5 Ways Healthcare Startups Are Managing Uncertainty

In the high-stakes arena of healthcare, uncertainty isn't a bug —it's a feature.
For starters, healthcare represents one of the most complex sectors in our economy—a labyrinth of regulatory requirements, reimbursement challenges, clinical validation hurdles, and stakeholder demands. Much of the industry relies on federal government cooperation and funding, creating dependencies that can shift with political winds. Building profitable business models within these constraints requires extraordinary creativity and persistence.
Managing uncertainty is a constant for most start-ups, particularly those in health-care.
And yet, within this landscape of perpetual uncertainty, exceptional leaders are forging paths forward. I sat down with some of the leaders whose companies made it to this year's Fierce 15 – a list of start-ups within the healthcare arena to better understand how they manage it.
Here were the five strategies that surfaced as common denominators among some of healthcare's most resilient start-ups:
The first step in taming uncertainty is to name it.
Kurt Roots, CEO of Bend, is candid about the challenge inherent within healthcare. "Trying to make changes in health care in this country is hard. These providers we meet with hear what we do and say, 'This is brilliant. We should be doing this tomorrow.' And then we have to go through all the business people, finance people, and legal people—all these hurdles to actually get something done."
Michelle Davey, CEO and founder of Wheel, acknowledges – both to herself and her team – that 'being in a startup is incredibly difficult. Being in a healthcare startup is even more difficult.' Within the confines of a complex legal infrastructure, "you have to will something into existence."
This candor – something that most CEOs are expressing openly to their teams – serves a key function: it transforms ambiguity from something teams try to avoid into a recognized part of the landscape they're equipped to navigate together. By naming it, they tame it – a strategy that's well supported by neuroscience.
When the path forward is shrouded in uncertainty, clarity becomes critical. Healthcare innovators counterbalance external uncertainty by creating internal clarity about what success looks like.
Elaine Purcell, co-founder and COO of Oula, distilled this principle to its essence: "Roles and goals. If I could boil down good management and leadership, it's making sure everyone is extra clear on the goals. That's mission, metrics, milestones. And then everyone needs to know what their role is in achieving that."
This clarity provides a strategic lighthouse that helps teams navigate regardless of what storms arise. And it's important to be clear not just about what they want to achieve, but how they go about achieving it.
Tracy Letzerich, VP of People at Wheel, emphasizes the power of being precise with language. Wheel replaces "high velocity" as a value with "accelerate impact"—a subtle but powerful shift which makes way for focusing on what truly drives success. "In innovative, fast-changing environments, success hinges on ruthless prioritization. Scanning the landscape of a hundred possibilities and relentlessly zeroing in on the three initiatives that will drive the greatest impact to the business is critical."
Dan Nardi, CEO of Reimagine Care, reinforces clarity with the right business tool: "I introduced Slack to the company right after I joined, but I didn't force it on anyone. I asked a few people to try it out with me and we evaluated the pros and cons. At the end of the day, they weren't quite sure, and I said, 'I'm going to make the decision. We're going to do it.' And people love it now, it's become an important platform for our remote culture."
In environments where everything seems important and urgent, this ability to be and to operate clearly helps move the team forward.
The multiple demands of healthcare innovation create a perpetual temptation to fragment attention—precisely when full engagement is most necessary. Leaders recognize that their own presence sets the standard for how their organizations respond to uncertainty.
Purcell describes her commitment to be 'fully present in whatever I'm doing. If I'm with my kids, my phone is away. Because if you're trying to do both at the same time, you're not going to do either well.' This presence extends beyond individual focus to creating meaningful connection within distributed teams.
Nardi has instituted specific practices to cultivate presence across his remote organization: "We set up morning coffees at 9:30 every Monday. It's totally optional. Come for five minutes if you want, come for the whole time, or don't come at all. Sometimes it's just me hanging out by myself. Sometimes we've got 25 people there."
This can be challenging, to be sure. The demands of having to run multiple work-streams and achieve ambitious milestones can deprive leaders from their ability to focus on the task ahead. But when leaders cultivate habits of the mind to actually be present with themselves, and their teams, success unfolds.
In environments of high uncertainty, no single perspective captures the complete picture. Healthcare leaders recognize that continuous feedback is the only way to grow. And, it's often the thing that they say is what's missing the most.
Michelle Davey identifies this directly: 'Feedback is what's missing the most. We're giving feedback to get better.' Purcell highlights that leaders particularly struggle with 'courage and making the unpopular decision,' noting the challenge of balancing "the team's perspective and the broader organizational perspective" in difficult conversations.
But just because feedback can be hard doesn't mean there aren't effective strategies to enable it. Tracy Letzerich describes how Wheel is "intentionally cultivating a feedback-forward culture, which is especially critical in startup companies, where feedback is often deprioritized or avoided entirely. Building this muscle sets the foundation for high performing teams."
She emphasizes that good feedback requires good framing: "A 'micro yes' is important to signal that feedback is about to be given. It cues the brain to shift into a mode where it can actually process and absorb input. Something as simple as, 'Can we talk about how that discussion went yesterday?' gives the other person a moment to prepare and receive the feedback."
This commitment to honest, well-delivered feedback creates organizations capable of self-correction—the essential capacity for navigating uncertain environments.
Finally, when the only certainty is change itself, adaptability becomes the ultimate competitive advantage. Leaders of healthcare's most promising startups recognize that their plans and assumptions will inevitably collide with evolving realities—and prepare their organizations accordingly.
Kurt Roots identifies resiliency as a foundational attribute of the hires Bend makes because "there is just constant change in a startup environment." This resilience extends beyond individual mental toughness to organizational adaptability.
When hiring in uncertain environments, Purcell prioritizes flexibility over experience: "When you're in a really early stage with so few roles, it feels like the pressure is on to get the perfect hire who has done the role before. But my perspective has shifted toward competencies, particularly resilience and flexibility."
Davey reinforces this view: 'People who have high agency and can get out of bed and not be afraid—those people in our company succeed.'
Dan Nardi emphasizes that adaptability requires both structure and versatility: "We are doing a lot with a lean team, we definitely punch above our weight class. Our Reimagineers are super talented and they're here for the right reasons. But I'm pushing people—I'm asking for a big commitment with the promise that we're improving people's healthcare journey, the promise of the next big client, the promise of securing the next round of funding."
Perhaps most importantly, leaders model that adaptability isn't just about endurance—it requires intentional recovery. Purcell advocates taking actual vacations: "Focus hard on being on vacation and taking a break so that when you come back, you're fully into the work you're doing."
This balanced approach recognizes that adaptation isn't an endless push forward but a rhythmic dance of engagement and renewal.
What distinguishes healthcare's most promising innovators, then, isn't freedom from uncertainty — it's the ability to navigate it. By naming uncertainty clearly, prioritizing clarity, cultivating deep presence, encouraging continuous feedback, and building adaptability at every level, health care leaders are transforming what could be debilitating ambiguity into strategic advantage.
For the healthcare ecosystem to evolve into something more sustainable, accessible, and effective, we need precisely these skills—not just to survive uncertainty, but to harness it as the catalyst for transformation that healthcare so desperately needs.

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