DGTL Voices | Xinan Rahman | What You Should Have Been Paid

You know, the average profit margin of health systems is just slightly over 0%.

With regards to underpayments and contracts specifically, health systems lose 1 to 3% annually on underpayments specifically. What I found from talking to folks, it's not that staff aren't competent. Staff in revenue cycle, they're extremely competent. Really, the challenge is the volume of underpayments that happen. The gap really is having technology that allows you to catch that underpayment, we're able to identify, hey, like, was this the right amount according to the contract that should have been paid? Welcome to Digital Voices, where healthcare and life science leaders explore the real work behind transformation. This podcast is about people, leadership, and the conversations that move healthcare forward. Now your host, Ed Marx.

Welcome to another edition of Digital Voices. Thank you for tuning in and listening and watching. We are at our 3 millionth download. Super excited. I know that you have a lot of choices in what you watch, listen to, and you've chosen Digital Voices, and we will make it worth your while. So today I have my friend Zeenand Rahman. She's the CEO founder of Cezara Health. Zeenand, welcome to Digital Voices.

Yeah, thank you for having me. It's great to be here.

No, it's really great because I love founder stories, people who are really trying to make a difference. And it's always interesting to hear about your journeys because other people inside of healthcare, they may have the same sort of desire to do what you've done and do something transformative. And they're always like, wow, I wonder how that person did it. I wonder what they're like. And, you know, is that something that I can do? You first came to me, the, your name, because I heard from other people some of the great work that you're doing. And I'm like, I got to meet this person. And hear more about it. So we connected and had some lengthy conversations, Azina. But the most important thing that we probably talk about in our podcast is what's on your playlist? What songs do you like to listen to?

Yeah, no, that's a great question. So for me, it's a variety, honestly. I think I have a very diverse taste. And nowadays, generally, I'm listening to a lot of nostalgic music. So for me, nostalgic Uh, you know, like any— anything from, uh, '90s, uh, or '80s rock to, uh, you know, I actually watched The Greatest Showman recently for the first time a few months ago, and that playlist has been on repeat for me. So, uh, songs like A Million Dreams and then Tightrope by Michelle Williams. I also just, uh, really admire, uh, Hugh Jackman as a vocalist as well as an actor. So yeah, that's one playlist that's been on repeat for me.

Yeah, that's very cool. I like that. What about life message and mantra? Is there words that you live by, some words or phrases that kind of guide your life?

Just keep going and have fun. One thing I've learned throughout the experiences I've had is that, you know, like everyone says that life is just Ups and downs, and you just have to keep going. So that's something I personally being honest with yourself, especially about what you want. Because I think for a lot of people, if you're really ambitious about what you want to achieve and you have a high bar for yourself, sometimes you can sort of forget about what you personally are honestly feeling like and how that relates to what you want to achieve. So yeah, I think. Honesty with yourself, most importantly, and then just keep going and have fun.

Yeah, no, I like that. Those are good words to live by. So you got the coolest name of anyone ever on the podcast before. And it's spelled, for those who don't know, it's spelled X-I-N-A-N. That is so cool. It's like, I wish I had a name like that. So tell us your story. Like, where are you from and how'd you get to where you are today?

Well, I'll start with the story of my name. So I'm originally from Bangladesh and I grew up in Bangladesh. And my dad, you know, he's the type of person, and I get a little bit of this from him. He likes doing things that he perceives as other people thinking to be unique. So that came with how he named me and my sister. So Zinan is in Arabic. It's an Arabic name. And technically, like phonetically, it should be spelled with a a Z. But my dad, he was like, my kids, they're going to be special, unique, whatever. So that's where he decided, okay, I'm going to just spell it with an X. And here we are. My sister's name is Zahra, actually, and her name's also spelled with an X. My dad, he was an entrepreneur as well. So he grew up in rural Bangladesh. He was the youngest son of 7 kids, I believe. And my dad, he was, you know, whenever I catch up with my uncles, cousins from my dad's side of the family, they told me that he was the type of kid growing up where, you know, my paternal grandparents, they didn't do very well growing up. So my dad, you know, he was very studious and he would cry all the time when my grandparents unfortunately couldn't afford all of the books that he wanted for So he did very well academically, got scholarships to go down into the city. He was also very entrepreneurial. He encountered tragedy quite early. His dad, my paternal grandfather, passed away when he was a junior in university. And so since he was one of the first to go to university out of his family, he sort of had the pressure to provide for the 7 other kids. Started a business in Bangladesh doing garments and clothing. That's the equivalent of the dot-com boom in Bangladesh a few decades ago. Yeah, I think for him, education was always a priority. So that's something he prioritized with me and my sister and I. And I think throughout my childhood, expectations were always pretty high and the bar was pretty high. in terms of what he expected that his kids would achieve, both academically and beyond. So I would say I had a good childhood in the sense that I think I really got the ambition that I have from my dad and how he sort of raised us. And I had a great time. I went to an international school in Bangladesh, grew up with folks from all over the world. Funnily enough, there's actually a Korean diaspora in Bangladesh. So a lot of my best friends growing up are Korean. Yeah, I had a great time. I came to the US when I was 18 for university. So I went to Johns Hopkins. That was also some of the best years of my life so far. In college, I knew I wanted to do something entrepreneurial down the line. I didn't really know when. In terms of academics, I was interested in both the humanities and mathematics growing up, but then I also got a little bit of practicality from my dad. And in my head, I was like, okay, if I want to build something, build a company down the line, I should just study computer science because, hey, what better way to learn how to—

do things.

You know, had the privilege of working at both startups and then big tech companies. Working at big tech companies, I sort of realized, okay, I definitely want to go the smaller company route, at least at the beginning. And coming out of college, one sort of pivotal moment in my life, I think, was the decision to start a company with 3 of my buddies from college. We were in, you know, similar organizations and were very good friends. All of us wanted to start a company someday. We were talking to a friend of ours who worked at Deloitte and did enterprise software implementations, and he was complaining about how implementations took so long. It, you know, like it takes years for the average Epic implementation to go live, right? So That's where we sort of stumbled into the world of implementation. And we realized, talking to a bunch of leaders at system integrators, that this takes really a really long time, and there's this opportunity for AI and agents to come in and really accelerate the timeline for software implementations. So we started that company, went through Y Combinator, scaled it to 40 or so people in a couple of years. And yeah, we were backed by Sequoia at our seed and then RA. And I can definitely go into specifics, but it was a great ride. Like, I had a great time. And I think some of the implementations that our customers did were actually healthcare specific implementations. So that's sort of where I got to see on the ground level some of the problems that led me to this company. Yeah.

Before we go there, what about your sisters? Did they make it? Did they come to the United States as well, or did they stay back in Beirut? They came over as well? Yeah.

Very cool.

And yeah, that's an awesome story, you know, how your parents, you know, gave you that bought all of your sisters and yourself that opportunity to do well. And then when you were working with your last company, I'm just curious, like, as just like a general example, so if a typical, let's just say Epic implementation might take 18 months, what would be like, would you cut it in half by 25%? I'm just curious.

Yeah.

Because I think when people hear that story, they're probably like, oh, what? That's pretty interesting.

Yeah, totally. So across our customers, what we would see is that, you know, like our wedge into sort of the implementate— end-to-end implementation process was the requirements gathering piece, which is, you know, anywhere between the first 3 to 6 months of an implementation. And what we would see is using our platform where we would consolidate all historical data of past implementations, the current state, of the software that's being implemented, the business processes, etc., we'd see over a 50% increase, in some cases up to 70%, 80%, in terms of the amount of time that went in.

Yeah, because, you know, I just have to smile because of how many implementations I've been through in my career, and it's always this cookie-cutter approach. And people just tell you, and you accept it as gospel, hey, it's going to take 6 months for this, 6 months for this. And pretty soon, like the 18 months, it's like, how in the world can anything take that long? So I was like, man, where were you when I was doing all these implementations? I'm, I'm, I'm kind of upset now. But that, yeah. So how long were you there creating the company? And then when you exited, how long was that period?

Yeah. Yeah. So that was a, a few years. So, um, I would say just about 2 years, uh, there. And yeah, I think we had the luck and privilege of growing really fast. I think what happened was that the problem that we were solving around implementations taking so long and system integrators, your Deloitte or your mid-market Epic partner, for example, they were feeling a little bit of an existential sort of feel with AI. Implementations, the status quo is time and materials.

Yeah.

But now AI comes along, Palantir is already doing outcome-based, and it's like, wow, our entire business is about to change and we need to get ahead. So that sort of existential feeling, I think, really allowed us to come in and provide value to our customers quickly. And yeah, like we grew to, you know, we're pushing 40 people right now and Uh, on my end, you know, um, the 4 founders and I, like all of us were technical, so we did both engineering and, uh, sales. And then I realized, wow, like go-to-market is something I enjoy. Went there, uh, scaled the team a bit, and then I switched to post-sales. So, uh, being in the trenches of doing our own implementations for our customers to ultimately help them.

So, Yeah.

Yeah, it was a great experience. Uh, you know, just learning how to, uh, manage your team as we're growing so fast, hiring great folks from, uh, places like Palantir and other companies.

So, all right, so this all led you into healthcare because you got this exposure on these, you know, cutting these implementation times way down, and then you started Cezara. So tell us the origin story. Like, how did this start? Like, you were seeing— I'm guessing that you were seeing these critical issues with underpayments that is happening in healthcare.

It's actually a series of moments that led me to really gaining conviction around this problem area of underpayments and just healthcare billing as a whole. Some of that came from the experience I had at Okta talking to other founder friends and executives in healthcare while I was there. And the other piece is, I remember while I was in college reading my EOBs for when I hurt my knee. I was a bit confused. I remember I was looking at the final bill and the final bill, even though my net patient responsibility was the same according to my insurance policy, the amount that the insurer apparently reimbursed was lower than what the health system or healthcare provider had charged. Now, you know, in some cases the bill charges are obviously different from the contracted rate in some cases. Moments like those made me continuously extremely curious, and I started talking with executives and leaders in the space, and I sort of realized that, hey, with regards to underpayments and contracts specifically, health systems lose 1 to 3% annually on underpayments specifically. Yeah. And yeah, like the status quo, the current macro environment with the rate of denials just increasing. What I found from talking to folks was that it's not that staff aren't competent. Staff in revenue cycle, they're extremely competent. They're very hard workers. The really the challenge is the volume of underpayments that happen. And the gap really is having technology that allows you to catch that underpayment, not 6 months after the fact when you're— when you finally have the downtime to review, but instantly, right? So going to Cezara, what we do is we unify all contracts, contracts that might sit in Epic, it might be in SharePoint, it might be somewhere else. We unify that and then we look at all of the remittances as they come in. So 835s. And we're able to identify instantly, hey, like, was this the right amount according to the contract that should have been paid? So that's sort of what we do in terms of the outcomes that we offer. We are with partners that we work with. What we're sort of able to do since we've rebuilt the infrastructure from the ground up to do this, we're able to identify over 90% of Valid underpayments, so over 90% of that 1 to 3% benchmark. And of that 90%, we're able to recover over 70%, and that's just in the pilot. So if we scope it to a specific service line, and long term, we run a program to sort of transform that and get to 100%, because ideally these are just contracted rates. You should be able to know as Uh, remittance comes in, hey, how much should I have been paid? And run a recovery workflow autonomously.

Yeah, that, that's amazing. Almost too good to be true, uh, sort of thing. Because as we know in healthcare right now, and we are recording in fall of 2026, you know, the average profit margin of health systems is just slightly over 0%, like, like a half percent profit margin. Obviously there's some that do. much better, 5 to 10%, but they're in the minority. And there's many that run under zero, right? They're in the rear. And so you would immediately be able to bring them up quite substantially. So it's pretty amazing. What are you most excited about? So there's this big launch event, right? Tell us about what's happening here in early October.

Yeah, totally. So we are doing a launch. Some of our investors, early investors, including Y Combinator, they will launching us in the coming week or so. So we're very excited about that. We're very excited. To this date, we've been pretty quote unquote stealthy, like, you know, working with our early partners, et cetera. But we're excited to sort of finally unveil the work that we've been doing. And it'll be good. It'll be good. I'm just really excited to show everyone what we've been working on.

No, it is really exciting. Like I said, I mean, I work with health systems all the time and it's just a struggle financially and kind of losing the, you know, if we called it AI wars with payers, kind of losing a little bit. And I think this is something that'll help definitely equalize things, if not give providers, you know, a little bit more of an offensive weapon to make sure they're getting paid what they're supposed to get paid. So for those watching visually, I am recording from my home. And so one of our dogs just jumped on our lap. So if you're watching visually, that's what you see. She decided to make a cameo. So the other thing, what I found super interesting is tell us the name. Like, how did you come up with the name for your company?

For me, I really like having some sort of implied meaning or some sort of hidden meaning whenever I, like, with regards to names especially. Cesara is actually a reference to Caesarea Mazaca, which is an ancient Byzantine city in present-day Turkey. So it was Cappadocia back then. And that's where, back in the day, Saint Basil of Caesarea, he founded the first sort of health system ever. So that's where the name comes from.

Yeah. No, I love it. Again, it goes back, I think, part of what your father gave to you in terms of uniqueness, right? And thinking of something. What comes after? I know you mentioned the focus right now is recovery on underpayments, which is something happening at 1 to 3%. What else is on the roadmap? So let's just say you have a health system client, they're doing really good thanks to your system. What's next? What can they expect next? What else are you going to attack?

Yeah, totally. So in terms of what we offer, an interesting place to start is the contracts themselves, right? These contracts, they sort of govern the payments and money that flows through between a health system and a payer. And here, what we're really trying to do is sort of transform the entire process. So we Eventually get to that end state of, hey, when a patient comes in, we're able to sort of as quickly as possible understand, hey, like for these procedures, this is the right amount that should be paid and it's a seamless process. So to sort of get there, the next few things that we offer are, you know, not only underpayments, but going upstream into pre-billing denials, et cetera. But also more downstream. So, you know, when you're able to accurately identify, hey, this is the right amount to be paid, giving patient cost estimates are seamless as well. You're able to give a more effective and accurate good faith estimate there as well.

You're hitting the most painful parts first, which I think is very clever. Tell us about your go-to-market strategy. What sort of unique propositions might you have?

Yeah, totally. So for us, I think one thing that's interesting is we are outcome-based, which isn't a new model, but specifically for the pilots that we do with our customers, we offer an at-risk model. So what does that mean? So that means that You know, like if we don't hit the metrics that we align on, whatever that may be, if the health system does not have dollars recovered or dollars identified to that aligned metric that we set, you know, for us, we don't, we don't make any money ourselves.

Yeah.

So the reason we do this is twofold. One, one, I think We're able to do this because we're confident in, uh, you know, the value that we offer. And then 2, it's also just to, you know, at its core, align our incentives with our, uh, partners, uh, the health system. So, uh, one thing that I've learned from starting my first company is it's always about your partners and the value you deliver, uh, to them. So that's something that is just in the DNA of this company as well.

Zinan, you're a super successful founder. We already talked about your first company where you exited after a couple years, and now you started this new company. What are some of the keys, do you think, to your success?

Yeah, that's a good question. I personally think there's still a very long way to go, but I would say being able to surround myself with sort of people who had similar interests and ambitions. I think being in an environment that's conducive to growing and constantly having a bar that's set is very helpful. I think even at, you know, when starting my first company, like one thing that, one quote that I heard from someone that I think rings really true is that you should work with people Even if they're your direct reports or your reports' reports, you should work with people that make you feel a little uncomfortable in the sense that you, in the sense that you just think that they're really, really good because that kind of pushes you to raise your bar as well.

Yeah.

So that's something there. I think the other thing is just surrounding yourself with people who believe in you, who believe in your ambitions. Like obviously, you know, the more support you have, the more conducive it is to Achieving goals that you may have.

Yeah, it makes total sense. And speaking of which, is there one particular person in your journey that helped you see who you could be? Like, because, you know, it takes a little bit of moxie to do everything that you've done already. Who's that person that maybe like gave you the most juice to help you, you know, go the places that you've gone?

Obviously, you know, the sort of expectations that my parents set For me growing up, like that, that sort of helped me have like really high ambition. I think, I think in terms of, in terms of starting my companies, it was definitely like our early investors. So, you know, from, from our first ever angel investor who invested in our first company 2 weeks into founding, I think he was just amazing. Like in terms of the support, he offered. And then Y Combinator, obviously, they're early investors in so many great companies, but my partner there, he's just been amazing too from a company standpoint. And then lastly, it's just all my friends, college to professionally. I think just the people around me have been great to continuously push myself.

No, I love that. This has been a great conversation. We We talked, you know, from your unique name to growing up in Bangladesh, and then songs on your playlist. Like, we're going to add Greatest Showman, the movie soundtrack, to our Spotify playlist for Digital Voices. We talked about your life message mantra about keep going, having fun, and being honest with yourself. And again, yeah, just your very unique background. And then we talked about really both your companies that you've already, that you started, exited one, started the new one with Cesare and all the great things that you'll be able to do helping kind of struggling hospitals become more profitable in a right way. And we talk a lot about leadership, like what helped you become the leader you are. And some of the things that you talked about was like work with people, but not exactly like you, right? That challenge you. And then people who've helped you and you had a whole list of people, including your parents, of course, and early investors. What did I miss? Or is there anything you want to double down on? I'll give you the last word.

I think, uh, I think that was, uh, pretty good. Yeah, we covered, uh, most things there.

Yeah. No, hey, it was great having you on Digital Voices, and I, I know Cezaro will be hugely successful. You're hitting a pain point that everyone struggles with, and, uh, and I know based on your credibility from your, from your last company and your successful exit that there's no doubt that you'll hit it out of the park with, uh, with this company as well. So thank you for being our guest.

Thank you for having me. Thank you for listening to Digital Voices. We hope today's conversation sparked ideas, reflection, and connection.

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