Hinge Health unlikely path to IPO

At digital physical therapy startup Hinge Health, CEO Daniel Perez used to recognize hard-working employees with the “Cockroach Award,” a distinction that brought with it a “cockroach squad” t-shirt and a cash payout.

References to the insect were abundant at the company’s old headquarters in London, where a picture of a cockroach was prominently displayed on the wall. For much of Hinge’s 10-year history, the cockroach was the unofficial mascot. Staffers named it Flossy after the viral dance move “the floss.”

Perez relishes the symbolism. In his determination to build a company that will push through adversity, he’s encouraged employees to think of themselves like cockroaches, due to the creature’s grimy resilience and noted ability to survive harsh conditions.

“It was the identity of every individual in the company,” said Joshua Sturm, a vice president at Hinge from 2019 to 2024 and now chief revenue officer at cancer prevention startup Color Health. “We are all in this together, and no matter what happens, we are going to survive together.”

Perez and his 1,400-person workforce now face the ultimate test of their mettle. Hinge, which moved from London to San Francisco in 2017, is trying to go public at a time of such extreme economic uncertainty and market volatility that several companies, including online lender Klarna and ticket marketplace StubHub, have delayed their long-awaited IPOs.

Hinge filed its prospectus on March 10, announcing plans to trade on the New York Stock Exchange under the ticker symbol “HNGE.” Three weeks later, President Donald Trump announced a sweeping tariff policy that plunged U.S. markets into turmoil after tariff concerns had already pushed the Nasdaq to its worst quarter since 2022.

But Hinge. led by its 39-year old co-founder and CEO, appears determined to power through the chaos. Hinge declined to comment or make Perez available for an interview. 

Going public was already going to be a risky endeavor for Hinge. The IPO market has been mostly dormant since late 2021, when soaring inflation and rising interest rates pushed investors out of risky assets. Within digital health, it’s been almost completely dead.

Health-tech companies have struggled to adapt to a more muted growth environment following the Covid pandemic, and many once promising business models haven’t panned out as planned.

The starkest example is virtual health company Teladoc, which has a market cap of just over $1 billion less than five years after buying digital health provider Livongo in a deal that valued the combined companies at $37 billion. Teladoc’s BetterHelp mental health unit has been a particularly troublesome business as paying users dropped off in the years following the pandemic.

Over time, Hinge’s Cockroach Award transitioned from a monthly prize to a quarterly distinction. The company phased it out entirely about a year ago in preparation for its next public-facing chapter, but the survive-at-all-costs mentality persists, according to current employees. Now, staffers are recognized with the “Movers Awards,” a nod to the company’s focus on movement.

“We have many decades of work ahead,” Perez wrote in a letter to investors in March. “We hope you join us on this journey.”

CNBC spoke to 13 current and former Hinge employees, investors, and people close to Perez for this story, some of whom asked not to be named in order to provide candid commentary.

Hinge uses software to help patients treat acute musculoskeletal injuries, chronic pain and carry out post-surgery rehabilitation remotely. Large employers like Target and Morgan Stanley cover the costs so their employees can access Hinge’s app-based virtual physical therapy, as well as its wearable electrical nerve stimulation device called Enso. 

The company says its technology can help users manage pain, cut down health-care costs and reduce the need for surgery and opioids. Revenue increased 33% to $390.4 million last year, while its net loss narrowed to $11.9 million from $108.1 million a year earlier, according to the prospectus.

Hinge’s roster of clients expanded by 36% last year to 2,256, and the number of individual members jumped 44% to over 532,300, the filing said.

Hinge has raised more than $1 billion from investors including Tiger Global Management and Coatue Management, and it boasted a $6.2 billion valuation as of October 2021, the last time the company raised outside funding. The biggest institutional shareholders are venture firms Insight Partners and Atomico, which own 19% and 15% of the stock, respectively, according to the filing.

Perez and Gabriel Mecklenburg, Hinge’s executive chairman, started the company in 2014. The pair met while they were both pursuing PhDs in the U.K. — Perez at the University of Oxford and Mecklenburg at Imperial College London. They were distracted students, according to Perez’s twin brother, David. 

By the time they launched Hinge, Perez and Mecklenburg had already co-founded two other ventures together. One was the Oxbridge Biotech Roundtable, an organization that connected academics and industry experts. The other was Marblar, which worked to commercialize academic intellectual property.

Perez took a leave of absence from Oxford while working on Marblar and never returned. His brother wasn’t a fan of the decision initially.

“I gave him terrible advice,” said David Perez, a graduate of Yale Law School and partner at Perkins Coie in Seattle. “I was like, ‘I think you’re an idiot, I think you should focus on your PhD. Only an idiot would not finish a PhD at Oxford.'” 

The twins have two older siblings. Their mother immigrated from Cuba in 1968, followed 12 years later by their father. Their parents met in Miami, got married after just three dates, and are still together after more than 40 years. 

The family moved from Miami to Salt Lake City, Utah, in 1990. Perez’s mother was a substitute teacher and his father worked at restaurants as a dishwasher and busboy. David Perez said their father “worked around the clock” and used to call out orders in his sleep. 

“It wasn’t a lot of money, I think combined they made about $19,000 a year,” David Perez said. “But they stitched it together and raised four kids.” 

The twin boys were competitive, particularly when it came to academics and playing basketball in the driveway. David said his brother got “great grades” and always had an inclination toward science and medicine, graduating from high school at age 16 and then starting college at Westminster University, a small liberal arts school in Utah.

“I swear,” David Perez said, “there were times where the only punishment that my mom could issue that would have the sting was restricting our ability to do homework.”

Perez was a student in the Honors College at Westminster, and he graduated with a degree in biology. Richard Badenhausen, dean of the Honors College, described Perez as an independent thinker and an ambitious student, especially for his age. 

“He didn’t care too much what people thought about him, which is a strength in my book,” Badenhausen said in an interview. 

When Perez was 13, he was hit by a car. He broke an arm and a leg, and had to be airlifted to a nearby hospital. After three surgeries and 12 months of rehab, he had a newfound interest in orthopedics and physical therapy. 

Mecklenburg had a serious injury of his own, tearing his anterior cruciate ligament (ACL) during a judo match, which also required a year of rehab, according to Hinge’s website.

One day in October 2014, the pair put their heads together and outlined the tools they wished were available while undergoing physical therapy. Musculoskeletal conditions affect as many as 1.7 billion people worldwide, according to Hinge’s prospectus, so there was no shortage of opportunities.

They had the early concept of Hinge within hours and a prototype ready by December of that year.

In Hinge’s early days, Perez and Mecklenburg would meet every Saturday morning to talk shop. Now, as they’ve aged and started families, they meet on Wednesday nights, according to colleagues. Perez welcomed his first child with his wife late last year. 

“Seeing the growth over the last six, seven, eight years has just been unbelievable,” said Jon Reynolds, a tech founder who contributed to Hinge’s seed funding round. “That comes down to the quality of Dan and Gabriel as leaders. They complement each other really well, and they’ve obviously got that mutual respect.”

Perez is a hands-on CEO who expects a lot from his staff. 

He’s direct, detail-oriented, opinionated, competitive and can be intense, according to current and former employees. But he’s committed to the mission and the wellbeing of his employees, they said.

“He’s one of those rare founder CEOs who I think can go all the way,” said Paul Kruszewski, a former Hinge employee who joined the company after it acquired his Canadian computer vision startup, Wrnch, in 2021. 

Employees say Perez is a voracious reader, often finishing two to four books a month. That includes books about business and leadership, an important source of information given that Hinge was his first real job. He’s a fan of “The Innovator’s Prescription,” by Clayton Christensen and others, “Crossing the Chasm,” by Geoffrey Moore and “The Long Fix,” by Dr. Vivian Lee.

He also likes his staffers to read. Executives will often prepare to discuss chapters from a book in their meetings. 

“I’d come home and there’d be a package from Dan, and it’s a book,” said Sturm, who led partnerships and new market development at Hinge. “That was just the norm.”

Sturm, who has worked in the health-care and benefits space for around 30 years, said Hinge was very deliberate with hiring, so there wasn’t a lot of turnover among senior executives. He said Hinge’s recruitment process was the hardest he’s ever experienced. 

Another “Dan-ism,” as Sturm called it, is Hinge’s philosophy around writing. Perez has employees write memos, typically up to six pages long, instead of preparing slide decks or other materials ahead of meetings. Perez was inspired by a similar practice at Amazon, according to current and former employees, and sees it as a way to force employees to think through what they want to say instead of hiding behind bullet points.

Hinge’s memo culture can be an adjustment, particularly for new employees. Sturm said he thought the practice was “insane” at first, but ultimately came to appreciate it and said it improved his pitches.

“When you sort of sit back, you go, ‘You know actually, he wasn’t wrong,'” Sturm said. 

Hinge has come a long way since venture firm Atomico led the $8 million Series A investment in 2017. The London-based firm said in a blog post at the time that it was “extremely impressed by Daniel and Gabriel, and their determination to tackle a big problem in society.”

Carolina Brochado led the round, though she left Atomico a year later and now works at investment firm EQT Group. She said that getting Hinge to the brink of an IPO was a “one in a million chance,” but noted that the company has managed to build a sizable business in digital health despite having so many odds stacked against it.

“Lots of learnings along the way, of course, like a big tech correction in the middle,” Brochado said in an interview. “But it really is one of those rare examples of just an enormous market that was under penetrated.”

For David Perez, whose firm now serves as Hinge’s outside counsel, watching the startup grow has been “fascinating,” he said.

“I’m a partner at a major law firm,” he said, “and I am only the second most successful twin. But I think I’m okay with that.”

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