A couple years after I joined Kannact, we had made real progress. Patient satisfaction had climbed to 96%, engagement increased by 67%, and coach efficiency improved more than 3X. Net churn stayed below 2%, and patient NPS reached 82.

But even with those gains, the employer benefits space was changing quickly. Point-solution giants like Livongo and Omada had already captured much of the market, and renewals were tightening despite strong outcomes. It became clear that incremental improvements wouldn’t be enough. We needed to rethink where our strengths could matter most.

So we started looking beyond employers and mapping where real gaps existed… places where our experience in patient engagement, chronic condition management, population health, and virtual support could create meaningful clinical and financial impact.

We had already shown we could close HEDIS gaps inside Kannact’s employer-sponsored program. In managed populations, 85% of hypertensive patients achieved blood pressure control, and patients with diabetes saw a 1.7-point reduction in HbA1c, surpassing national HEDIS benchmarks. We were also seeing 28% fewer emergency room visits among supported patients, driven by earlier intervention and steadier follow-up.

At the same time, value-based care was accelerating. Primary care clinics and health systems were taking on more risk and needed partners who could extend care beyond the clinic walls.

That combination sparked the idea for a virtual clinic.

If we could help their patients stay healthier between visits, it would directly improve their value-based care performance… fewer avoidable hospitalizations, more stable chronic conditions, and more HEDIS gaps closed across their population. Those improvements translate into shared savings and real revenue under value-based contracts. And that’s exactly what these organizations cared about.

Validating the opportunity

We began landing demos with large health systems and integrated clinic networks, especially organizations that had tried to build RPM programs internally and found them too costly or difficult to scale, or those facing high total cost of care, readmissions, and capacity constraints.

I ran these demos alongside our CEO. I walked teams through the end-to-end experience and workflows, and he tied the model to financial outcomes and potential ROI. Even though the clinic was still largely conceptual, the response was strong. Leaders could see how our coaching model, device infrastructure, and demonstrated health outcomes could support their goals.

Because we were remote, we could offer more touchpoints, more follow-up, and more day-to-day support than most health systems could realistically provide. That mattered. Our model had already proven it could increase patient touchpoints by 50% without adding manual work for care teams, while maintaining high satisfaction and long-term engagement.

Those demos validated product-market fit well before the clinic technically existed. They gave us the confidence to evolve from an employer-focused coaching program into a true virtual clinic, which ultimately became the foundation for Starlight.

The Gap We Needed to Close

Our program excelled at lifestyle support and long-term engagement, but it didn’t yet meet the clinical or operational standards required to function as a virtual clinic.

At the time, we were missing:

• Licensed providers to deliver a New Patient Visit (a.k.a. evaluation and management (E/M) visit)
• Documentation, time tracking, and clinical oversight needed for E/M, RPM, and chronic care management (CCM) codes
• Structured insurance verification workflows
• A clean referral and intake process aligned with primary care and cardiology workflows
• Clinical documentation standards and a way to share structured notes back to providers
• Escalation pathways and medical decision making rules for high-risk situations
• Compliance workflows for telehealth, scope of practice, and multi-state care

Becoming a virtual clinic meant rethinking the entire model, end to end.

Creating Referral Pathways That Helped Us Become Part of Their Workflow

A clinic’s relationship with a patient starts the moment their provider makes a referral. That handoff needed to feel effortless for clinic staff and predictable for the referring team. So we built the referral experience first, because everything else depends on getting that moment right.

Providers could:

• Refer directly from their EHR, or use a secure landing page when their system didn’t support that
• Add notes or instructions about why they were referring the patient, including focus areas or context our team should pay special attention to
• Trigger an automatic text message to the patient with next steps on joining Starlight

Behind the scenes, we built:

• A predictable outreach sequence within hours of the referral
• A structured handoff that pulled in the clinical and contextual data we needed from the start
• Escalation rules for clinical concerns that needed to be shared with the referring provider
• Clear communication back to the referring provider, including regular reports on engagement, individual patient updates, and population-level trends

This made our clinic feel like an extension of their practice, not an external vendor. Instead of a fragmented referral, it created a trusted, predictable handoff that set the tone for everything that came after.

Creating a Transparent Insurance and Coverage Experience

Once a referral came in, the next step was helping patients understand their coverage. Cost came up in almost every first interaction, and for many people, this was the opportunity to build trust and the moment when they decided if they actually wanted to join.

To design this experience and teach it to my team, I spent weeks learning the entire process myself. I created a secure form to collect insurance details, tested the accuracy of cost estimates across multiple eligibility channels, and mapped out which service type categories our RPM and E/M codes fall under so we could return reliable out of pocket estimates.

I also called patients directly to explain deductibles, coinsurance, and cost expectations in plain language.

From that work, we built an intake model that delivered:

• A clear out-of-pocket estimate
• Transparent explanation of benefits
• Options for financial assistance
• A self pay pathway when needed
• Personalized follow up when coverage was unclear

Patients understood their coverage, and that transparency built trust quickly, contributing to referral conversion rates approaching 70%, even in complex clinical populations.

Capturing the Right Consents Before Care Began

Once coverage was clear, we needed to gather the consents that allowed us to deliver care safely and compliantly. This step had to be simple for patients and thorough enough to support clinical regulatory compliance.

I designed a consent flow that captured:

• Informed consent for Telehealth & RPM services
• Financial responsibility acknowledgement
• Notice of Privacy Practices
• Authorization for release of protected health information
• Caregiver involvement authorization

Placing this early in the intake ensured our clinical team had what they needed before the New Patient Visit. It also created clarity for patients so nothing felt unexpected later in their journey.

Designing the New Patient Visit

Next, we needed a medical visit that was warm, structured, and clinically sound. It was also a required step for establishing patients under the care of our Nurse Practitioners (NPs) so we could bill compliantly for RPM, CCM, and ongoing clinical support.

In the beginning, there were a lot of no shows. Although the visit was required for us, it was clear that patients didn’t yet see the value in it. We needed them to experience it not as a box-checking step, but as something truly helpful. A visit that allowed us to dig deeper into their health history and goals, create a personalized RPM plan, and make sure they had the right devices and testing frequency for what they wanted to work on.

Once we onboarded our NPs, I collaborated closely with them to define:

• Clear scripting to communicate the purpose and value of the visit
• Guidelines for device ordering and technical workflows for setting up RPM
• Documentation requirements for billing, compliance, and clinical accuracy
• A smooth post visit handoff to the coaching team with the right context and next steps

This visit became the foundation for clinical care.

Creating Internal Systems That Functioned Like a Clinic

Once the patient experience was defined, the next step was building the operational backbone. A virtual clinic only works if the systems behind it are as rigorous as the care in front of it.

Building the engine for compliant billing

Billing the new patient visit (E/M code) is simple. There’s a clear visit, and you submit the matching code.

RPM is more nuanced because the codes aren’t tied to a single visit. They depend on what happened over an entire month… time spent reviewing data, time spent talking with the patient, and the number of days the device was used.

To build our billing engine, we automated E/M claim submissions so new-visit codes go out in real time. RPM needed a different path, so we created a separate monthly billing job for that. It looks back at the past 30 days to total interactive communication time, chart review, and device-use days. Those monthly totals determine which RPM codes can be billed and keep everything accurate and consistent.

To stay compliant, we created:

• A way to track interactive communication time, chart review time, and daily device usage
• Monthly audits by a supervising or collaborating physician when required under NP licensing, payer rules, or internal quality standards
• Integration with a certified EHR so NP visit documentation could be linked back to our care management platform
• The billing coding job that integrated with several different platforms to automatically submit insurance claims

Defining critical alert and escalation pathways

Remote care requires a plan for every scenario. I designed escalation models for:

• Critically high and low glucose readings
• Hypertensive urgencies
• Gaps in device readings
• New symptoms after hospitalization

Each pathway included how to reach the patient, what to ask, when to escalate, and how to loop in caregivers and providers.

Integrating with our referring provider’s EHRs and workflows

To support large health systems, our documentation needed to flow back into their world. I designed our integration strategy using:

• EpicCare Link
• Health Information Networks
• CCDAs, medications, allergies, and encounter history
• Workflows for pushing visit notes and alerts back to providers
• Plans for structuring our data so it could map to FHIR as we scaled

This made our work visible and trustworthy inside the systems providers already used.

Building a Post Discharge Pathway for Higher Acuity Patients

As we partnered with large health systems, we began supporting people during the fragile transition from hospital to home. Their needs were different. Recovery moved quickly, and the first 30 days were often the most vulnerable. This was also the period when health systems were most focused on preventing avoidable readmissions, so the support mattered on both sides.

A more hands-on patient experience designed for acute care

I helped shape the scripting and requirements for our post-discharge program and wellness checks, which focused on:

• Reviewing discharge summaries
• Clarifying medication changes and tapers
• Screening for red flag symptoms
• Confirming follow up appointments
• Reviewing wound care and home instructions
• Identifying caregiver support

Integrating a 24 hour nurse line

We partnered with a 24 hour nurse line so patients had immediate clinical support when something felt off, whether a wound looked concerning, pain escalated, a new symptom appeared, or medication side effects changed. It also gave them clear guidance on when to seek care in person, which helped avoid unnecessary ER visits.

Monitoring with the right intensity

Supporting patients after a hospital stay required a different rhythm than chronic care, so we adjusted our touch points to match the pace of healing.

During the first one to two weeks, we checked in daily or near daily to catch issues early and keep patients grounded while everything still felt new. We built short term monitoring plans that adapted to their symptoms and device trends, and we created rapid escalation rules so any concerning change was addressed quickly.

As patients stabilized, we tapered our outreach so the support stayed present without feeling overwhelming.

Hiring health coaches with nursing and acute care experience

To deliver this level of support, we expanded our team with clinicians who were comfortable managing the complexities of acute recovery… people experienced with surgical cases, transplant patients, infection risk, fluid shifts, and fast moving symptom patterns.

Their skill set bridged the gap between the hospital and the home, helping us reduce preventable readmissions and giving patients the kind of steady, confident care they rarely receive after discharge.

The Clinic We Built

Building the Starlight Clinic wasn’t a single project. It was the work of threading strategy, clinical quality, operational design, and deeply human care into one coherent system. We created a model that health systems could trust, patients could understand, and teams could deliver every day without guesswork.

My role was to take an idea that lived in a slide deck and turn it into a functioning clinic: one with clear referral pathways, transparent onboarding, licensed clinical visits, reliable RPM operations, and transitional care strong enough to reduce readmissions. Along the way, I shaped the scripting, workflows, data models, escalation rules, and experience design that now anchor the program.

The result is a clinic that feels both modern and grounded in real care… a model that supports providers, strengthens patient safety, and blends technology with the kind of day to day support most health systems didn’t have the capacity to provide.

It is one of the things I’m most proud of creating.

The Impact

In 2025, the clinic we built grew into partnerships with Providence Swedish and MultiCare’s Pulse Heart Institute, two systems caring for hundreds of thousands of people across Washington. Seeing our model fit inside organizations of that scale has been one of the clearest signs that our work matters.

We also have a new pilot beginning in January with a hospital inside CHRISTUS Health, one of the largest health systems in the country. This pilot combines remote monitoring with a post discharge program, and if successful, it has the potential to expand across seven states and reach more than ten million people. We’re still in the early phase, but the partnerships and expansion opportunities ahead are incredibly promising.