It's a distinct pleasure to share my recent interview with one of Redox's favorite people in health tech, Breanna Cunningham. From day one, Breanna has impressed our team with her infectious energy and amazing ability to execute. Join us as we learn about her path from trauma ICU nurse to CEO of the rapidly growing CODE Technology.
What brought you to healthcare?
I really wanted to be a surgeon. That was my dream from when I was a little kid. My dad was a fireman and my mom was in the Air Force. She was always overseas in Germany and other places, so I lived at the fire station with my dad. I would go on every trauma call with him and I loved it. I knew I wanted to do something similar, so when I was in high school, I took a lot of pre-health college courses and when I turned 18, I became a nurse. The whole time, I was still going down the medical school path while working in the hospital. I fell in love with the work. After a while, I moved into hospital administration and that’s when I realized, “hey, technology has helped me in every area of my life—except for work.” That moment is when I started obsessing over the different systems in use and what opportunities existed for improvement.
What lead you from the ICU to administration?
I guess I’ve always been business-minded. Back in high school, I started a pool cleaning company (Crystal Clear Pool Cleaning). I never even had a pool, but I lived in Phoenix so I started this company and wound up selling it when I was 18. I’ve always had a bit of an interest in operations and I became really obsessed with cost in hospital systems. Every time I would hang an IV bag or open up a new supply, I would wonder how much this would cost and how hospitals run. A few years into the job, I started getting involved in shared leadership teams. Soon after, I was spearheading a system-wide operations team that intertwined in every location of a big healthcare giant. That's where I learned all about cost, as it relates to outcomes, and how value is defined in medicine.
Aha! The origin story of any future entrepreneur. Tell me about the pool cleaning sale.
It wasn’t anything too formal, I sold it for like $10,000 to some guy who was my competitor in the neighborhood. Even keel deal. He gave me $10k and took over all my clients. I've always been a worker and have had countless little hustles. Not all of which I want the world to know about [laughs]. I recently had a reunion where an old friend reminded me of how in elementary school, I developed this system for trading lunches that stuck until we were in junior high. There needed to be a method to valuing snack bar lunches and pack lunches, I guess. Looking back, I suppose I was sort of born with the entrepreneurial bug. I still have no formal business training.
What made you take the leap from working within the health system to entrepreneur?
My (now) husband and I, when he was an intern at the health system I worked at, would sit in the trauma room and talk about how needed this system was. We would talk about data collection platforms and the need for a system that didn’t interrupt workflow for nurses. We thought: ‘There should be a way to passively collect information that healthcare professionals desperately needed to make good decisions.' We went back and forth on these ideas and then one day he asked if we could meet outside of the hospital. He was in a suit which I thought was really weird because he’s a pretty casual guy and he said let’s formalize this; lets stop talking about it and do it. I was in.
We started the company and the first generation of the product was actually for emergency cardiac care for when people code and are collecting data. It was actually a really popular app (CodeBlue). It kind of went viral. Nurses loved it, physicians loved it, but nobody would pay for it. An unfortunate little fact is that if a patient survives cardiac arrest, the hospital system actually loses money. That’s when I learned the hard way what a value proposition was. We took the same concept and framework and started collecting data on orthopedics. Ortho is a huge money maker for hospitals, so the value proposition was clear and that’s where we’ve been since.
What did your family think about you founding your own business?
Basically everyone in my family is a fireman, a teacher, or a nurse—I’m the first entrepreneur in the family. When I took the leap, I had this really stable job as a nurse, my college was paid for through a scholarship, I had sold my pool cleaning company. I've always worked a lot, so I had a 401k, an emergency fund, a Roth IRA—I was doing pretty good for someone in their early 20’s! When I started my company I cashed out, took all the penalties, refinanced my car (twice), pawned off things I owned... most of my family thought I was pretty crazy.
How were the early days?
We had a slow start. Selling into health systems is difficult. They're complex enterprises and the sales cycle can be painfully long. We were just busy enough that I had to stop nursing (those 13 hour shifts make running a company pretty impossible). However, couldn’t afford to have ZERO income, so to stay afloat early on, I did all sorts of crazy stuff. I did legal nurse consulting. I helped a healthcare marketing company get off the ground... really anything that allowed me to make a little money while still focusing primarily on CODE.
This is funny, there was a point in time where our biggest client was the WPGA. That’s right, Women’s Professional Golf. They loved our platform, because in a lot of ways, CODE is really a fancy CRM. The WPGA used our platform to evaluate golf courses for women friendliness. That was the trough of sorrow days where I was wondering if we were going to make it. I was doing my taxes that year thinking, “we’re a healthcare company” and this is our biggest customer.
When did you know this was going to work?
It all changed when we closed a big deal to a large private orthopedic practice called Ortho Arizona. They’re actually one of the largest private practices in Phoenix. We owe a lot to them for believing in us. The moment when we knew this was going to work was when we got our first few post-op patient-reported outcome surveys. That's when we were sure this is where healthcare is going and that's when people started reaching out ready to buy.
What has your experience been as a female CEO of a healthcare technology company?
Healthcare was the start of my professional life and I would say it's very equal men and women in leadership positions. As far as CEOs, hospital administrators, and the people I worked with on a daily basis (predominantly nursing teams), women were very well represented. So, on the healthcare side of things, I never found it challenging to navigate as a woman. Now, let's talk about tech. Tech has been a bit of a different story. I don’t want to say challenging, but there have been moments where I've thought, “woah, this is different because I’m a woman". I had never experienced that before. There were definitely times where I felt like I was the only woman at the table at conferences, in boardrooms, and in meetings. That being said, I feel as if I have been treated very fairly. There aren’t any deals we didn’t close because I am a woman. There is a transition period at first, though, and if you aren’t careful, you can kind of get talked over if you’re not bold enough.
You just had your first child. How has that changed things?
My daughter was actually born very sick. She had kidney issues and she was premature so she was in the NICU for 26 days. The whole experience has been rather humbling, to be honest. We had just moved to Minneapolis, where we have absolutely no family and my husband is a trauma surgeon… which means he works. A lot. Claire is doing better now, but for a stretch we had a very high needs baby and had to find a balance with our busy careers.
When I was pregnant, I hired a HR consultant and had her look at my schedule with the goal of helping it get to more reasonable hours. I love my work, and was literally on my computer while in the hospital in labor. I got off my last conference call when I couldn’t breathe through my contractions anymore. For my first hire in Minneapolis, we did all of her training in the NICU directly after Claire was born.
I don't want to romanticize this amount of work—I really do believe in work life balance. At CODE, we now make sure our employees take 3 weeks of vacation where they are totally off the grid. While bootstrapping, though—prior to funding—I had to do what I had to do.
In a lot of ways, Claire's birth has been a blessing for CODE. I think our team knew it would be. I’m super passionate about what we do and I love our product. If I could be on every implementation call, I would because I love it. That being said, that isn’t sustainable, so having the baby was a blessing for the company and has helped us with a natural SWOT analysis. It allowed me to identify opportunities to hire instead of me doing everything. Truthfully, it’s forced me to embrace delegating and get better at prioritizing.
As a female leader, do you have any suggestions for women moving into healthcare technology?
I don’t have any formal business training, so when I first got started, I sunk my teeth into absolutely any and every entrepreneurial resource that was out there. The group that I ended up deriving the most value from was a group that used to be called 85 Broads but now goes by Ellevate. As a matter of fact, I still have someone from the org on my board. That group was amazing and I would highly recommend getting involved. I think one of the main differences between the men and women's networking groups is that men predominantly have a “you scratch my back, I scratch yours” mentality, whereas women are often much quicker to identify a need and offer to fill it without it being a transactional thing. I found a lot of amazing guidance and support and I look forward to contributing more when my life settles down a little bit.
Any last advice?
You can’t do it alone. I wouldn’t be here today without the people who believed in me early on. It’s all about the people you surround yourself with. Especially early on, it's so important to have a team that is loyal and hard working and totally all in. That’s the reason CODE is where we are today.
More about CODE Technology
CODE Technology develops products designed to collect patient-reported outcome data. As healthcare transitions from a fee for service to a pay for performance reimbursement model, it's imperative that physicians are able to demonstrate the value of their services, particularly when it comes to surgical interventions. The key to demonstrating value is having validated patient outcomes. All healthcare providers recognize the need to collect both pre- and post-intervention outcome data for surgical patients—the challenge is actually doing it.
That’s where CODE comes in. We collect outcome data for healthcare organizations, medical groups, and hospitals- quietly while they work. The CODE PRO Platform is a software + service model that collects, stores, and analyzes patient outcome data. Rather than having patients fill out lengthy forms while at the office for their appointment, or mailing them surveys to complete and send back to the office, we handle the entire process in a behind the scenes approach.
With the data collected and reports generated through the CODE PRO Platform, doctors are able to provide the best possible evidenced based care for their patients, negotiate better insurance contracts, and improve healthcare through research.
Learn more at www.codetechnology.com.