PocketHealth’s Counterintuitive Path to Enterprise: Why They Started Local When Everyone Said Go Big

When you’re building a healthcare platform in Canada, conventional wisdom says to target the U.S. market immediately. The market is bigger, the opportunities are larger, and the potential returns are higher. But PocketHealth took a different path.

In a recent episode of Category Visionaries, Co-Founder and CEO Rishi Nayyar revealed why starting local in Toronto, despite having access to the larger U.S. market, became their secret weapon for enterprise success.

“The initial market was Canada,” Rishi explained. “A lot of healthcare is face to face. So we’re going to these different hospitals, these MRI clinics, and trying to convince them to adopt this software for their patients.”

This decision wasn’t about playing it safe – it was about building the right foundation. “Starting locally in the Toronto area was really important for us to get that early feedback, early revenue, and be able to get to the point where we felt we had a product that was heavily chipped away and refined not by us, but by the market before went to other areas,” Rishi shared.

Their approach challenged three common scaling assumptions:

1. Bigger Markets Equal Better Outcomes While the U.S. healthcare market dwarfs Canada’s, PocketHealth recognized that market size wasn’t their primary constraint. As Rishi noted, “The US has tried to solve this problem more than in Canada, but with the same degree of, you know, we could say more times at that same result.”
2. Patient Needs Vary by Region Contrary to the belief that healthcare needs vary significantly by market, PocketHealth found universal patterns. “Our core customer is a patient, and we find that patients are very similar from one region to another,” Rishi explained. “There’s high anxiety before an exam. They want to know how to prepare. They get an exam, they want to know what the results are.”
3. Enterprise First is the Only Path Rather than targeting large health systems immediately, they focused on proving their model with smaller clinics. Today, their ideal customers are “academic health systems or more complex medical imaging clinic groups…dealing with complex imaging, complex patient scenarios, and that imaging needs to move around a lot.”

This strategy created three distinct advantages:

First, it allowed them to iterate rapidly with direct user feedback. Being physically close to their early customers meant they could observe and adjust quickly.

Second, it helped them build a robust product before tackling regulatory complexities across different markets. As Rishi noted about the U.S. expansion, “Once we expanded there, growth really took off.”

Third, it gave them time to understand the deeper patterns in healthcare image sharing. This insight proved invaluable as they scaled – “We tapped into a massive wave…this concept that patients want access to their healthcare, they want to know what’s going on, they want control, they want to be empowered.”

The results speak for themselves. PocketHealth now serves over 700 hospitals and imaging centers across North America, with more than a million patients on the platform. Their growth continues to compound, with Rishi sharing that “2023 looks like it’s going to match previous years in terms of our growth rate, which is we’re growing multiples every year.”

For founders building in regulated markets, PocketHealth’s journey offers a powerful lesson: sometimes the fastest path to scale is the one that starts slow. By focusing on deep market understanding over rapid expansion, they built something that could truly scale when the time came.

Their story challenges us to ask: what if the conventional wisdom about scaling is wrong? What if the key to building a category-defining company isn’t about racing to the biggest market, but about taking the time to build something that genuinely works?