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Making health insurance frictionless | Loop
Have you ever experienced the broken healthcare system in India during a medical emergency? Mayank Kale did, and it was a wake-up call. That's why he started Loop.
Loop is on a mission to make healthcare frictionless for its users. And guess what? It's working! It’s now the most well-funded startup in its space.
The platform provides employees health insurance coverage, a primary care doctor, unlimited free consultations, and discounted diagnostics.
How did Mayank do it? Finding the perfect fit for Loop's product in the market was difficult, but Mayank did not give up.
Mayank shares how he found product-market fit and made Loop the most well-funded startup in its space!
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Mayank Kale: [00:00:00] Hey folks, co-founder and CEO of Loop. . I think there is this narrative of second generation of Indian business kind of taking over and just kind of, you know, sitting on the, on the business and not building much.
Mayank Kale: And so I always had that maybe, that chip on my shoulder to say, I'm gonna go do my own thing. That is completely unrelated, that is gonna be higher technology, higher impact, but also, you know, I'm, I'm grateful to him for providing all the things he has, but I do, I did feel from a very early age, I wanted to build my own identity.
Akshay Datt: So like those four years in the U.S. must have shaped your thinking on entrepreneurship, on what you wanna build, what you wanna do.
Akshay Datt: Tell me about that.
Mayank Kale: Yeah, so from a very early age, right, I've been really fascinated with Silicon Valley. Like, I used to write emails to all of these founders in the valley [00:01:00] back when I was in the sixth, seventh grade. Some of them ended up becoming now investors and board members. But, I honestly always wanted to go to Stanford.
Mayank Kale: That was the mecca for kind of, you know, founder types like me. But I didn't get it. I was just like, you know, depressed for months after I didn't get into Stanford. But my second choice was Illinois because the University of Illinois is like a top three CS program in the world, and it has a history of
Mayank Kale: amazing founders like Marc Andreessen, Max Levchin, you know, Jeremy Stoppelman, Luke Nosek, all of these folks have come from U of I , so deep roots of Mosaic and PayPal. And, , so that was my second choice. And so I ended up there. And, it has dramatically, I think, changed my perception of what startups were.
Mayank Kale: I always did feel like I was still away from Silicon Valley. I never felt like I belonged until I ended up at YC, in 2020. But, there was still a lot [00:02:00] of CS hacker culture at U IUC combined with just the deep roots in the valley. And I think that shaped a lot of ambition. I think for me, it's very, it's one of those things, it's very hard to know how to be really ambitious unless you see it.
Mayank Kale: And that was kind of the first realm that I really saw people take on world changing projects and so yeah, I think that was the, that was the...
Akshay Datt: Did you also try world changing projects while there, like, you know, what led up to Loop? , you must have tried a bunch of ideas before, reaching to
Mayank Kale: Loop.
Mayank Kale: Yeah. So, you know, I was pretty clear I always wanted to start a company. I've never had a job. This is like my first job out of college. , but I never thought about healthcare. , I was deep into the crypto space in 2014, so that's when Bitcoin was probably at like $50 or $60. And, we are just, you know, [00:03:00] kind of hacking at it in CS lab.
Mayank Kale: So I think I worked a lot on the crypto side of things on Bluetooth, low energy. That was an emerging technology at that point. So I was just trying out a bunch of projects. Obviously I didn't know anything about product development or product management. So as a, as an engineer, just building random things that actually don't, are not that useful
Mayank Kale: And then in 2015, second year of college, my dad had a heart attack. So, my parents both live in Pune. He's, he's luckily fine now, but he had a heart attack and, that completely changed how I thought about the basic necessities in the Maslow's hierarchy almost. I went through that whole experience with him, you know, he got diagnosed over that heart attack.
Mayank Kale: He got prescribed a really invasive heart surgery. I was 19, so we just ended up getting the heart surgery. It cost 10 lakh rupees. [00:04:00] I had to get that all back from the insurance company, which was the worst experience I've ever had. And, Later when, when we talked to a few friends and family, we found out that he didn't need the invasive heart surgery and took him like six months to recover.
Mayank Kale: And so that experience got me really obsessed with trying to figure out, you know, we have all of this, this progress in bits life, right? Your Twitter, your social networks, Google, all of these bits of innovations, but the atoms haven't shifted yet, right? The atoms like transportation and traffic and healthcare and power, like some of these core infrastructural things haven't moved.
Mayank Kale: And that got me really obsessed with saying, look, if healthcare sucks for me in India where I can pay basically as much money as I need to get the good healthcare, I don't even know what's happening to kind of, you know, someone who maybe cannot afford it or is, doesn't have a [00:05:00] doctor in the family, and so on and so forth.
Mayank Kale: So yeah, that, that started my obsession with healthcare. I spent, I took a semester off and I spent, those four months just talking to 200 doctors and a bunch of hospital owners. And I just was just uncovering, , horrendous kind of incentive problems in healthcare. You know, learning that, you know, care providers, doctors and hospitals are given targets for how many surgeries they should do.
Mayank Kale: What is the surgery mix? MRI, X-ray targets, , hospital owners are thinking about nber of bed occupancy multiplied by revenue per bed. That's the metric they're maximizing. And just thinking about all of that and learning, made it so obvious why my dad had the experience he had, right, even though his primary care doctor knew
Mayank Kale: 12 of his cousins had had heart attacks in the last 20 years. [00:06:00] They still couldn't prevent this guy from having a heart attack, right? And so it just became obvious why the experience is so broken, the incentives are broken. No one is using technology and product to help someone live longer, live healthier, and nor are the incentives aligned that way.
Mayank Kale: And so, yeah, that, that's what got me in healthcare. And I did a bunch of things while I was still completing my undergrad and then moved back
Akshay Datt: to India.
Akshay Datt: One way to solve this problem could be to build like an asset flight hospital model? Like say what maybe Pristine Care is doing, you know, something on those lines.
Akshay Datt: What did you want to do?
Mayank Kale: So at that point it wasn't clear, like, you know, like the journey to figuring out your core mission and product market fit is kind of a long arduous, expiratory one. At that point it wasn't clear, but I was clear in the fact that we needed to solve the core problem, which is that of [00:07:00] incentives.
Mayank Kale: If doctors continue to get more money, the sicker a patient is, regardless of what you improve, it's never gonna work because it fails at the atomic unit, at the logical unit. And so always, I think the core principle of design was can you build a health system where care providers are paid to keep people healthy and to keep people out of hospitals and can you align healthcare with what a patient wants?
Mayank Kale: Right? And so that's why the asset light hospital models where we are maximizing surgeries is wasn't ever that interesting to us because it doesn't take a genius to figure out the profit pools are in tertiary care or surgeries. Right? But I think we never wanted to go do that. I think. All the persistent attempt was to try to figure out can we rewire the whole stack so that the incentives are aligned and we solve the core problem with healthcare.
Mayank Kale: [00:08:00] But
Akshay Datt: tell me that journey, like you must have started with a certain thesis that this is the way to do it, and that which must have gone through multiple iterations.
Mayank Kale: Yeah, yeah. I mean, hindsight is always 20-20 . I feel it's so easy to piece it together looking back, but honestly it was a, pretty uncertain process.
Mayank Kale: So after my dad's, heart attack, I basically said, you know, what a software engineer would say is software solves this, right? That was the first hypothesis. I'm gonna write code to solve healthcare. And so I spent about a year while I was still studying, not going to class basically, but writing code for a EMR for electronic medical record that was built for rural India.
Mayank Kale: So there are thousands of villages in India where there are no doctors, that void is filled by health workers who are trained. And today these health workers, Asha workers, [00:09:00] are using paper notebook, forms to diagnose, diseases, right? Disease diagnosis is nothing but a flow chart, right? Yes or no questions, values, diagnosis.
Mayank Kale: So they've been using these thick books. And so I ended up, me and my dad ended up getting involved in a nonprofit in rural Maharashtra, in, in tribal villages in Maharashtra, which, is run by two ex Johns Hopkins doctors for the last 30 years. And, they had trained up a couple of hundred village health workers to do deliveries, to take care of pregnancy complications and to treat 50 diseases in those villages.
Mayank Kale: And they were using these horrible pen and paper notebooks, to do, to run this. And, I said, okay, look, if I can write code to fully fix this problem, you know, while I'm still in college, let me do that. And then we'll go and take it to the real world. We'll help doctors make better decisions and,[00:10:00] all of those things, and all will be well.
Mayank Kale: And so that's what I ended up spending two years of my college doing, while I was finishing up the degree, wrote a couple of lakh lines of code for the electronic medical record in Marathi, so these health workers could use that. , and ended up deploying it to about 500,000 patients. So about half, half their lives.
Mayank Kale: Ended up being touched with this EMR that health workers used. And, that was the first project, and that was as a 20 year old, that project was to say that I can build something and I can push it in the real world and it can have real impact, right? So that was when the whole, idea became clear that you can build technology, you can write code to save lives, which is a really powerful thing to realize, I think, as a 20 year old software engineer.
Mayank Kale: And so, that was the first thing I [00:11:00] built. And then, in 2018, I moved back to India with my friend and co-founder Ryan, who I met in college. And we said, look, we've built this piece of technology. , it works
Akshay Datt: in public health. So Ryan is like an American citizen.
Mayank Kale: Yeah, so I have three co-founders, Ryan, Amrit and Shami.
Mayank Kale: Ryan and Amrit are my friends from U I U C. They're both, native and born, in the US American, but , are Indian, origin and, ended up doing the reverse brain drain thing.
Akshay Datt: Amazing.
Mayank Kale: And yeah, so we moved in 2018 and, we were like, okay, I mean, this is great technology.
Mayank Kale: Let's deploy it in clinics and, all will be well. And so we tried to go and sell it to doctors and pretty soon we realized that doctors, GPs hospitals are not really interested in improving quality of care. Obviously, they want to do [00:12:00] it broadly, but in the moment they don't want to pay for things that improve quality of care.
Mayank Kale: They are trying to get as many patients through the door as possible, and they're trying to give them a service that they can build insurance companies for, right? Which is the right thing to do. I don't want to categorize, the service in that way, but, we realize that no one is interested in paying for a tool that helps you make better decisions as a doctor, because no one is incentivized to do that.
Mayank Kale: And so, you know, we miserably
Mayank Kale: failed basically at first. This tool was like a clinic management software where you could manage your patients and, keep docenting every visit in it so that next time a patient visits, you can see all pass visits and what was prescribed to him, and maybe send reminders for next visit, et cetera.
Mayank Kale: Like something like that, like a clinic management app.
Mayank Kale: That was half of it. So the half of this clinic management and the other half was what's called a C D S or a clinical decision support, and [00:13:00] so that was, basically using the information inputted by the doctor to help them make a better decision, right?
Mayank Kale: So pulling up algorithms, pulling up best practices, you know, potentially flagging up what the symptoms could mean, and so on and so forth.
Akshay Datt: Yeah. Give me an example of how it would work.
Mayank Kale: Like for example, like let's say you are, treating a patient with hypertension, right? And, you end up prescribing statins, to this patient.
Mayank Kale: You see some statin, you've been prescribing a statin for let's say the last six months, but the blood pressure is not going down or the blood pressure is going down, but the patient has high, kind of bilirubin or some other liver, enzymes. So the secretion is suddenly increased, right? So there's side effects.
Mayank Kale: And so, It's not, I mean, you could take pharmacological studies and show the physician that hey, this kind of statin produces this effect in X percentage [00:14:00] of patients. Try these six other statins, and if your patient fits this bill, then these two might be the best for them. Right? That's the kind of intelligence you can provide.
Mayank Kale: And we have built some of these algorithms across maternity, across some primary care conditions as well. And, and that, this sounds like
Akshay Datt: a fairly multiple things to solve to make this successful. First is how do you, get clean data in, like, I mean, if for example, you're saying that there are some liver markers, how do you get that clean data in?
Akshay Datt: Like typically those test results will be like a printout from a lab, and doctors may not have the time and patience to do manual data entry or so on. Like, what was your approach to get the data in?
Mayank Kale: Yeah, I mean, we didn't understand that, you know, we were just experimenting. We had deployed it in public health where you are mandated to do certain things because you're public health worker, but a random doctor or a GP in a clinic, you [00:15:00] are right.
Mayank Kale: That was why it failed. It's cuz they had no incentive to use a digital system. It was too painful for, that was kind of the first lesson. Product management, which is...
Akshay Datt: Okay. That extra, hassle of data entry was kind of a barrier to adoption. And, how did you, quote the intelligence in it like that, that must have been a manual process?
Akshay Datt: Like you would've had to like, collate studies and, and like, was that how you did it? Like with the help of like a doctor or a subject matter expert?
Mayank Kale: Yeah, so, in college I had interned at a health analytics company in Chicago. That was the fastest growing health analytics company in the U. S. and they, what they had done in the US because the US is already on medical records, electronic medical records, for 25 years, they had built a marketplace of algorithms on top of it.
Mayank Kale: So you could take an algorithm from a science research paper and you could [00:16:00] deploy it a hospital. And I was like engineer nber six on it. And I worked there for about 12 months while I was still studying and doing this startup, so to speak. And so I had learned a lot about how to do those things in that, from that experience, which translated really well to this.
Mayank Kale: So, , yeah, some background on how to build it. And then we used, some of my connections I built up during that internship to, to help us launch at least the top 25 kind of most common primary care places.
Akshay Datt: Okay. Got it. Got it. Okay. So then what, like you went to market and you saw that it is not getting adoption.
Akshay Datt: So
Mayank Kale: yeah, we went to market, we saw it's not getting adoption. , and then we were like, okay. , like any kind of, founder would do, ask the doctors, what do you want? Right. And the doctor, I think a lot of what came from the doctors was, , this I [00:17:00] this problem of, oh, we don't get specialist advice or as GPs we don't have access to specialist advice.
Mayank Kale: Right. And so, I was like, okay, cool. Let let us fix that problem for you. Will you pay for it? Yes. We'll pay for it. All right. We've said it, we'll build it. Right. So we ended up building a two-sided marketplace of specialist doctors from major hospitals in Pune and connecting them with the GPs. So if they had a case that they wanted advice on, they could ping this doctor or their assistant or their team, and they would solve it for them, and then they would pay them.
Mayank Kale: Right? So they would take additional money from the patient and then they would pay the specialist, right? And, that was a really attractive service for doctors. And so we grew very quickly. So in a span of six months, we had 350 doctors GPS in Pune using this service. And we had, we were doing a probably [00:18:00] close to 600 consults a day, with these specialist doctors.
Mayank Kale: And
Akshay Datt: the, onboarding would've been manual, right? Like you would've had to call up these people, tell them, Hey, another source of earning for you, and, just sit at your home and earn, and like something like that.
Mayank Kale: On the specialist side, yes. The supply side, the onboarding was manual on the demand GP side.
Mayank Kale: They told their friends, so they were like, Hey, check this out, word of mouth. And so we ran that for a couple of months, in 2019, early 2019. But what that ended up devolving into is something funny, that ended up devolving into a surgery funnel for specialists. So we get, we started getting calls from GPs saying that, Hey, this specialist did not prescribe surgery to this patient, but they have insurance.
Mayank Kale: So why didn't they, why didn't they prescribe a [00:19:00] surgery? And we started learning about this idea of kickbacks, that if. You send a patient for surgery, you can get five, 10, 20% off the surgery back, from the hospital or the specialist. And so we, we kept getting like a call a day from some of these gps saying, Hey, why didn't this person operate?
Mayank Kale: Hey, where's my money? And we were really confused. Well like, aren't you, aren't we helping you make better decisions ? And then we're like, oh wait, that's not what's happening. into a surgery funnel. And they were transacting, on top of our platform. And then we read through some of these chats they could use our app to chat with these specialists.
Mayank Kale: And it was about how much money and
Mayank Kale: so we're like, holy fuck. Like this is not the correct consequences product. I don't want to be the business of maximizing surgeries that doesn't feel like the right thing to do [00:20:00] for our users. And so we decided to shut it down. We said, look, this is not the right, thing we want to build.
Mayank Kale: We're gonna shut it down. But we learned so much about patients, about their experience at hospitals, about insurance, and about incentives that we said, look, if we really want to solve this problem, we are going to have to be really ambitious. We are going to have to commit to this problem of building a new kind of healthcare system.
Mayank Kale: And that's where this idea emerged that look, , no one except the insurance company is incentivized to keep you out of hospitals, right? The insurance company doesn't want you to claim. Now, there are two ways to do it. One way is just to deny claims, in which case no insurance company will succeed because they just will have an reputation of not paying back their consers.
Mayank Kale: The other way is to keep your patients healthy, [00:21:00] navigate them to the right doctors, navigate them to a trusted circle of specialists and broadly help them manage their conditions so that they don't end up at hospitals. Right. And so we ended up, and again, the team was like three people, right? At that point in 2019, we ended up talking to a lot of folks in the U. S., in the UK, in Singapore, learning about health systems around the world, and understanding what worked for them.
Mayank Kale: And, , we ended up discovering what is used to be called an integrated care provider that is now called a pay-vider, in the VC language. And a pay-vider is basically a payer and a healthcare provider combined, right? And someone like a Kaiser Permanente in the US is a great example of a pay-vider.
Mayank Kale: Of an old pay provider and someone like, Oscar Health or a Clover Health is an example of a, of a new kind of pay-vider where you are the insurance company, you take risk on a patient population, [00:22:00] but you're also the healthcare provider. So it allows you to keep them healthy, it allows you to influence them, and it allows you to kind of, be on the right side of the patient.
Mayank Kale: Right. And, , I think we got really excited with this model. And obviously it does doesn't, but,
Akshay Datt: yeah.
Akshay Datt: I have a question first. How is this any different from any health insurance company? It sounds like exactly the same thing, and health insurance company is doing that. Like they're taking a risk on a cohort and they pay, and especially like today, everything is cashless, so they would directly pay the hospital for the procedure, et cetera.
Mayank Kale: Yeah. So insurance companies today are like banks, right? You never think about ICICI being your healthcare provider. You know, you think about a doctor, you want a healthcare brand. ICICI is the bank that allows you to pay for hospitalization, right? So, so they are just purely payers today in India, , [00:23:00] what a pay-vider is, is they're not only your payer, but you also go to them to seek healthcare.
Akshay Datt: Ah, they would set up your appointment.
Mayank Kale: Okay. Yeah. They might be your family doctor, they might be the specialist. You fully trust them to deliver healthcare for you. And, that's the, that's the difference.
Akshay Datt: Got it. Okay. Okay. So, so you learned about this model, which excited you quite a bit in 2019 , so
Mayank Kale: then what? Then?
Mayank Kale: Then we said, look, we are like 23, 24 year old founders. , we have no business being healthcare or insurance. This seems like an old person's game, but, but fuck it. Like we, we're really passionate about this. Let's, , let's go build a new kind of health system in India and , let's do it right, and let's commit a couple of decades of our lives to doing that.
Mayank Kale: And so, yeah, that's when we said, look, you want to be eventually a pay-vider in India. How do we do that?
Mayank Kale: Do that by [00:24:00] getting a bunch of families covered under our health plans and we become their healthcare provider of choice. And, that's when we started building our health insurance product with our primary care product.
Mayank Kale: And, we were basically the first ones in 2020 to, offer that combined to companies because, we know that most people get their insurance from their company, right? And so, we were the first ones to be, essentially a healthcare broker to go in and say, take your insurance and here's some primary care with it.
Mayank Kale: And, we're gonna help your employees and their family members stay healthy, engage with benefits more, and if they need to go to the hospital, we'll be there of the whole care journey for them. So, yeah. That was the...
Akshay Datt: Company was a decision you took after, like trying b2c, b2b? Both. Or you straight away wanted to do b2b?
Akshay Datt: Yeah, we didn't do
Mayank Kale: B2C because it just seemed like not the right strategy for a [00:25:00] company that had no money.
Akshay Datt: Okay. Right.
Mayank Kale: B2B seemed like, okay, we, I can sell, my co-founder can sell. Let's just, just go and, build a base of, , consers
Akshay Datt: and so, you were taking the risk on your books or you had collaborations with insurance companies and like you were creating a bundle.
Mayank Kale: Yeah, we are a broker, right? So brokers in India can't take risk today. So we had a few insurance partners that we worked with and, still work with. And, they were the ones backing this group health plan, but we were delivering healthcare ourselves in-house. So we did have our own doctors and so on and so forth that, was part of the healthcare plan.
Akshay Datt: Okay. So one part of it is, an insurance policy from one of the traditional, health insurance companies. And the other part is like first level consult can be done through your app, because you have doctors, on panel, available on call. [00:26:00] And, subsequently, if , somebody needs to get admitted or needs to get a test, then that could be set up through the app, like, an appointment with a specialist or a test pickup, and stuff like that.
Akshay Datt: That's exactly right. Okay. Did your plan cover, there must be like say X consults a year per employee and stuff like that. Like, like tell me what exactly were you selling? What was the product to, to an HR head of a company?
Mayank Kale: Yeah. The product was simple. It was unlimited primary care, so you could actually consult and text us 24 x7 as many times as you want.
Mayank Kale: That was that risk. We underwrote on the primary care side because no one wants to just chat with a doctor for fun. Right. So.
Mayank Kale: Right. You don't have that problem of like induced utilization. That's what they call, you're not just gonna, you know, use it to use it. Right. So, we said unlimited primary care for your employees, along with a fully digital, modern insurance [00:27:00] journey that includes your insurance cards in the app, digital claims, an HR dashboard for you.
Mayank Kale: And so on and so forth, so both these pieces were fairly revolutionary when we introduced them in 2020, where we were then displacing their existing providers at a pretty rapid rate. The first company we sold to was two years ago.
Mayank Kale: Which company was that? It was actually a small subsidiary of General Electric,
Akshay Datt: GE.
Akshay Datt: Wow, okay. Amazing.
Mayank Kale: Yeah. And, we sold to them. And since in the last two years, you know, we've grown to about 550 companies. We cover more than 300,000 lives. I think, it's been, I think, phenomenal to see consers like HR and employees adopt this very quickly.
Akshay Datt: So, are you also, providing patient health record on the app?
Akshay Datt: Like say someone, goes for a test, like [00:28:00] diagnostics, they can just click a pic and it gets read by like, you know, machine vision reads it and puts those records and stuff like that.
Mayank Kale: Not yet. That is in our long-term roadmap. I think as we stack rank our priorities, there are so many other things to build before that, but if you do a test through us, it shows up as a PDF in your app.
Mayank Kale: And so we have people that have consulted with us like 10 times a year and all of their concerns, their prescriptions and their lab tests show up in the app, which is already better than what people have today. Right. And so, that's kind of where the experience is today. I think in the future, I'm sure we'll go and build more.
Akshay Datt: So what is the, list? So like you stack rank the features and these are features you wanna build first, and these are down the line, just talk to me through that. Like what, what were the top features you wanted to get out first?
Mayank Kale: Yeah.
Mayank Kale: I can, I can guys talk about the past more freely than, than the, but, you [00:29:00] know, we, we wanted to launch a few things quickly.
Mayank Kale: The first was HR. As a customer, how do we make your life easy? We make your life easy by completely extracting you out of the insurance administration, part of your job. So we replace that with technology. And so you as an HR don't need to email us the list of your new employees or email us the employees you want to remove from your insurance plan.
Mayank Kale: We just plug into your HR software. And, we are just able to essentially pick up from that, right, that was the first thing we ship. Were like, don't be involved, in insurance administration. Here is the technology to do it. Don't be involved in claims that are kind of people-centric. Customer support desk and our digital claims journey help you and your employees,[00:30:00] solve that problem. So you as an HR are not gonna get calls at 3:00 AM asking for, claim support, right?
Mayank Kale: So, , that was a first set of features we shipped for the HR and for the employee. , there's only two sets of features that were important, A) Access unlimited primary care. So consult doctors through the app, text them, and B) , see your insurance info, see what's covered, see what's not covered. File a claim.
Mayank Kale: So that sounds easy. There's a lot of magic that happens underneath it because the insurance partners we work with are not digital, right? And so there's a lot of duct taping and a lot of internal people plus tech happens, to make an experience that feels fully tech based and integrated. So it took us a while, a few quarters to build that.
Mayank Kale: But ,
Akshay Datt: like each insurance company would have their own formats and templates for claims. So you would need to give the customer one unified format, but then convert it to match the insurance companies format and have some automated [00:31:00] following up and stuff like that.
Mayank Kale: That's exactly right. That we had to do all that on claims, but I think just being scrappy, like one of the one of the core values at Loop is obviously -the first one is to be customer obsessed, but velocity is also a really important value that we have. And so we were being scrappy. We sold, we built, we sold, we built, in lockstep. And so it wasn't like there was an eight month development process. And then we launched, we just launched, and then we kept building and we still do that.
Mayank Kale: We will launch things and we'll build simultaneously.
Akshay Datt: Hmm.
Akshay Datt: This launch happened after YC, you got into YC right? In 2020?
Akshay Datt: Yeah.
Mayank Kale: So 2020 we got into YC, and we spent three months there. I think that was some of the most, fun three months I've had in the last few.
Mayank Kale: This was
Akshay Datt: pre pandemic?
Mayank Kale: Interestingly enough, ours was the first kind of virtual demo day. So ours was the first batch that the pandemic hit. And so, our group partner was Michael Seigel, [00:32:00] who is the CEO of YC. And, basically, when Covid happened in 2020, in March, demo day got shifted from in-person to virtual.
Mayank Kale: And now it seems so obvious, but back then it was, it just created havoc in the whole founder community in YC because everyone was really freaked out. Like, how do you raise money on Zoom? Like that sounds Yeah. crazy. Like, why, like why would anyone give you money over a video call? Right. And so, and so yeah.
Mayank Kale: And so Michael Seigel basically told us, look guys, we don't know how things are gonna be, take the first term sheet and run. I recommend you raise quickly. So we actually ended up raising a seat round in two days, before, before demo day happened. And,
Akshay Datt: this was pre-revenue. You had not made your first deal yet.
Mayank Kale: This was pre-revenue. That's right. As founders, we, so we had done, we had grown a bit during YC, from a slightly different subset of this business. You know, because we took time to get the insurance license, [00:33:00] we just sold healthcare to companies, so we, we did make some revenue dollars, there.
Mayank Kale: Okay.
Akshay Datt: Like just the primary care piece, like unlimited consultants.
Mayank Kale: Okay. Exactly, a bunch of companies wanted it, especially with Covid around. And so some forward thinking, HRs bought this from us. So, YC, we did YC, we were a team of, I think six or seven at that point. , raise our seed and then, and then was stuck in the US for six months.
Akshay Datt: Okay.
Akshay Datt: Yeah.
Mayank Kale: And then got back and then launched in September of 2020. Okay.
Akshay Datt: So, you need, a license for being an insurance broker also. Like, and that takes time, is it?
Akshay Datt: Yeah, it takes some
Mayank Kale: time.
Akshay Datt: Okay. And once you get that license, then what? Then every insurance company must work with you, or you still need to go and build relationships with each company?
Mayank Kale: Every insurance company can work with you.
Mayank Kale: The must is based on, your relationship and building supply, right? So it's essentially a marketplace. You are matching HR [00:34:00] and company risk to risk capacity of insurance companies. And so, yeah, you go and build relationships with, with insurers. So,
Akshay Datt: would they, do customize policies for you or is there like a standard policy?
Akshay Datt: Which, like how does it happen? What is your relationship with insurance companies?
Mayank Kale: It's a bit of both.
Mayank Kale: do, The standard policy that customers ask us, for, and we do your, customized ones where we think there is scope of innovation. We will go work with one or two partners, get those things in, and then, and then expand value there.
Mayank Kale: Okay.
Akshay Datt: What is the, onboarding journey for an employer? Like do they, is it like a, they can see policies and then they can add to cart what kind of policy they want? Or is it like a consultative selling where somebody is talking to them, understanding and then sending a proposal?
Mayank Kale: Yeah, it's all consultative. [00:35:00] Insurance is fairly complex. HRs don't want to mess it up, and so it's a, it's a consultative sale. B2b, it's like B2B SaaS in some ways. Sales team is involved in selling to the HR, but once they sign up, then the onboarding team ensures that every employee gets their benefits, hears from us, be integrated into the company's HR system.
Mayank Kale: All of that data gets pulled and, we, we do a bunch of, activities around healthcare to get people, to the primary care aspect of, our product as well.
Akshay Datt: Hmm. Okay. Okay. Okay, got it. Okay. So, why is there, so much, VC interest in this space?
Akshay Datt: You Would be aware that there are a lot of companies which have raised a fair amount of funding, although I think you've raised the maximum amount of everyone else in the field. So, but, what, what are the features of this business which excite, VCs?
Mayank Kale: Yeah, that's a, that's a great question. [00:36:00] I think the number one thing is that...
Mayank Kale: there's two things, right? I think what do, what do VCs want? The first one is they want, they want a massive market. Like they want to have a big opportunity to go after because only large BES can return that fund, right? And so, that's the first thing, right? And insurance and healthcare fit that bucket.
Mayank Kale: So one of the biggest reasons why VCs are invested in this space is it's cause both of these markets combined are massive. The second thing that is very interesting about this space is that it's largely dominated by incumbents, right? So you have these old 20 year old brokers, 20 year old insurers, slow moving, customer dissatisfaction is high, no use of technology and so on and so forth, right?
Mayank Kale: [00:37:00] So it just feels like, okay, this is prime for disruption. And any good business, has moats. And this is a business that has moats because you don't move your insurer often. You don't move your primary care or your healthcare, provider often. And so, yeah, some of these, some of these reasons make, made it make it very exciting for, venture capitalists to look at.
Akshay Datt: Okay. So customers tend to be very sticky. Unless like somebody's majorly screwing up, they, they will, there's a lot of inertia to change the provider and you'll have to get a lot of approvals and explain why you want to change and so on and so forth.
Akshay Datt: Mm, exactly. Mm-hmm, got it. Okay. Interesting. So, yeah, tell me that journey. So you told me you built up these two features as primary, like for the, HR to get onboarded and for, employees. What else, on the features did you build next and what's on the roadmap?
Mayank Kale: Yeah. So, so we ended up building that and, when we, [00:38:00] you know, we are a very design first company. One of our co-founders is a designer, so we are one of those rare companies in India where we have a design co-founder.
Mayank Kale: And so, a core ethos is just to talk, to talk to our users. And so, I think we kept doing that and kept building more features in these segments. And then I think very quickly we reached a point where we were 10 x better than, what was out there. And so that, that helped us just kind of rapidly scaled, as, as we were, as we were doing that.
Mayank Kale: And, we have been basically listening to our customers and, and building what they want. If you think about what we're building today, we're making progress on two vectors, right? The first one is we are going deeper in the healthcare stack, so we're going deeper in terms of helping our employee base or our member base deal with chronic diseases, deal with, , some acute primary care [00:39:00] problems. So building diabetes, hypertension, and some of these core diseases that, you know, people go through. We're building kind of management plans for that and helping them take care of themselves in the, in the journey.
Mayank Kale: And the other vector we're building rapidly towards this is more coverage or more benefits, right? So insurance is about covering your risk. There are a lot of problems and nitty gritties in terms of what's covered, what's not, how is it covered, what is the mechanism for paying back. And so there's all of these nitty gritties in terms of how much insurance covers and our attempt is every customer we sell to for the same price, we should show up with more coverage.
Mayank Kale: And the way to do that is technology partnerships.
Mayank Kale: And a more digital journey. So kinda two, two factors.
Akshay Datt: Yeah. Okay.
Akshay Datt: The stuff on, diagnostics, on OPD [00:40:00] visits and, procedures and all, is that stuff that you monetize, like what are those integrations? Like You must have got partnerships with various diagnostics companies and all.
Akshay Datt: How do, how does that
Mayank Kale: work? Yeah, so, today we don't monetize them. Today the goal is to provide a complete experience. So you can book, lab test through our app. You pay through us, but we pay the provider ultimately. And, it is basically to complete your care journey because, most people have become, you know, so used to using our app.
Mayank Kale: We have, you know, we do tens of thousands of these interactions every month. Invariably, 20, 30% of them require diagnostics and people wanna be in the same app and complete the same journey. So, yeah.
Akshay Datt: And this would be through like, digital first, diagnostics chain, like say, like a one mg or, like those kind of chains that you would be working with.
Mayank Kale: It's a bit of both.
Mayank Kale: Coverage is [00:41:00] important. So we work with traditional players, we work with the new guys. Yeah, pretty, pretty open about that bit. Yeah, so, not really monetizing those aspects today. I think it's easier to scale a business the simpler it is. And so, today we are in the phase where we have kept the business simple.
Mayank Kale: We know where we make money, we know how we spend it. The goal is to scale and, grow quickly. And then I think once we're comfortable that an engine is running, I think we would, we would want to go and, dig a little deeper in some of these, let's say ancillary revenue streams.
Akshay Datt: So how do you currently monetize? What is the model?
Mayank Kale: Well, we make a percentage of the premi that we sell, right? So you sell to an employer. They pay you, they pay the insurance company a premium amount for coverage, and we get a certain percentage of that, from the insurance company. And that's the pretty [00:42:00] simple monetization model today.
Akshay Datt: Hmm. What, percentage do you earn or what do you earn per employee covered or like,
Mayank Kale: so you can earn anywhere, depending on the kind of cover you sell, you can earn anywhere between 5% to 15% of, the premi set a company pays. So it depends on a lot of factors, risk losses, relationships, size.
Akshay Datt: Okay. Tell me about the fundraise journey and, you know, like we spoke that you have raised more money than anyone else in this field. How did you do that?
Mayank Kale: Yeah, so, when we started raising, right, so we started raising in, so we raised, we started raising in May of last year. That was our first institutional round, that was the c a and we were super clear.
Mayank Kale: 12 million round led by general Catalyst, elevation and Khosla ventures. I think when we started raising, we were really clear on what, [00:43:00] we wanted in a partner. And what we wanted in a partner was someone who understood that we are on a long journey to build a new kind of healthcare system in India.
Mayank Kale: We are not on a two year journey or a three year journey to go and scale something quickly. We are not on a five year journey to maximize top line. But we want to change the fundamental nature of healthcare delivery in India. And , there were a few people that understood that. So Hemant Taneja who runs General Catalyst, he has written a book called Unhealthcare.
Mayank Kale: And when we came across that book and we read it, we said, we looked at our internal memo of the company and we looked at this book and we're like, this is the same thing. And so we're like, and this is, I mean, Hemant is a prolific investor, right? He is. He like to seed at Stripe, at Snapchat at a couple of these massive, successes.
Mayank Kale: And so we were like, you know, this is the guy for us. [00:44:00] Because he really understands what it means to build, in, build in healthcare. And so, you know, that was the big, that was the big thesis. That was, the spiritual alignment almost with, with this investor. So we found a way to get connected to him and, we, we raised from him, with Vinod there was a similar story. Vinod's been a personal hero of mine since I was a kid. I think, you know, building Sun Microsystems and, just was such
Mayank Kale: an amazing story for me as a- him as an engineer building these massive companies. And, incidentally he had also written like a 50 page memo on the future of healthcare, called a 20% Doctor. And I had read that a couple of years ago and I'm like, this guy gets it. We wanna, we wanna raise from, from him as well. , and so we, we found a way to get connected to Vinod as well.
Mayank Kale: And, in India, you know, we, ended up chatting with obviously, most of the large venture funds.
Mayank Kale: I think Mayank Khanduja was our partner at [00:45:00] Elevation. Same name, my, same initials, MK. But, we, we just, we just felt like, you know, they understood what we were building. They were going to be partners with us for the, for the long run.
Mayank Kale: Thought, you know, that this was the fund we'd wanna partner with because they deeply understand India and they understand the founder journey really well. And so, you know, we, out of multiple term sheets that we had at that point, we ended up, we ended up going with these folks.
Mayank Kale: And then, and
Akshay Datt: by that stage, you already had enough attraction to demonstrate, that I went to demonstrate that this business has legs and the team has executed well. What kind of numbers were you at at that
Mayank Kale: time?
Mayank Kale: From a company perspective, I think we had just sold to about 40 companies. 30 or 40 companies. We were covering some 25,000 employees, give or take, I think 20,000 employees or something like that. [00:46:00] Yeah, yeah. So yeah, so that's how, that's how we, that's how we raised The aid was all remote.
Mayank Kale: It was during the pandemic. We were the only ones in the office every day and we were trying to raise through Zoom. Obviously as, first time founders, it's a nerve-wracking experience, but, we ended up pulling through and, raised the A and then the B we raised earlier this year.
Akshay Datt: Which was, same set of investors, 25 million dollars.
Mayank Kale: It was the same set of investors, but we also added Opt Ventures as part of the round. Opt is another company we've, admired in the U.S. Opt is a subsidiary of United Health. United Health is the largest health system in the us. They are 2% of the US GDP.
Mayank Kale: They are massive. Just felt like, you know, they would be the right partners as we go and build a new health system in India. And so we, connected to them, spoke to the ex CEO of Opt, who'd grown the business, to put [00:47:00] a hundred billion dollars. And, I think we wanted to pull them in as partners in this round as well.
Mayank Kale: We raised, we raised early. I think we all knew that kind of the macro world is going to go to shit at some point.
Mayank Kale: Okay.
Mayank Kale: It's, it's better to raise early and get the money in.
Akshay Datt: This was essentially like, just to have a war chest because you are in a business where the money comes in right at the beginning, right.
Akshay Datt: The moment you sell, you get the cash. So it's like a very healthy cash flow kind of a business, right? I mean, you don't necessarily need money for working capital and so on.
Mayank Kale: Exactly. It's a negative cash conversion cycle, which is helpful. We're able to get the money upfront. But mostly, you know, for us, It's like day 0.1.
Mayank Kale: It's not even day one. There is so much to build. There is so much innovation we want to do with insurance, and healthcare, Mostly that we just have this massive, you know, roadmap to [00:48:00] build. And, we said, you know, let's raise a capital. Let's invest up front. So we ended up, we ended up closing that round.
Mayank Kale: Then a month later the, the world went to shit, right? And so we, we felt pretty, pretty good about that, for our own business.
Akshay Datt: Okay.
Akshay Datt: Do You think, that, you know, there's gonna be consolidation in this space and like one way to grow could be through acquisitions?
Mayank Kale: There could be I think consolidation. I think one would have to think about why you are acquiring a certain company and, is the capital more efficient in deploying it in your own sales team to displace these companies or to acquire one. And so I think we're, I think the jury is still out. We're still, we're still doing the math.
Mayank Kale: No,
Akshay Datt: I mean, say patient health record as a feature, could we solve through an acquisition?
Akshay Datt: Correct.
Mayank Kale: Yeah. I think product [00:49:00] acquisitions make a lot of sense. That's right.
Mayank Kale: I mean, we have been, we have been looking. So if, if someone is hearing this and is a small team wanting to be a part of something larger, just a call out here,
Akshay Datt: So, can you share, some revenue metrics and you know, what you estimate them to be like? Like say, you know, do you have like a revenue target for 2025? What, what is your current ARR and stuff like that.
Mayank Kale: Yeah. Yeah. So I think the revenue and premi wise, , we tend not to shell these out, but I think what we do end up shelling out is just how large of a patient base we have.
Mayank Kale: I think it's fairly easy to estimate for the the, you know, the exercises left for the reader type of thing. I would say that, you know, today we cover more than three lakh lives.
Mayank Kale: I think for us in the, by 2025 we want to get to 2 to [00:50:00] 3 million lives covered in India. And so the goal is to basically, 10 x in the next two years, for us.
Akshay Datt: And what would be your ARR at that stage when you're at 2 million lives?
Mayank Kale: So, we hope to, I think, I think the way to think about it is, is
Mayank Kale: You know, the average person pays, you know, probably a hundred dollars. For insurance. And so 2 million, that's 200, two 50 million of a book that we have.
Akshay Datt: Okay. Okay. And five to 15% somewhere in that range is your, take rate in that.
Mayank Kale: That's right. That's
Akshay Datt: right. Yeah.
Akshay Datt: Okay. Okay. Amazing. So, do you wanna eventually, go deeper in terms of getting into the insurance business itself or do you wanna continue to be a broker?
Mayank Kale: I think it remains to be seen, to be honest.
Mayank Kale: Insurance base is also evolving very quickly. The regulator is more liberal now than they have been before. [00:51:00] I think today in the group health space, we have not seen prices normalized yet because there's a presence of some large public sector in insurers and so on and so forth. What does
Akshay Datt: that mean?
Akshay Datt: Prices are not normalized? Are you saying it is like subsidized?
Mayank Kale: Yeah, I think not subsidized, but I think the market is definitely a little skewed towards, lower prices because of the presence of these, massive government insurers. Okay. And, we are just, we are seeing every year prices normalized more and more to a more sustainable market clearing price, but I think it remains to be seen, the attractiveness of the segment and so on and so forth.
Mayank Kale: But what I will say is the, the goal is to align incentives. And so eventually we want to be able to, take risk, on the population. Now, whether it's by becoming [00:52:00] an insurance company or by any other means as a partnership, I think that remains to be seen. But, eventually we want to be punished if our employees, or if our members go to the hospitals more, and we wanna be rewarded if our members go to the hospitals less.
Mayank Kale: And, that's, that's what we want to get to.
Akshay Datt: Right. Amazing.
Akshay Datt: work with the government, insurance companies also, like, or you work mostly with private companies?
Mayank Kale: No, we work with, we work with both the government and the, and the private folks.
Akshay Datt: But, I'm guessing with the government folks, it might be more painful for like claim settlement and stuff like that, the integrations and all of that.
Mayank Kale: The tech, the technology integrations are definitely much harder with the government folks, but, surprisingly, it, it's a fairly well oiled machine. I think, it's it's crazy to say that out loud, but, sometimes they've been better, honestly, than the private, private ones. So, that's, that's come as a nice surprise to us.
Akshay Datt: Hmm. Amazing. Yeah. Cool. [00:53:00] Okay. What's your headcount like currently?
Mayank Kale: We're almost 340 folks.
Akshay Datt: And this would largely be sales and product, like these would be the two major
Mayank Kale: That's right. Sales product, some in operations, but mostly sales and product.
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