🎙️This post shares highlights from our Healthcare Ops Wave podcast, where Third Way Health CEO Frederik Mueller sat down with Neil Machhar, CEO of Greenbrook Medical.

Listen to the full episode here

When most startups raise millions and sprint toward scale, Neil Machhar took a different path.

He and his brother bootstrapped Greenbrook Medical, building three clinics from the ground up—without leaning on risk adjustment incentives, without a marketing team, and without venture capital.

Here’s what we learned from Neil about growing carefully, operating lean, and keeping patient engagement at the center of it all.

1. Bootstrapping gave them clarity—and control

Greenbrook launched in 2021, at a time when value-based care was still hot for investors.

But instead of raising capital, Neil and his team deliberately bootstrapped.

“We wanted to prove the model before setting expectations with investors.”

Growing slowly allowed them to build systems, culture, and clinical outcomes on their terms—not a funder’s timeline.

2. Risk adjustment isn’t the only way to win

Unlike many in Medicare Advantage, Greenbrook didn’t build their model around risk scoring.

Their core belief: if you improve outcomes and deliver great care, the rest will follow—even as risk adjustment benchmarks shift.

This mindset comes from lived experience—Neil’s father has run a MA-focused clinic in Florida since the ’90s, long before risk scores dominated the conversation.

3. “Firing yourself” is key to scaling operations

Each time Greenbrook opened a new clinic, the founders handed off more responsibilities—on purpose.

From personally scheduling patients to designing flyers, Neil did it all at first. But over time, they hired, trained, and delegated—clinic by clinic.

The focus: build a sustainable team that could deliver without founder dependency.

4. Patient engagement is their North Star

Greenbrook tracks engagement as a leading indicator of outcomes—how soon patients come in, how often they’re seen, whether they complete wellness visits, and more.

Their tracking system? EMR reports, payer data, and Google Sheets.

No fancy tools. Just discipline.

“It’s simple, but it’s hard. You need operational systems that reinforce the culture you want.”

5. Key Metrics for Patient Engagement

To stay on track, Greenbrook rigorously measures key performance indicators (KPIs) on a weekly, monthly, and quarterly basis. Their core metrics include:

• Growth metrics: new patient enrollments and referrals
• Engagement metrics: visit frequency, first-visit timeliness, and annual wellness visit completion
• Outcome metrics: emergency department visit rates and hospitalization rates

“We focus on leading indicators so we’re not just reacting to lagging data,” Machhar explained. “If something is trending the wrong way, we know early enough to intervene.”

Final Thoughts

Neil’s story is a reminder that great healthcare operations don’t need to start with a term sheet or a tech stack.

They start with patient relationships, strong processes, and clear-eyed leadership.

Want more conversations like this?

Listen to the full episode of Healthcare Ops Wave