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A
We firmly believe that in the next 12 to 18 months, most health systems in the country will actually have at least one autonomous medical coding solution, if not two.
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Welcome back to another episode of Builders. As always, this show is brought to you by Frontlines IO, Silicon Valley's leading B2B podcast production studio. If you're bringing technology to market and want to learn from your peers, we have a library of more than 1200 interviews with Venture backed founders and marketers. Where they talk, all things go to market. Of course, if you want to launch your own podcast, we offer Podcast podcast as a service to more than 80 tech startups. The idea there is very simple. You show up and host and we do everything else. Now with all that said, let's jump into today's episode. Today our guest is Nitesh Shroff, CEO and co founder of Ventra Nitesh, welcome to the show.
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A
Thanks Brad.
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B
So you have 30 plus patents. Talk to us about what that process is like and any lessons that you've had or any learnings that you've had so far.
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Yeah, this study includes the patents and the publications that I've had. My background is I did my Bachelor's from IIT Madras and PhD from University of Maryland, College Park. So during my PhD I published several publications. Specifically my PhD is in AI, so computer vision. So I published a lot of papers during that as part of my PhD program and then post that. I've been working at several cutting edge research organizations and one of them has been Zoox where I published several patents as well as part of building self driving cars. And for the past five years or so we have been building a redraw and have been very, very excited to actually build in this healthcare AI space.
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B
And given your background, did you have this master plan to go out and found a technology company and be a founder or. When did that idea start to form for you?
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A
I actually always had the itch to start something meaningful and my life's mission has always been to build a generational company, a company that outlasts all of us. So I've always had that and also had a specific incident that led us to get into this specific problem that we are solving, which is basically my co founder Preeti, she ended up going to one of the large health systems emergency room. There was a pretty uneventful visit, four hours visits, they sent her back home. But then after a month she gets like a bill of $19,000. Right. And that's sort of like way more than what her savings were and like, but she's very persistent. The fought back and realized that there were significant medical coding errors in it and realized and then fought those back, got those corrected, brought it down to $11,000. And that's when insurance paid 7,000 and Preity paid 4,000 out of it. Both Preity and I are PhDs in AI. We just started putting our AI hat on it. It's like, hey, this doesn't make sense. Absolutely needs to be solved. So we started digging into it and we realized it's a beautiful AI problem to solve that has a huge impact both on the patients and. And the providers. Right. And we learned the providers have even more of an impact because of the amount of money they are leaving on the table, the money they are losing, and several services they provide, they actually don't end up getting paid for. So we took upon ourselves to build this, and since then we have been building in this space and it has been extremely, extremely exciting to build and make this kind of impact.
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B
You mentioned it's a beautiful problem for AI to solve. What made it so beautiful?
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Yeah, the complexity of the problem, the kind of data that exists. Right. For instance, there are clinical documentations as part of medical coding. You have to understand the complexity of the patient in what is written, the complexity of the treatment that was provided. Right. And also the structure in which the care was provided. Was it provided in an emergency room where there are five doctors involved? Were there one nurse, one doctor involved with a technician? So you have to truly understand the setting in which the care was provided, what care was provided, and what's the complexity of the patient. Right. Luckily, most of this is in a documented form with all kinds of free text, all kinds of style, but it's in documented form. Right. So it lends itself in a beautiful way to solve. And just the amount of data that is being processed through US Healthcare on a daily basis makes it even more exciting to actually go solve. But to us, it's the big impact that it makes and that we have already been making with several health systems and physician groups across the country. That absolutely makes it an extremely beautiful problem to solve.
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B
What's the scale of the problem here? If you look at it from the patient's perspective, are there numbers about, you know, what percentage of invoices end up being incorrect or too much or more than they should be?
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Yeah. So I think we look at it much more from the hospital's perspective as well. Right. Coding is about being compliant. Coding is about being accurate. Right. And that's what we enable be whatever we Ensure that it is accurate, accurately coded based on what the documentation suggested. Right. We are about that. On the hospital side, we typically see around 8 to 10% of the claims that are denied, sometimes for valid reasons, sometimes for invalid reasons. Right. We want to ensure that hospitals get paid accurately and compliantly, on time and in full. Right. So that's the mission we are on. To ensure hospitals get paid for every service they have provided, accurately and timely.
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This show is brought to you by Frontlines Media, a podcast production studio that helps B2B founders launch, manage and grow their own podcast. Now, if you're a founder, you may be thinking, I don't have time to host a podcast. I've got a company to build. Well, that's exactly what we built our service to do. You show up and host, and we handle literally everything else. To set up a call to discuss launching your own podcast, visit Frontlines I.O. podcast. Now back to today's episode. What's the line item for your customers that you're working with for the hospitals? What's the line item there for what they're actually buying?
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A
They're buying for autonomous medical coding, right? Because this is a mandatory workflow in the US Healthcare, right. Hospitals will not get paid till the time they generate this invoice or the insurance claim. And the heart of this insurance claim is basically the medical coding, right? Which basically takes the clinical documentation and converts that into medical codes. Right? So our wedge is basically this. Our mandate is to actually convert this clinical documentation into accurate, compliant medical codes, so. So it can go out autonomously on the insurance claims. That's what we enter with, right? And then now we have already been expanding into other aspects of revenue cycle, which is how do you provide documentation insights so the documentation can continue to improve? And then how do you prevent some of the denials, specifically from prior authorization perspective and also in general, more accurate coding. Right. So the way we look at this is our mission, as I mentioned, is to ensure that hospitals get paid for every service they provide. However, it needs to be done in three different steps. But one is, first we have to ensure that it gets documented. Whatever care was provided gets documented accurately from a documentation insights lens, the CDI lens, and then ensuring that it gets coded accurately so the charges are captured accordingly based on the documentation. That's the medical coding lens. And the third aspect is making sure they get paid for everything that they have charged for. Right? Making sure the prior authorization was there and making sure there is no undue denials that happen. So that's how we look at it. Right. Document, charge, get paid. Right. And that's sort of the platform that we are building.
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B
And if you take a look at, you know, that first piece that you mentioned there, so autonomous medical coding. And if you look at your icp, what percentage of them would you say are roughly in market right now, where, you know, they're having their meetings to say we need to go out and find an autonomous medical coding provider versus those? You have to go out there and make the case and educate them and convince them to even create this line item in the first place.
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Yeah. There is a significant buying motion today. Everyhelp. Like this is a very acute problem in the country today. Like as I mentioned, this is a mandatory workflow. Someone needs to do it. But in reality, like the country is not producing enough medical coders today. Right. Very, very hard to hire the right coder for you. Secondly, the complexity from the payer side continues to grow from the regulation side. Right. Hey, for this we need to add this. Like the complexity continues to grow. And the third aspect is the revenue cycle. Leaders are continuously under pressure to sort of like especially the whole hospital systems are significantly running at a very thin margin already. So all these three factors actually have combined now and there is a significant buying motion today. Like what we saw with scribing companies, with scribing solutions getting adopted in the last three years or so. That's the kind of motion we are seeing with revenue cycles, specifically the coding space. Someone needs to do the work. Right. With the given complexity, it truly is about adopting the technology. Right. You cannot just throw in more and more people. It will not get solved. So we are seeing very, very significant buying motion. Most of our leads are inbound, most folks reach out to us. And we firmly believe that in the next 12 to 18 months, most health systems in the country will actually have at least one autonomous medical coding solution, if not two.
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B
What's the sales cycle look like for you? How long? I've had a couple hundred interviews now with healthcare technology founders and the one pattern I would say is that they're not short sales cycles, typically. Is that different for you because there's such massive demand and the problem is so clear?
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Absolutely, we absolutely see that. Of course, typically for health systems we see somewhere around six to eight months of sales cycle and call it short, call it long. That depends on the perspective. Right. But we typically see around six to eight months, which in for health systems is actually considered smaller. Largely on the smaller side. Largely. Exactly what you said. Right. That because the buying motion is so High. The meat is so acute and the ROIs are so high, right? We provide around very, very significant roi, both from like compliant revenue increase, improving the productivity, improving the coding compliance, right? So we are seeing very significant buying motion. And I tell my team, solve for velocity, right? Just solve for velocity, right? Because there is a very significant velocity that's happening and then take a similar velocity in delivering and adding the time to value, right? Sort of like within two to three months we are actually adding some significant value to our customer partners once we are live.
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I can't remember the exact numbers of the study, but something had come out a while back, a couple months back about how most AI initiatives fail. They never make it out of pilot or I think they called it pilot purgatory for you. Sounds like that's not a problem. How are you getting through those pilots?
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ROI is the real answer, right? Do it accurately. Like we provide very, very significant ROI. As I mentioned, we deliver around 5 to 8% compliant revenue uplift. We deliver around 32% reduction in cost of coding. We reduce the time to collect money right around by 64% or so and that we are able to deliver this kind of value within two to three months. And that's why we have had 100% pilot success and we continue to, we, in fact we, most of the times we lead with the pilot that hey, we'll do a pilot and we know once we deliver value it will continue to go on, right? So we have 100% pilot success and we'll continue to be at that path.
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And which Persona are you typically entering in? I would imagine that if you look across health systems, it probably varies, but is there one Persona that you're really seeing adopt this and be the champion for this?
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Yeah, typically. So it's a lot more specified in this specific case. Like meaning is the BPF revenue cycle, that is the buyout for us. So she typically reports to the CFO and leads the whole revenue cycle within the health systems. And the director of coding or revenue cycle is typically the ones who are evaluating us. So basically it's between the director, the VP and are the ones who are actually buying our solutions.
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From a messaging perspective, how do you approach that? Because it sounds like the cfo obviously I would guess has final approval there. Do you focus at all on messaging for the cfo or is that really all about that VP level Persona that you mentioned and then you empower them and arm them with what they need to go make the case to the cfo?
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Yeah, messaging is hierarchical, right? Like One message doesn't fit everyone. Right. You have to have messaging at all the levels, at the right levels. Right. What is it that the CFO cares about? Right. What is it that the VP cares about? Right. What is it the director? So we absolutely focus on the right messages. Like we almost always position it the right way to the buyer we are talking to the person we are talking because everyone has a specific thing they're looking for when they're evaluating a solution. So we talk about that, we show them, we demonstrate what kind of data around those things.
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Have you had to make any hard decisions on the website? A lot of the founders that I talk to, when there's multiple different Personas that they need to influence, that's a big thing they debate is what's our primary message and who are we trying to primarily hit. And then of course there's the secondary messages. Have you had to make that decision or is the message at least consistent enough that you don't have to have those types of hard decisions?
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Yeah, from a website perspective, it's a lot more consistent. Right? Of course, when we dive deeper, we actually get into different aspects of roi, different aspects of technical coding expertise. Right. So from a website perspective, we exactly know that, hey, the higher level messaging is about accurate compliant coding with the right roi and then the technical details matter, right? The kind of integrations we have, Epic, Athena and now NextGen. Right. So sort of like those things matter and we provide it at the right level.
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What else have you learned so far from a go to market perspective? And you can speak to the founders that are listening in the healthcare technology space. What advice would you have for them based on the lessons that you've learned?
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I'm an engineer by background and I firmly believe that a lot of the sales calls or the go to market has to be technical in nature. Especially it's a technical product like what we are building. Right. And I'm also a firm believer is seeing is believing. Truly make sure that you're able to show the data, show the actual workflows, right. And not just talk about it. Right? So make it as visual as possible, as easy as it possible to understand. But GTM is also not one thing right? Like one of the learnings has been, especially when it comes to demand gen. Right? There are a bunch of things that you need to be doing right, not just one thing right. And that has been one of my learnings and we continue to learn about that more and more. This show is brought to you by the global talent company, a marketing Leader's best friend. In these times of budget cuts and efficient growth, we help marketing leaders find, hire, vet, and manage amazing marketing talent for 50 to 70% less than their US and European counterparts. To book a free consultation, visit globaltalent.co.
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B
is there anything from a GTM perspective that was heavily debated, something that you were deciding on to say, okay, there's a fork in the road, we need to go here, we need to go here. That could be a message or a Persona, anything like that come to mind?
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Yeah. Our key design choice has been to deeply integrate with the EHR and only then take the solution to folks who are using those ehr. Right. So basically our definition of the ICP really is about also, like, we are deeply integrated with epic, we are deeply integrated with Athena. Right. And then now expanding our integrations to other folks. Right. So we have debated significantly that we will sell only to the hospital systems or physician groups that actually use these 2, 3 ehrs. Right. If you're not integrated, we will not do actual delivery. Right. So that's one thing. Right. And we work only with provider organizations. Right. That's like with hospitals, health systems and physician groups. So those are the two key decisions we have been continuously making. And we'll continue to evolve beyond this as well. But at this stage of the company, at this stage of our value proportion, this is our focus.
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Is there anything from a marketing perspective that you tried that didn't work, Anything that you wasted money on or burned some money on and you thought it was going to be promising and it turned out to not be promising?
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It's a good question. I've tried several things and all of them have worked out to a great extent. But the one that has really, really worked out is being at the. Especially because we sell to health systems, being at the conferences, being at the events, and consistently being there has been very, very helpful. Right. One choice we have always been making is to not make a big splash at like have a large booth at a conference that those roi. Like, we have always thought that it will not be consistent and being at the right events has been a lot more helpful for us.
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And what's the strategy there? Do you focus on, like the, you know, in all industries, there's kind of like the mega events, the huge ones where everyone goes to, and then like the smaller, more intimate niche events. Some founders I talk to, they say we're all in on the big ones, forget about the little ones, and others say vice versa. What does that look like for you?
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We focus on where the revenue Cycle leaders, actually the ones that they attend, right. And we know the ones that they attend. We typically present ourselves there, right. It's like over time we have learned exactly the ones which well attended those are the ones we focus on. And it's not the largest of the largest ones.
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What about building out the go to market team? Any big lessons there that you've learned that you could share with the founders?
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We have indexed heavily on healthcare experience, right. And that has played out very, very well for us. Right. Of course we'll continue to evolve this, but at this stage like healthcare experience has worked out very well and the folks who have built the zero to one capabilities, right, folks who have built like things from scratch are the ones who have worked out the best at this stage of the company. And I think that continues to be my thought process here. Right. Any function within an organization that when you're building zero to one really, really matters the ones who have done it.
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B
And final question for you, you touched on that a little bit. But let's just end with the final one about the big picture vision. So we can go out 3 years, 5 years, 10 years, however far out you want to go, what's the big picture vision here?
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The big picture vision is healthcare AI, right? We effectively take care of all the administrative burden through AI, right. And deploy AI in a very thoughtful, safe, regulated way. We are right now in the digital intelligence world, right. Post three years, four years later, we want to get into the physical intelligence. So just continue to expand and build a very thoughtful, very high value proposition product both in the digital and the physical intelligence world. Right. That's sort of like what we are building towards across and let the providers focus on more care providing we take care of the larger administrative inefficiencies that are existing today. And also like where it ties to is ensuring that healthcare becomes more affordable and accessible in this country. Especially if you were to go to any rural areas, right. Like you hear in Becker's news, right. Hospital is closing down because of the financial viability. So our mission really is to ensure the hospitals become financially viable so healthcare becomes more affordable and accessible in the country. Right. And we are on a mission to do everything that ensures that hospitals stay financially viable and not squeezed by because of this very, very thin margin that they're currently working on.
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B
Amazing. Love the vision and I really love this conversation. Before we wrap here for founders listening in that want to follow along with your journey. Where should we send them? Where should they go?
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A
We are right on the websites, on the LinkedIn right at the right conferences as I mentioned. Right. And we love talking to people, sharing our journey, what we have gone through and what we are planning to do. Absolutely love exciting conversations. All right.
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B
Amazing. Well, thanks so much for taking the time. Really appreciate it.
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A
Thanks, Greg.
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B
Well, that's all for today's episode of Builders brought to you by the Frontlines. If you want more amazing content like this, visit Frontlines IO where you'll find a library of more than 1500 interviews with founders, marketers and other GTM leaders where we unpack the tactical lessons from their journey. And of course, as always, if you do want to launch your own podcast, we'd love to have a conversation with you. Visit Frontlines IO Podcasts as a service. Mention that you listen, mention you love the show and we'll give you a 10% discount. Thanks for listening. We'll catch you on the next episode.