280. Meet the CEO of The $25M Backed Modern Healthcare Platform w/ Thuria Wenbar | Evaro

0:00Amardeep Parmar:Startups Inside Out. We have Thuria here today. Can you tell us about what you do and what you've built? Yeah. So thank you very much for having me on the show. So my name is Thuria. I am the CEO of Ivaro. For what we try and do is we're trying to build online banking, but for healthcare, which sounds kind of insane when I say it in that short sentence, the kind of punchy sentence. But if I try and paint it with an analogy, the goal is to try and build a version of healthcare that genuinely is as easy to access as online banking. We believe it's going to take 30 years. I'm eight years in. I have 22 years to go.

0:40And it's an incredible journey.

0:42Amardeep Parmar:You're being very humble there by saying trying because you've done quite a lot already. So tell us where you are now. Yeah. So what we do as a business is we allow people to access prescription medication over the internet without having to see their doctor. A lot of this is done algorithmically with clinicians in the loop. And to be able to actually do it, you have to own the whole chain. So if I take us back to kind of the businesses incorporation, by background, I was a software engineer whose parents told me they would disown me if I did not study medicine. so lo and behold in the middle eastern fashion i went and applied for medical school got into medical school and studied medicine um my original thought processes were to be a military medic so i joined the university air squadron i really like that ability to make order out of chaos really serves well in startup land turns out because i bought your nationality and it wouldn't make sense because i would not stay in the uk um so in the end decided let's not do military medicine, let's do emergency medicine.

1:44So roughly the same sort of desire to try and be in that heat at the moment, fix the problem, bring order to chaos. The challenge, however, was when I entered the working world. A &E wasn't as chaotic as I was hoping. I generally was looking for heart attacks, amputated legs, people in car crashes. Like that was what I was looking for. What I ended up seeing was people with acid reflux, people who had urinary tract infections, people with really serious migraines, who were coming to A &E out of desperation because their GP appointment was two, three weeks away. And we're talking back in 2017 without all the technology advancements we have in today's day and age.

2:29And you had NHS 111 that was directing people to A &E, people reaching desperation point. And I remember looking at all these people in the waiting room thinking surely there has to be a better way and so we built an algorithm and the algorithm was just a literal series of questions it's the same questions i would ask in a face-to-face appointment as a doctor and just turned into a quiz format and the hypothesis was if we added this to the end of nhs 111 when they say go to a and e if someone just needed prescription medication you could then be like okay cool you don't actually need to go to a and e but you do need emergency prescription, go here for your UTI treatment or your migraine medication or your shingles treatment.

3:08Somehow I managed to build a version of this and get it in front of people at NHS England. So I don't know how I actually managed to get that meeting, like just sheer tenacity. And then they laughed me out the room. Like it was one of the most disappointing conversations I've ever had. And in hindsight, I do get it. But back then I was 24 years old, full of ambition. I was only seeing the world through my lens, which was obviously this is going to make things better. Now I understand the need for data and trials, risk mitigation, all these other things.

3:51Amardeep Parmar:But it's in a way like I think we had the same thing recently where when we first started and we pitched people, I remember being so annoyed at people but it's like now look it's like I would never say yes to me and it's interesting how you need that delusion in a way just otherwise you wouldn't start absolutely there has to be absolute optimism and faith and not a single doubt that you are going to do something and you can actually make something better for the world and you also said as well that you were looking for the car crashes and stuff like that where do you think that came from like why were you looking for that that's a really good question straight into childhood psychology.

4:25We were an immigrant family that came to the UK in the kind of classic Middle Eastern version, or I guess even just expanded to all Asian households, or I'm stereotyping here, I guess. You had to be exceptional, right? You had to be the problem solver to get the pat on the back, the attention from dad. You essentially became a swiss army knife to be as useful as possible to your parents and then that transition happens to how you show up for your friends how you show up for your extended community um yeah so being able to find chaos meant that i could be the hero and for a lot of the early days of bootstrapping a business that served me well um in the recent months of scale up it has been a really interesting identity crisis where you then have to be like right I'm not the bottleneck anymore I need to find a way to make sure I empower other people to be able to make these decisions in a way that I would ideally like those decisions to be made when I'm not in the room and that has been hard.

5:34Amardeep Parmar:So so far you've been very humble and I think people might look at the idea of just how much impact you've already made and you said about being exceptional right so how many patients have been served through what your work is and tell us some of the numbers here. Yep. So, oh God, we are now supporting about 45 ,000 patients each month. We started off, for example, supporting only nine patients a day. We support patients across 500 different treatment areas, 500 different medications, 80 different treatment areas. So that's ranging from migraines to obviously the weight loss stuff, it's menopause, it's testosterone placement treatment.

6:15I think the big arcs that we look at are things that are painful enough to people but actually can be done in an online healthcare setting. So you're looking at pain management, longevity medicine, you're looking at things that may not even be available on the NHS. So we've recently started a service offering to Dalafil, which is a medication for male erectile dysfunction to women to have better orgasms. Because ultimately, if you think about embryology, the same way in which the male genitalia are formed is the exact same way the female genitalia are formed. So one medication works in one area.

6:53Hypothetically, it works in the other. And we then run things equivalent to a phase four human study.

6:58Amardeep Parmar:So obviously 45 ,000 patients a month is incredible. But you said we only did nine patients at the beginning. But obviously, she says each of those nine patients, you're making quite a big difference to each of their lives. So only nine patients is still actually quite a bit for them. Yes, that's true. I think if I generally look at it, it feels so small because the desire is to build something that's supporting an 8 billion people planet. And that's when I said this 30 year time frame. So if I take that analogy back to online banking, 30 years ago, if you wanted to send money to your mother, 50 pounds to your mum, You have to call work and say, excuse me, and take time off work.

7:32You have to get into your car, drive to the local bank branch. You wait in a queue. You see this beautiful cashier. She goes clickety-clack, clack, clack. And then the money goes from your account to your mother's, and you've lost half a day. And actually, that is kind of what we're doing with healthcare right now. You take time off work. You go to the GP. You see the GP for a 10-minute appointment. You then have to run around to different pharmacies to get your prescription.

7:53Amardeep Parmar:But a lot of it can be algorithmic. And I know that sounds really scary, but it was scary in the banking world. We thought it was mortifying. But right now, me and you and most of the viewers would think it's ludicrous to physically travel to a bank to ask for£50 to go from your account to your mother's. And so what we're trying to build is a version of healthcare that kind of is this new way of thinking. And it's going to take time, right? And what we've seen with banking, which has been really interesting, is it's been a phased approach. First, you could see your bank transactions. And then you're able to do the transfers.

8:27After the 2008 financial crash, you know what we learned? We learned making a decision on if you could have a loan based on data. It's a really good way to make a decision. And so we're looking at healthcare now. And, you know, you have someone who is an asthmatic, and you're getting them to cough into their phone microphone, and you're working out their lung volume, and you're charting in the data from previous asthma attacks, today's pollen count, the pollution catalytic that they're in. and you're saying, hey, maybe you shouldn't be on one puff of your aspirin steroid inhaler today. Maybe you should be on two puffs for this period of time whilst your lung volume is so tight.

9:01So it's building this completely different version of healthcare, not just what healthcare is online. And I think I know we have video call services in the healthcare space that mean people don't have to travel to their GP practices. But the reality is banking was not sold with video calls to the cashier. We have an 8 billion people turn it. We will never have the amount of cashiers to be able to service the sheer volume of financial transactions that exist. And likewise with healthcare, we are never going to have enough doctors, pharmacists, physicians, associates, nurses, everyone else in the loop to actually support people in the way that they really should be supported.

9:40We can support them in a way that, you know, with economic considerations is the sickest of the sick get help. but that's not really how you build like the best population health on a individual level yeah and

9:53Amardeep Parmar:you said about that obviously you bootstrapped to the beginning and you were kind of a force of nature there what were the it's like okay you did your first algorithm got a lot after NHS England how did you then get that initial traction start getting people to really test this out properly uh yeah so in the early days I built a website um Oscar uh my co-founder quit his job he was the manager of the local Asda pharmacy. We both signed a lease for a 2 ,000 square foot warehouse, which I thought was ludicrous at the time. Most pharmacies are shoe cupboards. And we had this massive space that essentially was a glorified ping pong room.

10:29It was about three minutes away from the house. And it was 1 ,500 per month. We knew nothing about VC land. So I was locuming, Oscar was locuming in our free time to be able to pay for this. We got counters, like IKEA tables, counters you kind of silicon them into the wall and stick them in we got um secondhand shelving from a closing down maplin store and it was just literally scrappy scrappy everything we didn't even have flooring it was just the chips and the concrete that was painted once upon a time and um thankfully oscar with his experience and his uh connections within the management world at the asda pharmacy his previous experience at super drug online pharmacy he was able to get all the regulatory stuff for the pharmacy over the line.

11:13And I simply built the tech and the clinical decision making protocols. Just the tech.

11:17Amardeep Parmar:Just the tech. It was questionable, I think. It was an ugly looking website. It probably spoke to how desperate people were back in September 2018, I think was when we went live, for them to buy something from a website that was that dodgy looking. I remember going around to family and friends and be like, hey, do you mind giving us a Trustpilot review so we can try and get at least 10 five-star ratings so it doesn't look like we're a nobody and people aren't chancing it. But yeah, I think our first ever customer is still an oil customer today. Yeah, it's quite interesting. That first customer came back in two weeks later to order a different medication.

11:59So immediately we saw like, this has legs. We needed 11 orders a day to break even, excluding salaries so that was rent that was electricity yeah and so very early on we knew

12:10Amardeep Parmar:that we were onto something i think that's an important point you made there as well because i think so many first-time founders are so obsessed with how it looks and with that stuff if you're really solving the problem people aren't going to care about what color is or whatever it is they're going to use the software for what it does yeah and the fact that you did that i think obviously says a lot in terms of having the right mentality skateboard first build a skateboard then build a bicycle then build a car then maybe build a rocket ship yeah and once you got to that point of okay you're getting your 11 orders a day how did you go from there to like maybe this is something we could really scale or when did that mindset start to shift um yeah so i think at the time we were looking at advertisement and uh oscar and i paid for a marketing agency to come in i think we paid five thousand pounds but in mind all of this was out-of-pocket cash um and they did jack shit they did maybe keyword research and we received this and both oscar and i looked at this And this was before the ability to use large language models to actually reach that area of the knowledge matrix where you don't know what you don't know.

13:09We looked at this and be like, this is not that hard. My mother has a beautiful saying, which is, he has two hands, I have two hands, he has two eyes, I have two eyes. Anything he can do, I can do. And so we looked at it and we were like, well, you know what, we're relatively intelligent people. Oscar is a pharmacist by background with a PhD in anti-aging. He is a smart man. And so he just went into the depths of Reddit forums and Google to just understand what marketing is. And to this day, Oscar still owns all the marketing of the business. I think it's probably the main reason why we are as successful as we are and our customer acquisition costs are as low as they are.

13:49Because if someone who deeply, deeply cares about the success of the business and the longevity of the business, rather than just becoming another business that, you know, is a charity funding Google, fueled by VC money. You have someone who's really thinking like, is this actually valuable? And I mean, Oscar will be working and tweaking ads on a Sunday at 10pm because he's off an alert and he's paying attention. I don't know if you'd get that if you're outsourcing to an agency. So that was probably one of the key pivotal things that allowed us to grow. And there were so many experiments done.

14:22It's the type of blog posts, it's the, you know, putting flyers around university, and it's trying to convince the concrete, which was the University of East Anglia's newspaper, to do a piece about STI chlamydia during Freshers' Week. So there's a lot of guerrilla creative marketing done in the early days. Now there's a very large marketing team. We have a chief commercial officer. It's interesting to see how that's grown.

14:47Amardeep Parmar:How big is your team now? oh uh growing constantly uh the last time i checked was 164 people um by the last time i checked is the amount of christmas cards i've just written it's a good way of being it right yeah i would 104 164 christmas cards obviously said so oscar's like owning the marketing side right and then as i see you're owning some of the other parts but like as you started to grow where was it that you started being a community to hire here first or and did you get that right or do think maybe you messed up the order there? So we took a really long time to hire senior leaders of the business.

15:22Rightly, wrongly, I actually don't know yet because when I say really long time, our CFO only came in in November, just but.

15:29Amardeep Parmar:It's December that we're recording this, so it's literally last month. Yeah, he's been in place for just under a month. You got this far about a CFO at all? Yeah, I learned a lot of stuff to run this business. So, you know, the finances, everything else. We bootstrapped for five years. We then took our first ever external fundraise from VCs. We took a really small amount. We took just under$1.5 million. And we took out secondaries in that, which I think is really important to share that we had the audacity to ask for secondaries. And we did the same thing in our Series A. I think it's really important to recognize that my entire financial risk lies in this business.

16:07And so there were some decisions that would be brilliant for the business. that I was probably not willing to make because actually the risk was too high for me personally. Whereas when you then decouple them, you're like, actually, this is a bet I really want to make. I am now safe. You know, my bills are covered, mortgages covered, that kind of stuff. Therefore, I'm OK doing this. And I would encourage all founders to ask at the very minimum, if they're doing an investment round, to see if they can take something off. I think in our first round, it was probably like 50 grand each. It wasn't huge, but it was meaningful enough to provide some level of safety.

16:43Yeah. So in our first financing round, that$1.5 million, we simply took the money to move warehousing. So remember that 2 ,000 square foot warehouse that I said was stupidly large? No, no, it wasn't big enough. So we raised money purely to move. We had some ridiculous line items and what we ended up thinking we would need, what I was actually comfortable spending. I think having grown up very poor, some things look practically reasonable and probably from a time's perspective makes sense. But in reality, there's a piece inside me that did not align with it. So, for example, in our new warehouse, which is 12 ,000 square feet, currently being expanded to 18 ,000 square feet, we were building these tables that are three meters long, 113 centimeters high to make sure that they're regulatory requirements for the pharmacy fulfillment.

17:31to have them bought their£2 ,700 to make them myself their under£700. So it was buying IKEA shelving roughly like this, Oscar angle grinding them to the right size, and then me getting kitchen counters, putting them on, like standing on top of these tables with a circular drill that would be able to make grommets so you could put all the cables from the computers inside. Yeah, the thought process is we need 40 of these tables at almost£3 ,000 for 40 tables that has£120 ,000. Yeah, you could capitalise it, whatever. Like we're not doing accountancy magic here. This is real cash leaving the business.

18:06It doesn't matter if it sits on your balance sheet. It is actual cash leaving your business. And I'm not an accountant, therefore cash is king. Whereas if I made them myself in the order of when we needed them, you're never going to have that£120 ,000 disappearing thing.

18:20Amardeep Parmar:So although it was something that we asked for in our fundraise, we never actually did it. because when push came to shove I realized I just I was never going to be comfortable with it it was also things like we said we would get nice new office chairs so people felt comfortable nope they were all secondhand yep some of them needed to get additional pieces from like AliExpress for like the cushions on the armrest because they came in a bit damaged but you know you take a picture AliExpress gives you the rough thing you bring it in maybe hammer it in a little bit it's good enough I say that as if everything's breaking it's not like everything looks very legitimate now but we are still quite scrappy so that was us growing um in 2023 where we were about 20 people at the end of uh 2024 we were then 81 people and I started to feel uh the pain of having 81 direct reports and I was like okay I now need to raise money to hire c-suite and yeah we went out we thought we were going to raise a quarter of what we actually ended up raising we thought we were going to be valued in terms of nothing because I yeah obviously in VC land people will pay for what they think you're worth we had very large discrepancies between what we people thought we were worth, whether it was I think our highest pre-money valuation that was offered or was talked about was 20 times revenue, which would have killed us.

19:49That is not a sensible way to run a business. That is not how you get to 30 years of existence. So we went with a VC who actually had a lot of medical doctors at the table because they aligned with 30-year vision. They aligned with the fact that if something maybe wouldn't make sense from a commercial perspective what was being made like the decision was coming from putting a Hippocratic oath before everything else I think it felt like you weren't going to be giving away chunk of the business to people who are going to be your overlords and then they say money is king like you have to remember as a health care business spending eight years acquiring seven different regulations technically we could be very very dangerous right uh hypothetically you could sell opiates over the internet.

20:34All it takes is someone who's incredibly greedy to say I'm firing Threya as CEO, I'm firing Oscar as COO, we're now putting someone else in, you're now going to sell opiates, we're all going to make a lot of money and we're going to cause a lot of harm to the world. And so for us value alignment was one of the most important things. Yeah so we raised a second round this year in April, we hired a c-suite and over the last few months they've been coming in and I've been learning to let go.

21:02Amardeep Parmar:Hello, hello. I hope you've enjoyed the show so far. I'm Amadouk Parma, co-founder of BayHQ and the host of this show. For those of you who don't know, BayHQ is the community for high growth Asian heritage founders and investors in the UK. Over 7 ,500 people have attended our events, 200 people have been for our impact programs, and obviously there's been over 250 episodes of this podcast. If you want to join us and take part in the programs and come to the events, go to bayhq.com forward slash join. We also just released our first ever book called Startups for Outsiders, which you can get on Amazon now and the link is in the bio.

21:43Amardeep Parmar:Hope to see you soon at our event. Hope you enjoy the rest of the episode. I was like, what's in about Australia, like you said, like you were so scrappy at the beginning and then, so you said 2023, 80 people now over 160 that like that's such a different style of leadership as you said right and being able to make that transition like how has that been like you said like it's difficult and you said it's hard but like how have you had to adapt or have you made any like personal changes or like letting go like what have you been able to let go like if somebody's in that position now okay I now need to hire lots of people but at the same time I feel this ownership and I don't want let go how did you deal with it how are you dealing with it in some cases reluctantly i think the first time i saw a job offer contract and in front of me that i had not been present in the cv the interview or anything like that that was scary but i actually recognize we've grown a really impressive team of people um i actually asked a lot of founders and the vcs that we were speaking to what were the reasons why you fired CEOs in some of your portfolio companies.

22:51And often it was about this adaptation from going from startup mentality to scale up mentality, the need for more process, even though it slows you down, how do you get the correct balance? I don't think we're at the correct balance. I think we've overcorrected a little bit and we'll come back. And it's this deep humility of being able to reflect on yourself and accept that if someone is giving you criticism or feedback ultimately it's a gift they are only sharing that with you for you to be better so i had um one of the venture partners at our main vc call me up one day after i was working with the recruiters for the cfo and they're like hey you need to own this process more you're being really passive i was like okay what does that look like and so having a conversation really bluntly that says hey the way that you're handling this you should not be giving um more ownership to the recruiters, regardless of the fact that this is, you know, their bread and butter, they've done it millions of times.

23:42This is still your process. You need to be more demanding. I was like, okay, cool. I'll like unpack that abrasiveness that needs to exist in this particular relationship. I got myself an exec coach who on a weekly basis, I go and ask, hey, I'm having this problem. These are my thoughts. I specifically went for someone who was in healthcare, ran companies bigger than me, because sometimes I don't want to be coached. i just want the answer and i'll give you a really stupid example um we were going through uh i think like people having uh finance cards to be able to make purchases and our figma licenses were going like going really high and i was like why the hell do all these people have figma licenses like half these people don't need to make edits they're just looking at it what's going on here it was really bothering me like the level of control was really bothering me and i was having this conversation with Duane, who used to be the ex-CEO of Emis.