How Brightside Turned 500 Cash Customers Into a National Insurance Contract
There’s a graveyard of healthcare startups that died the same death: waiting for pilot approvals that never came. They spent months crafting RFP responses. They endured endless stakeholder meetings. They built custom features for evaluation committees. And then, after six or twelve or eighteen months, the pilot either never launched, got deprioritized, or produced inconclusive results that led nowhere.
In a recent episode of Category Visionaries, Brad Kittredge, CEO & Co-Founder of Brightside, described how his virtual mental health platform avoided this fate entirely. Instead of asking Cigna for permission to run a pilot, Brad showed up with a 30-page report documenting results from a pilot they didn’t know they were running. The approach secured a national contract while Brightside was still small—and it reveals a playbook for how B2B healthcare companies can break the credibility trap.
The Credibility Trap
Every digital health founder faces the same chicken-and-egg problem. Consumers want to use their insurance for healthcare. But insurance companies won’t contract with unproven startups. You need proof to get contracts, but you need contracts to get proof.
Brad describes the dynamic clearly: “Starting a healthcare company, another reason that it’s hard is that obviously most people want to pay with their insurance for any health care that they get. When you’re starting as like a digital health startup, you have so such little credibility with any sort of traditional healthcare stakeholder, including the health insurance companies.”
The traditional solution—pilot programs—often just delays the inevitable. Pilots get stuck in procurement. They require custom integrations. Success metrics get debated endlessly. And even successful pilots often fail to convert to full contracts because the organization’s priorities shift or champions leave.
Brad knew he needed a different approach.
The Strategic Foundation: Cash as Data Collection
Brad’s decision to start with a cash-pay model wasn’t just about getting to market quickly. It was a deliberate strategy to build the data assets needed for enterprise sales.
“We decided that the strategy we might take is to start by accepting cash and that we can get customers that way, and that the way to build credibility was going to be with data,” Brad explains. “Instead of just going and telling people what we can do, let’s go show them with the data.”
Here’s where most founders would stop: build a cash business, prove the model works, then approach payers. But Brad added a critical step that transformed cash customers into B2B sales assets.
Even while charging cash, Brightside collected insurance information from every customer. This wasn’t for billing purposes. It was for targeting the right payer at the right time with the right proof.
The Execution: Surgical Targeting
The execution required patience and precision. Brad didn’t rush to payers after 50 customers or 100 customers. He waited until he had meaningful data with a specific payer population.
“We got 500 patients, or we call them members, who had, we started collecting their insurance information. Even though weren’t charging it, were still charging them cash. So we learned that we had 500 people who had Cigna insurance that were customers of ours after they had been customers for at least three months.”
Three months of data was critical. It wasn’t just about proving demand. It was about proving outcomes, engagement, and the clinical metrics that payers care about. Brad’s team could show retention rates, symptom improvement, medication adherence—all the data points that demonstrate real value.
“We analyzed all the data and turned it into like a 30 page report with a bunch of, you know, charts and takeaways and insights. And then I just went knocking on every door I could find at Cigna and tried to get intros and finally found an audience.”
The Positioning: Fait Accompli Over Request
The most brilliant part of Brad’s strategy was the positioning. He didn’t ask for a pilot. He didn’t request a meeting to discuss partnership opportunities. He reframed the entire conversation.
“Here are the results of the pilot you guys didn’t know you were doing with us. Because a lot of healthcare companies get stuck in pilot purgatory. And I didn’t want them to even suggest that’s how we start together.”
Think about the power dynamics this creates. Instead of:
- Asking for permission → Presenting results
- Promising future outcomes → Showing actual outcomes
- Requesting resources → Demonstrating value already delivered
- Being evaluated → Being the evaluator sharing insights
Brad wasn’t a supplicant asking for a chance. He was a partner with valuable data about Cigna’s own members, offering insights they couldn’t get anywhere else.
What Made This Possible
This strategy only works if you build the right foundations. Brad made several critical decisions that enabled this approach:
Starting with a consumer model: Unlike enterprise-first companies that need contracts to launch, Brightside could acquire customers immediately and start generating data on day one.
Collecting insurance data from the start: Most cash-pay businesses don’t bother collecting insurance information. Brad understood this data would become his most valuable sales asset.
Waiting for statistical significance: 500 customers with three months of data isn’t arbitrary. It’s enough to demonstrate patterns and trends while being specific to a single payer population.
Investing in analysis: The 30-page report wasn’t a slide deck. It was rigorous analysis that demonstrated Brightside understood how to measure value in payer terms—not just customer satisfaction, but clinical outcomes and population health metrics.
Targeting strategically: Rather than spreading thin across multiple payers, Brad focused on building an overwhelming case with one major national payer first.
The Unit Economics Bet
The move to insurance wasn’t just about market access. Brad had a specific hypothesis about unit economics that made the complexity and effort worthwhile.
“Part of thesis there was more people are going to want to pay with their insurance. And when you think about the value proposition, if you’re going to get healthcare, whether you’re going to pay out of pocket or pay with your insurance, obviously your out of pocket cost is just way lower with your insurance.”
This translated to acquisition costs: “That translates back into this assumption or thesis that we could acquire those customers for a much lower acquisition costs, that our CAC would be much lower, and that our CAC to LTV ratio would be much more attractive inside the insurance networks rather than cash outside.”
The bet paid off: “We have dramatically lower acquisition costs because of the value proposition when we can accept someone’s insurance, we have a great LTV with insurance and great unit economics and revenue dynamics.”
The Broader Principle
Brad’s approach reveals a framework applicable beyond healthcare: when facing credibility barriers in regulated or conservative industries, build proof before seeking permission.
The principles:
- Design your initial GTM to generate the proof you’ll need for enterprise deals
- Collect data about your target buyers’ populations from day one
- Wait for statistical significance before approaching buyers
- Present completed analysis, not requests for evaluation
- Reframe from “will you pilot with us” to “here’s what we learned about your customers”
The strategy requires patience and capital efficiency. You need enough runway to build meaningful data with a cash model before you can convert to enterprise contracts. But for companies facing long enterprise sales cycles and credibility barriers, it can dramatically compress time-to-contract by eliminating pilot purgatory entirely.
Today, Brightside serves 135 million covered lives across commercial insurance, Medicare, Medicaid, and healthcare exchanges. That scale started with 500 cash customers and one audacious conversation that reframed pilot programs as fait accompli.
The lesson: in conservative, regulated industries, the fastest path to enterprise contracts isn’t always asking for permission. Sometimes it’s building undeniable proof first, then presenting the results.
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