firsthand Health Inc Company Growth, Stability & Outlook

firsthand Health Inc holds a distinctive position in the behavioral health industry as one of the few value-based, peer-led companies operating at scale for individuals with serious mental illness- a population that is simultaneously among the highest-need and most underserved in the American healthcare system.

The SMI population is one that most health-tech companies have historically avoided, in part because the complexity of the work doesn't lend itself to lightweight digital solutions. firsthand's model, built around Peers with lived experience, supported by Nurse Practitioners, operating in-person in members' communities, is specifically designed for that complexity. 

The company has active partnerships with major national managed care organizations and has expanded to offices across multiple states. firsthand has been recognized by the New York Digital Health 100, named a Mental Health America Gold Bell Seal recipient for workplace mental health, and earned Modern Healthcare Best Places to Work honors,  external validations of both its model and its culture. 

The broader market is moving in firsthand's direction. In every KFF Medicaid budget survey over the past ten years, behavioral health services have been the most frequently reported area of benefit expansions. Medicaid has allowed states to use funds to pay for peer support services since 2007, and CMS considers peer support an evidence-based intervention- a policy foundation that continues to strengthen. Value-based care contracting in behavioral health is accelerating, and firsthand is purpose-built for that environment. 

firsthand navigated a significant challenge in early 2025 when the loss of a Medicaid contract required a workforce reduction across several states. The company responded with transparency, worked to support transitioning employees, and has since rebuilt its partner portfolio, signing contracts with multiple new payers and expanding to new markets. Many employees who were impacted have since returned to firsthand, with more planning to do so,  a meaningful signal of trust in the company's mission and leadership. The experience underscored both the inherent volatility of Medicaid contracting and firsthand's capacity to adapt and continue delivering on its mission. Contracts now in place represent multiple states and payers, reflecting a more diversified partnership base.

firsthand Health Inc's growth trajectory is visible across multiple dimensions: geographic expansion, a deepening care model, a growing workforce, and strong structural tailwinds in the market it serves.

Founded in 2021, firsthand has grown from operating in a handful of markets to maintaining a presence across Florida, Michigan, Ohio, Virginia, and Washington State, with active expansion underway in each. The company grew from operating in two or three markets to approximately eight within its first two years, and has continued expanding since, including its first West Coast office in Tacoma, Washington, opened in late 2024. New market launches in Michigan continued into 2026, with additional offices planned.

The care model itself is also maturing and expanding. In 2026, firsthand launched a significant update to its core care platform, expanding what it can do for each individual it serves.

Workforce growth tracks alongside. firsthand welcomed dozens of new team members in 2026 alone across Ohio, Michigan, Washington, Virginia, and Florida,  including clinical, operational, and leadership roles. Many employees who were impacted by the 2025 workforce reduction have since returned, with more planning to do so, reflecting confidence in the company's direction.

On the market side, the conditions for firsthand's model continue to strengthen. In every KFF Medicaid budget survey over the past ten years, behavioral health services have been the most frequently reported area of benefit expansions, and value-based care contracting in behavioral health is accelerating nationally. firsthand's outcomes-driven, peer-led model is purpose-built for that environment,  and its track record of engaging a population that traditional care systems routinely miss gives it a differentiated position as more health plans seek partners who can demonstrate results. 

firsthand's growth was interrupted in early 2025 by the loss of a major payer contract, which required a workforce reduction. The company has since rebuilt its partner base across multiple states and payers, re-hired affected team members where possible, and resumed market expansion, demonstrating resilience and the durability of its model.

firsthand Health Inc's stability and growth story is grounded in something that doesn't show up on a balance sheet: a model that works for a population the healthcare system has largely failed, and a team that is deeply committed to the mission of serving them.

Founded in 2021, firsthand has navigated the full arc of an early-stage healthcare company- rapid expansion, a significant market contraction in 2025, and a disciplined rebuild. What makes that arc meaningful is how the company responded at each stage: with transparency to employees, continued investment in the care model, and a return to growth backed by a more diversified partner base. Many employees who were impacted by the 2025 reduction have since returned, and more plan to- a signal that is rare and telling.

The internal numbers reinforce the foundation. A 7% voluntary turnover rate in a sector where frontline behavioral health turnover routinely exceeds 30–40% is a significant operational advantage. It means members keep the same trusted relationships over time, which is core to how the model works. An employee NPS of approximately 95% and an engagement score of 86% - industry-leading by benchmark, up 3% year over year,  point to a workforce that believes in what it's doing and plans to stay.

firsthand also offers equity and performance bonuses to all employees, including hourly frontline staff- an unusual practice that signals long-term alignment between the company's success and the people doing the work. Pair that with a sabbatical available to 100% of employees after five years, and the retention picture becomes even clearer: firsthand is building a workforce for the long run.