The following interview is a conversation we had with Rishi Nayyar, CEO and Co-Founder of PocketHealth, on our podcast Category Visionaries. You can view the full episode here: $22.5 Million Raised to Power the Future of Medical Image Sharing.

 

Rishi Nayyar
Hey Brett, thanks for having me. 

Brett
No problem. So, to kick things off, could we just start with a quick summary of who you are and maybe a bit more about your background? 

Rishi Nayyar
Yeah, definitely. So, my name is Rishi Nayer. I’m the Co-Founder and CEO of PocketHealth. PocketHealth is a patient centric image exchange that makes it easier for patients to get access to their imaging records and understand what to do next after they’ve been diagnosed. Most of my career has been building pocket elf. I started the business when my older brother was an engineer when I was 25, and before then I was working investment banking at Citigroup. So that’s the career so far. 

Brett
When you started out investment banking, did you always have the idea in the back of your head that you’d eventually start a company and be a Founder, or did that come out of nowhere for you? 

Rishi Nayyar
Entrepreneurship is something that myself and my brother have always been interested in. I think were inspired by the success of other startups and always felt that between the two of us, myself with a business background, I’ve always felt that sales marketing came naturally. And him being an extremely talented engineer, we felt that we could build something together without a lot of funding or prerequisites to get something off the ground. Basically, we felt we could build an mvp with just the two of us. We joke, he could build it, I could sell it. And even today, to some extent, that remains true in terms of how the organization is run. 

Rishi Nayyar
So even as went through, I went through my banking experience, I felt that this wasn’t necessarily the career I was going to be in long term, but it was a really good place to learn the fundamentals of how the corporate world worked, how to advocate, communicate in a professional way, and also save up money for many years of no income. In the tough world of startups, working. 

Brett
Closely with your brother. I’m sure that can get tricky sometimes, trying to separate family from business. What do you guys have in place? Like, do you have rules in place for now, these types of family events? No talking about business. Or what do you do to make sure that balance is there and you never have crossover where there’s drama on either side? 

Rishi Nayyar
No, there’s like, no rules. Basically, we’ll be at a family function and just relaxing and talking about regular family things. And then I’ll randomly interrupt Dale, by the way, for this meeting, we should prepare XYZ. And we’ve always had that flow. Work life balance is something, at least for us. And this isn’t advice. It’s more. This is how we operate. Somewhat nonexistent. It’s more both things are just happening simultaneously. So I think we’re just lucky that we work well together. We have similar temperaments. We align really closely in our values and what we want to build together and with our team. And it’s coming up on eight years, and it’s working well so far. 

Brett
You said it’s older brother. Does he ever play the older brother card on you, or is that not an issue? 

Rishi Nayyar
No. I always joke that if we get into a really big argument, I can tell on him, but no. We run the business of co-founders, and we have really clear lines in terms of what I work on and what he does in the organization. And those honestly weren’t formalized purposefully. Again, I just used the word natural based on our skill set that very naturally they broke up the organization like that. So there’s very few big disagreements, and he’s never leveraging his older brother card, luckily. 

Brett
A few other questions we’d like to ask, and the goal here is really just to better understand what makes you tick. First one is what Founder do you admire the most and what do you admire about them? 

Rishi Nayyar
So Mark Zuckerberg has been extremely interesting. Obviously, the success of Facebook, and that’s not really the reason why. I think it’s more when you start a company and you start at a very small scale, you are one type of Founder, then it gets to ten people, you’re a different type of Founder, 100 people. And he’s somehow been the right person for the job all the way through this Facebook or this meta story. And I think that flexibility and malleability in terms of his own skill set is something that I think is extremely challenging and really admirable. 

Rishi Nayyar
And you can put aside what you think of meta and what it does and everything, but I think fundamentally, as a Founder, to have someone who was the right person to create this concept and the right person to start scaling it, and the right person to operate it as one of the largest companies in the world, it’s all the same guy. And obviously he surrounded himself with the right team, but that’s part of it, that he was able to make that decision. I think that’s something that very few people would have been able to do successfully. So definitely the Founder that I admire. 

Brett
One thing I’ve found interesting about him is a few years ago, he was just getting a lot of bad press. The world hated him. Everyone was making fun of him. I think he had probably a lot of corporate consultants who were telling him, dress a certain way and act a certain way. And then sometime last year, he just went a different route, started going on, like Joe Rogan talking about MMA and fighting and rolling around on the ground. And now all of a sudden, he completely swayed public opinion. And a lot of people seem to like him now and support him and are rooting for him. So it was interesting to see how he kind of flipped that narrative by taking that approach of talking about what average people want to talk about. Yeah. 

Rishi Nayyar
And I think the emergence of other billionaire bad guys makes him look better. And I think he’s out of the trough of bad pr, and I think people appreciate candor. And he wasn’t necessarily the most candid person early, and I think most people know what’s on his mind. They’ve been interested in it. I know how I have been, for sure. 

Brett
He’s also super young too. Right? I think people forget that as well. I think he’s what, like 38 right now or something insane like that. 

Rishi Nayyar
Yeah, that’s what happens when you start a company, when you’re 18, basically. 

Brett
It’s fun watching some of those old interviews of him on tv when he’s like a 20 year old college kid. It’s fun going back to this. What about books and how we like to frame this? This comes from Ryan Holiday. He calls him Quickbook. So a quickbook is a book that rocks to your core, really influences how you think about the world and approach life. Do any quickbooks come to mind? 

Rishi Nayyar
I mean, it’s really basic. The hard thing about hard things was great. That rocked me. Not because of necessarily lessons in there, but it was extremely visceral how Ben Horowitz wrote it. You really feel like you’re in that war room and all these near death experiences. I think it accurately depicts the intensity of a startup and how quickly, things can scale, but also the pace that you need to work at. I really loved reading it. It almost felt like a fiction book. I don’t mean that in terms of it wasn’t. You know, nonfiction is not necessarily known for being nail biter material. And I love the hard thing about hard things for that reason. 

Brett
I just love the very premise of that book. When he was in the hot seat, when he was leading, I can’t remember the company, I think it was loudcloud, and he was going through all that. He was looking for books to help him navigate all the complexity there. And he could only find books that were written by management consultants or people who hadn’t been an operator for ten or 15 years. So him writing that book as that operator manual for hard times, I think that’s just super fascinating. It’s a really cool perspective. 

Rishi Nayyar
Yeah, definitely. I think some of the best ideas are born that way. We had a similar story where you want something, it doesn’t exist, and you’re like, okay, fine, I think I can build this or write it in his scenario. 

Brett
Well, that’s a perfect transition into talking about PocketHealth. So what was it that didn’t exist that made you say, yes, let’s build that? 

Rishi Nayyar
Yeah, I mean, the story started with my brother, who’s obviously our main character here. He’s in the valley in Mountain View, playing tennis, and this is maybe around 2013, 2014, and here it’s his ankle, and goes to his physician doctor, says, hey, get an x ray, get an MRI. He did that, and at the end of his MRI, they handed him two cdroms, and he was kind of stunned, like, how are they burning cds? There’s Netflix up the road, YouTube down the road, and cds are the state of the art here. And he doesn’t have a CDROM drive at home. Even back then, no one did. And he called me and said, look, this is a problem, and I should solve it. We should solve this. 

Rishi Nayyar
And I felt that it was worth investigating, but I had trouble believing this was anything beyond his one clinic not having the right tools. We did some research and realized this is like every hospital, every clinic in the US and Canada, they do not have technology that enables them to share digitally. And the ones that did have it weren’t using it or weren’t using it successfully. So we felt that, look, this is file sharing. 

Brett
Yeah. 

Rishi Nayyar
It’s healthcare. Yeah. It’s complicated and messy, but it’s just file sharing. So this seems like a problem that we could solve and was something that felt accessible enough that when the time came, about a year and a half later, we quit our jobs and started working. 

Brett
And why is that the case in healthcare? Is it because of HIPAA compliance reasons? Or why are files? And why are images exchanged in such a barbaric way? 

Rishi Nayyar
One, people haven’t invested in this space much. Two, the people that have invested in it have built systems that, unlike a Dropbox or a Google Drive, which is generally more peer to peer sharing, that doesn’t require a lot of account creation. Let’s just say it works pretty seamlessly. These systems work more like portals, these incumbent. You know, I don’t know about you, but I haven’t used a quote unquote portal since probably college. You don’t have to pick your classes, but that’s a common term inside healthcare, and it’s not very patient friendly. So what I would say is that basically there was a failure at the application level to build something that actually was easier than a CD. 

Rishi Nayyar
We laugh about cds and say they’re silly, they’re outdated, but at the end of the day, you burn a CD, you hand it to a patient who might not be tech savvy, and they walk it over to their doctor and it works. So if you’re trying to replace it with a complex portal where the physician has to create an account, and you need this code and that code and this pin from the patient who loses their pin, and all this is in a pretty fast paced healthcare atmosphere. You can imagine people defaulting back to the CD basically instantly. So a lot of solutions kind of dying the crib, so to speak, and never get the adoption that they needed to. We felt that, again, you could take what was working in the consumer world like outside of healthcare. 

Rishi Nayyar
How did Dropbox, how did docusign, how did these other peer to peer file sharing things take off so successfully and push it into healthcare and we could solve things there. 

Brett
I was recently watching an interview with Bill Ackman, and he mentioned this book called the Outsiders. And then I read it, and I think it was eight ceos that the book goes through who were outsiders to their industry. They managed to come in and just dominate the field. Do you consider yourself an outsider then, to this space? Because it sounds like you hadn’t spent 20 years in healthcare, you weren’t a doctor or you weren’t working in these facilities and experienced this problem firsthand. Do you view that as an advantage, though, that you are an outsider and you can come in with a fresh perspective? 

Rishi Nayyar
Definitely. Because our bias is how are these problems solved? In the entirety of tech, in the entirety of consumer applications, not, hey, what are other patient portals that we can look at? Because typically that’s not the bar that you want to be meeting. You want to be meeting the bar where the patient can go from Uber into PocketHealth. And they feel that these are applications that feel similar, that have been thoughtfully designed in the same way that when you click a button, it responds, and the button is probably where you expected it to be in the first place, and that it yields the result that you think it would. These are pretty basic things, but a lot of healthcare doesn’t work like that. So again, the bar is low. 

Rishi Nayyar
And being an outsider, that you could take that high bar that you find outside of healthcare from a tech perspective and bring it in and also be creative about problem solving. You don’t have the baggage what people have tried before. That’s been a winning formula for us time and time again. 

Brett
When you were first starting out, was the initial market Canada, or was the initial market us? 

Rishi Nayyar
The initial market was Canada. 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. You also want to talk to your users a lot in the early days, know, ideally continuously as you continue to scale. So being starting locally was important for us. The US is a much bigger market. So once we expanded there, growth really took off. But starting in Canada, starting locally in the Toronto area, that 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 area. 

Brett
This show is brought to you by Front Lines Media, a podcast production studio that. 

Brett
Helps B2B founders launch, manage. 

Brett
And grow their own podcast. Now, if you’re a Founder, you may be thinking, I don’t have time to host a podcast. I’ve got a company to build. Well, that’s exactly what we’ve built our service to do. You show up and host, and we handle literally everything else. To set up a call to discuss launching your own podcast, visit frontlines.io Slash podcast. Now back today’s episode. I know the US and Canada have very different approaches to healthcare. As you made that jump into the United States, was that like a big leap for you? Did you have totally change the approach at all with how the platform worked? Or are the US and Canada very similar in terms of the approach they. 

Rishi Nayyar
Take for medical image sharing, they’re very similar. I would say 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. What’s interesting is that our core customer is a patient, and we find that patients are very similar from one region to another. 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. Then they get the results. They want to know what they mean. What’s this complex terminology? And then what do I do next? How do I get a second opinion? 

Rishi Nayyar
So all of these workflows, these desires, are really similar, which probably isn’t surprising, someone getting an MRI or going through some significant health event in Toronto versus New York or San Diego. They’re probably going through the same types of emotions and desires throughout that process. 

Brett
Who’s an ideal customer for you today? What does that look like? 

Rishi Nayyar
So in terms of a health system, it’s probably an academic health system or a more complex medical imaging clinic group. So not just your basic x ray ultrasound, but they’re doing more. They’re dealing with complex imaging, complex patient scenarios, and that imaging needs to move around a lot. But they also have, because they’re larger, they have bandwidth to implement applications like PocketHealth. We’re a very lightweight solution, but you still need at least someone in it. And you can imagine a very small clinic, largely of things outsourced, and we’re in hundreds of clinics like that. But in terms of what’s an ideal scenario for them to get the most out of it’s probably your academic health system, your more medium and large size imaging clinic groups. 

Brett
How long did it take you to start to feel like you had product market fit? 

Rishi Nayyar
Probably about a solid year, building the product, pushing it out, and really grinding and grinding until we felt that there is some organic demand that’s happening, not just through sheer force of will. One thing we’re worried about, which maybe was kind of funny, was that, hey, we could just be really convincing, so we could go to a bunch of places and pitch it and just convince people to adopt it inside their clinics or their hospitals. And that’s not a true. How we thought about it. That was not a true product market fit. We said, look, once we adopt our patients signing up, because we can’t be there with a big spinning sign than in a hot dog costume, convincing people to actually sign up at the hospital. So they have to organically do it, they have to find value in it. 

Rishi Nayyar
So from that perspective, once we started seeing that happen on its own without us in the room, and it took about a year for us to feel like this was happening with some reliability, that there is something special here, is. 

Brett
There anyone that doesn’t like you? Is there anyone that hates you guys and stands to lose if you’re successful? 

Rishi Nayyar
The incumbents for sure. But honestly, image exchange for all of these incumbents is a widget within a widget, maybe a widget that they don’t want to even spend time on. So while image exchange is something that a lot of people have tried to solve, they’ve generally tried to solve it within the portfolio of a much larger enterprise solution. So I personally like to think that when we get to the market share that we expect to over the next couple of years, maybe people will be grateful and they’ll be eager to work with us and they can focus on their bread and butter. 

Brett
We are selling to these health systems then is that a new line item that they have to create for image exchange? Because it sounds like that’s a feature that’s typically rolled into a different type of product. So is that a new line item or what’s your thinking there? 

Rishi Nayyar
It sometimes is. Sometimes they’re creating a new line item for image exchange. They’re often pulling know they’re getting cost reduction in terms of their CD burning FTE assigned to that CD burning. They’re also getting on the revenue side, greater patient engagement. So when patients use PocketHealth, they come back more. They make sure they do their follow ups. We have appointment reminders functionality so we make sure they show up. So when our clients are building a budget for PocketHealth, they’ll create that pocket off line item. They’ll be able to offset it through cost savings and they’ll be able to put in some projections around decreased no show rate and increased recurrences and patient retention, which pretty comfortably builds in a really meaningful ROI for them as they go for approval. 

Brett
When it comes to growth and adoption, are there any metrics that you can share? 

Rishi Nayyar
We have over a million patients on the platform. We’re in over 700 different hospitals and imaging centers across North America and we keep growing really significantly. And 2023 looks like it’s going to match previous years in terms of our growth rate, which is we’re growing multiples every year. 

Brett
What do you attribute to that growth and attribute to that success? 

Rishi Nayyar
Part of it is our product is a pal sharing product. So there’s a natural product led growth motion as built into it. So growth begets growth. That’s very helpful. It’s not intentionally designed, necessarily. It’s just an issue of the actual product itself. Hospitals share with patients share with physicians or physicians who work in hospitals, and then that naturally generates inbound interest for us and gets us going there. The other piece is, I just think we’ve tapped into a massive wave, one that was accelerated by Covid. But just this concept that patients want access to their health care, they want to know what’s going on, they want control, they want to be empowered. That’s something that even ten years ago didn’t exist at nearly the same scale. But people want to know what is happening with their health. 

Rishi Nayyar
And one of the biggest inflection points in a person’s care journey is their medical imaging. That’s what diagnosed them in the. So we position ourselves right at that epicenter of this movement, and you want to have a great product, you want to have a great team. But if you can have tailwinds from this industry or this movement or cohort, that’s ideally where you want to be building a business. 

Brett
As I mentioned there in the intro, you’ve raised 22.5 million to date. What have you learned about fundraising throughout this journey? 

Rishi Nayyar
At the end of the day, you can’t build a business to fundraise, so you have to focus on building it in the way that is correct for the long term of the business. And then you have to have faith that when it comes time for fundraising, you can explain that to people who haven’t had the benefit of being inside your organization for multiple years and understand why during this period, growth was fast and then this quarter was slower. While you worked on XYZ, it ramped back up here. And why you’re focusing on this metric instead of that metric, why you’re monetizing earlier, why you haven’t monetized late. You can’t worry about all that, how that’ll land one, because I think that how you think it’ll land is probably irrelevant. Sorry, incorrect. 

Rishi Nayyar
Investors care about things that you probably didn’t expect and don’t care about things that you were worried about. And also, it can just be extremely distracting. So what we found through two funding rounds, so sample size of two, so take that for what it’s worth, is that we didn’t orient anything were doing in the actual business in anticipation for these funding rounds, we built the business we wanted, and it came time for funding, and were like, how can we best explain what’s happened over the last few years? And what’s going to happen over the next few years to an audience that is a unique audience? They’re not employees, they’re not customers, they’re not even investors that are in the company. They’re prospective investors that are seeing a bunch of other prospective investments daily. 

Rishi Nayyar
That was the right approach and will be the right approach for future funding rounds as well. 

Brett
Now, let’s imagine you were starting the company again today from scratch. What would be the number one piece of advice you’d give to yourself? 

Rishi Nayyar
It’s tough. I would say buckle up and it’s going to be a grind. I think that the naivete when we started the business was sorely needed. We didn’t really know what were signing up for. I always say, I don’t know if I could be warped back to that day, because when you’re business building, at least, my approach is you can’t look too far ahead because you’re climbing a massive mountain. So if you look to the peak, it’s always going to be extremely far away. But if you just focus on little tiny wins, then you get those little moments of achievement daily, weekly, whatever it happens to be. 

Rishi Nayyar
So it’s kind of a funny way of, I would prefer to not go back and give advice, if that makes sense, because I think that, one, I’m thrilled with the success that we’ve had so far, and two, I felt that were very in the moment and that was the exact right way to think about it. We weren’t trying to build this massive business. We weren’t trying to solve this global problem. We wanted to build a product that people would use because we thought it was cool and we thought it was a cool problem. And wouldn’t it be satisfying if we could solve it even locally? Wouldn’t that be great? Wouldn’t it be great if we could hire some people and then we could have a work environment that was satisfying and it would be rewarding? 

Rishi Nayyar
And then your goalposts move and they move, which is awesome. And then you keep achieving things that you didn’t expect you could, and after a while you’re like, oh, I guess we caught lightning in a bottle. But that’s something you realize retroactively. So anyways, I think that I’m happy with how things went and I wouldn’t have changed it. 

Brett
Final question for you, let’s zoom out three to five years into the future. What’s the big picture vision that you’re building? 

Rishi Nayyar
We think that imaging is this special moment, as I mentioned, it’s this moment that afterwards, everything in the healthcare journey happens. Your second opinions. What drugs do I go on? What treatment plan? What do I do next? Do I get more imaging? Someone explained this to me. Right now, we’re starting to go beyond, hey, Brett, here’s your records to hey, here’s your records. You want a second opinion? This is what your records mean. These are types of questions you can ask your physician. So we’re doing that work now. That intelligence, putting the patient in the driver’s seat, green to five years from now, we’ll not only be doing that in what I believe will be the vast majority of imaging locations in North America, hospitals and clinics, but we will also be doing a lot more. 

Rishi Nayyar
We’ll be helping you figure out what is the best course of care, understand that course of care. And we’ll probably be executing on some of it as well, in partnership with our hospitals and clinics. So that’s what’s really exciting. We’re almost eight years in, and the business is evolving so rapidly that we’re keeping up, but it’s hard mentally and just, like, stunning what’s happening so 45 years from now. I hope that we chat and you don’t really recognize the business that we’re doing every day, but I think you’ll find the vision and why we’re doing it to be eerily consistent with who we are today. Amazing. 

Brett
Well, I love the mission. I love the vision, and I really love the approach that you’re taking to building the company. We are up on time, so we’ll have to wrap here. Before we do, if any founders listening in want to follow along with your journey, where should they go? 

Rishi Nayyar
Go to pockethealth.com or find me on LinkedIn and add me, and we can start chatting there. 

Brett
Awesome. Rashid, thank you so much for taking the time. Really appreciate it. 

Rishi Nayyar
Great. Thanks, Brett. 

Brett
All right, keep in touch. 

Brett
This episode of Category Visionaries is brought to you by Front Lines Media, Silicon Valley’s leading podcast production studio. If you’re a B2B Founder looking for help launching and growing your own podcast, visit frontlines.io podcast. And for the latest episode, search for Category Visionaries on your podcast platform of choice. Thanks for listening, and we’ll catch you on the next episode.