Go Slow to Go Fast: Eliana Berger on Building Joyful Health

What does it really take to build in healthcare from the ground up? 

In this episode of First Builders, Amber Illig and Rachel Tsui sit down with Eliana Berger, co-founder and CEO of Joyful Health—a financial operating system for independent healthcare providers. Eliana has been a “first” more than most: first PM on Attentitve’s conversational messaging team, first PM at Charlie Health, founding PM at Moonbeam, and co-founder of Envision Accelerator, the first equity free accelerator for underrepresented founders. 

In this episode, Eliana shares more about: 
– Embedding herself inside practices as a fractional CFO
– Become biller-certified to understand the messy realities of revenue cycle management (RCM) 
– How to build trust with clinicians in the era of AI skepticism 
– How community building, workshops, and radical transparency became Joyful Health’s GTM edge
– Why going slow to go fast has been her core principle as a founder

It’s a conversation about tackling the messy problems in healthcare, diving in deep to understand the root problems, and creating a company that lasts. 

Follow Eliana Berger
LinkedIn: https://www.linkedin.com/in/elianaberger/
Joyful Health: https://www.joyfulhealth.io/
Careers at Joyful Health: https://www.joyfulhealth.io/careers#section-careers 

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Transcript

0:05

Welcome to First Builders, the podcast for those who shape companies from the ground up. I'm Amber Illig, founder and general partner at the Council Capital, where we invest in early teams solving critical problems in essential industries. And I'm Rachel Choi, partner at the Council. This show is about the people behind the playbooks, the ones who took a leap early and helped define what their companies would become before anyone else could see it. Today's guest has been a first more times than most founders ever will. First PM on Attentives Conversational Messaging Team, first PM at Charlie Health, founding PM at Moonbeam, and now co-founder and CEO of Joyful Health. And before this, she also co-founded Envision Accelerator, the first equity-free nonprofit accelerator for underrepresented founders, supporting over 60 companies that have collectively raised more than 50 million. At Joyful Health, she's tackling a massive and often invisible problem, helping healthcare providers get paid what they're owed. It's a pain point that's equal parts operational and emotional, impacting how clinics run and how patients get care. Now, this is a special conversation for us as Joyful Health is a portfolio company at the council, and we backed the company in their first ever fundraising round. We were particularly excited about Eliana's design and product management background mixed with her prior experience in digital health. Eliana's journey is a case study in what it means to be a first builder. Eliana, welcome to First Builders. Thank you so much for having me. I'm so excited to be here, especially with the council, and so appreciate you supporting Joyful from pretty much day zero. So I'm very excited to be here. Yeah, yeah, we're we're super excited. So let's dive in. Um obviously, you know, we mentioned this earlier, but you've been a first PM in so many different companies. What do you think is for you the thrill or the chaos of stepping into a role where there's not necessarily a blueprint? Great question. I've I've always loved doing that. I think that I, um even when reflecting on, you know, when I wanted to start a company and what that would look like, uh, been asked that question a lot recently, like when, you know, why did you choose to do this? And I think I've always felt most myself in zero-to-one environments. I have always kind of thrived in the undefined. Um, and particularly, particularly, um, I've really just loved the empathy that comes with it. I think at that point in time, when you're building something from the very ground up, like you have to just put yourself in the shoes of whoever it is that you're building for. And that's always something that has come really naturally to me. And I've loved doing that across so many different industries and complex spaces. Um, and I've kind of loved getting to set all that up from the ground up and it feels very similar to be doing that in a company setting as well. Yeah. And just diving back a few roles ago, like at Attentive, you built that MVP for conversational messaging, which went on to become one of their major revenue drivers. How did you design something in the early days that has the potential to scale that big? Yeah, I think what's cool about attentive was that it had already really, really strong product market fit. And it was cool to kind of be on a zero-to-one team within a larger organization. It's actually kind of the first time that I had done that, like not in a very like startup-y setting. And the interesting part about attentive was that it was kind of coming after a new use case, like in that sense. Um, and it was still pretty undefined in like how people would use it and like where they would find value out of it. So that sort of product work was really interesting. And then we ran a lot of different tests. It was very experiment-driven. I think we had a couple of different hypotheses around like how we thought people would use it. And I think we were actually pretty consistently surprised with the learnings that we had. So yeah, I think like I've I've always kind of taken that approach in product before. Um, but there was, yeah, a lot of learnings that we had from all of our different customers and we kind of just gave them a pretty versatile tool. And we really wanted to see like how they would actually put that into practice. Um we had different use cases like across customer success and more across like sales. And we uh had a lot of different patterns and things that were emerging. So that was a little bit more defined, but it was trying to kind of find product market fit for a new product within a company that was growing really quickly. So very interesting product work there. It's awesome. Yeah. And it seems like from the outside looking in, it's like, wow, how did you just launch this? And it ends up being the thing. But internally, probably it was a lot of iteration and um, you know, listening to users, seeing what's working. So thanks for sharing. Always. Yeah, we had a lot of open questions. I think that that's you know, in every role I've ever had. Like, I don't think we had any preconceived notions really of like how this would work or how it would function. I think just we actually shipped a lot earlier than we felt comfortable with and just started to kind of put things in the hands of users. And I think that's really the way that you learn and has always really been more of like my product philosophy. Totally. Yeah, I love that. And you know, you mentioned also that you've spanned a lot of different industries and we were looking, you know, and doing research for this podcast. You've done travel tech at Lola.com, podcast discovery at Moonbeam. Obviously at attentive, you're doing the e-commerce marketing and then mental health at Charlie Health, right? So lots of different industries, but now you're really going deep on healthcare. What was it about healthcare that made you stop and decide to go deeper? Yeah, I've always been really passionate about healthcare. I think like many healthcare founders wanted to be a doctor at some point and had actually spent a lot of time earlier on in life um volunteering in hospitals and like spending a lot of time in like more like clinical contexts. Um, although all the industries I've done seem really different, I think they've actually all been really, really complex. Like I actually still think like travel is one of the most complex industries I've spent time in, um, even though I've been like in healthcare now. Uh, I think those that have worked uh there can relate. Um, and Lola actually ended up being becoming more of like a fintech company. So I think I've always really just loved those really like thorny problems. Um I think it just puts a lot of really interesting constraints on product problems. Like you have to just go very, very in the weeds. And I've loved uh trying to kind of become a subject matter expert in in all these different spaces. I think e-commerce is also really difficult, a lot of regulation. But with healthcare specifically, my mom and grandma ran a therapy practice as I was growing up, and that was a huge source of inspiration for me to spend time um in healthcare. Uh, kind of originally thought that I wanted to be a doctor, um, ended up actually falling in love with entrepreneurship through some of the different nonprofits and things that I started when I was younger. And then the rest is history, but have always felt very drawn to especially kind of supporting providers and like the mental health space. That's awesome. And and you ended up co-founding Joyful Health as you were going deeper into healthcare in June of 2023. Why did you decide on a fintech problem within healthcare and why now? Yeah, it's funny. I always say I really wasn't a trying to get into fintech at all. Like I really was actually trying to actively stay away from RCM. Uh, you can ask some of our advisors in the early days. The way that I really like stumbled on this problem was through a very like first principles approach. Um, I'm sure Amber, you remember like when I first met you back when we were first starting Joyful, a lot of the thought process was around like how do we keep uh practices independent. So that has always been my interest. I think after watching my mom and grandma run their therapy practice, like there's just so many challenges that these providers face and face alone. There's really no community in it. You just kind of, as a business owner, like need to figure it all out. And there's really not that many resources that support you on the way. So when I first started Joyful, I really was trying to figure out like how do you help providers stay independent and what does that look like? And you've seen so many different iterations of that idea. And the way that I really stumbled on FinTech was I really embedded myself deep within these practices. And I spent pretty much the first like year and a half of the company just working really closely with a whole bunch of different clinics. And I first did that as a kind of free consultant. So I told them, like, hey, what do you need help with? What's top of mind for you? What can I do? And did everything from helping them order office furniture to helping them hire people to kind of deeper like data analytics on how their clinic is performing. Um, and across the board, every single time, what I kept seeing was that these practices like were really struggling to track their revenue and they really didn't know how much money was going to be coming in, who was going to pay them, where they might have been leaving money on the table. And it kind of naturally pulled me into this role where I kind of kept like playing like this fractional, like CFO type role or fractional like head of RCN. I didn't really know anything about that at the time. We actually ended up bringing on an advisor, um, James Heffernan. I was a former CFO of Bash Jen Brigham's physicians organization. And he actually met with me weekly for months, really bringing me up to speed on all things healthcare finance. I actually read a textbook. Um, my co-founder and I became biller like certified, and we just went really, really in the weeds because we just saw that no matter what practice I went to, like this is what I just naturally got drawn into. And so that's really what brought us to this space. It was very much so just what we saw to continuously be the biggest hair on fire problem. And as much as we kind of tried to shy away from it, I think we realized that like this was the biggest issue and we really needed to like just dig in. Yeah, I absolutely love that approach that you took of just like let me implant myself in their day-to-day and see what the actual biggest problem is versus, you know, what you're hearing about in the ecosystem is the coolest thing to be solving in healthcare or any other sector. Um and actually this is we've seen the success in Joyful Health, and we've actually shared that as like a helpful tip to other companies in our portfolio too, after seeing what you were able to learn from that experience. So it's awesome. Yeah, I appreciate it. I feel like often we actually were told like, don't go in that direction. Like it's really hard. It's really messy. Yeah. I think I've seen it as an operator prior where you you do that too early. And then like if the whole team is focused on building a services business, it's very hard to like change the culture to get into a product like platform style business. But I think because you have the product background, because you were doing that from day one, it was like very intentional. So you managed it well. Yeah. Thank you. I appreciate it. Yeah, definitely have lots of thoughts on on that whole process and services and all and all that fun stuff. But yeah, I'm I'm really glad that we ended up diving deeper into it because I think we're we're starting to see a lot of that pay off now. I think we're starting to see that, you know, that there's there's always been a pretty strong pull from the market. Like we were we were really focused on that in early days of building, like not really pushing anything, but like really seeing like where is the pull coming from and like what is truly the foundational problem for practices. And you know, that's kind of like Maslow's hierarchy of needs. You know, if you don't know where your business stands, like that's going to be most important at the end of the day. Yeah. Totally agree. Yeah. And, you know, I looked on your website, right? Like Joyful Health has a very simple, I would say like almost tagline. It's like helping providers get paid what they're owed. But obviously, underneath that, it's probably a lot more messy and complex. What's one part of the process would you say that like most people outside of the healthcare ecosystem don't realize is broken? Yeah, I love this question. The data, I think we talk about this all the time. Um, I think like what we found really in this process of working deeply with practices is that the data is really fragmented. And, you know, when I'd go work with a new clinic, pretty much what I would spend almost 90% of my time on was just trying to piece together where does their financial data live. And what's really tricky, you know, there's like thousands of insurance companies in the United States, you know, they're all sending information back to the practices. And uh a lot of these systems that clinics are on are not built for financial data. They're built for clinical data. But these, you know, clinical systems like these EHRs are also what practices use to manage their revenue. And that's really tricky because it's really not stored in a way that's useful for them. So the way that the majority of clinics, you know, that are not larger health systems uh manage finances is primarily through Excel. You know, they like export data out of their EHRs and they're living in spreadsheets. So I lived in spreadsheets for a year and a half. Um, and those spreadsheets aren't even useful. Yeah, you know, I actually had to stitch together multiple reports from many different systems and spend a lot of time actually manually cleaning up that data to make it useful. And no one can really run a business like that, you know, let alone a clinician that is trying to deliver care, like they're seeing patients all day. Like they really shouldn't have to live in Excel to really understand what's going on. So that's actually really the root cause of the problem. Um, I think there's a lot of different companies that have tried to kind of approach uh different like types of like provider tooling and trying to solve like all these all these different types of issues. We've always viewed that uh there's a lot of these different symptoms of things that are really difficult. But the thing that's actually really time-intensive and what is causing all these fundamental problems is all this data fragmentation. Until you can bring all this very messy, disparate financial data that is highly unstructured all into one place. You cannot help a clinic track their revenue, nor can you help them recover their revenue. So that's actually always been our hypothesis as a company and something that we spent the first you know year and a half of the business like really focused on is like how do we actually solve this problem first? Because until we can solve this data interoperability issue and like unlock like this information for providers, like we can't really build anything on top of it that we can, you know, that will truly be useful and will fit into their existing stack today. Totally. So if they're not using Joyful today, or they don't have a fractional CFO like you when you were, you know, working with them as a consultant, like how are they doing it? Like, is it are they hiring like an RCM person um or like a medical biller to do it, or does the clinician does it them do it themselves, or is it all different? Really depends on the clinic and the resources that they have. You know, some folks have um offshore or you know, kind of like outsourced like billing companies that they work with that do kind of the end-to-end billing for them. But those billing companies have the same issues. We actually talk to billing companies all the time, and they actually also are dealing with those exact same reports and sending those reports to the clinics. If you have in-house resources, it's actually very common depending on the size of the practice that the provider does the billing themselves, or they have a practice manager or somebody that actually hasn't had billing experience in the past that has just kind of learned it on the job, doing a lot of that work and also kind of living in these like EHR reports and things that are coming out of their systems. And then some of the more some of the larger clinics that have more resources will start to hire more like in-house RCM leadership. But once again, it's like it's actually a very big problem across the board that, you know, even with slightly more sophisticated billing software that even kind of these mid mid to like larger size clinics will have, like, though the reporting is like really challenging, even if it has like billing data in it, it doesn't really pull in the contracts that the practice has with the insurance companies, which actually show how much you're supposed to get paid. And it doesn't connect to your bank account, which actually tells you if the check made it all the way there. There's a lot of places where money can get lost. And I think people really struggle to track that today. It's pretty much entirely manual right now, no matter who you're doing who's doing it for you. Wow. Yeah. And if we go back to one thing you said, you you mentioned earlier that a lot of these private practices want to remain private, want to remain, you know, keep their ownership. Can you talk a little bit about like the PEFACON of healthcare and what's happening there right now and how that kind of impacts your customers and their patients? Yeah, there's a lot of roll-ups happening, you know, and for for some clinics that that actually works out really well for them. You know, some of them are looking to retire, they're actually looking to make a move. So um I think in some cases it's actually really wonderful. Um, and I think in other cases, like it's really hard to run a business. I think it's hard to run any business, um, you know, but I think with uh practices, right? Like many of them didn't go to a business school and there are really no classes in med school around how to run a business, like how to run a practice. It's like pretty focused on, you know, being an employed clinician. So I think that can be super challenging. And I think no one is born knowing RCM. And I think what makes it even harder is that even if you can kind of figure it out today, it might look entirely different tomorrow because payers change their rules all the time. And no one really has the resources to be keeping up with all of this. So I think that's oftentimes like why, you know, there's a lot of challenges as to like what might contribute to like a roll-up happening. But I think, you know, private equity will often offer practices like more support on a lot of like the business side of things and more support on billing and kind of taking a lot of this like administrative like headache away. So I think like those are some of the things that can lead to practices like struggling to stay independent over time. We actually see them, uh, yeah, it's like if you know if your biller's not collecting revenue collec correctly and you can't make payroll, like that's actually unfortunately a common thing that can happen. But in some spaces it makes a ton of sense. Like we actually work with roll-ups as well. Like there are, you know, digital health companies that support lots of different practices and things. So I think we we want to make it easier for folks to collect revenue, no matter who is doing the collection of revenue. But yeah, those are some of the things like we we've observed with practices that, you know, have struggled to stay independent even if they want to be. Yeah. Makes sense. And I appreciate you kind of sharing both sides of the coin because often it gets vilified. It's like PDFation of healthcare is a bad thing. But a lot of times we've also seen, you know, there's a whole population of people that are looking to kind of pass on their business and they're they haven't, they don't want to run it for the next generation. So it's helpful to know that you can help either way. Definitely. Yeah, we just we want to make it accessible. I mean, I think that that's been like my theme, I think, throughout my whole career, like even with other nonprofits and things I've started before. Like I've always been really passionate about removing barriers that prevent people from being able to like start and run their own businesses. Like, I view joyful very much as an extension of that, honestly. Like if you want to be able to run your business, like you really shouldn't have all these hurdles of not knowing how to handle insurance billing be like part of that process because independent care is so important to communities. And we work with so many, you know, behavioral health clinics and like therapy clinics that are really, really embedded with the folks that they work with and deliver like such like life-saving care. And um, it would be a huge shame if they are no longer able to deliver that care, especially some of the folks who work within like more rural areas. Like a lot of people really depend on the care that they deliver. And we often will see that clinicians are so frustrated by the experience of billing that um they actually, I've been told like multiple times, like, I don't want to be doing this anymore because of how, you know, much time and overhead it takes. Totally. Yeah, totally. And then, you know, in the healthcare industry, I feel like historically, like people were very um, or clinicians were kind of skeptical, right? Like of new vendors, of you know, EHRs were almost like forced on them because of policy, you know, things like that, right? How do you think, has that changed at all actually? Like, you know, especially since you've started Joyful Health, have you seen more adoption of that? Or do you feel like you still need to address kind of that skepticism at times? No, I think trust is a huge thing. Uh, I think that actually, if anything, there could be even more skepticism now in the age of AI. I think it's really hard to like know what to trust. I think like there's a lot of different folks selling things to clinics out there, and there's a lot of kind of exhaustion around like, I don't know what you're selling me. I don't know how this is gonna benefit me or my practice. Um, and I think that's even harder in RCM, honestly, because many folks come to us from different experiences with billers or billing companies or insurance companies and are just really burnt out. Uh, so a lot of our time that we spend with um, you know, what with practices generally, whether they're customers or not, is like really focused on trust because they haven't really experienced a whole lot of transparency. And I think when your data is so inaccessible and like you really can't even tell what you were supposed to be paid, like I think a lot of that um, there's definitely a lot of skepticism. Um, and I think honestly it's like it's very rightfully so. It's hard to know what's what's real. Uh and I think, yeah, they're just being pitched a lot and there's a lot of jargon out there and a lot of companies that, you know, say they have AI but don't, or vice versa. So no, I think we definitely still see a lot of that. But I think that's the most important part if you're building anything for providers, like you have to put yourself in in their shoes, really understand the problem, and make sure that they really understand what it is that that they're purchasing. Yeah. And and how do you guys try to like build that transparency, I guess, like in the product or in the process of working with you? Yeah. Well, first of a lot of it actually starts before we even have the customer. So we spend a lot of time on workshops. We do a lot of education and content for different practices, like both um, you know, folks that run practices, but also like practice managers and those that support clinics. And we do, we just teach everything we know about RCM. So we're very transparent. We actually tell them how to prevent denials, we tell them how to work denials, we uh we tell them we talk a lot about building RCM teams and how to evaluate vendors and tough questions to ask and like how to submit clean claims. So we've done dozens of workshops at this point. We do them for practices, we do them for digital health. We actually just ran a whole workshop series for digital health companies on setting up RCM processes. So we actually think that that level of like transparency has to happen way before anybody's a customer. Like there's just really no place to go right now to learn anything about healthcare billing. So we're very transparent about that. And then in terms of working with us, so we do our best to overcommunicate. So we, you know, we we have our software, but we also keep the customer system up to date so they can always kind of track and monitor where things are at because they're used to relying on their own systems as well. We send very frequent updates of what claims we're working on, what that looks like, what we're recovering. And we also really work on being a true partner to all of our customers. So they're often reaching out to us with all sorts of RCM-related questions that are not even related to the work that we're doing because we know that that knowledge is really hard to come by. So we actually say the same thing to folks who are not customers. Like they're welcome to reach out to us anytime there's any sort of RCM-related question or issue, and we'll do our very best to help. So I think it's always been like our ethos as a company, like lead with that transparency because it's it's like rare to come across from a vendor, but like especially one in RCM. Yeah. I absolutely love that you're doing the workshop angle as well, because we've also seen that help multiple portfolio companies in these sort of nuanced spaces where there's some some sort of like fear of wow, if I can't, if I can't learn how to manage this properly, I'm gonna lose my business. And sometimes it is related to AI. People are like, I'm seeing this happen in my industry. I don't know how to uh how to leverage it. And I'm worried that my peers are gonna catch up before me. So I love that you're kind of you know democratizing information about RCM for your network, uh, because that's a huge pain point for them and it establishes you as a point of credibility. So I think that's awesome. Um, yeah. And then just for anybody listening that's thinking about becoming a founder, say they're in a design role or a PM role, what would you say, and the spirit of transparency has been kind of the toughest thing that you've had to work through so far as a founder and CEO? Good question. Uh, I think that navigating the rate of change, honestly, I think is the biggest thing. Um I think like this role, your role looks different almost every day, uh, especially, you know, when when The company is changing pretty quickly. Like we're growing a lot. Like we have lots of new open questions and challenges and things that we're working through on a weekly, if not daily, basis. And I think that requires constantly stepping up to the plate. So a problem that you might have had last week might no longer be a problem. You might be feeling really confident, but then a whole new set of challenges like comes out of left field. So I think that that can be really difficult to navigate, both professionally in terms of like how you show up for your team and your customers and like all the responsibilities you have every day, but also personally, like how you navigate that kind of constant, you know, growth and like pressure. So yeah, I think that that's like it's very doable. I think like there's so many jobs out there that like put you in a really difficult position. But I think like this one by far, like really does stretch you to your very limits. And if you love that and you're a growth-oriented person, like you'll love this job as well. I I certainly do. Um, but you know, of course, it comes with its challenges. So for me, like I have found therapy and like coaching to be really helpful, like having an amazing community of like other founders that you can lean on, um, having an incredible co-founder of like all those things are are really important. Um, and kind of creating that like space for yourself. Um, also worth it. I think it's like the most I've ever grown in my life. I feel like I'm always evolving. Like I tell my friends every time I see them, like, why I feel like I've lived 10 years in the last like couple of weeks. But yeah, like that is probably like what I would say has been the biggest challenge for me. Yeah, definitely. Curious too for you, like as you think about like the next five to 10 years, what do you think is gonna be your north star for joyful and for your um customers? Yeah, I mean, I think we're really focused on this notion of like how do we help providers run their businesses? And I think there's so many opportunities within finance. I think we always say that our vision is to be like the financial operating system for healthcare. It is a massive opportunity. I think a lot of that really starts in getting the data piece. I think that for us, the vision is to be the financial operating system for healthcare. I think it is a massive opportunity. And, you know, like I shared earlier, a lot of the existing systems are built to deliver clinical care, but are not built to really help providers manage all of the stuff that happens on the back end. And although right now we've been very laser focused on revenue recovery, that's like one very small slice of this like much, much, much larger pie and this like, you know, huge problem. Um, so that is our kind of longer, longer term vision. And what's cool is like we're already really feeling pulled even further in that direction. Like customers are all asking for like the next set same like set of things. And it's really just like, can we keep up building for them and solving those problems for them? Right. It's such a good problem to have, right? We we know what they want, and yeah, now we just have to build for them. Yeah. The roadmap feels really clear, which is which is exciting. That's awesome. Yeah. And I'm not sure if you remember this because it feels like we've both lived nine lives since I since the council was considering investing in Joyful. But actually, I had heard of you, Eliana, probably several years in advance of us actually investing in Joyful Health. And it was because you were running the Envision Accelerator. So I think uh by our research, like in 2020, you co-founded Envision Accelerator. Not sure if that date's correct, but um you had supported 60 or more underrepresented founders who've raised over 50 million dollars. And I had just heard great things about you throughout the ecosystem from different VCs, from folks on your team, all over the place. And so I'd love to just chat about that briefly. What gap were you trying to fill in the ecosystem? Yeah, I love Envision, very, very near and dear to my heart and definitely inspired a lot of the ways that I've approached like uh building joyful as well. Um, the original story for Envision actually started back when I was at Northeastern because I one of the first nonprofits that I ever started was um a women's entrepreneurship group on campus. Um, when I got there, there really was no diversity in our like entrepreneurial ecosystem. And like I think a lot of the women like really were not coming to different entrepreneurial events. And when kind of asking around on campus, I noticed that's because many of them didn't identify with the word entrepreneurship, which I thought was really interesting. And I think uh didn't feel that they were an entrepreneur or a founder, even though so many of them had nonprofits and blogs and podcasts and all these different types of companies. So I founded WISE uh with a really dear friend of mine named Mia at Northeastern and it grew like wildfire. Like it was like the fastest like product market fit you could imagine. Like it has, you know, like I think 10 different programs now and like thousands and thousands of members and like dozens of companies that have come out of it. And I think a lot of it was just creating a space where people felt safe and could feel like they could identify with starting something. And when I wrapped up wise, you know, as I started to kind of look around more nationwide, like there really weren't that many resources that I could find that were supportive of founders of different backgrounds. And I think everyone throws a stat around a lot with, you know, the 2% of EC funding going to folks of underrepresented backgrounds. And there just weren't really that many resources that I could find. So um Envision, I launched uh during the pandemic with an incredible group of folks that I'm still very close with now. And we we actually had the idea and then launched the first cohort in like three weeks after that, also had like a ton of demand. Um, and we didn't really want to take any equity. We we noticed that like some of the biggest gaps, like why folks from underrepresented backgrounds weren't starting companies, were because they didn't have the funding, they uh didn't have the resources, they didn't have the mentorship or like the network of investors, and they didn't really have anybody that was like truly believing in them. Like they didn't really have that community. So we found that when we actually did all of that and we gave them non-dilutive funding and we built up this like amazing network of investors that were super excited to meet them and we put together like programming and it brought like this amazing community together that there was a lot of magic that would happen and like it was working and people were raising money at the end of it. And I'm still very close with lots of the founders that we worked with, but we ran that for a handful of years, ran a bunch of different cohorts. But yeah, there was a it was a very, very special thing and just once again kind of shows like the power of community. How is that experience of building this community translate to to joyful health? Yeah, I love communities. I think that like communities have been like really having a moment lately over like the last like couple of years, I think like especially during COVID. Um, but I think I've always been very community driven. I think Joyful is a very community-driven company. Like I think our go-to-market is very community driven. I think we build our team and our like relationships with our customers in a very community-driven way. And I think community just like can help in like so many different sectors, especially in a um in an area that feels very isolating, such as like running a business. And I think running a practice is like I said many times before, also like running any other business. Um, and envision, you know, like inspired in many ways, uh, just the idea behind joyful as well. And um, also in terms of like how we approach um kind of like our space and positioning in the market. Today definitely. Um, I think part of it was actually just starting something. Like I think coming up to bat and like feeling really comfortable with ambiguity and feeling comfortable with moving quickly. Like, I think I think all of that is founding experience. I think it's of course different from running a VC-backed business, but it's it's a lot of the same like soft skills. It's a lot of the same like leadership and recruiting a team. And actually, Joyful does a lot of like partnerships now and a lot of events. So uh we actually can we've been running dozens of events in the last like month or two alone. And I think for a lot of other folks, I hear like, how have you done that? Like, we haven't really figured out how to do events. And it's funny because for me, that feels like the most natural thing in the world. It's like we feel really comfortable doing a lot of that stuff. But yeah, I think there's a lot of lessons that came from Envision that are very, very applicable to joyful. I think it was just something else that I had founded. So I feel like it didn't feel super foreign to me when I had gone and done it again. Yeah, and speaking of leadership lessons, is there any like actually from your product days also that has like really guided you as a founder? Yeah, I think my biggest learnings from a product perspective are to really get in the weeds and understand how systems work. I think like this was the benefit of working in so many different, very like complex spaces that were highly regulated and and had a lot of these different like constraints. Like, I think I had to get, I think in every product role I've ever had, a lot of the advice that I had received was like, if you want to like really build something special, like you need to become like a true subject matter expert. It's how you influence without authority. Um, it's how you build something that people really want. So I think that came very naturally to me with Joyful. And I think it's pretty um, I think it's a little different for someone to spend like a year and a half, like literally like trying to become a medical builder. I think usually like the advice that you hear is like pick something and like iterate quickly and like move fast and and break things. And we move insanely fast. Um, uh, but I think we we we've really taken the approach as a company to like go slow to go fast. And I think all of that investment that we really put in at the beginning to like very deeply understanding the problem space led us to approaching the market in a pretty different way than than most people we've seen because we really got to the root of it, which is like the data is a mess. And that is such a hard problem that no one's really been able to solve. And we spent effectively a year and a half just sifting through that problem before we built anything else. And we were still alongside users. You know, the whole time that I was doing that work, I was putting stuff in front of them. I was putting Google Sheets in front of them, I was putting prototypes in front of them. Like the stuff that we're building now is effectively automating a lot of that work that I was doing myself manually for a long time. So it was very worth it. Um, and I'm very lucky that we had such incredible investors in our like first round that really encouraged this. Like every time I sent out an investor of data, I received like, keep going, like this is the right thing to do. Like you're, I know it probably feels really hard, but like stay in the weeds. And I'm so grateful for that because I think it could have gone very differently. And I think we would have been in a very different place now had we not really taken the time to like so deeply understand the customer problem and the constraints that we'd have to be working with, like as we built the company. Yeah. I love that lesson of just like, you know, go slow to go fast. I think that's like it's hard to like really, I think, uh balance that, especially when you feel like maybe other people are going much faster than you. And you know, you being able to stay focused on like, hey, this is the problem to solve and it's complex and we have to really dig deep. Yeah, it's it's great. Yeah. Yeah. And then we know like with the founding journey, every, every single founder we talk to, it's never a linear journey. So is there a mistake you can share with our listeners that you made early on at Joyful Health that ended up making the company stronger? I think we pivoted all the time. Like, I think we actually we fundraised our first, you know, like our pre-seed round around like a completely different idea. It was super, super different. And I think that like we um yeah, and I think like even though we only held on to that for a couple of months, I think we honestly could have pivoted even sooner. I think that's always been my perspective is like we we ran everything in the early days as experiments and as like hypotheses that we had. And um, there's this amazing article from first round uh around this like minimum viable test framework that I really loved and I share with a lot of early stage founders all the time. Like, if you're kind of testing like one thing at a time and going very, very deep on it, I found that to be very helpful. And I think like we it's definitely painful to part ways with like things that you've tried to build. And like uh it's really hard to sit in ambiguity, honestly. I think it feels a lot more comfortable to pick something and like really commit to it. So I'm glad we kind of like stuck in that um like ambiguity for as long as we could to kind of get to that outcome. But yeah, I think we like we pivoted all the time. There's like so many assumptions and things that were just wrong in the early days, and you know, sometimes we thought things were way easier than they actually were going to be. And we had to, you know, change things like pretty frequently. But I think because we were kind of willing to throw out whatever it was that we had and like start over time and time again, like I think that um that has enabled us to, you know, go faster now. Yeah, awesome. Um, and then I guess, you know, you kind of talked about this, but like how do you decide where you want to focus on as a founder when everything feels really urgent? Right. I know you said like right that goes slow to go fast, but yeah, what does that mean for you, like practically? It's something I'm still working on, to be quite honest. I think that I'm a very in the weeds type of person and and type of founder. I think like especially because I have spent so long kind of building up this subject matter expertise. Um, so uh, and and also I think we were just like a two-person team for so long and we've really only started to grow the team pretty recently. So we're still like really in this phase right now of figuring out like how do we truly like divide and conquer. But I think that it's really been about hiring the absolute best people we could possibly find and just getting out of their way. And that's been really helpful. I think recently more and more of my focus has been going towards go to market. And there's been a lot of things that, you know, I've been doing my best to kind of reshuffle around and bring in more support around me so that I can continue to be focused on that. But I definitely do um, you know, play a pretty big role in in product. And of course, time goes to hiring, but it's something that we're still working on as like a, you know, a team that grew from like two to nine in the span of like a couple of months. I'm hearing go slow to go fast as a key theme, like throughout this, even in hiring. I feel like that's something I've noticed as one of your investors is you've kept the bar really, really high. It feels like you've really waited for the right people in most cases, and that's really paid off. So I think that's that's awesome and a good lesson for anybody out there who's just like, I need to close this role immediately. Let me take the first person that comes my way. So yeah. We felt that. We really felt that when as soon as we like closed our most recent round, we were like, oh my God, like we need hands on, we needed hands on deck months ago. Yeah. And we kind of we actually waited longer than I think a lot of people to hire. I think it was like pretty rare for us to go into our like most recent round of financing as like a team of two uh with myself and my co-founder. But we were really intentional about that too. We didn't, we wanted to really de-risk a lot of these open questions that we had around this like fragmented data. And we wanted to feel a very strong pull from the market. So once again, like go slow to go fast, but we definitely felt that sense of urgency once we closed the round and we really needed a lot of hands on deck. And it it definitely took a lot of like soul searching and you know, definitely like some painful lessons. But I think it was it was really worth it to wait. Cause I think, you know, in the end, like the right hire will save you so much time moving forward. So it's like slightly more painful in the interim, but um, I think we were worried like we're removing fast. It's a lot of pain in the end, so yeah. Definitely. Yeah, that's awesome. Yeah. So we're gonna transition to quick hit questions. So these you can just say the first thing that comes to the top of your mind. What's the most underrated skill for a founder? I think stress management is a really important one. Stress management and like be and building like resiliency, like how how do you like take care of yourself first and foremost? I think that kind of gets thrown out the window uh almost always, but no one not that many people talk about it. But I think you know, the way that you take care of yourself really translates to like how you show up for for your team and your company. Totally. What's uh one decision that you were scared to make, but are really glad that you did I think I was, I think uh there was definitely some feeling of like feeling a little bit intimidated around finally picking a direction. I think that we had been very like in like experiment mode for a long time. And I think that there was definitely a little bit of like, oh, we're like really committing to this now. Uh and you know, I think that that was definitely by far the the right move. But I think especially when you've been in just like such a hypothesis-driven mode for a while, I think that that was like a you know, definitely like an interesting transition after being in ambiguity for so long. What's most important? Outworking everyone or timing the market, if you could choose one? That's a great question. I'd say it's probably I think probably like effort, honestly. Because I think like timing matters quite a bit, but I think that the outworking is one part, but I think approach really matters as well. I think like we've always been very like thoughtful around like how we've approached things and like speed definitely matters and like work ethic does as well. But I think part of like outworking people is really getting very, very deep. So I think like that can actually like I think we've been told many times, like it's a crowded space. There's like a lot of people that are out there, like what does that look like? And I think again, like approach to the market matters quite a bit. Yeah, totally. So, what's a book or a concept that's really stayed with you? I've been reading like Radical Candor recently, and that has really stayed with me. I'm still kind of like working my way through it, but very, very much recommend that that um book to folks. And what's a piece of startup advice that you think is total BS? There's a lot of startup advice out there. There is a lot of startup advice. I think some of the like grind against all odds mentality, I think is like is not great. I think like we we we kind of use the phrase a lot, like it's a marathon and not a sprint. And I think like, you know, in order to do big things, you need to have very reliable and consistent output for a very, very long period of time. Um, I think that goes towards like any early team member, but like especially founders. So I think, you know, you've heard me say multiple times like resiliency and like taking care of yourself really matters. But yeah, that's something that like comes to mind. Like you gotta do it in a sustainable way. Awesome. And then last question, and this is more like kind of like three questions in one, but if you had a magic wand, what is one thing that you would fix for yourself, for the healthcare system, and then for the next generation of founders? That's a great question. Yeah, I think for myself, I mean, I think more everyone has probably like more time in the day. I think that would be really nice. That would definitely like that would be helpful. Um, you know, I think that's where like prior prioritization comes from. But like I always wish that I, you know, had a little bit more time. Um I think for the healthcare system, um, I think it's tricky. I think a lot of it's very like incentive driven. I think that's like something that was really interesting for me to learn when I was first like starting to get into the space. Like it's like rare to find a way to approach a problem that actually works within the way that incentives are currently structured. Like you do need to appeal to like all of all of the different stakeholders. So I think like some of the changes are really actually on the incentive side. Um, I think like one thing would be like I would love more transparency in data. Like I would love for there to be more like there is more legislation moving towards like holding payers accountable towards like uh more uh kind of templatized communication with practices and like being a lot more like forthright about sharing the information that in the data that they have. Like that would make everyone's life a lot easier. Some are moving in that direction, but not everybody. There's thousands of pairs. Like that's like a smaller thing to change, but like that would make a very, very, very big difference to practices is just like having pairs be a lot more open about the information that they have. And then for founders generally, um, I mean, I think that there has been a lot of changes in the market, even I think like even since like starting Invision, like there's so many, even like female partners at VC funds, which has been uh so, so awesome to see. Uh, it's like why I've like loved seeing, you know, the council grow. So um, no, I mean, I think I think this is an amazing time for founders. Like, there's so many shifts in technology happening. Like everybody is starting companies left, right, and center. So um, I really think the only thing is just don't be afraid of the hard problems and the messy problems. Like even if they don't seem super sexy at first. I think there's gonna be a lot of really awesome, like generational companies that are built. And I'm hopeful that, you know, if those founders come from backgrounds that look a little bit non-traditional, that they're not overlooked. Yeah, could not agree more. We think that those messy industries are the ones where you can create the most defensibility. So you just have to be willing to go deep, like you have. So yeah, exactly. Your whole fun thesis. Yeah, exactly. Well, Eliana, what's the best way for folks to follow your journey with Joyful Health? And is there anything you want to shamelessly plug? We're hiring, so that's always fun. We have a couple more roles on our team. So if anyone's interested in solving these very messy, thorny problems and working with a very tight-knit team based in New York City, would love to meet them. I think LinkedIn's a great way to get in touch and to stay connected. Um, we've been posting a lot more now that we're like kind of out of stealth. So yeah, hope to keep in touch with everyone there. Well, thank you so much for coming on the show. This has been awesome to go deeper with you for an hour. Yeah. Thank you for having me. This is super fun. I really appreciate the opportunity. Awesome. All right. That was such a great conversation. Amber, what stood out to you from the conversation with Eliana? Yeah, it was awesome. So many things stuck out, but I think one was, you know, she talked a little bit about skepticism in the age of AI. You know, we asked her, are people still skeptical of new healthcare tools? And it was just absolutely yes, and now more than ever. And I've just seen that throughout our portfolio because we invest in healthcare, but we also invest in industrial tech, legal tech, any sort of essential industry that software is being built for. And we're seeing, you know, across the board, everybody's inboxes are inundated with kind of AI slop, whether you're a general consumer or whether you're a customer in one of these nuanced industries. And so the bar is just super high right now to show that yes, this is legit. We have real expertise coming to the table. So I think it's a good lesson for other founders out there that might think, hey, I can just piece this together with a bunch of AI stuff and it'll be fine. Uh, but people are just really skeptical right now, and especially buyers. So just making sure that you're willing to go deep on these things and have that expertise. And then the second thing is, you know, we asked a little bit about her taking on that fractional CFO role before she actually went in and built the product or the platform and and figured out what was worth building and what would she have product market fit with. And it's funny because building a services business in order to build a product platform in the in the past has been very unpopular in the startup and VC ecosystem. Because I think VCs get worried you're gonna stick in that phase forever and you're never gonna build anything venture scale. But she's definitely proven that it works. And now we're starting to hear more in the market about excitement about this model, especially with Palantir, because they kind of took that approach as well with their forward deployed engineers, which are kind of like customer support or customer success agents that go in and figure out what's working, what's not working, and then feed it back into the product. And so I would almost call her like a forward-deployed founder. And I'm seeing more and more of those in small little pockets and especially in our portfolio. It's worked really well. Yeah, definitely. And I think it was cool too that she was like really building out her expertise with actually her and her co-founder going out and getting their certification in medical billing is super complex, but it builds that trust, you know, as they're actually going out and meeting with their different customers and, you know, even just the community beyond the customers as well. Yeah, it just shows like how deep they were really willing to go. And then, you know, from that point of view, also she talked about, you know, going slow to go fast a lot in the podcast too, and just even being willing to sit in those phases of ambiguity where you don't yet know what you're gonna go build and being comfortable with that. Oh, yeah. And then finally, the last point for me was, you know, she talked about workshops and community as a go-to-market tool that she uses as she's growing joyful. And we've seen that in other successful companies like GCAI. But I think the common theme which she didn't mention and might not even realize is that in order to do that, you do have to go deep and have that expertise that people are looking for. In her case, RCM, in Chichilia's case, it's legal expertise. But if Chichilia hadn't been willing to do, you know, 10 to 15 years of, you know, work as a lawyer and a general counsel, she might not be the number one person that people, other lawyers want to come to for workshops. And similarly, Eliana, if she spent hadn't spent 18 months and previously worked at a digital health startup, uh, you know, her customers might not be as keen to come to her workshops and learn all about her product and and what she's building. So I think the community and workshops piece matters, but you have to be willing to really go deep on it and develop expertise in the area. So yeah. Absolutely. And actually when she was even talking about that, like for Joyful Health and the accelerator program that she was running, it reminded me a lot of what we do with the council as well and like what you had really cultivated with all the different community events and building out the council angels as being kind of a an ecosystem and go-to-market engine as well. Yeah, for sure. Rachel, anything else that stuck out to you? The last one um for me was really how she's like really building out for like the market pool as well, talking to the users and ensuring that, like, you know, especially given all of her product management background in various industries, just like really being user focused and being very like clear on what the product roadmap is because of the market pool. Yeah, totally. Well, everyone, thank you so much for listening. And we're gonna link everything that Eliana mentioned in the show notes. And if you want more First Builder stories like this, tune in next week for our next guest. And make sure to subscribe to First Builders wherever you get your podcast and sign up for our newsletter for all the behind the scenes insights and early drops from our guests. Thanks for tuning in, and we'll see you next time on First Builders.