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How Sikka Built a $30M Healthcare Platform by Ignoring Silicon Valley’s Playbook

Most founders raise venture capital first, then figure out distribution. Vijay Sikka did the opposite—and it changed everything.

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, shared how spending a decade building infrastructure before raising serious capital led to a business model that competitors would need six to eight years just to replicate.

The journey started in an unlikely place: working as an office manager in his wife’s dental practice.

From Semi-Retirement to Office Manager

After selling his second company, Vijay had settled into semi-retirement in Morgan Hill, overlooking a lake and city lights. Then his wife, a dentist, decided to open her own practice. “I said, you know, let me help you out. And she says, so long as you stay out of my way,” Vijay recalls.

He spent two years working in the practice, mapping every business process. What he discovered wasn’t just inefficiency—it was a systemic problem across an entire industry. “Dental offices are kind of like reverse pyramid. The person who is the most qualified is also doing the work. I mean, if he or she doesn’t show up in the practice that day, the practice does not make any money.”

The genesis moment came when Vijay identified $50,000 in missed revenue from unoptimized fees. His wife’s response: “I need this tomorrow.”

The Ignored Trillion-Dollar Market

Retail healthcare—dentists, veterinarians, optometrists, chiropractors—represents nearly a trillion dollars in annual services in the United States. Yet it operates with technology that’s decades behind hospital-based healthcare.

“It’s 50 years behind the hospital based healthcare technology,” Vijay notes. The market fragmentation was staggering: over 400 practice management systems in dental alone, with similar numbers in veterinary and optometry. Each practice operated in its own silo, with 250,000 independent providers across these verticals.

When Vijay first approached investors in Silicon Valley, they weren’t interested. “In the early days, I would get chased out of the room by the investors because were so focused on dental. And they would say, oh, dental is not a big enough market.”

The Ten-Year Infrastructure Play

Instead of raising capital and hiring salespeople, Vijay made a different bet: spend ten years building connections to 450 practice management systems. The goal was creating an API platform that could connect with 96% of the market through a single integration.

“It took us 10 years plus to build all the connections,” Vijay explains. During this period, the company grew organically by servicing customers and expanding their install base. No venture capital. No growth-at-all-costs mentality. Just patient, methodical infrastructure building.

This decision shaped everything that followed. “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. And we are running as fast as we can.”

Distribution as Product Architecture

The breakthrough wasn’t just technical—it was strategic. Vijay studied companies like Twilio, Stripe, and MuleSoft, recognizing they hadn’t just built good products. They’d embedded distribution directly into their business models.

Sikka built what Vijay describes as “build once, deploy everywhere” infrastructure. But the real innovation was turning every reputation management provider, payment processor, and revenue cycle management firm into a distribution channel.

“All of them are using our platform in order to run their applications,” Vijay explains. “And what that does is that gives us these channels which allow us. Because all the doctors, when they approach the doctor, they bring the doctor to our marketplace. 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.”

Every partner selling their solution had to bring customers onto Sikka’s platform. Distribution became automatic, embedded in the product itself.

The Economics of Patience

By 2016-2017, when Sikka finally raised institutional capital, the company had reached critical mass. The results speak to the power of the infrastructure-first approach: 45,000 practices, adding 20 to 25 new practices daily, with 90%+ recurring revenue and 110% net dollar retention.

More remarkably, the company achieved this with just 45 people while maintaining 80%+ gross margins. They hit EBITDA positivity and grew 40-45% annually—metrics that seem impossible for most SaaS companies.

“We are EBITDA positive and we are actually really enjoying. We have our first year of profitability this year, which is something which makes, you know, it’s a strangely empowering thing,” Vijay shares.

The Three Hacks Framework

Vijay distills startup success into what he calls “three hacks.” Understanding this framework explains why Sikka’s unusual path worked.

“The way I look at entrepreneurship is three hacks. The first hack is product market fit. The second hack is distribution, which is kind of go to market. And the third hack is people.”

Most founders celebrate after achieving product-market fit. Vijay sees it differently: “Product market fit is great, but you know, that’s just the first step, distribution. How do you get your product out there? How does, how does the product expand? That’s the second hack. And that in my opinion is really way more valuable and harder to do than the first hack, which is the product market fit.”

The distribution hack required Vijay to abandon conventional wisdom. Early on, he spent three days out of every five on the road, visiting study clubs and doctor groups. His young son would ask, “could you put me in a suitcase and take me with you?”

But direct sales couldn’t scale. “We realized was direct sales and direct one one is really not the best approach because you could probably be raising 100, $200 million and still not be able to get to this highly fragmented market.”

The DSO Strategy

Within the broader distribution model, Sikka identified another lever: dental service organizations. Private equity had begun consolidating independent practices into groups, sometimes creating multibillion-dollar publicly traded companies.

These DSOs faced a painful reality. “They may have offices all over the geographic locations within the United States. They may have different practice management systems at each location. And they really cannot transform, convert all those practices into the same practice management system because it’s really hard and it takes too much commitment and it takes two years or so to convert.”

Converting practice management systems meant stopping revenue for two years. “You cannot really stop the mother’s milk, right? I mean, you got to make sure that the practices are continuously working and the revenue generation is happening.”

Sikka’s platform solved this by sitting on top of heterogeneous systems. One DSO contract meant hundreds of practices—sales efficiency that direct sales could never achieve.

The AI Frontier

With infrastructure and distribution solved, Sikka turned to AI—and not in the way most companies approach it. Vijay’s background includes publishing papers on artificial intelligence 30 years ago, before the field went dormant and re-emerged.

The company built Dental LLM, the first large language model specifically for the dental industry. “It actually beat on benchmarks. It beat ChatGPT4.0 and Claude by anthropic and Gemini 1.5 by Google,” Vijay notes. The advantage wasn’t just domain knowledge—it was data sovereignty.

“It’s an LLM which does not transfer your data out into some mega corporation somewhere. So the dentists and the DSOs and the veterinarians and they all love it because their information stays within the bounds of what they want.”

Sikka is now using AI for life insurance underwriting, leveraging an unexpected insight: oral health and cardiovascular health are connected. “The plaque here is the same plaque that is gathering around the heart,” Vijay explains. The platform proved that oral health maintenance improves mortality—data now used by six or seven life insurance companies for underwriting.

Culture as Competitive Advantage

The third hack—people—manifests in unusual ways at Sikka. The average team member age is 15 to 20 years below Silicon Valley’s average. The gender ratio is 20 percentage points better than the Valley’s norm.

“Bringing the best people, best team members is in my opinion the greatest achievement of life,” Vijay says. At 45 people processing a billion transactions daily and serving 150 million patients, each team member carries significant weight.

“The company is not a giant in the sense that you lose your sense of identity, you still understand how to run how the business works. And that, I think, really appeals to the entrepreneurial team members who want to join us to learn how to grow.”

The Path Less Traveled

Sikka’s journey contradicts almost every piece of standard Silicon Valley advice. Don’t raise early. Build infrastructure for a decade. Let distribution emerge from product architecture. Stay small while processing massive transaction volumes.

Yet the results validate the approach. When Vijay finally brought in institutional investors in 2016-2017, they found a business with unassailable moats, embedded distribution, and a path to profitability that didn’t require burning hundreds of millions of dollars.

“Having a startup is like, you know, you’re late to a investor meeting, you have a flat tire and there’s a car on your tail,” Vijay reflects on the journey. The metaphor captures the constant tension of entrepreneurship—but Sikka’s unusual path suggests there might be more than one way to navigate that tension.

For founders in fragmented markets, Sikka’s story offers an alternative playbook: build infrastructure that creates distribution, embed your go-to-market strategy in your product architecture, and recognize that sometimes the patient path creates advantages that no amount of venture capital can buy.