For an entrepreneur, the biggest payoff is closing the circle

If you Google “phases of a startup,” you’ll see lots of up-and-to-the-right charts and rocket analogies. After launching a product or service, you can expect boosts— accelerating growth—and if you’re lucky, takeoff . A typical example looks something like this:







These charts may light a fire under aspiring entrepreneurs, but they don’t capture the real value and purpose in entrepreneurship. A business needs to grow revenue (among other things) to be viable, of course. But after cofounding two companies in two different industries, I now visualize one of the most important measures of progress not as a moonshot, but as closing the circle —getting closer and closer to delivering on the original mission and vision.



Let me explain.



A startup success story



I’ve been on the up-and-to-the-right ride before. In 2006, I cofounded a business to help individuals and businesses protect their privacy and reputation online, and Reputation.com (as it came to be known) was in many ways a textbook startup success story . We saw a problem—people were losing control of their identity in the Wild West of the internet—and we developed a solution that worked. In business-school terms, we had good product-market fit.



Seven years later, after multiple funding rounds and acquisitions, we had become the clear leader in online reputation management, and we were still taking off.



That’s when I decided to leave and let the team run from there. My heart just wasn’t in it anymore. Having grown up in a family of doctors and nurses, I’d always had my sights set on making an impact in healthcare. So for my second startup, I teamed up with a respected specialty physician at Stanford Medicine to launch a company called Grand Rounds.



A new startup



As with Reputation.com, we identified a problem—our country’s broken and expensive healthcare system—and we believed there was a better way. Our vision was to harness data and technology to improve experience and outcomes, lower costs, and create a better and more equitable healthcare system for everyone : patients, caregivers, doctors, insurers, and the employers who finance healthcare for most Americans.



It was a huge problem and an ambitious vision. But we started with a relatively small solution: second opinions. 



Before Grand Rounds, if people wanted a second opinion, on a cancer diagnosis, for example, they had to get on a plane and visit a specialist in person. But very few people had (or have) the wherewithal to do that. To close that gap, Grand Rounds collected patients’ records and info and connected them virtually to world-class experts, at a fraction of the cost.



The Wall Street Journal called us the “Mayo Clinic of the Internet.” It was a clever line, and a big moment of validation for our team of two—our first boost , you might say. But the Mayo Clinic analogy was a bit of a stretch.



For one thing, Grand Rounds didn’t provide care directly, like a hospital does; the second opinions we enabled certainly influenced and improved treatment plans—in an astonishing two-thirds of cases, actually—but the care itself was still managed by local physicians on the ground. Also, as critical as second opinions are, we knew they were just one sliver of a much bigger system and problem. The ultimate solution, we knew, would actually have to be much bigger than the Mayo Clinic.



From day one, we knew that delivering virtual care, specialty care specifically, was key to realizing our vision. Specialty care dominates the U.S. healthcare system, and it’s where the sickest and most expensive patients show up; it’s where the pain in the system is, both literally and figuratively. Second opinions addressed only some of those pain points, but it was the right place to start.



Though it seems like a baby step in hindsight, second opinions were doable and scalable with the technology we had then. In 2012, telehealth was still in its infancy, limited to a handful of niche players offering urgent care, online therapy, or remote consultations for rural hospitals. Reliable, HIPAA-compatible video conferencing was still years away, as was the regulatory framework that now enables doctors to see patients virtually across state lines. It would take a global pandemic to move the needle on that.



Closing the circle



We’ve come a long way from second opinions. Grand Rounds gradually expanded our healthcare navigation services and merged with a virtual urgent and mental health care provider, Doctor on Demand, to create the company we now call Included Health. Along the way we’ve added virtual primary care, programs for chronic and complex conditions, and specialized clinical support for the LGBTQ+ and Black communities. We now employ about 1,000 clinicians and provide care to millions of people across the U.S.



Earlier this month, we launched a virtual specialty care clinic, bringing us right back to where our journey started. Just as 2012 was the right moment for virtual second opinions, now is the right moment to begin providing virtual specialty care at scale. We always knew we’d get here, but now we’re ready, the market is ready, and the technology and infrastructure have caught up.



I no longer see our company as only heading “up and to the right.” Instead of just propelling us off the chart, our growth has empowered us to continue systematically diagnosing and addressing the remaining pain points in healthcare. With each new product or capability, I like to think we’re adding another segment to the circle, steadily closing the gap between what’s possible today and our original vision. In fact, if I had to stand in front of a business school class today and draw a chart of our purpose, it would look something like this:





Entrepreneurs and entrepreneurs-to-be may not like the idea of going in circles. But that’s how I’ve come to measure our success, right alongside sales, revenue, and impact. At a time when everyone seems focused on going “to the moon” (or to Mars), entrepreneurs will find a different kind of reward in closing the circle.



Owen Tripp is the cofounder and CEO of Included Health .