17: Matilde Giglio's Journey in Founding Even and Solving Healthcare for 1.4 Billion People in India
Matilde unveils her entrepreneurial journey, highlighting Even's impact on the Indian healthcare market, while also offering valuable insights into navigating challenges as a founder.
📝 Words: 2,053 | 🕰️ Estimated Reading time: about 10 mins
Hey Kula Readers,
This week we are bringing you the story of Matilde Giglio, an inspiring Italian entrepreneur who is based in Bangalore since 2021. She is the co-founder of Even, an healthcare startup that is redifining how more than 1.4 bn people have access to healthcare in India.
Continue reading to uncover how Matilde's startup is pushing boundaries in the Indian healthcare market, how she come up with the idea to address this pressing issue, and the key strategies driving successful execution.
Key Highlights
🏥 Medical Access & Insurance in India: Only 37% of the Indian population has health insurance, leaving a significant portion vulnerable to financial strain due to medical expenses. The health insurance market in India is valued at around $12 billion and continues to grow annually. The government has launched favorable initiatives to improve the situation, such as allowing 100% Foreign Direct Investment (FDI) in healthcare and mandating companies to provide health insurance to their employees.
🌟 Matilde’s Story: After her initial entrepreneurial venture and working in venture capital, Matilde served as Head of Digital for Rahul Gandhi's political campaign in India. This role gave her deep insights into the country's healthcare challenges, inspiring her to address the lack of access to medical care.
🚀 Rapid Growth and Impact: Even is a healthcare company with an insurance business model that provides consultations, tests, and diagnostics through their in-house doctors and partner clinics and hospitals. The company has grown impressively, achieving $12 million in revenue in 2023, with a client base of over 60,000 and a 97% retention rate.
🔑 Keys to Success: Even's success is driven by its strong team and strategic partnerships. The team includes experts with extensive experience in the healthcare and insurance sectors, while partnerships with clinics, hospitals, and insurance companies enhance service delivery and operational efficiency.
Matilde’s Entrepreneurial Story: From Compass News to Revolutionizing Healthcare in India with Even
Originally from Rome, Matilde Giglio completed her studies at LUISS in Rome and the London School of Economics.
Immediately after graduation, she embarked on her first entrepreneurial journey by founding Compass News, a journalism startup based on machine learning aimed at becoming the “Spotify” of journalism. Despite her success in assembling an exceptional team, securing partnerships with prestigious outlets like the Financial Times and The Economist, and raising £1.5 million from UK and US VCs, including Bloomberg, they eventually had to cease operations due to the inability to achieve product-market fit.
Afterwards, she joined the Venture Capital Fund Hambro Perks as the Head of Healthcare and Fintech. She was the youngest partner at the firm and carried out several investments. However, after only two years, her entrepreneurial spirit reignited, and Matilde felt the urge to create another company.
In the meantime, she was offered a role in Rahul Gandhi's political campaign as Head of Digital for the Congress Party. She managed a team of over 100 people and a $60 million communication budget. Reflecting on this experience, she said:
"We built an electoral campaign from scratch. In those six months, it was like getting a master's in India and its problems. I understood the needs of the people. The two most important ones: are jobs and access to medical care. We forget how lucky we are in Italy with public healthcare. In India, everyone pays out of pocket.” - Matilde Giglio
During this experience, Matilde realized the severe issue of access to medical care in India. Most people do not have insurance coverage, and existing insurance products are restrictive and not consumer-friendly.
Her driven spirit did not allow her to ignore this problem. Instead, she felt compelled to solve it and tap into this huge market.
Thus, Matilde founded Even with the mission to solve the medical access problem in India. Matilde emphasizes the importance of her co-founders, stating that without their complementary skills, she would not have been able to build Even.
In the picture, Matilde is with her two co-founders Mayank Banerjee and Alessandro Davide Ialongo.
Funny story, Mayank was one of Matilde’s co-founders at Compass news and Alessandro was her classmate in middle school and immediatley left his job at Google and moved to India when Matilde called him and proposed him to build Even.
Let’s dive deep more into Even!
Only 37% of the Indian Population is covered by health insurance
Access to healthcare in India faces significant challenges, particularly in rural areas. The diverse population of India has challenges with receiving comprehensive and accessible healthcare. Regional differences, inadequate infrastructure, a lack of qualified workers, and cultural issues all have an impact on how easily accessible healthcare is in India. (source)
The health insurance market in India is valued around $ 12Bn and grows year after year. There is a massive potential of growth, as there was for China some years ago, Matilde told us.
In the fiscal year of 2023, over 550 million people across India were covered under health insurance. Of these, the highest number of people were insured under government-sponsored health insurance schemes, while individual insurance plans had the lowest number of people.
500 millions may seem a lot, not in a country where the population is close to 1.4 billion!!
The problem becomes more evident in rural areas where communities suffer from a severe shortage of access to healthcare services. Patients often have to travel long distances of up to 100 km to reach facilities. There is a significant shortage of qualified medical personnel in rural areas. Nearly 90% of the population lacks health insurance coverage.
Most healthcare costs are paid out-of-pocket or through loans, creating a major economic burden. According to the World Health Organization’s list of “countries with highest OOP expenditure on health,” India ranks third in the region of Southeast Asia. In India, OOP expenses account for about 62.6% of total health expenditure – one of the highest in the world”. More than 50 millions Indians get dragged into poverty every year to cover medical bills
We launched Even to solve this huge problem and revolutionize the way Indians access the basic healthcare treatments. Even offers 360-degree assistance in India, a huge country where public healthcare is almost completely absent, and everyone has to pay for medical expenses. - Matilde Giglio
The Indian goverment realization of the healthcare crisis in India
The Indian Government increasingly supports certain sectors, including healthcare. If you operate in these fields, you benefit from this support. Examples include:
Mandatory Health Insurance: In 2020, the Insurance Regulatory and Development Authority of India (IRDAI) introduced regulations mandating medical insurance coverage for workers. Read more about this regulation.
Foreign Direct Investment (FDI): Up to 100% FDI is permitted under the automatic route in the hospital sector and in the manufacture of medical devices. This means non-resident investors or Indian companies do not require government approval for these investments.
As a result, these sectors are benefiting from increasingly favorable regulations, although regulatory uncertainty remains a challenge, particularly for smaller players.
We now find ourselves in a sweet spot, benefiting from increasingly favorable regulations and achieving a size that enhances our credibility. After three years of operation, we have gained the support of well-known investors and achieved 15 million euros in revenue in 2023. This has significantly strengthened our position. - Matilde Giglio
We made you curious to know what exactly Even does?
Even: A Comprehensive Healthcare Provider
Even is a healthcare provider offering a managed care plan known as "Even Care." Members can opt for an additional group insurance cover with an IRDAI-licensed General Insurance Company. Even members enjoy unlimited consultations and preventive health initiatives with Even's team of doctors, nutritionists, physiotherapists, and other in-house specialists. For those who choose the group insurance option, hospitalization and diagnostic coverage is also provided.
Even is not an insurance company, but it complements traditional insurance plans. While typical insurance covers only hospitalization, Even focuses on preventing diseases and encourages members to seek medical advice before conditions worsen.
Culturally, many Indians are not accustomed to taking preventive measures against chronic diseases. However, awareness is growing about the risks of these conditions, leading to a shift in attitudes toward preventive healthcare.
Consumers Are Their Initial Target, But Moving Into B2B
Even was initially designed as a consumer product. Matilde explained that they made this decision because the market is massive (Indian middle class consists of around 300 million people) and lacks focus and innovation from established players.
"The market is underpenetrated. No one knows how to do it. We are much more innovative, and our product is much better than any competitor." - Matilde Giglio
New products have mainly been launched in the B2B space due to recent government regulations requiring companies to offer health insurance to their employees.
Existing insurance products primarily cover hospitalization and often require an initial fee. Additionally, they typically do not extend coverage to family members. Particularly, individuals under 30 and the elderly are not well covered.
Even aims to address these gaps.
However, given their success in the B2C market and increasing interest from companies, they have started offering Even for Teams, which provides Even's services to employees.
How they do it
Matilde states that their strength is their incredible team and their network of partners. The team allowed Even to understand how to face the complexity of the market and the industry. While the network of partners is the pillar on how they function.
Building a team of experts
Bureaucracy in India is very challenging, probably one of the most difficult in the world. Matilde previously built a company in the UK and in the US, so where countries where the culture of innovation and entrepreneurship is very simple. In these countires you can build companies in 1 day and raise money in few days.
This means that you need to work with people with great expertise and knowledge. When we arrived in India, I was 28 years old and not with that much knowledge about the market. We had the luck to get in the team one of the main experts in the healthcare insurance Indian market. People with decades of experience and that worked in the public and private sectors.
For example, their CFO was the head of risk at one of the major health insurance companies in india, and their head of operations was General Manager of **Narayana Health** (one of the main chain of hospitals in India).
The support of this people has been essential to understand how to establish and execute partnerships with hospitals and insurance companies.
In addition to having experts, they also have outstanding investors and advisors supporting them, particularly in dealing with regulators and understanding how to scale a company in India effectively. Top investors include Khosla Venture and Founder Fund (their only investment in India), and Lightrock. Among their advisors, they have some of the most successful Indian founders, such as Nithin Kamath, Foudner of Zerodha and Kunal Shah, Founder of CRED.
Partnerships
Although they are vertically integrated, they offer basic medical services in-house and more specialized services and insurance through their partners.
We are a healthcare provider with an insurance business model, where their margins are derived from the difference between premiums and compensations. - Matilde Giglio
As a vertically integrated entity, many medical services are offered and controlled by them. They employ in-house salaried doctors who serve as the primary care layer, and they provide tests and diagnostics through their network of partner clinics and hospitals.
This model is very similar to the NHS system in the UK.
To access tests or specialist visits, patients must first obtain approval from their in-house doctors. They also recommend the most efficient and suitable facilities for their needs, ensuring that resources are not wasted on unnecessary visits.
Key Factors Enabling Success
Client Selection: Consulting with doctors to ensure appropriate client onboarding.
Clinical Triaging: Doctors recommend the most suitable locations and necessary tests, optimizing efficiency and effectiveness.
Partnerships with Clinics and Hospitals: Collaborations help limit unnecessary costs.
Preventive Care: Monitoring clients' health to prevent illness or detect it early.
Impressive Growth and Success Metrics
Matilde excitingly tells us that consumers love Even. The success in their:
Revenue growth from $1M to $12M in 2023
Over 60,000 clients
97% retention rate after the second year
Team of 150 people across two main locations: Bangalore and Abu Dhabi
Key Insights as a Female Foreigner Entrepreneur in India
Matilde is definitely an energetic and challenge-seeking woman, an inspiration for me, Silvia, and hopefully many other women around the world.
Here are some final key insights she shared:
Building for India: "If you want to build for India, you need to be here."
Female Entrepreneurship in India: Being a female entrepreneur in India is still tough, but she believes things are changing and there are growing opportunities for talented women. "Women need to put themselves in the game, the opportunities are there."
Approach to Time in India: The approach towards time is totally different in India. Dealines are often not met, but things happen anyway.
"Time does not exist in India. Everything is possible. I did things here that would not be possible anywhere else. Indeed, there is a word 'Gujar' that embodies the culture of getting by." - Matilde Giglio
What we definetely found impressive about Matilde is that from how she explains thigns, it seems everything can be achieved and that is not so difficult as it might seem at first glance.
Join the conversation!
What are your thoughts on Matilde's journey? Have you heard of Even before, or have you even tried it yourself? Do you have any additional insights into the healthcare or insurance industries? We'd love to hear your perspectives!