#1569Harry Stebbings@HARRYSTEBBINGSI have interviewed 1,000s of the world's best founders over the past decade. Few have impressed me like @ShivdevRao at @AbridgeHQ.
He navigated a brutal 5-year wilderness before exploding into one of the most dominant forces in vertical AI.
Today, Abridge is a $5.3BN powerhouse.
I sat down with Shiv to unpack exactly how he did it and condensed my notes below:
🚀 6 Lessons on Building a $5.3B Vertical AI Juggernaut
1. Survive Long Enough for Market Timing to Catch Up:
Abridge spent 5 years in the "wilderness" before hitting a tidal wave of adoption. When you have an absolute true north thesis, your primary job in the early days is simple: stay standing and don’t die. You must be alive when the sky finally opens up.
2. Pivot the Product, Never the Core Thesis:
Shiv was willing to pivot on features, go-to-market strategies, and business models. But he refused to budge on his core thesis that healthcare is ultimately powered by the spoken human signal. Die on the hill of your thesis; adapt everything else.
3. Target the Concentration of Scale Early:
A massive trap for healthcare and enterprise founders is staying down-market too long for "fast feedback loops". In the US, the vast majority of clinicians are concentrated within large, integrated delivery networks. Time your "YOLO shot" to go up-market the moment the market inflects.
Single biggest advice to founders on when to go up market @bhalligan @dharmesh?
4. Own Your Stack to Protect Your P&L and UX:
While many AI startups rely entirely on frontier systems, 40% of Abridge's model outputs are generated by in-house models. Milliseconds matter in high-stakes enterprise workflows. Building your own models gives you insane performance gains, lower latency, and ultimate control over your P&L.
When should you vs should you not build your own model @matanSF @MaxJunestrand @antonosika?
5. Don't Fight Foundation Models—Counter-Position Instead
If you try to fight the frontier model giants directly, you've already lost. You win by going millions of miles deep into regulated industries with proprietary datasets and workflows they can't easily replicate. Find ways to coexist and leverage their tailwinds.
Reminds me of what @bradlightcap said on his 20VC.
6. Move Toward the "Flat Company" Era:
With the explosion of AI agents and advanced tooling, the traditional management layer is compressing. Shiv’s latest idealistic shift is building a hyper-flat organization: fewer managers, and highly leverageable "Super ICs" who can move in lockstep and cover massive surface area.
(link in comments)
Youtube: https://www.youtube.com/watch?v=byZkrYBF-N0
Spotify: https://open.spotify.com/episode/0YGvcQY3nHkTO7lTHlvbC7?si=kMP2jdq8ReC9c7CbEnuBEg
Harry Stebbings@HarryStebbingsI have interviewed 1,000s of the world's best founders over the past decade. Few have impressed me like @ShivdevRao at @AbridgeHQ. He navigated a brutal 5-year wilderness before exploding into one of the most dominant forces in vertical AI. Today, Abridge is a $5.3BN powerhouse. I sat down with Shiv to unpack exactly how he did it and condensed my notes below: 🚀 6 Lessons on Building a $5.3B Vertical AI Juggernaut 1. Survive Long Enough for Market Timing to Catch Up: Abridge spent 5 years in the "wilderness" before hitting a tidal wave of adoption. When you have an absolute true north thesis, your primary job in the early days is simple: stay standing and don’t die. You must be alive when the sky finally opens up. 2. Pivot the Product, Never the Core Thesis: Shiv was willing to pivot on features, go-to-market strategies, and business models. But he refused to budge on his core thesis that healthcare is ultimately powered by the spoken human signal. Die on the hill of your thesis; adapt everything else. 3. Target the Concentration of Scale Early: A massive trap for healthcare and enterprise founders is staying down-market too long for "fast feedback loops". In the US, the vast majority of clinicians are concentrated within large, integrated delivery networks. Time your "YOLO shot" to go up-market the moment the market inflects. Single biggest advice to founders on when to go up market @bhalligan @dharmesh? 4. Own Your Stack to Protect Your P&L and UX: While many AI startups rely entirely on frontier systems, 40% of Abridge's model outputs are generated by in-house models. Milliseconds matter in high-stakes enterprise workflows. Building your own models gives you insane performance gains, lower latency, and ultimate control over your P&L. When should you vs should you not build your own model @matanSF @MaxJunestrand @antonosika? 5. Don't Fight Foundation Models—Counter-Position Instead If you try to fight the frontier model giants directly, you've already lost. You win by going millions of miles deep into regulated industries with proprietary datasets and workflows they can't easily replicate. Find ways to coexist and leverage their tailwinds. Reminds me of what @bradlightcap said on his 20VC. 6. Move Toward the "Flat Company" Era: With the explosion of AI agents and advanced tooling, the traditional management layer is compressing. Shiv’s latest idealistic shift is building a hyper-flat organization: fewer managers, and highly leverageable "Super ICs" who can move in lockstep and cover massive surface area. (link in comments)
#1569Harry Stebbings@HARRYSTEBBINGSDid USV liking music make them billions of dollars?
"Our Seed was $5M on a $15M pre, not the world we live in right now, but it made sense then.
There is founder-market fit, but there’s also founder-partner fit, when you have chemistry and know you’re going to work together.
From the first meeting, I knew I wanted to work with them." @ShivdevRao
What single investor meeting do you remember most where you left knowing you would work with them @LuisvonAhn @grinich @matanSF @samir_vasavada
Harry Stebbings@HarryStebbingsI have interviewed 1,000s of the world's best founders over the past decade. Few have impressed me like @ShivdevRao at @AbridgeHQ. He navigated a brutal 5-year wilderness before exploding into one of the most dominant forces in vertical AI. Today, Abridge is a $5.3BN powerhouse. I sat down with Shiv to unpack exactly how he did it and condensed my notes below: 🚀 6 Lessons on Building a $5.3B Vertical AI Juggernaut 1. Survive Long Enough for Market Timing to Catch Up: Abridge spent 5 years in the "wilderness" before hitting a tidal wave of adoption. When you have an absolute true north thesis, your primary job in the early days is simple: stay standing and don’t die. You must be alive when the sky finally opens up. 2. Pivot the Product, Never the Core Thesis: Shiv was willing to pivot on features, go-to-market strategies, and business models. But he refused to budge on his core thesis that healthcare is ultimately powered by the spoken human signal. Die on the hill of your thesis; adapt everything else. 3. Target the Concentration of Scale Early: A massive trap for healthcare and enterprise founders is staying down-market too long for "fast feedback loops". In the US, the vast majority of clinicians are concentrated within large, integrated delivery networks. Time your "YOLO shot" to go up-market the moment the market inflects. Single biggest advice to founders on when to go up market @bhalligan @dharmesh? 4. Own Your Stack to Protect Your P&L and UX: While many AI startups rely entirely on frontier systems, 40% of Abridge's model outputs are generated by in-house models. Milliseconds matter in high-stakes enterprise workflows. Building your own models gives you insane performance gains, lower latency, and ultimate control over your P&L. When should you vs should you not build your own model @matanSF @MaxJunestrand @antonosika? 5. Don't Fight Foundation Models—Counter-Position Instead If you try to fight the frontier model giants directly, you've already lost. You win by going millions of miles deep into regulated industries with proprietary datasets and workflows they can't easily replicate. Find ways to coexist and leverage their tailwinds. Reminds me of what @bradlightcap said on his 20VC. 6. Move Toward the "Flat Company" Era: With the explosion of AI agents and advanced tooling, the traditional management layer is compressing. Shiv’s latest idealistic shift is building a hyper-flat organization: fewer managers, and highly leverageable "Super ICs" who can move in lockstep and cover massive surface area. (link in comments)
#1569Harry Stebbings@HARRYSTEBBINGSYou just have to survive long enough to not die
"You have to have a true north, a thesis about the market that you know is going to come true, even if you don’t know when.
You live in anticipation that the moment will come, and that belief gives you resilience.
You just need to stay standing, you just need to not die, you just need to be there when it happens." @ShivdevRao
What do you know now about product market fit that you wish you had known when you started @rsms @raunofreiberg @jsngr @artman @lil_dill
Harry Stebbings@HarryStebbingsI have interviewed 1,000s of the world's best founders over the past decade. Few have impressed me like @ShivdevRao at @AbridgeHQ. He navigated a brutal 5-year wilderness before exploding into one of the most dominant forces in vertical AI. Today, Abridge is a $5.3BN powerhouse. I sat down with Shiv to unpack exactly how he did it and condensed my notes below: 🚀 6 Lessons on Building a $5.3B Vertical AI Juggernaut 1. Survive Long Enough for Market Timing to Catch Up: Abridge spent 5 years in the "wilderness" before hitting a tidal wave of adoption. When you have an absolute true north thesis, your primary job in the early days is simple: stay standing and don’t die. You must be alive when the sky finally opens up. 2. Pivot the Product, Never the Core Thesis: Shiv was willing to pivot on features, go-to-market strategies, and business models. But he refused to budge on his core thesis that healthcare is ultimately powered by the spoken human signal. Die on the hill of your thesis; adapt everything else. 3. Target the Concentration of Scale Early: A massive trap for healthcare and enterprise founders is staying down-market too long for "fast feedback loops". In the US, the vast majority of clinicians are concentrated within large, integrated delivery networks. Time your "YOLO shot" to go up-market the moment the market inflects. Single biggest advice to founders on when to go up market @bhalligan @dharmesh? 4. Own Your Stack to Protect Your P&L and UX: While many AI startups rely entirely on frontier systems, 40% of Abridge's model outputs are generated by in-house models. Milliseconds matter in high-stakes enterprise workflows. Building your own models gives you insane performance gains, lower latency, and ultimate control over your P&L. When should you vs should you not build your own model @matanSF @MaxJunestrand @antonosika? 5. Don't Fight Foundation Models—Counter-Position Instead If you try to fight the frontier model giants directly, you've already lost. You win by going millions of miles deep into regulated industries with proprietary datasets and workflows they can't easily replicate. Find ways to coexist and leverage their tailwinds. Reminds me of what @bradlightcap said on his 20VC. 6. Move Toward the "Flat Company" Era: With the explosion of AI agents and advanced tooling, the traditional management layer is compressing. Shiv’s latest idealistic shift is building a hyper-flat organization: fewer managers, and highly leverageable "Super ICs" who can move in lockstep and cover massive surface area. (link in comments)
#1569Harry Stebbings@HARRYSTEBBINGSHow do you know as a startup if the foundation models are going to kill you or help you
"If you are fighting against the foundation models, you’ve already lost.
If you haven’t figured out how to win with them and leverage the tailwinds they create, then you’re screwed.
The vertical AI companies with the most upside are the ones that reach down the stack and control their own destiny." @ShivdevRao
Do you agree with this @sama @bhalligan @destraynor @matansf
Harry Stebbings@HarryStebbingsI have interviewed 1,000s of the world's best founders over the past decade. Few have impressed me like @ShivdevRao at @AbridgeHQ. He navigated a brutal 5-year wilderness before exploding into one of the most dominant forces in vertical AI. Today, Abridge is a $5.3BN powerhouse. I sat down with Shiv to unpack exactly how he did it and condensed my notes below: 🚀 6 Lessons on Building a $5.3B Vertical AI Juggernaut 1. Survive Long Enough for Market Timing to Catch Up: Abridge spent 5 years in the "wilderness" before hitting a tidal wave of adoption. When you have an absolute true north thesis, your primary job in the early days is simple: stay standing and don’t die. You must be alive when the sky finally opens up. 2. Pivot the Product, Never the Core Thesis: Shiv was willing to pivot on features, go-to-market strategies, and business models. But he refused to budge on his core thesis that healthcare is ultimately powered by the spoken human signal. Die on the hill of your thesis; adapt everything else. 3. Target the Concentration of Scale Early: A massive trap for healthcare and enterprise founders is staying down-market too long for "fast feedback loops". In the US, the vast majority of clinicians are concentrated within large, integrated delivery networks. Time your "YOLO shot" to go up-market the moment the market inflects. Single biggest advice to founders on when to go up market @bhalligan @dharmesh? 4. Own Your Stack to Protect Your P&L and UX: While many AI startups rely entirely on frontier systems, 40% of Abridge's model outputs are generated by in-house models. Milliseconds matter in high-stakes enterprise workflows. Building your own models gives you insane performance gains, lower latency, and ultimate control over your P&L. When should you vs should you not build your own model @matanSF @MaxJunestrand @antonosika? 5. Don't Fight Foundation Models—Counter-Position Instead If you try to fight the frontier model giants directly, you've already lost. You win by going millions of miles deep into regulated industries with proprietary datasets and workflows they can't easily replicate. Find ways to coexist and leverage their tailwinds. Reminds me of what @bradlightcap said on his 20VC. 6. Move Toward the "Flat Company" Era: With the explosion of AI agents and advanced tooling, the traditional management layer is compressing. Shiv’s latest idealistic shift is building a hyper-flat organization: fewer managers, and highly leverageable "Super ICs" who can move in lockstep and cover massive surface area. (link in comments)
#1569Harry Stebbings@HARRYSTEBBINGSThe three variants of an AI native company
"There is 3 variants of AI native companies: post-transformer pre-LLM, post-LLM pre-agent, and post-agent.
Depending on your vintage, you have to become the latest variant as fast as you possibly can.
That means your product, and the way you organize and operate your company, has to evolve significantly." @ShivdevRao
Love to hear your thoughts on this categorisation and how you see it @mmurph @AnjneyMidha @annbordetsky
Harry Stebbings@HarryStebbingsI have interviewed 1,000s of the world's best founders over the past decade. Few have impressed me like @ShivdevRao at @AbridgeHQ. He navigated a brutal 5-year wilderness before exploding into one of the most dominant forces in vertical AI. Today, Abridge is a $5.3BN powerhouse. I sat down with Shiv to unpack exactly how he did it and condensed my notes below: 🚀 6 Lessons on Building a $5.3B Vertical AI Juggernaut 1. Survive Long Enough for Market Timing to Catch Up: Abridge spent 5 years in the "wilderness" before hitting a tidal wave of adoption. When you have an absolute true north thesis, your primary job in the early days is simple: stay standing and don’t die. You must be alive when the sky finally opens up. 2. Pivot the Product, Never the Core Thesis: Shiv was willing to pivot on features, go-to-market strategies, and business models. But he refused to budge on his core thesis that healthcare is ultimately powered by the spoken human signal. Die on the hill of your thesis; adapt everything else. 3. Target the Concentration of Scale Early: A massive trap for healthcare and enterprise founders is staying down-market too long for "fast feedback loops". In the US, the vast majority of clinicians are concentrated within large, integrated delivery networks. Time your "YOLO shot" to go up-market the moment the market inflects. Single biggest advice to founders on when to go up market @bhalligan @dharmesh? 4. Own Your Stack to Protect Your P&L and UX: While many AI startups rely entirely on frontier systems, 40% of Abridge's model outputs are generated by in-house models. Milliseconds matter in high-stakes enterprise workflows. Building your own models gives you insane performance gains, lower latency, and ultimate control over your P&L. When should you vs should you not build your own model @matanSF @MaxJunestrand @antonosika? 5. Don't Fight Foundation Models—Counter-Position Instead If you try to fight the frontier model giants directly, you've already lost. You win by going millions of miles deep into regulated industries with proprietary datasets and workflows they can't easily replicate. Find ways to coexist and leverage their tailwinds. Reminds me of what @bradlightcap said on his 20VC. 6. Move Toward the "Flat Company" Era: With the explosion of AI agents and advanced tooling, the traditional management layer is compressing. Shiv’s latest idealistic shift is building a hyper-flat organization: fewer managers, and highly leverageable "Super ICs" who can move in lockstep and cover massive surface area. (link in comments)