CHAPTERS
Repeated YC rejections and the prototype that finally got them in
Tanay recounts applying to YC multiple times, getting rejected twice (including for being in high school), and finally earning acceptance after showing a working prototype. He frames early entrepreneurship as rapid learning driven by direct market feedback and customer proximity.
Commure + Athelas today: an AI operating system for providers
Tanay defines the company as a suite of products that automate clinical workflows, patient engagement, and the financial/revenue cycle layer for healthcare providers. He shares scale metrics (payments volume, visits documented, patient touchpoints) to illustrate platform breadth.
Why LLMs change healthcare operations: replacing outsourced admin work with software
The discussion connects recent improvements in LLM voice/text interaction to automating work historically done by large human teams (often outsourced/offshored). Tanay argues that shifting these tasks to software reclaims time for patient care.
Origin story: smartphone microscope + early computer vision for blood analysis
Tanay traces the initial spark to YC Hacks and papers on using cheap optics with a smartphone camera to mimic a microscope. He built an early malarial-cell classifier using then-state-of-the-art classical ML methods and turned it into a science fair project that evolved into a diagnostics concept.
Building a regulated medical device at 19: conviction, mentors, and early backing
Tanay explains why he and his cofounder believed they could build a real-world microfluidics/imaging device despite regulatory hurdles. Influential mentors and early supporters reinforced the belief that ML could tackle complex industries like healthcare.
YC pace shock: first-principles clinical trials and an aggressive FDA plan
In YC, the team was pushed to challenge standard med-device timelines and strip processes down to essentials. They set a bold target: complete a clinical trial and prepare an FDA submission within the batch timeframe.
Clinical trial in Juarez: hands-on operations to compress timelines
To bypass slow institutional pathways, they found a smaller, fast-moving partner hospital in Juarez, Mexico. They personally ran key parts of the trial, compared results against a standard lab system, and completed end-to-end execution in weeks.
Post-YC med-device era: FDA clearance, manufacturing rigor, and first big contract
After YC, the company focused intensely on earning FDA clearance and hardening the device for real-world reliability testing. Commercial validation came early via a pharma customer using the device in a specific monitoring workflow, even before full approval.
The “punch in the face” after clearance: scaling realities and discovering bigger pain points
After regulatory success and early revenue growth, the team realized the true challenge was scaling and expanding impact beyond a narrow patient segment. Deployments put them inside clinics where they observed many adjacent workflow and billing failures ripe for software solutions.
Pivot era (2020): moving from hardware-first to software platform
Faced with a choice between building a solid standalone med-device business or betting on a broader software TAM, the team chose expansion. COVID accelerated demand for remote monitoring and catalyzed the first software offerings that later broadened across the practice.
Physician burnout and a new adoption dynamic: doctors become the buyers
Tanay argues prior healthcare IT digitization served compliance and billing, not clinician productivity. Post-COVID burnout plus clear time savings shifted adoption power toward physicians, including unexpected self-serve purchases that later expand into enterprise deals.
Ambient documentation at scale: what it is and the hard engineering underneath
Ambient scribing listens to patient-physician conversations and generates structured documentation for downstream billing and workflows. The chapter highlights why the product seems simple but becomes technically complex at large scale due to real-world connectivity and reliability constraints.
Rebuilding the financial layer: revenue cycle as a cybersecurity-like adversarial system
Revenue cycle management is framed as an adversarial interface between providers and payers, where denial tactics and broken payer workflows must be detected and resolved continuously. Commure automates claim status monitoring, denial analysis, and appeals—sometimes via LLM-driven interactions.
Platform strategy, bundling, and competing with Epic at national scale
Tanay explains why large healthcare outcomes require a platform approach: point solutions often plateau without distribution and expansion. He positions Commure’s speed, bundling, and physician-led momentum as differentiation, while noting Epic’s roadmap pace and economic impact on certain systems.
The next decade of medicine: sensors, home-based care, AI copilots, and shifting incentives
The conversation closes with a forward-looking view: more care moves to the home via sensors and virtual workflows, while hospitals specialize in complex procedures. Tanay predicts AI copilots will surpass humans in many diagnostic tasks but remain constrained by regulatory/accountability structures, and he anticipates insurance evolving toward more catastrophic coverage.
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