Designing Care That Delights Patients and Gets Reimbursed

Executive Summary

• Value-based care looks compelling in theory, but in practice it’s hard to contract and scale.
• Fee-for-service can work extremely well when designed intentionally, with billable visits keeping the lights on and relationship-driven features driving engagement and outcomes.
• By handling operational backend, Bridge removed the FFS scaling bottleneck, rapidly expanding in-network coverage and enabling Neura Health to double covered lives in 30 days.

The awakening

When Liz Burstein started building Neura Health, a virtual neurology clinic, she came in as a self-described "starry-eyed digital health founder." She'd spent years at Maven Clinic and ZocDoc, and she had a clear thesis: neurology was a specialty with terrible access, long wait times, and a lot of unnecessary ER visits. Surely there were value-based care deals waiting to be made—per-member-per-month contracts with employers for migraine, Medicare Advantage partnerships for dementia care.

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Then reality hit. "There was this big awakening moment," Burstein says, "of like, the system is not as value-based as one would hope."

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That awakening is a rite of passage for virtual care founders. You design the care model you believe patients deserve, and then you discover that the reimbursement landscape doesn't match your vision. The companies that succeed are the ones who learn to navigate that gap.

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Companies like Neura figure out that there are transactions and there are relationships. The billable video visit is a transaction—the bread and butter of fee-for-service reimbursement. But patients don't fall in love with transactions. They fall in love with relationships. The secret to designing an exceptional care model is surrounding the billable visit with care that makes patients feel known—so they keep coming back for the encounters that sustain the business. The relationship is what differentiates you; the transaction is what sustains you.

A Google sheet and a six-month wait

Burstein's insight came from her own patient experience. She was dealing with a trapped nerve during early COVID, bouncing between pain management and physical therapy, and eventually got a referral to neurology—with a six-month wait. During that time, she built a Google sheet tracking her daily pain levels, diet, exercise, and sleep, trying to understand why her pain was a nine out of ten one day and a two the next.

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When she finally saw a specialist, she brought the spreadsheet and he quickly responded "I don't know what to make of all that data." Here was a patient who had done extensive work to understand her own patterns, and the care system had no way to absorb it. That disconnect became the seed for Neura's care model—a place where patients could track symptoms, share data with specialists, and collaborate on solving their condition rather than compressing everything into a fifteen-minute visit every few months.

Funding relationships through transactions

Today, Neura serves over 43,000 patients across eight major neurological conditions. And despite Burstein's original vision of value-based contracts, the business runs primarily on fee-for-service—standard neurology visit codes. Those visits are the transactions.

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But Neura also offers unlimited chat access to care teams, twice-monthly health coaching sessions, an integrated symptom tracking app, and personalized treatment plans. None of that is separately billable. Like One Medical, Neura found that a membership fee helps solve this equation—patients pay a subscription for the better experience, which funds the coaching, the chat, and the app. The membership revenue covers what insurance won't.

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"The membership model with the coaching is kind of like that engagement and accountability driver," Burstein explains. "When you look at what it takes to meaningfully address the root cause of migraine or really bring down the frequency of seizures, typically a one-and-done appointment is not going to solve the patient's issues." The relationship features aren't revenue drivers—they're what make patients feel cared for rather than processed. And that feeling keeps them engaged, which means they keep coming back for the visits that are billable.

Designing the visit itself for surprise and delight

Dr. Kate Mullin, Neura's Medical Director, has thought deeply about how to make even the transaction feel like part of a relationship. The problem is patients forget most of what's said in a real-time conversation, especially when they're in pain. "For headache patients, half the time they're in a headache and they're not really absorbing anyways," Mullin notes.

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So Neura redesigned the visit structure. "We dedicate a solid third of our visit to really communicating the plan," Mullin says. "We have a section in our note template that gets pushed straight to the patient through the app, discussing the medicines we prescribed, the conversations about lifestyle."

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"I always say to them, you might not be hearing me right now, but you're going to get it all written down," Mullin explains. "You can look it over slowly. And you always have those doorknob questions—find me later and ask them."

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The visit itself is billable—a transaction. But the thoughtful communication, the written summary, the invitation to follow up via chat—that's what transforms the transaction into a relationship.

The outcomes that prove it works

Neura has published peer-reviewed studies showing a 73% reduction in ER and urgent care visits, a 55% median decrease in monthly headache days, and a 95% patient satisfaction rate. These outcomes demonstrate that the relationship-building features—coaching, symptom tracking, between-visit support—produce meaningfully better results than status quo neurology.

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Neura covers more than 70% of what a brick-and-mortar neurology practice handles—the consultations, the medication management, the ongoing chronic care. The procedures that require hands-on work (nerve blocks, Botox, EEGs) stay in-person, but most of neurology is conversation and decision-making, which translates naturally to virtual care.

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Local neurologists don't see this as competition—they see it as relief. "When you get to the practitioner level, they know they don't have the bandwidth," Mullin says. "They know they're burning out and they know their patients are suffering. They're happy for the help." For stretched brick-and-mortar practices, Neura becomes bandwidth extension: they handle the consultations and ongoing management while in-person neurologists focus on the procedural work that requires their physical presence.

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"To really get our foot in the door with health plans, one of the biggest hurdles is the clinical evaluation," Burstein says. "Having the outcomes study gives us proof points for why virtual care could actually deliver better outcomes." The investment in publishing was about building the evidence base that opens doors.

Scaling with infrastructure

For years, Neura tried to piece together insurance contracting on their own. "We knew it was going to be slow, but it was even slower than we thought," Burstein recalls. Regional plans would claim their networks were closed, with no explanation.

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When Neura partnered with Bridge, their access to covered lives doubled within 30 days. Bridge handled credentialing and contracting, giving Neura access to a broad network of thousands of health plans without building that capability in-house. "Bridge came along much later than I wish they did," Burstein says. Once Neura had their care model working, the constraint wasn't clinical—it was operational. Solving that unlocked scale.

Building experiences patients love

Fee-for-service isn't going anywhere. But within that reality, there's room to build something patients love. Design a foundation of billable encounters that work within reimbursement constraints, then layer on features that make patients feel like they're in a genuine relationship with their care team. The transaction keeps the lights on. The relationship is what makes patients stay.

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