Building Virtual Care the Right Way Requires Infrastructure with Accountability

Virtual care is entering a new phase of maturity.

As adoption has scaled, so have the questions surrounding how these models are built, governed, and held accountable. What was once a story of rapid innovation is now a broader industry conversation about structure, incentives, and long-term trust.

At the center of that conversation is a critical shift: moving beyond surface-level debates about individual companies or isolated incidents, and toward a deeper understanding of the systems that make those outcomes possible.

In this POV, Wheel Founder and CEO Michelle Davey offers a clear-eyed perspective on the structural dynamics shaping virtual care today. Drawing on more than a decade of experience building and scaling clinical infrastructure, she outlines why these patterns continue to emerge, how AI is accelerating them, and what it will take to build a more durable foundation for the future.

Virtual care doesn't have a bad actor problem. 

It has a structural one. 

When we started Wheel, the infrastructure layer for virtual care didn't exist. Not in any serious form. 

There were telehealth point solutions. There were video visits attached to legacy systems, but there was no real enterprise-grade layer that made it possible for health plans, retailers, digital health companies, and other organizations to launch and operate virtual care programs with clinical integrity and without rebuilding everything from scratch. 

We built that. We invented the category. 

I say that not to claim credit, but because it explains the particular weight of what came next. When you are the infrastructure — when health insurers, Fortune 500 companies, and major digital health brands are running their clinical programs on what you built — the cost of getting it wrong is not yours to bear alone. It belongs to every patient who flows through those programs, every clinician whose license depends on the integrity of the platform, every enterprise partner who trusted us with something that mattered. 

That weight shaped every decision we made. And the decisions we made are why I'm writing this now. 

Every few years, a new story surfaces about a telehealth company that grew impossibly fast, cut corners that should never have been cuttable, and left a trail of patients, clinicians, and regulators asking the same question: how did this happen again? 

It will keep happening. Not because the people building these companies are uniquely reckless, but because the structure in which most of them are built makes it nearly inevitable. 

Three structural conditions, in combination, create the pattern we keep seeing. 

The first is regulatory arbitrage. This is what happens when legitimate regulatory frameworks are stretched by extraordinary market conditions. Compounding frameworks serve an important purpose, but during the shortage period, demand moved faster than regulatory clarity. That created gray areas, and in those gray areas, companies moved aggressively before the governance around those models was fully tested. 

The second is consumer internet economics applied without modification to healthcare. Affiliate marketing is standard practice in e-commerce. But when patient acquisition is optimized for conversion volume, the clinical encounter can start to get treated like a cost to compress rather than a point of judgment to protect. That is not a values failure. It is an incentive architecture failure. 

The third is vertical integration without accountability. When the technology platform, the prescribing entity, and the dispensing pharmacy are controlled by the same owners, the governance structures that are supposed to create friction between commercial and clinical decisions disappear. That friction is the point. Without it, speed of growth and clinical judgment operate on the same axis — and commercial speed almost always wins. Specific to compounding, prescriptions written by clinicians give no patient choice for pharmacy options. 

None of this requires anyone to intend harm. It simply makes harm structurally more likely. 

I knew these conditions were in the market when we were making our foundational architectural decisions. That knowledge made me more careful, not less. 

We decided not to build revenue models around compounded medication programs, particularly for high-demand therapies where regulatory clarity was uncertain. This wasn’t a regulatory choice; it was a structural choice. I was not willing to build the foundation that enterprises and patients depended on over unstable regulatory ground. 

We decided to maintain a hard separation between commercial and clinical decision-making. Clinicians in the Wheel Provider Group are independent and make independent clinical decisions. Full stop. Those decisions are documented, auditable, and structurally separated from the commercial interests of our enterprise partners. That separation is not a feature. It is the load-bearing wall of everything we built. 

We decided that governance has to be embedded before programs launch. That means review gates including founder and board profiles, eligibility standards, and documented accountability at the start, not retrofitted when something goes wrong. 

None of this made us the fastest-growing company in the space during the times when everyone seemingly was coming in to compete with us. It meant we grew slower than we could have. I made those tradeoffs consciously because I understood what was sitting on top of what we were building. Patient data. Clinical decisions. Enterprise reputations. Clinician licenses. Those are not abstract considerations when you are the infrastructure. They are the reason you show up and make the harder choice. 

There is something new in the current environment that changes the stakes of this conversation. 

AI makes it possible to replicate the commodity telehealth playbook at near-zero marginal cost. A two-person team with the right stack can now operate at a scale that previously required hundreds of people. That is genuinely impressive. It is also a reason to be clear-eyed about what governance at that speed requires. 

AI does not compress accountability. It amplifies whatever incentive structure the platform was built on. A model designed around volume optimization becomes faster at optimizing for volume. A model designed around clinical accountability becomes faster at maintaining it. The question is not whether AI belongs in virtual care — it clearly does. The question is what architecture it is running on. 

The virtual care industry is entering a period of genuine reckoning. Regulators are asking harder questions. Enterprise buyers are conducting deeper diligence. Clinicians are thinking carefully about where they put their licenses. 

That reckoning is good. It is what a maturing industry looks like. 

When I built Wheel, I was building something I knew enterprise giants would eventually stand on. I felt that. I still feel it. And I believe the companies that built their infrastructure with that weight in mind (not for the conditions of a single market cycle, but for the long arc of patient care and clinical trust) are the ones that will define what virtual care becomes. 

We built Wheel for this moment. Not because we predicted the headlines, but because we believed the moment was always coming. 

So this is where I'll stop commenting on what's broken, because that was never really Wheel's role, and it isn't mine. A principle that has been at the core of how we've built this company from the beginning is that the most powerful thing you can do in a moment of industry confusion is teach. 

That's what we're going to do. We're bringing together a group of people who have been building responsibly in this space for years and I genuinely admire, from regulatory attorneys, policy leaders, and pharmacy executives, to lead a real conversation about how to do this right. Not a panel. Not a PR exercise. A deliberate effort to put the right frameworks, the right expertise, and the right questions in front of the leaders and organizations who are building the next chapter of virtual care. 

Because the stakes are too high for the loudest voices to be the ones pointing fingers. The most useful thing any of us can do right now is make it easier to build well. That's the work. And that's where our energy is going. 

Michelle Davey is the co-founder and CEO of Wheel, the virtual care infrastructure company she founded to power enterprise telehealth programs at scale.