A dietitian on the phone. Groceries on the way.
In a Cleveland kitchen at 6:42 p.m., a Medicaid member opens an app, talks to a registered dietitian for 20 minutes about her blood sugar, and taps a button. Three hours later, Instacart drops off the cart the dietitian helped her build. That is a Foodsmart visit. It is also, the company will gently insist, a clinical encounter.
Foodsmart - until 2019 known as Zipongo, a name even its investors struggled to pronounce - now operates the largest telehealth network of registered dietitians in the United States. It runs visits for more than 2.2 million members across employer health plans, Medicaid managed care organizations, Medicare Advantage plans and commercial insurers. Four of the five largest U.S. health plans use it. So do more than twenty percent of the Fortune 500.
The company calls what it does Foodcare. The rest of healthcare is starting, slowly and somewhat reluctantly, to call it billable.
The biggest preventable cause of death in this country is what you ate yesterday. Foodsmart wants the next prescription to be lunch.
— The thesis, more or lessThe most expensive thing in healthcare is the thing nobody bills for.
Roughly six in ten American adults live with at least one chronic disease. The CDC blames diet for the lion's share - heart disease, type 2 diabetes, hypertension, certain cancers. Healthcare spends almost five trillion dollars a year mopping up the consequences. It spends almost nothing on the upstream variable.
The reason is structural, not philosophical. Doctors are trained to prescribe drugs, not dinners. Insurers reimburse for procedures and pills, not produce. And the average primary care visit allots, by various estimates, less than three minutes to nutrition counseling. The system, taken honestly, has been treating the symptoms of a poorly stocked fridge.
This is the wedge Foodsmart drives itself into. Not a wellness app. Not a recipe blog. A clinical service - delivered by registered dietitians, reimbursed by health plans, integrated with the same claims rails as a cardiology visit - bolted directly onto a grocery checkout.
If food is medicine, somebody had to build the pharmacy. The job came with no shelves, no script pad, and a regulator who'd never seen a kale leaf.
— On the absurd practicality of the founding betA pediatrician, a software engineer, and a hypothesis.
Foodsmart began in 2010 in San Francisco, as Zipongo. The founders were Jason Langheier - a Williams biology grad with an MD from Duke, an MPH from Harvard's Chan School, and a previous stint co-founding a clinical informatics company called Proventys - and Milo Krastev, an engineer who, by all accounts, knew how to ship.
Langheier's CV is the kind that sounds invented. It is not. The bet he made, however, was nearly contrarian at the time: that the future of preventive medicine was not a new molecule, but a personalized grocery list. Investors found this charming, then puzzling, then - several boardrooms later - fundable.
The early years were spent doing the unsexy work of digital health: building a dietary assessment, integrating with employer wellness programs, getting the engagement numbers high enough that benefits managers stopped politely declining the next meeting. By 2018, Zipongo had stopped being a coupons-and-recipes app and had become something stranger - a clinical workflow that happened to know what was on sale at Kroger.
In 2019, the company rebranded. Zipongo became Foodsmart. The new name said what the old one had never quite admitted: that this was, at long last, a healthcare company.
One app. Three pieces. A surprisingly literal pharmacy.
Telenutrition
The core service. Members book a video visit with a registered dietitian - Foodsmart now runs the largest U.S. network of them. Visits are billed through the member's health plan. Dietitians handle weight management, diabetes, hypertension, GI disease, pregnancy, behavioral health and the great open category of I would like to eat differently and I do not know how.
Foodscripts
The newer product. A clinician - usually inside a partner health system - can prescribe specific foods, meal kits or medically tailored meals, the same way they would prescribe a statin. The order routes through Foodsmart. The groceries route to the patient's door. The follow-up belongs to a dietitian. In 2024, the program launched with Advocate Health, Intermountain Health and Memorial Hermann.
The Marketplace
The plumbing. Personalized meal plans become digital grocery lists become carts inside Instacart, Grubhub or Walmart. SNAP/EBT works, which is rare in venture-backed software and tells you a lot about what Foodsmart is actually trying to do.
Telehealth's first wave was urgent care over Wi-Fi. This is the second wave - the part where the chronic disease care happens between visits, in a kitchen, at 6:42 p.m.
— Why the model worksFoodsmart, by the receipts
The numbers, since you asked.
Healthcare loves a pilot study. Foodsmart, at this point, has run out of pilots. The platform has scaled into the kind of distribution that makes a CFO take the meeting and a CMO ask for a longer one.
Where Foodsmart shows up
Approximate distribution across payer & customer types
Source: Foodsmart customer disclosures & press, 2023-2024. Bars indicate reach, not market share.
You can't run a Series D off vibes. You can run one off two million people who came back for a second appointment.
— The Rise Fund, paraphrasedThe partnerships read like the membership directory of a hospital trade association: Advocate Health, Intermountain Health, Memorial Hermann on the clinical side; Instacart, Grubhub and Walmart on the fulfillment side. The investors are similarly catholic - Bee Partners and Founders Fund from the early days, the three big health systems on the most recent extension, TPG's Rise Fund leading the largest round.
Food as medicine, until the phrase stops sounding clever.
Foodsmart's stated mission is to make eating well simple. The honest version is more pointed: to make food a reimbursable, prescribable, accountable part of how Americans manage chronic disease. Mission statements are usually built to fit on a recruiter slide. This one is built to fit on a claim form.
The company's bet on SNAP integration is the tell. There is no venture math that rewards making your software talk to government nutrition benefits. There is also no plausible path to ending diet-related disease in low-income communities without doing it. Foodsmart did the work anyway. That is either mission, or stubbornness, or - most likely - the same thing.
If we get this right, the next decade of healthcare will be measured less in molecules and more in meals.
— The shape of the argumentThe pharmacy is being rebuilt. There's a produce aisle in it now.
GLP-1 drugs have spent the last two years rearranging the deck chairs on metabolic disease, and they have also surfaced a quietly inconvenient truth: even the best chronic-care drug works better with a registered dietitian standing next to it. Payers, slowly, are noticing. So are health systems. So, as of 2024, is TPG.
If Foodsmart's bet is right, the next several years bring three shifts. Food-as-medicine programs get reimbursement parity with traditional therapeutics. Health plans pay for prescriptions that arrive in a paper bag. And the registered dietitian - long the most under-utilized credential in American healthcare - finally gets a Zoom calendar that looks like a cardiologist's.
None of this is inevitable. The reimbursement landscape is a patient that resists treatment. CMS moves at the speed of CMS. But the platform exists, the members are on it, the evidence is accruing, and the money has been wired.
Back to the Cleveland kitchen, 6:42 p.m. The video call ends. The cart arrives. The blood sugar, three months from now, runs lower than it did. The chart updates. Somewhere in San Francisco, a piece of software files a claim. Healthcare, for once, picks up the check.
That is what Foodsmart is for. The rest is just dinner.