) as they do in terms of product. CarePods could be a differentiated customer acquisition channel because of their (a) visual distinctiveness, (b) ubiquity in highly-trafficked locations, and (c) 3rd-party apps. Perhaps CarePods will finally give Forward a durable way to lower customer acquisition costs, a notoriously difficult metric to drive down.

The prophesied Star Trek sick bay

A healthcare nirvana has been to create the Star Trek sick bay – a place with novel diagnostic and therapeutic hardware to detect and solve health problems. Whilst Adrian thinks CarePods could be it, other players in the game obsessing over diagnostic hardware might get there before Forward – companies like Q Bio or Neko.

Why CarePods probably won’t work

On the flip side, my base case is that CarePods won’t usher in the age of free healthcare for a billion people for a few reasons.

The future of healthcare is at home

Is the future really CarePods instead of at-home care? Using Amazon as an example, they didn't change retail by making self-service stores; instead, they brought the store into your home. Most of what can be done from a CarePod can be done at home. What can’t be done at home requires a clinician (aka a ‘service’). CarePods don’t solve a real customer job to be done yet.

An operational nightmare

The CAPEX to manufacture CarePods and OPEX to run them could be ruinously high if consumer adoption isn’t high enough, and Forward might not be equipped to handle the new demand brought on by CarePods. If you read the online reviews. Forward seems riddled with ops problems, and rolling out 3,200 CarePods by the end of 2024 will most definitely exaggerate the problem.

Product execution is lackluster

To date, Forward has obsessed too much with perceived value than actual value — the tech is gimmicky. The body scanners are largely inaccurate, the skin scanners don’t provide insight for most patients, and the 2-star app store rating speaks for itself.

Whilst Forward draws inspiration from Tesla (down to using the same font), Elon seems to have a far better understanding of customer jobs to be done. And if Apple were to launch something like this, I suspect it would be more biophilic and humane. In its attempt to differentiate from the existing market, Forward neglected the patient experience.

Vertical integration is f*cking hard

To rebuild healthcare as a product, Forward believes that healthcare’s foundations must be rebuilt on hardware & software rails. It’s like how for mobile phones to exist, there had to be 3G, small batteries, and micro CPUs. To that avail, Forward has built an in-house EMR, in-house revenue tooling, in-house hardware and in-house just-about-everything.

It’s hard for even specialized companies to build one of these tools, and through my own experience founding a healthcare company, I’ve seen the importance of focus. And yet Forward wants to build all of these tools. The belief is that vertical integration is needed to build the platform tooling for applications to be built on top of – which very well might be true. The catch? The applications don’t even exist yet. Enter health apps.

Step 3: Become a platform with millions of apps

7 of the world’s 10 largest companies are platforms and perhaps in healthcare, this will be no different.

The idea here is that just as Apple didn’t build the best mobile apps, one company won’t build the best health apps. Instead, if Forward wants to win the end game, they believe they must become the platform to enable others to build.

It’s a bold vision, but it could work. After all, it’s damn hard to build health apps today, and entire companies, like Livongo, Sword, and Lyra, exist to deliver just one app experience.

I’m currently building a healthtech company, and in a world with CarePods, I could see us using them as part of a care journey, for pathology APIs, skin cancer screens, or even body scans. It’ll be far more convenient for our members to use a CarePod than going to tradhealth (my abbreviation for traditional healthcare).

But building a platform doesn’t stop there. The next step in Forward’s platform vision is to create a unifying healthOS for consumers. Imagine if your wearable data was linked to your doctors’ consults, which was linked to your genomic data. Everything in one place. It would be pretty neat. Now, how to actually execute this? I’ve got a few ideas but the tl;dr is that it’s damn hard. But as I said in my last article, Primary Care Innovation Doesn’t Work, the hard is what makes it great.

Conclusion

If you need to get free healthcare to a billion people, I can see how you arrive at a vision as audacious as Forward’s – healthcare as a product, built on hardware & software rails, with platform tooling for health apps to be built on top.

It’s a very theoretical vision detached from a first principles understanding of customer jobs to be done, which is always the risk when building a company in a top-down manner. But in many respects, that’s the point. There’s a small chance that CarePods really do usher in a new wave of healthcare and Forward becomes one of the largest companies in the world.

And even in the more likely scenario that Forward does not achieve its mission, there’s still value in the pursuit – Forward will stand as an example of what it means to dream big, think outside the box, and not be afraid of tackling the world’s toughest problems. Adrian might inspire a new generation of tech founders to aim for new frontiers. And that, I believe, eventually will lead us to the future we dream of – the world’s best healthcare. For everyone. For free.