Healthcare Should Be a Product
How the conviction that medicine was an engineering problem led a $657 million company to starve the one part of itself that worked
THE SITUATION
In January 2016, a former Google executive named Adrian Aoun incorporated a company that would try to do to the doctor’s office what software had done to almost everything else. Aoun was not a physician. He had run special projects for Larry Page, built an AI startup Google acquired, and spent time at Sidewalk Labs. The thesis behind Forward was that primary care — slow, expensive, rationed, human — was a product waiting to be re-engineered.
For its first several years, Forward looked like it might be right. It opened a chain of membership clinics — eventually nineteen to twenty-five locations, staffed by more than a hundred primary care clinicians, charging $149 a month, cash-pay, no insurance. The experience was genuinely nicer than the system it competed with. Capital agreed. Across five rounds Forward raised roughly $657 million, and at its March 2021 Series D it crossed into unicorn territory: a $1 billion valuation, with SoftBank’s Vision Fund 2, Founders Fund, Khosla Ventures, and Marc Benioff on the cap table.
Then, in November 2023, Forward announced what it had really been building toward. Not more clinics — CarePods: AI-powered, self-service diagnostic kiosks you would step into without a doctor present, do your own blood draw, and let the hardware run the visit. The plan was to deploy 3,200 of them within a year. Aoun reached for the obvious comparison: the clinics had been Forward’s Model S, the expensive proof of concept; the pods were its Model 3, the version that scales to the planet.
Twelve months later the count was not 3,200. It was five.
On November 13, 2024, Forward shut down. The app went dark, every location closed at once, and about two hundred people lost their jobs. A company that had been worth a billion dollars three years earlier simply switched itself off.
The easy filing is “tech founder over-engineers healthcare, runs out of cash.” That filing is not wrong, exactly. It is just aimed at the wrong moment. Because the clinics — the part of Forward that actually worked, the part patients were still using — did not fail. Forward took them apart on purpose.
It didn’t abandon what worked because customers walked away. It abandoned it because its own valuation told it to.
WHAT ACTUALLY HAPPENED
The stated rationale, from roughly 2017 onward, was scale. Healthcare reached too few people too slowly; the answer was to migrate everything doctors and nurses did onto hardware and software and roll it out everywhere at once. Capture the category, ship the machine, fix the margins later.
What was actually happening underneath that rationale was narrower and more uncomfortable. Forward had built a real business — but a capped one. The clinics worked at $149 a month in dense, affluent cities. They held a billion-dollar mark for three years. By every public signal Aoun ever gave, they were not failing; he called them a “critical development layer,” a stepping stone, never a mistake. What they were was structurally incapable of producing the returns their own valuation now demanded. A premium urban clinic chain is a good business. It is not a venture-scale one.
That gap — between a good business and the business the cap table had been priced for — is the whole story. Forward never disclosed clinic-level economics, membership counts, or churn, so the honest description stops at working-but-capped; “profitable” is a word the record doesn’t support. The company was, in fact, almost silent on numbers of any kind — which is what makes the one concrete figure it did commit to, 3,200 pods in a year, the cleanest measure we have of the distance between Forward’s self-image and its reality. But working-but-capped was enough to set the trap. Because the moment a company carries a billion-dollar valuation funded by blitzscale-era investors, “we are a very good premium clinic business” stops being a success and starts being a write-down.
Three distortions did the damage. They are not three unrelated mistakes — each one made the next easier to miss — but the record doesn’t support pinning down a single clean chronology, so what follows is presented in the order that makes the mechanism clearest, not as a claim that one finished before the next began. And this time the first one to take hold was not in the boardroom or in the venture market. It was in the founder’s idea of what medicine is.
THE DISTORTION LAYER
First: Bias — the engineer’s view of medicine
Competence transference is the assumption that demonstrated mastery in one domain carries into another where it has no tools. It is one of the most reliable distortions in founder-led companies, and the mechanism is almost never arrogance. It is the sincere belief that first-principles thinking can stand in for the domain judgment other people spent thirty years acquiring.
Aoun stated the bias plainly and without embarrassment, which is what makes Forward such a clean specimen. He described himself as not a medical doctor but a computer scientist. The goal, he said as early as 2017, was to scale doctors the way “an engineer can scale through software.” By 2023 the worldview had hardened into a slogan: “Healthcare should just be a product.” Take everything clinicians do, migrate it to hardware and software. “We don’t even believe a doctor’s office should exist.”
Read those statements as a thesis and they are merely ambitious. Read them as a lens — the thing through which every subsequent decision got interpreted — and you can see the damage they were about to do. Because if medicine is “just a product” awaiting migration to a machine, then a building full of human clinicians is not your most valuable asset. It is scaffolding. It is the thing you climb up and then kick away. The bias didn’t only produce the pod bet. It quietly recoded the working clinics as disposable — a “development layer,” in Aoun’s own framing — and in doing so it removed the one brake that should have stopped the company from cannibalizing the only part of itself that worked.
The Tesla analogy was where the bias put on its costume. Model S to Model 3 is a roadmap: a planned sequence, run from strength, in which nothing is failing and each step funds the next. That is a flattering story, and it was the wrong one. Forward’s clinics were not a springboard generating the cash to build the pods; they were a capped business being dismantled under financial pressure to fund an unproven replacement. The Tesla comparison wasn’t a description of what was happening. It was a vivid, available image standing in for an honest account of it — the availability heuristic doing exactly what it does, supplying a clean narrative precisely where a hard one was needed. And almost no one in the room was positioned to say so, because the people around the table were technologists and investors, not clinicians.
That’s the first distortion. The two that follow are where the company began starving the one part of itself that actually worked.