Speed, safety, and scale: Microsoft's playbook for health AI, with Kimmi Grewal and Unity Stoakes

0:03If I say like, I mean, no one has a crystal ball, so I could be totally wrong on where we are in 12 months from now. But I would say like advising startups today, it's I think build fast, like speed is the name of the game. And I know I'm saying that in a coming from tech, it's like, of course, build fast, break things. That's not what I'm saying. But I think just the speed of innovation has increased so much that I think there's an expectation of, like faster product cycles in general, no matter which vertical. And then I, but then I coupled that with scaling smartly, right? So it's not just about building quickly, but it's making sure that you have a plan to grow that is sound and makes sense.

0:46And I think in particular in a vertical like healthcare, making sure, you know, responsible AI security kind of safety measures are all in place. And if that slows down speed, I think it's okay. But it's that tension between those two things. I think that's going to be the focus like in the next six, 12 months, right? I don't see the pace slowing down. In fact, I see it ever increasing.

1:14Unity Stoakes: Welcome everyone to today's Startup Health Fireside Chat. I'm Unity Stokes, co-founder of Startup Health, and I am thrilled to welcome I'm Kimi Gruel from Microsoft. We're excited about today's conversation because we are in the middle of, I really think, one of the most consequential shifts in healthcare since the dawn of the internet or of the electronic medical records. And that is because AI is really moving fast. And I think critically, the window for founders and healthcare companies to build the right AI-enabled companies is open right now. I think the big question is, how do innovators and builders turn AI potential into real-world products, partnerships, scale, and impact?

2:07Unity Stoakes: And well, Kimi has a front row seat to that answer. Kimmy is vice president of AI ecosystem partnerships at Microsoft, where she helps shape how leading frontier AI companies and innovators connect with Microsoft's global platform and reach. Kimmy also brings more than 15 years of experience in health and life sciences from her time at Accenture. And I think most importantly for us, Kimmy has been a Startup Health Impact Board member since I think 2021. So many years. She knows this community well. She understands the innovator journey. And she is here today for an interactive conversation with all of us.

2:55Unity Stoakes: So, Kimmy, welcome back to Startup Health. How are you doing? Thank you. That was a very generous and kind introduction. I'm doing well. And thank you for having me. It's great to be here with you all. So in Microsoft, I've had a few different roles, but the role I'm in as of the beginning of this calendar year is effectively leading our partnerships with the leading, I'd say, AI ecosystem partners. So think the Silicon partners like NVIDIA and others, as well as all the model labs, such as Anthropic, Meta, XAI, Mistral, and really thinking about how do we partner with those model providers and ecosystem providers on behalf of the ecosystem overall?

3:34And how do we make sure that they're serving customers, enterprises, and startups well?

3:40Unity Stoakes: That's really important. And you've got this unique view across so many different things today, but also over the course of arc of your career. You mentioned frontier model companies, there's infrastructure players, startups, you've been on the family office, investor side, enterprise partners and customers, I guess maybe frame the moment that you're seeing within that seeing, how do you describe the moment and maybe some of the things you're seeing that's working in this new world and some of the things that aren't? I mean, I think just to put into context this journey, right? So like the chat GPT moment that really made, I'd say like AI today mainstream was last November, about four years ago.

4:27And so I think just in four years, how far the market has come is really amazing. And I think then if you take stock of like how quickly it's been evolving year over year, like this year alone, I'm sure this community knows, but like the amount of venture investment in AI in Q1 surpasses the amount for the full year of 2025. Just to give you like a benchmark of like the pace of investment. And then also, as I look at, you know, from a Microsoft perspective, like I think for a long time, everyone's looking at the frontier labs, which are still really important, like your open AIs and tropics of the world.

5:07But now we're seeing open models really close the gap from a cost perspective. So I see if I think about the ecosystem, both enterprise, but really startups like building a lot more with open models. I think that's a big shift we're seeing because of that performance gap closing. A few other, I think, observations this year in particular, I would say is like context and data being like the primary moat around which folks are building, whether they're building solutions within enterprise or where startups are building, right? It's the model is not the differentiator, but it's like the workflow and the data and the proprietary data set that you have that really is the differentiator.

5:47and I'd say that drives stickiness in the market. And I think if I look forward, I think physical AI is where the puck is going. And so it'll be interesting to see how that plays out, particularly in the health space. But I think if you look, if I had a prediction of like next year, this quarter, what we'll be talking about more, I think it's physical AI.

6:10Unity Stoakes: I think it's really an exciting opportunity for all of us in health. I wanted to go a little deeper into, I know you were just at Viva Tech. You were at Microsoft Build. You're traveling all over the world. You're seeing kind of what's the big enterprise is doing, but you're also at these places where you're seeing a lot of different startups. And one of the things you were kind of touching on is, and I saw some of your observations that you shared insights online as well, like values moving up the stack, right? And, you know, you mentioned models matter, but the winning startups, what are they doing?

6:49Yeah, I would say a few things. I think the tools that we have available today, I think the speed of product development and then shipping of that product. I think the leading startups are just shipping a lot faster than they used to. And then also shipping product and getting real time customer feedback on that product and then being able to iterate and release the next version of that product. the speed of that feedback loop, I think is really different than it was 12 months ago. And I'd say that some of the leading startups, I know from a Microsoft perspective that we look at for investing in, it's like how quickly they can ship product, iterate, and then get that first POC with a customer.

7:32I think that's definitely an important area. I think also scaling smartly. So for anyone, I think obviously at the end of the day, depends on who your end customer is, but anyone who's looking to sell to hospitals or to large businesses, making sure that the speed is not getting in the way of being kind of enterprise ready, security governance in the regulated industry like health. That's so important. So it's balancing, making sure you're shipping product, but in a safe and secure way so that you're not just getting customer feedback on something that can never scale. So what you're actually putting out there is something you can get to production scale, I think is another really important piece.

8:14And then I would say like ecosystem, super important. I think today, like Microsoft's point of view certainly is like our success hinges on the ecosystem of partners and startups and VCs. And I think what I see the leading startups is making sure they're investing in like a intentional partnership strategy up front and making sure that that's not an afterthought post product and initial customer feedback.

8:43Unity Stoakes: Yeah, that's healthcare tech companies versus just tech companies shipping fast. It's almost like two different worlds in the context of safety, security, privacy, all these other issues, tension of needing to keep pace with how fast you're able to build with, you also have to balance validation and kind of all the safety and the components as you're building. Are you, so that speed to shipping, are you seeing that also with healthcare startups or just tech companies more broadly? And then kind of a follow-on to that is when you say ship, Are any type of company, are they shipping weekly, monthly, daily?

9:33Unity Stoakes: It's just has the cycle, how fast has the cycle gotten from what you're seeing? Yeah, I would say broadly in tech, it's weekly. In regulated industries, it's not quite as fast, but also it depends like which sector in the regulated industry. So I think in healthcare, for example, a company who is looking at documentation and workflow automation can ship very quickly. like the barrier there is much lower than if it's looking at like drug discovery or the diagnostic space, right? So I think it depends on like the slice of healthcare that you're operating in and how quickly you can get a product out to market.

10:10And that's why I say that balance is important because it's not just about speed. It is also about being able to scale post, like getting something out in the market. And so if you don't have the appropriate safety and security and the governance or like alignment with regulations, you're not winning by getting a product out quicker, right? I think spending the time to do that right up front will probably serve you better. So I would bifurcate like even within health or, you know, there is a difference between kind of lower regulated verticals. If you're doing a revenue cycle or pair operations type solution versus or a patient engagement, virtual care solution, a deeper clinical workflow solution.

10:52Unity Stoakes: That context matters. And as you compare it to your days, maybe working with life science companies or big enterprise healthcare, and then you come across those same types of partners, customers, enterprise healthcare companies today, are you seeing those big partners and customers operate at a different pace and speed? Or like what's What's changed, if anything, from when your days at Accenture, say? Yeah, it's really interesting. And I think a part of what I've observed is not what we expected. So the part we expected is you obviously see all the software development companies and AI native companies like quickly adopting, right, and leading from the front.

11:41What I didn't expect is like regulate industries like financial services, but also like healthcare being super fast followers in the enterprise in terms of adoption. Like I expected them to be laggards and maybe retail and media, telco, kind of some of the other industries to be faster followers. But we haven't seen that to be the case. I think there's multiple potentially hypotheses for that, but I think a big part of it is a lot of the problems, I think, in regulated industries have been known challenges for a long time. And I think now with where the AI capability is, you actually have a real opportunity to solve some of those challenges.

12:22And so there's an eagerness to figure out how to cut through the regulatory tape, way that makes sense, but to adopt. So I think we're seeing that adoption faster than we would have expected. Even on open models, I would have thought open models would be like lower on the list. And I think they're at least on the experimentation front, there's a lot of pickup in from health care companies. Slower shift to production still, because I think you have to test kind of the safety and governance around all of it. But definitely lots of experimentation.

12:55Unity Stoakes: And going back to something you said at the beginning, I mean, the context is this is we're only a couple of years into this. And I suspect if we're talking even 90 days from now, it'll a lot will have even changed since today. So that's that's the pace we're talking about, which is quite extraordinary. One of the other insights that I've seen you share or talk a little bit about is capital efficiency becoming the default now. I don't know, maybe unpack that a little. More investors pushing startups to really build on existing models rather than reinvent. You talked about open source models people are building on.

13:38Unity Stoakes: What are you seeing today and maybe put also your hat on from when you were at a family office and other places where you're advising startups to build and how you really have to be thinking about your capital very, very carefully as you're building? Yeah, I think a few things. So one thing, like Microsoft, as we are thinking about, whether it's companies we're investing in or whether it's startups we're partnering with is like kind of a rubric we look at. I think one is like start where the money exists today, right? So where is money already being spent in healthcare? And so like, who's your buyer?

14:17Like thinking about that upfront. And I think the other piece is the point on capital efficiency. Like we see startups are going to win on the workflow, not models, because I think if anyone who's following the state of the art models, the leaderboard changes daily on who's on top new releases. And so your differentiator is not going to be the model. Maybe if you have a proprietary model and then you're appending that with your proprietary data. But I think in general, like the fastest path to a solution and market is building on something that exists today and then owning and pointing it to a specific workflow where you know the buyer already.

14:56And then what is your differentiated data that is really your moat for your solution? And so I think and then I think being eyes wide open on like the regulatory lane that you're picking. Right. So my point on, is there a solution around like rev ops or kind of patient experience virtual care? Or is it like a drug discovery or something much more involved? Because that's going to really impact time to market and time to ROI as well.

15:26Unity Stoakes: that's really important companies not rely on one model because the leaderboard's changing you know you got to really be thinking not about a multi-model and be flexible would you recommend people go all in on one or just be very adaptive i guess i'm kind of leading the witness here but you know what's your thought on that yeah i would say you don't want to be over reliant on any singular model. So you want to, I think, have the flexibility in your architecture to be able to swap models in and out. And I'm being a little pedantic, like it's not so easy to swap, but you should be able to swap. And so the differentiate, because I think if you have too much lock-in with one model, I think you're assuming too much risk for something that's not stable in the market, meaning today, anthropics models are on top.

16:16I think tomorrow it could be a totally different model. And I think we're still, I'm quite bullish on like some of these open models being at the top of the leaderboard for quite some time at a much lower cost. So I think the other thing is like, even if you have super high performance with a specific closed model, is it at too high of a, I think that really matters for a startup. So I think my, my general view would be designed for being able to be flexible on the model. But I think what you really want to do is make sure you protect IP. And that's why I go back to like data. And I think enterprises and startups are, this is the piece that they should be focused on there, you know, and making sure as like, no matter what model you're using, making sure that your IP remains your IP and you're not exposing that anywhere because that truly is your differentiator.

17:01Unity Stoakes: Yeah, I think that's, that's essential. And, but shifting gears a little, I'd love to talk about Microsoft for, for startups and, and I think the Pegasus program, for example. And for those of who may not know, what is Pegasus? Let's start there. And then I'm very curious to learn for those who are tapping in the right way, what trends are you seeing? What are they doing to really get traction? But Microsoft for Startups, Pegasus. So for broad education, there's two big programs. One is Microsoft for Startups. So Microsoft for startups, anyone can apply startups.microsoft.com, you set up your Azure account, and you immediately get startup credits.

17:46And you can unlock up to 150k of credits as you build and grow your solution with Azure. And then the Pegasus program is kind of within the broad pool of Microsoft for startups, like a selective group where we nurture and provide much more hands-on support for co-sell and selling in through our marketplace. And so I think they're typically the companies that got selected for Pegasus, you know, are aligned to, I would say, Microsoft priorities in that they're selling to enterprise as first criteria, because that's our primary customer. They're continuing to build, test and deploy on Azure. I think there's focus on verticals within health, life sciences, in this case, that are important for aligned to our kind of industry strategy and our go to market motion.

18:39So I would say broad brush, like anyone can start with Microsoft for startups, just from startups at microsoft.com. And if you're, if you're part of that cohort, people can discover any of your solutions through our marketplace. And I think the other big trigger we look at is how much marketplace traction you're having. So how much are you selling through our marketplace? And the more you're selling, the more hands-on support you'll get from Microsoft.

19:03Unity Stoakes: This is important. And you're one of the key players out there. Is what we're talking about now the right best pathway in? Are there other pathways? Are there other opportunities for health tech, healthcare companies specifically that in addition to what we talked about, be looking? I would say for startups, we try to one single front door. So startups. That being said, I think once you're in the door and particularly if you are into the Pegasus program, we can connect you with like Microsoft Research, for example, depending on your businesses and how our research organization is investing in that area.

19:43So I think a lot more doors open, but that's the right front door is Microsoft for startups. And then I think from there we can help with enterprise selling, joint marketing, reaching more customers through our distribution and sales channels as like the primary benefits, right? That most companies get beyond the credits. Yeah.

20:03Unity Stoakes: Okay. You know, let's talk about the future for a second. And by the future, I mean, near future, I guess, you know, over the next 12 months. Where do you see this all going and how should builders innovators be thinking how should they be it's it's it's moving so it's so dynamic it's moving so quickly um it's hard to keep up by week but yet we also need to plan we've got to think about capital allocation we got to think about fundraising We got to think about product cycles. Is it, you know, just hold on by the week or how do you, for the companies that you advise or the ones you're seeing, the builders that are really doing it right into the future, you know, say 12 months and how we should all be thinking about that.

21:01Yeah, I think one thing I will say is like, even as an executive Microsoft, I find it very hard to keep up with the pace of innovation. So I would just say, broadly, it is impossible for any human to keep up with everything that's happening in the marketplace, I get a behind the scenes view sometimes, and I still can't keep up. And so I think that's one, like, I'd give yourself grace on, you know, what are you trying to keep up with, I would pick, kind of like, three or four spots where that are really relevant to what you're doing. what you're building that you want to keep up to date with. I also find it really useful to like, if there's certain thought leaders or builders that I really admire, like just keeping up with what they're doing, because they're kind of scanning that segment of the ecosystem on your behalf in many ways.

21:46So if you stay in tune with them, you generally are kind of up to date on the evolving landscape. But if I say like, I mean, no one has a crystal ball, so I could be totally wrong on where we are in 12 months from now. But I would say like advising startups today, it's I think build fast, like speed is the name of the game. Coming from tech, it's like, of course, build fast, break things. That's not what I'm saying. But I think just the speed of innovation has increased so much that I think there's an expectation of like faster product cycles in general, no matter which vertical. And then I, but then I couple that with scaling smartly, right?

22:24So it's not just about building quickly, but it's making sure that you have a plan to grow the sound and make sense. And I think in particular in a vertical like healthcare, making sure, you know, responsible AI, security, kind of safety measures are all in place. And if that slows down speed, I think it's okay. But it's that tension between those two things that's going to be the focus like in the next six, 12 months, right? I don't see the pace slowing down. In fact, I see it ever increasing in the past four years.

22:59Unity Stoakes: We're all in this together. So you said, give yourself grace, because I think everyone's going through this all at the same time. So you and I are both, you know, Bay Area, West Coast, in the bubble. But you're also traveling all over the world. You were just in France for VivaTac. You're meeting with global companies all the time. Are you, give us a little global perspective. We've got a lot of companies from all over the world that are builders and innovators. Are you seeing the same trends and patterns all over your travels? Or are you just mainly what you're describing kind of a West Coast, a US base?

23:40I would say the shift is global broadly, meaning like I think if you look at any enterprise globally, you're either being AI native or figuring out how to AI into your workflow and businesses like is looking at that because it's a topic in every board discussion. I think there's nuances in an application by geography. So like if I look at Asia, some of the best open models are coming out of Asia. And so naturally you're seeing much higher traction from building with open models as a starting point versus the frontier labs. If I look at Europe versus North, like the Americas more broadly, like Europe is, it's always been a leader on regulation.

24:23And so it's sovereignty, data residency, vertically having all the infrastructure in the region is super important, much more important than I'd say in the States where kind of a global standard is acceptable. So I think those nuances exist. So like, If you're building in Europe, I think trust, and I think I put this in my online account, trust is a part of product market fit. You can't later on think about trust or sovereignty because that's an expectation in the market, which means perhaps slower speed of product cycles, right? Because you're building that in upfront versus in the Americas, I would say our venture community largely rewards pace first and then figure it out later in terms of what needs to happen next.

25:07So I think those are some of the big nuances I see. I would also say there is a definitely much faster adoption in the Bay Area than there is broadly. I see a lot of enterprises come through the Bay Area and do an innovation tour of us, Google, and all of the VCs here. And it's interesting. Everyone here is talking about OpenClaw and all of the latest, and then people come in from other parts of the world and are still trying to figure out how do you apply agents in the four walls of an enterprise, right? So there's a broad understanding, but the delta is quite wide based on where you sit geographically.

25:44Unity Stoakes: But while we only have a couple minutes left to end a few minutes before the beginning of the hour, but Kimmy, what would you say to startups? What should one thing that a startup should do like today or tomorrow that maybe they're not doing in order to get in the game? Because there's a lot of innovators that have been so heads down on their plan from the last 12 months that they haven't yet recalibrated from, as far as I can tell, the world changed again in January and a month ago. And so what would just be one practical thing that would be maybe useful to early builders, early innovators that they should just get started?

26:36Yeah, I think one thing I would say is like, because the field and the space is evolving so quickly, like you're actually not behind if you start today. Like I think people like to say like, hey, you should have started four years ago. But even if you're a startup today that is trying to figure out how to leverage the latest tools, like you can really teach yourself almost everything right now. And so I think one thing is like, I think some folks feel like it's daunting. I think you like this entry point is really easy. If you're a self-starter, if I was a founder today, I think the opportunity like to exit has never been brighter because enterprises are not AI native by nature and they're looking to tell their boards how they are investing in AI capability.

27:24And if there's a really great focused startup that's operating top of their lane, I think your ability to find a path to skill and exit is much greater today than it ever was before. So I think just being mindful about that, if that is the plan for you or the strategy for you, being mindful about curating that today and thinking about that may not be five, 10 years down the road, maybe much sooner.

27:52Unity Stoakes: That is such an important insight. I think that's a great place to end the conversation. Kimmy, we are so grateful for your wisdom today and also just your, all the support and help you've given over the years and how you are of our whole ecosystem. Thank you. Thank you. Thank you. Again, Kimmy, thank you, everyone. Thank you all for being here. Have a great day and we'll see you all soon. Thank you for having me. Have a great week. Okay. Bye.

28:25Unity Stoakes: And finally, an invitation to all of the extraordinary health transformers, Whether you are a startup, someone building the future of health, or whether you are an investor, funder, or buyer of the solutions out there in the marketplace, this is an invitation to you to join the Startup Health member community. Learn more at StartupHealth.com. Look forward to hopefully seeing you soon.