Billing complexity and contra-revenue quirks

In this episode of Run the Numbers, CJ sits down with Manu Diwakar, CFO of Virta Health, to unpack why health tech breaks traditional SaaS thinking. They get into the realities of running a business where outcomes matter, half the company are medical professionals, and efficiency can’t come at the expense of care. It’s a conversation about sustainable scaling, smarter reinvestment, and building for durability over hype.

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SPONSORS:

SpendHound is a SaaS spend management platform built for finance and procurement teams that want visibility and leverage in every deal. By tracking all your software, benchmarking pricing across thousands of vendors, and surfacing contracts and renewals, SpendHound helps you stop overpaying and negotiate with confidence. Trusted by teams at ZoomInfo and Hootsuite. Get started at https://www.spendhound.com/cj

Brex is an intelligent finance platform that combines corporate cards, built-in expense management, and AI agents to eliminate manual finance work. By automating expense reviews and reconciliations, Brex gives CFOs more time for the high-impact work that drives growth. Join 35,000+ companies like Anthropic, Coinbase, and DoorDash at https://www.brex.com/metrics

Aleph is a modern FP&A platform built for teams that want more than another planning tool. By connecting your ERP, CRM, and other systems into one trusted data layer with AI workflows, Aleph helps you move faster with real-time insights. Get a personalized demo at https://www.getaleph.com/run

RightRev is an automated revenue recognition platform built for teams that have outgrown spreadsheets and billing tool workarounds. It handles high-volume subscriptions, usage-based contracts, and mid-cycle upgrades, so you can scale without scrambling at month-end. For RevRec that keeps your books clean, visit https://www.rightrev.com/CJ

Rillet is an AI-native ERP built for modern finance teams that want to close faster without fighting legacy systems. Designed to support complex revenue recognition, multi-entity operations, and real-time reporting, Rillet helps teams achieve a true zero-day close—with some customers closing in hours, not days. If you’re scaling on an ERP that wasn’t built in the 90s, book a demo at https://www.rillet.com/cj

EY works with high-growth tech companies to navigate the messy realities of scaling—from regulatory requirements to IPO readiness. By helping teams get it right early and often, EY lets founders stay focused on building while reducing risk as they grow. Learn more at https://www.ey.com/techstartups

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LINKS: 

Mostly Talent: https://mostlymetrics.typeform.com/to/cLTxtAsN

Guest: https://www.linkedin.com/in/manu-diwakar-1aa578/

Company: https://www.virtahealth.com/

CJ: https://www.linkedin.com/in/cj-gustafson-13140948/

Mostly metrics: https://www.mostlymetrics.com

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TIMESTAMPS:

0:00 Preview and intro

1:18 Welcome and guest intro

3:02 What sector is health tech?

4:34 Virta go to market explained

7:01 B2B to B2C model

9:00 Value based care and ROI guarantees

9:18 Half the company are medical professionals

10:36 Sponsors — SpendHound | Brex | Aleph

14:03 Annual planning process

16:42 Shape of the curve

17:33 TAM: metabolic health is massive

20:45 Fee for service vs. value based care

24:16 Sponsors — RightRev | Rillet | EY

27:24 Unique costs of health tech: billing, compliance

30:54 Corporate practice of medicine

31:44 North star: members under management

32:43 The flywheel: $250 charge, $500 saved

33:28 Early stage CFO job is easy

35:28 Bad habits baked in during high growth

38:02 Choosing not to profit vs. not turning a profit

41:15 Running a VC-backed business for sustainability

42:07 People, tech and process framework

44:31 Hiring philosophy: hard work, learning, curiosity

48:26 Athletes vs. experts in hiring

50:03 Clock hands interview question

50:49 Lightning round

51:09 Screwed up: having hard conversations late

51:57 Advice to younger self

52:15 Finance software stack

52:42 Craziest expense story

53:47 Credits