I’m not suggesting you should have a nice office, but one that creates the right atmosphere needed to stimulate high output from your team.

Consider what Jeff B’s setup from the early days at Amazon implies about the values of the company - in particular, the degree to which frugality is important.

As Peter T says, the best startups look a lot like cults. Building a successful startup is about convincing a small group of people to believe in a near-impossible outcome. And so, the most successful startups don't just build great products; they create an environment that enables insane belief.

Thousands of years of religion has proved that every group of believers needs a place to convene and to reinforce their values. To build your cult you need a temple. So for founders who can, I’d recommend avoiding coworking spaces. Build your own space.

In the early days at Loop we worked out of a two-bedroom flat. We put desks in the living room and converted one of the bedrooms into a conference room (the other bedroom is where our co-founder Ryan slept).

When people would come to interview for a job there would be nowhere to sit, so we’d kindly ask them to wait on the balcony. It felt like an office in the way a doghouse feels like a house. Which meant we could only hire two types of people: Those irrational enough to join, and those without other options.

As our startup grew, and particularly after we announced funding rounds, we started to attract better talent. We set up a proper office, started to build a brand, and suddenly people who would have never considered our outfit wanted in.

And that’s when I began to notice an interesting cultural dynamic—one I call the "Late Joiner Fallacy."

It goes something like this: People who join later, when a company is more established, look around and see some of the work that was done before them and judge it, often harshly. They see messy processes, half-baked solutions, or decisions that seem ill-considered. And they begin to question the people who made those decisions in the early days. "How did these people end up here?" they think. "Why are they still around? Surely, I could do better."

What they fail to recognize is the vast difference in the nature of the challenges faced early on versus those encountered later. The late joiners never lived in the doghouse.

In the early days, the ambiguity was thick. We had no map, just a compass and faith. Early employees weren’t just working with fewer resources—they were operating in an environment of extreme uncertainty. What looks like poor decision-making in hindsight often made perfect sense in the chaotic context of those early moments.

To judge early work through the lens of later clarity is a mistake. It’s like criticizing a builder for not laying down marble floors in a house when they were still struggling to put up walls with salvaged materials. The early team isn’t there because they were the "best in the business”, but because they were willing to take on a staggering amount of risk and uncertainty—long before anyone knew whether the company would even survive.

Late joiners also find it hard to swallow the fact that some early employees typically have more equity than they do. From their vantage point, these early employees may not seem as competent or skilled as the talent the company is now attracting. They may grumble about the "unfairness" of this dynamic.

But here’s the thing: equity isn’t just a reward for competence. It’s a reward for timing. It’s compensation for stepping into the unknown when failure was not only an option, but likely. Early employees gave up higher-paying jobs, worked longer hours, and stuck with you when the odds were against you. Their equity reflects that risk, not just their contribution.

Late joiners, by contrast, come in when the startup has more stability. They join when the risk is much lower. Naturally, so is the reward. You don’t get to ask for big upside without facing the big downside.

What’s interesting is that early employees and late joiners both play critical roles in the success of a company. The early employees build the foundation, sometimes clumsily but bravely. The late joiners help the company scale, often with more refined skills, but with the benefit of an existing foundation. The true magic happens when both groups recognize this dynamic for what it is—a necessary, symbiotic partnership.

The late joiner fallacy happens when late employees mistake their more refined contributions as inherently more valuable, overlooking the sheer difficulty of doing anything at all in the wild, early stages of a company’s life. In a startup, success is not just about competence. It’s about timing, resilience, and an appetite for ambiguity. Everyone contributes—just in different ways and at different times.

I sat down with Shashank ND, CEO & Co-founder of Practo, who has spent more than 15 years at the forefront of healthcare technology in India. Today, Practo’s software is used in more than 20,000 clinics and the company has over 150,000 doctor partners and healthcare providers on its platform. Practo sees more than 17 - 18 crore visits on their platform every year.

In this discussion we spoke about the paradox of abundance, a healthcare system burdened by ineffective primary care, mistrust of doctors, and geographic disparities. Shashank peeled back the common myth that India's healthcare revolution lies not in adding doctors, but in building more trust and prioritizing preventative care.

Below, I’ve broken up our conversation into five sections, including his direct quotes.

How we got here

AS: What are the systemic issues plaguing Indian healthcare and how did we get here?

Shashank: “First let’s consider where we are in the timeline of India’s history. India has lifted millions out of poverty. The poverty rate in India has plummeted from 55% in 2005 to 16% in 2019, and we’ve lifted almost 500 million people out of poverty. But now that we have sufficient access to nutrition, we are facing a new problem: the issues of abundance. ”

Economic reforms since 2000 propelled India’s services sector to contribute over 50% of GDP, creating millions of jobs. With respect to food, grain production witnessed a 25% increase, while the Public Distribution System ensured subsidized grains reached over 800 million people. Grain storage capacity has also expanded by over 50%, minimizing wastage and ensuring food security.

Shashank: “However, it’s hard to talk about India broadly because there are actually 3 Indias. You have your bottom of the pyramid making less than 2 lakh a year, those making between 2 to 10 lakh and then your upper class making more than 10L a year. Each group faces different challenges. The issue of abundance is concentrated in the upper two groups, which is about 150 million people who primarily live in urban metros.”

The preconditions for lifestyle diseases

AS: Can you say more about the problem of abundance? What is driving the massive rise of diabetes and other lifestyle diseases in our cities?

Shashank: “Well if you look at the average visceral fat and the obesity levels in urban India it is rising quickly. People spend very little time exercising or going to the gym. 30% of Americans have a gym membership, whereas only 2% of Indians do. Plus the Indian diet doesn't help.”

White rice, refined flour, and processed bread are the most commonly used carbohydrates in India. Like many regions around the world, India is also witnessing an prevalence of processed foods and sugary drinks. 

Shashank: “If you have a poor diet and limited exercise, you're a clear candidate for diabetes, hypertension, and all chronic ailments. Later in life that leads to other forms of neurological issues too. So underpinning the entire issue of reduced Indian lifespan are these factors. Plus Indians tend to work longer hours, the average work week here is 50 hours, compared to 40 hours in the US.”

People don’t utilize primary care regularly

AS: “How do we get people to engage in preventive care and do things like regular health check ups?”

Shashank: “Affordability and willingness to pay are big reasons. For a regular health check up people expect a price point of 1,000 to 2,000 rupees. It can be as low as 500 rupees for basic tests. But to do really good preventive checkups, it costs 10,000 to 20,000 rupees. Those tests can give you clarity on the calcium deposits in your heart and your overall cardiovascular health. Then, consider cancer screenings, especially breast cancer which is the most prevalent.

Insurance is also a major problem. A large portion of healthcare spending in India is out-of-pocket, meaning patients pay directly for services. I think we should cover things like physiotherapy and mental health where early issues can be caught and prevented. Because these things are expensive and paid without insurance, people wait too long to see a doctor.”

AS: “It’s a common habit for Indian patients to skip the primary care GP and go straight to the specialist. Why is that?”

Shashank: “That’s right, in other countries you talk to a GP and then that GP navigates you through the care path. Indians usually go directly to a specialist. One reason for that is because people wait until their problems are too severe. But then the market economics for GPs is also not great. They can’t charge much for a consultation. Hence the best doctors want to specialize and all the talent flows to the specialities. Then that further makes the GP experience worse. The need for quality GPs is high and that's causing a big gap in the ecosystem right now.”

Trust in healthcare

AS “We often hear the stats about the low doctor to patient ratio in India. We just have 1 hospital bed for every 10,000 patients. Do we have enough doctors and hospitals in general?”

Shashank: “That’s true, but there’s nuance there. We have an access issue, more than a supply issue. Even the busiest hospitals in Bangalore are running at 70% utilization. We have plenty of doctors in the metro cities. In rural India, where 700 million people live, we have limited infrastructure and less doctors. That’s mostly because doctors prefer not to work in low income areas because of the lifestyle and low pay. But there’s no shortage of doctors in the metros.”

AS: “Despite the availability of doctors in metros, we hear about patients not trusting health care providers. They feel they get taken advantage of by being prescribed unnecessary procedures and tests. Is that general mistrust in doctors warranted?”

Shashank: “There’s more nuance to the question of trust. In general, I don't think doctors are trying to squeeze patients out. They have a reputation to manage and healthcare is all about trust and reputation. If you lose your reputation, it's going to be very difficult for you to grow. So I think doctors are doing their best. 

But I think the challenge is how this information about affordability and quality is shared with patients in advance so they can make more informed choices of where they're going.

Today healthcare is a black box. You don’t know how much you’re going to have to pay for a service. You're not aware of your cost prehand, you're only aware of everything posthand and that's when the frustration and misalignments happen. We need to find ways to make the healthcare system more transparent. 

There’s vastly different healthcare options available to consumers. Like I said, there are 3 distinct income groups in India and all of them exist shoulder to shoulder. You can get a knee replacement done for 20,000 in some places. In other facilities, the same procedure would be 2 lakh rupees. Now imagine you’re in the lower income group and you walk into a nicer hospital and get a bill for 2 lakhs for something you thought would cost 20k. You would lose trust quickly. Same goes for high income patients going to lower-end facilities. They’ll complain about the quality of the rooms and the overall experience.

A lot of making healthcare experiences better comes down to matching the right patients with the right providers. Like we said, there are plenty of specialists in urban metros, but the patient doesn’t understand what quality or price point to expect until after the procedure is completed. By then it’s too late and this erodes a lot of trust.”

I think this is a fascinating point. Shashank challenges the black and white view of doctor mistrust, arguing it stems from information opacity, not malicious incentives. He sees doctors protecting their reputation, but patients lack pre-emptive cost and quality awareness to make informed choices. This shifts the narrative from villainizing doctors to understanding the systemic issue of information asymmetry.

The family doctor concept

AS: “Are there any models you’ve looked at within Practo that could help patients get access to care earlier, rather than waiting to see a specialist?”

Shashank: “There is this family doctor concept we have looked at. It’s about giving people one trusted point of contact in healthcare they are able to reach out frequently. Then they build a habit of speaking to that person about even their smallest health concerns. That would help people get ahead of their issues. 

That family doctor is the one who would intervene on a monthly, quarterly basis and would give you the heads up saying ‘Hey you can easily prevent this, just do these XYZ things. You're doing these small things wrong which is becoming a habit and that habit over years will become a symptom. Then that symptom over years will become a major health issue.’ So there’s a lot of power in having a trusted family doctor type provider in your life. Today, that model isn’t profitable yet, but it’s worth exploring.”

One way Practo solves the trust problem

Shashank: “We’ve been laser focused on solving the trust and transparency issue in healthcare. On every single doctor profile on Practo you can see reviews and ratings. Not just from patients, but our own internal Practo audit team who go to doctor’s clinics and actually reviews their overall cleanliness. 

We also provide ratings on the types of machines they use to sterilize medical equipment and the age and exact model of their medical devices. It takes a lot of time and effort, but it’s something we knew we had to invest in to ensure quality. Eventually that leads to trust. It takes a long time to build a great healthcare brand, and trust is at the center of it all.”

In Conclusion

Shashank: “In general, we have an awareness issue across the board. People aren’t aware of the right foods to eat. They don’t know the value of regular exercise. And there is low willingness to pay for the comprehensive annual check ups that actually give you a detailed picture of your health. There’s a lot of work to do to solve patient behavior and correct lifestyle diseases in our country. That being said, there’s also opportunities to use new technologies, like AI, that can solve these problems.”

My conversation with Shashank was fascinating. It’s clear he’s spent 15+ years in the deep end of healthcare, tackling some of the most significant problems in this space. As India's health paradox unfolds- abundance breeding chronic disease- we have new challenges to solve. 

Beyond doctor supply, it's trust and transparency that ails the system. Patients navigate a murky maze of costs and quality, fueling frustration and mistrust. Shashank suggests there are many things yet to build: matching patients with right providers, empowering choices through trusted family doctors, better rural infrastructure, and more insurance coverage.

Fixing a broken experience

AS: “For a person buying a diagnostic or a blood test, what is the experience like? What problems do they face in the process?”

Dhruv: “There are several problems. First it takes a lot of effort. You spend time in traffic, then waiting in the line at the collection center. If you are already sick, then you are potentially exposed to further infection. Or you Whatsapp someone for home collection. Very rarely do they show up on time. Then that phlebotomist visits a dozen homes before bringing the samples back to the lab, so the samples are not stored properly. This makes the results less accurate. Then, of course, the report processing time is long and highly variable. We heard many patients complain about getting delayed reports and knew this was a problem to solve. 

So that’s what we built: Book and within 60 minutes we’re at your home for collection, we have the shortest time from vein-to-machine, reports within 6 hours, and absolute reliability.”

Creating customer delight

AS: “How does decreasing the time to delivery impact the customer experience? How much does speed matter?”

Dhruv: “In healthcare, we show care to our loved ones by being responsive, action oriented and by providing quality care. Orange Health Labs does the same for its customers. 

Think about the healthcare experience in full: When you’re unwell, you can talk to a doctor within 10 minutes, any time of the day. When the doctor suggests medicines, they can reach your home in 30 minutes from the neighborhood pharmacy. But when your doctor prescribes tests to you, there is no one coming now, or in the next couple of hours. Maybe tomorrow morning, unless you want to drive to the nearby collection center with your sick relative. In a world where everything is available on demand, it seems broken that we can't get tested sooner!”

Dhruv believes speed of delivery cannot be compromised. That’s why Orange closely measures TATs on:

1. Time from order to collection which alleviates the patient's anxiety around their condition.

2. Speed of reverse logistics (taking the sample back to our lab) ensuring a high quality sample.

3. Time to report, ensuring the doctor can treat their patient faster, and as a result, get better health outcomes.

Starting the preventive care journey

AS: “Data is the starting point for preventive care and testing is a key component to collecting that data. How do you incentivize people to get blood tests more regularly?”

Dhruv: “That’s right, diagnostics is the starting point for data generation in healthcare, and upstream of all treatment. As we make the experience even more seamless, deeply integrated with your healthcare provider, and help people get deeper insights into their health risks, it will help people be more proactive about their testing and healthcare needs. With enough longitudinal data, consumers and doctors can also spot trends in their health and make better decisions.”

AS: “How do you personalize tests for people and their specific health needs?” 

Dhruv: “We recognize that each person is unique. Our lifestyle choices and family’s genetic history have a large impact on our health risks. As a result, picking standard health checkups may not be ideal to truly manage your health risk. 

As a result, we’ve recently launched a new product called Personalized Health Checkups, that enables customers to answer a few questions about their lifestyle and history, and our algorithm will design a personalized health checkup with a mix of advanced tests that the patient needs in order to manage their health better.”

This is a first of its kind product in the diagnostic space in India, and maybe globally. For the first time, a patient can input data on their health and get recommended which tests truly to take. Click here to see the product in action.

AS: “How do you make the results actionable, and drive better health outcomes?”

Dhruv: “The most important thing is making sure the results are interpreted quickly and correctly. Orange Health Labs sends your reports directly to your doctor, so they can guide you best for better health outcomes.”

AS: “What else matters to the customer that you’ve been able to differentiate on? How does this drive better health outcomes and increased longevity?”

Dhruv: “In our user research we found that anxiety around the collection and waiting for the test results significantly degrades the healthcare service experience. Besides speed and reliability, we focus on ensuring highly empathic communication through all our touch points, emanating care to the patient. This alleviates the patients and their family's anxiety. All of this combined has been a key factor in Orange Health Labs becoming India's highest rated diagnostic lab, or may I say, India's most loved diagnostic lab, in just 3 years since launch.”

It’s true. Orange Health commands a slight premium over other local diagnostic providers. Their customer NPS scores tops the market. And they continue to expand their services to new geographies each year.

In what has historically been a commoditized, race-to-the-bottom service, Orange has changed how customers experience testing and increased their willingness to pay. It’s deeply exciting that Orange exists and will continue to launch innovative products in the space making tests personalized and more actionable.  

If you pitch a venture investor in India on building a brick-and-mortar outpatient healthcare startup, you may never hear back. At best, you’ll be warned about the challenges of scaling and painfully low margins.

Yet the success of Proactive for Her offers a different narrative. Founder Achitha Jacob, fueled by a clear vision and empathy for women's needs, dared to create a healthcare company that defies the mold. Forget sterile environments and rushed consultations. Proactive prioritizes personalized care, open communication, and a holistic approach to women's well-being. This isn't just a new healthcare company; it's a new business model proving that patients are willing to pay for a more comprehensive, high quality healthcare experience.

I had a fantastic discussion with Achitha on how they’ve built the company and their vision for the future. Below, you’ll find the key highlights from our conversation.

How it all started

AS: “What prompted the idea of Proactive For Her and what’s missing in India’s healthcare system today?”

Achitha: “It was actually personal experiences and frustrations that ignited the spark. Growing up in India as a sexually active woman in my twenties, I faced the harsh reality of limited, often judgmental healthcare options. My experiences in sterile, intimidating hospitals with long wait times and little focus on preventive care or open communication were just the tip of the iceberg. I knew there were countless women like me looking for something better. That's how the vision for Proactive For Her was born: a safe space offering comprehensive, non-judgmental outpatient care that prioritizes women's holistic well-being, not just immediate medical needs.”

Proactive For Her is addressing unmet needs

AS: “Can you elaborate on the long tail of healthcare needs you're addressing that traditional setups often overlook?”

Achitha: “Absolutely. The traditional focus on tertiary care in women's health leaves a huge gap for everyday concerns like sexual health education, sexual dysfunction including vaginismus, menstrual health management, and routine checkups outside of pregnancy or major illnesses. If you look at your current setups, like Cloudnine, Motherhood or even Indira IVF, they have a very clear focus on certain procedures. Their entire machinery is geared towards high value treatment for inpatient customers. 

We're filling that gap by building a primary-secondary care model that caters to the entire spectrum of a woman's health journey, from adolescence to menopause. We offer services like STI screenings, contraceptive counseling, PCOS management, and menopause consultations, all in a friendly, supportive environment that encourages longer relationships with the patient.”

Achitha also described how they were intentional about building the right clinic aesthetic to create a more comfortable experience for patients.

“When we were doing our first experimental clinic, I was speaking to the architect and they were like, oh, you're building a clinic? And then they showed me all of these blue and green designs, all very hospital-looking. And I was like, ‘no, we need something better. Think of a salon. Think of a cafe.’ 

Healthcare is scary as it is, so we have a huge focus on creating a very nice, bright aesthetic. We've meticulously designed our clinics to feel more inviting. Women care about the bathroom and the waiting area. These things really matter. So we focus on creating a warm, welcoming atmosphere with soft lighting, comfortable seating, and friendly staff who genuinely listen. It all ties back to making women feel heard, respected, and empowered.”

Building a sustainable business

AS: “Investors often cite high CACs in retail healthcare as a reason that startups will fail in this market. In a world where everyone is paying top dollar to acquire customers, how do you attract new members sustainably?”

Achitha: “If you are a healthcare startup competing online and people are choosing between one online player and another, it gets hard because a lot of those services are commoditized. But, if you have a unique offline offering it can be game changing. 

I truly believe we have no direct competitor because we're not just providing a service, we're creating an experience. And we can see that in our organic growth. As far as acquiring customers, personal referrals from friends and family have been our strongest marketing channel. More than 50% of our members come through word-of-mouth and nearly 40% of our consultations today are returning patients.

Women connect with our story, resonate with our values, and trust the experiences of their friends who refer. We're actively fostering this organic growth by building communities, and we're also using social media to spread awareness about our services and educate women on proactive care.”

Measuring health outcomes and driving proactive care

AS: “The organic growth speaks volumes about the quality of the experience at Proactive For Her. But how do you measure health outcomes for patients?”

Achitha: “Right after every consultation we ask for the patient to provide a rating of their experience. So that's basically a customer saying, yes, you guys met my expectations, the doctor was good, the clinic was good, etc. This is a good proxy for if someone feels they're being given the right advice.”

Another fascinating thing Achitha mentioned was Proactive’s ability to change patient behavior by getting them to opt for preventive screenings more often.

Achitha: “One of the most striking examples is our Pap smear testing rates. We refer the highest number of samples in Bangalore, even more than the largest hospital chains, which is a significant feat. Consider that many women, especially unmarried ones, face stigma and hesitation in accessing these crucial screenings elsewhere. We've normalized these conversations, broken down barriers, and empowered women to actually prioritize preventive care. We're seeing a tangible shift in attitudes and behavior towards proactive health.”

The future of Proactive For Her

AS: “Looking ahead, what's your vision for the future of Proactive For Her?”

Achitha: “Our focus remains on expanding our offline presence. We believe that building meaningful relationships and trust with our patients requires a physical space where they can connect with our healthcare team face-to-face. We’re opening up three more clinics in Bangalore soon bringing our total clinics in the city to seven. 

We are CM2 profitable at our earlier clinics. So it's much easier to scale now with confidence. We've literally gone through every single iteration, and what we've learned is to have a sustainable business we need to have an offline component. Playing the digital-only consult game is just too much smoke and mirrors. 

While we'll continue leveraging online channels for education and outreach, our core strategy revolves around establishing accessible, high-quality outpatient clinics. We're also committed to expanding our services to cater to the evolving needs of women at every stage of their lives. Ultimately, our vision is to be a beacon of holistic women's healthcare, setting a new standard for patient-centric, inclusive care that empowers women to live their healthiest lives.”

In conclusion

From my conversation with Achitha it’s clear that Proactive For Her's success hinges on two key ingredients: patient-centric experience  and a focus on brick-and-mortar clinics. Forget the digital-only chase for customers; it's the curated space and genuine, face-to-face interaction that sets them apart. 

At Proactive, women don't just receive healthcare; they build relationships with a trusted team. This fosters loyalty, translating into word-of-mouth growth and sustainable profits. Patients are willing to pay a premium for the great outpatient care they receive. Proactive For Her isn't just changing the narrative around women’s healthcare; it's proving a viable business model in a traditionally low NPS and fragmented market. 

Forget sterile waiting rooms and foreboding drills. At the forefront of India’s dental care landscape is Clove Dental, a retail chain changing how India experiences dentistry. Clove has expanded to more than 400 clinics across India in just ten years and treats 40,000 patients per month. In this interview I spoke with Amar Singh, Clove's Founder and CEO, to understand the unique challenges they’ve had to overcome. 

The dental care landscape gives us a window into the systemic issues plaguing Indian Healthcare. Why do patients lack trust in the medical system? How do we incentivize doctors to think about long term outcomes for patients? Amar shares how his team has solved these problems using a unique combination of technology, quality control, and the right incentives.

Below, I’ve broken up our conversation into five sections, including summaries of Amar’s thoughts and many of his direct quotes.

Dental hygiene and lifespan

AS: “What do we know about the link between dental health and overall patient health and lifespan?”

Amar: “Periodontal Medicine is a new paradigm in dentistry. The proven periodontal - systemic link underscores the connection between oral health status with multiple systemic diseases. New research published in the past few years links chronic inflammation in the gums with elevated inflammatory response throughout the body. Poor periodontal health greatly increases the risk of chronic diseases like heart disease, diabetes, arthritis and even Alzheimer's disease. It affects pregnant women, resulting in preterm labour, premature birth and low birth weight babies.”

Bacteria from your mouth can also travel to your lungs, triggering respiratory problems like pneumonia and bronchitis. This is especially concerning for people with weakened immune systems or pre-existing respiratory conditions.

Research links here and here for readers interested in learning more.

The challenge of changing consumer behavior

AS: “Given the importance, how do you get patients to think about their dental health early and often?”

Amar “For most consumers, the dental care journey is reactive. It starts with a visible problem or tooth pain, meaning that they see discoloration or they see plaque, or they see bleeding, or they see a missing tooth, and that bothers them. Or in more serious cases they have a specific pain in their tooth or jaw.”

Naturally, awareness of the long term implications on health is low. Because most people wait until they feel pain, the problems go unnoticed for a long period of time. By the time a patient walks into a clinic, drastic measures (like a root canal or even reconstructive surgery) are required to solve the problem. 

Amar: “It’s a hard problem. We continue to nudge patients towards preventive care by offering annual plans or membership plans that lowers the friction of regular check-ups and maintenance. We suggest members also purchase plans for family members. On top of that, we digitize everything and use technology to drive follow ups.”

The challenge of building retail healthcare in India

AS: “Many companies have tried to build in the retail healthcare space and failed. Most investors complain of high CAC and low retention. How have you overcome these issues?”

Amar: “Let’s consider where most patients start their care journey. You need to see a dentist urgently because you have a bothersome amount of tooth pain. So you then start looking for a doctor or a dentist, and your typical questions are, who's close by? Who is a good dentist? Who's not going to rip me off? Oftentimes in dentistry people are not asking the question, ‘Who is the best in the country?’ like they would in cardiology or nephrology.”

For dental care, much like primary care, patients look for convenience, proximity, and upfront pricing as much as they look for quality. Therefore, growth relies on expanding to new locations so that Clove can be proximate to more target consumers.

Amar: “If you give patients easy access and quality, you can drive traffic, retain patients, and build a valuable business.”

Patient trust in healthcare providers

AS: “How do you solve the trust deficit with dentists?” 

Amar: “First, there is low awareness of the 8 dental specialties, each of them requiring three years of an MDS degree. There's no organ in your body that has eight subspecialties. Your lungs don't have eight. Your heart doesn't have eight, but your teeth have eight different specialties. And the reason for it is because of the complexity of a fairly small area in your body- a highly nerve sensitive, highly utilized part of your body. So there's a huge gap in how consumers perceive the complexity of dental problems and the reality.”

Because there is so much complexity and patients often wait for symptoms to develop to the point of severe pain, they are surprised by radical treatment paths like root canals, implants, and crowns (and their associated costs). They feel they are being taken advantage of, when in fact, there is no other option- the patient has waited too long to take action.

Amar: “The other issue is that some dentists do overprescribe. We have the problem of commercialized healthcare in India where most doctors work on a fee-for-service basis.”

Clove has solved for this issue in two ways:

First, all doctors at Clove are full-time employees and paid on an 80% fixed income basis, even if they are underutilized. They don’t get upside from overprescribing procedures and so naturally they default to what's best for the patient. 

Second, Clove has a strong audit system to ensure doctors are focused on quality.

Amar: “After a treatment is recommended, we anonymize the patient’s record and send it to another doctor in our system. That doctor goes through a checklist to make sure that the diagnosis was correct. We also ensure that billing was done appropriately for that treatment. Without a system like this, there's no way you can guarantee consistency of treatment quality. We are monitoring 40-50% of live cases at any given point in time. And of course, we have strict standards on the quality of doctors we bring on. We have standards on equipment and materials that we use. And we have consistent pricing. We audit all of this regularly.”

Other unique challenges in Dentistry

Amar: “One interesting problem we had to solve was maintaining cleanliness of the facilities. Every time a chair is used, it gets contaminated because of blood and saliva. Your doctor puts their hands in your mouth, there's blood coming out or saliva, and then they're touching the chair. As per protocol the dental chair needs to be sterilized, usually by a dental assistant. Now, that individual has to do this same job ten times a day, six days a week, 20 days a month. That gets really monotonous, and it’s easy for the dental assistant to skip out on the cleaning.”

To solve this, Clove has automatic sterilization chairs known as DORI, which are self cleansing. This process is monitored using the installed cameras that use computer vision and AI to monitor whether or not the chair has been sterilized after every appointment. This ensures a 100% sterilization rate.

Amar: “The average dentist in India does not possibly have the means or ability to set up these systems in every room. That’s one way we’re able to differentiate our experience and build trust.”

Another thing Amar mentioned was Clove’s internal certification system.

Amar: “We only hire specialists. 70% of our dental network is people holding MDS degrees. Beyond that, we do further accreditation. No matter which doctor we hire, we have to certify that doctor internally and approve them for a certain kind of procedure. We may hire an endodontist, and even though he's a qualified endodontist, we will not let him do RCTs until he has gone through our internal screening process. We are guaranteeing quality by hiring the specialist, but then further validating their skillset with an internal accreditation.”

In conclusion

Amar’s journey while building Clove provides fascinating insights into consumer behavior and how retail healthcare brands can successfully scale. The team at Clove deeply understands the nuances of dental care and the patient journey. 

Clove has tackled multiple hurdles on its path to success:

• Shifting patient mindset: Moving patients from reactive, pain-driven care to proactive, preventive habits by experimenting with membership plans and digital nudges.

• Building trust: Combating the trust deficit in healthcare by addressing the information gap around dental specialties, tackling overprescribing, and implementing rigorous quality audits.

• Scaling retail healthcare: Understanding the importance of proximity and transparent pricing in influencing patient choices

• Embracing technology: Automating chair sterilization with tools like DORI

Clove's success isn't merely measured in terms of clinics opened or patients treated. Amar and his team have completely reshaped the patient experience, instilling trust in a historically low-trust, low NPS category. By prioritizing preventive care, ethical practices, and transparency, Clove has paved the way for a more responsible and patient-centric healthcare model.

India's Healthcare Crossroads

India is at a crucial point in its healthcare journey. Our healthcare system has been underperforming for decades. While other countries progress, India's healthcare system has stagnated or even regressed. On average, Indians live to just 69 years, compared to 84 years in Japan. That's 15 fewer years of life per person.

The health numbers in India are alarming: over 100 million diabetics, the world's highest rate of cardiovascular disease, not enough doctors or hospital beds, and an abundance of unhealthy processed foods.

Challenges We Face

India's healthcare system has deep-rooted problems. We have too few doctors and hospital beds for our huge population. With just 5 hospital beds per 10,000 people and 1.2 million doctors for 1.4 billion citizens, doctors are overwhelmed. A typical doctor's visit lasts just 5 minutes, making it tough to understand a patient's medical history.

Worse, the current "fee for service" model rewards doctors for doing procedures, not for improving long-term health. This results in reactive healthcare, focusing on treating illnesses, not preventing them. Patients often seek alternative treatments due to concerns about unnecessary procedures.

Solving these big problems requires a fresh approach to healthcare. We need a brand-new system that realigns financial incentives for hospitals and uses technology to make top-notch primary care accessible.

Introducing Health Assurance

At Loop, we've created this new system called "Health Assurance." It's more than regular medical insurance. While insurance mainly covers major medical treatments, Health Assurance offers financial coverage for these treatments while also providing access to preventive care, wellness programs, and chronic disease management. Think of it as an insurance plan committed to preventing diseases, not just reacting to them.

The Key Elements of Health Assurance

Correcting Incentives: We reward doctors for achieving health goals, not just doing procedures.

Technology for All: Telemedicine makes care accessible to more people, offering continuous support for healthier lifestyles.

Prioritizing Prevention: Instead of waiting for severe illnesses, we focus on early intervention to improve health and reduce costs.

Data: Gathering comprehensive health data enables early disease detection and personalized care, including vitals over time, family health history, and genetic profiles.

What would Health Assurance look like?

Imagine a future where your cardiologist keeps track of your heart health through a wearable device. Picture your nutritionist checking in with you regularly. Envision your insurance covering annual lab tests. Health Assurance is about catching diseases early, helping you make better daily choices, guiding doctors to make better decisions, and ensuring you lead a happier, healthier life.

The urgency is clear. Our healthcare system is inadequate and costs us years of life. We need to restart and build a more effective system to extend the lives of over a billion people.

The foundation is already laid, with scientific protocols for personalized healthcare, lower sensor costs, increased insurance coverage, and growing health awareness. Now is the time to build Health Assurance for India.

Join the Movement

At Loop, Health Assurance is not just a plan; it's a promise. The current system is not just inadequate; it's unfair. We have the tools, technology, and talent to bring transformative change. India's health is its wealth and future. Let's not waste it. Together, we can reclaim those 15 years each of us deserves.

Join us in building a healthier, happier India. You can learn more at loophealth.com/health-assurance

Let’s say you’re a founder building a startup and things are starting to take off. You’ve raised a few rounds of funding, you have some semblance of ‘PMF’ and your team is growing.

Hiring has been a major challenge for years but suddenly you're getting more recognition. As you put out job posts, you see inbound applicants with “Tier-1” credentials. You’re getting resumes from people who went to Stanford, worked at McKinsey, BCG, and all sorts of other fancy places.

Though it can be tempting to hire a bunch of these folks, I’d advise you to proceed with caution. Yes, these folks have impressive backgrounds, but they are also usually 30-50% more expensive than other candidates of a similar skill level. In a sense, the labor market has already priced in their abilities.

In our current cycle (2023) where VC money is less available and burn multiple is the new north-star metric, it’s worth spending the time to broaden your search and find less expensive candidates.

I’ve found that you can find similarly qualified candidates at a lesser cost if you extend the interview cycle by just 15-20% and broaden your search slightly.

There are tons of talented people in the labor markets who remain ‘undiscovered’. These are the people who are hungry, passionate, and eager to prove themselves. Because they lack the status that comes with a Tier-1 brand, they arrive with a bit more humility and sometimes a chip on shoulder mentality that results in great performance.

If you're willing to invest in a broader candidate search to find those ‘hidden gems’, you can build a fantastic team at half the cost. Don't get too caught up in hiring brand name talent. Look for the diamonds in the rough, and give them a chance to shine.

Where this post started

Over the last few years, I’ve noodled over the problem of building a great brand in India. 

What used to be a novel idea for marketers- that any attention is good attention- is now widely understood. All companies are content companies. The battle to produce louder, more outlandish content is on. 

Therein lies the problem: how does a new brand break through the clutter?

So I talked to some friends…

In a world where distribution is expensive and mindshare is slim, these three guys have figured it out against the odds. Raj Kunkolienkar of Stoa School, Misbah Ashraf of Jar, and Ashwin Suresh of Loco and Pocket Aces. 

While speaking to them I realized something important which I had been missing all along- building a brand isn’t just about picking a good mission and talking about it. 

It is about making your brand a lived experience for customers. 

It’s about creating frames that your customers can step inside, which make them feel like participants in the mission you’ve chosen. More on this below.

What does great branding look like?

(At the risk of being reductive) Great brands convince customers to make irrational decisions. 

Why do people buy Apple when Androids are 50% cheaper? Because Apple is for artists. And green texts are ‘not cool’.

Why do young engineers work grueling 90-hour weeks at SpaceX? Because they are working alongside the smartest minds to make it possible for humans to exist on other planets.

Why do founders want to raise capital from the Tier-1 investors like Benchmark or Khosla, even if the deal is on less than ideal terms? Because these VCs know how to pick winners. If they back your startup, you’re a winner too.

These organizations have shrouded their reality in status and emotion, which makes their whole greater than the sum of the parts. They have the ability to make their customers feel rational while making an irrational choice.

How have they done it?

Picking your purpose

As is probably obvious to you, the meaning behind a brand has a powerful influence on consumer decisions. It entirely shapes the way consumers perceive a company.

Founders decide this purpose early on, usually in the form of a mission statement. But picking a good purpose is not enough. The only way to build a truly legendary brand is to find moments to authentically convey that purpose-- aka ‘creating frames’.

Any company can claim their purpose is to save the environment. They can claim to be a sustainable brand. But that doesn’t make them The Brand that environmentalists want to champion. You can’t build a brand as cherished as Patagonia by simply espousing your values on a website and doing some PR that no one reads. 

How do you become The Brand? You must draw your customers into an emotional space where they can understand and connect with you. You must create authentic ‘frames’ that your customers can step through.

Meaning is experienced through frames

For many Tesla customers, driving a Model-S is not just about getting from point A to B. It’s about supporting the environment. It’s about being on the frontier of technology. 

To a devout Teslan, the drive is much more than a car ride. It’s a special feeling. For a few moments, while driving that car, Tesla customers get to don a new identity. They are one step closer to an ideal version of themselves. They’ve gone “super-saiyan”.

That’s the kind of feeling that great companies can engender in customers. It’s that feeling that makes you want to tell others about a product you tried. 

How do you get your customers to this place? How do you get them to conflate a product experience with something that is much more- a feeling that borders on transcendent?

Framing. Elon has spent the last decade owning the frame of electric vehicles and what they mean for the future of humanity. When you drive a Tesla, you too are part of this movement. 

And, whether we realize it or not, we are constantly slipping in and out of frames each day. A few examples-

A marketing-led frame

Patagonia receives the same sustainability ratings as other competitors like The North Face and Columbia, yet their customers claim that Patagonia is a far more environmentally conscious brand. 

Why? Their messaging and marketing campaigns communicate an extreme view on environmentalism, which translates to how customers perceive them. They exude their value of sustainability. 

Patagonia’s “Don’t buy this jacket” campaign was designed to tackle the issues of consumerism head on. Patagonia recognizes that buying less is one step shoppers can take to reduce their eco footprint, saying “It would be hypocritical for us to work for environmental change without encouraging customers to think before they buy.” That’s a message that resonates with environmentalists.

Now, next time someone steps inside a Patagonia store, they know it’s entirely their own decision to buy. They are buying solely because they “need” the product, not because the company has pedaled some message. In fact, the company has gone so far as to discouraged them from buying too many products. It’s a powerful frame.

There’s that quote- “Those who least want power are most deserving of it.” Well for environmentally-conscious consumers, those who least want their business seem to be most deserving of it. 

A service-led frame

Costco claims to be extremely customer service oriented, and if you’ve visited any location you know about their generous return policy. They allow members to return almost any product if they are not satisfied with it. Literally anything— electronics, appliances, and even food items.

This is a powerful frame for Costco. When a customer walks into their store, they can rest easy knowing they won’t experience buyer’s remorse. By creating an environment where customers can return a product at any time if they are not satisfied with it, they are more likely to feel confident in their purchases and to buy more things during a trip to Costco.

A powerful frame that changes the shopping experience and results in more spend per store visit.

A personal frame

It’s not just companies and marketers that create frames. We do it all the time, with each other. 

One common way that people use frames is by ‘name dropping’. By getting you to associate them with other people you may know and respect, they take on a higher status. This is a frame.

They are bending their perceived status. They want you to interact with them through this distortion field, rather than meet them in reality as they are. (Thanks Raj, for this one)

So what’s the TLDR?

In short, frames rule everything around us. You too must learn to control the frame through which customers interact with your product. 

These frames can and should be placed everywhere- at the brand awareness stage, all the way down to core product experience and customer support. In the Costco example, their generous return policy is a frame that comes at the very end of the shopper’s journey, but has a powerful upstream effect on purchasing decisions.

Frames are not just for big companies. To win at any scale, you must create and own frames. We call this a “unique value proposition”. But it’s the “proposition” part where most marketers fail. We list reasons why we are better or different than competitors, but fail to translate that to a “feeling” that customers can experience. 

Feature comparison lists don’t convert customers to champions. Missions and Frames do. Here are a few examples of startups that have nailed framing--

Stoa: Good vs. Evil

Many of you know Raj because of his active voice on Twitter and his authentic, even outlandish, branding work. Over the past 2 years, he’s successfully deployed an excellent frame for Stoa’s mission: a ‘David vs. Goliath’ story.

The ‘Goliath’ in this story is the Traditional MBA run by old-school administrators who prey on the millions of students desperate to find good jobs.

Enter Stoa, the unlikely hero. Study part-time, learn useful information, and then get an excellent job at a modern technology company.

When students get admitted to Stoa, they feel they are joining a tight cadre of independent thinkers. They are outsiders, taking a contrarian-right bet against the status quo. It’s an incredibly powerful feeling and results in a lot of student-led promotion and word of mouth.

(I can personally vouch for the program. We’ve hired several Stoans and they are excellent.)

Jar: It’s about great people

From Day 1, Misbah has been dedicated to working only with the most talented product builders in the country. For him, the single most important input for a successful business is having great people. 

Every executive team says this, but the team at Jar lives it. Every quarter Misbah brings together hundreds of product managers to talk about user insights and to share learnings. 

The conversation is not about Jar. It’s about the craft of building great products. Hundreds of PMs show up for dinner and regularly stay until 3 am in heated discussion.

Over time, the best builders have come to see Jar as the place where they can do their life’s best work. It’s the reason that several of Jar’s top executives are successful ex-founders. Jar is a place where good ideas get heard and meritocracy reigns. 

Misbah’s careful cultivation of this frame will result in years of positive downstream effects for the company.

Loco: Meeting your users where they are

A core part of Loco’s mission is community building. So when they originally launched the platform, they decided to do everything they could to make the platform feel like a real community.

A few months in, an interesting trend emerged- Everyday, users would casually ping moderators on the Loco platform, asking questions like “how’s your day?” and “what are you having for lunch?”. 

Rather than ignore these seemingly insignificant messages, Ashwin decided he would personally respond to as many as he could. This was unscalable of course, but created an important frame for early users. One that made them feel they were part of a real community where they could meet the admins and get to know them as humans. 

The Loco team understood that “community” wasn’t just a value to talk about, but something they had to cultivate intentionally, even painstakingly, starting with the smallest interactions.

To wrap it up

Why share these examples of Stoa, Jar, and Loco? 

Because it’s easy to point to established brands and stitch together a story about frames retroactively a.k.a. “hindsight is 20-20”.

What’s more telling is when talented startup founders who have limited capital and time still dedicate so much time and attention to crafting the right frames. 

As founders and operators, it is our job to act on behalf of our mission. Not just to build great products, but to find those reality bending frames that make our customers feel they are on our mission with us. That’s the secret sauce. Use frames to bring your customers on your mission with you.

In our chat we covered—

1. Loco’s origins

2. Loco’s organic journey from an HQ Trivia style game to a streaming platform

3. Creating a brand that users love

4. How to “hack brand” and win your category

What is Loco?

Loco is India's leading esports and live streaming platform, as well as the world's largest independent live streaming platform.

What led you to this idea?

The origin came from the fact that there was no dedicated, Indian-built gaming platform for India. YouTube is the de facto standard for any type of content, whether it's live-streamed or not. That's because YouTube is preinstalled on every phone in India. It’s an Android market. 

Game streaming has unique requirements and needs a separate set of product features. Plus it has a vocal, loud and passionate community. We felt that creating a town square for the gaming ecosystem would be absolutely necessary, and could create a lot of value. We also felt that it had to be video-first because these are people who consume games, who play games, and who also consume the content of other people playing games. 

How do you approach brand building? How do you decide how much time and money to spend on the brand?

To answer that I have to go back to my first startup, Pocket Aces, because that’s when we developed the ability to build consumer brands in India. Pocket Aces was started back in 2013. By 2015 we launched our first digital brand called Dice Media. Today, Dice Media is a large creator of web shows and series. If you watch shows on Netflix, you probably have come across Little Things. That's a show we produced. We have a number of shows on Amazon and Hotstar as well. 

That's a content brand that's really gone beyond social and has grown to the OTT world. After that, we launched Filter Copy, which became very quickly the largest consumer general content brand in India. 

In fact, at one point, we were ranked #1 by views on Instagram in India. A lot of people in schools and colleges started to follow the brand. Today the audience for that is tens of millions. We touch 50 million people a week with the content on that platform, and it's an extremely well-known brand. If you go to any public place and talk to people about Filter Copy, they know who you are, and they recognize a lot of the talent. We've used that brand, in fact, to build a lot of individual talent out. Loco was built in a similar fashion, using a lot of the learnings we have from that journey.

If I had to distill that down to a few things:

[Distribution First]

First, we are very distribution focused. We think from a distribution hat before thinking from a content hat. If you know how you’re getting to your consumer, then you can back-calculate what kind of content will enable that delivery. If you know that your consumer is sitting behind a Facebook page or behind a YouTube channel, then you need to figure out what makes those algorithms work. Why does content proliferate on those platforms? How are you going to oil that machine to get it in front of your customers? That's something that we've done consistently. 

[Use data just for direction]

Second, we've learned to respect the data, but not be blinded by it. Most people here don't use data at all. In the West, most people are blinded by data. I think we found a nice middle ground where we look at the data, and it really influences a lot of our direction, but it doesn't drive the decision-making. While we consider it, we still take risks. Sometimes we take bets that go against conventional data. More often than not, those things turn out to be good decisions. 

[Can’t compromise on cadence]

The third thing to build a brand is having a very regular cadence. I think people trip up on the most basic of these things. 

We've always understood that we need to be in front of a consumer consistently at similar points during the day, during the week, during the month, etc. We see that with Dice, which is creating long-form shows. Dice can't create a show every week, so that channel doesn't grow necessarily as fast as something like a Filter Copy, which is putting out memes every hour, literally in front of consumers every hour. And so we clearly know cadence matters. 

[Make it unique]

The fourth and last thing is that you can't be everything to everyone. I think you have to realize there are multiple consumer segments and different people can like you for different reasons. Social media algorithms are pretty smart at figuring out why somebody likes you and serving them more of the things they like. 

Think about what the brand's personality is and what you're trying to push out there. You could have the most boring product or a dry product. But that doesn't mean the brand can’t be exciting.

[On the Loco name]

I came up with the name Loco because I felt like I wanted a brand that could transcend urban boundaries. In India, the word ‘loco’ is not understood. People don't know the Spanish meaning of the word and most people think it's just a sound.

It’s just a word… in fact, just a sound. It has no meaning. That's really helpful because that makes it easy for people across the country, across regional divides to say the word. Anyone can say these two syllables very easily. You can't really get it wrong. 

The second thing is we created the mascot, which is the little hippo. Very deliberately. We wanted something that was cute, fun, and easy to identify. You could do a tiger and those other kinds of animals, but they're all over the place. We wanted something that could stand out.

What customer segment did you decide to focus on first?

For Loco specifically, the journey was pretty organic. We actually thought about creating a live Trivia game show, much like what HQ Trivia was doing in the US. We wanted to build a distribution platform that we could own and would allow us to communicate directly with our customers. We felt that interactive live video was an area that was exciting, but we didn't originally think of it as a game streaming platform.

We launched just after HQ Trivia. A few months after that, we were actually growing faster than they were. We were the fastest growing Trivia platform in the world at the time. It became a real phenomenon. Offices would shut down between 1:00 to 1:20 pm everyday.

People would just sit in the cafeteria, just playing the game together. People would send us pictures, and some folks even had the hippo tattooed on their arms. The entire office would dress up in the Loco color and stand outside to take pictures. The fandom had gotten out of control. Very quickly, there were a bunch of similar businesses that started off, and I think somewhere along that journey we realized that business in and of itself wasn't sustainable. 

As we started to pivot, our brand messaging also changed. When we moved to game streaming, we realized game streaming attracted a much younger demographic and had to look and feel different.

[The rise of a new customer segment]

If you look at 2018, when we launched it, Jio was not fully penetrated. It just started to get penetrated. Xiaomi smartphones weren't available yet. I mean, they were just starting to grow themselves. So what happened in 2018 and 2019? Two very important things—

Smartphone penetrations went through the roof. Internet access got really stable. On the back of that, you had the entrance of new mobile games. What’s more, games like PUBG were free. You had all these games coming, and people started playing them regularly. Suddenly a random person in the middle of a small town with very low connectivity could suddenly download a two GB game on their phone and start playing it. It was just unheard of, just a year before that.

When that happened, the entire gaming revolution came about in India. For us as a brand, we had to change our messaging completely. We went from being, for example, more English-heavy to Hindi-heavy because were talking to a more regional audience. We started to see pockets of interest growing outside of the large cities.

For example in the South, over the last year and a half, we've seen a huge presence of Malayali Streamers and Malali viewers. This means we must have content in that language, in that format that adheres to that culture, and with the sensibility to make the right jokes.

[On brand market fit]

You can think about product market fit, but for a brand. It’s a constantly evolving thing. The audience evolves and you have to evolve the brand to match that. It's a bit of a chicken and egg thing, but there are enough leading indicators to see the shift. You see it through the comments. You see it in how customers speak to you.

How do you measure brand?

I don't think we've ever tried to measure it just speaking about our own brand. I think we've relied on empirical data, and anecdotal data, to give us a sense of how the brand is perceived.

Do I think it can be measured? Certainly, there are traditional ways to do it. You can do, like, brand NPS scores and get agencies to come and do these brand recall studies, but I feel like a lot of that is so specific that it doesn't give you any actionable, insight. 

I think the larger thing is to see the nature of your interactions with your consumers. That tells you what they think about you as a brand. If your customers are engaging with you, if you're a service brand, you're like a travel company or e-commerce company, a lot of times your customer only engages with you when they have to complain about something.

[On interacting with customers]

So with most companies, direct user interactions are mostly negative. It's like, “hey, my flight was delayed”, or “you should give me a refund”, or “my product was not shipped on time”, etc.

If you're a consumer brand that is focused on entertainment, like Loco, your interactions are more well-rounded. Sure, you do get people that are complaining about service, but you also get people that are there just generally just chatting with you. 

We get messages every day saying, “hi Admin, what are you having for lunch today?” They're just chatting with the administrator! They are like ‘I’m lonely, I'm just going to chat with somebody. Why don't I chat with the brand Loco?’ It’s bizarre. 

This happened even back in Filter Copy. Back then we would actually reply with, “Hey, I'm having xyz for lunch today. What about you?”. We’d have those conversations and people really loved them. They were innocent, very sincere messages.

I think the nature of your interactions with your customers will give you the best read on how your brand is doing. For the longest time, it was just my co-founders and I replying to these messages because it's the only way you really understand what people want, and what they think of the brand.

Everyone is human. Like, when I hang out with you, I'm reading the look on your face. I'm looking at a reaction to the things I'm saying to gauge what you think of me. It's the same thing with your customers as a brand. It’s common sense. 

Is there such a thing as ‘Brand Hacking’? Are there things you can do to grow brand quickly, or is it mostly an organic, long-term effort?

I think you absolutely can. You can have brand hacks and I think there are a few ways to in India, especially. I've seen brands that are irreverent, regularly break through the clutter.

Most brands here play it a bit safer. They stay within the guardrails and they follow the traditional brand-building techniques. 

But then you have brands like Cred, which did a very audacious marketing campaign around both social media as well as television, and then they stood out as a brand. It wasn't the product that was standing out, since the product was not mass market. I don't think the brand and products have to be tied at the hip. I think they could be slightly disassociated or at arm’s length. 

[Breaking the clutter]

We did a very interesting brand marketing campaign recently for a tournament. We worked with a very popular streamer to make an ad… but the ad was just him going about his day. He would wake up, look at the camera and say, “download Loco now”. He would go brush his teeth and look at the camera and say, “download Loco now”. He would have a coffee and look at the camera and say, “download Loco now”. He said it like eight times and that was it. That was our ad.

After that, we saw a lot of love because people thought it was funny and eventually it became a hashtag. We broke through the clutter.

#DownloadLocoNow. And we didn't even seed the hashtag. You can hack a brand by just doing stuff that's just off-kilter, which engages people. It doesn't matter what you say, so much as they’re finding it funny, they're engaging with it, they're interacting. That’s a good hack. The hardest way to build a brand is to stay within the guardrails.

Scrolling on Linkedin starts to feel like swiping on a dating app. There’s an endless pool of talented people who could join your company. You start to imagine that all your problems could be solved if you could just get that perfect person on your team.

This is true in some sense. You do need to hire talented people. But what many founders may fail to recognize is how much time it takes to manage managers effectively.

When we reached about 60 employees at Loop, we started to search for experienced managers to join the company. We knew that our core product resonated with customers. We had found PMF. It was time to start scaling, which required experienced hands.

We went out and conducted hundreds of interviews. We spent hours talking to candidates and found the right handful of people to lead functions like HR, Sales, and Marketing. We sent out offers, and everyone accepted.

Our problems were solved, right?

Not quite. We didn’t realize it immediately, but we had a big issue on our hands. Why? Because we didn’t understand how to manage managers. We assumed that experienced folks could do the job on Day 1. But even experienced managers need time to build context on your business.

It’s never enough just to get good people. Tons of work is required to make good people into productive assets for the company and eventually leaders that help you build further leverage.

A sports metaphor

Over the last 10 years, the English Premier League has spent more on players than any other league. EPL teams consistently spend more than other teams to acquire the best players on the market.

Below is a snapshot of spending by league in the 2022 summer transfer window. The EPL has spent more than all the other major European clubs combined. And this has been the case for years.

This should result in lots of wins in the European tournaments, right? English teams should obviously perform better. Except, in the last 10 years, English teams have won the European Champions League tournament just twice.

Having the best talent is not enough. So much more is required to win.

In the context of startups, managers are those expensive players you bring in to solve your problems.

How do you make those expensive players into effective players?

In my experience, there are two things you need to convey early and often to make this happen— the business strategy and your operating principles. The other details tend to get figured out on their own.

Strategy

The North-star metrics of the business will govern how managers should pick and prioritize projects.

We often tell managers to “attack the bottleneck first”. But unless you understand where the business is headed, it’s hard to know what to prioritize. If you don’t know the business's priorities, you’ll never know where the real bottleneck is.

As my professor at UIUC used to say, “strategy is a stream of decisions”. In the ‘Playing to Win’ framework, strategy requires setting a goal and then developing the core competencies to execute against that aspiration.

That is to say, every decision starts with the goal in mind. The “winning aspiration”.

Managers need to hear the winning aspiration early and often. If you do this, they will start to orient their decisions, even the subtle subconscious ones, toward the Northstar.

Operating principles

This is the “how” of the work you do, and it’s deeply intertwined with the company's culture. It shows up in the average pace of work and the quality of output. Operating principles can also show up in subtle ways, like how people speak with each other.

For example- Are you the type of founder that expects thoughtful written analysis and reports from your managers each week? Or do you prefer a verbal method where you set meetings to discuss progress?

Are you a founder that cares more about getting things done quickly at the cost of quality? Or are you a craftsman who expects the details to be perfect?

The answers will likely differ greatly based on the functions you oversee and the type of person you are.

Nonetheless, your managers (if they are experienced) have probably worked for many types of leaders in the past. They may arrive at your company with habits that don’t gel with your expectations. To minimize friction and increase the fidelity of your communication, express your operating principles early and reinforce the behaviors you want to see.

Wrapping it up

For the first set of managers that join your company, there’s probably not much documentation of your operating principles. This means that (without your involvement) your first set of managers will only be able to learn how to succeed in your company implicitly.

This leaves too much out of your control as a founder. Don’t leave things to interpretation and, therefore, chance.

Get comfortable dedicating an entire week to a new manager that joins. Say no to other burning issues to ensure your new managers get sufficient time with you. If you spend that time upfront and focus on communicating the two key concepts mentioned above, everything else should fall in line.

Roshan is a super-talented founder who recently raised a massive $110m Series A for his company, Walnut a BNPL startup in consumer healthcare. He works with his team of 30 folks out of NYC. I met Roshan in one of the first On Deck cohorts back in 2019 when we shared a bunk bed in a castle in Philadelphia (true story, for another time). He’s a good friend, and I’m excited to share this conversation with y’all.

Some highlights from this chat:

1. Walnut is a lending business, which means they are directly affected by all the interest rate hikes.

2. Roshan raised the Series A through May this year- well into the downturn for growth and tech stocks. Despite this, he was able to pull off a great raise.

3. Decreased valuations for Affirm and Klarna have resulted in less buzz about BNPL, so Walnut really has to prove the fundamentals of their business.

Let’s start with something simple. What does Walnut do?

Walnut increases access to healthcare for patients by making it more affordable. The way we do that is enabling patients to pay for any medical expense over time in monthly installments with no fees and no interest. This alleviates the financial burden of healthcare for patients without increasing the cost, while also helping healthcare providers capture more revenue. That's what we do at a high level. 

What's your role, and what do you spend most of your days doing? 

I’m CEO and co-founder of Walnut. I spend most of my days now doing sales and product. Most of my day is like meetings talking to customers, both our healthcare provider customers, as well as patients, our end users. That's probably about half of my day. I think the other half is more just like general company running stuff. Things like hiring, finance, budgeting, fundraising, investor relations, culture, just generic company, building stuff. 

If you had to say what percentage of your time you split across sales product and administrative stuff, how would you split it up? 

I'd say it's like 50% sales, 25% product, and then 25% percent administrative stuff. 

What are the north star metrics for the business? When Walnut has a town hall or when you bring everyone together, what are the core metrics that you discuss?

Yeah, we have three core metrics and this is somewhat unique to us as we're a lending company. We think about GMV or gross merchandise volume, which is the dollars that we've lent out. We think about yield, which is the percentage of every dollar that we make in revenue. We also think about our default rate. It's the percentage of every dollar that we lose to our borrowers defaulting. Those three numbers together can give us our actual profit. 

Are there any other secondary metrics that your team looks at? 

Yeah, we definitely look at our like number of customers that sign up every quarter, number of patients that we serve, and the retention rate of providers. Those are kind of secondary metrics. But we tend to just focus on GMV as our number one north star metric. The more dollars that we're processing, the more we're growing. 

You had a significant series A announcement that came out a few months ago. Can you talk about that fundraising process, how much you raised, and what those conversations were like?

Yeah, totally. We raised a $110 million Series A, this May (2022). The fundraise happened over the course of about three months in the spring. We raised 10 million in equity, and one hundred million in debt. I think the market started to shift sentiment in the spring. In our seed round about a year ago, (spring 2021) everything was about mission, vision, and story. There was not much discussion of traction. 

That didn't really work this time. The discussions were more focused on our numbers and specifically the actual margin we're making on every loan. It was a focus area I wasn't originally expecting. I originally went in trying to pitch our GMV and showing how many providers were signing up, but VCs have really started to care more about what the unit economics look like.

And other things, like how the metrics have been getting better over time. Also something I didn't expect was, is our sales organization able to be profitable? Do we justify our CAC?

If you're paying a sales rep, let’s say $85k, are they able to actually generate that much in business every year? I wasn't really expecting those types of questions until our series B or series C. So it was just interesting. It felt like the difficulty got turned up pretty high, but I mean, I think at the end of the day, like we have a really solid business, so were able to handle those questions. 

The whole process got me thinking more about the long-term success of our business instead of just how we are doing at the moment. 

Can you also unpack what it means to raise debt? What was that process like and how was it distinct from raising the equity capital? 

Yeah, we raised debt to fund the loans that we make. It's a bit unique to our business. This is not like venture debt or like a bridge loan. The process is a lot different than raising equity. It's a lot more in depth. They actually really do pick apart every single thing in your business. Even the legal diligence is much more thorough than what VCs would do. The universe of debt funds out there is fairly small. There are a dozen that do this kind of thing. You don't really have many shots on goal. You have to be pretty buttoned up from the outset. On the flip side, they don't care as much about your vision or ability to become a billion dollar company. They just wanna know if they give you X dollars in debt, whether or not you give it back with interest? 

Can you talk more about the process? How do you approach these lenders? And is it reassuring to the venture investors that someone else has validated the lending model?

I think it does help the equity investors get more comfortable and similarly the debt investors are more comfortable when we've raised a series a, so it helps both sides. I think the process of raising debt is not very transparent and there's not much information online. Like you can just Google, like how to raise a seed round or something. There's a million articles, but not the case with debt. 

Even just finding out who offers debt is really hard and you really just have to talk to people and, they say, “Hey, I know a guy who runs a fund and you just get into it that way.” It's still a ‘who you know’, type of industry.

The way it's structured is also a lot more complicated. They'll typically set up separate SPVs and have co-ownership of the loans that you're originating so that if the company somehow goes under, they can still have some assets in the case of a default event.

Most founders are indirectly impacted by interest rates, but your business could be far more directly impacted. Is there a big shift in the lending environment?

Yeah, absolutely. I think our business is really closely tied to the macro environment. 

For us, customer demand tends to go up in a recession because people have less money to spend on things like healthcare. They have a real need for what we're offering. 

But also, default rates go up in a recession, especially for subprime borrowers and interest rates change. Our debt facility is tied to LIBOR. That has an effect on our costs. So it can get very complicated. It's hard to juggle all of these different levers in a market downturn.

You also raised in May, which was well into the downturn for a lot of growth stocks. What was it like fundraising and what do you expect the fundraising climate to look like for you the next time you try to raise? 

The BNPL space was really attractive in the past couple of years. 

But in this market downturn, Klarna and Affirm got crushed. 

So, the sentiment just shifted pretty negatively towards BNPL and lending as a whole, even though we’re in a different market. 

I don't know what the sentiment will be when we raise again. I think in this series A, VCs started asking “Well, what are you building outside of the lending product? What's after that?” Or they were asking “How does this fit into a bigger vision” 

Earlier it was assumed that a BNPL business could become a hundred billion dollar company. With this market downturn, that's no longer the case. 

So have you significantly changed the plan for the business as a result? 

Not in the short term. But, we’ve definitely started to think about how we can capture more dollars flowing through healthcare besides BNPL. We haven't really taken any concrete steps towards that, but we are starting to think about how our product today fits into a bigger piece of the healthcare payments puzzle, which it's a very large, messy puzzle. 

We talked about the north star metrics earlier. Have those metrics changed as a result of the external pressure from VCs?

We haven't changed the way we're running a business, just because the market sentiment is different. Those three core metrics were the same three that we started with. 

But, one metric that we're trying to pay more attention to is retention rate of our customers. I think that may be more of a function of what we need for series B than the changing VC landscape or market.

If you're a venture backed company, you may be dependent on venture funding for the next few years, unless there's some path to profitability. How do you grapple with what's hot or interesting to VCs versus the idea you originally set out to build? 

Yeah, I think that's a really tough question. I don't know what the exact answer is, but as a CEO, I have to maximize our chances of raising our next round. If I steer the company in a direction that doesn't have great prospects of raising a series B that's not ultimately going to help the company. You definitely have to factor in what VCs are interested in and what's getting funded at what multiples, but at the same time, like you can't be jumping towards whatever's hot at the moment. You're not going to end up really building an enduring, sustainable business. It’s a real trade off. 

Are you thinking about the ‘default alive metrics’ more often? Have you changed the way you think about your burn multiple or cash flow?

Every startup has started to pay more attention to it. We just raised our round, so were budgeting for 24 months runway and the prudent thing to do is make sure you extend that as much as possible. 

We haven't cut spending at all, but we're being more conservative in how we're adding spend. Just slowing our hiring rate. For a company that has just raised a Series A, it doesn't really make sense to make cuts. 

We have so much runway at the moment, but yeah, things like burn multiple are great to keep track of your business. I always know our runway off the top of my head. We're fortunate enough not to have to stress about it, but it's something we've definitely paid more attention to because of the market. 

So there's no cuts to be made today, but maybe growth could come slower? Is it fair to say you will be more focused on getting the most out of the people on your current team?

It really comes down to risk tolerance. We could absolutely increase our hiring and reduce our runway, but we’d have to be pretty sure we can raise your next round in 12 to 18 months. 

We’re taking a more conservative approach where we give ourselves three to four years to show the metrics we need for a series B. That will involve a slower hiring process and less aggressive spend across the board. But, I think we'll maximize our chance of raising a series B by proving we can weather a downturn, which is an important signal too.

Last question, what's the biggest challenge your team faces this year? 

It’s transitioning from building a product to building a company. We’re a pretty lean team. We were just around 10 people at the beginning of the year and now we're at almost 30. I used to spend my days doing a lot of different things, but now I have to rely on my team to help me.

Our main goal as a company will be to continue to gain market share. Healthcare is so large and there are hundreds of thousands of doctors out there. We’re working with just a few hundred today, so there's a large opportunity ahead.

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However, there’s one thing I’ve noticed about the term which lacks some nuance.

Blue ocean implies that there are enormous pools of opportunity that are untapped. But this isn’t the case. It’s actually more like the world is full of red oceans, and there are small inlets of blue.

You have to sail for months, sometimes years before finding the blue inlets. If you can successfully identify a blue inlet and desire to capitalize on it, you then also must grow it. That’s because inlets represent early adopters - i.e. those who don’t need the same advocation and education cycles as other buyers.

There’s something reflexive about the whole thing. The more you take advantage of the blue inlet, the more it actually grows into a blue ocean.

We can take Tesla as an example. Tesla’s cars are often referred to as a classic example of a blue ocean strategy- marrying the existing behavior of purchasing a car with the philosophy of a better environment (and cooler ride). If the world didn’t know about Tesla’s vehicles today and there were no electric cars, it would take yet another decade of hard work to educate customers on the product and the company’s philosophy.

The blue oceans aren’t just sitting there. They have to be earned. They start as pools. Founders put in the work to expand those pools. Traction (network effects, brand awareness, scale effects, etc.) all influence the rate at which the pool grows.

This makes sense. If there was just as much blue water as red, it would be much easier to identify. It’s not. There are very few pockets of low competition, high value business. It takes a long time to find. It’s elusive and must be grown carefully.

Founded by Ralston Purina in 1894, Purina Mills began as a producer of pet food. By the 1980’s they were one of the largest producers of “Dog Chow” in the country. As the business grew, they recognized an opportunity to expand into feed products for livestock.

The agricultural economy in America was booming and millions of cows, pigs, and chickens were being systematically bred each year. These animals needed food and Purina had the right set of competencies to expand into the segment.

After successfully launching their pig feed product, they recognized an important opportunity. Every year they had to convince farmers to buy their feed over other producers. They only metrics to compete on were higher quality feed and lower prices.

The quality of the feeds weren't all that different, so ultimately prices would drop to the level of the cost of production. They were in a commodity business.

So how could Purina Mills change the dynamics of competition? Farmers were already buying weanlings (baby pigs) from hog producers each year. Purina realized they could set contracts with hog producers to buy weanlings in bulk, and sell those at cost to the farmers downstream. And, in exchange for the cheaper price on pigs, farmers would agree to only feed their pigs Purina Mills products.

It was a win win— Purina would use its scale to negotiate bulk discounts on pigs for farmers while guaranteeing the sale of its own feed.

This is classic vertical integration.

As I think about how we can apply this to our own business at Loop Health, it’s clear that certain layers of healthcare will commoditize over time. By way of vertical integration, we can hasten the commoditization of these layers of the health stack, neutralizing competitors. Or, we might expand into bands of the value chain which we believe will accrue disproportionate value over time.

But integration is never without risk. And not just the risk of opportunity cost— I mean existential risk. Going into new products in your value chain should be done with an eye towards competency.

What happened to Purina Mills? Two years after they doubled-down on their hog purchasing strategy, they went bankrupt. Hog supply tripled, and spot prices dropped. Purina was contractually obligated to purchase at a higher price- nearly 5x the spot rate. They failed to manage risk and ultimately went bankrupt on their strategy to verticalize.

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You can think of momentum as crude oil and your startup as the oil-drilling operation.

Oil drillers power their drills (called pump jacks) using combustion engines- which basically means they use oil to produce more oil. In this sense, an oil drilling operation is positive sum. We can use a source of energy (1 barrel of crude) to generate more of the same energy than was used (10 barrels of crude).

A startup is like this in many ways. Objectively, you may not be producing much “oil". You may only have a handful of customers and you may not be generating revenue, which means you’re probably far from breakeven.

But, in a sense, the momentum itself is enough to sustain the team. The feeling that things are happening- that the outputs are producing more than the inputs- is what creates a sense of optimism.

It’s the feeling of “winning”.

It’s also important to note how quickly this can fade. One bad month of sales and the vivacious cycle stops. You risk growing only linearly - or worse, not growing at all.

This is what I meant when I said momentum is both an input and an output. Momentum itself is enough to beget more momentum. This energy gets converted into optimism, which increases the pace and urgency of work. When momentum stops, morale decreases, and the future of the company is at risk.

Interestingly enough, the feeling of momentum can be removed from the company’s raw progress.

This is not a view most people agree with. But I believe in many cases it’s more important to generate a feeling “winning” than to objectively look at your company’ performance in the very early stages. The reality of the revenue and growth metrics might be too bleak in some months.

Assuming that management is keenly aware of the reality and not deluding themselves, generating a feeling of false momentum for the team is sometimes okay. Hope is the space between reality and optimism. And optimism is a required input in for future success.

Assuming businesses in a market all distribute it through the same grand channel — the internet — how can any one company in a market succeed?

Brand and trust, yes. Great product, yes. Novel distribution, yes. Growth loops, okay Andrew Chen. All of these are requisite. Yet, preventing all of these things from happening is your cash position. It costs dollars to create value to generate dollars.

In order to build product, then reach customers, requires capital. In order to be a winner in any sizable market requires a lot of capital. Even if you’re not trying to build a unicorn, all internet-based startups must pay taxes to the product lord, Chief Amazon and the distribution lords, Sir Facebook and Madam Google.

Cash is necessary. In fact, cash position is the seed of any competitive advantage. If a company has more dollars to spend on creating a better product and can afford to distribute it more widely, they are more likely to win.

So where does cash come from?

1. Generate cash (the ol fashioned way) and use profit dollars to fuel growth
2. SBA loans and grants, which are slow and painful
3. Traditional loans, invoice financings, or cash advances, but require an existing stream of revenue or other collateral
4. Crowdfunding
5. Venture funding

If you are generating predictable revenues, then merchant cash advance schemes are not a bad idea. But recall that cash is a competitive advantage. Simply, the more the better. If you have real competitors who are also generating revenue and competing for the same customers, the situation quickly falls to the level of each party’s incentives.

You don’t want to dilute your equity, but in order to get ahead, your competitors will. If you don’t take on venture funding and your competitor does, they now have more cash. They have a higher probability of winning and you’re forced to fight an uphill battle. So as much as you don’t want to dilute your equity, you need more for your company to survive and to win. Trading off equity for venture dollars becomes inevitable.

For this reason, venture capital can never die in the age of the internet. There will be no silver bullet that allows founders to hold onto their equity. Equity will always be traded off because it is another card founders can play to advance their cash position, really a strategic advantage.

Venture debt, cash advances, and other models are great. Not because they remove venture capital from the equation, but that they introduce additional opportunities for companies to gain cash-position advantages.

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In the digital ad economy, Google and Facebook are the winners (+ Amazon). They have become Mega-cap players relying on ads as their primary source of revenue. Google does about $375M in ad revenue per day and Facebook does $200M. To buy the banner on Youtube’s front page for a just single day costs almost $2M. This is incredible.

Unfortunately, there’s a force that’s actively working against these companies. It’s you and me. In fact, it’s all the users on the platform. Every day, we all get *just a little bit* better at ignoring the ads on Google and Facebook assets. Our brains realize that most of the calories spent on ads are not worth the expense (we don’t usually need the product or service). We train ourselves to scroll past advertising over time.

Based on this phenomenon, conversions on ads will decrease. People get better at ignoring and over time, the ad platforms will become less valuable. In order to combat this, Facebook and Google must do two things: find increasingly novel ways to present their ads and find increasingly novel content around which they’ll wrap their ads.

Of course there are other things they can do to increase their value: get more users, get more advertisers, or simply show more ads (to a point). The common network effects theory would suggest the value of these companies can continue to increase exponentially with more users.

But, I'd argue that, at some point, more users is not more valuable than better content. The network effects on some of these platforms are asymptotic. Utility and engagement are different things. I rarely use LinkedIn, but keep it because my professional contacts are there. I engage with Youtube for hours because the content is great. Both are networks, but one produces a much more engaging feed.

Great content means engaged and attentive users. Great content makes me feel like spending a few calories to pause and learn about a new product or service. It’s why I read the sponsored posts on Twitter, but not the promoted nonsense on Facebook.

Everything else is about aggregation. Acquiring more users and advertisers is a necessary game, but the core offering must also increase in quality. For Facebook and Google, ad impressions are the core offering: it's their atomic unit of value.

When content is great it means that ads have a chance of being considered because all the adjacent content has been entertaining or informative. The content earns the trust on behalf of the advertisement. Network effects increases the utility of the services, but not necessarily the willingness to engage.

With this in mind, I ask-- if you were to invest in Google or Facebook, which would you choose?

If you run a startup, it’s imperative to manage cash effectively. If you can miraculously get lean, reach profitability, and sustain positive cashflow you’re in a great place. But, if you don’t think it’s possible to be independently profitable (not just community-adjusted EBITDA) and your startup will rely on VC dollars in the next 24 months, then it’s important to find ways to keep growing. Yes. Unfortunately, growth can’t wait— even in this environment.

Growth is the defining characteristic of the successful, venture backed startup. Paul Graham has written about it. For founders operating during this pandemic, it can be hard to swallow. Especially when VC twitter is now excited about value strategies and cash conversion and balance sheets. The thing that hasn’t changed is that VCs are on the very end of the institutional risk curve. They can’t really be value investors because they’re not structurally setup to be. They will never earn their fees by buying stakes in small, but profitable companies. They bet on the Babe Ruth Effect. They bet on the possibility of disproportionate and outsized returns.

Come time for your next financing, your top line metric (be it MAUs or revenue) still needs to be headed up and to the right. Margin and/or business model leverage are the secondary indicators of a good venture-backed business.

In corporate finance there’s a classic tradeoff between ROIC and growth. A management team can either focus on growing their company’s share of the market or increasing the efficiency of their value capture machine (margin). Depending on the stage of the business, an incremental dollar of revenue or incremental dollar of margin will increase the enterprise value more than the other. For early stage startups, valuation (hell, ability to raise in the first place) is based almost entirely on top line metrics and not margin.

I'm not saying margin isn't important. Margin grants the company runway. But for an early stage venture investor, the likelihood of future margin will suffice. Top line growth is a must.

As you look to the future, it’s important to remember that some venture funds will get wiped out too. Others will have their LPs withdraw some capital. While there will be fewer startups, there will also be less cash in the system to back them. Growth is imperative.

It’s an interesting strategy because it takes the Berkshire view of intangible assets to the next level. Manny believes that most product categories in these countries have few established brands relative to the number of buyers in the near future. Second, most consumers purchase goods at tiny, mom-and-pop shops that are fragmented and have no purchasing power relative to the wholesalers upstream.

This translates to an opportunity to profitably develop brands. These brands will be the first to own mindshare in the heads of new consumers, and can retain pricing power / health margins over time.

As we apply this to our own business at Loop, I’ve been asking myself how we can develop a successful brand ourselves. How can we be the primary primary care health brand in consumer’s minds? In a previous post, I discussed building trust as a first step towards building a brand. But trust is just one variable in the formula.

There are 3 elements of a successful brand: trust, identity, and time. Trust is about reliability and quality. Identity is dependent on the product category, audience, messaging, and even company culture. Time is about the reaffirmation of the first two elements with enough frequency to own a slice of mindshare. These characteristics describe a single brand. But, that’s still not enough. Brands compete with one another to grow their respective slices of mindshare.

UberEats and DoorDash compete to be the first place you go when you feel hungry. Amazon and Walmart.com compete to be the first place you go when you want to buy something. If the products are the same and prices are fair, brand association will be the tipping factor.

Now imagine it’s a hot summer night. You head into a convenience store with some friends. Longing for a cold, refreshing drink, you walk over to the big glass window filled with soda. You can choose a Coke or a Pepsi. Both are the same flavor (if you don’t agree, just pretend) quantity, and at same price. Why do you pick one over the other?

Maybe it’s the packaging. Maybe it’s happy memories drinking Pepsi with family. Maybe it was a recent advertisement. One brand has slightly more mindshare than the other and so you go with that one.

In this example, brand is the final layer of decision making. It assumes rationality. As it turns out, most people actually walk into the store and blindly grab the Coke without checking the price or comparing alternatives. Why do they do it? Because it’s what they always grab. They’re a “Coke person” whether or not they even recognize that part of their identity.

Brand is much more than the final variable in a purchasing decision. Brand has the power to remove the decision altogether.

Brand allows the customer to remove cognitive load, representing a path of least resistance. Therefore, a good brand is actually about removing search costs. If I’m craving pizza, I don’t need to do much research to know where I can get a cheap, tasty pie relatively quickly. Dominos and Papa Johns have spent years building a relationship with me. I won’t go anywhere else.

I hope we can do the same for Loop Health. Anytime a person has a health query, feels even the slightest back pain, I want them to text their Loop medical advisor. Treatment can’t be instant, but care can and should be. Our brand should represent this value and remove the search cost for good healthcare. If we do a great job, we can be confident our patients won’t go anywhere else.

I hope to share more thoughts here as my ideas evolve. This writing is meant to be an open-ended exploration of ideas. I welcome your commentary and feedback.

In the classic value investor sense, Brand is a durable advantage. It’s an intangible asset, with a sort of esoteric value that can not be easily replicated by competitors. It’s made of a combination of mindshare and positive association across time— where that association is deep trust or alignment with the consumer’s identity, or both.

No doubt, good consumer businesses are amplified by good brands (which also act reflexively). 

As we consider how to develop our own brand, I’ve had to recognize that the purchasing psychology of the Indian consumer is quite different than what I’ve experienced in the United States. The individual criteria for purchasing may be similar, but the weighting of each factor is different. While buyers are still affected by price, aesthetic, brand association, perceived quality, etc., they seem to place greater weight on certain variables. 

One purchase input with outsized weight (and part of brand perception) is trust. When trust isn’t automatically implied in a market, reputation and reliability of the producers become increasingly important. In India, trust matters more. Historically, products and services have been less reliable and limited enforcement of regulation means snake-oil salesmen can be present in any market.

Because India’s healthcare system is littered with bad actors, motivated by perverse incentives, patient trust is currently very low. Over the last few years, the medical profession in India has been in a sustained state of crisis. Doctors across the country have been exposed and indicted on counts of corruption, professional negligence, taking kickbacks, and illegal dual practice.

To solve this, consumers rely heavily on referrals from friends and family for their healthcare decisions (Less than 10% of primary care interactions start with a Google search). It’s obvious how useful word-of-mouth is for combating the low-trust problem. This behavior minimizes the total number of "failed patient experiences” at the family and community level. Naturally, the inverse effect is powerful too. The reliance of word-of-mouth means that high quality product and services should experience meaningful organic virality. 

Okay, so here’s what we know-- We want to build a great brand. In Indian healthcare, trust is heavily prioritized. We need to effectively earn and then maintain each customer’s trust. And if we do a good job, we should see an organic viral benefit. 

How do we build trust?

(Complicated, and probably worth another post) In the beginning of our company’s life cycle, most of our customers will have never heard of us. We have no existing relationship with them. The brand needs to signal trust so that new consumers purchase the product. This should take several forms. Trustworthiness should be conveyed in our creative and messaging. And it could mean relying on partners that already have strong trust signals. Once a patient has purchased the service, we must be able to build upon that trust with a great service experience. 

How do we know that we’ve built trust? One way to know is if, at some point in the future, most new customers hear about Loop Health through family or friends (rather than our direct marketing efforts).

Brand building is complex. It's about trust, identity alignment, and time. It's also category and context dependent. I hope to share more thoughts here as my ideas evolve. This writing is meant to be an open-ended exploration of ideas. I welcome your commentary and feedback.