What to do when athena starts building what your marketplace company sells: a case study in Voice AI and 2-Way Texting
Last week athena announced native Voice AI and 2-Way Texting. Let's look at what the marketplace already looks like in both categories, because they'll require very different strategies.
Voice AI
28 Voice AI start-ups stormed the athena marketplace between 2024 and end of Jan 2026. 10 existing partners added Voice AI agents to their service offering. This created a bifurcation in the market between the two camps, established add-ons and new builders. Each will require their own GTM strategy with athena’s Voice AI solution on the horizon.
The established add-ons have the benefit of having a customer base with whom they can test. Practices are more likely to try a new feature from an established vendor. They may not have to get approval all the way up the chain. No one has to add a new line item into the accounts payable system for a new vendor, nor does a new relationship have to be established with a CSM. There is no increased risk of "another vendor has our data.”
The challenge the established add-ons face will be viewing the practice’s problem and their new solution for it, through the lens of their existing solutions, regardless of if they’re improving their core product, augmenting their core product, or building something novel. The novel build can be really attractive and customers will ask for it, but it can also be an unwise business decision. This is mitigated by a thorough market assessment. For example, a patient payment collection company shouldn’t get pulled into building self-scheduling functionality without understanding the complexities of practice scheduling and variability between practices, and how robust the market already is for scheduling solutions (red ocean alert). Everything can be improved, but a knife will go much deeper when you focus the energy at the tip of the blade. Almost every company I’ve worked with has made a version of this mistake.
The new builders come in with fresh eyes, looking for problems to solve, tend to have more product discipline in their quest for product market fit. The incentive alignment between a founder and a business tends to be greater than that between a PM and a business. That leads to more discipline for new builders ensuring new features drive financial outcomes for both practices and the company. The challenge facing new builders is getting their foot in the door with practices. Executive buy-in, legal review, all the admin stuff, plus building trust in a new relationship, all while keeping the sales motion going.
What makes the voice AI space stand out is just how many new entrants have sub 10 customers. 23 (data as of end of January) are clawing and fighting their way in. That tells me the barrier to entry is pretty low and it makes me wonder how deep the moats really are for the category leaders. With athena announcing their own Voice AI functionality last week, all voice AI companies have more pressure to find their niche, but for those start-ups the countdown could be existential.
2 Way Texting
2 Way Texting apps have had more linear growth than voice AI, both in the rate of new companies coming to market and adoption by athena practices. The 2017-2019 cohort has had years to build relationships and refine their product and they have the most customers. Recent entrants have fewer than 50. When I analyzed the current marketplace descriptions of each of the companies with Opus 4.6 I found a clear progression in the positioning of the companies.
2017-2019 texting is the product
2020-2022 texting is one feature in a platform
2023-2025 AI is the product, texting is assumed
The product descriptions tell the story of how the category evolved. Due to this trend, the newer entrants are better positioned to handle athena rolling out their own 2 way texting solution because they’re already deep into automation and customization (APIs from your marketplace vendor anyone?).
Practice managers for complex practices that want more automation should keep an eye on new entrants because Zapier/IFTTT type no-code workflows are becoming standard. The core functionality has been proven out in Slack integrations and many two way texting apps share a similar framework. Technology continues to chip away at the administrative burden of healthcare, until we have a broader systems change.
The practice managers for non-complex practices (I think those still exist) are the target audience for the athena version of 2 way texting, so companies where texting is the core product need to take a hard look at their roadmap, talk to their customers/prospects and figure out what problems practices will be facing in 2027 as this wave of AI tech crashes on the market.
Athena’s early entrance into both of these markets points to a shift in marketplace dynamics. Athena is building with the latest tech and they’re not waiting for a category to mature on the marketplace before competing. The companies that succeed will solve problems further into the tail of the distribution of practices and they’ll always be a step ahead so their customers can’t leave.