🎙️ This post recaps our Healthcare Ops Wave episode with Nick Soman, CEO and Co-founder of Decent, a health plan built around direct primary care.

Listen to the full episode here

Nick Soman has been through the kind of operating crucible most startup leaders only read about.

He built a health insurance company from scratch, scaled it to 50+ employees, pivoted the model twice, lost a key distribution partner overnight, and laid off 94% of his team.
Then, he rebuilt it.

Now, with just 9 full-time U.S. employees and a globally distributed team, Decent is moving faster than ever.
Here’s the timeline of how it all unfolded and what healthcare operators can learn from it.

2018: Launching Decent with a bet on direct primary care

Nick’s journey started with a family bias. His parents were both primary care physicians, and his dinner table was filled with stories about patient-first medicine and frustrations with big insurance.

That shaped Decent’s mission: to offer health plans that cost 40% less than market rates, built around trusted relationships with direct primary care doctors.

Their first market? Self-employed individuals. Their early go-to-market was fully digital and took off quickly.

2020–2021: PEO pivot and scaling up

When regulatory shifts made their original model unsustainable, Decent pivoted to selling through PEOs (Professional Employer Organizations). This meant serving small businesses, not just individuals.

The company expanded to more than 50 employees, added new capabilities like payroll, and prepared for a national launch with a major partner.

But operational complexity ballooned, and Nick admits now that his heart was never fully in the PEO model.

2023: Left at the altar and forced to rethink everything

Just before their nationwide launch, Decent’s distribution partner backed out. The impact was devastating.

Nick had to lay off the majority of his team and seriously consider winding down the company.

Instead, with just 5 employees, he and his co-founder asked a simple question: What can we do now, with the team we have?

2024: Rebuilding from first principles: AI and global talent

That question sparked a total reinvention.

They ditched the PEO model, simplified the plan design, and adopted a level-funded approach that worked for small employers without the overhead of payroll.

They also embraced two foundational strategies:

• Build everything tech-first (not “tech-enabled”)
• Rethink talent globally, leveraging senior operators in India and the Philippines

Now, the Decent team talks openly about building “Iron Man suits”—systems where a small number of humans, supercharged by AI and global teammates, can do the work of much larger teams.

Final Thoughts

Nick’s story is a masterclass in operational reinvention: how to navigate a business model pivot, survive near-collapse, and rebuild with more clarity, speed, and focus than ever before.

At Third Way Health, we share that philosophy. We believe the future of healthcare operations will belong to those who think creatively about people, process, and technology.

That’s why we design tech-enabled teams that can help providers move faster, scale confidently, and create better experiences for patients and staff alike.

Listen to the full episode of Healthcare Ops Wave