The Real Moat in Women’s Health Isn’t What You Think
Inside the capital stack required to build trust, outcomes, and returnable businesses in digital health
Too many investors still apply SaaS metrics to care models. In women’s health, that mismatch isn’t just limiting returns. It’s distorting the capital stack. This week, we unpack why trust, outcomes, and $300M exits are the real moat.
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Where is the Moat in Women’s Health?
A recent post by Andy Mychkovsky on LinkedIn stopped me mid-scroll. It was blunt, clear-eyed, and spot on:
“the future of digital health feels uncertain” …not because it lacks value, but because it doesn’t conform to the scale-obsessed expectations of venture capital.
He wrote: “$100B is higher than the combined market cap of the entire digital health industry that is publicly traded.”
That line has been sitting with me.
In the comments, things got even more interesting. Someone asked a hard question that founders and investors have to wrestle with:
“Where is the moat?”
One commentator suggested that most digital health companies repackage what already exists, get absorbed by incumbents, and lack defensible advantage.
Joanna Strober, founder of Midi Health, pushed back with clarity and conviction. For her, the moat is trust. Brand. An experience built patiently and credibly over time. I found myself nodding.
But the longer I sat with both perspectives, the more I realized: we are still looking at this through the wrong lens.
We are applying the wrong lens to the right market.
Digital health, especially women’s health, doesn’t scale like SaaS and it shouldn’t be expected to. Care delivery involves friction by design. It’s regulated, localised, and built on trust not speed.
Investors often want to see clean margins, viral loops, and rapid GTM (go-to-market). But founders operating in women’s health face a different reality:
Reimbursement pathways that take years to validate
Patient journeys that span multiple life stages
Clinician partnerships that don’t fit neat CAC models
More than 70% of women in the U.S. report leaving healthcare appointments feeling dismissed or unheard¹. That’s not a UX bug. It is a systemic design flaw.
The opportunity lies in rebuilding continuity, trust, and outcome-driven care for half the population. But that doesn’t lend itself to quick exits or blitz scale logic. The moat isn’t proprietary code. It’s:
Clinically validated outcomes
Integrated distribution within provider networks
Payer alignment backed by real-world evidence
And the companies building this don’t fail because they lack value. They fail because the capital backing them demands a trajectory that ignores the operational realities of healthcare.
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$300M exits aren’t failure. They are a feature.
We need to retire the idea that “venture-backable” means $1B+ or bust. Most digital health companies that succeed will exit in the $100–$500M range, often through strategic acquisition or private equity roll-up².
That’s not underperformance.
That’s returnable capital if you price the risk and structure the cap table accordingly.
Too often, we see mismatched expectations:
VCs pushing for consumer-style metrics in clinical environments
Founders burning cash chasing volume over trust
LPs expecting Stripe but underwriting public-sector infrastructure
In women’s health, speed isn’t the unlock. Retention, clinical credibility, and trusted navigation are. Those take longer but yield more resilient companies. If we back them on their own terms, the return potential is there.
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So stop asking “Where’s the moat?”
Instead, we should start asking:
What kind of capital stack do we need to build enduring care infrastructure in women’s health?
Here’s what that looks like:
Angels + seed investors who value early clinical proof as defensibility, not “mission.”
Series A funds that underwrite regulatory and payer timelines instead of defaulting to CAC/LTV shortcuts.
Growth investors who understand that reimbursement traction and regional density drive real scale even if it is not exponential.
LPs willing to back funds that target 3–5x cash-on-cash in underserved categories with moderate exit velocity.
This is where market-beating outcomes will come from. Not because they are splashy, but because they are disciplined. Because they are built around how women actually move through the healthcare system, not how investors wish they would.
We don’t need to find the moat. We need to build it….with capital that is structured to stay the course.
I write weekly at FemmeHealth Ventures Alliance about capital, care, and the future of overlooked markets. If you are building, backing, or allocating in this space, I’d love to connect.
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Sources:
Kaiser Family Foundation. (2022). KFF Women’s Health Survey. Retrieved from: https://www.kff.org/womens-health-policy/
CB Insights. (2023). Digital Health Market Outlook 2024: Exits, Consolidation & Investor Trends.
Frost & Sullivan. (2021). Women’s Health Digital Solutions: Global Market Forecast to 2027.
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Disclaimer & Disclosure
This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.
