Dhruv Sharma: Hey there, listeners. Today for the pre Independence Day stream, which is stream number 125 Utsav and I are chatting with Varun Dubey of SuperHealth, who is, I would say, reimagining health care from the ground up, not as it is, but as the way it should be. With that, Varun, welcome to the offline network.

Varun Dubey (SuperHealth): Hey. Thank you for having me, guys. Great to great to chat with you, and, also, always good to see you, man.

Utsav Somani: Thank you so much for giving us the time. You're the solo guest today, so we're gonna go on for longer with you. So much to unpack, but let's introduce SuperHealth, to our listeners. Can you describe it in your words?

Varun Dubey (SuperHealth): Yeah. Yeah. Of course. I mean, I can tell you the controversial version we started with, and then and then, you know, we where we kinda landed it. So when we started this about a year back, you know, I remember making a presentation to some of the the customers in buildings about the fact that we're building this hospital. And we started with a very simple line that said, hospitals that don't scam people. Okay? And that's really that's really how I felt, that every time I talk to customers, even in my own experiences and what I've seen from inside the industry, that there's a lot of openness and lack of transparency. And it was baffling to me that an industry that is effectively an $8 trillion industry globally, one of the largest in the world, one of the most important and core human needs, is so badly broken everywhere in the world. It's not an India issue. It's really I mean, India on balance is much better off than what our friends and families get in the US and the UK and Europe. But it could be much better. And, that's really what Super is trying to do. Our mission is to fix health care. What that means is that we must deliver the highest quality of care with radical transparency and extreme simplicity. Not just simplicity, extreme simplicity. So that's what we index everything on. We do that by delivering zero wait time for customers. So when you come, you you book the doctor and you show up at SuperHealth. You meet the doctor, you book. There isn't some other junior guy taking care of you. 95% of the doctors actually see you on time. 55% of our appointments start before time. So we are probably the only hospital with negative wait time. And, you know, we have fixed prices. We have zero commission doctors. Our doctors are full time salaried. They have no incentives, no sales targets. So they really tell what tell you what you really need, without any commercial pressures. We also do things like magic discharge, where we pre commit their discharge time to the patient at the time of surgery, and then we do it exact hundred percent patients have experienced that. We pick the patient up for the surgery. We drop them off for the surgery. And we do this for we I mean, we have done this for, you know, tens and tens and thousands of customers every month. So we are doing it at scale Center 1 has been live now for ten months. And it is a full set of multi specialty hospital. You know, we'll do all the major specialties here. We have a on-site full set of radiology, MRI, CT, cardiac CT, mammography, ultrasound, the works. We have an on-site lab. So when our customers come, you know, they can be sure that everything is happening set. They're not running around in five different places. And then the whole hospital actually is run by, this, amazing piece of technology we built called SuperOS, which essentially runs the whole hospital. So we are also probably, at least to the best of my knowledge, the only, hospital in the world that is that is run by agent AI systems on a live production platform doing things for actual doctors and patients. Like, not a pilot, not a press release by some hospital. Everyday, you know, patients come, they interact with SuperOS. It manages their care end to end and helps doctors do it. And we've now been doing that for a year. So we've learned a lot, but that's really what it's been. If you talk to customers, they'll tell you, very graciously, that they've told me that, you know, if Apple built a hospital, this is what it would feel like. And I personally for the effort the team has put into this, into building this, I can't think of a greater compliment. So as long as people keep feeling that, I think we we'll be fine.

Utsav Somani: And the numbers speak for itself. I believe you quoted some good numbers, in other interviews. But I think the one thing that, I mean, stood out from your website, when we land on your website, there is a VIP pass, which I think you've increased the prices for. Is it a product? Is it a funnel? Is it a subscription? What is it? And how do you make it work? No. At three to eight, if you're getting unlimited scans, unlimited diagnostics, unlimited consults, that is just mind boggling. Right?

Varun Dubey (SuperHealth): So, you know, actually, VIP pass is a very interesting product, and, you know, it was, like, the first product that we built, and it is really the culmination of all the things I said. Right? Like, it has to be very high quality care. Right? It has to be very, very transparent, and it has to be extremely simple. So VIP pass came from a bunch of problems that we were trying to solve on the business and the experience side. So the experience side, their typical first interaction that a customer has with the hospital is you show up there and they say, and then doctor will see you, right, at some few hours later. So registration is there. The billing desk is there. All this chaos is there. Then that is just to meet the doctor. The doctor will describe your test. And, again, I have to go back in the same line and stand there. And then I then go to the diagnostic lab, whatever, blood test or or scan or whatever, and then stand in line over there. And then they'll do a scan, and then you wait in line to get your report. The whole thing is just a mess. So, like, well, how do we not simplify registration? How do we delete it? So delete before you simplify is a very core design principle for us. So we just wanted to delete all of these steps. And so that how do you walk in and walk out with, you know, essentially no friction? So that was the first problem we're trying to solve. The second problem we're trying to solve was, you know, how do we communicate to customers just how much inefficiency there is in the system with respect to those, you know, some of the test prices, etcetera, that they do, end up paying to in other other places. As an example, you know, a CBC will cost you anywhere from 200 to $500 in a typical hospital. I should say the rupees. Last time I said bucks on our podcast, I got trolled in the comments. Okay. $2.01 200 of 100 rupees. Okay. 200 of 100 rupees. But the actual cost for me to do this is 22 rupees. Wow. Right? And falling as my volumes go up. Right? So it doesn't cause that much to actually do the tests. Right? So the VIP pass so that was the second problem we're trying to solve. The third problem we're trying to solve was how do we really take care of the whole family and, sort of, you know, make the relationship with them. And that's why VIP Pass is a family pass. You can't buy it as an individual. And the final thing was more a business and a marketing funnel question saying that, look, the industry's business runs on commissions and referrals, which we don't wanna do. Like, we do zero commissions, zero reference. So why will anyone send those patients? They will not. Right? And so if you look at the journey of a health care customer from you wake up in the morning and your stomach hurts, and then you go to a journey of meeting a few doctors a few times and few hospitals or whatever. In the end, you're told that you need the surgery. And then the entire health care industry fights for you here after the surgery has been prescribed, and therefore, they're paying different people different commissions to refer them to their hospital. So what we're trying to do is to how do we help you when your stomach hurts. Not only when, you know, you need it's clear that you need surgery. And so with VIP pass, we are able to be the fastest path to a good doctor for pretty much every customer near us. And so we all these four problems we're trying to solve, and we realize the answer is just, like, do a subscription service or something like that. And that's really what VIP pass was about. And, we started with a price of thousand bucks, and then it really took off. And then we're like, oh, we cannot, for the life of our supplies so much. So we've there is the prices more as a way to control the inflow of demand, which is sort of like a weird thing to say in our business. But we do want to give a great experience to people. And so we do it today for 4,000 rupees for a family of four for a whole year. And you can meet a doctor as many times as you want. And pretty much any test prescribed by our doctors, if they prescribe it, it's covered. So if they prescribe you an MRI, you don't have to pay for it. And, you know, you can come, you can do the test, and you can just go. And we send the reports digitally. It's completely paperless. It's a pretty pretty good experience, and I think that's really where it started. And that really also builds a lot of trust with customers because they can keep coming back, and they can meet doctors. And we found many people actually solve a lot of the latent issues they had because the access was so easy. Right? And I think that's really been one of the magical VIP pass has been. And lot of our products are actually like that. If you see SuperBirth, if you see IVF, we are now doing checkups as a pilot. So if someone is interested, you know, that would hit me up, and we can do a beta test with you. A lot of our surgery a lot of our products are built around that. Score principle of how do we drive high quality, of course, with extreme simplicity and extreme transparency in pricing and other ways.

Dhruv Sharma: Varun, and it appears to us that there are, like, just so many touch points at the point of care that you've that you've picked to solve these problems. I'm curious how many of those things you thought of before the first center came, you know, came live, came online, and, what was the process back then? And ever since the now you now that the center is live and you're treating customers in an everyday basis, how's the process of discovering, you know, these problems changed?

Varun Dubey (SuperHealth): Actually, you know, it's a very interesting thing that it goes back to how we really do product design in SuperHealth. Right? The customer experience design. So we we never ever worry about the technology and all of this first. We first take a blank sheet of paper and say, okay, what is the experience you wanna deliver? So there is there are two parts to that. Okay? The first is, well, what's the medical problem and then what's the clinical protocol? Right? And we write write a lot of our own clinical protocols beyond what you would get in a typical hospital to make the care better. And then we kinda keep that aside. And then we say, okay, if this is the effectively the physical flow for the customer, what is the experience we wanna deliver? Pure list. Completely pure list. Forget any constraints. And then the then our job as a company is to make sure that both get delivered to 100%. I'll give you a very simple example of this. So one of the things that we wanted to do was, have a very high quality monitoring experience for patients from a clinical standpoint when they are admitted inside. Right? Now to do that, the clinical team requires a charting to happen every four hours. So every four hours, a nurse has to go in the room and examine the patient and vitals and all of this, and then report back. It's a test. How the traditional hospital works? They don't do it every four hours, but that's that's what you should be doing. The experience design said that, well, the guy just had surgery. You want him to recover. Recovery requires sleep. So how do we make sure there is zero interruption in the room? Like, unless you really needed no intern, unless he wants you there, don't go there. So zero entry was their design goal. So how do you marry these two things? So what we did was we said, okay. We have to do both. We can't choose because, obviously, it's a good idea for the patient to not be troubled. And then, of course, you have to monitor the patient. So we actually built an aspect of the patient monitoring system of SuperOS from there, where we plucked into the neon garden monitors. We started pulling the data live from those monitors. And now our doctors get real time charting every basically, every two seconds instead of every four hours. So we exceeded the clinical goal. And unless a a nurse has to administer medicine or a physical exam, which is very, very few cases, there is zero interruption in the room as well. Right? So this is how we've designed every aspect of care. And, you know, to your question of, you know, so everything we've heard about. Okay. How do you how do you remove the friction for blood sample collection in the OPD? Right? So we actually have designed a care care room care counselor room right after the doctor's room where every patient goes, and that's where any medication that you want can be given to you. Blood test is taken over there. So you're not doing it standing in a line. We're already waiting for you. So the building and the software ended up getting designed together. And I think that's one of the reasons why we had to do the whole stack, because I couldn't figure out how to deliver the experience I want to deliver and then we control everything. Right? And I'll give you a really good example of what we've learned, in the similar areas since we've opened. So one of the things that we did was that, you know, SuperOS essentially holds the case, just as an architecture design just to explain. And so you come to come to the hospital, SuperOS holds your case, and it does a full context transfer as you move from department to department or area to area. So you don't have to explain to anybody why you are there. Right? One part of that is that whenever a doctor gives an instruction to SuperOS, Let's say it says, okay. I want to administer this medicine to this patient of mine. Right? And they can do that on Slack. They can just type the message and and SuperOS will pick it up from Slack, which, you know, is a whole episode in itself of doctors using Slack, I guess, because our doctors love using it, I think. And, and then what SuperOS will do is it'll actually assign an action to a nurse. Right? The nurse need not know know about the full context of this. She knows the doctor is giving a section at 2PM, have to go deliver this medicine. Right? And that experience is what allows the clinical quarter to be high and the response to be very, very fast. Now because of this, the nurse has all of the context. So the attendant in the room is not running around anywhere, which is absolutely not what happens with the hospitals. Right? And the other hospital doesn't attendant becomes part of the staff of the hospital, and they're told that, oh, go buy this medicine or go tell that doctor or go tell that nurse or whatever. No. That that doesn't happen at SuperHealth. Right? We'd come and do it. We are the experts. Why are you running around? It's my hospital. Right? You should just sit in the room. So, you know, this this I didn't realize this to be honest because we designed it like this for different reasons and not really from this perspective because we didn't fully think about this. But I learned this recently because I met a mom whose daughter who whose daughter had a surgery in our hospital. And she met me later the day of of the daughter being daughter being discharged. And then she said, you know, for the first half, I went to work today. So I assumed, oh, is she already discharged? She's like, no. She's gonna get discharged at 6PM. That's what the time you guys told me. So I was like, so you went to work today. Why? She's like, we said nothing to do? My daughter was fine. You guys were taking care of her. I had not no role here. So I thought I'll go to office at ten Koramangala only. So I I went there before hours of work. I mean, the mom leaving the daughter in our hands post surgery is probably the highest compliment I can think to what the team is doing on ground.

Dhruv Sharma: Amazing. Utsav, back to you.

Utsav Somani: So I think you mentioned SuperOS and agentic, use of software in, health care and your hospitals. There are many companies that we've hosted on the show itself. We're tackling one one vertical within, like, the health care space. Right? I mean, something as simple as I don't transfer of data between departments and vendors. Cora Healthcare was doing that, which is mostly done by fax in the US. And so many different, like I mean, transcribing medical transcribing as well. So all of these things are such different things to tackle, but you've honestly combined them mostly in SuperOS. So instead of, I mean, building actual physical hospitals, do you think that you should have just, like, built SuperOS and maybe taken over hospitals like OYO does?

Varun Dubey (SuperHealth): There, you know, there is a very, very famous quote that, often all of us in technology forget. Right? There's a very famous Alan Kay quote which said that those who care about building great software should build their own hardware. Right? And when you're in when you're in health care hospital, it's the hardware. So, one of the biggest reasons why SuperOS has come so far so fast is because we control the whole stack. Right? So the building is designed for the system. The op system is designed for the building, and the operations is designed with the context of all of this. Right? And we move things in all these three things in concert. Right? It's it's kind of like that. Now as an example, we've built SuperOS entirely in the web. It's not an app. Because at some point, we have aspirations that once we feel it's ready for a little bit broader deployment, we would love for other people to use it as much as possible. We would like to open source it. I mean, everybody should use it. Why not? You know, India's health care is a big problem to solve, and whatever we can do to contribute to the community, we would love to do. The challenge is that the reason why it's great software does not get built in for health care so far, it is because the software people and the health care people are solving different problems. Right? I'll let me give you an example. So say, take a simple example of saying how we have solved zero wait time in SuperHealth. And if you could just put that in any regular corporate hospital, they will solve it. No. They would not. Because nobody there is trying to solve this problem. This is not a problem they think they need to solve. Because it's a supply constraint industry. It's deeply cartelized, and it's a non optional spend. So you can complain all you want, but since I am in the hospital, you have no option but to be here. Right? So that's kinda like the mindset they operate from. Now why is this an issue? We have to understand. Right? So what happens is there is a there is usually a doctor who is working on this MG commission situation. They'll get a minimum guarantee. They have to recover five x or whatever. They are being paid at the hospital. So how do they do that? Right? They have to see that by seeing more patients. Right? Because money is made in admission, so they have to have a certain admission. Admission requires OPD. That whole funnel, it's literally like a sales funnel. Right? So now if you were gonna see 100 patients in five hours or say ten hours, you're wanna see 10 patients an hour. Right? Which is still a lot. But you realize that you can't do your MG recovery in that much. So you're gonna get fired. So what are you gonna do? You're gonna put 300 patients in the same ten hours. Right? And now you're able to see a patient every three minutes. Or you'll put 500 patients, and you're not gonna see I mean, I'm just making up numbers, but, like, that's essentially the concept. So now what is technology going to solve in this? It's a simple law of physics throughput issue. Right? So unless you unless you fix the model, you design an entire business model around the fact that I don't need to see 500 patients per doctor per day. Right? Unless you do that, you cannot really solve the wait time problem at all. Right? And then there is the general chaos in a hospital, which is not managed well, you know, where the OD is overrunning, and people are coming late, and there are other options problem. You should solve those. Those are solvable. But since nobody really cares about solving it, you can build all the technology in the world, but it's not gonna work. I think that's kinda like one side of it. The other side of it, I feel, and this is a big learning for me, is especially, you know, I came to health care kinda laid more from the technology software software lead the world type of mindset. The reality is, yeah, key, the technology company and the hospital company are fundamentally at odds. Because no matter what you do, every hospital for the same procedure often has slightly nuanced processes. Because there is a stylization of treatment that every doctor has, which is completely fine. It's within the SOP, but it is stylized. So the most lazy answer to this, right, obviously, is that the hospital says you customize my software. Because doctor a wants this and doctor b wants this, which is fully legit. The tech company wants the software to be as widely applicable as possible. They wanna sell it to a million hospitals. Right? So they can't build it for you. Right, if if they wanna be a SaaS company. Otherwise, they're a services company. Yeah. So the the the amalgamation of this ends up being a beautiful, glorified form fill, which is basically what all hospital software is. That's how everything ultimately converges to that. So the only way to solve it is to, you know, do, I guess, what way the reason we are doing the hard choice of building everything ourselves is because then everything is built custom built for it. The process building software, everything is dragged around that. And I tell you what I mean by the building. Right? So, you know, a lot of companies have tried to build so when you come to SuperHealth, when you see a doctor, right, SuperOS has ambient AI. It listens, it writes the prescription, shows it to the doctor, doctor okays it, and it goes to the patient. Right? Now I'll arguably, a lot of people have tried to do this, but it doesn't really work very well. 95% of prescription that SuperHealth go to the patient with zero human edits today. 95%. Right? And we are the hospitals. I don't get to sign a form saying problem. Right? So how did we get there? We got there because, a, we understood stylization, so we fixed for that. But secondly, we designed the room for great acoustics. What lot of companies don't don't perhaps realize is that only 30 to 40% of the consultation happens where the doctor and the patient sits, 60% happens on the examination table. Your mic is not there at the examination. So your your AI can't hear it. So if your AI can't hear it, it's obviously not gonna do a good job diagnosing it because all the clinical stuff happened on the bed. Right? So unless you can hear that, which means you have to put a mic there, which means you have to now convince a hospital they've change their doctor room with mics for a third party comp this this is not going to happen, guys. There is I can tell you having been at a hospital, no chance. They will be so scared of liability that they will not do it. But you can do it if you are the top technology company and the hospital company in one. And that's why we take a very, kinda, like, Tesla for health care kind of view of the world, and we realize that we'll have to build the whole thing. It's much harder, but I feel ultimately, from what we're seeing, the outcome is much better.

Dhruv Sharma: Well, we've covered hardware, software, but I also want us to spend a little bit of time on culture and mindset. It seems to me that this is almost like a live experiment in administering administering the highest quality of health care in the country. Can't happen without bringing in health care professionals who are equally committed to the cause. So how do you induct them, and then what is the unlearning, relearning sort of process that that they go through if they're coming to standard college?

Varun Dubey (SuperHealth): A great question. And, you know, I I feel this is, like, my, side crusade almost. Okay. It's too bad on behalf of their doctors. Because I think they are very, very misunderstood, and the picture that gets painted about them is extremely wrong. See, and I'll I'll give you a very simple example of that. Right? It's a very common question I get saying, oh, but how do you incentivize doctors to do the right thing? Can you imagine the insultingness of that question? Yeah. Okay. Because the the underlying premise is what? That by default, if there is no incentive, they're gonna they are bad people doing bad things. That's absolutely not true. There are good people fighting a system that is telling them to do bad incentives to push them to do things they don't wanna do. They're fired at every step, but everybody's human. So, obviously, at some point, things break. So what we have found is that clinicians want to be clinicians. They wanna do the best thing for their patient no matter what. I have not met a single doctor who didn't want the best thing for their patients, and I've met tens of thousands of doctors in the last many years. What they're looking for is a space that actually allows them to experiment and try things out and really build things. And I think that is really what the culture at SuperHealth has been about. You know, where we've been very clear from the start that, you know, this is a zero commission hospital. Doctors have we have zero volume and business discussions with the doctors. They are measured on only one thing, which is patient outcomes. And we spent a lot of time and energy on it. Right? As an example, because SuperOS writes the prescription, and SuperOS runs inventory, and SuperOS runs the, you know, the clinical data and all of those things, it has 100% context. So we don't unlike other hospitals, which typically end up doing manual case reviews six months later at, you know, 30% sample, We do a real time audit of everything. Like, literally real time. Right? And we do a feedback loop with the doctors. So we so the doctors design a clinical SOP for a treatment. We train SuperOS on it. SuperOS then writes the prescription, looks at the treatment, looks at every case real time because it is holding the case. Right? And then it sends a weekly update to the doctor. And I mean, their doctors can see it real time if they want, but we certainly do it every week, where they're able to now go through what happened in their cases and see where the protocol deviations happened from what they had only designed. Right? So today at SuperHealth, doctors are working closely to design SuperOS. They are working with us to improve clinical outcomes in the OTs. They're working with us to figure out how to make the clinical process more efficient. They're trying to bring in all the latest processes, devices, everything. Right? So there is just so much energy and excitement on how can we do the next great thing in clinical outcomes because this is a place that is enabling them. Right? As an example, I I I you know, if you talk to any doctors offline, they will tell you that, you know, when they send a request to what they call the IT team, right, it takes them six months to even hear back. Right? Our doctors will type will file will file a bug report on Slack, and we will resolve, and the tech team will resolve it in, like, fifteen minutes. Right? So this is a very different dynamic that is going on. Right? Where that and one amazing thing we have done, I think, in hindsight, I would say that was a good idea, is that we have deleted the product on. There are no product people in SuperHealth. Okay? And so I the goal we have is the engineers and the business teams and their clinical teams should just talk to each other. So I get I get this request once every, like, six to eight weeks from various parts of the company saying, I think we do we should hire a product people, hire some product folks. And then I have this letter, which is, like, please write this admission that I am I am incapable of explaining my point of view and incapable understanding the other team's point of view. And therefore, I need supervision. And, like, you sign and give this letter, I will have product people the next day. So this this this deletion of the product org has forced engineering and clinical teams to talk to each other on a daily basis, which has got clinical team to appreciate what the engineering team is doing, and how that can be done and on new ways of thinking about those things. And then the engineering team obviously understands clinical more and more. So they're able to build software that is much more sophisticated than Nuance. And I think that's really what the culture magic at least so far, we've seen long way to go. Obviously, we're still in central one, but that's sort of how we're doing some of these things. Little bit first principles, little bit extreme of no product or so we'll see how it goes.

Utsav Somani: There must be so many learnings. But before that, there's a live chat that's buzzing. So Shiv Kapoor, I think, your question's already been answered. I think think he's one of your investors also.

Varun Dubey (SuperHealth): Yes. She's on her most prolific

Utsav Somani: right now. So hey, Shiv. Devan Shagarwal, he's giving a shout out to doctor Kirti from SuperHealth. Alexandra has asked a bunch of questions on I think you've already answered. How did the plan go from triple nine to one triple nine. It's basically the gatekeeping mechanism for, I think, just delivering good care. Right? I think that's the thing.

Varun Dubey (SuperHealth): Yep.

Utsav Somani: We'll ask about the unit economics of running a hospital, but I think I wanna stick with that hardware and, software build because you mentioned some insane things that I haven't heard of them, like the ambient AI. The rooms are designed for acoustics. Eleven months into the first center, as you look towards building your next one and the third one, what are the learnings? What are the upgrades? How does

Varun Dubey (SuperHealth): my So many so many

Utsav Somani: so modified.

Varun Dubey (SuperHealth): Dude, the learnings have just been I mean, every day, I I feel more and more stupid about the things we did, some of the things

Utsav Somani: that that you would like to highlight?

Varun Dubey (SuperHealth): I I tell you I mean, there's so many, but I tell you a really big one. The first one, the most important, or the one I kick myself every day about is we thought we thought we are really clever, and we're gonna build this build this house because we have different flows. Right? And we thought we're gonna build this in stages. Okay. So, like, well, why don't we just build the ground in the 1st Floor, and then we'll build the 2nd and third floor later, and so on. Right? The hospital. So optimism also, but also some pragmatism saying, boss, like, this is capital flowing out. Starting with. And, it the the the demand ramped up way faster than what we thought. You know, in fact, we were just doing a one-year review, and we realized that our month 10 numbers are basically what we were in had done an month 44 projection on. So first of all, I realized first pick up is that stop projecting. You have no idea how to project anything. But, the the stupidity of the first mistake really was that we forgot that construction is noisy. And so you can't construct during the day because you have OPD. And you can't construct during the night because patients are asleep. So you can only construct on Sunday. So what took us four days became four weeks because you could only do it on each Sunday. So so then everything's kinda kinda crawled down. And so that was a really bad idea. So the next one, you're gonna build the whole thing. Also, now we have a little bit of money so we can, you know, build everything at one shot. The second the second, I think, learning has been that we, I think, underappreciated the the the volume of attendance we are going to get in some of the some of the specialties. Right, and so from a space design standpoint, I think we can do a much better job. So as an example, when we have women coming in, you know, let's say it's their, like, they're pregnant or whatever. And and so this mother-in-law is there. That's the actual the the mother is there. The mother-in-law is there. The husband is there. Sometimes this the sister-in-law is there also. And, you know, we just didn't think that this will happen so often. So sometimes the room can get a little bit cramped. So I think that's the second second part. I think the third one is that we just, did not anticipate the real real life nature of health care. And, so we've, we've had to learn to calm ourselves down a little bit because everything is urgent for us. Right? Because because especially since me and, you know, me and Manoj, who are the two sort of non doctor cofounders, doctor Alex, of course, has done this his whole life. One day we get a as an example, one day we get an alert, in the Slack channel. This is, like, the first, like like, second month of SuperHealth. Okay? We get this alert in Slack saying that, oh, ICU, oxygen levels are low. Okay. At 11:30 in the night, I have fully freaked out. Manoj has fully freaked out. And we are now calling our ops person to go there and check this. Okay? Now the person who sent the message is a is a clinical person. Right? And and they assume that the guys who built the hospital must know how this works. So so they have put no further context. But when later we learn what the what this alert meant was the following, that you have to now go from the 1st Floor to Basement 1 and flip a switch. And to flip the switch, we are in low mode, so you have four hours. And by the way, there is no patient in ICU. So so, you know, these these kinds of things of, you know, have been just a large learning for us, honestly. Well, another I mean, like, there are many, many, many, many more like this, but I think, structurally, the the big ones have been, you know, build the whole thing in one shot. Make sure that you're not piecemealing it. You know, move fast and break things is not a thing in health care. You know, you have to calm down and have a little bit more, you know, what's the right word, sanity, I guess, in in how you how you execute some of these things. People are a very, very big part of health care. You know, this entire we will automate everything. I mean, we do a lot of the tech stuff, but none of it is for replacing humans, honestly. You know, there is a certain element of empathy and care that exists in health care, and we want the frontline people to be as empowered to deliver that to customers as possible, this is not an easy thing to do, especially at scale. And I think that has been a big learning. Because, again, a lot of the mindset we came from was, you know, software lead the world. And, it might, but I don't think it would do that in health care. So so I think those have been three very meta sort of re refocosings that we've had. But otherwise, I think it's been positive learnings. You know, we underestimated how much demand we would get. That's been great. So mostly people agree with us, I guess. You know, more and more doctors are now, you know, coming to SuperHealth and want to be in a Center 2, Center 3, which we have under construction now. So I think those general directional stuff broadly is is on point. We have to now tweak the things to get better.

Dhruv Sharma: Or because center two and center three are coming up, I'm I'm thinking, say if you have a 100 bed hospital, what's the optimal, you know, sort of giver to receiver ratio? How many, you know, doctors, nursing staff, admin people do you need? Let's say on a base of 100, what what's the optimal mix?

Varun Dubey (SuperHealth): I mean, we typically do 50 bed hospitals with only private rooms. So I I can I can tell you for sort of, like, how the math will work? I can compare it to some of the public listed hospitals because, you know, thanks to our regulators, they have to disclose a lot of information, so benchmarking is easy. The the doctor to bed ratio is not really a thing in health care. Usually, what you do is you have an OP to IP ratio. The industry typically operates at eight to 12%. Our in going thesis was that a lot of these surgeries were unnecessary. So we have capped it at 5%, saying that Super has been never been more than 5%. And their whole model is designed around that. As an example, just to tell you some data, we run a program called honest second opinion, where people come to us for second opinion. We run for free. You don't have to be a member. Nothing. You can show up because I I mean, we launched it in anger because of a case that we had with a 20 year old girl who was prescribed a pacemaker, and turns out that she didn't need it, because she came to SuperHealth and we kind of found out she didn't need it. So forty two percent of the people who come to us for second opinions, which means that they were already prescribed surgery somewhere else, and they came to us for second opinion. Forty two percent people will tell them you don't need the surgery. Okay? It's an insane number. So, so I think eight to twelve percent, though, is what a typical industry would be at. We obviously operated much lower than that by design. We prescribe about 50% less surgeries than the industry on average. The second important metric would be, you know, what we calculate, and SuperOS is a big part of that, is ALOS, which is average length of stay. We operate at an ALOS of about one point to 1.3 days. You know, the industry operates at about four and a half days. So we operate about one third the ALOS, which is very important because I mean, part of it is case mix because some of the very large complex cases like transplants, we don't do. But things like knee replacement, spine, etcetera, we do. But they are generally not very long staircases. But but about 50% of the improvement is SuperOS because we just cut out all the nonclinical stay requirement. Right? When the admission happens, when the discharge happens, all of that is very, very cohesive. So we are able to reduce at least by 50% the ALOS, which obviously drives a lot more throughput and improves the overall model efficiency. The third is, you know, people per bed. If you look at, let's say, I I think I think Max's, annual report, if you if you look up the intro message, they have about 35,000 employees, I think the report says. And they have about 5,000 beds. So I guess they're at about seven employees per bed. We operate Center 1 at about four. So, you know and we still maintain one to one bed to patient ratio, which is bed to nurse ratio, which is quite high. One to one is typically done only in ICU. We do it for all beds because we just think that care is better that way. We are India's highest revenue per bed hospital of any category, you know, which is and have been for every month of our existence. Our lower rate loss is a big part of that. And I and I and this is despite being 40% lower price than a typical corporate hospital. So I mean, I think I think the biggest takeaway that I've had on our on our financial metrics has been that, you can deliver honest health care and makeup, really incredible business, when your baseline is the industry with so much inefficiency. Right, I mean, you can do good and, financially well both. This only happens in an industry that is kind of, like, stayed for five hundred years or whatever. So there's lot of lot of fat we can suck out of it. And I think I think this is just a really one. We're just doing the building and the people right now, the the improvements. I think at land and construction, I mean, as we get to devices, and medicines, I think it's gonna get even more interesting. But that's more in the future, so we'll see.

Utsav Somani: And talking a little bit about health care insurance in the country. Like, India still pays 40% of its bills out of pocket, and that's notoriously high because health insurance in India, like, the penetration is super low. Is that a problem, to solve on SuperHealth's list?

Varun Dubey (SuperHealth): Or 100%. I mean, actually actually, we are probably the best shot for any insurance company anywhere in the world. Right? See, because okay. Let's step back. Let's step back. Right? What is the problem? The problem is this, that, you know, some I think everybody is solving the wrong problem. The problem is that dal has become thousand rupees a kilo somehow. And we're all trying to solve 0% EMI on dal. This is the wrong problem. The problem is why has it become thousand rupees a kilo? Remember, it reduced to 50 rupees a kilo. How do we go back to 50 rupees a kilo? Because not there. No one needs EMI. Right? So I think I think if you look at I think this is the crux of the problem that SuperHealth is trying to solve, that how do we take the fat out of the system so that the health care can go back to being a price that is rational. Okay? Today, if you go to a corporate hospital in India, they deliver the highest quality of care in the world. There is no question about it. Right? You go to a Manipal or a Max or an Apollo, they do a fantastic job with their quality of care. Like, if they put a stent in you, it will be world class. No question. They will do it at 10% of global price. Also, this is objectively true. But yet, all of us who are on this call, like, 1% of India's population, affluent, whatever, we still worry about health care costs. This is off. What else are we worrying about? Nothing. Right? So clearly, there is a problem. The second way to think about it is that if you look at the last three to five years of IRDAI data, you will see in health care that insurance companies are basically at 90 to 110% of claim ratio. Right? So they take $100, and they basically pay out $100. Right? So this makes no sense. If the if you think of them as a subscription business, they have to be at least 50% gross margin. So the how will they do that? They'll either double premium because they're paying out 100% or the cost is to half. If the cost is to half, then the hospital has to bill you half. The most profitable hospital public listed in the country today is max. They do only 30% EBITDA. So how will they make a 50% discount? They can't give it. It's not there in the payment. So the problem is, you know, is not that, you know, although a lot of people say it like this that, oh, all these people in health care are making tons of money. They're making money, but it is not like they're at 600% profit or something like that. At least, it wasn't even right with those. So there is a structural cost of delivery problem. There is no getting away from that. And unless we fix that, right, no amount of insurance underwriting is going to solve it. Right? Because, ultimately, Indian health care is going the the need for Indian health care is going to grow exponentially. Let's look at the data today. Right? Today, India needs about 4,000,000 beds. We have a million beds only. So we have 3,000,000 beds shot today. Today, India's median population is 28 years old. Correct? So if today we're 28 years old, 28 years old, we have no health care problem. Yeah. Whatever we have, mommy will solve it. The problem is that it comes twenty years later. Now when you're in your third late thirties, early forties, late forties. The problem to be solved. So what will we do in twenty years? So I think unless somebody comes in and fundamentally resets the cost of care delivery without diluting the quality. Of course, the quality has to be high. How will how will we deliver health care to the people? That's really what SuperHealth is trying to fix. So eventually, once we do the whole stack, of course, you know, we should figure out what is the right way to do a VIP Pass subscription and all that. But the real answer is that why is that required? You should just be able to pay for it. Alright. Today, it is just too expensive. And, like, I mean, if you think about it I'll go ahead. I'll give a live example. I know somebody's gonna call me later and get angry with me, but I'm gonna give it anyway. So, you know, there is a there is a there is a there is a there is a company that bought land in Gurgaon. Okay. I'm not gonna name, but you can Google it. And then they spent three years litigating it. 800 crores, they paid for it. And three years of litigation cost of capital itself is $250 crores. Then they said three years is gonna take to make it. So another $250 crores. So before they put a single brick in the building, they have spent 1,300 crores. Then it's gonna take 500 crores to at least make the building and put the machines and get all that. Right? So at this point

Utsav Somani: already cost per bed has gone up significantly.

Varun Dubey (SuperHealth): You are not 1,800 crores for the cost of project at ribbon cutting. Right? But of the 1,800 crores, the first 1,300 crores has nothing to do with their health care quality. If some guy decided Right? Why are you paying 30 crores a bed for this? This doesn't make any sense. So I think I think we have been building health care wrong. Okay. This is my thesis. We've been building health care wrong. Because we've been learning all these things from the West. Okay? And, the West is a payer system where they're trying to count, payers and to control everything. The cities are built differently. The population profile and age and demographic is different. India is a completely different country. We're a consumer market, consumer and provider market. It's a young population. Our cities are dense and very complicated. So no one wants to go from, you know, to Whitefield to find the best gas. So that's not a thing. So people just go to whatever is near them. Like like, Nobody's going to buy. So if we move health care to hyper local high quality centers, and then increase the density like retail, right, then I think we will be able to do both, which is that bring very high quality care nearer people and make the cost structure so low that everybody can afford it. Like, if you see SuperHealth today, like, if you guy I invite you guys to come by and see the hospital. You will see the full span of people coming here. Right? Like, lot of people ask me, who have you made this for? Like, honest health care is for everyone. Right? The the rich people are also unsure whether they're being prescribed the right thing or not. And the poor people are definitely unsure whether they will prescribe the right thing or not. So, you know, it this this model allows us to solve those core problems. And I think unless we solve that, it's it's gonna be a stable big problem. So I think in insurance to me is like a band aid solution. While we figure this out, how do we get people health care? But that's why all the bad things happen now. Adverse selection is what they're trying to solve. Claim rejection is what they're trying to solve. I mean, if one way to think about the claim rejection piece is this. Well, whether you think the person needed surgery or not is irrelevant. The person had surgery. You were supposed to pay for it. Pay for it. That's what he paid you the premiums for. Right? He didn't pay the premium for you to judge whether he needed surgery. You know? That's the doctor's job. Right? And I'm not saying this because I'm a health care provider and I have something in the insurance. No. We have great partnerships with them. But just theoretically, right, the whole because the cost is high, the the model is create a pool of people and then sort of, like, reject certain set of people. Probably the people who need the most. I I mean, this is my opinion, you know, but Oh,

Utsav Somani: no.

Varun Dubey (SuperHealth): I think I think that's the insurance problem to really solve.

Dhruv Sharma: But I'm safe, you know, some other health care provider who wants to learn from the super health playbook, and, again, to use your words, suck the fat out of the system, lower the cost of delivery, but they can't you know, I mean, they have to, like, do something to their existing business. What what tips would you give them?

Varun Dubey (SuperHealth): I mean, I tried to do this with the next thing I'll get provider guys. Didn't go so well. But but

Dhruv Sharma: And you have to go up the sleeves and

Varun Dubey (SuperHealth): I would say look. To be to be honest, I mean, we are engaged with the fair of fair few of them to help them do what we're doing. I think the success of SuperHealth really is not just that, that we become a, you know, important player in the industry. Of course, that's an aspiration we want to do it. But no matter how much founder optimism I have, I am not going to build 30 lakh beds. Right? So the role SuperHealth must play is that we must demonstrate that this is of not just a great execution from a consumer experience and a fixed point of view, but, actually, this is a more profitable model. This is just a better model. Right? And I think we can do we are that's what sort of we are heading towards. And we are trying to share this with as many people who reach out to us, and that is people across some of the larger health care houses as well as some of the large but not as well known health care houses, some of the trust houses, etcetera. So we engage with them and we try to help them figure out. Some of them want to learn how to do supervised better. Some of them want to know, like, a couple of large trust hospitals I was speaking to yesterday wants to know how to do the whole model better because they have some land that they wanna build new hospitals on. But but I agree with you that doing it for them is very hard because they just have so much sunk cost, and they need to fundamentally reset their DNA because they need to start thinking like a consumer Internet company and not like a traditional health care provider. As not as far as the business and this customer experience goes, they should definitely continue to do what they were doing from a care quality standpoint because, obviously, they were doing really good work there. They have to reimagine how technology works. You know, let's buy and deploy. Azure is not a thing here. Right? And so so they will have to do this custom, which means they have to attract a completely different kind of talent, which currently does not have them on their shortlist to join. So let's say, like like, why would a I'm just making this up. But, like, why would a software engineer decide to leave and join a traditional hospital? But unless they get talent like that, how will they build something like SuperOS? And and they should build it. It's I mean, we built it in, like, six months, so it's not, like, it's not possible. And, I mean, we have an incredible engineering team. A lot of them joined us as interns, and, you know, they have been really and that allowed us, I think, to do a very fresh start. So I would say those are all the things that I think about.

Dhruv Sharma: Sorry to interrupt, Varun, but this is so cool. You get doctors to use Slack and your hospital has an engineering team.

Varun Dubey (SuperHealth): Yes. It's been it's been fun, man. I mean, it's like the best I mean, I have, like, the best job in the world, I think. Right? I like, my first some part of my day is designing building. Some part of the day, I'm sitting with engineering team designing. No. I mean, I don't get to code, although I've done a lot of work with Claude Code now. So I get honorary junior developer job in my engineering org. But, and sometimes I get to play with the design team. Lot of time I spend with the clinical team. So wouldn't have any of the of course, customers, I spent a lot of my time there. It's fun. I mean, I think reimagining health care has is good, but it is a lot of fun. I I encourage everyone to do it. Anyone anyone who wants to do something in health care, you know, build hospitals, guys. It's a great business, lot of job satisfaction, you know, and everything is the important part is figure out doctors know what they need to do. Just let them do their thing.

Utsav Somani: Varun, this was really, really fun, and you gave such solid answers. I think the live chat was buzzing, but, I mean, we're super excited by what you're building and cannot wait to come to Bengaluru and try it out. Hopefully, you come to Delhi and Bhutan very, very soon.

Varun Dubey (SuperHealth): Yes. No. No. 100%. 100%. Please do come by, guys. We'd love to love to have you guys over. Or you should try out our food and coffee, which is as very much as our doctors are now in Bengaluru. So we are we are the only hospital that gets customer request to send food home once they get discharged. So so so kind of figure out how to do subscription there as well.

Utsav Somani: I went to Apollo recently and they had a. Like, I think that explains what is I mean, I think some of you have what's wrong with the system, basically.

Varun Dubey (SuperHealth): It's a growth hack. Cardiology is a pretty straight line.

Utsav Somani: 90. I cannot wait to see SuperHealth scale to hundred, hundred and one, and beyond. I mean, what you're doing, I think, is a solid mission and trim the fat and make awesome experience affordable for everyone. Thank you so much for everything. That was

Varun Dubey (SuperHealth): awesome being here. Thank you for having me, guys. Have a great day. Bye.

Utsav Somani: Alright, listeners. That's it from us. India turns, 80. Eightieth Independence Day tomorrow. Twenty one more years to go for Vixen Bharat, and, we're putting out a special round table. Building for Bharat is the team. It should be out on our YouTube channel and other platforms. Have a safe, fun weekend, and. Bye bye.