Timing is everything in healthcare -- yet too often diagnoses, treatments and procedures are held up by paperwork, administrative red tape between patients, clinicians, carers, bookkeepers, insurance companies and others in the chain of relationships that needs to be processed before steps can be taken. Today a startup called Notable, which is building automation systems to help move that along, is announcing a growth round of $100 million as it finds a ready market for its technology among hundreds of customers, including large networks like Intermountain Healthcare and CommonSpirit Health to cut through the immense amount of what Pranay Kapadia, Notable's co-founder and CEO, describes as "administrative overhead."
"The healthcare industry on average has $1.1 trillion in administrative spend, which is eight times as many resources required per $1 billion of revenue as any other industry in the world," he said of the annual budget given to all that work. "There are tens of thousands of workflows that can be automated." He estimated that among Notable's current customers, across some 350 locations, Notable's systems are automating "millions" of tasks a year, "and growing exponentially." The company is most active in the U.S. but has plans to take its tech to other markets and to segments adjacent to healthcare, such as health insurance, over time.
ICONIQ Growth -- the growth-stage arm of the San Francisco wealth management and investment firm connected to Mark Zuckerberg, Sheryl Sandberg, Jack Dorsey and other high net-worth tech executives — is leading the Series B, with Greylock, Oak HC/ FT and F-Prime also participating. Kapadia confirmed to me that the round values his startup at $600 million post-money. That's a big jump for the company: previously it had raised just over $26 million and was last valued, earlier this year, at about $120 million, according to PitchBook estimates.
Notable's sweet spot has been using robotic process automation combined with API integrations and other technologies to speed up some of the administrative work that connects the dots in a healthcare regiment. This could involve the clinical notes that a doctor has to access or update when seeing a patient; the paperwork and billing details that payers need to receive to authorize a treatment or medication; a person registering for a service; or something else in the bigger mix of actions and levers that move when a person encounters a medical environment.
Kapadia tells me that Notable was built out as a concept in the U.S. -- it's based out of San Mateo -- out of conversations that he had with family members who are physicians and were complaining about all the busywork they had to do: it didn't feel like it used their expertise as such and took them away from having more time to do work they were trained to do. Kapadia -- who had spent years building products at Intuit and then fintech Blend (where he met the other two co-founders of Notable, engineer Justin White and product designer Adam Ting) -- said he saw this as, essentially, the same problem as the one he was building to solve in the back office and in financial services.
The turn to using RPA, meanwhile, for more specific use cases beyond general back-office tasks is a sign of how the concept and technology has been maturing, with innovative tech companies tapping into more specialized areas of knowledge and figuring out how to bring more efficiency to them (another example of that: last week's story of Gluware, which uses RPA processes in DevOps technology).
Notable really came into its own earlier this year, when the startup helped build a system to let people sign up for COVID-19 vaccination slots: its system automated the process of finding locations and also triaging people based on their ages, health conditions and so on. Kapadia also said that as the pace of vaccinating has slowed, the company is finding a more sustained impact in terms of not just what patients but also providers are looking for in healthcare experiences.
"The second order derivatives of the pandemic are that patients and consumers [now] expect touchless digital experiences," he said. "That's actually just absolutely crucial."
He added that the other interesting effect has been on the provider side, where tools like Notable's are taking away some of the less satisfying parts of jobs and potentially making working more engaging for people, and in some cases are picking up the slack when there are staff shortages.
"People talk about the great resignation," he said, referring to how so many have willingly pivoted careers during the pandemic. "Sure, but the reality is that only happens when people are doing jobs they don't want to do. What's more important in healthcare is it's actually really hard to hire. There's a staffing shortage at this moment in time. And so the way that we've built out the platform, really understanding the data model that exists in healthcare, really understanding the tools that you actually need to build what we call flows."
Kapadia said he doesn't see companies like UiPath or other big players in RPA as potential competitors because of the specialized body of knowledge that Notable has built up in healthcare, which is what both helps the system execute tasks and learn how to do them more efficiently. On the other hand, he says that the company's biggest challenge has been in the fact that so much up to now has been stuck in analogue processes, and the fact that healthcare as an industry has -- ironically, given that on the clinical and research sides there have been so many technological innovations -- not really been a technology-led one when it comes to administration.
"The road to purgatory in health tech is driven by integration, and the road to purgatory in deploying any technology is driven by timelines," he said, adding that, often when organizations have focused on back office elements in the past, "What they've created is a faster hamster wheel." In a wider healthcare system that doesn't look like it will be changing fast -- providers will continue to consolidate, payers will continue to exist, patients are continuing to live longer and have more problems as a result that can be identified and fixed -- this means that, simply put, a new approach to speeding up connections has to come.
“Physicians today spend more time in front of their computer than in front of patients,” said Dr. S. Nicholas Desai, chief medical information officer at Houston Methodist, in a statement. “By automating all of the administrative tasks that clinicians are required to perform, Notable empowers us to practice at top of license and better serve patients in our communities.”
“We’ve had the pleasure of knowing Pranay, Adam, Justin, and the Notable team for nearly two years. We’ve been extremely impressed by their long history of great collaboration, the talent they’ve attracted to Notable along the way, and their unbridled passion to affect impact through exceptional technology and relentless focus on customers," added Caroline Xie, general partner at ICONIQ Growth, in a statement. "Their vision resonated with us strongly—from digitally transforming and enriching patient-provider interactions with intelligent automation, to empowering providers, reducing administrative burden, and enabling state-of-the-art patient experiences. We believe Notable’s AI and extendibility of their platform are their key differentiators, and we’ve heard effusive feedback from leading health systems and customers citing strong patient and provider net promoter scores, fast time to value, and a strong return on investment."