By helping hundreds of hospitals like HCA Healthcare hire nurses faster and with less aggravation, Iman Abuzeid has built the rare VC-backed startup that’s already profitable. It likely won’t be long before it becomes a unicorn.
Iman Abuzeid walked into the Andreessen Horowitz annual barbecue in the summer of 2019 with two term sheets from other VC firms already in hand, but she was determined to leave with a third. The cofounder and CEO of Incredible Health was sure she wanted a16z managing partner Jeff Jordan, the former CEO of online restaurant reservation marketplace OpenTable and senior vice president at eBay, to help grow her nurse-hiring startup.
What she didn’t realize is that she would not only land a key investor that night but also one of her company’s marquee customers. Amid the endless trays of hamburgers and ribs at the home of Ben and Felicia Horowitz, Abuzeid, 36, walked past Tina Knowles (Beyoncé’s mom) and CBS anchor Gayle King, and honed in on Bernard Tyson, the late CEO of Kaiser Permanente. Abuzeid says she started the conversation with Tyson the same way she does with all hospital executives she’s pitching. “We’re in a huge nursing shortage,” she tells them. “I’m guessing your units are understaffed, and they don’t have enough nurses?”
Within a month of that barbecue, San Francisco-based Incredible Health, which Abuzeid cofounded with chief technology officer Rome Portlock, 41, had landed Jordan’s firm as the lead investor of its $15 million Series A round. Soon after, it also had inked a deal to work with Kaiser, which encompasses 39 hospitals and is now one of her company’s biggest customers.
To help hospitals find nurses, San Francisco-based Incredible Health flips traditional hiring on its head with hospital customers essentially paying to pitch themselves to nurses who join for free. “The biggest challenge now is chasing the demand for nurses,” says Jordan, who sits on Incredible Health’s board.
Since its 2017 launch in California, more than 500 hospitals have signed up for Incredible Health, including HCA Healthcare and Stanford Health Care, in addition to Kaiser. The company focuses on filling permanent jobs, rather than short-term travel nursing or contract gigs. Hospital customers pay for annual subscriptions with tiered pricing, based on the number of nurses they plan to hire. Revenue is expected to reach $16 million this year, triple last year’s $5 million. That growth helped Incredible Health gain a spot on this year’s Next Billion-Dollar Startups list, one of 25 companies we think most likely to reach a $1 billion valuation.
Unlike most venture-backed startups, Incredible Health is profitable—“accidentally profitable,” as Abuzeid likes to say. Each state has its own rules on healthcare licensing, making expansion slower in this business than it would be in a less regulated one, and Incredible Health is careful to line up enough employers and nurses to make the marketplace work in each state before moving on to the next one. That slow-and-steady strategy has helped the company move into 21 states profitably, and Abuzeid plans to go national in 2022.
Nurses are just a starting point, Abuzeid explains, with the long-term goal to be the “market leading company in healthcare labor.” The company is looking to expand to customers beyond hospitals in the future to urgent care, surgical centers, skilled nursing facilities and home health. Abuzeid expects the company might eventually serve doctors, physical therapists and pharmacists.
“I wanted to build and create things that would have an impact on a large scale. Not just one-on-one with patients.”
The U.S. Bureau of Labor Statistics projects that healthcare and social assistance will “add the most jobs of all industry sectors”—around 3.3 million over the next ten years—as aging Baby Boomers need more care and the number of Americans with chronic conditions continues to rise. Rather than be a one-off solution for job-seekers, Incredible Health is taking a page from LinkedIn, which Microsoft bought for $26 billion in 2016, by creating a social network of nurses and building tools like salary estimators and free continuing education credits. Abuzeid says there are hundreds of thousands of nurses on the platform and hospitals have made thousands of hires (she declined to give specific numbers). The average salary for a registered nurse in the U.S. is around $90,000 (though there is significant regional variation). Nurses who use Incredible Health get a 17% salary bump on average when switching jobs, says Abuzeid. “It enables us to not just be the place where a nurse—and eventually every healthcare worker—finds his or her job,” she says, “but it’s also the place where they manage their career.”https://embedly.forbes.com/widgets/media.html?src=https%3A%2F%2Fe.infogram.com%2Faff4c3da-198c-4df7-b243-cdeca107ebe4%3Fsrc%3Dembed&display_name=Infogram&url=https%3A%2F%2Finfogram.com%2Fbar-1h8n6m3n0p9oz4x&key=cfc0fb0733504c77aa4a6ac07caaffc7&type=text%2Fhtml&schema=infogram
Abuzeid was born to Sudanese parents in Saudi Arabia, where her father, an ear, nose and throat surgeon, had taken a job. While her grandfathers in Sudan had started businesses in transportation, agriculture and real estate, her two older brothers became doctors like their father. One brother is an ear, nose and throat surgeon in Seattle, while the other is a trauma surgeon outside of Atlanta. Abuzeid started down the same path, getting her undergraduate and medical degrees from University College London. But it was her grandfathers’ influence that gave her the courage to leave the daily practice of medicine. “It made me very comfortable with risk,” she recalls.
At age 24, Abuzeid skipped her medical residency program in the U.K. and moved to the U.S. for a job in healthcare consulting. It was the start of a decade-long journey to becoming her own boss. “I wanted to build and create things that would have an impact on a large scale,” she says. “Not just one-on-one with patients.”
Coming Up Short
Even before the pandemic, some states were facing shortfalls of registered nurses. These six states will have the biggest gaps by 2030.
In 2009, she joined Booz & Co. in New York City, consulting on hospital operations and strategy. She then got her M.B.A. at Wharton and landed as a product manager at San Francisco-based digital healthcare startup AliveCor, which was developing a personal heart-monitoring device connected to a smartphone. That’s where she met cofounder Portlock. An MIT graduate with a degree in computer science, Portlock had previously worked for Linden Lab (creators of the video game Second Life) and EventBrite before becoming one of the first engineering hires at AliveCor. After two years of working together, the duo struck out on their own. “I knew [Iman’s] the kind of person that will make things happen and get things done,” says Portlock.
In 2015, they started working on Lift League, customer-retention software for small and medium-size healthcare companies, which was accepted into an accelerator program run by venture firm NFX. But after multiple strategy sessions trying to figure out how to grow it, they scrapped the concept. For their second venture, Abuzeid and Portlock decided to apply the concept of Hired.com, originally a recruitment tool for software engineers, to healthcare. “That was where we saw the model of employers applying [for] the talent,” says Abuzeid. Many hospitals were still stuck in the dark ages, pushing paper and taking months to hire nurses and other staff, even as healthcare spending was closing in on 18% of U.S. GDP, while tech hovered around 10%.
Portlock’s sister, brother-in-law and sister-in-law were all nurses, so they vetted the idea with family before floating it by potential hospital customers. In January 2017, with less than two months to go until the NFX Demo Day, they hunkered down, with Portlock writing code and Abuzeid cold-calling hospitals and shaping the business plan. Portlock was also juggling a newborn baby. He now counts the age of the company—four years—by the age of his first child. By March, Incredible Health was in contract discussions with HCA Healthcare, one of the largest hospital systems in the country. The first check (which is framed on the wall of the company’s office in San Francisco) arrived a few weeks later, as did a $2.4 million seed investment led by James Joaquin at Obvious Ventures.
When the pandemic hit in March 2020 and cases overwhelmed hospital ICUs, hospitals were focused more on surviving than hiring. Now ,18 months later, hospitals are contending with a different challenge: staff burnout. David Jones, chief human resources officer at Stanford Health Care, says the number of nurses taking leaves of absence from the health system has increased 312% over the past year due to pandemic-related burnout and stress. As the demand for nurses increases, job-seekers have more power in the face of growing shortages, he adds. This means employers who make the first offer are most likely to seal the deal. “Speed is right now probably the most important variable in how nurses decide where they want to work if they’ve got multiple opportunities,” says Jones. Even before the pandemic, California was predicted to have a shortage of 44,500 nurses by 2030, according to federal estimates. Incredible Health’s software, Jones says, “has really helped us get in line first and be able to present our opportunities and to try to close the deals much more quickly.”
Incredible Health estimates the average hospital customer can save at least $2 million that would otherwise go to traveling nurses, HR or other administrative costs. (Neither Stanford nor Kaiser would confirm the financial payoff of their deals with Incredible Health.)
For job-seekers, it’s also a much faster, more transparent system. Shenita Anderson, an ER nurse, says she had multiple job offers within two weeks of building what she calls her “power profile” on Incredible Health. She accepted two in Los Angeles: a full-time gig at Cedars-Sinai and a per-diem opportunity at Glendale Adventist. Compared with filling out tons of online applications to never hear back, Incredible Health’s process was not only easier, but let her know where she stood because she could see which recruiters were looking at her profile. “[It] took some of that angst out of the equation,” says Anderson, who is now pursuing a doctorate in nursing at UCLA, where she is researching how to help African American smokers quit, while also working full time.
For Abuzeid, the success of Anderson and other nurses is personal. After all, the odds were stacked against her—on paper, at least. “Raising money as a Black female founder is, of course, challenging. The statistics are kind of stacked against you in many ways,” says Abuzeid, who points out that just 1% of VC money goes to Black founders and even less to Black female founders. Knowing the chances, she sought mentors and applied her skills at fundraising. It worked out for her in an industry dominated by white men—and she hopes the same is true for the tens of thousands of nurses her company seeks to empower. “You just have to go for it,” says Abuzeid. “You just have to be as assertive as you can be.”
By Katie Jennings, Forbes Staff