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Eight years building membership and payment software for a market investors kept calling too small: close to a thousand clinics, three quarters of a million lives, and more than half a billion dollars of payments running through it.
about three quarters of a million lives across a few thousand doctors · more than $500M of payments processed through the platform (the interview never says over what period) · about 40 people · about $60M raised across four rounds, which the host puts at $64M · growing about 80% a year on a small base · first revenue within 30 days of committing to the idea · the revenue figure itself is garbled in the captions and is not reported here
"Dr Rob, if you miss payroll, I will personally guarantee that I'll pay your bills." About $20K of his own money on the line is what it took to get one of the first customers past the fear that a startup would break their cash flow.
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Zach spent three years at a healthcare company before this one and came out of it with a number he still quotes: the US wastes about a trillion dollars a year on healthcare, which he compares to NASA's entire budget since inception, every year, while getting a worse result than other developed economies for 20% of GDP. He and his co-founder spent two or three months running half a dozen ideas through a three-part test. Would it address the trillion-dollar problem if everyone in America had access to it, or would it just move money around? Was it a technology business? Could they get into the market fast and make money quickly, rather than building for years first? What they landed on was a community rather than a product: the doctors stepping outside insurance fee-for-service and selling directly to patients or contracting directly with employers. Those doctors were running their payments on spreadsheets. Hint became their membership management, billing and payments system. They moved immediately — first conference, cold calling, flying around the country, the co-founder coding while Zach sold the promise of a product. First revenue inside 30 days. First ten customers inside three or four months. Eight or nine years later: close to a thousand customers, about three quarters of a million lives, a few thousand doctors, more than half a billion dollars in payments through the platform, about 40 people and roughly $60M raised across four rounds. The market was never big enough for the investors he pitched — more than a thousand of them across the life of the company — so the money came with dilution instead of speed.
The first customers came from a movement, not a market. Once they identified the community of doctors leaving insurance, they went to its first conference, cold called hard, networked and flew around the country — and within weeks had early prospects.
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Data credibility: Founder interview on a podcast whose name is never stated in the transcript, and the source index carries no title, channel, view count or date for this video, so everything here comes from the recording itself. All figures are stated by the CEO with nothing shown: close to a thousand customers, about three quarters of a million lives, a few thousand doctors, more than half a billion dollars of payments through the platform, about 40 people, about $60M raised across four rounds (the host says $64M), a first round of $250K that grew to about $1.3M, first revenue within 30 days, first ten customers in three to four months, early contracts of $20K and $15K, a one percent take on payments, about 80% annual growth on a small base, more than a thousand investor pitches, and conference attendance of roughly 120–150 then about 450 at $350–$550 a ticket. Two things are deliberately not reported here. The revenue figure is garbled in the auto-captions — it renders as "Class A figures in revenue" — so no revenue number appears in this entry. And the half-billion payment figure is given with no period attached, so it cannot be read as annual. The customer count is also stated twice with different hedging: close to a thousand early on, and later "I'm not even sure if we've crossed a thousand yet." The founder is referred to only as Zach in the recording.
The first dollars were not software revenue at all. Walking into early offices, Zach found doctors about to spend $20,000 customising a Salesforce implementation to escape their spreadsheets.
Free data migration was the first loop. It was a nightmare at the start and obviously unscalable, and then patterns appeared: "once you've done it ten times, then it gets easy."
The stretch here lasted years, and the thing that was missing was not customers but validation from outside. Growth was about 80% a year on a small base, which is healthy and looks like nothing next to the companies raising on total addressable market.
Hint is the billing system for doctors who have stepped outside insurance fee-for-service in the United States — practices selling memberships directly to patients, and practices contracting directly with employers. "We're their billing system, so their membership management and billing and payments." That is a narrower thing than a healthcare platform, and the narrowness is the point. The software they replaced was not a competitor; it was spreadsheets. Payment details in one place, patient details in another, recurring membership charges reconciled by hand. The scale it runs at today: close to a thousand customers, about three quarters of a million lives, a few thousand doctors, and more than half a billion dollars of payments moving through the platform. The interview does not say whether that payment figure is annual or cumulative, so it should be read as unspecified. Around the core product sit two things that are not software but function as product. Free data migration, now a practised operation rather than a favour. And the DPC accelerator — free education, content and webinars given to the direct primary care community, built out of the interviews and webinars they had been running anyway. Zach describes the accelerator as something people talk about, which is to say it is distribution that looks like a service.
The founding model is a percentage of payment volume: one percent of everything flowing through the platform, with no upfront fee. That is the right shape for this customer, because a small clinic will not sign a software contract before it trusts you but will happily let you take a slice of money it is already collecting — and it means the vendor grows automatically as the clinic grows. Zach says exactly that: "you scale with these clinics, they grow." He notes the model changed "at some point" without saying to what, so current pricing is unknown. Our read: with more than $500M of payments and close to 1,000 customers, a pure one percent take would be a materially larger business than the headcount suggests, which points to a blended model — subscription plus a smaller payment margin — rather than one percent of everything today. Two other lines are worth noting because both are deliberately not profit centres. The early $15–20K custom builds were cash that funded the real product and bought access to the customer's actual problem. And the annual conference is priced to break even, with sponsorship used as a partner filter rather than a revenue line.
No infrastructure, vendor or margin detail is given, so what follows is the cost structure as it can be read from headcount and model. About 40 people against close to a thousand customers and more than half a billion dollars of payments. Roughly $60M raised across four rounds funds that, and the first raise was $250,000 that grew into about $1.3M — raised once customers were onboarding and it was obvious they needed another engineer and someone on support, and specifically because the founders did not want to put personal finances behind a model where revenue arrives as clinics grow. Our read on where the money goes: free data migration is the standout line. It is human work performed before a customer pays anything, which is a real cost of acquisition that never appears in a marketing budget, and the only reason it is affordable is that they industrialised it after about ten repetitions. Payments businesses also carry compliance, reconciliation and support load that pure software does not, and handling health data means HIPAA obligations across the whole stack. The conference runs at break-even by design. No gross margin, burn or profitability figure appears anywhere in the interview.
Copy the choice of customer. Not a market segment, an organised community with a shared identity and a conference already on the calendar — and sell it on why rather than what. In a group of roughly eighty practices, turning up and saying "we are here to support this community" opened doors that no feature list would have. Copy the two objection-killers. Free migration removes the switching cost that keeps people on spreadsheets forever, and it gets cheap after ten reps. And for the fear that a startup will break their cash flow, nothing beats personal exposure — his $20K guarantee to Dr Rob closed a customer that no reassurance could. Copy the pre-product contract: $15–20K to build the thing by hand for a customer who was about to spend the same money on a worse alternative. Change the speed. His own regret is the sharpest advice in the interview: he would go slower, even offer to work free in a doctor's office as an admin for three weeks, before writing code. Building fast off a shallow understanding created product debt he estimates cost roughly two years. And change the assumption that horizontal expansion is cheap — their attempts to sell the same software to adjacent verticals stalled because none of the trust or the inbound engine transferred.
Market size is the risk that has already partly materialised. Investors repeatedly judged the addressable market too small for venture returns, and the result is a founder eight or nine years in with less ownership than the numbers would normally imply, after more than a thousand investor pitches. He is at peace with it because money is not his primary driver; a reader copying this model should decide whether they are. The second is dependence on payment volume. Revenue tied to a percentage of payments is excellent while clinics grow and brutal in a downturn, and it puts the company inside payments regulation, dispute handling and reconciliation risk on top of HIPAA obligations. The third is the ceiling on the wedge itself. Close to a thousand customers in a community he could once describe as "there's eighty of us" means a large share of the movement is already signed, so growth increasingly depends on the movement itself expanding — which is outside the company's control — or on segments where the mission-led pitch does not land. Our read: the fourth risk is the horizontal one he describes trying and failing. Adjacent verticals need their own outbound engine or their own community, and a company that grew on being authentically part of one community does not automatically get a second.
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