Cenote Is Building the Sales Rep That Digital Health Clinics Actually Need

The Macro: Digital Health Has a Conversion Problem Nobody Talks About

Telehealth took off during the pandemic. That part of the story is well known. What’s less discussed is how bad the unit economics still are for most digital health clinics. Patient acquisition costs are high, often $100 to $300 per lead depending on the specialty. And conversion rates from lead to booked appointment are abysmal. Industry data consistently shows sub-1% conversion rates for many online health platforms. That means for every 100 people who show interest, 99 of them evaporate before they ever see a provider.

The reasons are predictable. People get distracted. They comparison shop. They fill out an intake form at 11pm and forget about it by morning. They see the price and hesitate. They want to ask one question before committing but there’s no one to ask. The clinical side of digital health has gotten good. The sales and retention side is still running on email drip campaigns from 2018.

This is a problem that traditional SaaS sales tools don’t solve well. Outreach, Salesloft, and HubSpot were built for B2B sales cycles, not patient engagement. The compliance requirements alone make healthcare a different animal. You can’t just blast text messages to potential patients the way you’d follow up with a B2B lead. HIPAA, state licensing regulations, and patient communication preferences all constrain what outreach looks like.

The companies that have tried to address this are mostly doing it with human call centers or basic marketing automation. Neither scales well. Human outreach is expensive and inconsistent. Marketing automation is impersonal and easy to ignore. There’s a clear opening for AI that can operate in the space between: personalized, immediate, multi-channel, and compliant.

The Micro: Abandoned-Cart Recovery, But for Healthcare

Cenote builds AI sales reps for online health clinics. The framing as “sales reps” rather than “chatbots” or “patient engagement tools” is deliberate. These aren’t passive FAQ answerers. They’re designed to actively convert and retain patients through outreach campaigns.

The two core use cases are abandoned-cart campaigns and win-back campaigns. If a potential patient starts the signup process and drops off, Cenote follows up. If a previous patient hasn’t rebooked, Cenote reaches back out. The outreach is personalized, multi-channel, and happens immediately rather than on whatever schedule a marketing team gets around to setting up.

That immediacy matters more in healthcare than in most verticals. Someone researching a health concern at 10pm on a Tuesday is making a decision right then. If no one responds until the marketing team sends a batch email on Friday, that person has already booked with a competitor or decided to postpone care entirely. Speed of response is directly correlated with conversion, and AI has an obvious advantage over human teams on that dimension.

The multi-channel aspect is also important. Different patients prefer different communication methods. Some respond to texts. Others open emails. Some want a phone call. Running personalized outreach across all of those channels simultaneously is the kind of coordination problem that’s easy for software and hard for people.

Cenote is a YC W25 company with a three-person team. Co-founder Kofi Ansong previously worked at Google and Promise (YC 2018) and studied Computer Science at Yale. Co-founder Kristy Gao worked at Google, PayPal, and Watershed, with a Computer Science degree from the University of Waterloo. Both founders have experience at companies that handle sensitive data at scale, which is relevant when you’re building in healthcare.

The competitive field includes companies like Klara (patient communication), Luma Health (patient engagement), and Weave (multi-channel communication for healthcare). But most of these are communication platforms, not AI-driven sales agents. The distinction is between providing the channels and actually doing the selling. Cenote is trying to do the selling.

The Verdict

The problem is real and the market is large. Digital health is a $300+ billion market globally, and every company in it has the same conversion problem. If Cenote can move conversion rates from sub-1% to even 3-4%, the value proposition is immediate and quantifiable. Clinics know exactly what a patient is worth over their lifetime, so the ROI calculation is straightforward.

The risk is in the execution of AI-driven patient outreach at a quality level that doesn’t feel robotic or, worse, insensitive. Healthcare is personal. A follow-up message about a mental health consultation requires a different tone than a reminder about a dermatology appointment. Getting that wrong doesn’t just lose the patient. It damages the clinic’s reputation. The AI needs to be genuinely good at nuance, not just fast at sending messages.

The compliance angle is both a barrier and a moat. Building healthcare-compliant outreach is hard, which means companies that get it right have a defensible position. Generic sales AI tools will have a hard time entering the space without significant healthcare-specific engineering.

I’d want to see retention data at 90 days. Converting a patient once is valuable. Keeping them engaged over time is where the real LTV sits. If Cenote can prove it drives both acquisition and retention, the product becomes very sticky for clinic operators who are tired of watching leads disappear.