Clinicians are stepping into the entrepreneurial spotlight as AI transforms healthcare at breakneck speed—with rapid buy-in happening across the industry and providers leading the way, experimenting and implementing AI across multiple use cases. Consider SmarterDx: in just a few years, this healthcare AI rocketship has redefined how hospitals analyze patient records to unlock new revenue, elevate care quality, and streamline operations.
“SmarterDx is an AI rocketship in healthcare.”
The journey of Dr. Mike Gao (CEO) and Dr. Joshua Geleris (Chief Product and Data Science Officer), SmarterDx’s co-founders, was anything but straightforward. Rising from frontline medicine to industry leaders meant navigating clinical demands, pandemic turbulence, and the notoriously tough healthcare sales cycle. Their perseverance paid off, culminating in SmarterDx’s rapid ascent and recent acquisition by New Mountain Capital.
Mike and Josh’s shared experience as practicing physicians exposed them to the systemic revenue leaks and documentation gaps plaguing hospitals. This clinical credibility empowered them to design AI that integrates seamlessly into hospital workflows—delivering value without disruption.
We sat down with Mike and Josh to distill their hard-earned lessons for the next generation of healthcare AI founders. Their first piece of advice? “Don’t start a company during a global pandemic,” Josh quipped.
As we looked back on Bessemer’s relationship with SmarterDx since our Series A investment, the founders unpacked how to navigate the eccentricities of healthcare, build enduring co-founder relationships, and master founder-led sales while scaling with discipline.
The SmarterDx story is a blueprint for clinicians and technologists alike who are ready to build the future of healthcare—one patient record at a time.
Takeaways on scaling a healthcare AI company from SmarterDX
- Listening to customers drives product evolution
- Maintaining patience and persistence is crucial with longer sales cycles
- Founders need to lead the charge in early-stage sales
- Talent is everything—focus on hiring quality
Innovating in healthcare AI with clinical expertise and customer care
Mike and Josh first crossed paths during their residency at NewYork-Presbyterian, quickly discovering a powerful combination: Mike’s healthcare systems acumen and customer empathy paired with Josh’s technical problem-solving and product vision as they frequently worked together on hospital digital transformation and artificial intelligence innovation efforts. Together, they forged a partnership grounded in mutual respect and a shared conviction that supercharging patient care is possible through smarter, more efficient hospital systems.
At Bessemer, we saw the duo brought not only deep domain expertise and technical fluency to SmarterDx, but also a rare persistence and grit—traits we see in the very best founders and frontline clinicians. As Josh put it, “Mike has a talent for delivering a level of white glove service to customers I’ve never seen before. I’m still in awe of how he can instantly understand what they need and ensure we deliver on that promise.” Mike, in turn, admires Josh’s long-term product vision and technical depth: “Josh doesn’t just optimize for the short term—and he can architect an entire data pipeline for client onboarding, a level of engineering skill that’s incredibly rare among physicians.”
Their experience offers a lesson for co-founders everywhere. Early on, Mike and Josh recognized the importance of owning distinct parts of the business. They naturally gravitated toward a division of labor: Mike as the external-facing “white glove” customer partner and sales lead, and Josh as the internal anchor for product, operations, and technical support. The key to their success has been complementary skills, deep mutual trust, and a willingness to stay hands-on across functions—setting the standards and ensuring quality as the company scaled at warp speed.
SmarterDX’s response to COVID: Lessons in resilience for startups
In their industry, every startup faces long sales cycles, fragmented buyers, and deceptively narrow markets—but a global pandemic forced Mike and Josh to rethink momentum from the ground up.
“In the early days, we saw immediate traction—two out of our first three hospitals wanted to move forward,” Mike recalled. “Then COVID hit, and a Chief Medical Officer told us, ‘I have to deal with this coronavirus. Can I get back to you in a couple weeks?’ That hospital became a customer three years later—a stark reminder of how much this industry is at the mercy of macro events and just how drawn-out sales cycles can be.”
Of course, a few weeks became months with COVID, and so did the potential customer conversations. Even after the initial crisis, hospitals remained unstable and hesitant to engage with new vendors, leaving Mike and Josh in a year-and-a-half holding pattern. They returned to serve as hospitalists, waiting patiently until the market was ready to re-engage.
This experience highlights a core founder principle: master the rhythm of when to push, when to pause, and the patience required to build trust in healthcare. Customer relationships were the engine of innovation—nuanced feedback from early partners drove product pivots and go-to-market refinement. Their adaptability, relentless customer focus, and knowing how to weather slow periods and seize momentum when it returns set SmarterDx apart and fueled their breakout growth.
Founder-led sales for early-stage success
Winning in healthcare starts with founders driving early sales to uncover real product-market fit. SmarterDx’s team discovered that selling directly to customers revealed what resonated—and what didn’t.
“Early on, we pitched a concurrent CDI solution, but customer feedback pushed us to pivot to post-discharge analysis, focusing only on net-new findings,” shared Mike on developing their SmarterPrebill™ solution. “We learned that offering too many options confused buyers; simplifying our pitch to a single, clear value proposition was the breakthrough.”
But the real test? When you can run a clear-cut, 20-minute call that consistently lands—only then is your sales message ready to scale beyond the founders.
As Josh put it, “In healthcare, you only get a handful of shots with potential customers, and each conversation yields just a sliver of feedback—maybe one or two questions. But those questions are gold. Mike excelled at obsessively analyzing every customer query, connecting insights across months, and refining both pitch and product. If we’d just kept selling what we thought was best, we’d have missed our breakthrough. By triangulating these subtle signals, we discovered the core product and go-to-market engine that fueled our growth.”
Three rules for founder-led sales:
- Treat every customer conversation as a learning opportunity.
- Obsessively analyze every question or objection to refine your pitch and product.
- Don’t scale sales until you have a repeatable, teachable motion that lands.
What the SmarterDx founders wish they knew at the early stage
As our conversation wrapped up, Josh shared a moment of vulnerability:
“On a podcast, I was listening to Jensen Huang from NVIDIA, and when asked what kind of company he’d start today, he said, ‘I wouldn’t do it. It’s too hard.’ I nearly cried walking my dog—it resonated so deeply. Building a company is one of the hardest things you’ll ever do. My advice: be prepared, go all in, and know it’s not for the faint of heart.”
From their trials, Mike and Josh distilled these essential lessons for early-stage founders:
- Listening to customers drives product evolution: Actively listen to your customers and use their feedback to refine your product and value proposition, especially during longer sales cycles.
- Maintaining patience and persistence is crucial with longer sales cycles: Recognize the inflection point. In healthcare, product-market fit is often hindered by long sales cycles. But when growth accelerates, founders must adapt quickly or risk being outpaced by demand. Hypergrowth—like scaling 600% a year—means even rapid hiring can’t keep up.
- Founders need to lead the charge in early-stage sales: Before product-market fit, stay scrappy, do everything yourself, and iterate fast. Once you hit product-market fit, shift gears—resource aggressively to capture the market. Don’t underinvest when the signal is clear.
- Talent is everything—focus on hiring quality: Maintain a relentless focus on hiring quality, even when you’re understaffed. The long-term payoff of a high-talent bar far outweighs the temptation to hire quickly just to fill seats.
SmarterDx’s journey from early stage to acquisition is a case study in the power of “compounding learning”—years of domain immersion and customer discovery create an unshakeable foundation for scale. Mike and Josh’s unwavering focus on solving real problems, listening to customers, and executing with discipline turned SmarterDx into one of healthcare AI’s standout successes. We’re so grateful to them both for letting Bessemer be part of their exceptional journey.