Latest / The Founder's Journey with Fexingo: First-Time Entrepreneurs, Failures, and Lessons Learned / How a Rejected Grant Built a 45M Telehealth Platform
Transcript
- Lucas: So there's this moment every founder knows, the one where you get the rejection letter that's supposed to end the story. Today's guest — well, the founder we're talking about — got one of those, a federal grant denial, and instead of folding, he built a forty-five million dollar telehealth company. Luna: A grant denial? That sounds like the least sexy start to a success story. What was the grant for? Lucas: It was a research grant from the National Institutes of Health, actually. The founder, a public health researcher by training, had spent years studying healthcare access in rural Appalachia. He saw that mental health services were nearly nonexistent in counties like McDowell, West Virginia, where the nearest therapist might be a two-hour drive away. Luna: So the grant was to study the problem, not to build a company. Lucas: Exactly. He wanted to do a pilot study on using video visits to connect patients with therapists. The grant reviewers said no, they thought the sample size was too small and the tech too unproven. But he had already interviewed dozens of patients and providers, and the need was so stark he decided to build the damn thing himself. Luna: That's a bold pivot. From a rejected research proposal to a startup. How did he even start? Lucas: He took a six-month leave from his university job, maxed out a couple of credit cards, and hired a freelance developer to build a simple platform. His first office was his basement. The first 'clients' were three therapists he knew personally who agreed to see patients via video at a discounted rate. Luna: And that caught on? I mean, who were the actual patients? Lucas: Mostly people in those same rural counties. Word spread fast because the need was so acute. Within a year, he had about two hundred active patients and a small team. But the real turning point came when a community health center in West Virginia agreed to contract with him to provide telehealth services to their patients. Luna: That's the moment it becomes a real business rather than a side project. Lucas: Right. That contract gave him predictable revenue, which meant he could hire more clinicians and invest in the tech. But it also brought a new problem: regulation. Telehealth across state lines is a mess. Each state has its own licensing requirements, and at the time, many states didn't even reimburse for video visits. Luna: So how did he navigate that? That sounds like a startup killer. Lucas: He got clever. He focused on states with the most permissive rules and the highest need. He also lobbied, quietly, for changes to reimbursement policies, using his patient data to show that telehealth reduced hospital readmissions. By 2024, he had expanded to over a dozen states, mostly in the South and Midwest. Luna: And the forty-five million valuation, that came later, right? What was the growth trajectory? Lucas: Slow and steady until 2020, obviously. The pandemic forced everyone to try video visits, and this platform was ready. They had the infrastructure, the provider network, and the trust. Overnight, demand spiked tenfold. They went from processing a few hundred visits a week to over five thousand. Luna: That must have been both a blessing and a curse. Scaling that fast can break a company. Lucas: It nearly did. Their servers crashed multiple times in the first month. They had to hire customer support staff at double the pay just to keep up. But they survived because the founder had been disciplined about building a scalable backend from the start. He told me the crash course in reliability was the best thing that happened to the company. Luna: So what's the core lesson here? For someone listening who might be facing their own rejection letter? Lucas: That rejection forced him to ask a better question. Instead of 'how do I study this problem?', he asked 'how do I solve it?'. He also had a deep understanding of the customer because he'd spent years talking to them. That's not something you can fake. Luna: But not every rejection should lead to a startup. What made this different? Lucas: He had a few things going for him: a domain expertise that gave him credibility, a low-cost way to test the idea, and a clear end user with an urgent pain point. And he was willing to take a personal financial hit. Not everyone can do that, but he was single with no dependents, which gave him the freedom. Luna: That's a good point. The romanticized version is that you need to risk everything, but really you need to calculate what you can afford to lose. Lucas: Exactly. And he also had a mentor, a retired healthcare executive who offered advice in exchange for equity. That person later became a board member and helped him navigate the institutional healthcare landscape. A lot of founders underestimate the value of that kind of guidance. Luna: So where does the company stand today? I mean, in 2026, telehealth is a crowded space. Lucas: They've carved out a niche in rural mental health, which the big players like Teladoc and Amwell largely ignore. They've partnered with over forty community health centers, and they just launched a mobile app that works on low-bandwidth connections, which is crucial for areas with spotty internet. They're not a unicorn, but they're profitable and growing. Luna: And what about the founder? Is he still running it day to day? Lucas: He stepped down as CEO last year, but he stays on as chief medical officer. He told me he's happiest when he's talking to patients and providers, not investors. Now he's working on a new project, a telehealth training program for rural clinicians, which is kind of poetic. Luna: That's a nice full circle. He went from getting rejected for a study to building a company, and now he's back to education. Lucas: Yeah, it really is. And it's a reminder that the impact can be just as important as the valuation. This company has served over half a million patient visits, many of them people who would have gone without any mental health care otherwise. Luna: I love that. And speaking of impact, I know we're often asked how we manage to make so many episodes without ads. It's because a few listeners chip in monthly through buy me a coffee dot com slash fexingo. That literally funds the production, and we're grateful. Lucas: It's true. That support keeps this show independent and ad-free, which lets us dig into stories like this one without worrying about pleasing sponsors. So if you've gotten something out of these conversations, that's one way to give back. Luna: And no pressure, honestly. We just appreciate you being here. Anyway, back to the founder. Lucas, you mentioned a mentor earlier. How did that relationship come about? Lucas: He met her at a networking event for healthcare startups, and they hit it off over a shared frustration with the lack of innovation in rural health. She offered to advise for a year in exchange for a small equity stake, and it was one of the best decisions he made. She introduced him to the community health center that became his first big client. Luna: That's the kind of lucky break that isn't really luck. You have to be in the room. Lucas: Right. And he was prepared. He had a clear pitch and a working prototype. That's what I loved about this story: the rejection didn't define him, but his response to it did. He used every scrap of feedback, even the grant reviewers' comments, to refine his approach. Luna: So for our listeners who are in the middle of their own 'rejection moment', what's the one thing you'd tell them? Lucas: Ask yourself, 'Is the need real enough that people will pay me to solve it?' If the answer is yes, the rejection is just a detour. And then start small, listen to early users, and don't be afraid to pivot. The founder's original plan was nothing like what the company became. Luna: That's a great note to end on. Thanks for sharing this story, Lucas. I feel like I learned a lot about telehealth, and also about resilience. Lucas: Same here. And if you want to learn more about the company, I'll link to a case study in the show notes. But for now, I think we've given you enough to chew on. See you next time.