About this episode
Michael Meucci runs Arcadia, the data platform underneath a large share of America's value-based care contracts — aggregating claims and clinical data so risk-bearing providers and payers can actually see the populations they're accountable for.
Value-based care is healthcare's most repeated promise, and its bottleneck is almost never the care model — it's the data layer. This conversation is about that unglamorous plumbing: what it takes to make claims and clinical data usable, and who wins when it finally is.
Michael Meucci is the President and CEO of Arcadia, a data platform for healthcare that has built a business with annual recurring revenue in excess of $100 million. Their customers include organizations like Cleveland Clinic, Ochsner, Cigna, Aetna, the state of California, and Providence — big, scaled, really innovative organizations. But when Michael joined in 2009, Arcadia was a small-to-mid-sized consultancy that partnered with health systems primarily to help them implement electronic medical records. So how did he transform that into a data platform now doing $100 million in ARR?
In this conversation
- How Arcadia went from a mid-sized EHR-implementation consultancy to a $100M+ ARR data platform serving Cleveland Clinic, Ochsner, Cigna and Aetna — by riding the "meaningful use" regulatory tailwind and building the product that let hospitals prove it.
- The counterintuitive sales-hire that fixed a team they'd fired and rebuilt over and over: not a salesperson, but someone to shadow Meucci in the field and turn what worked into the "Arcadia Academy."
- Meucci's core selling move: get so fluent in the buyer's problem that the buyer starts teaching you — "that's when you've won." A concrete value-based-care coding example shows exactly how the dialogue differs from a normal pitch.
- Why relationships are necessary but not sufficient in healthcare — and where the real disruption money is: massive pools of spend on vendors like Optum that customers "begrudgingly buy."
- Micro-tactics for enterprise sales, straight from Jamie Dimon's dinner table: the Sunday avoidance list, the promises note-card, and why you still have to get out of Zoom and into the field.
Transcript AI-generated
In the early days, you were throwing a bunch of stuff against the wall.
We were. I remember we built a product that did real-time monitoring of patient devices in the ICU to provide early alerts. Very cool project, arguably a little bit ahead of its time, and we loved it — but it never got off the ground. What ultimately ended up sticking was accelerated, frankly, by policy. There was a policy in the United States that provided incentives to physicians and hospital systems to implement EHRs.
There was a lot of money on the line for these systems. They wanted to maximize their incentives, and to do that they had to demonstrate they were meaningfully using the technology. There was a set of very structured, data-driven measures you had to report on to maximize your incentives — and the question was how they could then deploy resources to drive performance against those.
So if I have to take away the formula of your first breakaway product, it was essentially: look, here's a regulatory tailwind coming in with this meaningful use stuff. Let's build a product that just solves this problem for healthcare organisations. An easy way for them to have a dashboard, to report that they're reaching this meaningful use set of criteria — and that's at least an incentive for them. Let's just solve that problem and build a product around it. That's basically what you did.
Yeah. And I could simplify it even more: find something that provides value. At the end of the day, there was a regulatory tailwind where performing drove ROI. We built a product where you could sit down in front of the administrator and say, "Today you have limited visibility into how to maximize your incentive. We're going to give you ultimate visibility so you can manage to maximize that incentive." And if you do that, it brings you significant value.
Okay, so hardly rocket science. In 2009, in the United States, as part of the HITECH Act, "meaningful use" is brought in as a policy initiative. It basically says healthcare providers must show Uncle Sam that they're meaningfully and effectively using electronic health record systems — and if they prove this, they receive some kind of financial incentive from the government. Michael's team built the product that helps them prove it. So I asked Michael why healthcare is such a blue-ocean opportunity for any technologist.
There was a really wonderful McKinsey stat that came out a few years ago that ranked industries by their digital maturity. Healthcare in the United States ranked third to last — only ahead of the public sector and the industrial sector. That's kind of damning, to be honest. You have an industry that represents a third of the United States' GDP, that in most markets is the largest employer, and that is responsible for the health of our populace — which becomes a national security issue and has cascading effects on productivity and the overall economy.
When you look at where the bolus of technology innovation has happened globally, it's been in big tech, sexy tech, consumer tech. We all have iPhones or Androids. You have amazing AI, search engine tech, cloud computing — these are all really sexy problems to solve. Moving physicians from paper to an electronic medical record so you can bill claims differently is not the sexiest problem. Because of that, there wasn't always the draw of the smartest technologists into healthcare.
The second problem is that most healthcare organizations operate on really thin margins. Healthcare in the United States is a business — whether people like that or not, that's just a fact. A lot of hospitals operate on operating margins that are sub-5%, and in most businesses that's not a sane, sustainable operating cadence. Because of that, investment is really hard in certain economic periods.
We're in an economic period right now in US healthcare where, coming out of the pandemic, there have been massive increases in human capital costs. We have a huge physician shortage we're wrestling with and an upcoming specialist shortage, and that's driving the cost of labor up. That's putting tremendous pressure on health system, payer and employer P&Ls, because it all cascades upstream and downstream — and it makes it really hard to make huge capital investments.
When I joined the startup world, especially early-stage startups, you're told you either need to learn how to build or how to sell. And as a physician, I didn't know how to do either. So I'm very interested — and selfishly so — to ask: what have you learned about selling to healthcare, both payers and providers? We can start off high-level, but I'd really love you to get granular. Tell me: how do I send the calendar invite? Do I use Zoom or Teams? Get down and dirty into the details.
“When your customer starts teaching you about how their business problem is constructed, because they want you to jump into the trench and solve it with them — that's when you've won.”
Michael
First — I've actually never heard the "as a founder you have to learn how to build or sell" framing, and I love it. I'm going to steal it, because it's true. I'd actually add that in this economy you also have to learn how to finance. That's really selling your vision — it is selling, but there's also an understanding of how it works, because if you partner with the wrong partner it can be really, really detrimental.
Personally, I chose to learn how to sell. In the world of technologists I'm a mediocre-at-best technologist. In the world of sales, I'm a really great seller.
The first thing I think is important: when you're an entrepreneur, you're betting on yourself. There was an inflection point at Arcadia where I approached our then-CEO and said — we raised a bunch of money, a big use of proceeds was to build a sales team, and we'd built one a couple of times. It kept failing. Failure is fine; as an entrepreneur you're going to fail more than you succeed, and you have to learn from it. But what I was observing was that we weren't necessarily learning from those failures. Every time we built a sales team, fired it, and went back to the drawing board, the narrative was always "we hired the wrong people, they said they had connections and they didn't." It was never introspective. It was never, "What are we doing wrong to not enable these salespeople? What are we not doing as a business to help them succeed?" Because ultimately, as leaders, it's our job to enable our teams to be successful.
My inflection point was going to our CEO and saying, "We keep making the same mistake over and over, rebuilding and expecting a different result — that's the definition of insanity. So let's do it differently. Let me build your sales team, and I'm going to start with my first sales hire — who is not a salesperson. It's someone who's going to partner with me and follow me into the field and listen to every word I say to a customer and every word the customer says back. And we're going to build the Arcadia Academy."
That Academy is focused on teaching people what resonates with our customers, what they care about, what their pain points are. So when we hire our first salesperson, we can say: the way you sell our platform is to learn why we're excellent, what problems we solve, and what pain points the customers have. We're not going to teach you how to sell. We're not going to do what IBM and Oracle and Salesforce do, teaching new college grads how to sell. We're going to hire people who already know how to sell, and who know how to sell healthcare. What we're going to teach them is how to sell Arcadia.
What people want is to buy from someone who deeply understands their problem and can jump into the trench to solve it. One of my best customers was the chief operating officer of a big hospital system in Massachusetts — she and I are very good friends to this day. I remember going to her office and she'd say, "Okay, we're entering this new contract, here's how it works," and she'd talk through all the bells and whistles of the alternative payment model contract. I tell our sellers all the time: your goal is to build enough trust with your buyer that they'll share those details — that they view you as a peer and an expert. And the way you test that is to be able to ask them to explain something to you, because it's impossible for a seller to know the buyer's problem as well as the buyer does.
It's your job to reach that relative trust advantage where you can say, "Hold on — I don't actually understand what it means to have a different risk adjustment model, explain that to me," or "Explain how your carve-out with a community partner works." When your customer starts teaching you about how their business problem is constructed, because they want you to jump into the trench and solve it with them — that's when you've won.
That's what we started to build towards: sellers so knowledgeable about the market problem that they could ask their customer to teach them, because there was this exchange of ideas. And in a lot of ways that went back to how we built the company. We built Arcadia by partnering with really smart healthcare leaders who trusted us to solve part of their problem. It created a great collaboration where our product was made better, because you had this continuous loop of feedback — and we were coming to the table with solutions as often as the customer was coming to us with an idea.
Help me understand this. Take an example — you're building an AI that helps physicians with letter writing, documentation, something like that. How might a traditional salesperson talk about it? And then how would someone who'd gone through your academy be different?
“Walk me through your process for charting and coding today. Tell me about the existing programs you have in place to improve coding. Where are the pain points?”
Michael
I'll use an example directly relevant to our business. In value-based care, it's really important to appropriately document patient diagnoses, because it drives your risk adjustment factor. A lot of organizations and vendors focus on helping partners improve their risk adjustment capture. Often that pitch sounds like: "We have a set of coders who'll review your charts, identify misdiagnoses, and provide recoding services or reports. Customers who use our services typically see a recapture rate of X percent, which is Y percent better than the market average, and average risk scores that are X percent higher than their peers." All really important facts — and you'll hear those same facts from our sellers.
What you'll also hear is: "Walk me through your process for charting and coding today. Tell me about the existing programs you have in place to improve coding. Where are the pain points?" And then, "Are you doing a claim hold on all of your Medicare claims?" That sparks a conversation — "Oh, we are" or "We're not, tell me why we should" — and we can offer anecdotes from other customers where that specific workflow change has helped drive code capture improvement.
At the same time you'll ask, "How much of the physician's time is spent on this versus a centralized coding team? Oh — you don't have a centralized coding team? Have you ever considered that this is administratively burdensome for physicians and isn't driving physician satisfaction? Why don't you cordon off a specialized team using our technology to focus on this, giving physicians time back and only querying them when you need clarity on the note?"
It creates a solution-oriented dialog about how you architect — not technically architect, but people-architect — the solution to drive towards the ultimate business outcome. That's where you see a lot of opportunity to have a more educated dialog. It demonstrates to the buyer that you deeply understand not just your own technology, but its deployment inside their ecosystem, and your ability to flex it across a number of different human capital architectures.
Interesting. So you become more of an intellectual sparring partner rather than some greasy salesperson. That's pretty cool. My naive, fresh-eyes take on selling in enterprise healthcare is that it's all about relationships — that's essentially 99% of it. Realistically, there are a lot of products and services that look pretty similar from the buyer's perspective. You might argue "we're different," but really all that matters is building a good relationship. Do that and 95% of it is solved — every roadblock becomes an opportunity, it just greases the pole. Do you generally agree, or do you have a different take?
I don't disagree — relationship is really important, people buy from people they like. I'll go to car sales, because it's a commodity. If you want to buy a Mercedes — I live in Boston, there are like five Mercedes dealerships. Put inventory and colors aside: two dealerships, exact same car, exact same price. You're going to buy from the person who you feel is going to make the transaction easy and be the right partner — because if you drive it for a month and there's a problem, you want to go where you feel they'll take care of you. That's human nature. So relationship is incredibly important in healthcare.
There's another factor that's really important, which is trust. In my realm, we're dealing with an enormous amount of patient information, which is hugely risky. Customers put an enormous amount of trust in us to protect it and act in their best interest. Part of that is the organizational architecture: how do you make sure that when something goes wrong, they're going to pick up the phone and work with you to solve it? We don't always get that right — as CEO, it's one of my biggest areas of focus: how do we be a more accountable partner and solve problems faster and better? That's what people really care about in healthcare, because it's complicated, messy, and not as straightforward as you want it to be.
I do think there's still a place for innovation to be the driver of buying. But there's also the opposite effect — a lot of people buy things from people they don't like, because they kind of have to. It's the only shop in town. And I encourage entrepreneurs who want to get into healthcare tech to study the market: go look at where there are big expenditures on technology or services solutions that people begrudgingly buy. There's a huge opportunity to find massive pools of spend that people have to spend money on but just don't like.
I don't like to pick on any vendor, because this is a hard sector — but Optum has a bunch of technology solutions where, if you could bring an equally capable product set to market at a similar price point, people would love to buy from someone other than Optum, because everyone competes with Optum at this point. So there's a lot of opportunity there to go disrupt existing patterns.
Okay, so we've talked about the high-level architecture. Can you give me some micro-tips on selling in healthcare? I mean really the details — Zoom or Teams, do you send a note after, do you remember the kids' birthdays? Give me some of that, please.
A couple of things. One, my favorite sales book is The Challenger Sale. Have you read it?
No, never heard of it.
“You have to drive value in every interaction. So my micro-tip is, don't just pitch. If you're talking to a customer, give them something of value, even if it's not related to your product.”
Michael
If you send me your address, I'll send you a copy — I'm serious, it's an excellent book. In a nutshell: you have to drive value in every interaction. So my micro-tip is, don't just pitch. If you're talking to a customer, give them something of value, even if it's not related to your product.
I was on the phone the other day with a prospect, right as the 2025 proposed physician fee schedule was released by CMS. This is a 2,200-page policy document that outlines so many aspects of how Medicare payments work — a really stressful document, because it governs how physicians get paid and how accountable care models are deployed. This specific executive had responsibility for their organization's accountable care organization. We were just chatting — about the deal we were trying to do together, his vacation schedule this summer, how busy he is, economic headwinds, a report coming out from CMMI on the efficacy of ACO REACH.
And I said, "I think the new physician fee schedule is really interesting. There are some really challenging things for physicians, but there are some real tailwinds." He said, "Oh, like what?" And I said, "I've got a great summary we've put together, let me send it to you. As it relates to you specifically, I think you should focus on this advanced payment feature of ACOs, because it helps drive cashflow" — which I knew was a problem for his business. He hadn't had a chance to review it. That wasn't an insight I exclusively found — lots of folks who read the fee schedule found it — but he was looking for some good news that day, and that was something we could provide. I sent him a bunch of resources I thought were useful, because he doesn't have time to read a 2,200-page document, and he doesn't have time to figure out which summary is most relevant to him, because it has so many different audiences.
So as you think about every sales interaction: leave something of value. A lot of the cheap tricks sales trainers tell you about — "find a reason, I'm going to be in your neighborhood" — I don't think that works in healthcare enterprise sales. In-person interaction is really important. Find out what conferences people go to, what issues they really care about, and focus the knowledge you impart on those specific areas.
I've also recently been using an AI call recorder — in my case Otter, but there are a whole bunch out there. I really like it because you can go back and refer to the transcript, but it also auto-summarizes your takeaways. And one of the best pieces of advice I've gotten recently came from a very cool dinner I was invited to. Jamie Dimon, CEO of JP Morgan Chase, does these regional dinners — very small, like 15 people, typically for their banking customers. I was invited as part of a healthcare Boston dinner he did. He had two pieces of advice I really loved and have integrated into my work.
Every Sunday, he writes down a list of the things he's avoiding doing, and he resolves to get them done by Wednesday. I love that, because as a leader you're always avoiding something — making a hard phone call, terminating an employee, writing a proposal. There's always something you're putting off. By putting it on paper and physically manifesting it, saying "I'm going to cross this off by Wednesday," you're managing yourself.
The other thing he does is carry a note card in his pocket. On one side, all the things people have promised him; on the other, all the things he's promised people. So he's constantly working that balance. What I like about the AI copilot is that it's actually keeping track of it — "Michael, you said you're going to send this thing, or connect this person with that person." So as I think about that roster of promises, I have an accountability matrix.
From a sales perspective, I love Zoom and these AI copilots, because they help make you more efficient at keeping your promises — and as a seller, it's important to keep your promises. That said, in-person interaction is really important. Coming out of the pandemic, one of my biggest challenges is that we've all gotten very comfortable being remote and virtual. On one hand, I love hanging out at home; I love that I'm not on a plane every day like I used to be. At the same time, I'm really encouraging my teams to get back out there in the field, spend time with customers, and listen to them. Because the challenge with virtual is that it boxes you in.
You have an hour slot on the calendar, people are a few minutes late and drop a few minutes early, and the organic relationship-building isn't happening the way it used to. It's important to be able to say, "Let's go have lunch, let's have a drink, let's go to dinner" — organic time where you can talk about families and kids and sports and hobbies and really get to know who you're selling to. I think about some of our customer relationships that started during the pandemic — you miss that human interaction. You're in battle together, and you need to know who your partner is in that battle. When you're not getting to know people as people, it becomes too transactional. So my other big tip: get to know your customer, your peer, your prospect. You kind of can't do it totally virtually, especially in enterprise sales.
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