MiSalud: Telehealth Built for Spanish Speakers

A conversation with Bismarck Lepe, CEO of MiSalud Health.

During the early days of COVID-19, one data point stopped Bismarck Lepe cold:

Hispanic communities in the U.S. were four times more likely to die, three times more likely to be hospitalized, and twice as likely to get infected compared to the general population.

Telehealth platforms existed. Employers were paying for them. Providers were available.

So why weren’t the people who needed care most using them?

For Lepe—a serial entrepreneur who’d previously built and sold companies including Ooyala (a video technology platform) and Wiseline (a nearshore software development firm with thousands of engineers globally)—that question became deeply personal. And it became the foundation for MiSalud Health, a telehealth platform now serving tens of thousands of Spanish-speaking patients across 15 states.

But the path to product-market fit required abandoning nearly everything the telehealth industry takes for granted.

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The Problem Isn’t Demand. It’s Design.

Most telehealth companies operate on a quiet assumption: low utilization is good for margins.

When you’re charging employers $3-8 per member per month, the business only works if most people never show up. Single-digit engagement becomes the norm. Employers renew out of obligation, not impact.

MiSalud flipped that model.

“We started by asking: why was the Hispanic population getting hit so hard by COVID?” Lepe explained. “The answer wasn’t behavior. It was access.”

The data was stark:

• 80% of Hispanic populations live in healthcare deserts (vs. 38% of the general U.S. population)

• 43 million Latinos prefer to conduct their healthcare in Spanish

• Less than 1% of U.S. physicians feel comfortable practicing medicine in Spanish

• Cost barriers make care inaccessible even when language-concordant providers exist

Language was only the surface issue. Culture, trust, and economics ran much deeper.

And that’s where MiSalud’s hybrid model entered.

▶️ Watch the full conversation:

Below are the lessons that matter most for founders, operators, and investors building in HealthTech today.

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1. Cost Structure Determines Whether Compassion Is Possible

Lepe’s background in building technology companies with global teams gave him a unique lens on healthcare economics.

“We thought: what if we applied a nearshore model to healthcare?” he said.

The structure works like this:

• Mexico-based physicians serve as health coaches for 90-95% of consults

• U.S.-licensed physicians handle escalations requiring prescriptions, labs, or regulated interventions

• The hybrid model dramatically lowers per-consult costs while maintaining clinical quality

But the real breakthrough wasn’t just cost savings—it was what those economics enabled.

“Other platforms have countdown clocks,” Lepe said. “Doctors feel like Uber drivers trying to get through as many rides as possible. Our clinicians can spend more time because the model actually supports it.”

Compassion wasn’t a brand value. It was an economic outcome.

When your margin structure doesn’t punish longer visits, providers can build relationships. And in healthcare, relationships drive outcomes.

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2. Translation Isn’t the Same as Cultural Alignment

Speaking Spanish and understanding Hispanic patients are not the same thing.

Lepe shared a story that crystallizes why cultural context matters more than language toggles:

A patient had previously told other providers he’d eliminated bread and sugar from his diet—yet remained pre-diabetic. Numbers weren’t improving despite reported compliance.

When MiSalud’s health coaches asked how many tortillas he ate daily, he answered 12.

To that patient, tortillas weren’t “bread.” They were something different entirely.

“That insight doesn’t come from a dropdown language selector,” Lepe said. “It comes from shared context.”

This plays out across the care continuum—from medication adherence (understanding cultural beliefs around pharmaceuticals) to mental health (recognizing stigma patterns that vary by country of origin) to preventive care (navigating family dynamics around health decisions).

MiSalud’s health coaches aren’t just bilingual. They’re bicultural. And that distinction is the difference between a telehealth visit that gets ignored and one that changes behavior.

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3. Trust Is Built Onsite Before Digital Works

Here’s the uncomfortable truth most virtual-first startups don’t want to hear:

Remote-only doesn’t work for populations that have been systematically excluded from healthcare.

“Healthcare moves at the speed of trust,” Lepe said. And trust isn’t built through an app.

MiSalud’s playbook when launching with a new employer:

1. Show up physically: Health coaches and physicians come onsite

2. Conduct biometric screenings: Blood draws, baseline measurements, health assessments

3. Establish longitudinal programs: Place members into hypertension, diabetes, mental health, or wellness tracks based on actual data

4. Then go digital: With trust established and a health coach relationship in place, members engage remotely

The results speak for themselves:

• 80-90% participation rates (vs. industry standard of 10-20%)

• ~50% monthly engagement (vs. single digits for typical employer telehealth)

• 20% of consults prevent an ER visit that otherwise would have happened

“Many of our customers had telehealth platforms before us,” Lepe noted. “Teladoc has been around since 2005. But people weren’t using those tools. They were still ending up in the emergency room.”

The difference? MiSalud built trust first.

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4. Platform Thinking Beats Point Solutions

MiSalud didn’t set out to be a “diabetes app” or a “mental health solution.”

The company’s north star: coordinate the whole human.

“The healthcare system is incredibly siloed,” Lepe said. “We want one person—a health coach—thinking about your overall health, not just one episode.”

The roadmap reflects this:

• Started with physical health (acute + chronic disease management)

• Added mental health (recognizing that physical and mental health are inseparable)

• Expanding into dental, pediatrics, and women’s health

All coordinated by the same health coach who knows your baseline, your goals, your family situation, and your cultural context.

To support this vision, MiSalud made a controversial decision: to build its own EMR.

“We didn’t build it around billing codes,” Lepe explained. “We built it around longitudinal patient health.”

The system still integrates with Epic and Cerner where needed for care coordination, but the core data model prioritizes patient outcomes over reimbursement logic.

It’s a bet that technology should serve care delivery, not the other way around.

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5. Growth Came from Knocking on Doors—Then Letting Survival Speak

MiSalud’s early GTM wasn’t elegant.

“We knocked on a lot of doors,” Lepe said. “Employers, brokers, consultants, payers. Many dismissed us initially.”

What changed? Survival.

“If you’re still around three years later, people start listening.”

The company initially tested B2C during COVID, offering direct-to-consumer telehealth. Early traction looked promising. But churn was brutal.

“We abandoned B2C because the economics didn’t work,” Lepe admitted. “It was only after we committed fully to B2B that we found product-market fit.”

Now, with revenue traction and inbound demand, MiSalud has built a formal sales organization: SDRs, AEs, and broker-led distribution. But that infrastructure came after proving the model, not before.

The lesson for founders: don’t scale distribution until you’ve actually solved the problem.

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Why This Matters

Healthcare doesn’t fail for lack of innovation. It fails when solutions ignore:

• Who the user actually is (language, culture, literacy, trust dynamics)

• How trust gets built (often requiring physical presence before digital works)

• What the economics actually incentivize (throughput vs. outcomes)

MiSalud’s lesson is uncomfortable but clear:

If people don’t use your product, your strategy doesn’t matter.

And fixing utilization requires far more than a Spanish-language toggle or a culturally diverse stock photo on your landing page.

It requires redesigning care from the ground up—starting with the populations that traditional healthcare has systematically failed.

As MiSalud expands beyond Hispanic populations (25% of consults now happen in English) and into Mexico itself (serving employees on both sides of the border), the model’s potential becomes clear:

Nearshore healthcare isn’t just a cost play. It’s a way to make compassionate care economically sustainable.

And in a system where compassion is usually the first thing sacrificed to margin pressure, that might be the most disruptive innovation of all.

Thanks for reading. Stay healthy,

Rodrigo Hütt