467: Healthie with Cavan Klinsky

Cavan Klinsky is Co-Founder and CTO of Healthie, a scheduling engagement and Electronic Medical Records (EMR) platform used by healthtech organizations who seek to build long-term relationships with their clients.

Will talks to Cavan about providing an underlying infrastructure that other digital healthcare companies use to be able to focus on patient care and not reinventing the technology wheel by providing a scheduling platform, an electronic medical record, and a patient engagement solution–all available via API, via an API-first design as well as through fully branded interfaces. Healthie lets companies get to market faster, scale with less headaches, and provides effective patient care much cheaper than if they tried to build everything themselves.

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Transcript:

WILL: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Will Larry. And with me today is Cavan Klinsky, who is a part of Healthie, a scheduling engagement and EMR platform used by healthtech organizations who seek to build long-term relationships with their clients. Cavan, thank you for joining me.

CAVAN: Thanks for having me on.

WILL: Yeah, I'm excited about this. Healthcare is always an exciting topic to talk about, so let's start there. For the people who may not know, tell us about Healthie and what's in store for 2023.

CAVAN: Healthie, as you mentioned, provides underlying infrastructure that other digital healthcare companies use to be able to focus on patient care and not kind of reinventing the technology wheel. So we do that by providing a scheduling platform, an electronic medical record, and a patient engagement solution. That's all available via API, via an API-first design as well as through fully branded interfaces. So we let companies get to market faster, scale with less headaches, and provide really, really powerful patient care much more cheaply than if they tried to build everything themselves.

WILL: Oh, sweet. Okay, so who is your main audience? Is it the patient, or is it the healthcare provider?

CAVAN: Healthie is a B2B company. So we sell basically the software to the digital healthcare organizations that are looking to deliver care, but there's a patient side of the platform. So they're able to onboard their patients. It allows patients to video chat with their provider, message, track goals, view care plans, et cetera. But our customers are the businesses.

So before Healthie, people would basically either try to cobble together like eight or nine different solutions to provide the experience they wanted, or they would spend millions and millions of dollars building in-house trying to piece together. But when you look at these different healthcare organizations, 90% of the functionality they're using ends up really being the same.

But people were trapped in this build versus buy decision where they were really concerned that they wouldn't be able to have a platform flashy enough for them. But the downside of that was just the cost of building that in-house. So Healthie really changes it from a build versus buy decision to a build and buy. So our customers buy the platform. They are able to launch very quickly. But because we're API-first, they are able to extend the pieces that are most unique to them.

WILL: That's really neat. Yeah, one of the most frustrating things I find, especially when it comes to visiting a doctor, is having to call in to schedule an appointment. And I'm like; I just need an appointment; just show me the available times. I want to select it and be a part of that. And so research shows your software takes care of that, correct?

CAVAN: Yeah, that's exactly right. And patients really, really love self-scheduling capabilities. When you talk to healthcare providers, if you ask a doctor, hey, why have they not embraced it? It's because they really want this fine-grained control over their calendar. A lot of them are used to calling the receptionist who's worked there for a decade and understands their preferences and how they want things sequenced. And they want this type of appointment able to be scheduled back to back but not this other type.

That's kind of really what we enable is we have this almost eye-wateringly long settings page where you can go in there checkboxes, configure things. And what you end up is just this really nice middle ground where patients are able to get that easy, self-schedule experience, not calling anybody, not waiting on hold. But doctors and other medical professionals aren't giving up control over their calendar. So it allows our customers to be able to do a lot of optimization, making sure their providers are fully booked but in a way where for patients, it's a really, really easy experience. And that's kind of a lot of the secret sauce that we offer.

WILL: Wow, that's neat. So tell us this, tell us about your background. How did you get started into the healthcare world?

CAVAN: So I got started in the healthcare world as I think a lot of people in this space which is I really got started as a patient. I had open-heart surgery after my freshman year of high school. I had eight weeks after that where basically I ended up kind of...I wasn't able to exercise, run around, kind of do most of the things I'd spend summers doing. So I ended up really stuck in a bedroom for most of it.

But that whole experience, kind of from prepping for the surgery, having it, recovering, got me really interested in healthcare and also really frustrated at just having a bunch of poor healthcare experiences. And it also really gave me time to start learning a lot about the engineering side of things. So I built my first web application that summer with Rails. So I found a lot of great thoughtbot posts, and I have a ton of respect for thoughtbot as an organization. I've been using Rails ever since.

WILL: Wow. That's really neat. I read an article about this. Tell us about your React Native experience because, at thoughtbot, we're trying to get that started. We actually are started, but we're trying to get that same momentum as we have with Rails.

CAVAN: So I think with React Native, initially, we were just a web platform. We realized very quickly that to enable a really strong patient experience...patients wanted to be using their mobile device. They don't want to be using a mobile web browser. They want a native application. So we initially launched, and this is maybe six months after we started the company, we launched an iOS app. We realized a couple of months later that we were going to need an Android application.

So we had a Swift and an Android application written in Java. We had a server-rendered Rails web application that we expose a very, very limited set of features via a REST API. And it worked out okay, but what we realized from doing that for about a year and a half, two years, was that we were duplicating a lot of work. The iOS app and the Android app were very similar to each other. But we had two separate developers who weren't able to really code review or help out the other.

We weren't a large enough company where it made sense for us to have a bunch of iOS developers and a bunch of Android developers. And then we were also duplicating a lot of functionality with this REST API, basically copied the things that we were doing just with server-rendered HTML. So in 2018, we had basically a from-the-ground rewrite of the whole web application, which was kind of a crazy experience. We moved to a single-page application on the web. We switched over to using GraphQL for everything.

And then we initially rebuilt our mobile application still using Swift and Java but now on top of GraphQL but really with an eye towards saying, hey, how do we end up getting off of these kinds of very siloed developer experiences and not to something where even if we don't have multiple developers who can do it, at least where developers can help each other out and understand?

So a few months after that, we kicked off our React Native rebuild. We built our whole mobile applications in React Native. Ultimately, having gone through a few different React projects, I think it's the only one in my life that kind of went as expected in a positive way. We did the rewrite. It came in on time. The mobile developers, instead of having an iOS and an Android, it was just two mobile developers who were able to help out each other and collaborate.

We can have web devs do code review for mobile, and they're able to provide feedback because we use React on the web. So it's definitely not write once, run anywhere, but I do think it's pretty close to at least understand everywhere. And that's been a really, really big thing for us. And then we're still able to bridge out to Swift or to Java for some more of the OS-specific features.

WILL: Yeah, yeah, I totally agree. That's the beauty of React Native, especially for your SaaS company. It's a perfect scenario because, like you said, web developers can code review. Sometimes they can even help with the code because it's right along the same lines and everything. So that's really neat.

CAVAN: Yeah, and we're able to share libraries, so, like, some of the NPM packages end up being the same. So it's just, yeah, it's been a lot of really, really nice experiences with that.

WILL: That's neat. So as the Founder and the CTO, what keeps you up at night?

CAVAN: I think what keeps me up at night is primarily for exciting things. We're in this position where we're seeing this huge sea change in how digital healthcare is delivered. Healthie is in this really nice balance where we're a mature company, you know, we're seven years old. We serve thousands and thousands of providers, millions of patients. But we're not like the Epics of the world, that are 35 years old and are just super resistant to change.

So we ended up in this kind of nice, sweet spot where we're tech-forward enough and flexible where we can really support these high-end use cases but then also basically mature enough where we have the scalability and the resiliency as an organization to be able to do that. So, I mean, a lot of what I think about is we provide business-critical healthcare, critical infrastructure for a lot of people. And that number continues to grow every day. It needs to work. It needs to work quickly. It needs to work securely.

And that's what, a lot of the time, I think about both from a technical perspective and then also as the organization as a whole grows, from a hiring and an organizational structure perspective. So I think you really go from hacking on the codebase day one seven years ago to kind of hacking on the organization as a whole. And that's really where I spend my time and what keeps me up.

WILL: That's neat. Wow, that's really cool. So as a first-time founder, tell me this, you've been around seven years. That seems like a long time, so kudos to you for enduring that and sustaining that. That's amazing. What are some of the things that day one when you started the company...if you could look back, what are some advice that you would give yourself to say, hey, don't do this or do this?

CAVAN: Yeah, the piece of advice I would give myself is advice we actually received pretty frequently and didn't believe, and then it ended up almost totally derailing the company.

WILL: Oh wow.

CAVAN: And that's that, you know, both my co-founder and I were first-time founders. I think we're really smart. We're definitely hard-working, you know, very motivated people. And we were really convinced that we'd be able to just do a full-out sprint and never stop sprinting. And we kept on getting told by advisors and investors, "Hey, it's a marathon. It's a marathon." We were like, you know, we're just going to sprint the marathon. That started out okay, and then a couple of years in, we started hitting walls and really realized that you can't sprint a marathon.

Startups take way longer than I think founders hope they do or think that they're going to take to develop. Digital health and our healthcare system moves much, much more slower than kind of people think. So especially if you're a founder in digital health, you need to be building both a company and, I think, a personal lifestyle that's sustainable. You need to make sure that the company has money in the bank and can be around for years and years and years. And you need to make sure that your job, your day-to-day, is something that you can also continue to do for years and years and years.

So that's ultimately, I think, the most important thing that we're able to tell our customers and something that we've now gotten the company in a position to be in, which is, hey, we're a sustainable business. We're a stable business. We'll be around in 10 years. And that ends up being a huge selling point for us. But definitely, if I would go back and do it again, I would have been smarter about that from day one. I would have avoided a lot of big pain points.

WILL: Yeah. It reminds me of when I started in development. I tried that same sprint the marathon, and so many of my co-workers were like, "Slow down, you're going to burn out. You're going to burn out." And it reminds me of that when you say that.

CAVAN: Yep. And everybody thinks they're invincible, and then you realize occasionally you're not. And then also you look at it from hindsight, and you're like, well, the code I was writing between 2:00 a.m. and 6:00 a.m. every night for three months was not the best code.

WILL: [laughs]

CAVAN: And once you get to a point when you get some breathing room, it's almost that you got to go slow to go fast type things where a lot of these best practices, having really good test cases, having good CI, having good work-life balance for employees I do think on a long-enough timeline actually allows you to go much, much, much faster versus just trying to crunch the whole time.

WILL: Totally, totally. I can't tell you how many bugs that I fixed that I was sitting down for hours and hours. I go on a 15-minute walk, and I solve it in the first 5 minutes.

CAVAN: Yeah, absolutely. I literally, I mean, if I get stuck on something, you know, I just end up doing too much coding. But if I ever really, really get hung up, whether it's coding, or design, or anything like that, I'm like, at this point, I'm a cognizant of the pain. I'm not making progress. I'm spinning my wheels. I'm getting more and more frustrated with everything happening on my laptop and, like, exactly as you mentioned, go walk around the block. Come back, and you have that eureka moment pretty frequently.

WILL: Definitely, definitely.

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WILL: You kind of mentioned it, mental health. And I was listening somewhere where you said, "It's not about doing 100-hour weeks, every week, every week, every week." So for Healthie, what are some of those things that you have implemented to stay healthy, to be able to run the marathon and not burn out?

CAVAN: I loved startups and entrepreneurship stories growing up. I would read TechCrunch and Hacker News and all this stuff and Twitter. It's gotten a little better, but there's still really this pervasive mentality of like, you know, I used to have my background computer screen was, you know, "Work like somebody's trying to take it away from you 24 hours a day," which is a Mark Cuban quote. And just all these things where if you're not doing the hustle porn, if you're not putting in the 100-hour weeks, you're not a real entrepreneur. You're not going to build a good business, like, you're going to lose out.

I had really, really taken that to heart. And that kind of goes back to the sprinting a marathon piece where eventually, in 2018, it's like, well, this is not really a sustainable thing. And for us to build a sustainable, long-lasting business, for us to have the impact that my co-founder and I and the rest of the people in the company wanted to have, you need to build really a sustainable business and a sustainable lifestyle.

So I think at Healthie, or what I generalize to other companies, is the number kind of day one thing is how was the company funded? Because that ultimately drives a ton of what is determined to be sustainable. We've been lucky enough where we've had this interesting fundraising story. We raised a million dollars to basically build a related but kind of more narrow in scope business. I realized pretty quickly that that was not going to be some huge venture-scale success that we would not be able to raise more money.

We were profitable for years and years and years, kind of rebuilt the whole platform, and got into this much, much larger space. And we did last year raise another 16 and a half million dollars. But one of our most important questions, when we raised that money, was, hey, we need to find investors that are long-term aligned. We weren't looking for people looking to flip their equity in a year. We weren't looking for people who are going to push us to grow at all costs and not look at spending or how we were growing. We just wanted growth, growth, growth.

So we found investors that were really, really aligned with our long-term vision for the company. We still look at cash very, very closely. The Slack message I'm going to look out for most every week is our VP of finances, like, our breakdown on our cash flows, so I keep a very close eye there. And then really build a business that people want to pay for and use. And, at this point, we have 80-something people. Payroll is getting more and more substantial, but that's all offset by our customers and their revenue, and that is really what's sustainable. And so that's more the finance side of things.

And then, as far as the company as a whole, I mean, being super cognizant that having crunch time is not a good thing. It's not a feature; it's a huge bug. When we agree to projects, we're making sure that we're planning things out. We're leaving breathing room where we're not asking employees to work crazy hours. We're not burning employees out. We're not burning ourselves out.

And it's not not working hard because it's still working hard, but it's working hard in a very smart and focused way that is less all-consuming. I think also as a boss, just being a decent person. If people have life events that pop up, if people have crises, and people have things they need to deal with, you know, work is incredibly important. I love what I do. I think about it all day. But there's a life outside of work, and making sure that we're allowing employees to have time for that, once again, is really important for long-term sustainability.

WILL: Wow, that's really neat. That's really neat. And yeah, I totally agree with that. That sounds like a great company. And I think that's the building blocks of what it takes to start the company. So that's amazing. What are some of your accomplishments? I love for my guests to come on and brag about themselves. I know you said that you've been around seven years. You just raised $16 million. You have about 80 employees. That's amazing. What are some of the things that we don't know? Would you like to share anything with us?

CAVAN: I mean, look, I started Healthie as a freshman in college. I dropped out to work on it full-time, so Healthie has been my whole career. And I think to go on a bit of a bragging rant; Healthie has had a lot of success so far. But my co-founder and I always like to joke we're halfway into being a 13-year overnight success. So when I like to brag, I like to brag partly about what Healthie is doing. But what Healthie does is enable other companies. So I really like to brag about what those other companies are doing.

Companies using Healthie have raised over $2 billion in venture. We're supporting millions and millions of patient lives. We're supporting thousands and thousands of providers. We've seen people go from two founders in a venture studio up to these massive hundreds and hundreds of people organizations, and we do it not just in one space but in a big range of spaces. We're doing it in weight loss, behavioral health, addiction treatment, sleep, other kinds of mental health areas, chronic pain.

And the type of care that we're enabling people to provide is proactive. So we're having people treat obesity, not a heart attack, diabetes, not an amputation, addiction, not an overdose. And ultimately, what I really, really think that does is that's enabling kind of this sea change in how healthcare works in this country where the more proactive we get, the less people end up in hospitals. The cheaper healthcare is, the more efficient healthcare is, the better patient experience patients receive, and ultimately, the better healthcare they receive. So that's really what I like to brag about because, ultimately, we are kind of that core infrastructure layer that's enabling a lot of that.

WILL: Wow, that's really neat. I can't remember the name of the guy that said it, but he said there are usually three Ps, and most companies struggle with one. So it's people, products, and processes, and mostly people struggle with the processes. And it sounds like Healthie is able to help people, medical providers, with that process and to kind of say, hey, let me take that. That may not be your strong suit, so you can go and do your product and the people and stuff like that.

CAVAN: Yeah, what I really say is when you think about what makes kind of these digital healthcare companies unique, a lot of time, it's a new insight or a new type of care model. They want to combine a newly approved FDA drug that's really effective with a series of coaching encounters in a different sequence than people have been doing with really great educational content, et cetera.

We see all these different care plans in all these different areas, and they end up unique to the company and then even to patients within the company. But to be able to deliver that care plan, there are so many kinds of table stakes things you need that I really describe as boring, difficult, and non-differentiated and can only really negatively impact the company. If you have an appointment with your doctor and the video call works, you're not necessarily thinking more highly of the doctor, but if it doesn't work, if it's a shitty piece of software...

WILL: [laughs]

CAVAN: If you're not able to connect, then suddenly you think a lot worse of them. And these things are hard; getting reminders out in the right time zones, handling daylight savings time, running servers 24/7 with great uptime. These things are non-trivial, but you need to be able to do them just to be able to get to like the 5% that really makes the business unique, which is the unique care model. So that's kind of really what we enable. So yeah, I would say it's a lot of the process. It's a lot of those kinds of table stakes infrastructure but in a way that's flexible enough where they're not having to sacrifice those unique insights that they have.

WILL: Yeah, that's really neat, really, really neat. I want to shift a little bit, and I read this in a blog, so companies have been getting in trouble for data sharing. That's been the big thing right now. And I think it was your CEO that said, "Data is our customers' data; it's not Healthie's data. And that is true day one, and it's true today." Tell me more about that. Tell me kind of the outlook of Healthie with customers' data.

CAVAN: So ultimately, I think one of the things going back to sustainable long-term success is around aligned incentives. So we need to make sure that the business we're building, the way we make money, the way we succeed as a company is aligned with the way our customers succeed. And when you think about it from a data perspective, our customers are the businesses. We help them deliver care. We have, as I mentioned, millions and millions of patient lives kind of all these visits, outcomes, et cetera.

And hypothetically, you could say, try to build a business where you don't really sell the software. You give it away very cheaply, but you retain rights to the data. And then you package that, anonymize it, and sell it to pharma, or whatever, and just kind of use it really as a data platform. And I think definitely there have been EHRs out there who have done similar approaches or at least thought they would.

And ultimately, why it's so bad, or at least why we think it's so bad is because it's a fundamentally different incentive. At that point, your customers are no longer your customers. Your customers become the product, and your customers' data becomes the product. And there are some cases if you're running a free social media site, well, maybe that's the way you have to run it. What's really great about what we do is we're selling underlying software to really successful businesses that build great companies, make a lot of money, and are more than happy to pay subscription fees for that.

And then, once you're in that really enviable position, it's not worth muddying the water with anything that misaligns those incentives. So we've been very, very clear from day one that we don't provide healthcare. We are not a data play. We are a software infrastructure company. That's what we do, that's what we're great at. That's what we focus on, and we don't mess with the other stuff.

WILL: That's amazing. I love that. One of the other big things, especially in healthcare, digital healthcare, have been online threats and things like that. Tell me a little bit about that. How are you keeping your company safe from those online threats?

CAVAN: Ultimately, one of those things where let's say all our customers try to build their own stuff, they don't have the resources. They don't have the know-how. They don't have the focus. And you end up even if they have the functionality, who knows how good that security is? So one of the benefits we offer companies is, going back to one of the things we have to be really, really good at, is security. So Healthie is a secure platform. We're HIPAA compliant. We're SOC 2 Type 2 compliant. We're audited by a third party on both of those. And it's something that we think a lot about ourselves, but it also becomes a big benefit to our customers.

So if you're a brand new startup and you're trying to sell to a major hospital system, and we've seen this a lot, like, very often, they'll have myself or another security-focused person on Healthie on the call. And we enable them to have good answers to these questions because we're the ones running the servers. We're storing the data. We are already making these good decisions. We have best practices in place and have these accreditations and certifications. And that enables our customers, once again, to focus on delivering care and not in reinventing the security wheel.

So it's a big thing we think about. We're talking about security constantly here at Healthie, you know, always running kind of 24/7 compliance tools, always making sure that we're improving our security posture. But ultimately, we do it so that our customers need to worry less about it. And it is one of the...going back to the things that, you know, we don't mess with data. We do worry a lot and think a lot and do a lot around security.

WILL: That's amazing. Awesome. Love it. I want to close on this: what does Healthie have coming up, anything exciting coming up in the next year?

CAVAN: I mean, I'm excited every day when I see our customers expanding when I see the new customers we're talking to. I mean, I think, really, we've been doing the same thing, just at a larger and larger scale, for the past seven years. And our goal for 2023 as a company, and we talk about this a lot internally, is to go from startup to scaleup.

So at the end of 2023, if I look back ten months from now and say, hey, what did we set out to do? What did we accomplish? It's did we continue to build the best team? Did we continue to build the best product? Did we continue to provide the best customer experience? And are our customers seeing a lot of success on the platform? And it's not like there's a new product line to enable that. You're not going to have some silver bullet that's going to change the dynamics. But it's really we just want to take what we're doing that we're doing a really good job of and just do that on a higher scale. So that's really what we're thinking about for 2023.

WILL: I love it. Sometimes just being consistent is the way to go, so I love that.

CAVAN: Yeah, you got to show up. Look, I used to wrestle. The way you become a good wrestler is not by knowing 800 wrestling moves. It's by knowing five moves and practicing them every day over and over again for years, and that's true of a lot of sports. It's true with startups. It's just consistent focus and having an aligned mission at the company. Really, really focused on pushing the ball forward every day, day in, day out, is just so, so important. And that's really what we do here.

WILL: I love it. Love it. Love it. Is there anything that we didn't cover that you would like to share with the audience?

CAVAN: I think if you're a company building in the digital health space, if you care about having these strong relationships with your patients, definitely check us out; we're gethealthie.com. Healthie is with an I-E. And then love talking to startups, love talking digital health, and always happy to talk.

WILL: You can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, email us at hosts@giantrobots.fm. You can find me on Twitter @will23larry.

This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thanks for listening, See you next time.

ANNOUNCER: This podcast is brought to you by thoughtbot, your expert strategy, design, development, and product management partner. We bring digital products from idea to success and teach you how because we care. Learn more at thoughtbot.com.

Special Guest: Cavan Klinsky.

Sponsored By:

• thoughtbot: Are you an entrepreneur or start-up founder looking to gain confidence in the way forward for your idea? At thoughtbot, we know you’re tight on time and investment, which is why we’ve created targeted 1-hour remote workshops to help you develop a concrete plan for your product’s next steps. Over four interactive sessions, we work with you on research, product design sprint, critical path, and presentation prep so that you and your team are better equipped with the skills and knowledge for success. Find out how we can help you move the needle at: tbot.io/entrepreneurs

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