Counsel Health: A Doctor in Your Pocket

Welcome to the 28th Network Effects Newsletter.

In the summer of 2023, Dr. Muthu Alagappan — a Stanford-trained physician and former Chief Medical Officer at Notable, launched Counsel Health with cofounder Rishi Kerkar to rethink how consumers access primary care.

Primary care in the U.S. was collapsing under physician shortages, scheduling bottlenecks, and administrative fatigue. Wait times averaged 26 days for a family doctor visit. Yet studies suggested that 60% of those visits could be handled virtually with context, data, and quick physician judgment.

Counsel Health’s platform leverages AI to act as a patient's first contact, instantly scaling the ability to field questions and provide answers, then seamlessly pulling a physician into the chat for licensed tasks like diagnosing and prescribing

Problem with Primary Care

Access is the first bottleneck. Doctors are bound by physical capacity. As a result, care happens only when the doctor is ready, not when the patient needs it. You wait days for an appointment or settle for a brief, impersonal portal message. 

Knowledge is the next constraint. Medical information now doubles every 73 days (up from 50 years in 1950). No physician can keep up. Specialization has filled some gaps, but it fragments care. Clinical decision tools help, but most still require doctors to seek out answers manually rather than surfacing insights at the right moment.

Finally, personalization. Modern medicine still applies population averages to individuals. Few physicians can interpret genomic or wearable data, and most remember only fragments of a patient’s full history. The result is care that’s efficient but impersonal — rarely tailored to your biology, environment, or behavior.

Therefore, Counsel was founded to invert these constraints with AI that is:

• Always accessible: available anytime, anywhere.

• Infinitely knowledgeable: able to recall every study and case outcome

• Hyper-personalized: adapting treatment to your unique data footprint.

Counsel Health - Four Layers of Asynchronous Medicine

Counsel Health is a virtual medical practice designed around asynchronous, messaging-based care, enabling patients to message licensed doctors anytime for advice, prescriptions, or referrals.

Unlike traditional telehealth, Counsel Health doesn’t rely on scheduling video calls. Instead, it builds an always-on relationship between patients and physicians, enhanced by AI that automates intake, charting, and clinical documentation.

1. Counsel Access (Launched 2023)

Counsel Access is Counsel’s core product, which is a secured messaging platform where patients can text physicians directly. AI handles intake, summarizes symptoms, and suggests possible next steps. Physicians can step in with one click, within 15 minutes during clinical hours (8am–9pm, 7 days a week).

As a result, patients get care within minutes, not weeks, with the same level of oversight as a clinic visit, but none of the friction.

2. Counsel Connect (Launched 2024)

Counsel Connect is built for employers and health plans, where it allows organizations to offer asynchronous care as a benefit. Employers saw reduced ER visits and faster return-to-work times. For insurers, it meant fewer claims tied to avoidable in-person visits.

3. Counsel IQ (Launched 2025)

Counsel IQ is a co-pilot offerings for physicians to accelerate their workflows (e.g., summarizing triage results, searching medical knowledge search, handling documentations with referrals) 

It automates charting, clinical summaries, and referral notes using data pulled from EHRs. It’s trained on real clinical workflows and verified by doctors, cutting administrative time by 60%+ while preserving medical integrity.

4. Counsel Hub (In development)

Counsel Hub is a backend integration engine connecting Counsel’s physician network to labs, pharmacies, and specialists, to streamline and integrate the end-to-end primary care process from triaging to prescription delivery.

Together Counsel Health can capture every part of the client primary care lifecycle, including every message, diagnosis, and prescription, which enriches Counsel’s data graph, and provide a seamless user experience

Business Model

Counsel does not require you to have health insurance. That means you can access our doctors anytime, without restrictions or prior approvals. We keep things simple with one low, transparent price of $29 for each 7-day visit, which is less than most insurance copays. Alternatively, users can subscribe for unlimited conversations with doctors for $199 per year. 

For employers and insurers, Counsel operates on a per-member or per-claim savings model.

AI Escalation Path: Can AI Be Trusted in a Medical Emergency?

As Counsel scaled patient volume, it faced a defining question — could its AI triage match the instincts of seasoned physicians?

If a patient types:

“I’m having sharp chest pain after climbing stairs, my left arm feels numb.”

A good AI triage system should immediately flag this as an emergency 

Now, what if the same patient says:

“I’ve had mild chest tightness for two days after a workout.”

That case is more subtle. Over-escalate, and you flood the ER. Under-escalate, and you risk a heart attack.

To quantify how well AI handles this spectrum, Counsel built HealthBench Consensus — an open-source evaluation framework designed to measure clinical judgment under uncertainty.

It includes 5,000 standardized cases covering emergency and primary care presentations — from anaphylaxis and stroke to chronic coughs and rashes — each annotated by physicians. Every model must decide: Is this an emergency, urgent care, primary care, or self-care case?

All models caught every emergency, but only Counsel’s was selective enough to avoid crying wolf. In practical terms, this means for every 100 people Counsel flagged as “go to the ER,” only 8 turned out to be unnecessary visits, compared to 30–35 for general LLMs.

As Counsel offerings scale, fine-tuning and improving the algorithmic precision to minimze Type I and Type II errors are going to be significant to reduce the occurrence of false alarms, recommending ER visits that drive unnecessary patient stress, higher costs, and added strain on already overloaded emergency departments.‍

If you found this valuable, consider sharing with a colleague or founder in vertical SaaS.

Have a product or case study worth profiling?

→ Reply to this email or reach out at [email protected]

Resources 

• AI-First Healthcare with Counsel Health

• Pear VC Founder Story: Counsel Health

• Counsel Health Blog