Summary

The Offline Network Episode 22: Equity & Agentic Healthtech (aired 2025-10-20). Guests: Kashish Sharma, Ankit Maheshwari from EquityList, Innovaccer. Kashish: "So EquityList is actually a compliance tech platform, allowing companies to put any equity-related operations on autopilot, basically." Kashish: "And it's crazy how we're seeing equity being implemented, not just, of course, in the Western hemisphere, because those markets are a lot more mature than let's say what India is, in fact, proverbially as well." Topics: venture capital and funding, AI and LLMs, consumer brands and D2C, health tech. The Offline Network is India's live show on startups, tech, and venture — streaming M/W/F at 4 PM IST on YouTube.

Full Transcript

Dhruv Sharma: Thank you for joining us, we will be getting started in about a minute. Hello listeners and welcome to the Friday stream of the Offline Network. If you've been watching this show, if you've been following this show, then welcome back. Our first guest is here today, is here already, we have two guests for you today. Our first guest is a good friend, a colleague and a supporter of this show, Kashish Sharma, who's the CEO of this company called EquityList, which is building the modern operating system for equity, cap tables, stakeholders across the public and private universe. We're going to have a lot of fun chatting with him. And then after Kashish, we'll have Ankit Maheshwari, who's a very early team member at Innovasa and has been their CDO ever since. Kash, how's it going, bro?

Kashish Sharma (CEO, EquityList): It's going fantastic. Friday week.

Dhruv Sharma: It's great to have you.

Kashish Sharma (CEO, EquityList): Not really for us though, but it's yeah, I'm equally excited to be here. One of the first few subscribers of TON, right? I'm just wondering, is this going to be like our usual chit chat? Like what we have, what we usually do offline?

Utsav Somani: We can do it however you want.

Dhruv Sharma: It can be whatever you want it to be, yeah.

Utsav Somani: And it's not Friday, he's following 996, he subscribed to the 996 ideology.

Kashish Sharma (CEO, EquityList): You gotta do what you gotta do, right?

Utsav Somani: Awesome. So tell us, what is EquityList for our listeners? Introduce the company.

Kashish Sharma (CEO, EquityList): Yes, sir. In our words. So EquityList is actually a compliance tech platform, allowing companies to put any equity-related operations on autopilot, basically. If you were to further kind of double click on that, we help companies manage and administer securities by completely, you know, like streamlining the cap table operations, equity grant operations, the compliances and accounting around it. So as you can imagine, throughout the company's or the business's life cycle, you probably start off with like, you know, two shareholders, it's probably the founders, and then you start hiring people, and then you raise your first institutional capital, or you bring up Oriental Investors, etc. A lot of these operations are just, you know, like Excel is the go-to platform, which is how everyone pretty much starts. But, you know, it goes without saying is it's erroneous in nature, it's highly error prone, not scalable. And as and when you start becoming bigger, compliances pretty, you know, pretty much come knocking at your door, you know, with disclosures, accountings, the right level of documentation, etc. And that's what we have been doing, right? We have been solving and digitizing the atomic level security record keeping for businesses. Of course, all of this, the genesis of EquityList was within AngelList. You know, both of you are highly, you know, aware of it. But for our audience, we were building EquityList as a mini project, project internally for quite some time until we decided to spin it off. And we officially launched ourselves roughly in the beginning of 2023. Right now, we have reached a scale where we work with 600 plus businesses from super early stage organizations to large public listed companies like Tata Consumer Products, BlackBark, which went public last year, BlueSow now, Bajaj Auto that we recently onboarded, and hopefully a lot more. So we manage, we manage securities for roughly 45,000 stakeholders at this point of time globally. India, of course, is our home turf, you know, close to the heart market that we truly started kind of building for. But now we work with companies that are based out of Southeast Asia, Maina, cross-border US, India, etc. So that's a very quick gist of what it is that we're doing. Not really sexy.

Utsav Somani: Yeah, Naval's quote, I remember, he tweeted this very recently. I mean, not recently, I think a few years back that the new landowner is the shareholder or shareholder is the new landowner, right?

Kashish Sharma (CEO, EquityList): That's correct. Equity is the currency of the future, right?

Kashish Sharma (CEO, EquityList): And it's crazy how we're seeing equity being implemented, not just, of course, in the Western hemisphere, because those markets are a lot more mature than let's say what India is, in fact, proverbially as well. But like even in India, the amount of equity adoption that companies are pretty much kind of introducing from the earliest of stages, it's absolutely bonkers, right? Because as you can imagine, you know, depending on the kind of industry you're in, maybe you're in commerce, you're building a marketplace, you're in logistics, you're a D2C brand, etc. You end up hiring a lot more, especially when you compare to the Western markets, right? So by the time you're probably Series A, you have close to 100 people on your payroll, right? But the openness or rather the democratization of making everyone an owner in the company, give them some sort of skin in the game, that has opened up massively over the last half a decade, at least, right? So, you know, people are using equity, not just as a attractive level to bring about, you know, like promising talent, but then also to open up very ingenuous and interesting forms of compensation as well. Tying it with performances, opening up liquidity. So Naval, of course, everything that he says is pretty prophetic. And this furthered outlook makes sense, right? Yeah.

Utsav Somani: He says, I think it's in the title, right? You gotta own. Own equity to get rich.

Kashish Sharma (CEO, EquityList): Yeah. Yeah, you gotta own equity. That's the only way to get rich, right? You gotta break the payroll cycle.

Utsav Somani: And you gotta use equity list for it.

Kashish Sharma (CEO, EquityList): 100 percent. 100 percent.

Dhruv Sharma: How early is too early to start using equity list, Kashish? When you talk to founders?

Kashish Sharma (CEO, EquityList): Yeah. The answer is not too early, right? It's always the right time. So if you think about it, a company that's just recently incorporated, right? The cap table looks very basic. So maybe that's not a problem that you're trying to solve for. But then immediately, what's the next thing that you start doing? You start looking for the right folks to bring aboard, right? And clearly you can't match their market compensation. So, you know, you start giving them or rather promising them equity in some shape or form.

Dhruv Sharma: You're actually the best person to do this, Kashish. Can you tell us how cap tables evolve over stages and how does complexity creep in? And you can always tell us how equity list just whisks it away stage by stage.

Kashish Sharma (CEO, EquityList): Right. No, 100 percent. It's interesting you say that I'm the best person while I have two people here who are built AngelList, right? Solving for cap table complexities with syndicates, right? But all right, I'll take what I get. No, but yeah. At the earliest of stages, cap tables aren't too complex. They're pretty simple, right? But the cap tables that we are used to, it's nothing but an Excel sheet which just has a bunch of numbers and, you know, just like a percentage attributed. That is what we usually see as founders, right? And as operators who probably have to think about round dilution, who have to think about fundraising, etc. But what you really have to do is double click and see what's happening under the hood, right? The percentage of ownership that we see, how do we really come up with that figure? And that basically is nothing but built on top of, you know, like a foundation of multiple securities and shares related data that all gets added up and then gives you that final percentage of 50 percent, 60 percent, 89 percent, so on and so forth that you attribute against every each and every shareholder. So the complexity or rather the best practice is how do you maintain that share registered and how do you ensure that every single data point that you're entering is absolutely correct or not? How do you ensure that one rounding off error does not lead to a filing discrepancy, right? In general, you'd be surprised.

Dhruv Sharma: They come back to haunt you later, right? All these misgivings.

Kashish Sharma (CEO, EquityList): 100 percent. I mean, imagine the dematerialization push that's happening right now in India, especially where physical share certificates are being traded in for, you know, shares actually being allotted in your demand accounts electronically. If I empirically speak, almost six out of 10 companies, you know, that we have been engaging with have had cases where share certificates have been lost, right? Over a period of time, the account does not tally up. Maybe there are like five different people over the course of 10 years who are managing that cap table and now no one person has the right Excel version that they could really refer to basically, right? So yeah, but talking about the evolving journey, of course, cap tables at first are pretty simple. They start getting, of course, complex as in when you start raising a round. And typically by the time you do your seed round or CBZ, you of course, you want to empower your cap table by bringing the right cheerleaders in the form of angel investors who bring SPVs, syndicates, et cetera, right? That give you a lot of ammunition. You know, you diversify your shareholders and cheerleaders, et cetera. And by then you probably have 15 or 20 maybe line items on your cap table, right? In the form of shareholders. Complexity most likely starts when you probably start, let's say, giving a lot more grants out, right? You start giving ESOPs to your employees. You need to account for those ESOPs in your fully diluted calculations. You need to understand who owns how much. And as I was saying, especially if you look at Indian companies where we hire a lot faster than our Western peers, et cetera. By the time you read CBZ, you probably have 100 employees. You probably want to give stock options to at least 50 folks, right? So how do you kind of take all of that into account, right? An Excel sheet now, for example, which was doing the job is totally incapable of ensuring that your share related calculations are correct. There's no discrepancy. There's no expectation mismatch, so on and so forth. And of course, with every successive institutional round that you keep adding, you probably start witnessing some sort of transfer and transaction related activity happening. Maybe there's a secondary, there's a scope up, there are shares being repurchased, so on and so forth. Imagine accounting for all of those transactions, right? I mean, once again, I keep coming back to like Excel sheets. It's highly unscalable and doesn't really work. So at least what we do, right? We atomically build the entire share transfer and the share registry on your behalf, on the platform, ensuring that shareholders get the right dashboard. They get all documentation under one place. This becomes a single source of truth for company, for investors, for employees, for your accountants, auditors, et cetera. Imagine all of the due diligence that goes behind just attributing all of these securities in line. You get rid of that because you're always audit ready, right? I mean, everything is just always ready for you to kind of look into.

Utsav Somani: For our listeners, like what does a good ESOP plan look like? Like five things to look for when designing an ESOP plan as a founder who's just starting up.

Kashish Sharma (CEO, EquityList): Yeah. First of all, myth busting. Seven out of 10 companies probably do not have an ESOP scheme document created before they've started promising stock options to the employees they've just hired. Can you imagine? Right? And it makes sense because most founders aren't aware of this one critical step, which is when you think about creating an ESOP pool, right? Maybe you want to attribute a certain percentage of your stock option pool. The thumb rule is seven to 10% in the earliest stages. People promise it. Maybe you have a board approval for it, but they don't have an overall governing ESOP scheme agreement, a scheme plan or a scheme document, right? That pretty much inculcates how the scheme is supposed to be administered. Which authorized individual is going to authorize the governance of that pool? Who's going to sign the grant letters? What does your exercise period look like? How do you think about liquidity when it comes to your employees? Do you have the right indemnities and liabilities set in to protect the company, its shareholders, et cetera? That overarching document, as I was saying, six to seven out of 10 usually does not exist. So we call this the promise date delta, right? Like a lot of time founders come to us and they're like, Hey, you know what? We promise stock options or stock options to these 10 employees. They've already been with us for two years, but we don't have a scheme document.

Utsav Somani: And you can't back these, right?

Kashish Sharma (CEO, EquityList): Not really, especially not in India, because as per MCA, you need to oblige with the one year mandatory cliff requirement, which means that from the date of, of course, when your scheme document was board approved and all the necessary filings were done from then on, you could very well start issuing grant doc grant letters to your employees, promising them some sort of stock options, but you have to meet the minimum one year criteria. So imagine this example that I was giving you with 10 employees have supposedly already spent like roughly two years at the super early stage startup in their mind, if it's a four year investing, they're like, Hey, we've already, we've already covered 50% of our vesting, right? Like, you know, we've been paid for all of the hard work we have done, but the startup does not have a scheme document in the first place. So now what will happen is if, if the founders want to course correct, they get a scheme document today. Now they have to make those employees wait for another year, right? Just so that they could actually encash even those last two years that they were kind of promised. So that already creates a lot of, you know, disconnect and just not super transparent. So that itself, by the way, doesn't exist.

Utsav Somani: What are the other four suggestions for a good document or a good ESOP plan?

Kashish Sharma (CEO, EquityList): 100% keep it a bit liberal. You know, we have seen, we have seen people keep ESOP scheme documents and usually the ones that are, I mean, it's not a dig at anyone, but you know, when, when you go with a typical boilerplate ESOP scheme documents, right. As a, as an operator, you're not really sure what you're signing up for. So like a very simple example, most scheme documents say that grants can only be given out by board members. It needs a proper board approval. Now imagine as an early stage startup, right? Maybe at the board, it's just, you know, the founders at this point of time, but tomorrow you bring someone aboard as well. Every time you want to give a grant letter out, you need a board consent for it. That slows you down, right? That's, that's an opportunity cost, you know, for you, like just giving that trust to this new employee that you really want to hire and retain. Right. So for example, keep it super liberal, appoint an authorized founder or maybe both of the alongside with the board who can ensure that administration of ESOPs is not super tedious. Like do not introduce bureaucratic, you know, processes and layers early on. It's just going to bog you down unnecessarily. That is one. Second is in your scheme document, I will, I will go, go as far as saying, do not hardcode your vesting template as well, right? Because today you're thinking about four-year vesting, which is a very typical vesting schedule to follow. But tomorrow, maybe you want to give refresher grants to top performers, but you want to treat those vesting schedules very differently. You know, you want to say that, Hey, you know, for you guys, I'm going to give these refresher grants at a two-year vesting period. But then you can't do that because you have to abide by whatever is written in the ESOP scheme document. So now you have to undergo changes, get the approvals. It's just a lot of thought. It's just a lot of pain, basically. Right. So keep your ESOP scheme liberal. Don't keep it super tightly knitted. You know, attribute a lot of those configurations at a grant level that you could very easily, you know, just tweak, especially with products like EquityList. They allow you to, like, we allow you to kind of customize it on the fly, super easily issue it, get it countersigned. So it's very simple. And third, biggest blunder, which I believe most of the companies are plagued with, irrespective of them being early stage or late stage, is when you promise stock options to your employees in some sort of hard rupee or dollar value. That is super, super painful. Right. Because if you think about it today, when we're hiring a new employee, you think about their cash, you think about the variable, you think about the stock options. And in order to make them understand what these stock options are worth, you tend to attribute some sort of INR or some sort of tangible currency amount to it. Right. But imagine when you hard code that amount in your grant letter as well. What happens tomorrow if the company unfortunately gets devalued? You end up over-diluting yourself. You have to oblige by everything that you have written in that grant letter, which is the contract between the company and the employee. Right. So what you do is, it's a big no-no. In grant letters, you do not mention the INR or the USD or any sort of currency value. Mention the number of shares or options that you're issuing out, and then use dashboards like ours to show the portfolio growth to the employees. Right. So legally, you are safe because you've promised them some sort of tangible stocks. But then you're giving them, you're abstracting away the complexity, you're giving them a dashboard, which actually shows them the monetary value as well. So you solve for that problem using software.

Dhruv Sharma: How would you explain to a first-time founder? I'm assuming it's easier for you to sell all of this to second-time founders than first-time founders. Is that correct?

Kashish Sharma (CEO, EquityList): Second-time founders, for sure. Because they've seen some of this over the years.

Dhruv Sharma: But if you're speaking to a first-time founder, what would you say to them about keeping the house in order so that, you know, follow-on fundraising becomes easier and even running liquidity programs for employees or other stakeholders becomes easier?

Kashish Sharma (CEO, EquityList): You know, let's be honest. When you're a first-time founder, especially a first-time founder at an early stage startup, you're not thinking about liquidity programs. I was speaking with a CDSD Fintech founder, well-loved in the ecosystem, and we were just, you know, like over lunch, we were understanding, you know, how do they think about equity, etc. And, you know, they kind of phrased it just so beautifully well for us, is that for the first maybe three to four rounds, like the first three rounds of a company, it was all about exploring TMF. It was all about survivability. It was all about getting the confidence from the external, you know, like macro kind of, you know, stakeholders, investors, etc., customers that this is a viable business. So for the first three to four rounds for us was all about where you use equity as a way to, you know, compensate for not being able to match maybe the market compensation for your employees, right? To help them, to retain them when you can't give those extravagant 25-30% appraisals in general, right? To make them feel like an owner so that you're all in it together, etc. But then once you cross, you know, once you're in that growth stage, right? Probably CDC and beyond, etc. At that point of time is when we started actually looking at stock options as a wealth creator security, as a wealth-creating tool. So like no matter how much you want to emphasize to early-stage founders that keep your house in order, etc., the fact of the matter is that's a tomorrow's problem, that's not a today's problem. Yeah, right. And that's just a better truth for all of us, especially the ones selling in the space to swallow. But this is what you do, right? You start solving for a lot of ancillary problem statements for such individuals. For example, as an early-stage founder, like the scheme creation, right? That is one problem that we solve for. So hey, like maybe you can get the software for free if you're raised less than a million dollars. You have less than 10 stakeholders to manage, the software comes to you for free. But then there are supporting services that would otherwise require some sort of, you know, like some sort of legal time commitment, etc., that we could kind of take upon ourselves. Do you need to dematerialize?

Dhruv Sharma: Yes. Do you also have an advisory part of the business?

Kashish Sharma (CEO, EquityList): We do. We have an in-house advisory layer that creates all of the supporting documents, the secretarial documents, the secretarial services, etc. Everything for us is in-house for our customers. And that's not just for ESOP advisory, by the way. Very recently, we have launched a CS Retainership Program, which we're trying to productize using a platform in which every single company secretarial operation will be done through EquityList. Even if you're about to fundraise, be it a private placement or a rights issue, you need to do, you know, FIRTC filing, whatever it is, FLA filing, etc. Everything will be taken care of by EquityList because for us, all of this plays on top of the shareholder knowledge graph. As long as your cap table and stock options are accurately represented and maintained on the platform, we can very easily supercharge your secretarial operations with, you know, inbuilt consent modules with just dashboards that give you all of the data, the reporting, so on and so forth, right? So an early stage or a first-time founder would probably need to figure out who's the right vendor. But now we've become that, you know, super app solution of sorts, where at least when it comes to equity and compliances, EquityList kind of gets plugged in into all of those, you know, avenues per se.

Utsav Somani: One final question before we end the segment. Our next guest is also waiting. A lot of hype around unlisted shares in the market, right? Something more topical, as recent as Lenskart, where I think Piyush bought shares for much lesser. And then, of course, now he's doing an OFS for much higher price. So, I mean, break it down for our listeners. What does this mean? Like the world of unlisted shares and what's really happening behind the scenes? What do you make of the Lenskart move?

Kashish Sharma (CEO, EquityList): First of all, honestly, I think they're better qualified people to kind of talk about the Lenskart move. In fact, for the past two days, I've been coming across some very crazy memes over Twitter in general, which I think you should just probably pull up, you know, throughout the segment at some point. It's just hysterical how hardcore public market investors and traders kind of look at, you know, all of this. But I want to preface, by the way, with the fact that all in all, it's always hearty. It's always great to see a venture-backed startup, you know, crossing that chasm. It's not simple, right? Like, I mean, building such a large, a well-renowned, homegrown brand, etc., that has reached the scale. We can, of course, make our remarks about, you know, the multiples and the crazy PE ratios that people are already talking about and how, quote-unquote, you know, the bump and dump strategy, of course, for venture, you know, founders where we don't understand how it's supposed to work.

Dhruv Sharma: The average across the last 161 IPOs has been 25, price to earn.

Kashish Sharma (CEO, EquityList): Yeah. Right. But here's the thing. When it comes to unlisted markets, first of all, we have to understand these are unregulated environments, right? Second is that, naturally, a lot of employees, most importantly, that have been holding on to these illiquid securities for close to a decade, naturally want some sort of liquidity, right? And they would want to signal to, you know, a buying cohort that, hey, we want to liquidate, we want to sell, we want to do all of this and make it happen. That process is not simple because, first of all, you could sign up, you could even, and most of the marketplaces work in such a fashion where, you know, you probably have exercised some sort of shares when you are at an early stage. You know, like, you're a super early investor, you want to maybe, you know, like, participate, et cetera, figure out a secondary. All of this is contingent on, A, the board's and the founders' blessings in the first place. So it's not super easy to, like, even think about that, hey, I, as a long employee of the, early employee of the company holding these exercised shares for such a long time, can actually go and list myself and get some sort of liquidity from these secondary marketplaces. A, it doesn't work like that. B, also for the buyers, right? Like, I don't know. Once again, we really hope OYO makes a turnaround. But like, if you look at the OYO example, their shares have been trading in the secondary markets for, what, close to four years now, right? Imagine all of those folks who are just, every year you're hoping for a company to go public, right? And a lot of the new-age companies are going public. But imagine there are a lot more examples where, you know, renowned, well-signaled, large unicorns are trading in the secondary markets. They signal that they're going to go public. People buy those shares as well in the gray markets, but then the public listing never really happens, right? So you're once again holding on to illiquid securities all over again, without actually, you know, like finding yourself liquidity, et cetera. In fact, I believe the Ken did a very interesting reporting, right? Where roughly two months ago, three months ago, where they pointed out that around 35%, I believe, I'm paraphrasing, somewhere in the range of 30 to 40% of all secondary marketplace transactions have resulted in a devaluation once the companies have gone public, right? So just the pricing itself, like who's really solving for it? Who's really doing that hardcore technical analysis, ensuring that they have the right attributes, right data points to ensure that price match is absolutely correct? I'm not really sure. Once again, these marketplaces probably do have the best intents. I'll just be very curious to see what SETI has to say around, you know, like what is the best practice around pricing and making all of this happen? Because right now it's pretty much a black box.

Utsav Somani: So yeah. And SETI also bought that company very recently, right? I think just a day back, equities and...

Kashish Sharma (CEO, EquityList): That's correct.

Kashish Sharma (CEO, EquityList): Equities and in the United States, right? It's crazy how large banks in the US are, of course, super keen, you know, when it comes to secondary marketplace transactions, et cetera. And it makes sense for US as well. Companies in US are staying private much longer. You know, you don't see the likes of Stripe going public anytime soon, right? And of course, there's an insane amount of liquidity demand. There's an insane amount of share demand for, you know, these high touted, you know, companies that are floating at $15 billion of, you know, private valuations. And we're probably going to stay private longer for the next five to six years in general. Which is why you see a lot more secondary marketplaces in those kind of markets. Makes sense for them.

Utsav Somani: All right, Kashish. Thank you so much. We can go on for much longer, but we have to leave Ankit on as well. Thank you so much for coming on.

Utsav Somani: Thank you for your time, guys. Take care. Cheers.

Dhruv Sharma: Super fun. Thank you, Kashish.

Utsav Somani: All right, folks. Our next guest is Ankit Maheshwari of Innovisor. Let's welcome him and ask him to introduce what the company does. Ankit, welcome to the show.

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, okay. Hello. Thank you. Thank you for having me.

Utsav Somani: Tell us, what does Innovisor do for our listeners?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, for sure. So at Innovisor, what we really do, like we work with the US healthcare majorly, working with the providers, payers, jointly trying to make sense of health data, right? So bringing data from all these varied sources, like a typical health system in the US has more than 300 plus systems from where the patient data is scattered around, right? So how do you get all this data together, be it labs, be it imaging, be it your clinical data, be it your insurance data, and create a unified patient record for each and every individual and give that data to the provider at the point of care so that they can make more informed decisions. And when they are taking care of the patient, they are spending more time with the patient rather than with the systems and entering data and trying to fetch insight from there, right? So that's the whole ballgame, that how do you make data talk to these providers, to these nurses, to the care teams, giving them the right alerts about the patient, who are your chronically ill patient, who need more care, and how to assist them better, like getting those historical data, getting their social determinants data, right? A 65-year-old woman living alone in New York will have a very different kind of care guideline than somebody living with a family in San Francisco, right? So how do you bridge all those things, give those insights to those care teams so that they can make those more informed decisions? So yeah, in simple terms, this is one of the biggest pieces that we do in the US healthcare ecosystem.

Utsav Somani: What's the scale? Like paint a picture of what does InnoVisa look like? How much have you raised? What countries you're live in, kind of customers that you have?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, so right now we have around 80 to 90 million patients on our platform, right? So yeah, so US is the primary country that we have been operating in. So eight of the top 10 health systems in the US, including like Kaiser, which is the biggest health system in the US, Banner, CommonSpirit, they are all live on our platform, what we call Gravity. Then the only other geography that we started playing in, where we saw a big traction, which was adopting a very similar to the US model, the value based care and going more outcome driven about the GCC market, right? And that is where we started playing, I would say two years back. So working with John Hopkins in Abu Dhabi, and now basically very recently, like two days ago, I was in Riyadh at the GCE and we signed two market deals, one with Tavania, which is the biggest insurer in Saudi, and the other one with Lean, which is the biggest information system player in Saudi. So it's the GCC area and the US where we are prominently in, but we have around 110 odd health system in the US right now, covering around 90 million patients. And from a base point, we are right now valued somewhere around, we closed our series F, where we essentially valued somewhere around 3.2 billion, right? So growth has been good till now, and we're very excited where we are today and how the whole healthcare ecosystem is right now moving, like specifically with the AI pieces coming into play and more and more like startups, as well as the large horizontal players trying to get into the healthcare space, right? Be it Microsoft or be it AWS in that matter, but yeah, it's a very exciting time for health tech generally.

Dhruv Sharma: Ankit, can you give us, give us and our listeners a quick capsule on what is value-based care?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, no, for sure. So, and it's a great question because in India, like when you start to explain, okay, the difference between fee for service and fee for value, right? So one, like in India, if you go for a surgery, right, no matter if you get better or not, if the surgery was done, you have to pay a particular amount, right? And that is fee for service because the service was provided. That is why the fees is due, right? Fee for value is a concept that started to come with the Obamacare Act, came into the US because, and you need to understand the whole financial implication for that. When 85% of the population in the US is on healthcare insurance, either you're on a government insurance or a private insurance, like the Medicare, the Medicaid or any of the private insurance. So when you are getting sick or something is happening to you, it's not you who is paying the money, it's the insurance who is paying the money. And that is why they have an incentive to keep a check on where is money going and to keep you healthy. And that is how they started incentivizing or pushing these doctors and the provider that, okay, if you are able to keep my patient healthy or healthier, it will definitely save me money because I don't have to pay you. But I understand that it has to be an incentive for you as well. So if you keep my patient healthy and save me, say $100 million, $50 million of that is yours. That's called the shared saving concept. And so you are not only getting paid for the service that you're providing, but if it was valuable, if the patient didn't get readmitted for the next 90 days, and everything went fine, and actually their vitals improved a lot, and they recovered in a much better fashion, then yes, you get paid more an additional bonus amount for say, so you're not only getting paid for the service, but for value. And they first started with an incentive. And then they also started, okay, if you now provide a service, and the patient got readmitted in 15 days, didn't improve, then you might even have a penalty. So that is a whole difference between just paying for the service, and then also paying for the value or the outcomes that the care needs to provide.

Utsav Somani: And you mentioned 80 to 90 million customers or patients in the US, right? I mean, that's almost one third or one fourth of US population, right? Yeah. So I mean, insane amount of scale of data in the world of AI, like data is the new oil. What's happening under the hood in terms of AI? Like, are you working with external providers? I'm guessing this data is very tightly regulated. But many players must have approached you on ways that you can do this, or make this useful even internally.

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah. So internally, definitely, I think we, what we call ourselves, like when we talk about the whole healthcare data or healthcare AI platform, that is our play, right? So we never even, when we started working in the healthcare space, didn't want to create just one siloed application for one particular persona. Our piece was that if we create this unified platform, which has all this connected data, then from one application to move into another would be easier and will actually solve this siloed problem of the US healthcare and healthcare in general, where you have multiple application and none of them talk to each other. Right. But we are not in the business of like commercializing or selling the data for any other person. We do use all these 90 million patient record that we have to improve our own system. And we have been building our own small language models. Okay.

Dhruv Sharma: It'll be hard to compress a multi-year journey of getting to like 80 million, 80, 90 million, you know, unified patient records. But still, this is the, the InnoVisa Health Cloud is one of the most fascinating data stacks like created ever. Right. And you guys were the first vertical software company from India to build that corridor between India and the US and then go start selling in a very, very regulated space. How do you build that platform? What were the questions CIOs would ask you when you were going trying to unlock a large pair? What's that journey like? And then we have a bunch of AI questions for you as well. We'll get to them.

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah. No, and that's a, that it just takes me down the memory lane when we were like 26, 27 year old kids coming, going from Noida, sitting in front of the CIOs and CMO, CMI office and convincing them to give their highly regulated healthcare data for a company which has most of the engineers sitting out of India, right? Operate on top of it. But I think one thing that when I also like, I also basically advise other founders who are trying to operate from India and go into such a either a verticalized or a regulated space is sometimes just taking what you've built in India to the US doesn't work because it's a very different contextual setup, right? Even in healthcare, it might look very similar to healthcare in India, similar to the healthcare in US, but it is a very, very different space. The incentives are very different. The regulations are very different. The security and the compliances are very different. So our piece was how can we build with them? And that is how we approach our first few customers, right? And we took them as more of the partners to build our stack. And that's a piece that even our first customer, which was there like 12 years ago, are still our customer because we entered them as partners and we kind of cobuilt with them. Like, so I stayed, like I've worked out of that hospital for eight months in the same stretch to understanding, working with their care managers, with their nurses, understanding their workflows and how do we build that stack and how do you build that trust also. And you can also not, I would say, undermine the value of like having a deep domain expertise. And that is why we onboarded a few of our key advisors at that point in time, a chief medical officer, people who understand US healthcare, because just thinking, because we are bright engineers, we will figure everything out. Doesn't happen like that, right? When you're going in a verticalized and a highly regulated space, you need people who have done that, who bring that gray hair experience. And then you combine your good engineering with that and figure out the right solution. I would say like building with the customer. And that has been our motto, like how do you make your customers win, right? And all the times and for building with them rather than building inside a glass door and thinking, oh, we will build the most perfect solution, but how you can build and deploy it quickly and iterate very rapidly with the customers is how we figured building that whole data stack one step after another.

Dhruv Sharma: Ankit, when any of us go to our physicians, the last thing we want is for them to make clinical decisions by asking chat GT. So and you mentioned how you guys are building your own small language models and now all the data that you have with AI entering the picture, how's it going to become relevant both for making clinical decisions, but also things like remote patient monitoring and everything else that you've done over the years?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, yeah. And I see that even internally, like when we go to our prospective customers, actually the first phase where AI is solving the most in the US healthcare, we talk about US healthcare, the $4 trillion expense that they make out of that $1 trillion is just sheer wastage on the admin work that doesn't need to be done, right? And even when we entered, we used to say this $1 trillion is what we're trying to reduce. And this is a lot of administrative wastage around priorities, around things which are redundant in the system because the data is not connected and not produced at the right time. And AI has a huge role where nobody's going to compete because if you start like the thing that you're talking about, hey, can AI be the doctor and can tell the doctor how to provide the better care? Neither the doctor would trust that nor the patient in the first go, right? But can AI help in reducing what they call a pajama time, like where they have to spend countless hours in front of a system, keying all this data down to get the right insight or fetch from the care guidelines, what is the right piece, what general they need to refer to? Yes, there is where AI can definitely, definitely work and save them hours and days to figure those things out. And that is where we mostly try to play and how do we can save all this administrative workload and save a huge amount of cost.

Utsav Somani: A lot of AI co-pilots which are coming for doctors as well, right? I mean, describing or like, I mean, text to, I mean, speech to text is one, but there are many AI co-pilots, like somebody who's like a, I don't know, ultrasound specialist or even an x-ray specialist. You can analyze and sort of, I mean, AI-assisted decision-making for even doctors coming big. So how are they able to source this data?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, no, definitely. We also provide that what we call differential diagnosis, for example. So like whenever like describing we have, so when the ambient thing, ambient dictation happens, it gives you, okay, this is what the conversation was. And these are suggested differential diagnosis that can be applied. And they can just look through that and then make that decision. So it actually helps the provider that they are not missing anything out, right? So that is right there in front of them without going through multiple knowledge bases. So, and similarly, like, so these data definitely lives in the system, right? Like we talked about the imaging data, right? The pharmacies and like all the radiology companies are partnering where you are getting these radiology data. Getting good quality data is hard. In healthcare, it's hard everywhere. It is very, very hard. And I think that is one of the big value that we have that at least on the patient side, we have this very clean, robust, clinically verified and high quality data where we can basis these clinical guidelines on. And that is what the specific agent that we are building are for that particular region that can be assessed in how should the care guidelines be structured. Okay, if there's a particular diabetic patient in this particular age cohort living at these places, given that we have this historical data for these many patients across the last nine years in different, different geographies, can we help you define a care protocol for this particular individual? And how, what is the confidence score that it will be effective? So it's more of an assistant rather than taking the place of a provider. Yeah.

Dhruv Sharma: And Ankit, this mission of improving the quality of care while also reducing the cost of providing care, no one player can do it, do all of that by themselves, right? So I believe at some point in time, you also had this idea of on top of this data layer, you'd also allow third party developers to come and build applications. What were the learnings from like, you don't come across many companies every day that have attempted that. What were the learnings from that journey?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, so I think definitely. And we, because whenever you build a platform, right, the first thing is a platform is platform and it's not just you, but there are multiple other people building on top of that. Otherwise, it's just your own house, right? So we did attempt it when we did that on the first go, because I don't think we were that big at that point in time, so that we could invite and excite everybody. Because the larger people were not that excited. The smaller people were excited and wanted to build, but they wouldn't have enough R&D resources to like put in or invest in that. And that is where that got a little pause for us. But we kept at it. And what we took a strategy, okay, we can still have more assets on top of the platform. And then we started doing some of the acquisition that we did, right? Because we knew that we wanted to build more things on the platform and our customers needed more things on the platform around patient outreach, around patient experience, then around pharmacy. So we went out and got the small asset that then we bought and then put it on the top of the platform, got it integrated, and then started creating what we call a whole suite of applications. And now when we have a good enough scale of the number of lives and the number of systems on top of the platform, that ball is now in motion more rapidly because now we also have some of the success stories. The asset that we acquired were on the top of the platform are easily able to cross sell across our customer bases. So now we are getting more of these applications, even from a mid and large players to be on top of our platform where they can start utilizing all the data that we have and start reaching out to these health systems.

Utsav Somani: Ankit, you're a CTO, so zooming out as the final question, I know we're over time, but I wanted to ask you one question or one trend that I keep seeing from some investors. Why coding? That's the buzzword, right? On Twitter and LinkedIn and everywhere, lovable, everyone's like 100 billion ARR and plus very, very quickly. And investor side is saying why coding say SaaS is dying and you're one of the leading vertical SaaS players from India and gone global as well. What's your personal take on all of this? Do you think SaaS is dead in the world of AI or the answer is not black and white?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Yeah, I don't think it's a black and white answer for sure, right? Because see, if you want to really build systems which are going to solve these complicated problems, right? When you talk about healthcare or any, I don't believe white coding can solve that problem, right? And I can bet all my whatever we have built here and it can't, right? But what it can do is give micro problem and because we use that, we use, it's not that we don't use AI-assisted coding tools for different aspects of our work to bring in efficiency. But okay, you can explain a small enough problem well enough for it to automate and do those tasks for you. But thinking that white coding will build a healthcare platform which will get all this data, understand all the healthcare nuances about ICD codes and lying codes and bring out and give you a structured application. I doubt that that is any near future, no matter how many tools that I have seen and I have seen them all. So I doubt that in specifically in these complex systems, SAS systems, white coding can today do that. Yes, it can build you a cool website, it can build you a cool mobile application for a very small specific need. And that is what people demo it on all these YouTube shots and everything. They're here. Yes, it is all possible. But solving real world problems, complex problems like healthcare, like health tech, I still feel that it's a little far from white coding.

Utsav Somani: What are your three personal favorite AI tools?

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): So I use ChatGPT a lot specifically because it has got good memory so it can remember and it's almost become my personal assistant in a lot of these stuff, right? So ChatGPT for sure. I do like the like we use cursor a lot internally, right? And mostly for the code reviews and the other pieces, not that much for the build. We have started using for build. So when I'm in a dev mode, then cursor for sure. I think these two are mostly in the third is, yeah, Gemini when I have to do some not for work related stuff, basically image editing and some of those things, then Gemini works really well.

Utsav Somani: Awesome Ankit. Thank you so much for coming on the show. I hope to see you soon.

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Thank you for having me.

Utsav Somani: All the best for the Middle East expansion.

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Thank you. Have a great day.

Utsav Somani: Bye bye. Bye bye.

Ankit Maheshwari (CTO & Founding Team Member, Innovaccer): Thank you Ankit.

Utsav Somani: Thank you for tuning in listeners. Have a wonderful.