Commure Hits $7B Backed by GC, Sequoia, Morgan Stanley

Tanay Tandon, Co-Founder and CEO of Commure, joins Sourcery to break down the company's new $70M round at a $7B post-money valuation, led by General Catalyst with participation from Sequoia Capital, Morgan Stanley, and Kirkland & Ellis. With $750M raised to date, Commure now runs inside 500+ healthcare organizations, 3,000+ sites of care, and processes tens of billions of dollars in annual claims — with 85%+ of revenue cycle work completed without a human in the loop. Tanay started the company at 18 out of his Stanford dorm room. Today, Commure has 1,200 employees across seven offices, supports 200M+ patient encounters a year, and has doubled ARR three years in a row. We get into the round, the use of General Catalyst's Customer Value Fund (CVF) for non-dilutive growth capital, why he believes point solutions will be wiped out, the Augmedix acquisition, the Summa Health partnership in Akron, the JPM flip-flops story, and his IPO plans. Topics covered: • The $70M / $7B round and why he didn't need the capital • CVF and non-dilutive financing for go-to-market • Building an AI-native OS for healthcare • HCA, Tenet, Epic, and Meditech partnerships • Why platforms beat point solutions • Lessons from acquiring Augmedix • What Alfred Lin, Hemant Taneja, and Teresa Carlson taught him • The path to IPO Tanay Tandon: https://www.linkedin.com/in/tanaytandon Molly O’Shea: https://x.com/MollySOShea Sourcery: ⁠https://x.com/sourceryy 𝐄𝐏𝐈𝐒𝐎𝐃𝐄 𝐋𝐈𝐍𝐊 YouTube: https://youtu.be/Vd4HHQ1l9mM 𝐒𝐏𝐎𝐍𝐒𝐎𝐑𝐒 • Brex https://brex.com/sourcery—The modern finance platform, combining the world’s smartest corporate card with integrated expense management, banking, bill pay, & travel. https://brex.com/sourcery • Turing https://turing.com/sourcery—Turing delivers top-tier talent, data, and tools to help AI labs improve model performance—and enables enterprises to turn those models into powerful, production-ready systems. https://turing.com/sourcery • VCX https://fundrise.com/vcx—VCX is the public ticker for private tech, allowing investors of all sizes to invest in venture capital. View The Portfolio at http://GetVCX.com http://getvcx.com • Deel https://www.deel.com/sourcery—Deel is the global people platform that helps startups hire, manage, pay, and equip anyone, anywhere. Trusted by more than 35,000 fast-growing companies, Deel is the people platform that just works, so teams can scale without the chaos. Visit: https://www.deel.com/sourcery • Public http://public.com/sourcery–Investing platform Public just launched Generated Assets https://public.com/generated-asset, which lets you turn any idea into an investable index with AI. With Generated Assets, you can build, backtest, refine, and invest in any thesis with AI. Gone are the days of one-size-fits-all ETFs. https://public.com/sourcery • Merge https://merge.dev—The leading provider of customer-facing integrations and agentic tools for frontier LLMs, Fortune 500 organizations, and B2B SaaS companies. Visit https://merge.dev Follow Sourcery for the latest updates! https://www.sourcery.vc https://www.sourcery.vc/ Disclosure Paid Endorsement. Brokerage services by Open to the Public Investing Inc, member FINRA & SIPC. Advisory services by Public Advisors LLC, SEC-registered adviser. Crypto trading provided by Zero Hash LLC, licensed by the NYSDFS. Generated Assets is an interactive analysis tool by Public Advisors. Output is for informational purposes only and is not an investment recommendation or advice. See disclosures at public.com/disclosures/ga. Matched funds must remain in your account for at least 5 years. Match rate and other terms are subject to change at any time.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Molly O'Shea?

  You've raised 70 million on a 7 billion valuation led by General Catalyst with support from Sequoia and Morgan Stanley.

• 0:06Speaker 01

  In total, the business has raised about 750 million bucks. We support 200 million patient encounters every year now, saving at least 75 million hours a year for physicians. The progress over the last 18 months in the business has been rapid. We've expanded in geographies, we've expanded logos, we've added some of the largest health systems in the country. And now we're really going to use those dollars to accelerate R and D, accelerate some of our investments in further model development for everything from voice agents to back office automation. In health systems like HCA, we've been able to add a couple hours to every physician's day. And this is a company that generates north of $100 billion in top line revenue. LLMs are this gift that we've received to go nuke all of that work tax. And that in some ways is going to be my life's work in terms of just eliminating the work tax and making the system a trillion dollars more efficient.

• 0:50Speaker 01

  Because if you do that, then you make the entire American middle class wealthy.

• 1:03Molly O'Shea?

  Today, welcome to Sorcery.

• 1:04Speaker 01

  Thank you for having me.

• 1:05Molly O'Shea?

  Thank you for having us here at one of your investors' offices. Where are we?

• 1:09Speaker 01

  We are at the Human Capital office. Their Human Capital is run by two of my closest friends, Varsh and Armon, and they really helped start Kumyur and have been with me on this journey for six years now.

• 1:19Molly O'Shea?

  And it's beautiful.

• 1:20Speaker 01

  It is beautiful.

• 1:21Molly O'Shea?

  It's a beautiful journey.

• 1:22Speaker 01

  It's way prettier than our dingy Mountain View office. So we use this one instead.

• 1:26Molly O'Shea?

  Okay, we have a big congratulations for you today. You've raised 70 million on a 7 billion valuation led by General Catalyst with support from Sequoia and Morgan Stanley. What happened?

• 1:39Speaker 01

  We raised around, thank you. And I think the progress over the last 18 months in the business has been rapid. We've expanded in geographies, we've expanded logos, we've added some of the largest health systems in the country, and we've helped physicians save time and physicians make more revenue every single day. And based on that growth, we raised at a pretty large premium to the last price and have now really going to use those dollars to accelerate R and D, accelerate some of our investments in further model development for everything from voice agents to back office automation. It's a massive trillion dollar problem and you can build for decades.

• 2:15Molly O'Shea?

  You started the company at 18. You had a bunch of M and A in the process of that. And how many employees do you have now?

• 2:25Speaker 01

  The full company today is about 1,200 people.

• 2:27Molly O'Shea?

  Oh, my gosh.

• 2:28Speaker 01

  Yeah, we're, you know, seven different offices, India, Bangladesh included. And then a New York hub, a Boston hub, an Asheville hub, and then Mountain News HQ. And Salt Lake as well.

• 2:39Molly O'Shea?

  And you raised how much in total?

• 2:41Speaker 01

  In total, the business has raised about 750 million bucks.

• 2:45Molly O'Shea?

  Okay, well, what makes this round different than other rounds?

• 2:50Speaker 01

  I think, you know, this round, one, we really didn't need the capital. We raised it for pricing purposes and we saw a couple of interesting opportunities to accelerate R and D, particularly around air, which is our LLM native V M R platform, and our voice agent platform. And so the idea is if we can accelerate timeline, bring in a team of 40, 50 killer engineers to attack some of these problems that are adjacent, but converging upon the same solution set that we have in R C M and Ambient, it's going to be net better for our customers. Number two, we've extensively used C V F, which is General Catalyst's non-dilutive customer value fund, to fund our go-to-market expansion without needing to dilute shareholders. And so the last two years have been very non-dilutive for the company and for shareholders.

• 3:34Speaker 01

  And this was, you know, a pretty non-dilutive round as well against the valuation. We raised not a ton of capital because we didn't really need it. But it sets a new mark and it lets us sprint and continue building.

• 3:45Molly O'Shea?

  I want to talk about C V F. We had him on not too long ago and we talked about how General Catalyst is not a venture fund. They're a company, they're a huge platform. And I also just had Teresa Carlson on and we talked about General Catalyst Institute. She gave you a nod, too. But I want to talk about C V F. So what does C V F do? Because it is a new type of vehicle, especially for startups and venture companies. And I just want to know, like, what the process is like, how you got introduced to it, what was the sell there?

• 4:18Speaker 01

  Yeah, I mean, I think if you back up the timeline super aggressively and you go back to the father of capitalism in some way, Rockefeller. Rockefeller was the O G when it came to using credit. And he really didn't dilute himself or his shareholders much at all. And they aggressively knew that hey, if we drill in these places and we drill for 10 years and we develop our refineries and we develop our supply chain, these many dollars are going to show up. And we're going to use credit to fund that expansion as opposed to, you know, taking on more and more dilutive equity. And CVF is really, I think, built along that concept and credit is not a unique concept in a lot of ways. The reason startups shy away from it is it often puts this massive liability on your balance sheet.

• 5:00Speaker 01

  And if the worst case Armageddon happens, you're now, your whole company could implode. And CVF is built to address that need very, very particularly, which is instead of risking against balance sheet, it's risk against forward-looking customer cohorts and performance. So if you're confident that your SaaS cohorts will perform and revenue will show up and when you put in go-to-market dollars, net new logos will show up. You can use, you can essentially forward pull that revenue to fund expansion faster and faster. And I think this is the purest form of go-to-market. You actually don't want to use balance sheet for go-to-market. You want to use balance sheet for R and D and these more durable, long-term investments. And that's why we used it. And I think that's why it's an amazing vehicle.

• 5:42Molly O'Shea?

  Yeah, I haven't talked to many people about that. We do a lot of equity fundings and then we've done some public companies. But there's definitely more nuances to the types of capital you can buy now, especially as tokens increase costs within companies. Are you seeing that? Are you guys using lots of tokens? Is that compressing your margins? What are you?

• 6:05Speaker 01

  I think it's a great question and there are a lot of businesses where, you know, you look at VCs have a good sense of what a SaaS business looks and feels like in terms of its margin structure, its payback, its CAC, its LTV. And one of the challenges is that these token businesses have essentially turned a lot of software businesses to service-level margin. And if you play the game the same way you did two years ago, you can blow up and you can burn a lot of cash in the process. And I think good operators and, you know, good CFOs have a fundamental understanding of their margin structure and their payback structure. So when we use CVF, we, you know, we have parts of our business that run at pure SaaS margins in the high 80s. Mid nineties and you have other parts of the business like full cycle RCM that have a labor component and a heavy token component and those run at everywhere anywhere from the

• 6:50Speaker 01

  high sixties in their implementation stage to the mid seventies in their steady state. That's a different margin structure than SaaS. It's still great. You can, you know, that's still,

• 6:59Speaker 01

  many businesses would take 70% margins like with every day of the week with their eyes closed. But, but I think the, you know, for us, the question is, can you, if you fundamentally understand the payback periods, then you should use CVF. You should use non-dilutive mechanisms to fund that expansion.

• 7:13Molly O'Shea?

  You mentioned before that you want to go public. Is that still the case?

• 7:16Speaker 01

  100%. I think the best American businesses go public and become long durable parts of retail and allow the public to invest in them. I also think, given the size and shape of our business, we're in the hundreds of millions of dollars in revenue. We support some of the largest systems in the country. Our acceleration in some way will, would be fueled by going public as opposed to being hampered by it.

• 7:39Molly O'Shea?

  Camira is building the AI-powered OS for healthcare. Can you unpack that a little bit more and the state of healthcare?

• 7:47Speaker 01

  Yeah, I think that's a great question. So Camira at its core is a software company that builds tools for providers and for healthcare administrators. This is a multi-trillion dollar problem and even when you cohort it down, there's a trillion dollars spent on healthcare admin every year. That's clinical admin, that's financial admin, like revenue cycle management, all of the tasks that happen in the back office of a health system, like scheduling, prior auth appeals. We've built a series of fine-tuned language models and agents that automate all of those tasks and truly take a health system that might operate at 2%, 3% operating margin today because of all the labor it needs and turn it into something that can operate at 20%, 30%

• 8:30Speaker 01

  operating margin, like the top percentile healthcare practices and systems. And our belief is that that's not going to be 100 different point solutions. That's actually, actually going to be one revenue engine and a series of agents that are orchestrated on a single platform, which is Camira OS. And so for us, the, the, the next couple, I mean, today a practice that Uses our platform will use this for their scribing, their practice management, their documentation, their autonomous coding, their revenue cycle and all of their back office needs. And see that boost in margin because they can grow without needing to have labor directly track their top line, which is historically when a healthcare practice grows, you just linearly tack on more and more labor. In health systems like HCA, it's a very similar story.

• 9:14Speaker 01

  We've been able to add a couple hours to every physician's day. And this is a company that generates north of $100 billion in top line revenue. So if you can add even a couple percentage points of juice to that, that is billions of dollars of operating cash flow that get created across the country and obviously across HCA's empire as well. I think the state of healthcare today is really interesting because you have the early adopters, the physicians, the practice owners, the health systems that use 2025 to really leapfrog ahead and turn into these bastions of what an agentic healthcare system looks like. And for certain parts of the systems, it really feels like the future. Documentation is automatic, billing is automatic, coding is automatic.

• 9:57Speaker 01

  All of these tasks are now entirely done by software. Other systems, the vast majority of the country, if you look at rural healthcare, if you look at a lot of the nonprofits, a lot of the academic institutions have been slower to adopt. I would actually say that healthcare's biggest problem today is it is run by politicians. It is not run by ruthless pragmatic business operators. And if you look at the for-profit institutions that are growing the fastest, that are compounding the fastest for shareholders and for patients, the single trend that's shared amongst all of them is you have amazing aggressive CEOs at the top, as opposed to designed by committee and decide by committee, which a lot of your smaller academic nonprofit systems historically have used.

• 10:40Speaker 01

  So for me, the most important thing in the next five, 10 years of American healthcare, if we're truly going to build a durable system, is we need to shift into all operators of healthcare systems and hospitals, need to shift their mindset to being business managers and being very aggressive CEOs, as opposed to being local politicians, which has really been the game for the last 20 years.

• 11:01Molly O'Shea?

  And you're at over a hundred million in patients annually?

• 11:05Speaker 01

  We, well north of that. We support, I want to say 200 million patient encounters every year now.

• 11:10Molly O'Shea?

  Oh, wow.

• 11:11Speaker 01

  And the, for just patient engagement, Comer Engage, which is one of our, it's a language model that can speak to the patient, help schedule the appointment, reschedule, cancel. We do about 100 million patient interactions on that one product every year. Ambient Documentation, which essentially you press a button, it listens to the appointment, a language model summarizes the appointment, plugs it into the EMR, and then generates the super bill which you send to insurance. That does about 50 million annualized appointments every year, saving like, I want to say at least 75 million hours a year for physicians. And that's just productivity straight back into the American economy.

• 11:48Molly O'Shea?

  How did you scale that up so aggressively? Do you have specific partners that unlock more volume? Like, how does that work?

• 11:55Speaker 01

  The, there's really two or three components to that business. One is the PLG motion, which is a physician literally finds the product online, loves it so much, starts using it, tells the other physicians in their practice, and then we go sign an enterprise agreement and expand organically within the system. And then there's a more top-down approach. We have a deep relationship with both HCA and Tenet, who are two of the largest for-profits in the country, and two of the largest businesses in the country. And there, they own a lot of hospitals, they own a lot of practices. HCA alone owns about 185 hospitals, 2,000 sites of ambulatory care, and we've worked with the management there to essentially propagate these tools through the EMRs and through the software across all of their, you know, their whole empire.

• 12:36Speaker 01

  And then finally is EMR partnerships. So we have a deep relationship with Metatec, as well as a really, really close relationship with Epic, where we're a toolbox partner, and at the press of a button, an Epic physician can turn on Comer Ambient, start using it. They can also turn on Comer Autonomous Coding and start using that for the next piece of the revenue cycle. And I think because we've partnered with the EMRs as opposed to just entirely try to disrupt them, we've had a really fruitful relationship in expanding through that as well.

• 13:05Molly O'Shea?

  Because you're going after a unified platform versus a point solution, you're increasing the complexities by like...

• 13:12Speaker 01

  For sure.

• 13:13Molly O'Shea?

  Crazy multiples.

• 13:14Speaker 01

  Yes.

• 13:15Molly O'Shea?

  So with each one of these verticals that you start, how do you drum up those teams and then condense the stack?

• 13:22Speaker 01

  I think this is one of the big debates, honestly, in our company, which is you. The beauty of a platform is you can deliver definitive ROI across the whole continuum of care. And there's no question that when you deploy the full Comiratelle's platform, you get 15, 20% more revenue at the other end of it because everything is connected. It's a way more complex implementation, though, and it's a way longer implementation. And so our strategy has been twofold, which is one, have a series of point solutions like ambient documentation, autonomous coding intake. That can be those wedge products that enter a health system or enter a practice and allow for quick adoption. And then the platform sell, which quickly follows, but might be a 12-month sales cycle

• 14:07Speaker 01

  or longer, a 24-month sales cycle for the larger, larger health systems. But, you know, contracts that are worth tens of millions of dollars at the, at the tail end of it. So getting good at doing both, is there are companies where all they do is that one point solution, and it's a three-month sales cycle, and it can grow quite quickly. We've had to be very disciplined about ensuring that we focus go-to-market resources on both and that these two motions support one another as opposed to, you know, being just two completely different parts of the business.

• 14:36Molly O'Shea?

  Why are you doing that?

• 14:38Speaker 01

  I think the long-term bet is the, the final ACV capture in the space is going to be the company that provides that full platform. When, here's a great example. When we launch our platform in a 100 provider practice, the first thing we do is we displace the point solution scribe that they're using. And so that company's revenue just went to zero. And our revenue just went up by, you know, a factor of 10 on the account. So if you look at where the world heads, these, you know, these things do tend to consolidate. Whenever there's a paradigm shift like language models, you will have eventual consolidation on the one platform that provides them all the tools in a unified manner. And yes, you could probably get ephemeral revenue right now. There's a lot of point solutions garnering a lot of interest. There's a lot of nonsense GPT wrapper businesses out there right now.

• 15:22Speaker 01

  I won't say them by name, maybe I'll say them by name later. But the, you know, they grew fast, they got a lot of VC interest, but they're going to be gone in three years because companies like our will completely disintermediate them. And this happened before, you know, in the in the 80s and 90s, there was a software that came out called grammatic. And it was a auto correcting tool. And every, you know, all the VCs of the time loved it because it was growing so fast. You plugged it on top of, you know, the word processors on the early computers and everybody loved it. And then Microsoft Word came out with autocorrect as part of the software. And this company's revenue went to zero. And this happened again and again and again in multiple verticals. And the VCs just kind of forget.

• 16:03Speaker 01

  But if you study history and you're a student of of business, I think you see that these point solution businesses either have to turn into platforms very quickly or they die.

• 16:12Molly O'Shea?

  I was just going to ask you before this amazing question. What's going to happen to point solutions?

• 16:18Speaker 01

  Yeah, that.

• 16:20Molly O'Shea?

  They're gonna die.

• 16:21Speaker 01

  I we will in healthcare, I think we will kill most of them. And it is, we do it with a passion. Like it is something that we care about deeply in our business. That these multiple point solutions that create chaos for the IT department and for the healthcare provider need to be eviscerated and turned into a consolidated platform.

• 16:42Molly O'Shea?

  Because of the regulatory environment that healthcare sits in, and this is a Teresa Carlson question. But what does the actual process of AI implementation look like in healthcare today? And what does that look like transformationally in the next five years? Because it's a different point in which, you know, we were joking earlier, I was like, today, congrats on your consumer company, blah, blah. But like, it's totally different than like a consumer company, like an AI thing. But like, deep seated regulatory environment, what does it actually take to get this off the ground and like, where are we?

• 17:16Speaker 01

  Yeah, first of all, Teresa's a legend and she's a board member. And I said this before, but nobody shoots whiskey like Teresa. And the woman is is like truly a legend in many ways. And I think the, you know, when you listen to her stories from Amazon, which they did the hardest, one of the hardest things in the world. They went to the CIA and they went to the governments and they told them, you guys are going to turn into like cloud first, cloud native organizations. This is insane. Like, imagine going to an IT team that is, you know, literally has file cabinets and scanners and massive on-prem mainframes and telling them, no, the company that you, you know, you buy your books from is actually going to be the company that transforms you and turns you into a digital native organization.

• 17:59Speaker 01

  And she did it in partnership with Jassy and the whole team there. And, you know, I think the learnings, whenever I've talked to Teresa about this, the learnings have always come down to, you've got to align it. It comes down to dollars and it comes down to ROI. You have to be able to sit in a room and you have to tell, you know, a very clear story of what the world turns into three years from now and its investment. Like, when we sit in a room with HCA, they're investing millions of dollars in resources in implementation time, in training time, in physician overhaul to make sure that people use these AI tools correctly and they turn into an AI-native organization. And that's another reason why I think many of these point solutions will fail. Even if you get some early adopter bottoms-up usage, you'll never get that organizational change.

• 18:43Speaker 01

  There's no version of the world where AWS could have been a PLG cell. It needed to, it really needed that enterprise motion where Teresa and Jassy and Garmin and the team at the top came in and sat down with these government officials and pitched them on the vision of digital transformation. And now we're doing the same with language models. And the best teams are the ones that know how to tell that story, paint a very precise picture of transformation, bring the IT teams along rather than leave them behind.

• 19:12Molly O'Shea?

  Because this is such a sensitive environment with very sensitive data, life or death information.

• 19:18Speaker 01

  Yes.

• 19:19Molly O'Shea?

  It's critical. So where does accuracy and reliability sit in decision-making?

• 19:24Speaker 01

  Yeah. I think the, where you see rollouts get completely stopped or companies go to zero overnight is in cases where, you know, a model or a tool hallucinates or performs incorrectly and ends up impacting patient care. And so it ends up being maybe the most important thing. And the only way to truly ensure that is, one, great evals. You need to have a massive dataset of historical. Documentation or whatever the task might be, coding, voice calls, to then measure your model iterations on. Because when you release a new version of a model or a new version of an agent, it does some things amazing, but then it does a couple of things that are kind of weird. And there might be regression and performance deterioration

• 20:08Speaker 01

  on the fringes in categories that you weren't even thinking about. And I think in smaller companies or in companies that don't have a lot of engineers, you can ship quick and get this stuff out. But that performance degradation goes unseen and then turns into cascading problems for the organization later. So our belief is we work hand in hand, one, with the regulators, but I think more importantly with the customers to show them that the edge cases they care about always work in the test harnesses, always work in their backtesting data, and then make that super public. And then at the same time, like when there are inevitably hiccups, you need to have a very fast way to iterate and give feedback to the model and patch it so that you're not sitting around with a faulty, hallucinating agent in a healthcare setting.

• 20:52Molly O'Shea?

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• 21:38Molly O'Shea?

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• 22:07Molly O'Shea?

  Turing builds realistic reinforcement learning environments and data systems based on real operational traces, the kind of infrastructure Frontier Labs need to train superintelligence. Visit turing.com/sourcy. I know AI insurance sounded really silly when it was just first rolled out, but it's clearly deep seated in lots of companies.

• 22:31Speaker 01

  Yeah.

• 22:32Molly O'Shea?

  Is that something that you have thought about? Like, how do you think about that?

• 22:36Speaker 01

  You know, I think my prediction for the space is it's eventually all going to converge upon some sort of like general liability software or cyber insurance package. And the reason is, is that I think in most cases, the language model actually, like widespread use of the language model in healthcare in particular actually improves outcomes enough where the malpractice exposure will, I mean, it's just going to be a better look for, it's going to be a better end outcome on a dollar basis, too, for the CFO department and the CLOs department. When we talk to health system C-suite, the CFOs and the CLOs are like so excited because they see in the data, just like with self-driving, that yes, occasionally you have like weird performance,

• 23:21Speaker 01

  but on the averages and like in the 99% of cases, it improves outcomes so much that the malpractice implications are actually very net positive. And I think because of that, you will, you should see a reduction in premiums. And maybe there's like an AI subcategory that, you know, emerges in general liability or cyber insurance. I don't think it's going to be this, you know, category of its own because it, in terms of like pricing it, it's no better or worse than, than general software for, for most industries.

• 23:51Molly O'Shea?

  Not to go like too far off of it.

• 23:52Speaker 01

  Yeah.

• 23:53Molly O'Shea?

  Like off the line, but like, what is the implementation process with these teams? Like, do they have the technical rigor to under, like, obviously, like AI, this whole thing is like very new. It's not just like you're deploying software, but like you do need to be trained for it.

• 24:07Speaker 01

  Yes.

• 24:07Molly O'Shea?

  Like, how do you do that for the different partners that you work with?

• 24:11Speaker 01

  Yeah, I think the, so we have this forward deployed team of engineers that, you know, obviously stolen from Palantir. But I mean, the model works so well. You take smart, hungry people that are early in their careers, and you throw them into the face of the problem within the hospital, within the health system. And you, you know, you, you kind of let them free. And, and that has been one of the ways that we have actually propagated usage of these models very quickly. Because a physician sees this, you know, excited young engineer come into the, into the hospital and wants to co-develop with them and wants to work with them and wants to iterate on these models. And so our first implementations with HCA was literally a couple of engineers on the ground in a hospital with three physicians. And it was like two months of back and forth. How do we make this model work really well

• 24:56Speaker 01

  in a hospital setting or an ED setting? Which are really hard settings to perfect documentation in. And once it started working super well, we expanded it to another group and then another group. And then there was a top-down decision to go enterprise-wide. And, and so, and the implementation teams, now it looks a lot more like just general software trainers. They come in, they help launch, they teach them, you know, how to speak into the microphone, what to say, just really be natural in, in your conversation with the patient. And then on revenue cycle, we'll usually have a team that goes into the billing department, migrates their system using a set of agents that'll take, you know, old system of record and populate it into new system of record. And then really show them how to invoke an agent to do a task for them.

• 25:40Speaker 01

  The beauty of, I think, LLMs and agents is it's quite intuitive. Everyone, anyone who's worked in a corporate setting for years and years has a sense of how to delegate and how to give someone a task. You pass them context and you give them a direction. And I think in healthcare, it, it, it's even, it's even simpler. It's usually the context is the claim and the encounter history and the patient's chart information. And then the direction is whatever you want, you know, the, the person do, which is resubmit the appeal, work on the denial, file the prior authorization. And we've been able to get these models to get very, very, very good at these tasks because of the sheer volume of data that we have. And so the training ends up being maybe a day, day and a half in person. And then you see people just run with it

• 26:24Speaker 01

  and eventually just train each other as well.

• 26:26Molly O'Shea?

  Have you seen the composition of healthcare teams change at all? I mean, I know this is probably still too early, but it is really, it should be improving their workload a lot because it's really redundant, it's handwritten. But how are you seeing compositions change? And what do you think it'll look like?

• 26:43Speaker 01

  Yeah, I think. To the first point, the feedback from the physicians and from the providers and the medical billers is insane. We had a quote last week that Hemant actually posted, and it was from a physician that said, "I was about to quit. I was looking for another job because these 14-hour shifts were just ridiculous, and it was getting, you know, I couldn't take care of my kids, and it had just turned into too much for me. And then I used the tool, the career ambient tool, paired with revenue cycle, and it literally finished 14 charts instantly." And she was like, "Boom, I have two more hours in my day. I can do this now." And decided to stick with the job, like literally didn't leave healthcare. We have a massive labor shortage in healthcare. We cannot have trained people leave the system.

• 27:27Speaker 01

  And like, you know, this woman did not leave healthcare because of the tool and because of a language model and because of our software products. So that's been amazing to see. And you hear stories like that every day, where nurses, physicians, medical administrators feel like they have another 10, 15 years they can give back to the community because the tools have given them that. Number two, in terms of composition, I think the smartest health systems are starting to hire these AI implementation teams, are starting to hire engineers of their own to come in and help with implementations. Now, the only systems that can do that are the ones that, it's kind of like a chicken and egg problem, the only systems that can do that are the ones that generate enough operating cash flow to forward invest. And that's sort of our bet, is step one, give them the tools that improve cash flow, and then that cash

• 28:12Speaker 01

  flow lets them invest in R and D teams, who will then go build more and more interesting stuff in partnership with us, within the hospital and within the system. Suma is a great example of this in partnership with GC.

• 28:23Molly O'Shea?

  What is it like working with Suma? It's a real hospital?

• 28:26Speaker 01

  It's a real hospital. It's a real hospital in Akron, Ohio. And, you know, I gotta hand it to Hemant, the beauty of GC and I think Hemant is, you are so ambitious. And they are not content being a VC firm that makes just great returns for LPs by investing in a Series A, and, you know, the two or three companies that matter every year getting into the rounds. They really want to bend the universe. And part of that means going to Akron, Ohio, buying a system that was on track to go bankrupt in the next couple of years, and transforming it with AI. There are a lot of people that would be more than happy to sell tools to the miners and make a lot of money doing that. I think it takes a special person and a special organization to say, no, we're actually going to go direct.

• 29:10Speaker 01

  And we're going to show the world that you can build a better hospital. You can build a better health system. You can do it today. You don't have to wait around and just make your money on software. We had RFK Junior visit the hospital last week and we hosted him there and it was an amazing visit. Showing him the transformation with ambient documentation on Kameer Stack with ADOC, which is an imaging-based company that's essentially automating a lot of the scan process. And so, you know, one of the things that we've noticed at SUMA is the appetite from the physicians is just, I mean, they're ready to go. They want those hours back in their day. They want those dollars to show up in the system to create that cash flow cycle. And, I mean, it's been so much fun on the ground.

• 29:52Speaker 01

  We have 10, 15 engineers there at any given point in time and we're working hand in hand with the physicians.

• 29:58Molly O'Shea?

  This might be a total tangent, but I travel a lot, so I'm often fatigued and like, over exhausted to the point where I like all pass out. And because of that, I get IVs to my house. And I always chat them up. It's always really fun because they have the craziest stories, these nurses. And most of them are ER nurses. And this woman who came to my apartment like a couple of weeks ago, I was asking her about her job and like she was an ER nurse. And I was like, well, which do you like better? Do you like coming to, you know, nice, calm environments? Or do you like being an ER nurse and like dealing with all the complexities? And like the chaos and all the adrenaline, all that stuff?

• 30:41Molly O'Shea?

  She was like, no, I actually like prefer that. Like I like it. Like she's just like wired to do that.

• 30:47Speaker 01

  Yes.

• 30:48Molly O'Shea?

  Which is so cool to hear and like know because, I mean, from the outside, like that scares me. But they love their jobs.

• 30:56Speaker 01

  They love their jobs and I think there's something to it where in the ER in particular, we've spent a lot of time building our tools for the ER. It is a chaotic environment and you are, if you're a triage nurse, you are literally making life or death decisions in front of you. I mean, you pick who goes in first, who goes in second, who gets care right in the lobby. And those are not easy decisions. And I think the, you know, the mental fortitude of these nurses, combined with their appetite to just take on the craziest problems is super inspiring. And it makes it really easy to build tools for them. When we, some of our engineers, their favorite visits are the ones where they get to go to the ED and sit with the nurses because they just see so many problems, so much pain

• 31:40Speaker 01

  that they can come and just sink their teeth into and build tools for. And I think as a software engineer, for me, that's exhilarating. It's like, what more could you ask for?

• 31:49Molly O'Shea?

  Yeah, that's crazy. That's amazing. They have the craziest stories too. I can't repeat it, but like, people in California are effed up.

• 31:57Speaker 01

  I believe it.

• 31:57Molly O'Shea?

  They do weird stuff.

• 32:00Speaker 01

  There's a lot of weird people in the world.

• 32:00Molly O'Shea?

  Sometimes it involves animals.

• 32:04Molly O'Shea?

  Which the state needs to change the regulations on. I don't, anyways, I just can't.

• 32:11Molly O'Shea?

  So I guess since we're already on the regulatory kind of topic. Sorry for the transition.

• 32:18Speaker 01

  People do weird things with animals is what I learned today. I'm gonna take that with me.

• 32:24Molly O'Shea?

  Speaking of regulatory.

• 32:29Molly O'Shea?

  Is the admin more or less acting with urgency? Like, what are you seeing with this new change of plans?

• 32:36Speaker 01

  I think this admin is doing an incredible job. And they are, they're stepping out of the way in the areas where you want innovators to just quickly get on the ground and do good work. And they're intervening in the areas where regulatory intervention is needed, like Interop. I think one of the biggest problems in healthcare over the last 30 years was an EMR could guzzle up all your data and then sit there. And then when you ask for it back, quote you some crazy fee to move one piece. Piece of data from one system to another is insane. Like genuinely, if for all the shit Salesforce gets as a company, if I want to move data from one, you know, place in Salesforce to another place in Salesforce, I can do it with my eyes closed. Like there's no, I don't have to ask for permission.

• 33:19Speaker 01

  If I want to do that in Epic, I gotta go sacrifice my firstborn child to Judy. And then maybe I will be granted a meeting to meet with someone who lets me move data from point A to point B. This is insane. And so data liquidity is like a very real problem in healthcare. And I think the admin is tackling it head on. They're not, you know, they're not dealing with any more interop bullshit. And they're funding the Department of Justice to come after folks that are engaging in information blocking or violating the Cures Act. And as an innovator, that's welcome change. So I love the work of this administration.

• 33:53Molly O'Shea?

  What do you think the biggest misconception is working with the government?

• 33:57Speaker 01

  I think, you know, we work with a lot of branches of government with the FDA on med device and regulatory and algorithms. We work with CMS on payer policy and, you know, everything from what, when you think about the revenue cycle, what sorts of things should be approved instantly? And what sorts of things should require an appeal or prior auth process? And I think the biggest misconception is that they're hard to get in touch with or that they won't take a meeting. I've actually found that you can meet with someone in the administration fairly quickly, which is amazing. I mean, this is the, this is not how it always was. You can literally send an email in and probably get a meeting in a couple of weeks, air out your concerns and get a very structured, rational response back.

• 34:42Speaker 01

  And, you know, nothing in the government is going to get done tomorrow, but there is a timeline and there's a plan. And I think, you know, folks like Chris Klomp, who, you know, who's come in and is leading a lot of those initiatives are just a breath of fresh air. And to see innovators in chair, in government positions, I think most people don't realize how forward thinking this admin is.

• 35:02Molly O'Shea?

  I asked Teresa the same question.

• 35:04Speaker 01

  Yeah.

• 35:05Molly O'Shea?

  And she said similarly, like, start earlier.

• 35:08Speaker 01

  Start early. Yes.

• 35:09Molly O'Shea?

  Talk to them sooner. They want to listen to you.

• 35:12Speaker 01

  Yep.

• 35:12Molly O'Shea?

  Definitely wear the right outfit.

• 35:14Speaker 01

  Yes.

• 35:16Speaker 01

  That was a job.

• 35:16Molly O'Shea?

  Which we'll come to in a bit.

• 35:18Speaker 01

  Later in the show. Yes.

• 35:20Molly O'Shea?

  But she did say that. And then I was at a conference earlier today and one of the heads of HHS was there and he said, yeah, like, come, come talk to us.

• 35:30Speaker 01

  Yes.

• 35:30Molly O'Shea?

  Like, don't wait.

• 35:31Speaker 01

  They're willing to engage early.

• 35:33Molly O'Shea?

  And start, yeah, start, just start early.

• 35:35Speaker 01

  Yep, and there's good people. There's good people in the admin and it's great to see.

• 35:40Molly O'Shea?

  Okay, so you have 1,200 employees?

• 35:43Speaker 01

  Yes.

• 35:43Molly O'Shea?

  You went viral for something that Alfred Lin doxed you on. I want to ask about how you felt about that after I recited verbatim. But you went viral for what you want to look for in employees.

• 36:00Speaker 01

  Yep.

• 36:01Molly O'Shea?

  Specifically, heat-seeking missiles, just super aggressive. But, you know, it's an aggressive mission.

• 36:08Speaker 01

  It is.

• 36:11Molly O'Shea?

  So you said, describing this person, "This person actively seeks out the hairiest, gnarliest problems that customers have, or exist generally in the business, i.e. go-to-market efficiency, and then surgically works to eliminate said problem. They have almost an addiction to seeking out sources of pain and blowing them up."

• 36:32Speaker 01

  Heat-seeking missile for pain. I think, well, first of all, I was honored that so many people resonated with it because it is something we really look for in our business. And it was an email that I had sent out to our whole company describing what it means to work at Comer. And you have to be a heat-seeking missile for pain. And Alfred forwarded it to some of the other Sequoia founders and then tweeted about it. And, yeah, it went viral. We got, I mean, from a hiring standpoint, we got some amazing inbound that day.

• 36:58Molly O'Shea?

  Really?

• 36:58Speaker 01

  So I'm very grateful that Alfred posted about it.

• 37:02Speaker 01

  For me, I think, it's interesting because if you, if you look at value creation, like, in many ways, pain is the genesis of all capitalism. Like, there is problem, and then someone comes up with solution, and then there is value creation and value capture in that process. Without pain, there is no capitalism. And as a result, I think we should all pray at the altar of pain. Pain is signal. Pain is signal in a business, pain is signal outside with customers. It means that there is something broken in the human experience and you should go fix it. And that's what, you know, humans are wired for. And I think to be successful in starting companies and building companies and working at fast-growing companies, if you do not have an addiction for finding pain and blowing it up... You won't survive.

• 37:44Speaker 01

  And the reason is that without that mindset of I need to find pain, not just like let it happen to me and then deal with it, but find pain and blow it up. Your company won't grow as fast as your competitor. Your go-to-market will never be as fast as the next guy over. Your products will never evolve as quickly because every product has pain. Every organization has pain. And a heat-seeking missile for pain is addicted to finding that and blowing it up. So it is, to me, maybe the most important signal in hiring. And it's probably also the most important signal in investing and in finding founders that have that addiction to finding pain.

• 38:22Molly O'Shea?

  You started the company at 18. You're not 18 anymore. We clarified that.

• 38:26Speaker 01

  Yes.

• 38:28Molly O'Shea?

  Sorry.

• 38:29Speaker 01

  It sucks, but I'm not. I tried.

• 38:33Molly O'Shea?

  Good. So with that, the company has been through a couple of rounds of M&A. You've acquired, you've merged, you've done many things. Was that process part of which changed your perspective on how to build a company? Like, that is not a conventional way to build a company. So like, how did that?

• 38:51Speaker 01

  Yeah.

• 38:52Molly O'Shea?

  What is the strategy there and like the process and the thinking?

• 38:55Speaker 01

  I think, you know, one of the interesting things is if you look at the history of American businesses, the great American businesses were built on the backs of M&A. Rockefeller was maybe the best acquirer of businesses of all time. I would say that Disney, like Igr's Disney, was one of the most acquisitive and well-structured acquirers of IP and talent and technology that we've ever seen in the 2000s. I think there's a ton of other just amazing businesses that are worth hundreds of billions of dollars that people don't even talk about that are amazing acquirers. Dell, Dell is another great example. People don't talk about Dell. There was maybe $100 billion worth of value created in the last 15 years through Michael Dell and Silver Lake's partnership. And they acquired some very interesting businesses,

• 39:38Speaker 01

  put them together in interesting ways, unlocked distribution, unlocked products. And I think it is a skill that as you grow as a founder, you need to get very good at. In our journey, we've used M&A really for distribution. In some cases, I think for talent, where there have been critical people that are building amazing products in a space and we've brought them in and accelerated the whole company as a result. In the Camer and Thelis merger, I think it was really both of those things. One, Haymont had amazing distribution in through his general catalyst, health assurance framework and all the hospitals that have partnered with him. He had an amazing access to capital that has really helped and accelerated Camer. And then I think on the Thelis side, we had

• 40:23Speaker 01

  great engineering talent. We had heat-seeking missiles for pain that could go in and solve problems. And you put those two things together and there was a lot of value creation in that process. We've also acquired some businesses like Augmedics that was a public company and it was particularly done for distribution. They were in 40 different health systems and trading at like 1.5x revenue. The public markets weren't valuing this company correctly and we seized that opportunity, brought it in and used their distribution to very quickly expand our products. And also transform their margin structure using LLMs, primarily labor-based business that is now primarily software-based using language models.

• 41:00Molly O'Shea?

  What's the biggest takeaway lesson or challenge that you've had through those processes?

• 41:06Speaker 01

  I think the number one learning in M&A is there's a lot of people that think M&A is about finding the perfect asset or acquiring the perfect asset and diligencing every, making sure that it's pristine. Pristine assets are usually, there's no price disparity. There's no advantage that you can take of a pristine asset.

• 41:26Speaker 01

  Most M&A and I think most good M&A, they're skeletons. There are things that you have to internalize that are not working in the company and be okay with that because you have the other pieces that will make it work. In the case of Augmedics, great distribution, great legacy relationships, but the pace of innovation wasn't there and they didn't have a software engineering team that was iterating every week or in some cases every day, which is what you need in the age of LLMs. And when we brought that in, I mean, it created so much value at HCA, it created so much value at Sutter, it's created so much value at our other, these other health system partners. And so, but we have to be okay with the fact that It was suboptimal in some ways and we were going to plug those things out and make a quick change.

• 42:09Speaker 01

  And say number two is you have to be very ruthless about stating what the culture of the combined business is. You can't, I think this idea of you acquire companies and like everyone's friends and you know, we're going to be like your little bit of your culture, a little bit of our culture. No, there's always a winning acquiring culture that becomes the culture of the combined business. And there are people in the company you're acquiring that heavily opt into that. There's also people that opt out and that's totally fine. You gotta just give them that opportunity and then start from fresh.

• 42:37Molly O'Shea?

  How long is that window?

• 42:39Speaker 01

  I think you have like, probably have like 90 days to make like a very aggressive, maybe less. I would say like 45 days is like kind of set. Like people are now, they know what they're doing. They're either locked in or they're not. And by day 90, if you know, that reset hasn't happened, you're going to continue to run the business the way it was running before, which probably isn't a good thing. If, if you know, if you had a, you know, very genuine acquisition thesis around it.

• 43:04Molly O'Shea?

  We didn't talk about this at all, but you started off as a blood testing company.

• 43:08Speaker 01

  Yes.

• 43:08Molly O'Shea?

  And you were inspired by Elizabeth Holmes.

• 43:11Speaker 01

  I would not say I was inspired by Elizabeth Holmes. That sounds like an Alfred jab, but we were started around the same time that the whole Theranos saga was, was happening. That is not untrue.

• 43:24Molly O'Shea?

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• 44:41Molly O'Shea?

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• 45:12Molly O'Shea?

  Um, but we do have another Alfred question.

• 45:14Speaker 01

  Yes.

• 45:15Molly O'Shea?

  Um, what is the craziest hack that you and Deepika pulled off?

• 45:21Speaker 01

  He, I know what he's referring to, and I don't know if I can tell, I'll tell most of the story. And the, I, I told the story in my speech at Deepika's wedding. But the way that it goes is that we, um, we were partnered with a health system, and I won't say their name. And they had given us access to residual blood samples. Now, Deepika was like, she's like a saleswoman. She's really good at like getting into situations, talking our way into things, out of things. And, you know, our residual blood sample partnership with this health system was actually nothing more than Deepika being friends with the security guard and the front desk lady.

• 45:57Molly O'Shea?

  Oh my gosh.

• 45:58Speaker 01

  And so we had accumulated hundreds of samples. And they were, you know, anonymized and, you know, there was, there was no like HIPAA concern, but we were using these samples.

• 46:08Molly O'Shea?

  You were getting them from the security guy?

• 46:09Speaker 01

  We were, we were getting them because we would walk past the security guy. I guess he liked Deepika. And, um, and, and one day we, you know, I found out that, you know, this was the situation. And, um, we, we quite literally had to meet with. We were summoned to meet with the Health System Administration and they were like, like, what the fuck is going on? Like, we were like 19-year-olds, we were scared out of our minds.

• 46:33Molly O'Shea?

  You're like, what are you, this is bad?

• 46:37Molly O'Shea?

  We're building a company here, don't you understand?

• 46:39Speaker 01

  We're trying to make it work. And they were like, look, pharma buys these samples for like tens of thousands of dollars of samples. You guys are just picking them up. Like, what are we talking about? And ultimately, we were able to use the fact that it had been going on for so long as a negotiating chip. And the worry that's

• 46:56Molly O'Shea?

  Their fault.

• 46:56Speaker 01

  It's their fault. Like, you know, we just really turned it on them. And ended up having a very fruitful partnership. And it was an amazing, it's an amazing academic health center, still a very close partner of ours. Just had a slightly unconventional beginning to that relationship.

• 47:10Molly O'Shea?

  At the end, they were just like, respect.

• 47:12Speaker 01

  Respect. No, it was, it was very much like, we get it. You're hustling and we support.

• 47:18Molly O'Shea?

  Another good Alfred question. Did you ever think you'd become an enterprise salesperson?

• 47:24Speaker 01

  You know, I, it is, Alfred truly reminds me at every chance that he gets that I am now a sales rep. And that's okay, because I think sales is the most important skill in the world. And I think the best, you know, the best CEOs are always selling, they're always closing. And a big part of, you know, to Alfred's point, a big part of my job today is I'm an enterprise sales rep. And I would, you know, when I started my career, I was at the Stanford AI Lab. I thought I would be a hacker my whole life. I thought I would get a PhD. I thought I would go work at a research lab. And that would have been a fun career too. This is just a very different set of skills. And I had to learn how to sell. I, it was not something that initially came naturally to me. But I'm so grateful that I had, I took the punches and eventually got reasonably good at it.

• 48:10Molly O'Shea?

  Now that I'm saying these questions out loud, I'm really noticing a pattern.

• 48:17Molly O'Shea?

  Here's the next one.

• 48:20Molly O'Shea?

  He would like to know, did you think it was a good idea to show up to the JP Morgan Health Summit in a t-shirt, shorts, and flip flops?

• 48:30Speaker 01

  This is a, the story is turned into lore within the company because the first JP Morgan conference that we went to, I did in fact show up in t-shirt, shorts, and like cargo shorts, like with the buttons and everything and flip flops.

• 48:43Molly O'Shea?

  Wow.

• 48:44Speaker 01

  There were sandals, they were open toed, but they were velcroed.

• 48:46Molly O'Shea?

  Were you 19 at this time?

• 48:48Speaker 01

  I was 20, I should have known better.

• 48:49Molly O'Shea?

  Alright, yeah, 20.

• 48:50Speaker 01

  But, but the, you know, we go to the conference and I guess the cool thing at the time was you're a tech bro, you underdress, you go to these things, and honestly, and at the JPM conference and these people are looking at me like I'm a fucking joke, and that was when I got my first suit. And so, ever since then, anytime we go to JPM, I look good. And Alfred always comments on it as well, so he, I remember he saw me that day and he was like, "This is ridiculous, this is completely unreasonable." And then he saw me like a year or two later when I showed up suited up and, and that's when he started calling me an enterprise sales rep. So there's no winning with Alfred Lin.

• 49:29Molly O'Shea?

  So you can confirm you own a suit?

• 49:31Speaker 01

  I own multiple suits now.

• 49:33Molly O'Shea?

  Okay.

• 49:33Speaker 01

  All the colors, the best colors.

• 49:36Molly O'Shea?

  That's great.

• 49:37Speaker 01

  Yep.

• 49:37Molly O'Shea?

  So for Alfred's interview, I think, so Tarek introduced us probably over the summer, and then I was interviewing Alfred and I asked you if you have any good questions for him.

• 49:48Speaker 01

  Yes.

• 49:49Molly O'Shea?

  And you described Alfred as being more of like a CFO, COO brain versus a VC brain.

• 49:57Speaker 01

  Yeah.

• 49:58Molly O'Shea?

  So what is that like, what is it like working with him and Sequoia?

• 50:02Speaker 01

  I think Alfred is so analytical and I think in some ways, the world, you know, the world has been shortchanged that Alfred Lin doesn't still run a company. And, and, I mean, he gets to exert his leverage and advice across, you know, dozens or hundreds of companies now, but in some ways, he's such an incredible operator and he has such a great instinct for how the roles of a COO and CFO overlap because he did both of them. I think what that means is when you show him a P and L, he will scrutinize everything down to like the last item. Like, why was T and E on sales and enterprise in the Western segment so high this quarter? And you're like, dude, what? What are you talking about?

• 50:42Speaker 01

  And then you look in and you're like, well, actually, they threw a couple of big dinners for clients and we better see some ROI on that in a couple of months. And so his instincts are very sharp. I think he is honed in on the numbers that matter in a business. And he can read very early the signals of when you see traction and when you see great customer retention and when you see customer love in these products. I think makes him such a great investor. And then on the operating side, I think he's an incredible hire and aggregator of talent. One of the biggest value adds we've gotten from Sequoia and Alfred is whenever we've had a candidate that we are right there at the finish line and we're competing with a larger company or a larger comp offer, Alfred comes in and gets the job done. And so he's a closer.

• 51:26Speaker 01

  He pitches the vision, he pitches the long-term bull case for the company and for me and Deepika as founders. And I'll say early on, the massive difference that made, I mean, it was trajectory changing. There were executives, like amazing engineers at companies who probably had no business joining us. Without Alfred putting in that word and vouching for us, they would have probably gone somewhere else. And now they're still at the company to this day. I mean, our CTO, Alfred was the closing call. Drew is still with the company and like really one of the founding partners of the business. So I'm always grateful to Alfred for that and to this day, he does it for us.

• 52:05Molly O'Shea?

  That's great. Any other lore you have on your investors? What can we, I mean, you're warmed up now.

• 52:11Speaker 01

  Lore, I mean, I gotta position the missiles back. That's like, I would say about Heyman, I think one of the, the first time I met HT was I was in, I was in college and I showed up.

• 52:26Molly O'Shea?

  Because they like, didn't they, wasn't this incubated with them or so, it was very early.

• 52:30Speaker 01

  So, exactly. Camille was incubated at GC and Othello's like, which is what I was running when I first met HT. You know, I was starting it right out of my Stanford dorm room at the time. And so I went to the GC office, which is on University Avenue. And I rolled up and I had a bike and I rolled up and the old General Catalyst office in Palo Alto was like, it was like a house and then there was this like, like white picket fence. And he was like on the porch on a phone call. And I was like, where the fuck do I put my bike? There's no bike rack. Like this is like, you know, we're in Palo Alto, where are the bike racks? And so he's on the call and I'm just like, I had no idea who he was. I was like, hey man, is it cool if I like lock my bike to this fence? And he was like, what, like who the fuck are you?

• 53:13Speaker 01

  And he was like, sure. And then he saw me walk in and we had a meeting later. But I think it just goes to show that the best investors are so plugged in that they're meeting with the random autistic kid on campus. And giving them time of day when, you know, HT was, he was already running Levango and he was already, you know, big, big time investor in Stripe. And the fact that he was giving me even like 20 minutes as a Stanford freshman just shows you, I think that's what it takes. I think, I think that was to be great at anything, you have to give it so much time. And both Alfred, Himant, Theresa, Kassar from Applied, who's also on our board. I mean, these guys are just always fucking on.

• 53:51Molly O'Shea?

  Before I ask you the last question, we're gonna ask you a pre-last question.

• 53:56Speaker 01

  Deal.

• 53:56Molly O'Shea?

  What is your hottest take right now?

• 53:58Speaker 01

  I think the US healthcare system gets shit on a lot in, in that people say that we have a bad health system and it's expensive and this and that. The reality is, is that the American healthcare system is the engine of innovation for the whole, whole world. Like the vaccines that are made are the best in the world. The drugs that are made are the best in the world. And I, I think from a, we owe it like to the American healthcare system to make it more efficient. But this idea that you can get the same quality of care in Canada or in the UK is preposterous. I mean, you're waiting in lines for a basic primary care visit for a year in the UK. You're waiting. You're not going to get care. You're not going to get good long-term care in Canada, just period. Because the the systems and the infrastructure and the funding doesn't exist.

• 54:43Speaker 01

  And you have these 18 fucking provinces all never talking to each other. And so the American healthcare system is quite advanced. And when you meet with the operators that run it, they're all really well-meaning. And I think there has been 50 years of middleware that's gotten created with insurance companies and PBMs and, you know, all their interactions that there's a lot of profit-seeking and a lot of rent-seeking. But the quality of the system is probably the highest in the world. And now it's just a matter of LLMs are this gift that we've received to go nuke all of that work tax. And that, in some ways, is going to be my life's work in in terms of just eliminating the work tax and making the system a trillion dollars more efficient. Because if you do that, you you make the entire American middle class wealthier.

• 55:27Molly O'Shea?

  As we look forward the next 12 months, what are you most excited for?

• 55:32Speaker 01

  I think the the capabilities of these like truly agentic models, we see them in R and D today. We see them even with our own engineers. And to see that now transition to the nurses and the physicians, it's like 2023 all over again, where the first time a physician adopted ambient scribing, their jaw dropped. The first time a nurse was able to, you know, recite a prescription and it all showed up perfectly in in transcript as a structured note, her jaw dropped. And this year, you're going to see agents where you give it a task in an EMR, and it just goes and does all the work. And dollars show up at the other end of it. And so for for me, I think the the, as an engineer, the thing you love is giving people these jaw-dropping moments. And we're at the precipice of another one in healthcare.

• 56:16Speaker 01

  So that's that's what I'm I'm pumped for.

• 56:18Molly O'Shea?

  Wow, that's a great way to end it. Well, tonight, thank you so much. Thank you for sharing so much on Camer, the company, the history, everything that you've learned in the healthcare system. I haven't done many healthcare interviews yet. And it's really cool to see now the inflection points being had in that industry with AI. So thank you so much for taking the time and congratulations.

• 56:40Speaker 01

  Thank you so much. Appreciate the the time. It was a fun conversation.

• 56:43Molly O'Shea?

  Hey, it's Molly. If you enjoy our interviews, check out our newsletter, sorcery.vc, where we deliver a once-a-week top deals and tech headlines email, and also go deeper on our podcast interviews. Subscribe to Sorcery today. And don't forget to subscribe to the podcast on YouTube, Spotify, Apple, or wherever you listen. Link in description to sign up.