He runs healthcare like a marketplace - matching supply to demand. Then he pointed that instinct at one of the messiest mismatches in America: people with a gambling problem and almost nowhere covered to turn.
Walk into the gambling-addiction system as it existed a few years ago and you found a maze of hotlines and 12-step rooms. Those rooms have done real work for decades. But for a 24-year-old who lost a paycheck on a Sunday parlay and opens an app to find help, a church-basement meeting is a strange fit. Elliott Rapaport built the thing that fit instead: Birches Health, a virtual clinic that treats gambling and gaming disorders, takes insurance, and shows up on the same phone where the betting happened.
The origin is uncomfortably ordinary. A friend was struggling. Rapaport went looking for a high-quality, insurance-covered, virtual provider for gambling addiction and discovered there essentially wasn't one. Back at Amherst, he remembered classmates combing Western Massachusetts for care that didn't exist. The gap wasn't a market insight on a slide. It was a phone call he couldn't answer.
So he answered it at scale. Founded in 2023, Birches now operates in all 50 states, contracts with more than 100 national insurance plans, and partners with 18-plus state governments. That footprint did not appear by accident. Before Birches, Rapaport was Marketplace Operations Director at Elemy, where he launched and scaled new healthcare businesses and learned the unglamorous art of balancing supply and demand when both sides are fragile and the stakes are clinical.
Rapaport's organizing belief is almost suspiciously simple: care has to be available "when and where they need it most." In practice that means embedding responsible-gaming resources and treatment links early in a user's journey, not buried in a footer after the damage is done. He has spent the company's first chapter knocking on doors most founders avoid - sports-betting operators like Sporttrade, BettorEdge and SaharaBets, professional leagues, fantasy platforms, state regulators - to wire treatment into the places people actually gamble.
His own team is the part he won't shut up about. "Our company is only as strong as our clinical program," he says, and he means the nationally distributed bench of specialized clinicians who do the actual work. The pitch to them, and to patients, is consistency: a combined plan that can pair abstinence and self-exclusion with individual, family, couples and group counseling, plus peer support. Birches reports an 81% drop in problem behaviors after nine appointments. That is the kind of number a marketplace operator likes - measurable, repeatable, defensible.
Ask Rapaport who's actually showing up, and the answer maps neatly onto the last few years of American life. "The fastest growing segment of our patient population is without a doubt sports betting," he says, "especially the 21-to-40-year-old demographic." Legalized mobile betting spread across the country; the harm spread with it; the care lagged behind. Birches is the lag, closing.
*Birches Health, after nine appointments.
"Access to care, when and where they need it most." - Elliott Rapaport, on the whole point of Birches
Founders love to narrate their "no" pile after the fact. Rapaport actually lived in his. Partners, press and investors said no, often. What's notable is the metabolism: he treats a "no" as information about timing, not about the mission. When one well-known investor passed and then circled back, Rapaport didn't gloat - he restructured the round around the renewed interest.
The optimism is real but calibrated. "There's a long way to go in reducing the potential for gambling harm," he says, "but we feel significant strides can be made through conscientious dialogue." It is the sentence of someone who has sat across the table from regulators and operators whose incentives don't naturally align with his, and decided the conversation is still worth having.
Recognition is starting to catch up. Birches landed on the 2026 New York Digital Health 100. In January 2026 the company pushed treatment further onto smartphones and expanded provider training under a new clinical VP. Two years in, the operator's bet is reading like a thesis.
A founder is more than a cap table. A few things he has admitted, on the record, that no pitch deck would include.