Starlight.MD — Business Plan
Source: starlight-md-plan.netlify.app Date: March 2026 — Confidential Author: Deepak Surana (CPO)
info
This is a reverse-engineered documentation of the Starlight.MD business plan prototype. Source: starlight-md-plan.netlify.app
Executive Summary
The Thesis
Starlight.MD is the all-in-one operating system built by a DPC doctor, for DPC doctors.
Direct Primary Care is the fastest-growing movement in American medicine. Over 25,000 physicians have left fee-for-service to practice membership-based, insurance-free medicine. Yet not a single platform is purpose-built for how they actually run their practices.
DPC doctors juggle 4-7 disconnected tools: a generic EMR, a separate billing system, a CRM spreadsheet, a messaging app, a scheduling tool, and maybe a Google Sheet for revenue tracking. They spend 40% of their non-clinical time on administrative tasks that should be automated.
Key Market Stats
| Metric | Value |
|---|---|
| DPC Physicians in the U.S. | 25,000+ |
| DPC Market by 2028 | $2.4B |
| Purpose-built DPC platforms | 0 |
| DPC docs using cobbled tools | 85% |
What's Already Built
- 14-page practice management platform (dashboard, patients, pipeline CRM, billing, wellness, actions, revenue analytics, messaging hub, pricing guide, reports, backup)
- 17 email templates with merge tags, CAN-SPAM compliance, HTML formatting
- 5-step automated nurture sequences for prospect conversion
- Age-based tier pricing engine with automatic plan change detection
- Google Review tracking with 30-day follow-up cadence
- Newborn home visit checklist with structured clinical assessment
- Revenue simulator with what-if scenario modeling
- 4-layer data protection with auto-backup and recovery
The Ask
$500K pre-seed round to hire 2 engineers, achieve HIPAA compliance, migrate to cloud backend, onboard 50 DPC practices in a 6-month pilot, and prove product-market fit before a Series A.
Problem & Opportunity
The DPC Movement
Direct Primary Care eliminates insurance middlemen entirely. Patients pay a monthly membership fee directly to their doctor. The model works:
- 40% lower overhead than traditional practices
- 93% physician satisfaction
- 20% fewer ER visits among patient panels
- Growth from ~1,000 practices (2018) to 2,500+ practices (2026)
The Tool Gap
| What DPC Needs | What Exists Today | The Gap |
|---|---|---|
| Membership billing (monthly/annual) | Insurance claim processors | Completely wrong billing model |
| Pipeline CRM for prospects | Nothing — spreadsheets | No conversion tracking |
| Patient communication hub | Personal texting + email | No templates, no tracking, no automation |
| Revenue analytics (MRR/ARR) | Accounting software | Not integrated with patient data |
| Wellness scheduling (preventive) | Sick-visit focused schedulers | DPC is wellness-first, not sick-first |
| Family billing (sibling discounts) | Individual patient billing | DPC family plans are common |
| Age-based tier pricing | Fixed fee schedules | Pediatric DPC has age-tier models |
| Practice growth tools | Separate marketing platforms | No referral tracking or review automation |
Dr. P's "Duct Tape Stack"
Current tools: Atlas.md ($300/mo, EMR + basic billing) + personal iPhone (texting) + Gmail (email) + Google Sheets (revenue, pipeline) + Wix (website) + Instagram/Facebook (marketing). 6 disconnected tools.
Why Now
- DPC legislation expanding: 38 states now have DPC-enabling laws (up from 25 in 2020)
- Employer adoption: Self-insured employers adding DPC as benefit, driving 2x patient panel growth
- Physician burnout crisis: 53% of physicians report burnout; DPC is #1 cited alternative
- AI-native advantage: Build intelligent automation that legacy EMRs can't retrofit
- Pediatric DPC is the wedge: Fastest-growing DPC segment (30% YoY) with zero purpose-built tools
- Post-COVID trust shift: Parents want direct physician relationships
- Working prototype: Already managing a real practice
Product Overview
Core Modules (14 integrated)
| # | Module | Description |
|---|---|---|
| 1 | Smart Dashboard | At-a-glance KPIs: active patients, MRR, wellness checks, overdue payments, pipeline, referral leaderboard |
| 2 | Patient Management | Full profiles, dynamic views, contact info, visit history, payment status, family linking, notes |
| 3 | Prospect Pipeline (CRM) | 4-stage Kanban: Inquiry → Meet & Greet → Scheduled Visit → Ready to Enroll |
| 4 | Membership Billing | Age-based tier pricing (5 tiers), auto plan change detection, family discount calculations |
| 5 | Wellness Scheduling | AAP guideline-based scheduling for 9 checkpoints (2-30 months) |
| 6 | Communication Hub | 6-tab messaging: Patient Journey, Send Now, Templates, Reviews, Nurture, Sent Log |
| 7 | Revenue Analytics | MRR/ARR, 6-month forecast, 12-month projection, growth simulator with sliders |
| 8 | Clinical Workflows | Visit logging, newborn home visit checklist (20 items, 5 categories) |
| 9 | Practice Report | Printable/PDF practice summary with census, revenue, wellness compliance |
| 10 | Website Lead Capture | Embeddable HTML form for Wix/Squarespace with auto-import |
| 11 | Action Items | Aggregated to-do list across wellness, billing, follow-ups |
| 12 | Pricing Guide | Constellation-themed tier display with family savings |
| 13 | Reminders | Monthly email checklist generation and delivery |
| 14 | Data & Backup | 4-layer data protection with auto-backup and recovery |
Atlas.md Deep Dive
What Atlas.md Is
Founded 2012, Wichita KS. Bootstrapped. ~400 DPC practices. $300/mo per provider + 2.1% payment processing.
What Atlas.md Does Well
| Capability | Details |
|---|---|
| Clinical Charting | Clean pen-and-paper feel. AI-powered SOAP notes. ICD-10 lookup. Voice transcription. |
| Patient Messaging | Direct video calling. Text message integration with auto-archive to charts. |
| Prescriptions | In-office dispensing. Pharmacy integration. ePrescribing. |
| Lab Integration | Quest, LabCorp, 100+ regional labs via ELLKAY partnership. |
| Family Scheduling | Family member self-scheduling via Patient Hub and Patient App. |
| DPC Workflow | Built ground-up for subscription model. Membership management. |
Where Atlas.md Falls Short (19 gaps)
| Atlas.md Gap | Starlight.MD Solution |
|---|---|
| No prospect pipeline or CRM | 4-stage Kanban pipeline CRM |
| No nurture sequences | 5-step automated nurture sequences |
| No patient journey mapping | 16-milestone patient journey timeline |
| No Google Review tracking | Review tracking + 30-day follow-up |
| No MRR/ARR dashboards | Real-time MRR/ARR dashboards |
| No revenue forecasting | 12-month forecasting + growth simulator |
| No age-based tier pricing automation | 5-tier age-based pricing engine |
| No plan change alerts | Automatic plan change alerts with dates |
| No family discount calculations | 25% sibling discount, $500/mo cap |
| No AAP wellness check calendar | 9-checkpoint AAP wellness calendar |
| No newborn home visit checklists | 20-item structured home visit checklist |
| No email template library | 17 templates with 8+ merge tags |
| No website lead capture | Wix/Squarespace embeddable form |
| No referral source tracking | Referral leaderboard on dashboard |
| No practice growth analytics | Revenue by tier, cohort, and scenario |
| Patients can't see labs in portal | (Roadmap) |
| Patients can't see chart notes | (Roadmap) |
| Dated 2012-era UI | Modern 2026 UI |
| Occasional system crashes | 4-layer data protection + auto-backup |
Strategic Approach
- Strategy A (Now): Complement Atlas.md — Practice management layer alongside Atlas.md for charting
- Strategy B (Later): Replace Atlas.md — Build clinical charting (Phase 3) and offer complete replacement, saving doctors $300/mo
Competitive Landscape
Direct Competitors
| Platform | Type | DPC Focus | Price | Key Weakness |
|---|---|---|---|---|
| Atlas.md | DPC EMR | Yes | $300/mo | Clinical-only — no CRM, no comms, no analytics |
| Hint Health | DPC Billing | Yes | $199-499/mo | Billing only — no EMR, no CRM, no comms |
| Elation Health | EMR | Partial | $349-599/mo | Insurance-centric with DPC "mode" |
| Cerbo | EMR | Partial | $350+/mo | Functional medicine focus, not DPC-native |
| SigmaMD | DPC Platform | Yes | Varies | Newer, less community trust |
| Practice Better | Practice Mgmt | No | $69-129/mo | For wellness coaches, not physicians |
| Jane App | Practice Mgmt | No | $54-114/mo | Allied health focus, insurance-centric |
Feature Comparison (of 19 total)
| Platform | Features |
|---|---|
| Starlight.MD | 14 + 5 roadmap |
| Elation | 6 |
| Atlas.md | 5 |
| Cerbo | 5 |
| Hint Health | 3 |
Competitive Moat
Five layers of defensibility:
- Clinical Founder — Built by a practicing DPC pediatrician, not consultants
- DPC-Native Architecture — Every data model, workflow, and UI designed DPC-first
- Network Effects — Templates, workflows, and benchmarks improve with every practice
- AI-Native — Built in 2026 with automation, not retrofitting 2012-era code
- Community Trust — Dr. P is a known, trusted voice in pediatric DPC
The Flywheel
More DPC Practices → Better Templates & Workflows → Higher Patient Satisfaction → More Referrals & Reviews → More DPC Practices
Switching Costs
| Factor | Strength | Why |
|---|---|---|
| Patient data migration | High | Years of visit logs, notes, family relationships |
| Template library | High | Custom templates and nurture sequences take months to build |
| Workflow habits | Medium-High | Staff retraining expensive for 1-3 person practices |
| Revenue history | Medium | Historical analytics and forecasting baselines |
| Pipeline + nurture data | Medium | Prospect pipeline history is practice IP |
Market Sizing
| Segment | Value |
|---|---|
| TAM — All DPC practice software | $780M |
| SAM — DPC practices willing to switch | $195M |
| SOM — Year 3 target (500 practices) | $12M |
TAM Breakdown
| Segment | Practices | Avg Annual Spend | Revenue |
|---|---|---|---|
| DPC Primary Care (Adult) | 2,000 | $3,600/yr | $7.2M |
| DPC Pediatrics | 400 | $3,600/yr | $1.4M |
| DPC Family Medicine | 600 | $3,600/yr | $2.2M |
| Concierge/Hybrid | 12,000 | $6,000/yr | $72M |
| Employer DPC Programs | 5,000 | $12,000/yr | $60M |
| Total | 20,000 | ~$143M core / $780M expanded |
Wedge Strategy: Pediatric DPC First
- Fastest growing DPC segment — 30% YoY vs 15% for adult
- Highest switching pain — age-based tiers, wellness schedules, newborn workflows
- Tight community — pediatric DPC doctors know each other
- We have the founder — Dr. P is a practicing pediatric DPC physician
- Atlas.md is weakest here — zero pediatric-specific features
Expansion Path
| Phase | Timeline | Market |
|---|---|---|
| Phase 1 | Now | Pediatric DPC (400 practices) |
| Phase 2 | Month 12 | Family Medicine DPC (600 practices) |
| Phase 3 | Month 18 | Adult DPC (2,000 practices) |
| Phase 4 | Month 24 | Concierge & Employer DPC ($72M market) |
Pricing Strategy
Philosophy
DPC doctors hate surprise fees. Flat-rate, transparent pricing. Every plan gets every feature.
Plans
| Plan | Price | Patients | Key Features |
|---|---|---|---|
| Solo | $149/mo | Up to 200 | All 14 modules, 1 provider seat, email support |
| Growing | $249/mo | Up to 600 | Multi-provider (3 seats), employer panel, custom branding, onboarding concierge |
| Enterprise | $499/mo | Unlimited | Unlimited seats, multi-location, API access, dedicated success manager, SLA, HIPAA BAA |
Pricing vs. Competition
| Platform | Monthly Cost | What You Get | Still Need |
|---|---|---|---|
| Starlight.MD Solo | $149 | Everything (practice mgmt) | Atlas.md for charting ($300) |
| Starlight.MD Solo (Phase 3+) | $149 | Everything incl. charting | Nothing |
| Atlas.md alone | $300 | Charting + basic billing | CRM + comms + analytics + growth |
| Hint Health | $199-499 | Billing only | EMR + CRM + messaging + analytics |
| Elation Health | $349-599 | EMR + scheduling | DPC billing + CRM + messaging |
Unit Economics
| Metric | Value |
|---|---|
| Annual Revenue / Practice (Solo) | $2,388 |
| Blended Annual ARPU | $3,588 |
| Gross Margin (SaaS) | 92% |
| Payback Period (CAC) | <4 months |
Go-to-Market Strategy
DPC is a Community, Not a Market
DPC physicians share tools on Facebook groups, recommend software at conferences, and trust peer endorsements over advertising.
Channel Strategy
| Channel | Tactic | CAC | Volume |
|---|---|---|---|
| DPC Conferences | Demo booth at DPC Summit, Hint Summit, AAFP DPC track | $200 | 50-100 leads/event |
| DPC Facebook Groups | Dr. P shares real practice screenshots | $0 | 10-20 leads/month |
| Atlas.md User Community | Position as the companion Atlas.md users need | $50 | 10-15 leads/month |
| DPC Frontier Directory | Listed as recommended tool | $50 | 5-10 leads/month |
| Pediatric DPC Network | Direct outreach to ~400 practices via Dr. P's network | $0 | 3-5 signups/month |
| Content/SEO | "How to start a DPC practice" guides, revenue calculator | $30 | 20-30 leads/month |
| DPC Residency Programs | Free tier for residents planning DPC post-training | $0 | Lifetime customers |
Launch Sequence
| Phase | Timeline | Target | Tactic |
|---|---|---|---|
| Founder-Led Sales | Month 1-2 | 10 practices | Dr. P onboards from her network, white-glove setup |
| Community Launch | Month 3-4 | 25 practices | DPC Facebook groups, video testimonials, 30-day trial |
| Conference Circuit | Month 5-6 | 50 practices | DPC Summit demo, Atlas.md integration announcement |
| Scale & Expand | Month 7-12 | 150 practices | Content marketing, family medicine expansion, referral program |
Financial Projections
3-Year Revenue Trajectory
| Period | Revenue |
|---|---|
| Q1 2027 | $54K |
| Q2 2027 | $108K |
| Q3 2027 | $180K |
| Q4 2027 | $270K |
| H1 2028 | $450K |
| H2 2028 | $810K |
| 2029 | $1.8M |
Key Assumptions
| Metric | Year 1 | Year 2 | Year 3 |
|---|---|---|---|
| Practices (EOY) | 50 | 200 | 500 |
| Blended ARPU (monthly) | $175 | $225 | $299 |
| Annual Recurring Revenue | $612K | $1.26M | $1.8M |
| Monthly Churn | 3% | 2% | 1.5% |
| Gross Margin | 85% | 90% | 92% |
| CAC | $400 | $300 | $250 |
| LTV:CAC Ratio | 5:1 | 8:1 | 12:1 |
| Net Revenue | $520K | $1.13M | $1.66M |
Cost Structure
| Category | Year 1 | Year 2 | Year 3 |
|---|---|---|---|
| Engineering (B4M allocation + hires) | $280K | $420K | $560K |
| Sales & Marketing | $80K | $150K | $250K |
| Infrastructure (cloud, HIPAA) | $24K | $48K | $72K |
| Customer Success | $0 (founders) | $75K | $150K |
| Legal & Compliance | $30K | $15K | $15K |
| Founder Compensation | $180K | $240K | $300K |
| Total Costs | $594K | $948K | $1.35M |
| Net Income | -$74K | $182K | $310K |
Path to Profitability
Cash-flow breakeven at ~55 practices (Month 12). By end of Year 2: $182K net income on $1.13M revenue. The $500K pre-seed gives 18 months runway — more than enough to reach profitability without additional funding.
Use of Funds ($500K Pre-Seed)
| Allocation | Amount |
|---|---|
| Engineering (2 FTEs x 12mo) | $280K |
| Sales & Marketing | $80K |
| HIPAA + Cloud Infrastructure | $60K |
| Operations + Buffer | $80K |
Team
Founding Team
Yogini Prajapati, MD — Co-Founder & Chief Medical Officer
- Board-certified pediatrician, founder of Starlight Pediatrics (Austin, TX)
- Left traditional medicine to build the practice she always wanted
- Currently runs practice on Atlas.md — found it so lacking she commissioned Starlight.MD
- Not just CMO; most demanding power user, testing every feature on real patients daily
Deepak Surana — Co-Founder & Chief Product Officer
- Product leader at Futurum Group (Constellation Research company)
- Leads Futurum Intelligence Platform — AI-powered decision intelligence for Fortune 500
- Built the entire Starlight.MD prototype as a single-page application
- Enterprise product rigor, investor relations experience, AI-native product thinking
Erik Bethke — Co-Founder & CTO / CIO
- Serial technology entrepreneur, CEO of Bike4Mind (B4M) — 35-person AI + engineering company
- Decades of shipping consumer products and building scalable platforms
- Brings entire engineering organization — not just a CTO title, but production-ready team
- B4M's infrastructure, CI/CD, and AI processing means no 6-month hiring ramp
- Final say on all technology architecture decisions
Three Pillars — No Gaps
- Clinical (Dr. P): Practicing DPC pediatrician who IS the user. Community trust that opens doors at every DPC conference
- Product & Business (Deepak): Built the working prototype. Enterprise product experience. Drives product vision, growth strategy, fundraising
- Technology (Erik): CEO of 35-person engineering org. Production-grade AI/ML, full-stack, DevOps from day one. No hiring ramp.
The Bike4Mind Advantage
Unlike most pre-seed startups, we don't start at zero on engineering. Erik's B4M team (35 people) can allocate dedicated resources from day one, collapsing the typical 3-6 month hiring ramp.
Company Formation
Entity Structure
Delaware C-Corp — Standard venture-backable structure for fundraising, stock options, and acquisition.
Equity & Ownership
Founder equity allocation under active discussion. Key considerations:
- Time commitment (full-time vs. part-time)
- IP contribution (prototype, engineering org, clinical practice)
- Domain access (clinical credibility and community)
- Engineering capacity (B4M's 35-person team)
Employee option pool: 15-20% reserved for early hires.
Vesting
- 4-year vesting with 1-year cliff for all founders
- Single-trigger acceleration on change of control
- 83(b) elections filed at incorporation
Decision Rights
| Decision Type | Who Decides |
|---|---|
| Company strategy & vision | All founders (collaborative) |
| Product roadmap & features | Deepak (CPO) |
| Clinical workflows & medical content | Yogini (CMO) |
| Technology architecture & infrastructure | Erik (CTO) |
| Engineering execution & DevOps | Erik (CTO) + B4M team |
| Growth, pricing, conversion | Deepak (CPO) |
| Fundraising & finance | Deepak |
| Community & DPC partnerships | Yogini |
| Pivots or major strategy shifts | All founders (unanimous) |
Formation Checklist
- Finalize equity split among 3 founders
- Incorporate Delaware C-Corp (Stripe Atlas or Clerky)
- File 83(b) elections for all founders
- Execute Founder IP Assignment Agreement
- Set up option pool (Carta or Pulley)
- Open business bank account (Mercury)
- Register for EIN
- Draft and sign Operating Agreement
- HIPAA compliance assessment with healthcare attorney
- Obtain cyber liability insurance
- Register domain: starlight.md
Product Roadmap
Current State (v1 — Prototype)
Live at starlight-pediatrics.netlify.app. Single-page HTML app, 14 modules, 17 templates, 5,200 lines of code. Browser localStorage. EmailJS for email. Zero server costs. Used alongside Atlas.md.
Phase 1 — Months 1-3: Cloud Migration & HIPAA Foundation
- Migrate from localStorage to cloud database (PostgreSQL + auth + RLS)
- HIPAA compliance: encryption at rest/transit, audit logging, BAA
- User authentication with role-based access (doctor, staff, billing)
- Multi-tenant architecture (each practice = isolated schema)
- Migrate from vanilla JS to React + TypeScript
- Atlas.md data import tool (CSV/API)
Phase 2 — Months 4-6: Payment Integration & Automation
- Stripe integration for automated membership billing
- Auto-invoicing with dunning (failed payment retries, overdue notifications)
- Family billing: single invoice for sibling groups with discount
- Automated tier transitions when patients age across boundaries
- SendGrid/Postmark for transactional email
- Two-way SMS via Twilio
Phase 3 — Months 7-9: Clinical Features (Replace Atlas.md)
- Clinical charting — SOAP notes with AI assist
- Appointment scheduling with patient self-booking portal
- Growth charts and immunization tracking (pediatric-specific)
- Lab order tracking and result notifications
- ePrescribing integration
- Patient portal: parents view appointments, labs, notes, pay bills
Phase 4 — Months 10-12: Mobile, AI & Expansion
- Mobile-responsive PWA
- AI-powered features: wellness predictions, revenue optimization, auto template generation
- Telehealth integration (video visits)
- Generalize beyond pediatrics: configurable tier pricing for any DPC specialty
- Practice benchmarking across Starlight.MD practices
- Full Atlas.md replacement
Tech Stack Evolution
| Layer | Current (Prototype) | Target (Production) |
|---|---|---|
| Frontend | Vanilla HTML/CSS/JS | React + TypeScript + Tailwind |
| Backend | None (client-only) | SST (Serverless) + DynamoDB |
| Auth | None | Cognito (Google + B4M OAuth) |
| Data | localStorage | DynamoDB / PostgreSQL with RLS |
| EmailJS (200/mo) | SendGrid (40K/mo) | |
| Payments | Manual tracking | Stripe Billing + Invoicing |
| SMS | — | Twilio |
| Hosting | Netlify (static) | AWS (SST + CloudFront) |
| Compliance | — | HIPAA (encryption + BAA + audit) |
Tech Stack Update
The production tech stack has been updated from Deepak's original plan (Supabase/Vercel) to align with Erik's Bike4Mind architecture: SST + DynamoDB + Cognito + AWS. This leverages B4M's existing infrastructure patterns from VibesWire.
Risks & Mitigation
| Risk | Likelihood | Impact | Mitigation |
|---|---|---|---|
| Atlas.md adds practice management | Medium | Medium | They've been charting-focused 14 years. Small bootstrapped team. 12+ month head start. |
| Hint Health builds similar features | Medium | Medium | Hint's DNA is platform/API billing, not all-in-one. |
| Elation adds DPC-native mode | Low | High | Insurance-centric codebase makes retrofitting harder than building fresh. |
| HIPAA compliance delays | High | Medium | Phase 1 is non-PHI. HIPAA-ready infrastructure from day one. |
| Small practice reluctance to pay | Medium | Medium | Phase 1: $149 ROI saves 10+ hrs/week. Phase 3: replace Atlas.md, save $300/mo. Free trial. |
| CMO availability limited | High | Medium | Dr. P continues practicing (that's the point). Deepak handles product, Erik handles eng. |
| Atlas.md data migration | Medium | Low | Build CSV import as first-class feature. DPC panels are small (200-600 patients). |
HIPAA Compliance Plan
- Phase 1 (Months 1-6): Practice management only — no PHI. No HIPAA requirements.
- Phase 2 (Months 7-9): HIPAA-compliant infrastructure. Encryption (AES-256 at rest, TLS 1.3 in transit). Audit logging. BAA executed.
- Phase 3 (Month 12+): SOC 2 Type I certification. Annual penetration testing. Employee HIPAA training.
Exit Scenarios
| Scenario | Timeline | Valuation Range |
|---|---|---|
| Acquisition by Atlas.md | Year 2-3 | $8-15M (3-5x ARR) |
| Acquisition by Hint Health | Year 2-3 | $10-20M |
| Acquisition by Elation/athena | Year 3-4 | $15-30M |
| Series A & continued growth | Year 2 | $20-40M pre-money |
| Profitable lifestyle SaaS | Year 3+ | $1.8M ARR at 92% margin |