Uptiv Health’s Pre-Launch Gamble: Why Torben Nielsen Spent 6 Months on Payer Contracts Before Treating a Single Patient

Most healthcare startups prove demand first, then negotiate insurance. Torben Nielsen bet everything on the opposite approach. Here’s why removing structural barriers before launch is acceleration, not delay.

Every founder faces the same pressure: get to revenue as fast as possible. Prove demand. Show traction. Use that momentum to unlock the next thing. But in markets with structural gatekeepers, this approach creates a trap that kills momentum before it starts.

In a recent episode of Category Visionaries, Torben Nielsen, CEO and Co-Founder of Uptiv Health, revealed the most important go-to-market decision he made: spending six to seven months securing contracts with every payer before opening a single clinic. No revenue. No patients. No proof. Just a bet that removing the biggest barrier first would unlock everything else.

He was right. Within 12 months of opening, over 150 unique providers were referring patients. The company achieved a 99 NPS score among patients and 87 among referring providers. Their first center became cash flow positive. And none of it would have happened without those six months of pre-launch work that most founders would call delay.

The Healthcare Chicken-and-Egg Problem

Healthcare has a structural problem that destroys momentum: specialists won’t refer patients without payer contracts, payers want volume before contracting, and patients won’t come without insurance coverage.

Most founders try to brute-force through this cycle. Launch with limited coverage, sign up a few patients who happen to have the right insurance, use that small volume to negotiate more contracts, gradually expand coverage, slowly build referral networks. It works, but it takes years.

Torben saw this trap from his previous company, HealthSparks, where he scaled a price transparency platform from 11 people to over 100, landing at number 196 on the Inc. 5000 list. He spent five years at Cambia Health Solutions before that, building member-centric services for a major payer. This wasn’t theoretical—he’d lived inside both sides of the healthcare payment system.

“We decided very early on that it was important for us to get on contract with all the payers so we could see patients regardless of what insurance company they had,” Torben explained. “Actually, you know, six to seven months before us even opening up our first clinic, we started working with payers to get on contract.”

Why Payers Actually Want This

The counterintuitive insight is that payers have their own problems that make them surprisingly receptive to new infusion providers. Hospitals are experiencing capacity issues. Aging populations need more infusions. New therapies are coming to market. Better diagnostics mean more chronic conditions are being identified and treated.

And hospital-based infusion is expensive. “Nobody wants to go to a hospital, right?” Torben noted. “It’s very hard to find parking. It’s hard to find the building where you’re going to get the infusion. Once you find the building, maybe it’s up on the third floor. Once you get to that third floor, then it tends to be an open room where chairs are just lined up in a row, where you almost take a number, you take a seat and then you get your infusion over the next couple of hours.”

Uptiv’s retail-based model costs 40 to 70 percent less than hospital settings while delivering dramatically better patient experiences. For payers dealing with capacity problems and cost pressures, this isn’t a risk—it’s a solution to two problems they already have.

Torben’s experience at HealthSparks gave him credibility and connections. He understood how payers evaluate new providers. He could articulate the cost savings in their language. He had relationships from selling price transparency software to health plans for years.

But most importantly, he had conviction that this would work because he’d seen the alternative: trying to build momentum without full payer coverage creates a self-fulfilling prophecy of slow growth.

How It Changed Everything After Launch

When Uptiv opened their first clinic in Detroit with all payer contracts secured, the sales motion became remarkably simple. They hired a salesperson to knock on specialist doors with one message: “Give us just one patient and we will show that we can deliver on that promise.”

This pitch only works because of the payer contracts. A specialist won’t risk sending a patient somewhere that might not be covered by insurance. The administrative headache alone prevents referrals. But with every payer contracted, specialists face zero barriers to trying Uptiv.

The company also removes all the other friction that makes infusion painful for medical practices. “We will do the prior auth, we will collect all patient information, medical information that’s needed for this infusion to take place,” Torben explained.

Specialists doing in-office infusion deal with constant headaches around payer contracts, wholesaler contracts for drugs, prior authorizations, and patient intake. It’s operational overhead that distracts from medicine. Uptiv absorbs all of that while getting patients in chair faster and delivering better experiences.

The referring provider NPS score of 87 reflects real value creation, not just satisfaction. Specialists become advocates. They talk to other specialists. The network effect compounds. Over 12 months, 150 unique providers started referring patients to just two centers.

“I think we decided very early on that it was important for us to get on contract with all the payers so we could see patients regardless of what insurance company they had,” Torben reflected. “And I think that was a key decision that we made because we started on that very early. Actually, you know, six to seven months before us even opening up our first clinic, we started working with payers to get on contract. And so when we open our doors, were on contract with all the payers and we could see all patients. And that just opened up the funnel and was really important for us to start taking care of patients.”

The Unit Economics That Follow

The payer contract strategy also unlocked faster path to profitability. Healthcare businesses typically struggle with long sales cycles and slow ramps. By securing all payer contracts before opening, Uptiv compressed what could have been years of building credibility and volumes into months.

Their first center became cash flow positive in just over 12 months. The second is tracking even faster. “At full scale, when we are at steady state for any one of our centers, those centers will return about, you know, anywhere from a mil to a mil and a half in positive cash flow,” Torben shared.

This unit economics story only works with volume. Volume requires specialist referrals. Referrals require payer contracts. The six-month investment in contracts enabled the 12-month path to profitability.

The Principle Beyond Healthcare

This lesson extends far beyond healthcare. In any market with structural gatekeepers—platform partnerships, enterprise procurement, regulatory approval, industry certifications—founders face the same choice: prove demand first or remove barriers first.

The instinct is always to prove demand first because it feels lower risk. You’re not betting the company on relationships that might not materialize. You can pivot if the model doesn’t work. You get to revenue faster.

But this creates a ceiling on growth velocity. Every customer conversation includes friction around the missing partnerships or approvals. Your best early customers can’t buy because they’re blocked by structural barriers. Your sales cycle extends because buyers have legitimate concerns about whether you’ll still exist in six months.

Torben’s insight was seeing that in markets with known, identifiable barriers, removing those barriers first is actually lower risk than launching without them. The risk isn’t that you invest six months and fail to get contracts. The risk is that you launch without contracts and spend three years trying to build momentum that never materializes because the structural barriers were always going to be there.

When This Strategy Works

Not every market has structural barriers worth tackling pre-launch. This strategy works when three conditions are met:

First, the barriers are identifiable and finite. Payer contracts in a geographic market are a known list. You can literally name every organization you need agreements with.

Second, the gatekeepers have reasons to say yes that don’t depend on your traction. Payers wanted lower-cost, higher-quality infusion solutions regardless of whether Uptiv had proven demand.

Third, you have credibility or relationships that make the conversations possible. Torben’s decade-plus in healthcare, his previous company’s success, and his understanding of how payers think made these conversations viable.

If your market lacks these conditions, prove demand first. But if all three exist, the six-month investment that looks like delay is actually the move that compresses years of painful growth into months of explosive momentum.

Looking ahead, Uptiv is applying this same playbook to new markets. Each expansion starts with securing payer contracts before opening clinics. The initial investment of six months has become the template that enables 50 to 60 clinics in three to five years. “I would love to have optiv with, you know, 50 or 60 clinics across the nation and really prove out that hybrid model of in person care and virtual care creates better outcomes for the patient and will decrease costs in the system,” Torben shared.

The lesson isn’t “always remove barriers first.” It’s “understand when pre-launch barrier removal creates exponentially more momentum than post-launch proof.” For Uptiv Health, those six months changed everything.