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Q&A with Founder and CEO Dunston Almeida
triValence recently celebrated its one-year anniversary. In this Q&A, triValence Founder and CEO Dunston Almeida reflects on the company’s launch and successful first year and discusses what he envisions for the future of triValence.
Dunston Almeida: triValence was incorporated in mid-September 2021. Our venture capital backers said I should be excited because I was now officially a “founder,” and I’m thinking to myself that I have nothing except an idea and a laptop!
Once I received the funding, then came the next big challenge: How do I get started? Even in January of this year, it was still unclear how we could build a product in fewer than six months, go to market, and convince what has traditionally been a very risk-averse, conservative healthcare industry to embrace this new solution. But we knew what the first step needed to be: assembling the right team. We knew we needed to find enough people with backgrounds in healthcare and technology and financial services and technology, including experience with payments. We knew we would need to convince these people to change their career plans or quit great jobs at great companies to join us. We couldn’t do any building until then.
The first person who came aboard was Steve Smerz, our chief technology officer. That was huge for us. He has nearly 40 years of IT experience and has built and sold five healthcare IT companies. We convinced him to hold off on retiring. I told him there was one more cool thing he needed to do before he could call it a career — and that cool thing would change the world. That got him on board fast!
So much of the early part of 2022 was focused on team building. In addition to Steve, we brought on people like Brian Giessler, who was at Johns Hopkins and is our senior vice president of operations, and Piper Su, who came to us from leadership roles at the Mayo Clinic and Advisory Board/Optum. Piper is our head of strategy and business development operations. We’ve also brought impressive professionals in from places like the Hospital for Special Surgery, Premier, University of Pittsburgh Medical Center — you name a great healthcare company, chances are we have somebody who’s worked there and left a very nice job to come here.
Everyone on the triValence team is based in the United States. That was a conscious decision. We knew there was no way we could build a great healthcare business without having everybody in the company understand the fragility of the U.S. healthcare system. An offshore person will just have a hard time understanding the frustration of experiencing healthcare here.
The months leading up to the Ambulatory Surgery Center Association’s (ASCA) 2022 annual meeting in late April were all about hiring people who were passionate about what we envisioned and wanted to create a solution that would be dramatically different than what was currently available. Our original mission — which hasn’t changed — is all about how we can help ambulatory surgery centers (ASCs) and providers do better with less and how we can simplify their lives.
By the time the ASCA meeting rolled around, we had the core underpinnings of the product team. We were starting to scope out the solution. We were getting initial feedback from ASCs on what we were envisioning and built on that during the ASCA meeting where we had the opportunity to meet with many more ASC leaders. We were also receiving great insight from ASC industry veterans.
DA: It’s mid-spring, and we’re still very early on in the product cycle. But not long after, we signed up our first pilot customer. It’s a national pediatric surgery center chain. They’ve been instrumental in providing feedback — telling us what works and what other features would be helpful. The organization was using paper and credit cards for its payments when we brought them on board. This was one of many aha moments for us: If a leading national chain that’s growing fast and has numerous sites is using paper and credit cards, can imagine what other organizations are doing? We knew what we were building would be a difference-maker for ASCs big and small.
We spent the summer finishing hiring our team. We now have about 40 employees, of which I’d say about 80% are in our product development or technology divisions. Our team is very heavily focused on building an amazing product that’s simple, powerful, and easy to use. We set out to apply what we know about the online consumer process we now take for granted and bring that knowledge and experience over to the ASC space. Whether you shop at Amazon.com, the Gap, or so many other e-commerce stores, it’s easy to find and purchase what you want. The challenge for us was: How do you carry over that simplicity to the very complex healthcare B2B purchasing environment?
We didn’t take much time off this summer. People were working nights and weekends, and this effort paid off when we officially launched the platform on Labor Day. The procurement side came together smoothly, as did the payments part of the solution. The payments component was definitely more involved because when you’re dealing with payments, you need to address financial services regulations. Healthcare is already heavily regulated. When you add financial services on top of it, then you need to deal with all the banking regulations around transferring money, security, compliance, PCI standards, bad debt, checking accounts, interchange fees — the list goes on. There’s a whole universe of things you must ensure you do well and are in compliance with state and federal financial laws. Kudos to our team for getting that facet of the platform to work so well.
DA: We announced the launch and worked to gauge the broader level of interest in our solution. A big development came when we were introduced to a large ASC in the Mid-Atlantic. The CEO of the surgery center came from a big health system where he had managed supply chain. Over the past few years, that ASC had been working to implement a supply chain and procurement platform but had encountered ongoing challenges with implementation and getting the data the center needed to optimize its supply chain and expense management. He said it took less time to install a huge electronic health record (EHR) system.
When he learned about triValence and our vision, he said that if our platform could combine purchasing, payment/cash flow information, and data, he’d essentially make triValence the ASC’s “central nervous system” that controlled everything for all the ASC’s sites. That was another aha moment for us. We didn’t realize that even an organization as sophisticated as this ASC that has successfully installed a complex EHR would have such a disjointed, fractured process for managing what is clearly a mission-critical item: materials for their surgeries. After all, you can’t do procedures if you don’t have the supplies.
This ASC made the decision to move on from its existing platform and bring us on board for all their sites. The center also wanted triValence to manage all its non-purchase order (PO) spend. This was another aha moment for us. The experience we had with this ASC showed us how much of a need there was for what we had built and were still building. We were finding that what ASCs were trying to use to manage their procurement and payments was even messier than we thought.
We know these processes don’t need to be difficult. Consider financial B2B platforms such as Ramp, Coupa, and Concur. They’re cloud-based expense management accounts companies. They go to small and large businesses and offer them a single portal to manage all their spend as an alternative to trying to juggle multiple credit cards and checking accounts. These companies entice businesses of all sizes by offering the ability to manage advertising and marketing, real estate bills, credit card spend, and essentially any other expense through a single portal.
These companies have been growing fast because, unlike traditional expense management platforms, they make everything very simple and make users feel powerful. That’s what we’re largely working to recreate in triValence. It’s about getting visibility into your supply chain and procurement, being able to truly manage your spend, and getting a dashboard that clearly tells you your center’s story. Not surprisingly, our biggest audience has been chief financial officers or members of ASC administration tasked with financial responsibilities who want the ability to ask their supply chain and materials managers about what’s happening with everything the ASC needs to purchase. This is extremely important for ASCs since these expenses usually represent 25-30% of their entire cost base and are the biggest single expense outside of labor.
In addition, CEOs, like the one I mentioned earlier, or those in similar positions want financial controls and benchmarking capabilities. They want to know their ASC has good data on their costs, including cost per case and costs associated with specific surgeons and specialties, so the data can guide smarter decisions.
We have used all the feedback and insight we’ve received to continue to expand the platform without deviating from our mission of helping ASCs do better with less and simplifying their lives. The triValence platform can now help ASCs manage not just their supply chain and PO spend but their non-supply chain spend as well. That includes utility bills, contractors, consultants, the list goes on — essentially everything else except for payroll and real estate. Building this expanded functionality was a logical progression. If the dashboard can tell administration and leadership how much they’re paying for implants, IVs, tissues, and screws, we figured it might as well tell them about their other accounts payable. This is yet another example of how we’re working to simplify the lives of ASCs.
It’s been exciting to see our product progression and the amount of interest it’s generating. The good news is there’s a tremendous amount of interest in the platform. The question for us is how do we get in front of the right opportunities and make sure we can satisfy that interest?
One of the ways we’re hoping to achieve this goal is by launching a free version. This is designed for the smallest ASCs — those using paper that can’t afford a more robust solution but want something easy to use yet powerful that can make a big difference in their procurement and payments. This 100% free version automates supply chain, finance, and data operations. The version doesn’t have all the functionality that a larger ASC may want, such as integration with an existing EHR, but it will be enough for these small ASCs to better manage their spend and gain the visibility and data they need to achieve big improvements in these areas. All in all, these are really exciting times for us.
DA: Our roadmap for the new year is very simple. There are two major parts to our equation. On one hand, we’ve got the demand side of the equation, which is ASCs. We want to build up awareness of and excitement around the solution and its different versions, whether it’s a free product, enterprise product, or something in between. On the other hand, we have the suppliers and distributors. That’s a separate challenge as they are dealing with a very inefficient process in doing three-way or four-way match for invoicing and accounts receivable as they work to connect to these thousands of ASCs.
As we go into 2023, we’re focused on two things. Let’s make sure we have as many ASCs as possible using the solution. This means they’re buying as much as possible electronically through the solution and digitizing their end of the equation. On the supplier side, we want to build as many connections to them as possible. Right now, suppliers are generally using electronic data interchange (EDI) for purchase orders, invoices, and other aspects of transactions with their ASC clients. But EDI is a slow, clunky mechanism. It’s going to take time to transition towards a true modern mechanism that creates an experience like the way you transfer money from your bank account to your credit card account. That happens seamlessly. How do we make that seamless transaction happen using the supplier’s infrastructure? It won’t happen overnight. Our goal on the supply-distributor side is to build “pipes” with these companies and make sure we can process all the information flow to their ASCs. To get these companies engaged, we must make sure suppliers, distributors, and manufacturers are getting enough value by aggregating all this data on our pipe that connects what I call a “superhighway” between suppliers, distributors, and manufacturers with ASCs and providers.
If I had to look into a crystal ball and predict where we’ll be a year from now, I’d say we’ll have a lot of surgery centers using the free product and probably 3-4 times as many enterprise customers as we have today. The ASCs using the free product will be completing transactions and further simplifying their operations. The ASCs on the enterprise solution will be buying hundreds of millions of dollars of surgical and non-surgical items.
Then there’s the so-called “payments/fintech” piece. We’ve built this amazing “healthcare rail” connecting everybody. It’s part of the underlying infrastructure of the solution and it’s processing hundreds of millions of transactions in real time. All users can see in real time what’s happening to their orders, data, invoices, POs, and shipping, and they’re able to make smarter decisions based on that information. Within the triValence platform, there are widgets you can move around so you can see at any given time what’s outstanding, overdue, and due in the next few days. Ideally, this dashboard will become the control center for ASCs nationwide.
Those are our goals: end 2023 with a lot of connectivity and a lot of transactional volume that’s digitized. We hope we can get to a point where we can say we save ASCs and the supply chain system a substantial amount of money in administrative costs and free up significant time for surgery centers so they can put even more of their energy into delivering an exceptional surgical experience. This would represent a level of achievement for our mission to make life better, simpler, and faster for the ASC industry.
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