Lessons from Bobby Guelich, CEO and Co-Founder for Elion, on transforming how founders choose their tech stack

Bobby Guelich, CEO of Elion, a marketplace for healthcare tech components helping founders design their tech stacks

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Dec 20, 2023

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Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.

Today, we’re excited to get to know Bobby Guelich , Co-Founder and CEO at Elion, the Glassdoor for Healthcare Tech.

Founded in 2022, Elion has raised $3.3 million in seed funding from NEA, Max Ventures, 8VC, AlleyCorp, Charge Ventures and Floating Point.

Bobby has spent decades making build versus buy decisions at various companies and now is dedicated to the problem of improving that experience in healthcare. Bobby began his career in investment research at Bridgewater Associates and later worked as a VP of Customer Care Strategy and Head of Sales at Oscar Insurance. After that, he spent three years at Formation Bio (formerly TrialSpark), a technology company that specializes in clinical trial management, eventually transitioning into an Advisory Role. In May 2022, he founded Elion.

Bobby earned an AB in Economics and Finance from Princeton and briefly attended Stanford Graduate School of Business before he pursued an opportunity at Oscar Insurance.

In this episode, we learn about the Elion marketplace and reviews platform, how Bobby advises founders on building versus buying and coming up with a taxonomy for the health tech software stack.

If you prefer listening, here’s the link to the podcast!

Bobby’s mid-air pivot into Oscar

Bobby started his career at Bridgewater Associates, a relatively unknown global macro hedge fund situated in Connecticut at the time of his graduation with an economics and finance major.
At Bridgewater, he found himself amidst a group of highly talented individuals working on compelling problems, particularly focused on understanding the intricacies of the global macroeconomy. At the time, Ray Dalio, Bridgewater's founder, was introducing principles that later became the foundation of a New York Times bestselling book.
After spending about 5 years at Bridgewater, Bobby decided to attend Stanford business school, driven by a realization he wasn’t interested in a career in finance.
Through pure happenstance, Oscar Health's CEO, Mario Schlosser, a former Bridgewater associate, connected with him as he was building out Oscar (a revolutionary consumer focused insurance company).

Oscar Health, founded in 2012, became the first new health insurance company in New York in 15 years, with a focus on creating a member-centric and outstanding experience aligned with the Affordable Care Act. [Source]

Bobby interned at Oscar Health when it was a small team of around ten people, and over that summer, he developed a deep affinity for the mission, especially during the exciting period of the Affordable Care Act launch.
Although Bobby had originally attended business school to explore options, he unexpectedly found his passion for healthcare sooner than anticipated. Bobby was excited to be part of an early-stage startup and contribute to the development of an innovative company.
He departed business school after the first year to commit himself full-time to Oscar Health. More than ten years later, Bobby continues to dedicate his career to healthcare.

On consumerism in healthcare

Although Oscar is considered a pioneer in consumerism in healthcare, at the time, the team didn't fully realize they were on the forefront of this shift. The hypothesis was to build a consumer-centric health plan, and they focused on differentiation, from technology friendliness to innovative advertising, such as subway ads.
Nevertheless, working at Oscar was challenging and marked by significant moments like narrowly avoiding potential demise three times due to Supreme Court decisions.
In hindsight, Bobby acknowledges that, ultimately, the hypothesis was correct and the product, specifically the consumer friendliness and experience, resonated with customers.
Bobby hopes that Oscar has positively influenced the approach to building consumer-oriented healthcare companies.

TrialSpark’s evolution (now Formation Bio)

TrialSpark started as a patient recruitment firm, transitioned into a contract research organization and then into a pharma company acquiring and developing its own drugs. [Source]

“It's been essentially on this long journey to essentially becoming a next generation pharma company. And the way that it's gone there is through essentially a series of a stepwise set of business models.”

Bobby's tenure at TrialSpark spanned from approximately 2017 to 2020, during which the company evolved from a patient recruitment firm for clinical trials to a site management organization and eventually a contract research organization, before transforming into a full-fledged pharmaceutical company.
TrialSpark transitioned through various business models, starting with patient recruitment, moving on to site management, and ultimately taking on the role of overseeing the entire clinical trial process as a contract research organization. Towards the latter part of Bobby’s tenure there, the company started owning stakes in drug assets, marking its evolution into a comprehensive pharmaceutical entity.

[Source]

The site management business line was like an "Airbnb for clinical trial sites," involving collaboration with clinical practices like dermatology or pulmonology private practices that had experience in patient care but not in running clinical trials.

TrialSpark's role was to equip these practices with the necessary tools and support, including training physicians and staff, providing technology, sourcing trial studies from pharma and biotech companies, and even staffing clinical research coordinators to facilitate the trials.
Bobby emphasized the complexity of building within the pharmaceutical industry, expressing a newfound appreciation for the challenges in the heavily regulated environment of pharma compared to his previous experiences in health insurance.

On what makes building in Pharma complex

In the realm of clinical trials, ultimate drug approval by the FDA hinges on thorough data analysis, ensuring the drug's effectiveness, gathered through the clinical trial process. The FDA conducts audits to verify that the study adhered precisely to the predefined study instructions, creating a need for constant scrutiny from the trial sponsor, typically the pharmaceutical company. The sponsor is expected to maintain comprehensive procedures documenting every aspect of the operations and prove meticulous adherence to these procedures during audits.

Building a startup in the pharmaceutical sector presents unique challenges due to the additional layers of overhead. Not only must the company develop the underlying operations and infrastructure, but it must also create procedures and processes concurrently.
The regulatory environment in pharma demands meticulous documentation and adherence to procedures, adding significant overhead to the already challenging task of building a startup.
Clinical trials often last a year or more, with potential delays due to various factors, such as manufacturing issues, which significantly impact startup timelines.
The slow pace of clinical trials contrasts sharply with the typical agile mindset of rapid iteration seen in tech companies, making it a counterintuitive and challenging process akin to "walking in quicksand."

Reflections on Oscar and TrialSpark

Drawing a contrast with his current role, Bobby highlighted the operational intensity of Oscar and TrialSpark, both involving the building and scaling of large teams. In contrast, his present focus is on a smaller team with a content and information-centric approach.
Though Bobby acknowledges this period was likely the most stressful time of his career, it provided a wealth of lessons on building, managing, and scaling teams.

It’s crucial to “be able to quickly learn in an area that you don't know anything about and build and manage and scale a team. [I] learned a ton through that, how to operate in a fast-paced environment where you don't have a ton of depth or experience and kind of be able to figure it out and have confidence [in yourself].”

In the early days at Oscar, Bobby had to build and scale the sales team, responsible for enrolling individuals in the health plan during the open enrollment period.
This required the rapid expansion of the team from five to 40 people within six months for a seasonal role. Bobby had to navigate unfamiliar territory, lacking prior experience in sales and call centers, but the experience taught him valuable lessons on quick learning, team management, and operating in a fast-paced environment.
These experiences have contributed to his ability to navigate fast-paced environments, build confidence in unfamiliar territories, and effectively manage teams which translates directly to the work he is doing now.

Elion’s Origin Story

Elion aims to simplify the process for healthcare organizations to discover, evaluate, and select the technology essential for their operations.

The overarching goal is to democratize the word-of-mouth that significantly influences healthcare tech sales, drawing from Bobby's personal experiences grappling with technology and vendor decisions at Oscar and TrialSpark.
As a healthcare tech marketplace and reviews platform, Elion facilitates the identification of solutions to address specific challenges faced by healthcare entities.
The platform streamlines decision-making by helping users understand the quality and suitability of different solutions through candid feedback from other users.
Elion conducts in-depth, first-person interviews with individuals who have utilized these solutions. These interviews cover various aspects, including the problem the solution aimed to solve, the vendors considered during the evaluation, the chosen vendor and the reasons behind the selection, and the overall experience with the solution.

“We ask questions like: What was the problem they were trying to solve? Which vendors did they evaluate as part of that? Which one did they choose and why did they choose them?

What was it like to implement? Have they built against their APIs? What's been the quality of their support? And then ultimately, would they make the same decision about that solution again?”

[Source] Reviews from Elion’s Platform

The interview process delves into details such as the strengths and weaknesses of the solution, the implementation experience, API integration, the quality of support, and whether users would make the same decision again.

On why this hasn’t been done

One major reason why a platform like Elion hasn't emerged earlier is the significant surge in healthcare technology companies over the past five years. In the early days of ventures like Oscar, there was a necessity to build a lot of technology in-house, partly due to the lack of robust off-the-shelf options at that time.

The landscape has drastically changed in the last five years, with a notable acceleration spurred by the impact of Covid-19. The influx of healthcare technology companies has led to a more fragmented and challenging landscape to navigate.

The increasing number of options in the market has created a compelling need for a solution like Elion, aiming to simplify the process of discovering, evaluating, and selecting technology.

[Source] CB Insights highlights 50 digital health companies to watch. How should we evaluate each of these?

Despite the challenges posed by the proliferation of solutions, Bobby sees it as a positive development. Previously, many organizations were redundantly building the same commoditized technology, leading to wasted resources and time.
Now, with a plethora of options available, the focus can shift towards accelerating business growth and differentiation. Bobby believes that platforms like Elion can play a crucial role in helping organizations navigate and make informed decisions in this increasingly complex landscape.
While addressing the problem of a more challenging market to navigate, Bobby sees the proliferation of healthcare solutions as an overall positive, making it easier to build healthcare companies and fostering innovation in the industry.

The ideal customer journey

Bobby walks us through the process of creating a provider organization and the types of tech stack decisions that Elion could help them with.

The initial and crucial decision often involves selecting an electronic medical record (EMR) solution, which significantly influences subsequent technology choices.
The chosen EMR solution has cascading effects on other tech solutions, such as intake and scheduling solutions, as well as considerations for built-in or separate revenue cycle management.
For revenue cycle management, there are multiple steps, including eligibility verification, medical coding, billing submission, and denials management. Elion aids founders in navigating these complexities and making informed decisions.

[Source] Compare EHR’s with Elion complete with helpful demos.

The platform helps founders identify the foundational solutions and then guides them through decisions on specific solutions based on what will differentiate their company or solution.

On Build vs. Buy

Today's landscape differs from the past, with more viable options available for core technologies. The decision-making process between building and buying has shifted, with a current bias towards buying for most foundational elements, reserving building for instances where suitable options aren't readily available or when building is a core differentiator.
The stage of the company also plays a crucial role in the decision. In the early stages, where there's much to learn about the business, care model, and processes, judiciously opting to buy helps avoid wasted efforts that may need modifications rapidly. As confidence in the business model grows, investing in building becomes more sensible to tailor processes to specific needs.

“You have some kind of foundational infrastructure that you can use to give you a head start, or even a lot of the, for example, the EHRs today have a pretty robust set of APIs, So you can use the EHR as kind of your foundational piece, but then you can build around it, especially if a lot of folks really want to customize the patient or member experience.”

There's a growing middle ground between building and buying. Headless EHRs can offer a foundational infrastructure, reducing the need to start from scratch. API-driven EHRs, especially ones that are built on FHIR can then be customized to allow for tailored workflows and user experiences.
Bobby emphasized the importance of considering a reasonable middle ground, especially when dealing with the proliferation of point solutions. It's not purely a binary choice between building and buying; often, companies buy solutions but need to build to integrate them effectively.

On developing a sane taxonomy for health tech

The proliferation in healthtech and the inaccessibility of company’s marketing pages has made it impossible to figure out what a company actually is! Consider TrialSpark’s evolution into a next gen pharma company. Where in the value-chain would people looking for point-solutions place them?

Elion's process for creating a taxonomy for different digital health products involves a first-principles approach. They identify the essential components needed to build various archetypes of healthcare companies, such as scheduling and intake. They also sketched out different categories and established clear definitions around them.
The taxonomy is a dynamic and evolving structure, involving continuous refinement as Elion explores and learns more about the companies within each category. They compile lists of companies, gather information from their websites, and engage in conversations with people to grasp the nuances of each company's offerings.

[Source] The Elion Digital Health Taxonomy

The recently introduced reviews product has significantly enhanced their understanding. While marketing websites can provide only limited information, user feedback through reviews helps to grasp the real-world experiences with the products.

“We've been joking internally. Should we have a section of our profile pages for each of these companies? It's just called, ‘oh, that's what they do’ where we explain in as simple language as possible, like what this company actually does.”

The complexity is especially pronounced in areas like value-based care, where there is considerable overlap and a mix of technology and services. Parsing apart different offerings in such areas requires careful examination and understanding of the intricate details.

The ideal customer

Elion predominantly receives reviews from various personas, including product professionals, engineers, data specialists, clinicians, and frontline users. This diversity in perspectives aims to provide a comprehensive and well-rounded view of different healthcare solutions.
The review outreach began informally, involving networking and referrals. Users contribute reviews to access the review platform, creating a community-driven model that attracts users seeking informed decisions.

Elion targets key decision-makers in healthcare technology. Their focus extends to founders, product managers, engineers, and clinicians involved in provider organizations, with a current emphasis on larger entities like hospitals. This encompasses roles such as chief medical information officers, members of innovation or digital teams, and clinician leaders in specific departments.
On the vendor side, Elion's platform serves companies offering healthcare solutions, creating a two-sided platform that benefits both buyers and vendors in the healthcare technology landscape.

Future of Elion

Bobby envisions Elion's mission as making it radically easier for people to build excellent healthcare companies that deliver exceptional care. He draws inspiration from other industries, especially the tech world, where abundant content and information facilitate the building of different organizations.

“I just felt like building Oscar and Trialspark were so incredibly challenging to do and it just didn't feel like it needed to be as hard as it was.”

One of the ways in which this landscape is changing is the introduction of big tech into healthcare. However, while Bobby acknowledges some progress on the care delivery side, such as Amazon's initiatives, he reserves judgment on their ability to win particular use cases like EHRs.
Epic, particularly in the Electronic Health Record (EHR) space, stands out as an interesting counter-example. The increasing focus on artificial intelligence (AI) and its application across various healthcare use cases adds complexity and presents new opportunities in the industry.

Comparing Elion and an EMR digital marketplace

Major players like Epic exert significant influence in the EHR digital health marketplace, leading hospitals and health systems to often wait for Epic's offerings. This is driven by the ease of integration with existing systems and the trust associated with a well-established company.
The key challenge for startups and innovators in this space is convincing large healthcare institutions, particularly those using Epic, to consider their solutions instead of waiting for Epic's releases, even if the startup's offering is superior.

[Source] EPIC’s connection hub where you can see which applications have integrations with EPIC.

Major EHR providers, such as Epic, Athena, and Cerner, have their marketplaces, where the value depends on the integration level and solution usability. Bobby contemplates the meaningfulness of being part of these marketplaces and the extent of integration they represent.
Elion offers an independent perspective on the quality of digital health solutions, aiming to provide users with a comprehensive and unbiased assessment beyond what major EHR providers' marketplaces offer.

On staying agile and working smarter rather than harder

As a founder, Bobby emphasizes the importance of being competent in various areas due to the wide-ranging responsibilities that come with the role. The goal is to be proficient enough in each aspect until specialists can be hired for specific roles. This strategy allows him to learn from the best thinkers in each field and follow the threads to discover additional valuable resources.

Below see different experts that Bobby leans on in various disciplines:

For product management, Bobby mentions finding valuable insights from Lenny Rachitsky's podcast, "Lenny's Podcast," which provides a deep dive into the perspectives and practices of great product professionals and organizations.
For marketing, Bobby turns to the content provided by a source called MKT1, which he considers to offer some of the best-structured and framework content in the marketing space.
For growth, Bobby recommends following Kyle Poyar's substack called "Growth Unhinged," part of Openview, a venture capital firm. This resource is particularly strong in providing insights into growth-related topics.

Tips for Founders

Bobby advises that founders should be mentally ready for the commitment. Building a successful digital health company is a lengthy journey, often spanning ten years or more. Founders need to be committed for the long haul, understanding that it takes time to achieve profitability and make a substantial impact in the healthcare industry.
Founders should also be honest and realistic about the economic potential of their ventures. Bobby emphasizes the importance of being clear about the true market size, funding requirements and growth possibilities.
Bobby also recommends that tech-savvy founders should not overlook the challenges associated with the services part of a tech-enabled services company. Building and scaling services requires demanding and diligent ops expertise.

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