Thirteen years ago, Zak Holdsworth co-founded Hint Health to build technology for a healthcare model that most people had never heard of. Today, Hint is one of the core platforms powering the Direct Primary Care movement in the United States. In conversation with Mehul Agarwal, Founder of HealthCompiler, Zak traced the path from a rural childhood in New Zealand to Stanford to Silicon Valley, and reflected on what it takes to build a company in a market that barely existed when he started.
A Farm, a Village Doctor, and No Talk of Payment
Zak's earliest experience with healthcare was defined by proximity and trust. His family lived on a farm in rural New Zealand, and the local doctor practiced out of a nearby village. He was not just a physician; he was part of the community. He came to family barbecues. When someone was sick, you called him, and he told you to come around right then.
"I have this memory of being sick, and my mum called the doctor at 6pm on a Friday night, and the doctor said bring him around right now," Zak recalls. The care was personal and immediate.
There was a telemedicine component before anyone used that word: you called the doctor, talked through what was happening, and then went in if needed. And because New Zealand runs a nationalized health system, the financial side of healthcare was largely invisible. If you broke your leg, you went to the hospital, they patched you up, and you went home. No one talked about payment.
That system had its trade-offs. Specialist care could mean months of waiting, and the level of sophistication available in the U.S. was not always matched. But the primary care relationship left a lasting mark.
"The primary thing I remember is just the relationship I had with primary care," he says. "It was profound."
The Entrepreneurial Instinct
The instinct to build things came from home. Zak's father was an entrepreneur who started a manufacturing business in the farm shed before scaling it into an industrial operation. Business was part of the fabric of daily life: dinner table conversations, after-school chores at the factory, working for his parents during school breaks.
"I would say it was very early on," Zak says. "I wanted to create things, build things."
He tried a few startup-type ventures along the way. Most did not work out. But the instinct stayed. His father had also been the first person in their town to get a computer, and Zak grew up with a quiet fascination with Silicon Valley, even before he fully understood what it was.
He applied to Stanford's Graduate School of Business almost as an afterthought, not expecting to get in. He had been rejected by several other schools. Stanford accepted him.
"I was pretty lucky, honestly," he says. "I thought I may as well apply because I am likely going to get in somewhere else and I would have missed the window."
From Biohacking to Healthcare
Zak had always assumed he would not work in healthcare. The system looked too broken, too bureaucratic. But he was interested in personal health, human performance, nutrition, and the quantified self movement.
That interest led him to WellnessFX, where he was on the founding team as the first employee. The company was building a consumer-grade product around real labs, real doctors, and real health data. It was consumer wellness on the surface, but underneath, it was doing substantive clinical work.
It was at WellnessFX that Zak's perspective shifted. He realized there was an opportunity to do something meaningful inside the broader healthcare system, not just adjacent to it. Once he saw the problem, he could not look away.
"When I see problems, I try to fix them," he says. "I just happened to pick quite a large problem."
Starting Hint
After WellnessFX, Zak and his co-founder spent about two or three months identifying a market they found compelling: the direct care space. From that point forward, the core mission has not changed. The vision has evolved and the product has expanded considerably, but the fundamental idea, building technology to support doctors who practice outside the insurance-driven fee-for-service system, has remained constant.
When Hint launched roughly thirteen years ago, DPC was a small, fringe concept. Zak did not need to pivot. He needed to be patient.
How DPC Has Changed
Asked how the DPC ecosystem has evolved, Zak draws a distinction between what has changed and what has not.
What has not changed is the underlying principle. It is still doctors trying to escape a system that does not serve them or their patients. The ethics and motivations of the movement remain intact.
What has changed is scale, maturity, and visibility. The number of DPC practices has grown by close to a thousand percent in the last decade. The ecosystem of supporting vendors is more developed. The playbooks for starting a DPC practice are more refined. And critically, Zak no longer has to explain what DPC means when he tells people what he does.
"It is transitioning into more of a mainstream conversation," he says, "from something that was very fringe."
That shift in awareness is also helping drive employer adoption.
What Employers Get Wrong About DPC
The biggest misconception Zak sees among employers is that they evaluate DPC the same way they evaluate every other point solution: solely through the lens of direct ROI, line-item cost comparisons, and incremental analytics.
DPC does improve these metrics, but this approach misses the bigger picture. The impact is not as binary as one drug being cheaper than another. What DPC changes is the underlying system of care delivery, and the real value shows up in second-order effects: fewer ER visits, better chronic disease management, improved employee health over time, reduced downstream claims.
"The mindset shift that needs to happen with employers is that you cannot compare this to other point solutions," Zak says. "This is a solution that actually eliminates point solutions. It helps fundamentally change the underlying mechanics of how healthcare is delivered, as opposed to an incremental fix to a problem."
If employers can stop evaluating DPC through a point-solution lens and start thinking of it as a foundational part of redesigning their entire health plan, the ROI question answers itself.
Where Cash-Pay Care Is Headed
Zak sees a parallel evolution happening across the broader cash-pay landscape. It is not just primary care anymore. Specialty care, labs, imaging, and ancillary services are all developing direct-pay models outside the insurance infrastructure.
The real power, he believes, will come at the intersection of those movements: connecting DPC providers with carved-out specialty care networks in a way that is integrated and thoughtful.
"To the extent where you can connect those two in a way that is really integrated, that is where the massive improvements come from," he says.
Data plays a central role in unlocking that future. The ability to show longitudinal impact on a population, to compare outcomes between groups with and without DPC access, and to demonstrate savings clearly and credibly is what will open the floodgates.
"If you can show this thing saves money while improving outcomes and quality of care," he says, "that is the holy grail."
AI in Direct Care
As a technology founder, Zak sees AI fitting naturally into the DPC model. In DPC, the incentive is simply to provide the best possible care as efficiently as possible.
Hint has integrated AI tools directly into its EMR. A single click can analyze a clinical note and generate structured data, tasks, and documentation. The adoption among Hint's customers has been rapid.
Beyond clinical tools, Zak notes that AI is accelerating Hint's own product development. The team is building more valuable features faster than at any point in the company's history.
"Our product acceleration is quite high right now," he says. "I think that benefits our customers and the community."
The Biggest Mistake
When Zak started Hint, he internalized the startup orthodoxy around focus: stay lean, build less, take on less surface area. In hindsight, he believes he misinterpreted what focus actually meant.
"When I heard the word focus, I thought build less," he says. "But actually, the way I should have manifested focus was narrow down the type of customer you are serving, but within reason, build everything that ideal customer profile could benefit from."
A tighter customer profile with a broader product would have served Hint's users better than a broad customer base with a narrow product.
On Investors and Staying Profitable
Zak has been through the full venture cycle and is candid about what he learned. The key lesson: pair the right type of investor with the right stage of growth.
In the early days, Hint partnered with venture capital firms looking for 100x or 1,000x returns. The market was simply not large enough to support that kind of trajectory. Eventually, Hint transitioned to growth equity and private equity investors with longer time horizons, investors who valued consistent double-digit growth over the triple-digit expectations of traditional VC.
"Once you are profitable, you control your destiny," he says.
The number of companies for which the raise-and-grow-at-all-costs strategy is the right approach is very small, Zak believes. Most companies should be more conservative. But for the few where it does make sense, the timing and the partner have to be right.
Leading by Letting Go
Zak describes his leadership style as one built on delegation and trust. He hires people who are better than him at their specific function, whether that is product, engineering, sales, or operations, and then gives them room to run.
"You may be the generalist that on average knows more about any topic than anyone else on the team," he says, "but you are not the expert in the room."
He works in bursts, directing energy toward the most important problem at any given moment, whether that is an ambitious new project or a bottleneck that is holding the company back. He believes in trusting his team. If you asked him Hint's current revenue, he could estimate within about 5%. His head of commercial could tell you to the nearest dollar.
Thirteen years in, Hint has grown the way Zak always said it would: steadily, close to its original mission, serving a market that no longer needs explaining. The doctors Hint was built for are still the doctors it serves. The problem Zak saw at WellnessFX, that healthcare could be simpler and more personal, is the same one he is still working on. The scale has changed. The conviction has not.