Commure CEO Tanay Tandon on merging Athelas and Commure to automate healthcare administration with AI

Welcome to the stream. We made it. How you doing? We made it. Fantastic. Sorry for audio issues. Oh, no. It was a pleasure. We got to do extra ads. So, you know, you're making my day. It's a dream. It's a dream. You're making my day. Uh, what's going on? Quick intro. You've had a big day. What's What's happening? Yeah.

Thanks for having me. We We uh we announced a $200 million round. Oh. with General. That's fantastic. Buried the lead, Jody. You guys got to start selling those. I feel like we need one in our office. Um, but yeah, know we're super excited. Uh, obviously works in healthcare.

Uh, you know, we we power AI workflows, everything from ambient to revenue cycle payments in uh in large hospitals. Oh, interesting.

Give us give us a quick history of the company because It's not often I see a 200 on six something billion and I haven't I hadn't heard of the company before but I hadn't um Josh Browder connected us last nighting and um so I'd love to hear your quick story kind of how you got here history of the company.

I want to hear about the first customer too for sure. So I mean Josh is great. I've known him since we were at Stanford together same year. Um and the you know the story behind Kamir is interesting because Kamir started as an incubation inside General Catalyst.

it it you know the best analogy I have is it is uh Hmon's uh Palunteer very focused on healthcare uh I started a company while I was at Stanford calledis which was focused on applying language models and computer vision in healthcare uh we started as a blood diagnostics company and then eventually grew into this uh mid-market SMB OS for for physicians uh we merged the two companies about uh a year and a half ago or almost two years ago now.

Uh and then I took over as CEO with our management team. And so it's really, you know, it's sort of a coming together of these of these two businesses. Uh and yeah, I mean the company powers large hospitals about 250,000 physicians and nurses. We power uh the you know private practices here in California.

That was our first first customer. It was someone that my co-founder, Deepka, literally walked up to and, you know, cold knocked on their door and then got them to use one of our first devices and and remote monitoring solutions. Uh, and uh, yeah, that's that's the the the quick story.

I got a bunch of questions, but I I want to kind of like contextualize this around the broader general catalyst uh discussion because there was news, I think just today, that uh Ohio authorities approved the first ever purchase of a US hospital by a venture capital firm.

That's General Catalyst's uh bid to acquire Suma Health, a hospital system in Akran with over 20 facilities. And I'd love for you to I'm sure you've studied this. What is going on there? And then how is that is there any sort of synergy across the portfolio?

Venture uh general catalyst has has had like a very differentiated strategy there. Um but I haven't had the chance to dig into it. So I'd love to get you to contextualize it and then we can go into uh how this links to your business again. So the Suma transaction is super interesting.

It is a venture capital firm buying a health system transforming it. Uh and Kamir is obviously a big part of that. We're serving as the office of the CTO. So our engineers are forward deployed. We work hand inand with the uh Suma IT teams.

Uh we've been working with with with the revenue cycle leaders, the clinical leaders. And it's a really special system. I mean it's in Akran. If I'm not wrong, it's where LeBron James was born. U literally the the hospital itself. And um many people have been calling you the LeBron James of healthcare AI.

Now we got to put that out there. Um, yeah. I mean, I I maybe have been the first person to say it. You might have coined it here, but many people I'll say it right now. You're the LeBron James of healthcare. Yeah. Now, many people, not just one. Two is two is many. Yeah.

In our book, we're just going to make that a thing now. Um, fantastic. It it's it's remarkable because running a health system is super hard. It is a 1 to 3% operating margin business. Uh, most of them go out of business.

uh and uh I think what what general catalyst believes in is language models and technology can transform the operating margin uh and also lead to better care. So it's not a PE you know cut and and and juice play. It's it really is a an investment. That's awesome. Uh talk about uh Kir's overall product strategy.

You guys have a number of different products.

It seems like a very different you know that we we've talked with founders and covered companies that come on and and just want to own uh one you know one key area but uh healthcare feels like somewhere where if you can get embedded with the set of customers you can you know you know more you know rapidly kind of add add products to uh to the platform.

So I'd love to understand the the product strategy.

we we really look up to businesses like Ripling and and Rams um where you know there's this concept of you you enter with a wedge and in our case that wedge is uh either ambient AI which is a tool that helps a physician document and really automate the revenue cycle of their appointment generates the claim automatically.

Uh and then the back office which is all when you walk when you walk into a hospital there are tens of thousands of people at large health systems whose sole job is fill out claims call up insurance companies fight denials fill out new forms all of that's going away with LLM and our belief is that if you do that as a point solution as like a single you know little part of the part of the solution you might get some initial usage but eventually the EMRs like Epic or companies such as ourselves will just eat you And uh you have to be that compound startup from the get-go.

And I think payments is a really interesting vector to deploy software. RAMP has shown it where if you get into the transaction suite and then you build a whole bunch of tools for the CFO's office. We're trying to do the same for a health systems CIO and and and CFO.

Can you tell me a little bit of the the history uh of the healthcare industry broadly and how uh I I I know that there was like this kind of catalyst around Obamacare.

I remember talking to Jonathan Bush, the founder of Athena Health about uh electronic health records mandates and there's been a number of changes kind of at the federal level that have kind of uh opened up different pockets of opportunity.

Like what is the story that you tell about the recent history of healthcare in America? I think it's it's fascinating. The 90s physicians had amazing lives. I mean, they they drove Porsches. They had work life balance. They had personal relationships with their Let's hear for Porsches. We'd love to hear that.

Let's get back to Porsches. We need more of those. We need to return. We need to return. And and you know, all in all, physic patients got great experiences too because because of that personal relationship. And then, you know, the admin work tax just increased. Everything from insurance to filling out an EMR.

Digitization came in the 2010s with Obamacare and meaningful use and really EMRs proliferated.

And Jonathan Bush and and Judy and, you know, all these people are legends in the industry because they built Athena, a $20 billion company, Epic, probably a hundred billion dollar company now on the backs of that very quietly and under the radar from for most of tech.

I think the theme and the story of today is labor is turning into software. And where is most white collar labor in America? It's in healthcare. Where like where where are the majority of administrators sitting behind a computer clicking on forms? It's in healthcare. And we believe that the EMR will be transformed.

We also believe that the labor stack of healthcare will be transformed and it'll create more operating cash flow for hospital owners. Is that narrative of the uh like the the administrative ratio or the administrative load increasing? Is that similar to what happened in in academia?

Because I I remember seeing these charts of like the ratio of professor. Everyone loves the idea of like uh a high functioning university with a lot of professors teaching students and a great ratio there. Uh everyone's a little bit more skeptical about like wait why do we have five times as many people to add admin?

Is that the same thing that's going on in healthcare? And and kind of what was the underlying driver of that? Was it just regulation or or lack of tools? Where'd it come from? I I think it's very similar. What I will say is I think in healthcare it bred more out of necessity. And in academia, it just kind of happened.

Um in in in healthcare, there's this game of attrition between the insurance company and the provider. And you're they're making it a little harder every month, every year to get an approval on a claim. And as a result, the health system needs to add a couple more people in order to fight those claims.

And then it just kind of built up into this arms race. And I think the insurers kind of carried the power after Obamacare. Like the when you look at United Health's market cap, I mean the it's like what is it like a 12x since Obamacare got passed. It's it's quite shocking.

And the power dynamic I think will shift again back in the favor of physicians and hospitals because of LLMs and because of what you can now automate. Yeah. It was kind of just like the the game theoretic Nash equilibrium was like hire a lot of a lot of admin staff. Interesting. There was no other option. Yeah. Yeah.

Talk about uh your personal ambition and the team's ambition. You're a six billion dollar company now. seems like uh you know it's cliche but it the way you're talking it feels like you're just getting started. Is the job finished? Yeah. Yeah. It sounds like the job's not finished.

I don't want to put words in your mouth. It's not finished. Um we're Look, I I think when you walk into a healthcare practice, the inefficiency is shocking. And it's and the the positive intent from the physicians and the nurses and the caregivers themselves is all there.

And I think all it takes is for a company like ourselves to come in and try to nuke that work tax. Uh so our ambition is look, we're going to come after the EMRs. We're going to come after the payers, the revenue cycle businesses. Um this is a $4 trillion industry. You can build for a very long time.

Uh what done looks like is when you walk into a physician's practice, scheduling, intake, insurance, like all handled. There's no filling out a little clipboard of the same information again and again. The appointment happens and instantly the doctor is paid out.

There's no reason we can't have instant adjudication instead of, you know, waiting 30 45 days, but it's going to require a system overhaul like new payment rails to go do that. And that's really what what's at the heart of what Kamir is building. Awesome. Well, this is super exciting.

I'm glad you're doing what you're doing and uh you are new you're our new uh healthcare uh expert and correspondent. So, expect a call next to LeBron James. I'm And LeBron James specifically. LeBron James of EMRS. Yes. All right. According congratulations on the milestone. Uh hope hope to have you on again soon.

We'll talk to you soon. Okay. Cheers. Have a good one. Uh should we do some timeline? Fun show. Fun show. Yeah, we definitely should. We got to talk about uh Sam Lesson's Oracle versus uh Salesforce. He's getting in He's getting in hot water. You got in hot water. The timeline's in turmoil.

We love Sam Lesson on this show. He he posted a uh screenshot. He says I will defend big tech. I will defend Sam Sam Lesson uh Oracle is 2x Salesforce but Ellison is worth 25x benny off what this sale says about the limitations of the SAS business model.

He said uh he had a fun riff yesterday with the slow partners on this. Oracle is obviously crushing it. But if you take a today snapshot basically the market cap of Oracle is 2x Salesforce 500 billion versus 250 billion.

Meanwhile, according to previously directional at best uh data, Beni off's net worth is 125th that of Larry Ellison's 10 billion versus 250 billion. What do you learn from that? What lessons do you draw? I like this. The revealed preference. Um for founders and companies, the old licensing model is better than SAS.

That's interesting. Imagine having hot take 10 billion and just getting little bro by Larry. He has a sort of little little broing effect on most people.

There's an amazing story about a little bro, a famous little broing where Phil Knight of Nike was worth something like 10 on the order of like 10 billion dollars and he was in like maybe Sun Valley or something going to a movie and he runs into Bill Gates and Warren Buffett who are just going out to a movie and they're they're both worth 10 times him and he's just like yeah I had this weird awkward moment where I was like nervous to meet them for the first time in a long time because typically he's like the most successful businessman he runs into all day, Right.

But he was just like, yeah, uh he in his book Shoe Dog, it's a fantastic book. Shoe Dog is a great is a great book. Great book.

Uh and he talks about like all the weird effects of like having immense wealth, how like his wife would like hoard immense amounts of like uh paper towels just because they were like money is no object. Like what should we do? Paper towels. What should we do with this?

And I got a lot of paper towels and they had to like figure out okay this is like some weird psychological thing that's going on in my brain. like I don't actually need all these paper towels. The fact that money is no issue doesn't really matter. Yeah.

People like to talk about, you know, you're the you're the you're the what whatever the the average of your five friends. And it's like, yeah, well, if you want there there should be some similar law of like like your growth rate is like should be is like tied to how often you're little broad, you know? Yeah. Yeah.

Never get little broad. No. No. You want to be Oh, yeah. Yeah. That's true. Yes. You can be on the upward swing. That's right. If you're not getting little broad enough, you're not on an upwards upward trajectory. This is good. Yeah. Yeah. This is good. I've been in that situation before.

Anyways, um we could cover what Sam said. Uh but I think we can just skip to We're also going to have him back on the show. We're going to have him back on the show. He's a regular. We're going to skip to Miles. He says, "Wrong take.

Allison is much richer because he didn't sell shares and has steadily been buying back 2% of the company every year for 30 years. He's increased his ownership from 17% to 40%. Such an incredible story. Founders complain about dilution. Yeah. Oh, you got diluted. Yeah. Oh, I'm sorry.

Why don't you just buy back shares every single year for decades? Yeah. Um, if Ellison, you know, keeps doing this, he could very well own 150% of his company at some point. That's the future for OpenAI. OpenAI just becomes the the agentic organization.

It just it just buys back so many shares that it eventually owns itself. Yeah, that's the real That's the real goal. Any uh anyways Miles says meanwhile uh CRM aka Salesforce made a lot of dilutive acquisitions and Beni offly sells his shares yearly. He doesn't sell them yearly.

He sells daily 2 million daily bu oh liquidity events you know they're they're few and far between you know daily not happening every day. Not for bounty off daily liquidity. It's pretty good. Um, you know, the the real uh, you know, another How much does he pay Matthew McConnA to just Oh, yeah. That's got to be pricey.

I think it's only like 10 million a year. So, it's like, yeah, couple Super Bowl ads. Not bad. Uh, so Sam responds to the the hate. He says, "Since a lot of folks are making the same comment about buybacks versus sales strategies, that is at best the noob answer.

If you're smart, you understand why they have different paths. And the answer is path dependency from business model quality. Take a 2011 level class. And then Buho Capital Blow quote tweets that and says it's a timeline in turmoil. Wrong again. CRM has executed poorly.

They've diluted shareholders with bad acquisitions. They have 75,000 employees who they give excessive stockbased compensation to. They let hubs scale up in their face. HubSpot. They've diluted versus shrunk their share count uh versus the other companies Adobe that eat shares. Uh investors don't trust him.

If Beni off held and cared about shareholders, it would be a closer call. He doesn't care. It's not about the business model. Well, you'll love to see some some timeline and turmoil. Very very fun. Uh in other news, Shil Monot has the story about Telegram's founder Pavle Durov.

Consistent feature on the Techbro Drip account. Everybody says they're pronatalists until they until you ask how many how many uh children, you know, have you fathered through sperm donation. Apparently, he has fathered over 100 kids via sperm donation. And he is worth $14 billion.

And he says he'll leave his fortune to all of them with no difference between his six kids conceived naturally versus via uh compared to the hundred via sperm donation. So, every one of them is going to get $140 million. just to kick off fundraising, just start investing that.

You got your family office on day one if you're one of Pavle Durov's kids. Pretty remarkable. Yeah. Single LP. It's kind of a good dynamic. Yeah. I wonder how he's going to get liquidity for for Telegram at some point because you get a bunch of Telegram shares. It's kind of like this this difficult beast to wrangle.

Uh, but I mean, I guess you take it public and at some point and and get liquidity out of that. I don't know. I mean, it also just prints money. So even if it's like 14 billion, like you could just get like get a stake in the in the distributions because it's making money.

I think he kind of figured out life and wanted to make his life basically a hundred times more complicated. Uh you know, having having this type of dynamic, you know, not just with his many uh children that that he helped conceive directly versus the hundred others. So, um, had to one up Elon. Had a little bro Elon.

And little and Elon's commented on this, too. He was like, "A I got rookie numbers. Gang Gangaskhan over there is really taking over the world. " Uh, Gangghask Khan of encrypted messaging. Yep. It's very, very odd. Uh, only CFO says the finance department outrinks sales.

Feels like sales is inviting finance to the party so they can stick them with the bill. And this is this is the data you can only get from ramp. ramp. comdata. Apparently, apparently, uh, finance, marketing, sales teams lead in alcohol spend. Alcohol as a share of business meal spend. Not in that order.

So, marketing is absolutely dominating. Dominating 20% 20 19% of all spend on alcohol. No, no, it's 19% of business meals are alcohol. So, if they go out and they're getting $80 worth of food, they're adding on $19 or something or $81 of food, $19 of drinks. That's the idea. Alcohol share finance.

They're getting, you know, $84 of food, $16 of booze. Marketing is drinking sales under the table. Yes. Yes. Narrative violations. It in the in the the tail end there, 9. 7%. Uh many Huberman devotees in the IT department apparently. Yeah. Not a not a power lunch uh you know, category.

No, but the three martini lunch will make it back for the for the tech teams. Uh, should we go to this story about the vibe coder who sold his business to Wix for $80 million? It's only a six-month old company and there's no external funding. $189 $198,000 $189,000 in profit in May.

Uh, Bryce Roberts, this is just the beginning. There's going to be more stuff like this. I think this is pretty cool. Base 44 only employs six people. hasn't raised any any external funding. The 31-year-old built a viral app AI app maker as a side project.

So, you go in there, you design an app, obviously um uh plays very well with Wix, which is in the uh website building business, but he flipped it for $80 million and he's post economic now. Congratulations. Yeah, when I saw this headline, I was I was confused.

I was like, "Okay, so he just vibe coded some something and sold it. " But it is a tool to built a vibe coding tool trusted by over 250,000 builders worldwide. And nice quick flip. Amazing.

Um he he's basically getting a similar uh similar outcome to you know a a founder that sells their company for a billion dollars but you know goes through a bunch of different financing or kind of like a midtier AI researcher these days. Yeah. Starting you know like starting out. Yeah, starting starting out.

Uh, in other news, John Carmarmac is absolutely jacked. This is fantastic news. Uh, Yaxine has the news. He's looking he's looking very built. Uh, but John Carmarmac chimes in.

He says, "A chunk of this is just uh his wife dressing me in tighter shirts, but I did put on several pounds of muscle this year after switching my random grab bag of vitamins and supplements over to Brian Johnson's blueprint system. " Let's hear for Brian Johnson. Really making a difference in the technology world.

Uh, I was probably not getting enough protein to take advantage of the exercise I was doing. I have always been roughly upper quintile for fitness. Let's go. Uh, regular exercise, but not at the level of serious athletes that most offices tend to have a few of, and now he's looking built. Palmer Lucky chimed in.

Uh, it's a great great day on the timeline. Uh, let's check in with Tyler. Close out the show. I was going to check in with this poly market. Will Chimoth launch a spa in 2020? It is up to 70%. It's up to 70%. It was 33% when I posted it this morning. Wow. That's big news.

It was partially because he came out and he said, what did he say? He said 58 He asked yesterday, should I launch us back? 58,000 people voted. 71% said no. He said, uh, I hope everyone that voted no feels seen. Now, on to business. I got calls from many Wall Street and crypto titans yesterday.

They all want in and their vote matters a lot to me. So, I will probably do it. I love it. Maybe this time it will go better. Who knows? The risks are clear, though. The last time wasn't a success by any means. I will include this poll and the community note in every SEC filing possible.

It will make an excellent disclosure about the risks and is not short of irony. So, what kind of company do you guys want? No crying in the casino. So, let's go. People are absolutely fuming in the comments, I'm sure. But honestly, get after it. Pretty fair. Everyone knows he's going to play by the rules, you know?

And I think I think at the end of the day, it's it's very like I I look at the next Chamath as like it it totally will like it probably will pop. It'll probably it'll get a lot of attention. It might turn into a meme stock, right?

Um, I uh I will be interested to see what kind of target he I'm 100% excited to follow the story. Yeah, it's going to be fascinating. Anyway, let's check in with Tyler and then close out the show. Tyler, I have a question for you. Can you guess a number between 1 and 50? Like a random number?

Yeah, random number between 1 and 50. Uh, 27. 27. Are you an LLM? Did you see this? Every single model, they all guess 27. When you ask them between a number between 1 and 50, uh, Chad GBT, Claude, Perplexity, Meta, they all guess 27. We got to get a world.

We got to get a world coin orb in here to be able to prove that Tyler's not in fact Yes, we do. We He might just be a DP. Uh, final review. What did you get done this show? Uh, did you keep playing with Mid Journey? Were you doing something else? What's been going on the last couple hours? Uh, yeah.

I think I I just sent uh another video. Oh, no. Uh, I've been pretty productive. You can watch this. Let's see. Gorilla. I like that the gorilla crosses behind. What's he doing? Did he just How he just took my spot? Oh, he took your spot. Wow. Wow. Slides in. Oh, he comes in with a paper. Breaking news.

That's the breaking news gorilla. The breaking news. We need to get you a a breaking news gorilla outfit and and if he has breaking news, you can print it out. Come sit down. Take a seat. That'd be amazing. That's good. That's good. Uh are there any others or we're closing it out? Uh yeah, I think that's it. That's it.

That's it. Well, good work. Good work today. I feel like the productive team laughing like they have some other ones that are too scary for for our audience. I saw I I saw one get sent in the chat and it and it just was really scary, bad looking. Well, we will be back tomorrow. Uh we have a great show for you folks.

Leave us five stars in Apple Podcast and Spotify and thank you for watching. Thanks for being here with us. Fantastic show. Have a great evening.