Startup aims to keep employees healthy at a lower cost

Metabolic diseases such as Type 2 diabetes can be expensive for employers to cover, especially if employees are prescribed GLP-1s, which can cost $1,000 to $1,500 per person per month. Startup Twin Health aims to change that. Its technology, offered to employers, uses a combination of AI and wearable devices that track metrics such as blood sugar, weight, and activity levels to create “digital twins” of employees with metabolic conditions. Employees receive health coaching and can view meal recommendations and health data on an app.

A Cleveland Clinic study found that, over one year, 71% of diabetics using Twin Health were able to lower their blood sugar. The percentage using GLP-1s dropped from 41% to 6%.

Twin Health, founded in 2018, has nearly 200 companies as customers, including giants like Blackstone and Walmart. A Series E round last year brought in $53 million, taking the company’s valuation to $950 million. But its business model rests on a proposition more closely associated with law firms than health care startups: In some cases, Twin Health doesn’t get paid unless employees enrolled in the program reach certain benchmarks, such as lower weight or blood sugar, or using fewer medications.

We spoke with Tom Samuelson, who joined Twin Health as VP of finance and strategy in 2021 and became CFO in February 2025, to hear more about the company’s business model and how the finance function has changed as the company matures.

This interview has been edited for length and clarity.

Twin Health prices partly on outcomes. How do you model revenue in that kind of situation?

The vast majority of our customers choose to have their pricing at risk, whether that’s via milestones or whether that’s a PMPM [per-member, per-month] contract with a performance guarantee. The beautiful thing for us is, once we have a company that has more than 100 people or so on the platform, the distribution of the outcomes is so normal that it actually is fairly straightforward to do the forecasting.

How has the finance function changed over the time that you’ve been with Twin Health?

The challenge with my role, particularly if it’s at a company that’s doing well, is never lack of opportunities or options or places where to spend. It’s the wild number of different places you can go, things you can do. I think as the company has grown, the discipline with which we navigate that decision tree has increased a lot as well. And AI has made that so much easier, because you can do so much concurrent scenario analysis. You can look down paths in half an hour that would have taken two days beforehand. That’s a real luxury that frankly every CFO should be taking advantage of.

What are some key metrics that are always top of mind when you report to the board?

The North Star for me is gross margin and operating margin. That may sound obvious, but I think it’s the barometer of whether you’re valued as a tech company that can scale really well or more of a health care clinic that won’t scale nearly as well.

What do you see coming for Twin Health in the next 12 months?

Right now, our major programs are Type 2 diabetes, pre-diabetes, and healthy weight. We are launching a customer on a preventive offering for the first time later this year. But there’s a whole host of other spaces within the metabolic health continuum that are very compelling and exciting to us…If you look at our clinical trial, for example, at the Cleveland Clinic, we’re seeing results in hypertension. We’re seeing results in cardiovascular disease, liver disease, kidney disease. We need to develop the chops to optimize for those things.

The direction of travel is clear. If you help employers get to people before they get sick, not just afterward, that is very valuable both financially and ethically. The world will be better if that’s the case.

You’re a first-time CFO. How are you finding your CFO role different from your previous role?

Honestly, I love it. I think that once you sort of are sitting in this seat, especially after about a year or so, you get to a point where you will hear athletes say things like “the game is starting to slow down a little bit for me. I’m able to see around corners a little bit more.” I really have felt that significantly more this year than either of the past two.

The role itself changing is a big part of it, but then it’s how much the company is changing concurrently as well; that’s really I think a critical driver. So we’ve gone from essentially pre-revenue in the United States when I joined to being significantly in the nine-figure range, and so it’s just a very different kind of company, the type of things that you’re focused on. And then I think the last part of it is the degree to which the external-facing work becomes a real component to it. And frankly, I really like that part. I’m excited about our story. It’s fun to tell it.