If the Covid era marked a boom time for digital health companies, 2024 was the reckoning.

In a year that saw the Nasdaq jump 32%, surpassing 20,000 for the first time this month, health tech providers largely suffered. Of 39 public digital health companies analyzed by CNBC, roughly two-thirds are down for the year. Others are now out of business.

There were some breakout stars, like Hims & Hers Health, which was buoyed by the success of its popular new weight loss offering and its position in the GLP-1 craze. But that was an exception.

While there were some company-specific challenges in the industry, overall it was a “year of inflection,” according to Scott Schoenhaus, an analyst at KeyBanc Capital Markets covering health-care IT companies. Business models that appeared poised to break out during the pandemic haven’t all worked as planned, and companies have had to refocus on profitability and a more muted growth environment.

“The pandemic was a huge pull forward in demand, and we’re facing those tough, challenging comps,” Schoenhaus told CNBC in an interview. “Growth clearly slowed for most of my names, and I think employers, payers, providers and even pharma are more selective and more discerning on digital health companies that they partnered with.” 

In 2021, digital health startups raised $29.1 billion, blowing past all previous funding records, according to a report from Rock Health. Almost two dozen digital health companies went public through an initial public offering or special purpose acquisition company, or SPAC, that year, up from the previous record of eight in 2020. Money was pouring into themes that played into remote work and remote health as investors looked for growth with interest rates stuck near zero.

But as the worst waves of the pandemic subsided, so did the insatiable demand for new digital health tools. It’s been a rude awakening for the sector.  

“What we’re still going through is an understanding of the best ways to address digital health needs and capabilities, and the push and pull of the current business models and how successful they may be,” Michael Cherny, an analyst at Leerink Partners, told CNBC. “We’re in a settling out period post Covid.”

Progyny, which offers benefits solutions for fertility and family planning, is down more than 60% year to date. Teladoc Health, which once dominated the virtual-care space, has dropped 58% and is 96% off its 2021 high.

When Teladoc acquired Livongo in 2020, the companies had a combined enterprise value of $37 billion. Teladoc’s market cap now sits at under $1.6 billion.

GoodRx, which offers price transparency tools for medications, is down 33% year to date. 

Schoenhaus says many companies’ estimates were too high this year.

Progyny cut its full-year revenue guidance in every earnings report in 2024. In February, Progyny was predicting $1.29 billion to $1.32 billion in annual revenue. By November, the range was down to $1.14 billion to $1.15 billion.

GoodRx also repeatedly slashed its full-year guidance for 2024. What was $800 million to $810 million in May shrank to $794 million by the November.

In Teladoc’s first-quarter report, the company said it expected full-year revenue of $2.64 billion to $2.74 billion. The company withdrew its outlook in its second quarter, and reported consecutive year-over year declines.

“This has been a year of coming to terms with the growth outlook for many of my companies, and so I think we can finally look at 2025 as maybe a better year in terms of the setups,” Schoenhaus said.  

While overzealous forecasting tells part of the digital health story this year, there were some notable stumbles at particular companies. 

Dexcom, which makes devices for diabetes and glucose management, is down more than 35% year to date. The stock tumbled more than 40% in July – its steepest decline ever – after the company reported disappointing second-quarter results and issued weak full-year guidance. 

CEO Kevin Sayer attributed the challenges to a restructuring of the sales team, fewer new customers than expected and lower revenue per user. Following the report, JPMorgan Chase analysts marveled at “the magnitude of the downside” and the fact that it “appears to mostly be self-inflicted.” 

Genetic testing company 23andMe had a particularly rough year. The company went public via a SPAC in 2021, valuing the business at $3.5 billion, after its at-home DNA testing kits skyrocketed in popularity. The company is now worth less than $100 million and CEO Anne Wojcicki is trying to keep it afloat.

In September, all seven independent directors resigned from 23andMe’s board, citing disagreements with Wojcicki about the “strategic direction for the company.” Two months later, 23andMe said it planned to cut 40% of its workforce and shutter its therapeutics business as part of a restructuring plan. 

Wojcicki has repeatedly said she intends to take 23andMe private. The stock is down more than 80% year to date. 

Digital health’s bright spots

Investors in Hims & Hers had a much better year.

Shares of the direct-to-consumer marketplace are up more than 200% year to date, pushing the company’s market cap to $6 billion, thanks to soaring demand for GLP-1s. 

Hims & Hers began prescribing compounded semaglutide through its platform in May after launching a new weight loss program late last year. Semaglutide is the active ingredient in Novo Nordisk‘s blockbuster medications Ozempic and Wegovy, which can cost around $1,000 a month without insurance. Compounded semaglutide is a cheaper, custom-made alternative to the brand drugs and can be produced when the brand-name treatments are in shortage.

Hims & Hers will likely have to contend with dynamic supply and regulatory environments next year, but even before adding compounded GLP-1s to its portfolio, the company said in its February earnings call that it expects its weight loss program to bring in more than $100 million in revenue by the end of 2025. 

Doximity, a digital platform for medical professionals, also had a strong 2024, with its stock price more than doubling. The company’s platform, which for years has been likened to a LinkedIn for doctors, allows clinicians to stay current on medical news, manage paperwork, find referrals and carry out telehealth appointments with patients. 

Doximity primarily generates revenue through its hiring solutions, telehealth tools and marketing offerings for clients like pharmaceutical companies.

Leerink’s Cherny said Doximity’s success can be attributed to its lean operating model, as well as the “differentiated mousetrap” it’s created because of its reach into the physician network. 

“DOCS is a rare company in healthcare IT as it is already profitable, generates strong incremental margins, and is a steady grower,” Leerink analysts, including Cherny, wrote in a November note. The firm raised its price target on the stock to $60 from $35. 

Another standout this year was Oscar Health, the tech-enabled insurance company co-founded by Thrive Capital Management’s Joshua Kushner. Its shares are up nearly 50% year to date. The company supports roughly 1.65 million members and plans to expand to around 4 million by 2027. 

Oscar showed strong revenue growth in its third-quarter report in November. Sales climbed 68% from a year earlier to $2.4 billion.

Additionally, two digital health companies, Waystar and Tempus AI, took the leap and went public in 2024. 

The IPO market has been largely dormant since late 2021, when soaring inflation and rising interest rates pushed investors out of risk. Few technology companies have gone public since then, and no digital health companies held IPOs in 2023, according to a report from Rock Health. 

Waystar, a health-care payment software vendor, has seen its stock jump to $36.93 from its IPO price of $21.50 in June. Tempus, a precision medicine company, hasn’t fared as well. It’s stock has slipped to $34.91 from its IPO price of $37, also in June.

“Hopefully, the valuations are more supportive of opportunities for other companies that have been lingering in the background as private companies for the last several years.” Schoenhaus said. 

Out with the old

Several digital health companies exited the public markets entirely this year. 

Cue Health, which made Covid tests and counted Google as an early customer, and Better Therapeutics, which used digital therapeutics to treat cardiometabolic conditions, both shuttered operations and delisted from the Nasdaq. 

Revenue cycle management company R1 RCM was acquired by TowerBrook Capital Partners and Clayton, Dubilier & Rice in an $8.9 billion deal. Similarly, Altaris bought Sharecare, which runs a virtual health platform, for roughly $540 million.

Commure, a private company that offers tools for simplifying clinicians’ workflows, acquired medical AI scribing company Augmedix for about $139 million.

“There was a lot of competition that entered the marketplace during the pandemic years, and we’ve seen some of that being flushed out of the markets, which is a good thing,” Schoenhaus said.

Cherny said the sector is adjusting to a post-pandemic period, and digital health companies are figuring out their role.

“We’re still cycling through what could be almost termed digital health 1.1 business models,” he said. “It’s great to say we do things digitally, but it only matters if it has some approach toward impacting the ‘triple aim’ of health care: better care, more convenient, lower cost.”

President-elect Donald Trump is tapping tech heavyweights to join his new administration, continuing a trend of Silicon Valley’s growing influence in a second Trump White House.

Trump said Sunday he would nominate Scott Kupor, a managing partner at Andreessen Horowitz, to be director of the Office of Personnel Management, which coordinates recruitment and provides resources for government employees.

Kupor thanked Trump in a post on X and said the opportunity would allow him to work with Elon Musk and Vivek Ramaswamy in their leadership of the Department of Government Efficiency, or DOGE, a nascent commission aimed at cutting government spending and regulation.

Trump also picked Sriram Krishnan as senior policy advisor for artificial intelligence at the White House Office of Science and Technology Policy. Krishnan, who most recently served as a general partner at Andreessen Horowitz, has had a long career in tech, with roles at Microsoft, Meta, Twitter, Snap and Yahoo. He has previous ties to Musk, helping him “temporarily” run the social media service X after Musk acquired the platform, formerly known as Twitter, for $44 billion in 2022.

Musk, a tech billionaire who was one of Trump’s top donors and most vocal supporters during his campaign, has emerged as one of the president-elect’s closest advisors. His outsized influence over Trump has led to growing consternation among Democrats, foreign leaders and business executives, some of whom compete with Musk’s companies. Along with X, Musk runs vehicle maker Tesla, defense contractor SpaceX and brain tech startup Neuralink.

Krishnan will likely work closely with David Sacks, another tech executive who has a long history with Musk. Trump earlier this month named Sacks — a venture capitalist, former PayPal COO and popular podcaster — as “czar” of crypto and AI.

Trump on Sunday also tapped Ken Howery, a co-founder of PayPal and Founders Fund, as his pick for U.S. ambassador to the Kingdom of Denmark. And he appointed Michael Kratsios, who was most recently a managing director at tech startup Scale AI, as the director of the White House Office of Science and Technology Policy. Kratsios served as chief technology officer during Trump’s first administration.

In addition, Trump named former Uber executive Emil Michael as undersecretary for research and engineering.

Tech business leaders cheered the choices in social media posts. Former Meta executive David Marcus called Trump’s selections “remarkable picks,” while Box CEO Aaron Levie said the choices were “very strong.”

Since Trump’s election victory, a slew of tech companies have thrown their support behind the president-elect — a significant departure from his first term, when the industry at large maintained a tense relationship with Trump.

Amazon, Meta and OpenAI Sam Altman have announced donations of $1 million each to Trump’s inaugural committee. And in recent weeks, Silicon Valley executives have made pilgrimages to Trump’s residence Mar-a-Lago in Palm Beach, Florida.

On the eve of MicroStrategy‘s stock market debut in June 1998, founder Michael Saylor stayed in a penthouse suite at the Lotte New York Palace in Midtown Manhattan. Saylor, who was 33 at the time, says it was the most exquisite hotel room he’d ever seen, paid for by lead underwriter Merrill Lynch.

The next morning, Saylor went to the floor of the Nasdaq to watch his company’s stock open. He recalled seeing a note scrolling across the ticker, warning traders: “Please do not confuse MSTR with MSFT.” The latter belonged to Microsoft, the software giant that had gone public 13 years earlier.

MicroStrategy shares popped 76% in their debut, joining the parade of tech companies benefiting from the dot-com boom.

“It was a good day,” Saylor told CNBC.

More than 26 years later, MicroStrategy and Microsoft were again linked together, but for an entirely different reason. In December 2024, Saylor stood before Microsoft’s shareholders to try and convince them that the company, now valued at over $3 trillion, should put some of its $78.4 billion in cash, equivalents and short-term investment into bitcoin.

“Microsoft can’t afford to miss the next technology wave, and bitcoin is that wave,” Saylor said in a video presentation that he released on X last week. The post has more than 3.6 million views.

Saylor has gone all in on that strategy. MicroStrategy has purchased 439,000 bitcoin since mid-2020, a stockpile that’s now worth about $42 billion and is the basis for the company’s market cap explosion to $82 billion from roughly $1.1 billion when the plan was put in place.

MicroStrategy’s software unit, which specializes in business intelligence, generates just over $100 million in revenue a quarter. After zooming up in 1998 and 1999, the stock crumbled in the dot-com bust, losing almost all its value. In the decades that followed, it slowly bounced back before rocketing up due to bitcoin.

Four years into its bitcoin buying spree, MicroStrategy is the world’s fourth-largest holder, behind only creator Satoshi Nakamoto, BlackRock’s iShares Bitcoin Trust and crypto exchange Binance.

At Microsoft, the shareholder vote supported by Saylor failed by a wide margin — less than 1% of its investors voted for it.

But the spectacle provided Saylor, now 59, with yet another opportunity to preach the gospel of bitcoin and tout the benefits of converting as much cash as possible into that single digital asset. It’s a story that Wall Street has been gobbling up.

MicroStrategy shares are up 477% this year as of Friday’s close, second to only AppLovin among all U.S. tech companies valued at $5 billion or more, according to FactSet data. That follows a 346% gain in 2023.

While the rally was in full force well before November of this year, Donald Trump’s election victory, funded heavily by the crypto industry, propelled the stock even more. The shares have climbed 60% since the Nov. 5 election, and finally exceeded their dot-com era high from 2000 on Nov. 11.

Saylor has long talked about bitcoin in an evangelical fashion and co-authored a book about it in 2022 titled “What is Money?” But his critics have gotten louder than ever of late, describing Saylor as a cult-like leader and his strategy as a “ponzi loop” that involves issuing debt and equity to buy bitcoin, watching MicroStrategy’s stock price go up, and then doing more of the same.

“Wash, rinse, repeat — what could possibly go wrong?” wrote Peter Schiff, chief economist and global strategist at Euro Pacific Asset Management, in a Nov. 12 post on X to his 1 million followers.

Saylor, who has 3.8 million followers, addressed the growing chorus of skeptics last week in an interview with CNBC’s “Money Movers.”

“Just like developers in Manhattan, every time Manhattan real estate goes up in value, they issue more debt to develop more real estate, that’s why your buildings are so tall in New York City,” Saylor said, in a clip that’s been posted to X by his legion of fans. “It’s been going for 350 years. I would call it an economy.”

Saylor is a frequent guest on CNBC, making appearances on various programs throughout the year. He also agreed to two interviews with CNBC.com, one in September and another soon after the election.

The first of those chats came back at the Lotte, just a few elevator stops from the penthouse where he stayed the night before his stock hit the Nasdaq. Saylor was delivering a conference keynote at the hotel and taking meetings on the side.

He wore a designer suit and an orange Hermes tie, matching bitcoin’s designated color. The election was less than two months away, and crypto companies were pumping money into the Trump campaign after the Republican nominee and ex-president, who previously called bitcoin a “scam against the dollar,” started guaranteeing a much more crypto-friendly administration.

Two months earlier, in July, Trump delivered a keynote at the biggest bitcoin conference of the year in Nashville, Tennessee, where he promised to fire SEC Chair Gary Gensler, an industry critic, and said the U.S. would become the “crypto capital of the planet” if he won.

“I think the election year has inspired the crypto community to find its voice, and I think it has catalyzed a lot of enthusiasm that was latent,” Saylor said in the September interview. “When Trump came out tentatively positive, that was a big boost to the industry. When he came out fully positive, that was another boost.”

Until this year, MicroStrategy was one of the few ways many institutions could buy bitcoin. Because MicroStrategy was an equity, investment firms didn’t need any special provisions to own it. The environment changed in January, when the SEC approved spot bitcoin exchange-traded funds, allowing investors to buy ETFs that track the value of bitcoin.

Since Trump’s victory, it’s all been up and to the right. Bitcoin is up about 41% and BlackRock’s ETF has climbed 39%. Gensler is preparing to leave the SEC, and Trump has picked deregulation advocate and former SEC Commissioner Paul Atkins to replace him.

Venture capitalist David Sacks, an outspoken conservative who hosted a fundraiser for Trump in San Francisco, will be the “White House A.I. & Crypto Czar,” Trump announced earlier this month in a post on his Truth Social platform.

“With the red sweep, bitcoin is surging up with tailwinds, and the rest of the digital assets will also begin to surge,” Saylor told CNBC in a phone interview, soon after the election. He said bitcoin remains the “safe trade” in the crypto space, but as a “digital assets framework” is put into place for the broader crypto market, “there’ll be a surge in the entire digital assets industry,” he said.

“Taxes are coming down. All the rhetoric about unrealized capital gains taxes and wealth taxes is off the table,” Saylor said. “All of the hostility from the regulators to banks touching bitcoin” also goes away, he added.

MicroStrategy has gotten even more aggressive with its bitcoin purchases. Saylor said in a post on Dec. 16, that over a six-day stretch starting Dec. 9, his company had acquired 15,350 bitcoin for $1.5 billion.

So far this year, MicroStrategy has acquired 249,850 bitcoin, with almost two-thirds of those purchases occurring since Nov. 11.

“We were going to do it regardless,” Saylor said, referring to the election results. “But what was a headwind has become a tailwind.”

A week before the election, MicroStrategy announced in its quarterly earnings release a plan to raise $42 billion over three years. That included a stock sale of up to $21 billion through financial firms including TD Securities and Barclays, opening up that much more liquidity for bitcoin purchases.

Saylor told CNBC it was “probably the single most important earnings call in the history of the company.”

No amount of ownership is too much for Saylor, who predicted in September that bitcoin could hit $13 million by 2045, which would equal 29% growth annually.

“We’ll just keep buying the top forever,” he said in the same TV interview where he compared bitcoin to New York real estate. “Every day is a good day to buy bitcoin. We look at it as cyber-Manhattan.”

Saylor talks glowingly about bitcoin as the foundation of a new digital economy that will only get bigger. But even since his bitcoin strategy got underway in 2020, there have been pockets of severe pain for investors — the stock lost 74% of its value in 2022 before soaring the past two years.

Still, he’s advising companies to mimic his strategy. Microsoft didn’t listen, but Saylor said there are plenty of “zombie companies,” with core businesses that aren’t going anywhere that could make better use of their cash.

“The traditional advice would be, you do a transformational acquisition, you find that you need a merger partner. You’re dead in the water. Go find somebody to merge with,” Saylor said at the Lotte in September. “Bitcoin is the universal merger partner, right? The real appeal of digital capital is you can fix any company.”

WATCH: CNBC’s full interview with MicroStrategy CEO Michael Saylor