# Abridge started with providers to build a three-sided network

Markdown copy of https://realalpha.app/s/abridge-started-with-providers-to-build-a-three-sided/ on Real Alpha, the best minutes from long interviews with the people building AI. Cite and link the page, not this copy.

- Speaker: [Shiv Rao](https://realalpha.app/builders/shiv-rao/) · Shiv Rao is cofounder and CEO of Abridge; practicing cardiologist. · Co-founded Abridge, which brings context and understanding to medical conversations, and practices as a UPMC cardiologist.
- Host: [Alex Konrad](https://realalpha.app/people/alex-konrad/) · Founder & editor, Upstarts Media · Ran Forbes' Midas List for ten years and co-created its Cloud 100 list; founded Upstarts in 2025.
- Show: Upstarts
- Episode: [Abridge’s Shiv Rao: Taking On Microsoft To Cure Doctor Burnout With AI](https://realalpha.app/v/W4_aRWsHogM/), Jul 23, 2026
- Moment: 23:20 to 26:35 of the episode (3 min), playing on https://realalpha.app/s/abridge-started-with-providers-to-build-a-three-sided/; the episode from there: https://realalpha.app/v/W4_aRWsHogM/?t=1400

## Quote

> “But I think to create this three-sided network, to go after this bigger operating system, you have to **start provider first**.”
> — [Shiv Rao](https://realalpha.app/builders/shiv-rao/) at [24:14](https://realalpha.app/v/W4_aRWsHogM/?t=1454) · Upstarts

## Takeaways

1. Healthcare sales cycles could historically stretch to 18 months.
2. Provider-first put Abridge at the point where care is delivered.
3. Its health-system logos reach 250 million Americans.

## About this segment

Shiv Rao says health systems, insurers and drugmakers must align for Abridge's larger platform. Starting with providers made sense because that's where care is delivered and value is exchanged.

From “Abridge’s Shiv Rao: Taking On Microsoft To Cure Doctor Burnout With AI”, Jul 23, 2026. [Watch the full episode](https://realalpha.app/v/W4_aRWsHogM/)

## Transcript

Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there.

[23:24](https://realalpha.app/v/W4_aRWsHogM/?t=1404) audience was. Yeah, totally. The personas are very different. So healthcare is a hard sell on the enterprise side. When you think about healthcare, I would think about health systems as one stakeholder. Another stakeholder is insurance companies. And then another one is pharmaceutical companies like the life sciences companies. If you can find a way to align across all three, you're transforming things. You can get access to new business models that actually benefit people you can find a way to be cheaper better faster and that's like that's what we're aspiring for and it's all starting to come together for us now finally now that we're we're at lever like we're at scale and now that we've earned trust we can we're starting to like thread the needle across all three in a health system itself that's the hardest part i'd say to go after this

[24:12](https://realalpha.app/v/W4_aRWsHogM/?t=1452) bigger picture there are companies or startups out there fully focused on pharma there are companies fully focus on insurance. But I think to create this three-sided network, to go after this bigger operating system, you have to start provider first. Because that's where the value is actually exchanged. That's where care is delivered. So going into providers really hard, sales cycles can be like 18 months long, historically. So when we were first raising capital, all these VCs would look at this industry and be like, oh my God, this is never going to work like do we have the patience for this and we had to keep telling them look it's going to be different like ai is going to make it different and it has been different these last four years haven't been hockey stick it's been more like telephone pull growth for us we're at scale now

[24:58](https://realalpha.app/v/W4_aRWsHogM/?t=1498) across i mean our health system logos represent 250 million Americans. That's how much scale that we've got, the ability to impact really everybody. But on the health system side, how do you do this? CMIO, that's the doctor sort of persona. And they just want the best tools that can help them deliver better care. They don't want to have to worry about what they call pajama time, doing clerical work after the kids are in bed, after they've eaten ants, like they're just sitting in their pajamas and they're writing notes and placing orders and making prior authorization calls or completing paperwork for clinical trials. That stuff just really burns you out over time. They're very aspirational.

[25:36](https://realalpha.app/v/W4_aRWsHogM/?t=1536) They want to save lives too. So clinical decisions board technologies they love. And then there's the CIO. The CIO is thinking, okay, is this another startup in healthcare that's going to die in two years? Like, is this a company that I can actually think about as being a part of our platform? Are they trustworthy? Do they have what it takes to scale? Can they integrate with their existing stack? Whatever that looks like. It's an ERP or a CRM or an EMR. And then there is the CFO. And the CFO is thinking, okay, healthcare looks like grocery stores on the provider side. The margins are that narrow. Are we going to be able to afford this company over time? If they're a platform, how is this going to be? Like, how is this going of impact our top line and our bottom line, you need to be able to sort of channel all those

[26:24](https://realalpha.app/v/W4_aRWsHogM/?t=1584) personas to be successful. Yeah. So that was kind of why I was asking is because I can imagine with your doctor peers, you're like, this will help with burnout. This will help you do more with