4 Pivots in 7 Years. Now He Serves Millions of Patients | MedMe Health, Purya Sarmadi

1. 0:00 – 1:27

   Intro

   1. PSPurya Sarmadi0:00

      I went through many pivots. We had four different pivots of MedMe, but all throughout all those pivots, my conviction for the market only grew and grew and grew. If you have conviction around the market, don't give up on the market. For example, healthcare or, like, vertical SaaS on the outside looking in might be, like, unsexy, but I was very fixated on building in healthcare because my mom, she had a heart valve failure when I was around six, seven years old. At the time, uh, many surgeons were, uh, hesitant to operate on her. It was very risky. It's kind of a core tenant of our mission, which is to change healthcare access for over 100 million people. Every single one of those pivots, I started to get more and more information about pharmacies, about pharmacists, about their patients, and in fact, that also helped narrow down which wedge was the most important wedge. Like, if you're a first-time founder, don't mistake being in the wrong wedge as being in the wrong market. So you might be in the right market. You might have conviction about that market. You might just be on the wrong wedge. My name is Purya Sarmadi. I'm the CEO and co-founder of MedMe Health. MedMe is serving over 4,500 pharmacies across North America today. We power the operations, integrations, and automations to transform drug dispensaries to community healthcare hubs. [gentle music]

2. 1:27 – 4:11

   You Can Be Right But Still Fail - Don't Give Up

   1. PSPurya Sarmadi1:32

      I was born in Cologne, Germany. My family and I moved from Germany to Canada when I was around six, seven years old. Not so long after we moved to Canada, my mom, she had a heart valve failure. That was a very complicated period, both for her and, and by extension, our family. At the time, uh, many surgeons were, uh, hesitant to operate on her. It was very risky. They would always present things in an optimistic light, but in a realistic light as well. And one thing that really does stick with me is at that time, there was fear, fear in my dad's eyes, fear that he might have to raise two kids on his own if things didn't go well, and there was a lot of uncertainty there. And I just remember observing that interaction between my parents and the surgeon as a child. And I think when you're around that age, like eight, you know enough to feel things, but you can't do enough to change, change things. You can't really enact change, and there's a feeling of helplessness. But one surgeon was very confident amongst others in his ability to try his very best to help my mom, and his name was Dr. Tyrone David. He's a legendary surgeon. Afterwards, I had the opportunity to meet Dr. David, and I remember shaking his hand as a, as a young kid and having this really vivid memory of this feeling I had in that moment where that realization that he, with his impact, not only saved my mom's life directly but had this rippling effect on the folks that relied on my mom, whether it be myself, my dad, uh, my sister, and all of her, uh, my mom's even younger siblings 'cause she's the oldest of five. And that feeling was something that really stuck with me, this feeling that through healthcare you can have this large impact on people. Growing up, I wanted to be a cardiovascular surgeon because of that. Fast-forward later, I realized, you know, I have a not the steadiest hand and also some trouble with, uh, sleep. The combination of those two things didn't really make for a great surgeon, but one thing I was always passionate about was technology, and so the way to make a really scalable impact maybe is to double down on my passion for technology and, and data science and try to see how I could really make that impact through another channel at a larger scale. Combining that with my passion for healthcare was sort of really what drove me through my career and eventually to starting MedMe. When my mom had the heart valve surgery, she put in a mechanical valve, and folks who live with mechanical valves, they have to check their INR. Broadly, it's a measure of their blood viscosity, and they have to do that through diagnostic

3. 4:11 – 4:53

   Why couldn't a pharmacy do this?

   1. PSPurya Sarmadi4:11

      testing, so they have to check their blood very weekly or biweekly. Growing up after the surgery, one thing that was very, a big memory for me, uh, throughout my life is my mom always saying to me... She would always see new specialists, but she would always say it was the pharmacist that knew the most about her holistic treatment. What didn't make sense to me was that why couldn't she just get that diagnostic service at the pharmacy? I had this very strong conviction that pharmacies were, were underutilized, and there was an underserved need of what pharmacies could do for the public because at that point they were just drug dispensaries. And I really believed that they could be far more than just drug dispensaries because 95% of North Americans live within five miles of a pharmacy.

4. 4:53 – 5:42

   The Pivots

   1. PSPurya Sarmadi4:53

      The very first iteration of MedMe, the idea was, hey, you have a lot of prescriptions coming in. Wouldn't it be nice if you can just scan the prescriptions and automatically the data entry happens? Now mind you, this was in 2018, so this was pre-LLMs. The business problem we were solving was a real one, but the technology wasn't there to make this viable. That actually sent us to a pivot where MedMe was actually a physical product. It was a product related to drug adherence. But hardware is hard. There's a lot of starting capital cost to hardware. That's partially why we pivoted away from that kind of iteration. As we were talking to pharmacists and pharmacies, we realized there is a need for clinical care for the community and the panels of patients that pharmacies have, but they just don't have the time to do this clinical care.

5. 5:42 – 7:04

   Wrong wedge vs. wrong market

   1. PSPurya Sarmadi5:42

      That actually led us to the pivot, which is closest to what MedMe is today, to give software to pharmacies to allow them the capacity and the tools to be able to provide consultative care to their patients. What, what I was looking for was the one problem that could be served with one solution for one customer. If you were to say, "Hey, we won't exist tomorrow," and they would say, "Well, if you don't exist tomorrow, my life will be worse," then you knew that you have the right wedge. We were in Ontario and we were introduced to someone in Alberta. There was literally a day that I remember very vividly where he's like, "Hey, guys, I've canceled all my subscriptions. These four different subscriptions that I was using before, I've canceled. I'm just using MedMe." That's when we knew, okay, we solved this underserved problem with our solution for this one ICP. I think one lesson I can share from that period is that every single one of those pivots, I started to get more and more information about pharmacies, about pharmacists, about their patients, and that was all part of the same data set. What was changing was the wedge, and in fact, that also helped narrow down which wedge was the most important wedge. Don't mistake being in the wrong wedge as being in the wrong market. So you might be in the right market, you might just be on the wrong wedge. And then fast-forward a few months later,

6. 7:04 – 8:04

   From 100 to nearly 1,200 pharmacies in ten weeks

   1. PSPurya Sarmadi7:04

      COVID happened. That really proved out our thesis. All of a sudden, this broad network of pharmacies across the continent had to become these sites for physical clinical services, whether that be vaccines, whether that be point-of-care testing to respond to the pandemic. Literally in a two-and-a-half month period, we went from near 100 pharmacies to almost 1,200 pharmacies. What was really important was building that conviction both personally, but also functionally pivoting through which wedge made the most sense. As long as you find the right wedge, then you have a avenue in order to kind of build on that wedge and capture a much larger market opportunity over time. Really spend the time to figure out you're building the right thing. That same kind of rippling impact that I felt and I alluded to kind of revered from Dr. David in meeting him, that's a really core part of what drives me and is kind of a core tenet of our mission, which is to systemically change healthcare access for over 100

7. 8:04 – 10:06

   Build on What Tech Can't Replace

   1. PSPurya Sarmadi8:04

      million people. Every dot you see here represents a pharmacy that closed just last year. I wouldn't say it's collapsing. I would say it's being disrupted and it's transforming. One big motivator around the timing of when MedMe started, you were seeing a lot of online pharmacies pop up. So these online pharmacies, they were direct to consumer, they had big marketing budgets, and they really had better unit economics and logistics. And so with drug margins shrinking, the increase in acceleration of online pharmacies simultaneously, there's a shortage of primary care, there's an increase of chronic illness. Now more than ever, patients were looking for proactive, personalized, and consumer-driven healthcare products and services. Where I think you're gonna see a resurgence is the pharmacies that are investing in the clinical side, patients coming back to them not only to pick up their drugs, but to get their flu shot, get their A1C levels checked, get consulted on a blood monitoring device or a glucose monitor or blood pressure monitor. Those types of pharmacies are the ones that are gonna thrive because they have this enduring lifetime value and patient relationship. One thing that will never be replaced is that human element of patient care and that that trusted healthcare practitioner is there to take care of you and knows your longitudinal care history and knows what your likes and dislikes are and knows your family. That is something that's very hard to replace. That is what makes pharmacies indispensable. And in Nova Scotia, patients like my mom who are on blood thinners are able to go to the pharmacy for INR monitoring, and they're doing that today as we speak using MedMe. So patients like my mom in growing jurisdictions all across North America are now able to rely on a pharmacy rather than going to an emergency room or an outpatient, uh, diagnostic center or an urgent care center for the care that they're reliant on to stay healthy. And I think that's really, really exciting to see that come full circle and, and in practice in North America.

8. 10:06 – 10:32

   What AI changes for founders, and what it doesn't

   1. PSPurya Sarmadi10:06

      In the AI era, a lot of very optimistic early stage founders, they see big market opportunities. AI is changing the playbook. Like, the old playbooks for different industries might not be relevant today, but for your customer, AI is not changing their jobs to be done. Their jobs to be done are still the same. AI is just giving us the right to be able to solve a different class of problems or a broader class of problems.

9. 10:32 – 11:16

   Comfort Quietly Kills Your Best Partnership

   1. PSPurya Sarmadi10:37

      Most companies, uh, they end because of co-founder breakups, and those happen in a couple of years. I did meet Nick via something called the Next36. The Next36 is a startup accelerator in Canada. From the moment we met, I really felt we had a complementary skill set. We had a mutual respect, but also a mutual interest in this problem space. And in the first, uh, week of the program when we, uh, started full-time in the summer of 2019, I kind of presented to him all the data that I had collected using that early data that I had collected through the pivots. I basically convinced him we should work on this together rather than what he was working on, and, uh,

10. 11:16 – 12:23

    The message that nearly broke his co-founder

    1. PSPurya Sarmadi11:16

       he agreed with me. Nick and I have been together for seven years and counting, but there was a moment where I became overly critical of how something had gone under his purview. My frustration led me to almost frame it as, "You're not capable of doing this. You've shown that you're not capable of doing this. I don't believe that you're capable of doing this." That set of kind of messaging to your co-founder is really damaging. I think it's defeated, and you never wanna defeat your co-founder. I, I really learned that the hard way. Like, I think that sort of messaging can be, uh, very demotivating. I've seen others not be able to overcome this. There's a very big risk for you to kind of default to blaming the other person. That blame can be so counterintuitive. It could actually work so much against you. It works against the organization. It also works against you because you are losing your number one ally. As a good co-founder, one of your main responsibilities is to make sure both yours and your co-founder's candle stays alight.

11. 12:23 – 14:41

    The candle principle

    1. PSPurya Sarmadi12:23

       The ups and downs of a startup will sometimes make that candle become more fierce. The flame will be more strong. And when you go through the, the down parts of being a startup founder, that's when the candle dwindles. And you have to do anything you can to keep those flames alight. Because if you don't, it's very hard to reignite the flame once the flame goes out. Sometimes when you go through the trials and tribulations, there's not many people that understand you. It's hard to... Yes, you know, you have your family, you have your friends, but they're not gonna fully be able to empathize with what you're going through as a C-suite of a company or as a founder. The person that you can lean on the most through those ups and downs is your co-founder. So that's one of the things that I think is a strength. Like, having a co-founder and having someone to lean on in that way makes a huge difference. I, I literally said this in my wedding speech at Nick's wedding a couple months ago. When COVID happened, we obviously had, had built this, like, early-stage web app with independent pharmacies. They were using it. And we actually had an enterprise come to us and say, "Oh, we need a solution for this. We need it at an enterprise scale." Uh, Nick and I, but a lot of it was Nick at the time, he built a prototype. He pulled two all-nighters with me. 72 hours of nonstop work, two all-nighters of just being able to build a prototype. We demoed it. We presented it to the leadership team, and they were like, "That's amazing. When can we go live?" And then we had to go back to our team, and we're like, "All right, guys, we have, like, six to eight weeks to make this real." That was our first enterprise customer, and since then, that first enterprise customer was what built us the trust and credibility to win subsequent enterprise customers. Having the pleasure to work with him side by side during that 72-hour period, that's how I really knew that he was kind of who I needed as a business partner. No matter what the constraints were, we would be able to take them on head-on and not only survive, but thrive. Don't contribute to your co-founder's candle dwindling, 'cause you're just working against yourself and your startup. [gentle music]

Episode duration: 14:42