He had paying customers before he even incorporated—then hit $1M ARR in a year and raised a $19M Series A. | Rahul Shivkumar, Co-Founder of Assured

00:19:30 · Pablo Srugo, Rahul ShivkumarPlay from here

[00:19:30] S0: So even your V1 actually was able to deliver onboard doctors very fast at 100% accuracy rate. The only drawback was you had to put humans in the loop to kind of make some of this thing work. [00:19:41] S1: Correct. So maybe our margin structure looked different than it does today, right? Or the way to scale was harder back than it is today because again, there is a balker of a human needing to sign off on some of the workflows and maybe it wasn't as faster as it is today but that accuracy thing is something we had to guarantee, right? Like if it wasn't as close to 100% as possible, no one wanted it, right? They're like, you could give it to me super fast, super cheap but if it's only 80% accurate, we don't want it. [00:20:05] S0: How many doctors do you need to be hiring for this to even be a problem for you? [00:20:10] S1: Yeah. So it's not just doctors, right? It could be therapists, it could be dieticians, it could be physical therapists. [00:20:16] S0: Any health practitioner. [00:20:17] S1: Exactly. So the spectrum kind of gets really large and post-COVID there's this trend of providers working at multiple practices, right? Like working in a 1099 capacity across four practices, five practices. So you actually see people, even if Practice X has 100 providers, for them to stay at 100 from one year to the next, they've probably had 15 people leave and they've added 15 people, right? So there's always consistent turnover just to stay at the current level.

00:20:17 · Rahul Shivkumar, Pablo SrugoPlay from here

[00:20:17] S1: Exactly. So the spectrum kind of gets really large and post-COVID there's this trend of providers working at multiple practices, right? Like working in a 1099 capacity across four practices, five practices. So you actually see people, even if Practice X has 100 providers, for them to stay at 100 from one year to the next, they've probably had 15 people leave and they've added 15 people, right? So there's always consistent turnover just to stay at the current level. [00:20:46] S0: Is that that big of a deal? That's like one a month, like whatever. Somebody does it, takes an hour or two, you know, big deal. Or is it worse than that, more painful than that? [00:20:53] S1: It usually ends up being more, right? So I think it depends on kind of the type of group. So if it's a group where each provider actually has to be licensed in multiple states, right? They're seeing patients over telehealth for 30 states. And in each of those states, they have to work with four insurance companies. That becomes, for every provider I hire, there's actually 120 insurance workflows that I have to kick off, right? That can suddenly start stacking up a lot. Like even if I hire two providers a month, it might be 250. And then I need one full-time person just doing that, right? So it can like quickly stack up depending on the way the organization works. [00:21:28] S0: Walk me through, like actually, if you don't mind going deeper on that, like the ROI of it, right? So like if somebody spends, what's your ACV today? Let's say it's 100K? Is it more?

00:21:28 · Pablo Srugo, Rahul ShivkumarPlay from here

[00:21:28] S0: Walk me through, like actually, if you don't mind going deeper on that, like the ROI of it, right? So like if somebody spends, what's your ACV today? Let's say it's 100K? Is it more? [00:21:36] S1: Yeah, it's in the six figures, yeah. [00:21:37] S0: So let's say it's 100K. Like maybe you could do it at the unit level, you know, per doctor. Like how much time does it take to onboard a doctor? Therefore, how much does it cost? Versus, you know, using a shirt, like whatever, however you do the ROI math.

00:21:37 · Pablo Srugo, Rahul ShivkumarPlay from here

[00:21:37] S0: So let's say it's 100K. Like maybe you could do it at the unit level, you know, per doctor. Like how much time does it take to onboard a doctor? Therefore, how much does it cost? Versus, you know, using a shirt, like whatever, however you do the ROI math. [00:21:49] S1: Totally. I'll take maybe a specific example of like a dermatologist, right? And the reason I'm picking them is because each day they're kind of sitting on a bench, they're actually losing out on a lot that they could be billing, right? Like that becomes a reasonably important factor, which is, hey, if I am a professional that bills a lot every day, like $5,000, $10,000 a day, right? Then if I'm delayed by 20 days, my organization is missing out on $50,000, right? There's like a top line ROI that they're missing out on. And then on the back end, if I have to submit 120 forms, I have to follow up every week, either over a phone call or an email for these 120. And I have like an error rate of 5%, right? Like where maybe I like typo something or I miss a phone call because, you know, I'm out of office for a week. That could cause delays. That adds up to the number of days that I actually can't see a patient, but also it adds labor costs where there's a person on my side that has to do all these things, right? So when we think of ROI, we think of it as a combination of two things. It's one, can we activate your provider faster in these days? Can we get you 10 more billable days, 20 more billable days? How many providers can we do this for?

00:21:49 · Rahul Shivkumar, Pablo SrugoPlay from here

[00:21:49] S1: Totally. I'll take maybe a specific example of like a dermatologist, right? And the reason I'm picking them is because each day they're kind of sitting on a bench, they're actually losing out on a lot that they could be billing, right? Like that becomes a reasonably important factor, which is, hey, if I am a professional that bills a lot every day, like $5,000, $10,000 a day, right? Then if I'm delayed by 20 days, my organization is missing out on $50,000, right? There's like a top line ROI that they're missing out on. And then on the back end, if I have to submit 120 forms, I have to follow up every week, either over a phone call or an email for these 120. And I have like an error rate of 5%, right? Like where maybe I like typo something or I miss a phone call because, you know, I'm out of office for a week. That could cause delays. That adds up to the number of days that I actually can't see a patient, but also it adds labor costs where there's a person on my side that has to do all these things, right? So when we think of ROI, we think of it as a combination of two things. It's one, can we activate your provider faster in these days? Can we get you 10 more billable days, 20 more billable days? How many providers can we do this for? [00:22:58] S0: Yeah, that's the question. How much faster do you typically get people onboarded? [00:23:01] S1: About 30% faster right now. [00:23:03] S0: And usually it's what, 15 days down to 10 days or what's the normal?

00:23:03 · Pablo Srugo, Rahul ShivkumarPlay from here

[00:23:03] S0: And usually it's what, 15 days down to 10 days or what's the normal? [00:23:07] S1: It varies so much across every single state, but if I were to take like an average time, it probably goes down from like about 90 days to 65, 60 to 65. [00:23:17] S0: Okay, so you're getting somebody like 30 more billable days. [00:23:19] S1: Exactly. Yeah, and again, for specialties, it differs, in states it differs, it's such a hard thing to quantify, but I think when we sampled our data across every single specialty, every single state and insurance company came out at about 30%. We have tens of thousands