Medallion

Instacart

Medallion

Medallion charges healthcare organizations a subscription based on the number of providers being managed. The platform handles initial credentialing (verifying a new provider) and ongoing monitoring (ensuring licenses stay current, no disciplinary actions arise).

The value is measured in speed and cost savings. Credentialing departments at hospitals can cost millions annually in staff salaries.

Medallion replaces much of that manual labor with software. Faster credentialing also means faster time-to-revenue — a doctor who can start seeing patients weeks earlier generates revenue weeks earlier.

The platform also manages payer enrollment — getting providers into insurance networks — which is a related but separate bureaucratic process that's equally painful and equally automatable.

Instacart

Instacart operates as a marketplace connecting consumers with personal shoppers and grocery retailers. Revenue comes from multiple streams: delivery fees and service fees charged to consumers (typically $3.99+ per delivery), tips to shoppers (passed through, not revenue), retailer partnerships (grocers pay Instacart for access to the platform and fulfillment services), and advertising.

Advertising has become the crown jewel. Instacart Ads lets consumer packaged goods (CPG) brands like Coca-Cola, Procter & Gamble, and Nestlé pay for sponsored product placements within the Instacart shopping experience.

When someone searches for "chips," Doritos can pay to appear first. This is incredibly valuable because it's advertising at the exact moment of purchase intent.

Ad revenue was $871 million in 2023 and crossed $950 million in 2024.

The retailer partnership model is key. Unlike DoorDash or Uber Eats (which listed restaurants without permission early on), Instacart works with grocers as partners.

Over 1,500 retail banners including Costco, Kroger, Albertsons, and Publix have formal partnerships. Instacart provides the technology and shoppers.

Grocers provide inventory and stores.

Medallion

Derek Lo was working in healthcare operations when he encountered credentialing — the process of verifying that healthcare providers have the proper licenses, education, training, and malpractice history to practice medicine. Every doctor, nurse, and therapist in America must be credentialed before they can see patients at a new facility or join an insurance network.

The process was absurdly manual. It involved contacting medical schools, state licensing boards, previous employers, malpractice insurers, and the DEA — often by fax or mail.

A single credentialing verification could take 90-180 days. Healthcare organizations employed entire departments of people doing nothing but chasing down verifications through a patchwork of government databases, phone calls, and paper forms.

Lo founded Medallion in 2020 to automate this process. The platform connects directly to primary sources — state licensing boards, the National Practitioner Data Bank, DEA databases, and medical school registries — and pulls verification data automatically.

What used to take months of manual work now takes days or weeks.

Instacart

Apoorva Mehta was a 26-year-old Amazon engineer in Seattle who quit his job in 2012 to start a company. The only problem: he had no idea what to build.

Over the next year, he started and abandoned roughly 20 different projects. A social network for lawyers.

A way to track restaurant wait times. Nothing stuck.

Then one day he was too lazy to go grocery shopping. He looked for a service that would shop for him and deliver everything to his door.

Nothing good existed. The existing options were grocery store delivery services that only worked during specific windows, had limited selection, and required ordering days in advance.

Mehta wanted to order groceries the way he ordered everything else online — immediately, from whatever store he wanted.

He built a prototype in 2012 and applied to Y Combinator. The demo was rough — he ordered a six-pack of beer through the app and had it delivered to a YC partner's house during the application process.

It worked. He got in.

Instacart launched in the San Francisco Bay Area in 2013 with a simple promise: order from your favorite local grocery store and have someone shop for you and deliver within an hour.

Medallion

Medallion grew by targeting healthcare organizations that were drowning in credentialing backlogs. Telehealth companies scaling rapidly during COVID were the first ideal customers — they needed to credential hundreds of providers quickly across multiple states, and the manual process couldn't keep up.

The platform expanded to hospitals, health systems, and staffing agencies that manage large provider networks. Each customer type faces the same fundamental problem: too many providers to credential, too few staff to do it, and too many regulatory requirements to track manually.

Integration partnerships with HR systems and practice management platforms drove distribution. When Medallion plugs into a health system's existing tech stack, the switching costs climb and the data integration deepens.

Instacart

Instacart grew by solving a problem one city at a time. They launched in San Francisco, proved the model, then expanded to other major metros.

Each new market required recruiting shoppers, signing up retailers, and building enough consumer density to make the economics work.

The COVID-19 pandemic was the inflection point. Grocery delivery went from luxury to necessity overnight.

In March 2020 Instacart announced it would add 300,000 shoppers, then raised that by another 250,000 weeks later. Order volume increased 500%.

Years of planned growth happened in weeks. The pandemic proved that grocery delivery wasn't a niche — it was the future of how a significant chunk of the population would shop.

The enterprise play is the long-term moat. By providing white-label technology to grocers, Instacart becomes embedded in their operations.

Even if a grocery chain wanted to build its own delivery service, they'd need years and hundreds of millions to replicate what Instacart provides. The more deeply integrated Instacart becomes in grocery operations, the harder it is to rip out.

Medallion

Healthcare is notoriously slow to adopt new technology. Decision-makers at hospitals and health systems are risk-averse and procurement cycles are long.

Selling enterprise software to healthcare organizations requires patience, compliance certifications, and relationships that take years to build.

The credentialing ecosystem involves hundreds of independent data sources — each state licensing board has its own system, formats, and response times. Building and maintaining connections to all of these sources is operationally complex and requires constant updating as boards change their processes.

Competition from established credentialing verification organizations (CVOs) and legacy software providers means Medallion is displacing existing processes and vendors, not entering a greenfield market.

Instacart

The post-COVID hangover was brutal. After pandemic demand normalized, growth slowed dramatically.

The company's valuation dropped from a peak of $39 billion in early 2021 to about $10 billion at IPO in September 2023. Investors who bought at the peak saw a 75% paper loss.

The narrative shifted from "essential infrastructure" to "nice-to-have luxury."

Unit economics are perpetually tight. Paying a person to walk through a grocery store, pick items, bag them, and drive them to someone's house is expensive.

Unlike meal delivery (one restaurant, one bag), grocery delivery involves dozens of items per order, refrigeration requirements, and substitution decisions. Every order that requires a shopper to call the customer about an out-of-stock item eats into efficiency.

Amazon is the existential threat. Amazon Fresh, Whole Foods delivery, and Amazon's own logistics network represent a competitor with nearly unlimited resources and a Prime membership base of 200+ million.

Amazon has been willing to lose billions on grocery delivery to build market share. Instacart's advantage is retailer partnerships — Kroger and Publix use Instacart specifically because they don't want to help Amazon dominate grocery.

Medallion

Medallion Credentialing — automated primary source verification of healthcare provider qualifications including licenses, education, training, and malpractice history. Medallion Monitoring — continuous license and exclusion monitoring that alerts organizations when a provider's credentials change or expire.

Medallion Payer Enrollment — automated management of insurance network applications and re-enrollments across multiple payers. Medallion Provider Network Management — a unified platform for managing the complete provider lifecycle from recruitment through credentialing to ongoing compliance.

Medallion Analytics — dashboards showing credentialing pipeline status, bottleneck identification, and compliance metrics.

Instacart

Instacart Marketplace — the core platform where consumers order groceries from 80,000+ stores for delivery or pickup, with personal shoppers fulfilling orders. Instacart+ — subscription service ($9.99/month) offering free delivery on orders over $35, reduced service fees, and credit back on pickup orders.

Instacart Ads — a retail media platform letting CPG brands run sponsored product listings, display ads, and coupons within the shopping experience. Instacart Platform (Enterprise) — white-label e-commerce technology that lets grocers build their own online ordering and fulfillment powered by Instacart's infrastructure.

Caper Cart — AI-powered smart shopping carts (from the 2021 Caper AI acquisition) with built-in screens, barcode scanners, and payment that let shoppers skip the checkout line.

Medallion

Sequoia Capital led the Series B. Optum Ventures (part of UnitedHealth Group) invested — a significant strategic validation from the largest healthcare company in America.

Tiger Global and GV (Google Ventures) participated in earlier rounds.

Instacart

Sequoia Capital was an early and consistent backer. Andreessen Horowitz invested in growth rounds.

D1 Capital Partners led the 2021 round that valued Instacart at $39 billion. Existing investors including Valiant Capital, T.

Rowe Price, Fidelity, and Tiger Global participated across rounds. Y Combinator was the starting point (Summer 2012 batch).

The September 2023 IPO on NASDAQ priced at $30 per share, valuing the company at approximately $10 billion.