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Commure: The AI Operating System for Healthcare

Tanay Tandon is the co-founder and CEO of Athelas / Commure, the AI operating system for healthcare. Commure’s technology powers over 20 million appointments annually and processes more than $25 billion in claims volume, helping clinicians and health systems work faster, smarter, and spend more time on patient care. In this fireside with YC’s Ankit Gupta, Tanay shares how he built one of the most ambitious companies in healthcare, what AI means for doctors and patients, and why the next decade of medicine will be defined by software. Chapters: 00:00 – From Rejection Letters to YC Acceptance 02:30 – What Athelas and Commure Actually Do 05:33 – Building a Medical Device at 19 09:00 – Lessons from Clinical Trials and Early Healthcare Startups 16:39 – Pivoting from Hardware to Healthcare Software 21:24 – Fixing Physician Burnout with AI 27:14 – The Rise of Ambient Documentation 32:43 – Stripe for Healthcare: Rebuilding the Financial Layer 36:45 – Competing with Epic and Scaling Nationwide 45:41 – The Next Decade of Medicine

Tanay TandonguestAnkit Guptahost
Oct 28, 202549mWatch on YouTube ↗

At a glance

WHAT IT’S REALLY ABOUT

Commure and Athelas build AI platform automating healthcare operations nationwide

  1. Athelas Commure sells a bundled platform—ambient clinical documentation, revenue-cycle/payment automation, and patient engagement—used by everyone from solo practices to major hospital systems like HCA.
  2. The company began as a computer-vision blood diagnostics medical device built by teenage founders, accelerated by YC’s pace, and achieved rapid clinical trial execution and FDA clearance.
  3. After discovering broader clinic pain points while deploying hardware, the team pivoted in 2020 toward healthcare software (telehealth, workflow automation, and claims/payments) to expand from a narrow initial TAM to a platform strategy.
  4. LLMs enabled step-change improvements in two high-friction areas—ambient documentation and payer interactions—turning previously labor-heavy workflows into software-driven processes at massive scale.
  5. Tandon argues healthcare’s biggest bottleneck is distribution and that point solutions often plateau; platform companies with embedded financial workflows (revenue cycle) have the best chance to reach venture-scale and compete with incumbents like Epic.

IDEAS WORTH REMEMBERING

5 ideas

Start with a painfully specific problem—even if the TAM looks tiny.

Athelas began with an initial market of ~100,000 patients, but deep trust and workflow proximity created a wedge to expand into broader software and financial workflows across entire practices.

Healthcare product discovery requires field immersion, not desk research.

Many “real” workflow bottlenecks (manual portal uploads, fax/pharmacy coordination, claim form friction) were only discovered by being physically in clinics running deployments and hearing day-to-day complaints.

LLMs are most transformative where language meets high-volume operations.

Ambient scribing and payer negotiations/appeals map directly to transcription, summarization, and conversational interaction—unlocking automation of tasks previously handled by large billing and admin teams.

Physician-led adoption is a new distribution vector in healthcare software.

Commure Scribe’s self-serve motion (doctors finding it online and paying by credit card) bypasses traditional CIO-led procurement and can later be expanded enterprise-wide via integrations.

Revenue cycle is a compounding moat and distribution engine.

Because practices feel revenue improvements directly (“my revenue went up 15%”), RCM creates powerful word-of-mouth and funds platform expansion into adjacent workflows.

WORDS WORTH SAVING

5 quotes

The market is a great… it’s just like punch in the face.

— Tanay Tandon

We went from having no revenue to having $3 or $4 million in revenue in, like, a year… and then you’re like, ‘Well, no, actually, the game starts now.’

— Tanay Tandon

Ambient documentation listens to the conversation… summarizes that… and then generates all of the documentation… ready to go.

— Tanay Tandon

There are tens of thousands of people whose sole job it is to do these types of tasks… and if you can free up their time, you can bring that productivity back onto… patient care.

— Tanay Tandon

I would love a world where the market cap of a UnitedHealth is… a fifth, but every doctor is a millionaire.

— Tanay Tandon

YC rejection-to-acceptance journey and prototype-driven credibilityBuilding and accelerating clinical trials and FDA clearancePivot from med device diagnostics to healthcare software platformAmbient documentation (AI scribe) and physician-led self-serve adoptionRevenue cycle as “Stripe for healthcare” and denial/appeals automationDistribution advantages, bundling strategy, and acquisitions/roll-upsCompeting with Epic: speed, go-to-market, and system-of-engagement layerFuture of care: sensors, telehealth, catastrophic insurance model, AI copilots

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