Circadian and Bridge: Reimagining Specialty Care for Cardiometabolic Health, nationwide

Executive summary

• Circadian, a national virtual specialty care provider integrating endocrinology, cardiology, pulmonology, and sleep medicine, has partnered with Bridge to accelerate its nationwide insurance expansion.
• By leveraging Bridge’s API-first infrastructure, Circadian unlocked coverage for over 80% of commercially insured and 70% of Medicare Advantage lives within 30 days. This eliminated the need for a costly, 18-month internal buildout.
• The partnership allows Circadian’s leadership to stay focused on clinical excellence and scaling its integrated cardiometabolic care model, while Bridge powers the insurance infrastructure behind the scenes—enabling rapid growth, predictable revenue, and nationwide reach.

Circadian’s approach to redefining cardiometabolic care

Most people managing chronic conditions like diabetes, sleep apnea, hypertension, or heart disease see multiple specialists—an endocrinologist for blood sugar, a cardiologist for heart health, a sleep doctor for apnea, a pulmonologist for breathing issues. But these conditions don't exist in silos. They're interconnected, each influencing the others in ways that fragmented care often misses. And traditional specialty care faces two critical challenges: capacity to manage patients in real time and access to expertise. Even when specialists are available, their clinics lack the time and infrastructure for real-time monitoring and proactive intervention—patients typically wait 90 days for appointments and receive episodic check-ins rather than continuous care. More fundamentally, many communities across the United States don't have an endocrinologist, heart failure specialist, or pulmonologist within reasonable reach. This leaves patients without adequate care options and health plans struggling to meet network adequacy requirements.

Circadian was founded on a unique vision: integrated virtual specialty care that treats the whole patient, not just individual conditions.

Led by CEO Gregg Kimmer and Chief Medical Officer Dr. Sandeep Palakodeti, Circadian brings together specialists in endocrinology, cardiology, pulmonology, and sleep medicine to deliver coordinated, longitudinal care for adults managing complex cardiometabolic health conditions. Instead of bouncing between disconnected appointments, patients work with a care team that understands how their metabolic health, cardiovascular risk, sleep quality, and respiratory function are all connected.

But building a virtual specialty care practice—especially one spanning four distinct clinical verticals—comes with operational complexity that most founders underestimate. For Circadian's leadership team, the question wasn't whether to accept insurance (that was essential for patient access), but how to build the infrastructure to do it well, nationwide.

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"We're not just treating sleep apnea or diabetes. A consistent care team is managing multiple complex conditions for a patient over time—their metabolic health, cardiovascular risk, sleep quality, and respiratory function—all in one coordinated care model." — Dr. Sandeep Palakodeti, Chief Medical Officer

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The Circadian patient experience

From a patient's perspective, Circadian works like this: You start with a comprehensive intake assessment that looks at your full health picture—your sleep patterns, metabolic health, cardiovascular risk factors, and respiratory function. Based on that assessment, you're matched with a care team of specialists and equipped with cellular-enabled remote monitoring devices. These devices are plug-and-play tools that automatically transmit your health data directly to your care team. A continuous glucose monitor tracks your blood sugar patterns in real-time. A cellular blood pressure cuff sends readings to your team. A pulse oximeter monitors your oxygen levels for your pulmonologist. A connected scale tracks weight trends. And a home sleep study device helps your sleep medicine specialist diagnose and treat sleep apnea. Your care team is monitoring your health continuously through Circadian's integrated platform and can intervene proactively when they spot concerning trends. Throughout your care journey, your specialists work as a coordinated team—not separate doctors sending separate bills and making separate recommendations, but an integrated care team with a unified treatment plan informed by real-time data. All visits happen virtually, with flexible scheduling that fits your life. And because Circadian accepts insurance, you're using your existing coverage for both specialist visits and remote monitoring.

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Circadian’s impact

By partnering with local primary care services, Circadian functions as a specialty clinic in the cloud connected via remote patient monitoring across all 50 states. This ensures timely diagnosis and treatment, better outcomes and adherence, and cost savings for all stakeholders. Under Circadian’s care, patients see:

• A 24-48 hour wait for specialists, instead of 90 days
• HbA1c is reduced 1.56 points for patients presenting above 9
• A 22% decrease in hospitalizations
• A 40% improvement in quality measures

When patients get better care, all stakeholders benefit.

The Challenge

Circadian built a world class care model that fundamentally changes how specialty care is delivered. But they faced a big dilemma: how to scale their integrated care model to all 50 states quickly enough to meet the expectations of both their investors and the major health plans?

Large health plans want to work with telehealth companies that can serve their members nationwide, not state-by-state. But achieving that kind of reach traditionally requires building massive infrastructure in-house.

For brick-and-mortar practices, this infrastructure already exists and they only need a handful of contracts. They can partner with established billing companies and practice management organizations that have spent decades building these capabilities. But telehealth companies have historically had to contract across hundreds of plans and build everything from scratch—there simply weren't infrastructure partners designed for virtual-first care delivery.

Circadian had deliberately kept their operations simple by leveraging value-based care arrangements instead of traditional fee-for-service billing. But even with that simplified approach, building the infrastructure to scale nationwide would take years.

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The "build vs. buy" math:

• Timeline: 12-18 months minimum to build contracting, credentialing, enrollment, and RCM operations
• Team: specialists in credentialing, billing, compliance, and payer relations
• Cost: millions spent on in-house employees
• Opportunity cost: Leadership focus diverted from clinical excellence to billing operations

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"Care delivery is our core competency. Bridge lets us focus 100% of our energy on what we do best—delivering integrated specialty care that improves patient outcomes." — Dr. Sandeep Palakodeti, Chief Medical Officer

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The strategic question was clear: Should Circadian spend years building billing infrastructure, or find a partner who had already solved it—and stay focused on delivering exceptional integrated specialty care?

The “aha moment”

When Circadian evaluated their options, the calculus was straightforward. As a startup, each funding round buys 18-24 months of runway. If building national insurance infrastructure internally would consume that runway—sacrificing capital and the leadership team's focus—that left almost no time or resources to actually build and scale their clinical programs.

For startups, time and money are the two resources you must use most wisely. Bridge offered a way to preserve both.

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Speed to market

Bridge gave Circadian something that would have taken years to build internally: immediate access to 500+ payer contracts covering 200 million lives across all 50 states. No multi-year negotiation cycles and no state-by-state contract buildout. From day one, Circadian could tell major health plans, "Yes, we can serve your members in both Walla Walla, Washington and Topeka, Kansas, today."

The credentialing and enrollment process that traditionally takes months per payer was condensed to 30-45 days across multiple payers simultaneously. Bridge clients go from contract signing to seeing their first insurance patients in under 60 days.

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"Bridge gave us something we couldn't buy anywhere else— time. Instead of spending 18 months building billing infrastructure, we spent that time building our clinical programs and serving patients." — Gregg Kimmer, CEO

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Operational simplicity

Rather than hiring people across credentialing, billing, compliance, and payer relations—or stitching together multiple point solutions—Circadian had one partner managing the entire insurance stack: contracts, credentialing, enrollment, eligibility verification, claims submission, denials management, clinical quality, and compliance monitoring.

Bridge handles the complexity behind the scenes. Circadian's team stays focused on clinical operations.

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Focus on core competency

Bridge solved a problem that has plagued telehealth companies for years: Before Bridge existed, digital health companies had to be excellent at two completely different things—delivering great care AND building insurance billing infrastructure.

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Financial prediction

Bridge also assumed the financial risk of reimbursement. No bad debt on Circadian's books. Predictable revenue. Aligned incentives—Bridge succeeds when Circadian succeeds.

The implementation

One of Bridge's differentiators became immediately clear during implementation: they're a technology company that happens to solve insurance billing, not a billing company trying to bolt on technology.

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Seamless technical integration

Bridge's platform is built API-first, designed to integrate cleanly with a client’s existing tech stack. The technical documentation was clear, the API endpoints were well-designed, and Bridge's engineering team was responsive when Circadian's developers had questions. For a telehealth company building a modern care platform, this technical approach was essential—Bridge felt like a technology partner, not a legacy vendor.

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"It was refreshing to work with a healthcare partner that acts with the speed and attention to detail of a tech company." — Gregg Kimmer, CEO

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From contract to first visit

But Bridge didn't just hand over API documentation and wish Circadian luck. The implementation team provided white-glove support throughout the launch process. The result: providers were credentialed and enrolled across multiple major payers. Real-time eligibility checks were integrated into their booking flow. Claims were processing smoothly from day one.

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Ongoing Partnership

The relationship didn't end at launch. As Circadian scales—adding new providers, expanding service lines, and growing visit volume—Bridge scales with them. The infrastructure is already there, the processes are proven, and the partnership continues to enable Circadian to focus on what they do best: delivering exceptional integrated specialty care.

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"Bridge made the complex feel simple. The tech integration was smooth, but what really stood out was their team—always responsive, always focused on getting us live as quickly as possible." — Gregg Kimmer, CEO

Lessons for virtual care founders

Circadian's experience offers clear strategic lessons for digital health founders:

1. Speed to market is a competitive advantage: In digital health, delayed launch means lost market opportunity. Partner to move fast, build internal expertise in your core clinical model.

2. Preserve your runway for what matters: If building insurance infrastructure would consume 18-24 months of an 18-24 month runway, you're spending your funding round on non-core-competency operations instead of growth.

3. Focus on your core competency: Circadian's value proposition is integrated specialty care. Bridge's value proposition is insurance infrastructure. Partnership allows each to excel in their domain.

4. One partner beats multiple vendors: Managing separate vendors for credentialing, billing, and compliance creates operational overhead. A single end-to-end platform from a focused partner means simpler workflows and clearer accountability.

5. Financial risk mitigation matters: Bad debt from denied or underpaid claims can significantly impact margins. A partner who assumes reimbursement risk creates more predictable unit economics.

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"If we had tried to build this ourselves, we'd still be negotiating our first contracts. Bridge let us focus on what we do best—delivering great patient care." — Gregg Kimmer, CEO

Are you a health plan or employer? Join Circadian in transforming healthcare.

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Ready to start growing your telehealth company quickly?

• See how Bridge can help you go from idea to insurance billing in weeks
• End-to-end platform: contracts, credentialing, billing, compliance
• Partner who assumes reimbursement risk = more predictable unit economics

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