There is a particular kind of executive that behavioral health technology companies have been reaching for lately: not the clinician-founder who built the original product in a spare room, and not the growth-stage venture darling chasing the next funding round, but the seasoned operator who has spent decades figuring out how to make complex software businesses run. Dinesh Senanayake, whom RethinkFirst announced on March 12 as its new Chief Executive Officer, is that kind of executive. Whether the board has found the right one is a separate question, and one that the company’s recent leadership history makes somewhat harder to answer on faith.
Senanayake comes to the New York-based company after a career that has taken him across several continents and through some of the more demanding corridors of enterprise software, most recently as Chief Operating Officer and Chief Financial Officer at Paessler, a German IT infrastructure monitoring firm, where he arrived in May 2024. Before that, he held the same dual role at Ventiv Technology, an insurance risk management software company that was acquired in January 2024 by Riskonnect, a rival RMIS provider backed by private equity firm TA Associates. His healthcare-specific experience runs through leadership positions at Optima Healthcare Solutions, a cloud-based electronic medical record provider for post-acute care that was acquired by Net Health in 2019, and at Net Health itself, where he served as an executive vice president overseeing go-to-market and operations for data services and revenue cycle management.
RethinkFirst—which was founded in 2007 by Daniel Etra and Eran Rosenthal under the name Rethink Autism and has since broadened its focus across the full arc of neurodiversity and behavioral health—operates a cloud-based platform that the company says serves more than eleven million employees worldwide, one-third of Fortune 100 companies, many of the country’s largest public school districts, and more than ninety-six thousand individual behavioral healthcare providers. Those figures are company-reported and have not been independently verified, but they speak to the unusual breadth of RethinkFirst’s market positioning, which straddles employer benefits, special education, and outpatient clinical care in ways that most of its competitors do not.
A Familiar Face at the Top
What the announcement did not mention, but public records make plain, is that Senanayake and RethinkFirst’s board chairman, Salil Donde, are not strangers. At Ventiv Technology, Donde served as Chief Executive Officer while Senanayake served directly under him as COO and CFO. It was Donde who publicly announced the Riskonnect deal in January 2024 as Ventiv’s CEO, with Senanayake as his operating partner throughout. Donde joined RethinkFirst as executive chairman in May 2024, the same month Senanayake moved to Paessler. The appointment of Senanayake to lead RethinkFirst now looks less like a national search and more like a chairman betting on someone he has already watched perform under pressure through a company sale.
What the press release also did not mention is that Senanayake is not the first person Donde has installed in the role since joining the board. In January 2025, RethinkFirst announced Ben Semmes, a veteran of Monotype, Pitney Bowes, and Oracle, as Chief Executive Officer. Semmes lasted roughly fourteen months. The circumstances of his departure were not disclosed, and RethinkFirst did not respond to a request for comment before publication. A company cycling through its second CEO in little more than a year is not necessarily in distress, but it is worth noting, and the compressed timeline makes Donde’s turn toward a trusted operational partner more legible as a deliberate choice rather than a coincidence.
A Career Built on Transitions
What distinguishes Senanayake’s resume, at least on paper, is less any particular industry than a consistent pattern of arriving at companies in motion. At Ventiv Technology, he helped lead the operational groundwork that preceded the sale to Riskonnect. At Paessler, which had recently taken on a strategic investment from Turn/River Capital, he was brought in to help expand the firm into new markets. In each case, the mandate was a version of the same thing: stabilize, professionalize, grow.
That pattern is precisely what RethinkFirst’s board appears to be banking on. Donde cited advances in artificial intelligence and the strength of the company’s existing team as central to the company’s positioning. The claim is not without foundation. RethinkFirst, which has been backed by K1 Investment Management since 2020, has been building out AI-assisted tools, including a product called RethinkFutures, which the company describes as using machine learning to help insurance payors optimize ABA service recommendations and authorization workflows, drawing on what it calls the largest published dataset in autism services. The product is payor-facing rather than provider-facing, a distinction that signals the company is pushing upstream toward the managed care market.
Senanayake himself offered something rarer in a CEO announcement: a candid statement of personal motivation. “Behavioral health, neurodiversity, and disability support aren’t abstract,” he said in the company’s release. “RethinkFirst touches real people and families, often at vulnerable moments.” Whether that sentiment reflects the specific pull of the mission or the general instinct to frame a career move in the most compelling possible terms, it is a reminder of what distinguishes behavioral health technology from most other enterprise software sectors: the population it serves tends to make the stakes feel concrete in ways that IT monitoring rarely does.
What the Appointment Signals
The behavioral health technology market has seen a steady influx of operationally oriented leaders over the past several years, as the sector has matured past its early-stage roots and private equity ownership has become more common. The calculus is familiar: clinician-founders build products that work; operators build companies that scale. Whether that division of labor holds in a field as clinically specific as applied behavior analysis is a question the industry continues to debate, though the evidence from adjacent health IT sectors suggests the model is workable, provided the new leadership maintains close ties to the clinical side of the house.
The choice of a dual COO/CFO background for the Chief Executive slot is worth noting in its own right. It suggests that RethinkFirst’s board is prioritizing operational rigor and financial discipline, at least as a primary lens, over product vision or market development. That emphasis is consistent with a company that has been filling out its executive team at a significant clip, adding a Chief Revenue Officer, a Chief People Officer, a Chief Financial Officer, a Chief Product Officer, a Chief Technology Officer, and a head of AI over the past two years, all of them hired under Semmes. The picture is of a company assembling the organizational infrastructure that a founder-era business tends to leave incomplete—Etra and Rosenthal built something durable; the question now is whether the operators who follow them can scale it without losing what made it credible.
Whether Senanayake’s background, rooted more deeply in enterprise software than in the clinical and regulatory specificities of behavioral health, proves to be an advantage or a liability will depend largely on the team he inherits and the relationships he builds with the clinicians and providers who constitute RethinkFirst’s core constituency. In behavioral health, where trust between technology vendors and clinical practitioners is hard to earn and easy to lose, the operator’s edge cuts both ways.
