How to Shift from Direct-to-Consumer Healthcare to B2B2C

A practical guide for founders who’ve hit the DTC ceiling—and know it.

About the Author: Cameron Jacox is the founder of Rocket Digital Health, the foremost digital health scale platform. Go-to-market is hard in healthcare, and we believe that you don’t need to reinvent the wheel to bring your brilliant invention to market.

A practical guide for founders who’ve hit the DTC ceiling—and know it.

Most DTC healthcare companies don’t fail because the product is bad.

They fail because the economics quietly stop working.

CAC creeps up. Retention looks fine—until you realize it’s compensating for acquisition fragility. Brand stops compounding and starts renting attention from Meta, Google, and Apple. Growth becomes spend-driven instead of insight-driven.

At that point, teams start saying the phrase that sounds strategic but usually isn’t:

“We should go B2B2C.”

Sometimes that’s right. Often it’s disastrously wrong.

This post is about how to make that shift intentionally—and when not to make it at all.

1. Why DTC Healthcare Breaks at Scale (Even When It Looks Healthy)

DTC healthcare works best in the early innings because it’s fast, controllable, and informationally rich. You learn quickly. You see every step of the funnel. You own the relationship.

But it breaks for structural reasons:

CAC inflation is not a temporary problem

Healthcare is an inherently competitive attention market. Once you educate a category, everyone piles in. You don’t get rewarded for pioneering—you get punished with higher bids.

Trust plateaus

Healthcare decisions are not impulse purchases. At some point, ads stop working harder. Incremental spend produces diminishing belief, not just diminishing clicks.

Behavioral friction is real

Even when someone believes you, healthcare requires effort: scheduling, showing up, follow-through. DTC funnels carry more friction than most founders model.

Margins are fragile

Healthcare margins often depend on volume, utilization, or downstream monetization. When CAC rises faster than LTV expansion, the math snaps.

Platform dependency is existential

If one policy change, attribution shift, or auction dynamic can materially alter your business—your business is not durable.

At scale, DTC becomes a treadmill, not a flywheel.

2. B2B2C Is Not “Enterprise Sales With a Wrapper”

Here’s the first mistake teams make:

They think B2B2C means replacing marketing with sales.

It doesn’t.

B2B2C introduces a second buyer and a second incentive structure. That’s not leverage by default—that’s complexity.

Some hard truths:

• Distribution ≠ demand
  An employer, health plan, or channel partner agreeing to “offer” your product does not mean end users will adopt it.

• Contracts ≠ revenue
  Signed agreements feel like progress. They are not usage.

• Logos ≠ outcomes
  A Fortune 500 logo can mask a fundamentally broken activation model.

• Misaligned incentives kill adoption
  If the buyer doesn’t feel economic pain when users don’t engage, you own the downside.

Most failed B2B2C healthcare companies didn’t have a bad product.
They had no credible theory of why the end user would actually act.

3. Why B2B2C Does Work—When It Works

When B2B2C works, it’s not because sales replaced marketing.

It’s because economics, trust, and behavior shifted simultaneously.

Here’s what actually changes:

1. Risk transfer

You’re no longer front-loading all acquisition risk. Some of it moves upstream—to an employer, plan, provider, or institution with budget and incentive.

2. Trust inheritance

Healthcare trust is asymmetric. People trust employers, doctors, and insurers more than ads, even when they complain about them.

You borrow trust instead of buying attention.

3. Cost externalization

Enrollment, education, and sometimes payment are partially subsidized by the channel partner. Your CAC is no longer purely media-driven.

4. Funnel compression

The buyer has already “pre-sold” legitimacy. Your funnel is shorter, even if it’s slower.

5. Behavioral pre-commitment

Benefits enrollment, referrals, and care pathways create default behavior—which matters more than persuasion in healthcare.

This is why B2B2C can unlock scale that DTC cannot.

But it only works if all five are true. Miss two, and you’ve just added sales drag without economic relief.

4. The Hidden Operational Tax of B2B2C

Founders often underestimate this part.

B2B2C extracts a tax you don’t pay in DTC:

Slower feedback loops

You lose immediate signal. Product decisions lag quarters instead of weeks.

Sales-led roadmap distortion

Enterprise buyers push for features that improve procurement, not outcomes. Weak teams comply. Strong teams say no and lose deals.

Integration drag

SSO, eligibility files, claims data, reporting—none of this compounds. It just consumes engineering time.

Procurement gravity

Once procurement is involved, pricing, timelines, and scope are no longer yours. Margin erosion often hides here.

This is why many DTC-born teams feel like execution got worse after “going B2B”—when in reality, the system just got heavier.

5. The Real Inflection Point: When You Must Evolve

There’s a specific moment when DTC stops being the right primary motion.

It usually looks like this:

• Growth is explainable primarily by spend, not insight

• Brand lift no longer lowers CAC meaningfully

• Retention metrics look good but mask acquisition decay

• Incremental creative and channel tests no longer move the curve

• You are “optimizing” instead of discovering

At that point, staying pure DTC is not discipline—it’s denial.

The question is not whether to change the model.
It’s how far to change it.

6. A Practical Decision Framework

Here’s the framework I actually use.

Stay DTC if:

• You still have genuine CAC arbitrage

• You control a differentiated channel or audience

• Usage is high-frequency or habit-forming

• Expansion revenue is real, not theoretical

Hybridize if:

• DTC still works, but only with increasing effort

• Certain segments respond far better to institutional trust

• You can pilot B2B2C without re-architecting the org

Go full B2B2C if:

• Unit economics materially improve only with upstream buyers

• Distribution partners have aligned financial incentives

• You can enforce adoption, not just offer access

Do not do B2B2C if:

• You’re chasing logos for fundraising optics

• You don’t have a credible activation thesis

• Your product requires heavy consumer motivation

• You can’t survive longer sales cycles financially

This last category is bigger than most founders admit.

The Contrarian Take

B2B2C is not “more scalable” by default.

It is more brittle operationally—but more durable economically when aligned.

DTC fails loudly.
B2B2C fails quietly—under the surface of contracts, pilots, and “strategic partnerships.”

The companies that win are the ones that treat the shift not as a go-to-market tweak, but as a full systems redesign: incentives, metrics, product, sales, and expectations.

If you’re going to make this bet, make it deliberately.

Because half-measures don’t hedge risk—they compound it.

Learn more.

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