How Sikka Turned 450 Integrations Into a Distribution Engine: The API-as-GTM Playbook
Every software vendor selling into retail healthcare faced the same nightmare: 450 different practice management systems, 250,000 independent practices, and no way to reach them all without burning nine figures on integrations.
In a recent episode of Category Visionaries, Vijay Sikka, CEO and Founder of Sikka, a retail healthcare technology platform that’s raised over $30 million, explained how he spent ten years solving this problem once—then made every other vendor pay to use his solution. The result: automatic distribution where partners can’t sell their products without bringing customers to Sikka’s platform.
This is the playbook for turning infrastructure into an unfair distribution advantage.
The Fragmentation That Kills GTM
Retail healthcare—dentists, veterinarians, optometrists—operates in radical technological fragmentation. “There are over 400 practice management systems and financial systems that the dental industry uses, same as with veterinary, same as with optometry,” Vijay explains.
This fragmentation creates an impossible economics problem for any software vendor. Build integrations to the top 10 systems and you reach maybe 40% of the market. Build to the top 50 and you’ve spent years of engineering time for 70% coverage. To reach 96% of practices, you need connections to 450+ systems.
The math doesn’t work. Each integration takes weeks or months to build. Testing and maintenance multiply the cost. A company would need to invest $50-100 million in engineering resources just to achieve comprehensive market access. And by the time you finish, systems have changed and new ones have emerged.
Most vendors give up and serve only practices using popular systems. The market stays fragmented. Innovation stalls.
The Build-Once Infrastructure Bet
Vijay saw a different path, inspired by infrastructure companies like Twilio and Stripe. Instead of each vendor building 450 integrations, what if one company built them all—then let everyone else plug in?
“We built an API platform which lets you connect with 96% of the market if you just build to one platform. So it’s build once, deploy everywhere,” Vijay explains.
The vision was simple. The execution was brutal: “It took us 10 years plus to build all the connections to 450 practice management systems.”
Ten years. No venture capital pressuring for faster growth. No pivoting to easier markets. Just patient, systematic integration work, one system at a time. “We kept growing organically by servicing our customers. We kept growing our install base,” Vijay notes, describing how customer revenue funded the infrastructure build.
During this decade, competitors could have replicated the strategy. Some tried. None succeeded. The work was too boring, too expensive, too slow for venture-backed timelines.
How Infrastructure Becomes Distribution
Once Sikka connected to 450 systems, something remarkable happened. Every software vendor trying to sell into retail healthcare faced the same integration problem Sikka had solved. They had three options:
- Build 450 integrations themselves (6-8 years, massive cost)
- Serve only 40% of the market using popular systems
- Integrate once with Sikka’s platform and access 96% of the market immediately
The choice was obvious. “We have some of the biggest names in the industry. Dental, veterinary, optometry, for reputation management, revenue cycle management, payments, business performance management. All of them are using our platform in order to run their applications,” Vijay explains.
This created a distribution flywheel that required no sales team. When a reputation management company wants to sell to a dental practice using an obscure practice management system, they can only do so through Sikka’s platform. When a payment processor wants comprehensive market access, they integrate with Sikka.
But here’s the key insight: these partners don’t just use Sikka’s infrastructure. They actively bring customers to Sikka’s platform.
The Automatic Customer Acquisition Machine
“Because all the doctors, when they approach the doctor, they bring the doctor to our marketplace,” Vijay explains. “The doctor signs the C. AI paperwork, business associate agreements, and then starts to get that service. So you see how our distribution is built into our business model.”
Parse that carefully. When a Sikka partner sells their solution to a dentist:
- The partner needs Sikka’s infrastructure to make their product work
- The partner handles the sales process and customer acquisition cost
- The dentist signs agreements with Sikka to enable the integration
- Sikka gains a new customer without spending on sales or marketing
- The dentist now lives in Sikka’s platform and can access other services
The partner paid to acquire the customer. Sikka owns the relationship. The platform gets credit card details, signed agreements, and an activated account. From there, Sikka can introduce additional services, monetize data access, and expand within the account.
This isn’t just distribution. It’s customer acquisition funded by partners who have no choice but to participate.
The Economics of Platform Leverage
The results reveal the power of this model. Sikka reached 45,000 practices—adding 20 to 25 new practices daily—with just 45 employees. That’s 1,000 practices per employee.
Traditional SaaS companies measure sales efficiency in thousands of dollars spent per customer acquired. Sikka’s infrastructure-as-distribution model means partners bear the acquisition cost. The company maintains 80%+ gross margins while achieving 90%+ recurring revenue and 110% net dollar retention.
“We are EBITDA positive and we are actually really enjoying. We have our first year of profitability this year,” Vijay shares. For context, most SaaS companies burn massive capital for years before approaching profitability. Sikka achieved it while growing 40-45% annually.
The infrastructure moat created efficiency that looks impossible through traditional GTM lenses.
The Competitor Time Barrier
The most powerful aspect of this strategy is that it becomes more defensible over time, not less. “If somebody else tries to do it’ll take them six to eight years trying to just get to connections that we already have built,” Vijay explains. “And we are running as fast as we can.”
Six to eight years is a lifetime. By the time a competitor builds equivalent infrastructure, Sikka will have:
- Added connections to hundreds more systems
- Deepened integrations with more data and functionality
- Locked in partner relationships that depend on the platform
- Built switching costs through customer data and workflows
- Extended into adjacent use cases and verticals
The gap widens rather than narrows. Infrastructure moats compound.
The Replication Playbook
What can founders learn from Sikka’s API-as-GTM strategy? The model works when specific conditions exist:
Market fragmentation: You need a market with hundreds of systems creating integration nightmares. If there are only 5-10 dominant platforms, this approach doesn’t generate enough leverage.
High integration cost: Each connection must be expensive and time-consuming enough that vendors will pay to avoid building them. If integrations are trivial, you’re not solving a hard enough problem.
Multiple vendor types: You need various categories of software vendors all trying to reach the same customer base. Sikka has reputation management, payments, revenue cycle management, and more—all needing practice management system integrations.
Long build tolerance: You must have funding or revenue to sustain a multi-year build period. Sikka bootstrapped for ten years. Most venture-backed companies can’t wait that long.
Network effects: Each new integration should make the platform more valuable to both sides. More systems = more vendor interest. More vendors = more customer value.
When these conditions align, infrastructure-first GTM creates compounding advantages that traditional sales models cannot match.
Why Most Companies Won’t Do This
The strategy works precisely because it’s so hard to execute. Ten years of integration work is boring. Investors pressure for faster growth. Teams want to build features, not infrastructure. The payoff feels distant and uncertain.
“Initially we thought honestly that we’ll just build a bootstrap business,” Vijay admits. Only after reaching critical mass did the platform strategy become obvious. Most founders pivot before that point.
But for those willing to invest the time, the payoff transforms economics. Zero customer acquisition cost. Automatic distribution. Competitors locked out by time barriers. Partners funding your growth.
Sikka now processes a billion transactions daily, serves 150 million patients, and maintains profitability while growing fast—all with a team of 45 people. That’s the power of making infrastructure your distribution engine.
Twitter
facebook
linkedin