1/10
ACUITYhealth 20-Month Strategic Roadmap
🎯From NIH-Funded Pilot to Series A Ready
Mission & Strategic Context
Core Mission: Transform value-based healthcare delivery through AI-powered predictive analytics (Continuous Health Index) and nationwide interoperability via TEFCA/QHIN networks, targeting a 30% reduction in preventable hospital admissions for chronic disease patients while building a venture-scalable SaaS platform.
Market Opportunity: The U.S. spends $4.3T annually on healthcare with 30% ($1.3T) considered wasteful. Our initial focus on CHF addresses 6.2M patients with $30B in annual costs, where 25% of patients are readmitted within 30 days. CMS penalties and value-based contracts create immediate ROI incentive for providers and payers to adopt predictive intervention tools.
$1.5M
Initial Budget
+ NIH SBIR potential
+ NIH SBIR potential
20 Months
Timeline
To Series A ready
To Series A ready
$1.68M
Target ARR
$140K MRR by M20
$140K MRR by M20
15K+
Patients Managed
Across 3-5 clients
Across 3-5 clients
Strategic Phases with Key Inflection Points
Phase 0 (Month 1): Foundation Setting
• Establish CommonWell integration (access to 5B+ health records nationwide)
• Deploy CHI algorithm v1 with home health pilot (700 patients)
• Set pilot-to-paid conversion criteria (e.g., 10% readmission reduction = auto-convert)
• Burn: $30K/month | Cash: $1.47M remaining
• Establish CommonWell integration (access to 5B+ health records nationwide)
• Deploy CHI algorithm v1 with home health pilot (700 patients)
• Set pilot-to-paid conversion criteria (e.g., 10% readmission reduction = auto-convert)
• Burn: $30K/month | Cash: $1.47M remaining
Phase 1 (Months 2-4): Pilot Validation & First Revenue
• Achieve pilot success metrics (15% readmission reduction documented)
• Convert pilot to $20K/month subscription (validates business model)
• Begin NIH SBIR Phase I submission (non-dilutive funding pathway)
• Burn: $30K/month | Revenue: $0→$20K | Cash: $1.38M
• Achieve pilot success metrics (15% readmission reduction documented)
• Convert pilot to $20K/month subscription (validates business model)
• Begin NIH SBIR Phase I submission (non-dilutive funding pathway)
• Burn: $30K/month | Revenue: $0→$20K | Cash: $1.38M
Phase 2 (Months 5-6): Product-Market Fit Confirmation
• Complete patient engagement tool (90%→100%) and payer portal (70%)
• Secure second client commitment (ACO with 3K patients)
• Document ROI evidence portfolio for sales/investors
• Burn: $40K | Revenue: $20K | Net: -$20K | Cash: $1.32M
• Complete patient engagement tool (90%→100%) and payer portal (70%)
• Secure second client commitment (ACO with 3K patients)
• Document ROI evidence portfolio for sales/investors
• Burn: $40K | Revenue: $20K | Net: -$20K | Cash: $1.32M
Phase 3 (Months 7-10): Multi-Client Scale & Break-Even
• Onboard clients #2 and #3 (total 12K patients under management)
• Achieve cash flow positive operations (Month 9 milestone)
• Build enterprise features (multi-tenancy, OASIS-E, ambient capture)
• Burn: $50K | Revenue: $40K→$80K | Net: +$20K | Cash: $1.27M→$1.35M
• Onboard clients #2 and #3 (total 12K patients under management)
• Achieve cash flow positive operations (Month 9 milestone)
• Build enterprise features (multi-tenancy, OASIS-E, ambient capture)
• Burn: $50K | Revenue: $40K→$80K | Net: +$20K | Cash: $1.27M→$1.35M
Phase 4 (Months 11-16): Enterprise Validation
• Deploy with anchor client (10K+ patients, major health system)
• Demonstrate 20% readmission reduction at scale
• Initiate Series A discussions with proven enterprise traction
• Burn: $60K | Revenue: $100K→$120K | Net: +$40K | Cash: $1.50M
• Deploy with anchor client (10K+ patients, major health system)
• Demonstrate 20% readmission reduction at scale
• Initiate Series A discussions with proven enterprise traction
• Burn: $60K | Revenue: $100K→$120K | Net: +$40K | Cash: $1.50M
Phase 5 (Months 17-20): Growth Acceleration
• Scale to 5 clients with shared-savings PMPM models
• Close Series A ($5-8M at $20-30M valuation)
• Expand team from 6 to 15 (engineering, sales, clinical)
• Burn: $70K | Revenue: $140K | Net: +$70K | ARR: $1.68M
• Scale to 5 clients with shared-savings PMPM models
• Close Series A ($5-8M at $20-30M valuation)
• Expand team from 6 to 15 (engineering, sales, clinical)
• Burn: $70K | Revenue: $140K | Net: +$70K | ARR: $1.68M
Critical Success Dependencies
- Technical: CommonWell/QHIN interoperability must deliver nationwide data access - this is our competitive moat vs. single-EHR solutions
- Clinical: CHI algorithm must achieve c-statistic ≥0.8 for credible predictions (NIH Phase I requirement)
- Business: Pilot-to-paid conversion rate must exceed 70% (industry average is 30-40%)
- Financial: Must reach break-even by Month 9 to extend runway without bridge funding
Strategic Narrative: We're building essential infrastructure for value-based care transformation. By leveraging NIH validation, TEFCA's nationwide interoperability, and proven ROI at multiple sites, we create a defensible position that's difficult for competitors to replicate. The 20-month journey systematically de-risks each component: clinical efficacy → business model → operational scale → enterprise readiness → venture scale.
2/10
Phase 0-1: Foundation & First Revenue (Months 1-4)
🚀Phase 0: Critical Foundation Setting (Month 1)
$30K
Monthly Burn
Lean team of 4-6
Lean team of 4-6
700 pts
Pilot Cohort
CHF patients, home health
CHF patients, home health
3 months
Pilot Duration
With conversion triggers
With conversion triggers
5B+
Records Access
Via CommonWell
Via CommonWell
Month 1 Deep Dive: Setting Up for Success
COO Critical Tasks (Operational Foundation):
- Pilot Agreement Structure: Define explicit success metrics (10% readmission reduction = conversion), payment terms post-pilot ($20K/month target), and escalation clause for expansion to additional departments
- Compliance Framework: Execute HIPAA BAA with 48-hour breach notification, establish IRB determination (likely exempt as quality improvement), document data use agreements for NIH reporting
- Resource Optimization: Engage 2-3 1099 developers at $100-150/hour for 20 hours/week, establish weekly sprint cycles, implement daily standups for pilot period
- Budget Controls: Set up burn rate monitoring dashboard, establish vendor payment terms (NET 30), negotiate cloud credits from AWS/Azure ($5-10K typical for startups)
CTO Critical Tasks (Technical Infrastructure):
- CommonWell Integration: Implement OAuth 2.0 authentication, configure patient matching algorithm (probabilistic matching with 95%+ accuracy target), establish real-time data sync for ADT (Admit/Discharge/Transfer) feeds
- Data Pipeline Architecture: Deploy Apache Kafka for streaming, implement FHIR R4 data model, map to USCDI v3 (covering 23 data classes including SDOH), establish data lake in S3/Azure Blob
- RPM Foundation: Integrate with 2-3 device vendors (blood pressure, weight, pulse ox), implement anomaly detection for vital signs (±2 SD triggers), create alert routing to care team
- Security Baseline: Implement AES-256 encryption at rest, TLS 1.3 in transit, set up VPN for clinical access, enable audit logging for all PHI access
CMO Critical Tasks (Clinical Integration):
- Baseline Metrics Collection: Document current 30-day readmission rate (typically 22-25% for CHF), ED visit frequency, average length of stay, medication adherence rates via pharmacy data
- Workflow Mapping: Shadow nurses for 2-3 days to understand current process, identify integration points (morning huddle, discharge planning), document time spent on documentation (typically 2-3 hours/day)
- Champion Development: Identify and nurture 2-3 clinical champions (typically charge nurse + physician lead), provide them with early access and input opportunities, establish weekly feedback sessions
💰Phase 1: The Critical Pilot-to-Paid Journey (Months 2-4)
Month-by-Month Execution Plan
| Period | Technical Deliverables | Clinical Outcomes | Business Milestones | Risk Factors |
|---|---|---|---|---|
| Month 2 Iteration |
• UI/UX refinement based on Week 1-2 feedback • QHIN sandbox testing • Alert algorithm v2 (reduce false positives by 50%) • Mobile responsiveness |
• First CHI scores generated • 10-15 interventions triggered • Provider adoption at 60% • Initial time savings documented |
• Weekly pilot reviews • Stakeholder buy-in meetings • Pricing validation ($20-30K/mo) • Reference site prep |
• Low user adoption • Data quality issues • Integration delays • Champion turnover |
| Month 3 Validation |
• Ambient documentation beta • Performance optimization (sub-2s load) • Batch processing for reports • API documentation complete |
• 30+ interventions completed • First prevented admission documented • Provider adoption at 80%+ • Patient engagement at 40% |
• Contract negotiation start • ROI calculation (expect 3:1) • Expansion discussion • Case study draft |
• Outcome attribution • Budget approval delays • Competing priorities • Contract scope creep |
| Month 4 Conversion |
• Production deployment • Security audit complete • Disaster recovery tested • v2.0 roadmap defined |
• 15% readmission reduction achieved • 90% provider satisfaction • Workflow integration complete • Training materials finalized |
• Contract signed: $20K/mo • Payment terms: NET 30 • 12-month commitment • Expansion option included |
• Legal review delays • Procurement process • Competition emerge • IP concerns |
Pilot Success Metrics & Conversion Triggers
Pre-Defined Conversion Criteria (Any 2 of 3 triggers automatic discussion):
- Clinical: ≥10% reduction in 30-day readmissions OR ≥15% reduction in ED visits
- Operational: ≥80% provider adoption with ≥70% saying tool is "valuable" or "very valuable"
- Financial: Projected annual savings ≥3x annual subscription cost ($240K savings vs $80K cost)
Conversion Strategy: Week 10 of pilot: Present interim results → Week 11: Contract discussion → Week 12: Sign or extend decision
Critical Success Factors for Phase 1
Why Most Pilots Fail to Convert (And How We Avoid It):
- Unclear Success Metrics: We define these upfront in contract with automatic triggers
- No Budget Allocated: We confirm budget availability before pilot starts and get written commitment
- Lack of Champion: We identify 2-3 champions and make one a co-signer on pilot agreement
- Pilot Fatigue: We limit to 3 months maximum with clear end date
- Poor Change Management: We provide dedicated clinical support throughout pilot
NIH Phase I Alignment: Throughout Months 1-4, we're executing Aim 1 (develop and validate CHI algorithm with c-statistic ≥0.8) and Aim 2 (demonstrate feasibility in clinical setting). We document all activities for quarterly NIH progress reports, positioning for Phase II application ($1.5M over 2 years) by Month 6. The pilot success directly supports our Phase II commercialization narrative - showing market validation alongside technical achievement.
3/10
Phase 2: Operational Excellence & Scale Preparation (Months 5-6)
⚙️Building Repeatable Success Systems
$30→$40K
Burn Increase
Infrastructure scaling
Infrastructure scaling
$20K
MRR Baseline
Client #1 stable
Client #1 stable
-$20K
Net Burn
Still investing mode
Still investing mode
$1.32M
Cash Runway
44 months at current
44 months at current
Month 5: Systematizing Success
Product Development Priorities (CTO/Dev Team):
- Patient Engagement Tool Completion (90%→100%):
- Mobile app with biometric integration (Apple Health, Google Fit)
- Automated symptom surveys via SMS/app (2-3 questions daily, 85% response rate target)
- Educational content delivery based on CHI risk tier (low/medium/high)
- Medication reminders with pharmacy fill tracking integration
- Gamification elements: streaks, badges for adherence (increases engagement 40%)
- QHIN/CommonWell Advanced Integration:
- Implement record locator service for 95%+ patient matching across networks
- Set up bi-directional data exchange (not just consuming but contributing data back)
- Configure data freshness monitoring (flag if data >48 hours old)
- Implement consent management per TEFCA requirements
- Mission Control Dashboard v1:
- Real-time patient risk stratification view (red/yellow/green)
- Automated daily huddle reports (top 10 at-risk patients)
- Care team assignment and workload balancing
- Intervention tracking with outcome correlation
Market Development Strategy (CSO/Sales):
- Reference Site Documentation: Create 3-page case study with 15% readmission reduction, 2.5 hours/week time saved per clinician, 3.2:1 ROI within 6 months
- Second Client Pipeline Development:
- Target ACO with 3,000 Medicare Advantage lives (high readmission penalties)
- Leverage warm intro from Client #1's medical director
- Offer 60-day pilot with success-based pricing ($10K setup + $30K/mo if targets hit)
- Present bundled offering: platform + implementation + quarterly optimization
- ROI Evidence Portfolio: Compile metrics across clinical (readmission rates), operational (time saved), financial (cost avoidance), and satisfaction (NPS scores)
Operational Scaling (COO):
- Process Documentation: Create 50+ SOPs covering onboarding, training, support, billing, security incidents
- Resource Planning: Model capacity needs for 2, 5, and 10 clients - identify breaking points
- Vendor Management: Negotiate volume discounts with cloud providers (save 20-30% with committed use)
- Quality Assurance: Implement weekly client health scores, monthly business reviews, quarterly outcome assessments
Month 6: Acceleration & Second Client Preparation
Product Completion Status & Priorities:
Payer Portal: 70% (Dashboard, Reports, ROI Calculator)
Patient Engagement: 100% (Mobile, SMS, Education, Tracking)
AI Primitives: 65% (CHI Complete, NLP 70%, Ambient 50%)
Interoperability: 85% (CommonWell Live, QHIN Testing, USCDI v3)
Critical Month 6 Achievements:
| Category | Target Metric | Actual Achievement | Impact |
|---|---|---|---|
| Clinical Outcomes | 10% readmission reduction | 15% reduction achieved | $450K annual savings for client |
| User Adoption | 70% weekly active use | 82% weekly active | Strong product-market fit signal |
| Pipeline Development | 1 qualified lead | 2 LOIs in negotiation | $60K potential MRR |
| Technical Performance | 99.5% uptime | 99.8% uptime | Enterprise-ready reliability |
OASIS-E Integration Planning (Home Health Focus):
- Automated Assessment Capture: Pre-populate 60% of OASIS-E fields from EHR/QHIN data (saves 45 minutes per assessment)
- Compliance Tracking: Real-time validation against CMS requirements with error prevention
- Quality Measure Optimization: Predict and improve star ratings through targeted interventions
- Reimbursement Maximization: Ensure accurate case-mix capture (average $200 per episode increase)
⚠️ Month 5-6 Risk Mitigation Strategies:
- Second Client Delay Risk: If Client #2 negotiations stall, implement "Rapid Start Program" - pre-packaged 60-day pilot with guaranteed outcomes or money back. This reduces buyer risk and accelerates decision-making.
- Technical Debt Accumulation: Allocate every Friday for refactoring and optimization. Technical debt interest compounds - address it before scaling to multiple clients.
- Client #1 Attention Deficit: Assign dedicated "Customer Success Lead" (even if part-time) to maintain Client #1 satisfaction while pursuing growth. Losing first reference would be catastrophic.
- Cash Flow Gap: If Client #2 delays beyond Month 7, consider invoice factoring for Client #1 or negotiate partial upfront payment from Client #2.
🎯 Phase 2 Success Criteria (Must Hit 4 of 5):
- ✓ Client #1 achieving target outcomes (≥10% improvement in key metric)
- ✓ Second client commitment secured (LOI or contract)
- ✓ Product feature completion ≥85% across all modules
- ✓ Documented, repeatable onboarding process (≤30 days)
- ✓ Cash burn rate controlled (≤$40K/month)
Why This Matters: Phase 2 proves we can deliver consistent value and prepare for scale. Without operational excellence here, multi-client operations in Phase 3 will fail. This is where we transform from a pilot project to a real business.
Strategic Inflection Point: By end of Month 6, we've proven three critical things: (1) Our solution delivers consistent, measurable outcomes, (2) Our business model is repeatable with predictable unit economics, and (3) We have systems to scale beyond founder-led everything. This positions us to confidently pursue multi-client operations in Phase 3, knowing we can deliver without overwhelming our small team. The $1.32M remaining cash gives us 30+ months runway at current burn, but we're targeting break-even by Month 9 to control our destiny.
4/10
Phase 3: Multi-Client Operations & Scale Validation (Months 7-10)
📈Proving Scalability While Achieving Break-Even
Months 7-8: Second Client Onboarding
• ACO with 3,000 Medicare Advantage patients goes live
• Revenue doubles from $20K to $40K MRR
• Technical infrastructure tested at 3x scale
• First multi-tenant architecture challenges resolved
• ACO with 3,000 Medicare Advantage patients goes live
• Revenue doubles from $20K to $40K MRR
• Technical infrastructure tested at 3x scale
• First multi-tenant architecture challenges resolved
Months 9-10: Break-Even Achievement
• Third client pipeline matures (10K patient opportunity)
• Cash flow positive operations ($60K revenue vs $50K burn)
• Anchor client discussions initiated
• Series A narrative crystallizes with proven unit economics
• Third client pipeline matures (10K patient opportunity)
• Cash flow positive operations ($60K revenue vs $50K burn)
• Anchor client discussions initiated
• Series A narrative crystallizes with proven unit economics
Multi-Client Architecture Evolution (Months 7-8)
| Component | Single Client Reality | Multi-Client Requirements | Implementation Details |
|---|---|---|---|
| Data Infrastructure | • Single PostgreSQL database • Basic backup strategy • Manual data refresh |
• Multi-tenant with isolation • Real-time replication • Automated ETL pipelines |
• Implement schema-per-client in PostgreSQL • Set up streaming replication to read replicas • Deploy Apache Airflow for orchestration • Cost impact: +$2K/month infrastructure |
| Integration Layer | • Custom CommonWell connection • Hard-coded mappings • Single EHR type |
• Configurable QHIN connections • Dynamic field mapping • Multiple EHR support |
• Build integration abstraction layer • Create mapping templates for Epic, Cerner, Allscripts • Implement webhook architecture for real-time updates • Development time: 3 sprints (6 weeks) |
| Support Model | • Founder-led, ad-hoc • WhatsApp/email • No documentation |
• Ticketing system (Zendesk) • Defined SLAs • Knowledge base |
• 4-hour response for critical, 24-hour for standard • Create 50+ help articles, 10 video tutorials • Implement chat widget with business hours support • Cost: $200/month tools + 20 hours/week support |
| Deployment Process | • 3-month manual process • Custom everything • High-touch onboarding |
• 60-day standardized • Templated approach • Self-service elements |
• Week 1-2: Technical setup & integration • Week 3-4: User training & workflow design • Week 5-6: Pilot with subset • Week 7-8: Full rollout & optimization • Success rate: 85% on-time delivery |
Financial Evolution & Break-Even Analysis (Month 9)
Month 7
Revenue: $20K
Burn: $40K
Net: -$20K
Burn: $40K
Net: -$20K
Month 8
Revenue: $40K
Burn: $50K
Net: -$10K
Burn: $50K
Net: -$10K
Month 9
Revenue: $60K
Burn: $50K
Net: +$10K ✓
Burn: $50K
Net: +$10K ✓
Month 10
Revenue: $80K
Burn: $60K
Net: +$20K ✓
Burn: $60K
Net: +$20K ✓
🎯 Break-Even Milestone Significance (Month 9):
Achieving positive cash flow with just 2 clients ($60K MRR) demonstrates exceptional unit economics:
- Per-Client Economics: $30K revenue, $15K marginal cost = 50% contribution margin
- Fixed Costs: $20K/month (core team, infrastructure) covered by 1 client
- Scalability Proof: Client #3+ are nearly pure margin (70%+ contribution)
- Investor Signal: Efficient capital use - can grow without burning cash
This positions us to control our destiny - we can choose when/if to raise, not be forced by runway.
Client #2 Onboarding Deep Dive (ACO, Months 7-8)
Week-by-Week Implementation Plan:
Weeks 1-2: Technical Foundation
- Connect to ACO's Cerner EHR via FHIR API (different from Client #1's Epic)
- Set up dedicated cloud environment with HIPAA-compliant boundaries
- Configure CHI algorithm for Medicare Advantage population (adjust for age/comorbidity)
- Import historical data for baseline (12 months claims + clinical)
Weeks 3-4: Clinical Integration
- Train 15 care managers across 3 locations (virtual + on-site)
- Customize alerts for ACO's care gaps (HCC coding, quality measures)
- Integrate with ACO's existing care management platform (bi-directional)
- Set up automated reporting for Medicare Advantage metrics
Weeks 5-6: Pilot Launch
- Start with 300 highest-risk patients (top decile by CHI score)
- Daily huddles to review alerts and interventions
- Track early indicators: alert accuracy, intervention rate, user feedback
- Adjust thresholds based on ACO's intervention capacity
Weeks 7-8: Full Deployment
- Expand to all 3,000 MA patients
- Implement automated workflows (alerts → tasks → documentation)
- Launch patient engagement for high-risk cohort (500 patients)
- Begin tracking ROI metrics for quarterly CMS reporting
Anchor Client Preparation Strategy (Months 9-10)
Target Profile: Regional Health System (10-15K patients)
- Why They're Interested: CMS readmission penalties costing $2M annually, need proven solution
- Our Approach: Lead with multi-site evidence (20% reduction across 2 clients)
- Negotiation Leverage: Offer co-development partnership for specialty expansion
- Deal Structure: $50K implementation + $100K/month subscription (6-month pilot)
Pre-Anchor Requirements Checklist:
- ☐ SOC 2 Type I audit initiated (Month 9, $15K investment)
- ☐ Performance testing completed for 50K patient load
- ☐ Disaster recovery plan tested (RPO: 1 hour, RTO: 4 hours)
- ☐ Enterprise SSO capability (SAML 2.0, Active Directory)
- ☐ Advanced analytics dashboard with executive views
- ☐ 24/7 on-call support plan (even if manual initially)
Phase 3 Strategic Achievement: By Month 10, we've proven three critical capabilities that investors and enterprise clients require: (1) Multi-client scalability - successfully managing different client types with different EHRs, (2) Positive unit economics - break-even with just 2 clients shows efficient growth potential, and (3) Enterprise readiness - technical infrastructure and support processes ready for 10x scale. Cash position remains strong at $1.35M (actually growing from operations), providing negotiating leverage for Series A. The $960K ARR run rate puts us on track to exceed $1.5M ARR by Month 20.
5/10
Business Model Canvas: From Hypothesis to Market Validation
🎨Strategic Evolution Across 9 Building Blocks
Key Partners
Evolution:
- M1-4: CommonWell (data access)
- M5-8: + RPM vendors (3 devices)
- M9-12: + Clinical advisors
- M13-16: + Anchor as co-dev
- M17-20: + Channel partners
Strategic value: $2M+ in avoided dev costs
Key Activities
Resource Allocation:
- Product Dev: 40% → 25%
- Clinical Integration: 30% → 20%
- Sales/Marketing: 10% → 35%
- Customer Success: 10% → 15%
- Evidence/Compliance: 10% → 5%
Shift from building to selling/scaling
Value Propositions
Quantified Benefits:
- Clinical: 30% readmission ↓
- Financial: 3.2:1 ROI in 6mo
- Operational: 2.5 hrs/week saved
- Compliance: OASIS-E auto-fill
- Strategic: QHIN nationwide data
$450K annual savings per 1,000 patients
Customer Relationships
Engagement Model:
- Pilot: Daily touchpoints
- Onboarding: Weekly reviews
- Steady-state: Monthly QBRs
- Expansion: Quarterly strategy
- Advocacy: User groups, referrals
NPS: 45 → 65 over 6 months
Customer Segments
TAM/SAM/SOM:
- TAM: $15B (all chronic care)
- SAM: $3B (CHF + risk contracts)
- SOM Y1: $2M (5-10 clients)
- Primary: ACOs, MA plans
- Secondary: Home health, IDNs
Focus: 500 qualified prospects
Key Resources
Asset Value:
- CHI Algorithm: Patent pending
- Clinical Data: 50K patients
- Team: 6 FTE + 4 contractors
- Capital: $1.5M + NIH grants
- References: 3-5 case studies
Enterprise value: $20-30M by M20
Channels
Customer Acquisition:
- Direct Sales: 60% (founder-led)
- Referrals: 25% (client intros)
- Conferences: 10% (HIMSS, etc)
- Partners: 5% (emerging)
- CAC: $15K → $8K by M20
Sales cycle: 6 months → 3 months
Cost Structure
Monthly Breakdown (M20):
- Personnel: $42K (60%)
- Infrastructure: $14K (20%)
- Sales/Marketing: $7K (10%)
- Compliance: $3.5K (5%)
- Other: $3.5K (5%)
Gross margin: 60% → 75%
Revenue Streams
Pricing Evolution:
- Pilot: Free (3 months max)
- Starter: $20K/mo (500 patients)
- Growth: $40K/mo (2K patients)
- Enterprise: $100K+ custom
- Add-ons: Training, PMPM bonus
LTV:CAC = 10:1 (best-in-class)
Canvas Maturity Progression & Risk Mitigation
| Phase | Canvas Focus | Key Risks | Validation Metrics | De-risking Actions |
|---|---|---|---|---|
| Phase 1 M1-4 |
Value Prop Testing | • No product-market fit • Technical feasibility |
• 15% outcome improvement • 80% user adoption |
• Weekly user feedback • Rapid iterations |
| Phase 2 M5-6 |
Revenue Model | • Price point rejection • CAC too high |
• $20K MRR achieved • <6 month payback |
• A/B price testing • Reference selling |
| Phase 3 M7-10 |
Scalability | • Operational breakdown • Quality degradation |
• 2 clients concurrent • <60 day onboarding |
• SOPs documented • Multi-tenant arch |
| Phase 4 M11-16 |
Enterprise Validation | • Can't handle scale • Security concerns |
• 10K+ patients live • SOC 2 compliant |
• Stress testing • Security audits |
| Phase 5 M17-20 |
Growth Engine | • Sales efficiency • Competitive pressure |
• CAC < $10K • 20% MoM growth |
• Sales playbook • IP protection |
Strategic Moats & Competitive Advantages
What Makes Our Canvas Defensible:
- Network Effects: CommonWell/QHIN access gives us 5B+ records competitors can't easily replicate
- Switching Costs: Deep workflow integration makes replacement painful (18+ month commitment typical)
- Data Advantage: CHI algorithm improves with each patient (50K patients = significant training advantage)
- Regulatory Compliance: USCDI v3 + OASIS-E integration creates high barriers for new entrants
- Clinical Validation: Published outcomes + NIH backing provide credibility competitors lack
Result: By Month 20, we have 3-4 sustainable competitive advantages that justify premium valuations (5-8x revenue multiple vs 3-4x for typical SaaS).
Canvas Evolution Summary: The Business Model Canvas transforms from untested assumptions (Month 1) to validated, scalable model (Month 20). Key transitions: (1) Partners evolve from vendors to strategic co-developers, (2) Activities shift from product building to sales/success, (3) Value prop moves from promise to proven ROI, (4) Segments narrow from broad to specific high-value targets, (5) Channels mature from founder-only to multi-channel, (6) Revenue evolves from free pilots to $100K+ enterprise deals. This systematic validation reduces investor risk and justifies a $20-30M Series A valuation based on proven execution capability and clear path to $10M ARR within 18 months post-funding.
6/10
Phase 4: Anchor Client Deployment & Enterprise Validation (Months 11-16)
🏢Enterprise Scale: The Make-or-Break Moment
10-15K
Patients Managed
5x previous scale
5x previous scale
$100K+
Monthly Contract
Largest deal to date
Largest deal to date
500+
Provider Users
Across 8 facilities
Across 8 facilities
$1.2M
ARR Run Rate
72% from anchor
72% from anchor
Anchor Client Profile & Strategic Value
Target Organization: Regional Integrated Delivery Network (IDN)
- Scale: 2 hospitals, 15 clinics, 3 home health agencies, 1 ACO with 50K covered lives
- Pain Points:
- $2.2M annual CMS readmission penalties (heart failure, pneumonia, COPD)
- 23% 30-day readmission rate vs 18% target (5% gap = $450K per 1% improvement)
- Fragmented data across Epic (hospitals), Cerner (clinics), PointClickCare (home health)
- Care coordination gaps causing 40% of readmissions
- Decision Makers: CMO (clinical champion), CIO (technical feasibility), CFO (ROI focus), CEO (strategic alignment)
- Budget Authority: $3M annual innovation fund, ROI requirement: 2:1 within 18 months
Why This Anchor Transforms Our Business
- Validation: Proves enterprise-scale capability to VCs (de-risks Series A dramatically)
- Economics: Single client provides 70%+ of revenue, extending runway indefinitely
- Product: Forces enterprise features (SSO, audit logs, SLAs) needed for all future large deals
- Market Signal: Creates FOMO among competitors ("If Regional Health chose them...")
- Expansion: Internal growth potential to $300K/month across full network
6-Month Implementation Timeline
| Period | Technical Milestones | Clinical Milestones | Business Milestones | Success Metrics |
|---|---|---|---|---|
| M11-12 Foundation |
• Epic + Cerner integration • 10K patient data load • Disaster recovery setup • Security audit passed |
• 50 providers trained • Workflow mapping complete • Champion network built • Baseline metrics captured |
• Contract executed • $50K setup fee received • Board presentation • PR strategy aligned |
• 100% data flowing • 60% provider logins • 500 CHI scores/day • Zero security incidents |
| M13-14 Pilot Ops |
• Alert optimization • Performance tuning • API rate limiting • Mobile app launch |
• 1,000 high-risk patients • Daily huddle integration • First interventions • Patient enrollment begins |
• Quarterly review #1 • Invoice $200K total • Reference site prep • Upsell discussions |
• 80% adoption rate • 1,500 interventions • 10% readmit improvement • 4.5/5 satisfaction |
| M15-16 Full Scale |
• All facilities live • Claims integration • Predictive models v2 • OASIS-E automated |
• 10K patients enrolled • 500 providers active • Outcomes documented • Case studies complete |
• Renewal negotiated • Expansion to COPD • Co-marketing launch • Series A pitch live |
• 20% readmit reduction • $1.8M cost avoided • 90% would recommend • 3.6:1 documented ROI |
Technical Scale Requirements & Architecture
Infrastructure Scaling (10x Load)
- Database: PostgreSQL cluster with 3 read replicas, 1TB storage, point-in-time recovery
- Compute: Kubernetes cluster with 20 pods, auto-scaling 10-50 based on load
- ML Pipeline: GPU instances for CHI batch processing, 6-hour SLA for all patients
- Integration:
- Epic: Real-time HL7 feeds + FHIR API for clinical data
- Cerner: Batch extracts nightly + webhooks for ADT
- Claims: X12 837/835 processing for cost tracking
- QHIN: Nationwide queries for 30% of patients with history elsewhere
- Monitoring: DataDog for APM, PagerDuty for incidents, 99.9% uptime SLA
Security & Compliance Enhancements
- Access Control: SAML 2.0 SSO with Active Directory, MFA required, role-based permissions
- Audit Trail: Immutable logs of all PHI access, 7-year retention, real-time anomaly detection
- Encryption: TLS 1.3 in transit, AES-256 at rest, key rotation every 90 days
- Compliance: SOC 2 Type I achieved (Month 12), Type II in progress, HITRUST roadmap defined
- Incident Response: 15-minute detection, 1-hour containment, 4-hour resolution SLAs
💡 Critical Success Factors for Anchor Deployment:
- Executive Alignment: Monthly steering committee with C-suite ensures resources and removes blockers
- Phased Rollout: Start with highest-impact department (heart failure clinic) for quick wins
- Change Management: Dedicated change agent from anchor + our clinical lead = adoption success
- Performance Guarantees: We guarantee 10% improvement or provide credits (confidence in our model)
- Co-Innovation: Develop 2 custom features for anchor (becomes product roadmap for others)
Series A Preparation in Parallel
| Month | Fundraising Activity | Materials Prepared | Proof Points |
|---|---|---|---|
| M11-12 | Investor research & warm intros | Pitch deck v1, financial model | Anchor contract signed |
| M13-14 | Initial meetings (15-20 VCs) | Data room, customer references | Early anchor success metrics |
| M15-16 | Partner meetings & term sheets | Due diligence responses | 20% reduction achieved |
Phase 4 Strategic Impact: The anchor client deployment is the single most important phase of our journey. Success here means: (1) Proven enterprise capability - managing 10K+ patients across multiple facilities with different EHRs proves we can handle any healthcare organization, (2) Financial sustainability - $100K+ monthly revenue from one client validates premium pricing and provides runway independence, (3) Series A readiness - VCs see de-risked investment with clear path to 10x growth. By Month 16, we'll have transformed from a promising startup to a proven health tech company with $1.2M ARR, enterprise validation, and documented 20% readmission reduction at scale. This positions us for a $5-8M Series A at $20-30M valuation - a 10-15x multiple on current ARR, justified by our growth trajectory and proven execution.
7/10
Clinical & Technical Integration Excellence
🏥Healthcare Workflow Integration: Where Technology Meets Care Delivery
Clinical Implementation Framework - Daily Workflow Integration
| Workflow Point | Current State (Baseline) | ACUITYhealth Integration | Measurable Impact | Time to Value |
|---|---|---|---|---|
| 7:30 AM Morning Huddle |
• 15 min reviewing charts • Manual risk assessment • Reactive planning |
• CHI dashboard auto-prioritizes • Top 10 at-risk with actions • Predictive 48-hr alerts |
• 8 min time savings • 3x more patients reviewed • 85% preventable events caught |
Week 2 of deployment |
| 9:00 AM Care Coordination |
• Phone tag with providers • Fragmented notes • 30% missed handoffs |
• Real-time alerts to team • Unified care plans • Automated task routing |
• 50% fewer readmissions • 2 hours saved weekly • 95% loop closure rate |
Month 1 |
| 11:00 AM Documentation |
• 45 min OASIS-E forms • Manual data entry • 15% error rate |
• 60% pre-populated fields • Ambient capture option • Real-time validation |
• 25 min completion time • <2% error rate • $200/episode increase |
Month 2 |
| 2:00 PM Patient Rounds |
• Paper assessments • Delayed data entry • Limited history access |
• Mobile app at bedside • Voice-to-text notes • 5B records via QHIN |
• 100% real-time capture • 15 min/patient saved • 40% better histories |
Month 1-2 |
| 4:00 PM Quality Reporting |
• Monthly manual reports • 2-week lag time • Limited insights |
• Real-time dashboards • Predictive quality scores • CMS measure tracking |
• Daily visibility • 4-star → 4.5-star rating • $500K bonus captured |
Month 3 |
Interoperability Architecture: The Data Foundation
Multi-Source Data Integration Strategy
CommonWell/QHIN (Primary)
Coverage: 75% of US providers
- Volume: 5B+ records accessible
- Query Speed: <2 sec for patient match
- Data Types: Clinical notes, labs, meds, imaging
- Use Cases: History retrieval, care coordination
- Cost: $0.50 per query after 1000/mo
Implementation: OAuth 2.0 + FHIR R4
USCDI v3 Compliance
23 Data Classes Mapped
- SDOH: Housing, food, transport captured
- Care Team: All providers + roles tracked
- Goals: Patient preferences integrated
- Encounters: Full visit history available
- Coverage: Insurance details for auth
Enables 360° patient view
RPM Device Ecosystem
6 Device Types Integrated
- BP Monitor: 3x daily for CHF
- Weight Scale: Daily trending
- Pulse Ox: Continuous SpO2
- Glucometer: Diabetes tracking
- Activity: Steps/sleep via wearables
85% patient adherence achieved
Data Flow Architecture & Processing Pipeline
Real-Time Stream (Latency: <5 seconds)
- ADT Feeds: Admit/Discharge/Transfer via HL7 → Kafka → Alert Engine → Provider notification
- Vital Signs: RPM devices → IoT Gateway → Stream processor → CHI recalculation → Risk alerts
- Lab Results: Critical values → FHIR webhook → Clinical rules engine → Immediate intervention
Batch Processing (Every 6 hours)
- CHI Recalculation: All patients scored using latest data, GPU cluster processes 50K patients in 45 minutes
- Predictive Models: Update readmission risk, deterioration probability, optimal intervention timing
- Quality Measures: Recalculate CMS stars, HEDIS gaps, care opportunity identification
AI System Architecture: Beyond Simple Alerts
Five-Layer AI Stack with Progressive Intelligence
Layer 1: CHI Core Algorithm - 100% Complete (c-statistic: 0.84)
Layer 2: Symptom NLP - 80% (Processes clinical notes, extracts symptoms)
Layer 3: Trend Analysis - 70% (Identifies deterioration patterns)
Layer 4: Ambient Documentation - 60% (Voice → Structured data)
Layer 5: Care Orchestration - 50% (Suggests optimal interventions)
| AI Component | Technical Approach | Training Data | Accuracy/Performance | Clinical Value |
|---|---|---|---|---|
| CHI Algorithm | XGBoost + LSTM for temporal | 2M patient records, 5-year history | AUC: 0.84, Sensitivity: 78% | 30-day readmit prediction 7 days early |
| Symptom NLP | BERT fine-tuned on clinical notes | 500K annotated notes | F1 Score: 0.76 for symptom extraction | Catches subtle deterioration signals |
| Vitals Trending | Time-series anomaly detection | 10M vital sign sequences | 95% detection rate, 2% false positive | 4-hour early warning for decompensation |
| Ambient Capture | Whisper + Medical vocabulary | 1000 hours clinical conversations | 92% transcription accuracy | Saves 20 min documentation per visit |
⚠️ Technical Debt & Scaling Considerations:
- Performance Bottleneck: CHI batch processing hits limit at 100K patients - need distributed computing (Spark) by Month 18
- Data Quality: 15% of QHIN data has quality issues - implement data quality scoring and fallback logic
- Model Drift: CHI accuracy degrades 2% per quarter - implement continuous learning pipeline with clinical review
- Integration Complexity: Each new EHR adds 3-week integration - build abstraction layer and template library
- Regulatory Risk: FDA may regulate CHI as SaMD (Software as Medical Device) - prepare 510(k) pathway documentation
Integration Excellence Impact: By deeply embedding into clinical workflows rather than adding another dashboard, we achieve 82% weekly active usage (vs 30% industry average). The interoperability foundation accessing 5B+ records creates an insurmountable data advantage - competitors would need years and millions to replicate. Our AI stack processes 500K+ daily decisions across all clients, continuously improving with each interaction. The result: providers save 2.5 hours/week, patients experience 30% fewer adverse events, and payers reduce costs by $4,500 per patient annually. This clinical-technical integration excellence justifies our premium pricing and creates switching costs that ensure 95%+ annual retention.
8/10
Financial Strategy & Unit Economics Deep Dive
💵Path to Sustainable Growth: From Burn to Profitability
20-Month Financial Journey - Detailed P&L Evolution
| Phase | Period | Revenue Details | Cost Breakdown | Net Cash Flow | Key Ratios |
|---|---|---|---|---|---|
| Foundation | M1-4 | • M1-3: $0 (pilot) • M4: $20K (first contract) • Total: $20K |
• Personnel: $60K (50%) • Dev/Cloud: $36K (30%) • Other: $24K (20%) • Total: $120K |
-$100K Cash: $1.38M |
• Burn Multiple: ∞ • Runway: 46 months • CAC: $30K |
| Validation | M5-8 | • M5-6: $40K ($20K/mo) • M7-8: $60K ($30K avg) • Total: $100K |
• Personnel: $80K (50%) • Infrastructure: $32K (20%) • Sales/Mktg: $24K (15%) • Total: $160K |
-$60K Cash: $1.32M |
• Burn Multiple: 1.6x • Gross Margin: 40% • CAC Payback: 18mo |
| Break-even | M9-12 | • M9-10: $140K ($70K/mo) • M11-12: $200K ($100K/mo) • Total: $340K |
• Personnel: $120K (55%) • Infrastructure: $44K (20%) • Customer Success: $22K (10%) • Total: $220K |
+$120K Cash: $1.44M |
• Burn Multiple: 0.65x • Gross Margin: 65% • Rule of 40: 45 |
| Scale | M13-16 | • M13-14: $240K ($120K/mo) • M15-16: $280K ($140K/mo) • Total: $520K |
• Personnel: $168K (60%) • Infrastructure: $56K (20%) • Sales/Growth: $28K (10%) • Total: $280K |
+$240K Cash: $1.68M |
• Burn Multiple: 0.54x • Gross Margin: 70% • NDR: 120% |
| Growth | M17-20 | • M17-18: $320K ($160K/mo) • M19-20: $360K ($180K/mo) • Total: $680K |
• Personnel: $210K (65%) • All Other: $90K (35%) • Total: $300K |
+$380K Cash: $2.06M |
• Burn Multiple: 0.44x • Gross Margin: 75% • LTV:CAC: 10:1 |
Unit Economics Model - Per Client Deep Dive
$40K
Avg Contract Value
Monthly recurring
Monthly recurring
$15K
CAC (Blended)
3-6 month sales cycle
3-6 month sales cycle
$480K
Annual Contract
12-month minimum
12-month minimum
$1.44M
3-Year LTV
95% annual retention
95% annual retention
Customer Acquisition Cost (CAC) Breakdown
| Component | Pilot Client | Direct Sale | Referral | Channel Partner |
|---|---|---|---|---|
| Sales Effort | 80 hours founder time ($8K implied cost) |
60 hours sales team ($6K at $100/hr) |
20 hours coordination ($2K cost) |
10 hours support ($1K cost) |
| Marketing | $2K (materials, travel) | $3K (conferences, ads) | $500 (testimonials) | $200 (co-marketing) |
| Pilot Cost | $20K (3-mo free service) | $10K (1-mo trial) | $5K (2-week POC) | $0 (partner covers) |
| Total CAC | $30K | $19K | $7.5K | $1.2K |
| Payback Period | 18 months | 11 months | 4.5 months | <1 month |
Strategy: Shift mix from 60% pilot → 20% pilot, 40% direct → 30%, 0% referral → 35%, 0% channel → 15% by Month 20
Revenue Model Evolution & Pricing Strategy
Phase 1-2: Foundation Pricing
• Per-provider: $300-500/month (testing price sensitivity)
• Minimum: 40 providers ($12-20K/month)
• Discount: 50% for 6-month commitment
• Value Metric: Providers managed (easy to track and scale)
• Per-provider: $300-500/month (testing price sensitivity)
• Minimum: 40 providers ($12-20K/month)
• Discount: 50% for 6-month commitment
• Value Metric: Providers managed (easy to track and scale)
Phase 3: Tiered Model Introduction
• Starter: $20K/mo (up to 100 providers)
• Growth: $40K/mo (100-300 providers)
• Enterprise: Custom (300+ providers)
• Add-ons: Training ($5K), Integration ($10K)
• Starter: $20K/mo (up to 100 providers)
• Growth: $40K/mo (100-300 providers)
• Enterprise: Custom (300+ providers)
• Add-ons: Training ($5K), Integration ($10K)
Phase 4: Enterprise & Value-Based
• Base Platform: $50-100K/month
• Performance Bonus: $2 PMPM for >15% improvement
• Shared Savings: 20% of documented savings
• Multi-year: 20% discount for 3-year commitment
• Base Platform: $50-100K/month
• Performance Bonus: $2 PMPM for >15% improvement
• Shared Savings: 20% of documented savings
• Multi-year: 20% discount for 3-year commitment
Phase 5: Mature Pricing Model
• Land: $30K/mo average (quick decision)
• Expand: $60K/mo within 6 months
• Enterprise: $150K/mo for full network
• Platform Fee + Success Fee hybrid model
• Land: $30K/mo average (quick decision)
• Expand: $60K/mo within 6 months
• Enterprise: $150K/mo for full network
• Platform Fee + Success Fee hybrid model
💰 Key Financial Inflection Points & What They Mean:
- Month 4 - First Revenue ($20K): Market validation - someone will pay for our solution
- Month 9 - Break-even ($60K MRR): Unit economics proven - we control our destiny
- Month 12 - $100K MRR: Enterprise validation - large contracts are achievable
- Month 16 - $140K MRR: Scalability proven - ready for venture capital
- Month 20 - $180K MRR ($2.16M ARR): Series A threshold - 10x growth potential clear
Series A Math: At $2.16M ARR growing 15% MoM, we project $8M ARR in 12 months. At 5x forward revenue multiple (typical for 100%+ growth SaaS), that's a $40M valuation. Raising $8M at $32M post-money (20% dilution) provides 18-24 months runway to reach Series B metrics ($15M ARR).
⚠️ Financial Risk Factors & Mitigation:
- Customer Concentration: Anchor = 60% of revenue. Mitigation: Rapid diversification post-anchor, no client >30% by M24
- Long Sales Cycles: 6-9 months average. Mitigation: Develop "Quick Start" program for <90 day closes
- Churn Risk: 5% monthly = death. Mitigation: Quarterly business reviews, success metrics tracking, 18-month contracts
- Competition: Large vendors could copy. Mitigation: Deep clinical integration, network effects, continuous innovation
Financial Strategy Summary: Our path from -$30K/month burn to +$110K/month profit in 20 months demonstrates exceptional capital efficiency. Key achievements: (1) CAC payback improves from 18 to 4 months through referrals, (2) Gross margins expand from 40% to 75% via operational leverage, (3) Cash position actually grows from $1.5M to $2.06M despite no external funding, (4) LTV:CAC ratio of 10:1 places us in top 10% of SaaS companies. This financial performance, combined with proven healthcare outcomes, justifies premium Series A terms and positions us for either profitable growth or strategic acquisition within 36 months.
9/10
Phase 5: Growth Acceleration & VC-Backed Scaling (Months 17-20)
🚀From Scrappy Startup to Growth Machine
$180K
Monthly Revenue
9x from Month 4
9x from Month 4
$2.16M
ARR Run Rate
108x from start
108x from start
5-7
Active Clients
Mix of sizes
Mix of sizes
$110K
Monthly Profit
61% margin
61% margin
Series A Execution Strategy (Months 15-18)
The Fundraising Machine - Systematic Approach to $8M Raise
| Stage | Timeline | Activities | Key Deliverables | Success Metrics |
|---|---|---|---|---|
| Preparation | Month 15 (4 weeks) |
• Hire fractional CFO for financials • Legal review of all contracts • Customer reference preparation • Advisory board alignment |
• 30-page pitch deck • 3-year financial model • Data room (100+ docs) • 5 reference customers |
• Model shows $10M ARR Y2 • 3+ customer testimonials • Clean cap table • IP assignments complete |
| Outreach | Month 16 (3 weeks) |
• Target 40 health tech VCs • Warm intros via advisors • Initial emails with teaser • Conference meetings (HLTH) |
• 1-page exec summary • 10-slide teaser deck • Calendly for scheduling • Response tracking sheet |
• 25% response rate • 15 first meetings booked • 3+ tier-1 VCs engaged • Pipeline of $50M interest |
| First Meetings | Month 16-17 (4 weeks) |
• 30-min pitch + 30-min Q&A • Demo of live product • ROI evidence presentation • Vision for $100M business |
• Refined pitch narrative • Live demo environment • FAQ document • Follow-up materials |
• 50% advance to partner • 8 second meetings • 2+ term sheet interests • Valuation range defined |
| Due Diligence | Month 17-18 (6 weeks) |
• Customer reference calls • Technical architecture review • Financial audit • Legal documentation |
• DD response tracker • Customer call scripts • Tech deep-dive deck • Competitive analysis |
• 95% positive references • Clean technical review • 2-3 term sheets • $25-35M valuation |
| Closing | Month 18 (2 weeks) |
• Term sheet negotiation • Board composition • Option pool sizing • Final documentation |
• Signed term sheet • Legal agreements • Wire instructions • PR announcement |
• $8M raised • 20-25% dilution • 2 board seats • $32M post-money |
Post-Series A Scaling Plan (Months 18-20 and Beyond)
Team Expansion Strategy - From 8 to 25 People
Engineering (3→8)
- Senior Backend: $150K (scale infrastructure)
- ML Engineer: $140K (AI improvement)
- Full-Stack: $130K x2 (features)
- DevOps: $135K (reliability)
Focus: 10x scalability
Sales (1→5)
- VP Sales: $180K + commission
- Enterprise AE: $120K x2 OTE
- SDRs: $60K x2 OTE
Target: $5M new ARR/year
Customer Success (1→4)
- Dir. Success: $130K (retention)
- CSMs: $90K x2 (accounts)
- Implementation: $85K
Goal: <5% annual churn
Operational Infrastructure Buildout
- Finance: Upgrade from QuickBooks to NetSuite, implement Carta for equity management
- HR: Implement Rippling for payroll/benefits, create employee handbook, D&I initiatives
- Legal: Transition from $500/mo to $5K/mo retainer with health tech specialists
- Office: 3,000 sq ft space in Nashville ($8K/month) with hybrid policy
- Tools: Salesforce CRM, Gong for sales intelligence, Looker for analytics ($15K/mo total)
Market Expansion & Product Roadmap 2.0
| Quarter | Product Releases | Market Expansion | Strategic Partnerships | Revenue Target |
|---|---|---|---|---|
| Q1 Post-A Months 19-21 |
• COPD module (30% TAM increase) • Mobile app v2 • API marketplace beta |
• Southeast expansion • 2 new ACO clients • First MA plan pilot |
• Humana pilot program • Epic App Orchard • AWS healthcare partner |
$250K MRR ($3M ARR) |
| Q2 Post-A Months 22-24 |
• Diabetes management • Payer analytics suite • White-label option |
• West Coast launch • Hospital systems (3) • Home health chains |
• CVS Aetna integration • Microsoft Cloud for Healthcare • KLAS research rating |
$400K MRR ($4.8M ARR) |
| Q3 Post-A Months 25-27 |
• Full ambient AI suite • Population health platform • Predictive staffing |
• National coverage • 20+ enterprise clients • Federal contract bid |
• United Health collab • Cerner integration • Academic medical centers |
$600K MRR ($7.2M ARR) |
| Q4 Post-A Months 28-30 |
• Multi-condition AI • Outcomes guarantee program • Provider network effects |
• 30 clients total • 3 Fortune 500 payers • International pilot |
• Google Health AI • Value-based care orgs • Series B lead investor |
$850K MRR ($10.2M ARR) |
Key Performance Indicators & Board Metrics
| Metric | Current (M20) | Target (M24) | Target (M30) | Best-in-Class Benchmark |
|---|---|---|---|---|
| ARR | $2.16M | $4.8M | $10.2M | T2D3 growth path |
| Growth Rate | 15% MoM | 12% MoM | 8% MoM | >10% MoM at $10M |
| Gross Margin | 61% | 70% | 75% | 80% for SaaS |
| CAC Payback | 11 months | 8 months | 6 months | <12 months |
| Net Revenue Retention | 120% | 130% | 140% | >120% elite |
| Logo Retention | 95% | 95% | 97% | >90% good |
| Magic Number | 1.2 | 1.5 | 1.8 | >1.0 efficient |
🎯 Exit Strategy & Value Creation Path:
- Series B (Month 30): Raise $20-30M at $100M+ valuation based on $10M ARR and 100%+ growth
- Strategic Options:
- Continue independent growth to $50M ARR → IPO candidate
- Strategic acquisition by Teladoc/Amwell ($300-500M at 10x ARR)
- PE rollup with other health tech assets ($200M at 8x)
- Merge with complementary platform for market dominance
- Value Drivers: Proprietary CHI algorithm, 5B+ records access via QHIN, proven ROI at scale, 95%+ retention
Phase 5 Strategic Impact: The transformation from bootstrap startup to venture-backed growth company requires systematic execution across fundraising, team building, and market expansion. By Month 20, we've achieved: (1) Financial independence with $110K monthly profit proving we don't need capital to survive, (2) Venture validation with $8M Series A at strong terms showing market belief, (3) Scalable foundation with team, processes, and technology ready for 10x growth. The path from $2M to $10M ARR in 12 months post-funding is aggressive but achievable given our proven playbook, strong unit economics, and massive market opportunity. Success here positions ACUITYhealth as either a category leader heading to IPO or an attractive acquisition target delivering 10-20x returns to early investors.
10/10
Critical Success Factors & Strategic Execution Framework
🎓Hard-Won Insights from the Trenches
Top 10 Success Factors - Deep Dive
- Pilot-to-Paid Conversion Excellence (70% target vs 30% industry)
- Pre-negotiate conversion terms in pilot agreement: "If we achieve X metric, contract automatically converts"
- Limit pilot to 90 days maximum - longer pilots rarely convert (data shows 15% conversion after 120 days)
- Get budget confirmation upfront: "If successful, do you have $X allocated?" Get it in writing
- Weekly scorecards during pilot showing progress toward conversion metrics
- Clinical Champion Development (Need 3+ per client for resilience)
- Identify champions at 3 levels: Executive (funding), Clinical (adoption), Technical (integration)
- Give champions early wins they can showcase internally (quick ROI proof)
- Create champion incentives: Co-authorship on publications, speaking opportunities, innovation awards
- Build redundancy - if one champion leaves, others can maintain momentum
- ROI Evidence Architecture (94% of investors demand quantifiable outcomes)
- Track 4 ROI dimensions: Clinical (readmissions), Financial (cost savings), Operational (time), Satisfaction (NPS)
- Implement automated ROI dashboards updating real-time (not quarterly reports)
- Get third-party validation: Academic partners, KLAS ratings, peer-reviewed publications
- Document counterfactuals: "Without our intervention, expected outcome was X"
- Interoperability as Competitive Moat (5B+ records creates 3-year advantage)
- CommonWell/QHIN access costs competitors $500K+ and 12 months to replicate
- Each additional network connection adds exponential value (Metcalfe's Law)
- Become the integration layer others depend on - create switching costs
- Patent the unique aspects of multi-network data reconciliation
- Lean Operations Discipline (Stay under 50% burn/revenue ratio by Month 12)
- Use contractors for non-core work until $100K MRR (saves 30% vs FTEs)
- Negotiate success-based pricing with vendors ("pay more when we grow")
- Implement zero-based budgeting monthly - justify every expense
- Track burn multiple religiously - best companies achieve <0.5x
Common Pitfalls & Mitigation Strategies
| Pitfall | Warning Signs | Impact if Unchecked | Mitigation Strategy |
|---|---|---|---|
| Pilot Purgatory | • Extensions requested • Scope creep • No decision maker |
• 6+ months wasted • Team demoralization • Competitor entry |
• Hard stop at 90 days • Convert or walk away • Pre-defined success criteria |
| Feature Factory | • Custom requests multiply • Core product diluted • Technical debt grows |
• Unmaintainable code • Slow innovation • Team burnout |
• 80/20 rule for features • "Innovation fund" from client • Quarterly feature freezes |
| Premature Scaling | • Hiring ahead of revenue • Expensive office • Enterprise tools too early |
• Runway <6 months • Forced bad terms • Layoffs damage culture |
• Hire at 80% capacity • Remote-first initially • Graduate tools with revenue |
| Single Champion Risk | • One contact only • No exec buy-in • Champion overworked |
• Champion leaves = churn • Slow decisions • Limited expansion |
• Map org chart early • Quarterly exec reviews • Build champion network |
| Investor Misalignment | • Pushing wrong metrics • Forced hypergrowth • Strategy conflicts |
• Bad unit economics • Unsustainable growth • Founder replacement |
• Choose aligned investors • Set expectations early • Regular board education |
Performance Triggers & Decision Framework
Monthly Health Check Scorecard
| Milestone | Green (On Track) | Yellow (Caution) | Red (Crisis) | Recovery Action |
|---|---|---|---|---|
| M4: First Sale | Contract signed $20K+ MRR |
Verbal commit only $10-15K MRR |
No commitment Extended pilot |
• CEO takes over sale • Offer guarantee • Find new prospect |
| M9: Break-even | Cash flow positive 2+ clients |
-$10K monthly 1 client + pipeline |
-$20K+ monthly Client at risk |
• Cut burn 20% • Accelerate sales • Consider bridge |
| M12: Scale Validation | $100K+ MRR 3+ clients <10% churn |
$60-80K MRR 2 clients 10-15% churn |
<$60K MRR High churn No pipeline |
• Pivot strategy • Replace sales lead • Product overhaul |
| M16: Anchor Success | 20%+ improvement Expansion planned Reference agreed |
10-15% improvement Renewal likely Neutral reference |
<10% improvement Churn risk No reference |
• Executive escalation • Free extension • Pivot to mid-market |
| M20: Series A | Term sheet signed $25M+ valuation Good terms |
DD ongoing $15-20M valuation Tough terms |
No interest Bridge needed Down round risk |
• Revenue focus • Cut burn to extend • Strategic alternatives |
The ACUITYhealth Execution Playbook
Weekly Operating Rhythm (The Engine of Execution)
- Monday: Metrics Review - Dashboard of 10 key metrics, variance analysis, action items
- Tuesday: Customer Success - Client health scores, NPS feedback, intervention plans
- Wednesday: Product/Engineering - Sprint progress, technical debt, feature prioritization
- Thursday: Sales Pipeline - Lead flow, conversion rates, deal reviews, bottlenecks
- Friday: Strategic/Finance - Cash position, strategic initiatives, investor updates
The 10 Commandments of Health Tech Success
- Clinical Outcomes First: No ROI, no business - everything follows from measurable improvement
- Time-to-Value Obsession: Show value in <30 days or lose momentum
- Integration Depth: Be embedded in workflow, not another dashboard
- Evidence Over Features: One proven outcome beats ten promised features
- Champions Are Everything: Nurture them like your business depends on it (it does)
- Interoperability Is Moat: Data access others can't match = sustainable advantage
- Capital Efficiency: Grow on customer revenue, not investor dollars when possible
- Regulatory Readiness: Stay ahead of compliance - it's a feature, not a burden
- Team > Everything: A players attract A players; compromise here and fail
- Patient Impact: Never forget we're improving lives, not just metrics
Final Strategic Wisdom: Building a successful health tech company requires balancing three forces: (1) Clinical Excellence - without proven outcomes, nothing else matters; (2) Technical Innovation - leveraging AI and interoperability for competitive advantage; (3) Business Discipline - efficient capital use and systematic execution. The 20-month journey from idea to Series A is intense but achievable with the right playbook. Key success factors: 70% pilot conversion rate (vs 30% industry), 10:1 LTV:CAC ratio (top decile), 95% retention (vs 80% average), and 30% clinical improvement (vs 10% typical). Companies that execute this playbook successfully typically achieve: $10M ARR within 30 months, Series B at $100M+ valuation, and either IPO or strategic exit at 10x+ revenue multiple within 5 years. The path is challenging but the impact - transforming healthcare delivery while building a valuable business - makes it worthwhile.