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Mariano García-Valiño.
Founder, Chief Engineer and CEO · Axenya
I am a four-time entrepreneur currently leading Axenya, where we are transforming the healthcare experience by integrating advanced software, cutting-edge AI, data science, and human-centered support. Recently, Axenya was recognized by Newsweek as one of the World’s Best Digital Health Companies and included by Galen among the Most Promising Health-Techs in the World, a testament to our commitment to innovation and excellence in the field. Throughout my career, I have built and scaled companies at the intersection of healthcare and technology, exploring the space from multiple angles and employing a range of strategies, including entrepreneurship through acquisition, buy-and-build approaches, turnarounds, and founding businesses from the ground up. I have led the development, expansion, and exit of three major firms: B+L, which was sold in 2013 for approximately $9B; GBT, which went public in 2017 with an IPO valued at around $1B; and M8 Pharmaceuticals, which was sold in 2023 for roughly $250M. In addition, I have invested both time and capital in several ventures led by others. Earlier in my career, I held key roles at leading investment firms such as Advent, Warburg Pincus, and Aqua Capital, and worked with global giants like Pfizer, Lilly, and McKinsey, across the US, Latin America, and Europe. As a side hustle, I am an experimental art photographer, focusing on hyperobjects, entropy, and inter-temporality. My work is in private and museum collections in Argentina, Uruguay, Brazil, Colombia, Spain and the US, and featured in temporary exhibits in contemporary galleries. I also occasionally write about the intersection of data, technology, and AI, and I recently published "Inedible", a book exploring why healthcare has been so slow to embrace technology, and what we can do to finally move forward. "Inedible" reached the #1 Best Sellers List and was named the #1 Hot New Release on Amazon upon launch. I hold an Engineering degree from the Universidad de Buenos Aires, a PC in Photography from Cornell University, and an MBA from Harvard Business School, for which I earned a Fulbright Scholarship.
Guest
Mariano García-Valiño
Founder, Chief Engineer and CEO
Company:
Axenya
Location:
unta del Este, Maldonado, Uruguay
Funding:
$16M Raised
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Axenya is rebuilding healthcare around chronic disease prevention through AI-powered continuous monitoring. Covering 100,000 lives in Brazil and processing 95 million clinical inferences monthly, the company pivoted from clinical technology provider to healthcare broker - achieving cash flow positive status before their Series A. In this episode of BUILDERS, I sat down with Mariano García-Valiño, CEO and Founder of Axenya, to learn how they spent $3 million building the "perfect product" before discovering no one would pay for it, why they acquired a small broker to unlock their revenue model, and their regulatory-constrained approach to geographic expansion.

Topics Discussed:

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Five takeaways from this conversation.

Actionable for Healthcare Tech founders

  1. Validate payment willingness before product-market fit
    Axenya spent $1 million on a prototype, then $2 million more building what they believed was market-ready. They ran a year of proof-of-concepts in Brazil without generating one dollar in revenue. Doctors wouldn't pay (not their job), patients were too fragmented to understand the purchase, and health plans had misaligned time horizons—employees churn before preventive investments pay off. Only after exhausting their capital did they discover companies would pay because employees stay longer than health plan contracts. The brutal lesson: technical validation means nothing without a buyer who has budget authority, procurement access, and economic incentive to pay your price.
  2. Restructure your entire business model to align with buyer economics
    When Axenya finally identified companies as buyers, they still faced a problem—HR and finance teams couldn't evaluate complex healthcare products and traditional brokers charge 3-5% regardless of outcomes. Mariano's team acquired a 25,000-life broker and rebuilt as a zero-fee model, earning solely from cost savings they generate. This wasn't a pricing tactic—it was a complete business model redesign that required broker licensing, insurance expertise, and risk assumption. The result: they quadrupled to 100,000+ lives in two years. The insight for founders: when buyer incentives don't align with your value delivery, repricing won't fix it—you need structural model innovation.
  3. Map regulatory constraints before market size in expansion planning
    Brazil and Mexico represent 85% of Latin America's addressable market, but Axenya won't enter Argentina despite proximity because regulated health plan pricing prevents capturing cost savings—the foundation of their model. Europe requires a completely different revenue model since employers don't pay for healthcare. Even US expansion targets Florida specifically because Brazilian companies operate there, reducing friction. Mariano's framework: clinical efficacy travels, but business model viability depends entirely on regulatory structure and payment norms. For B2B founders in regulated industries, TAM analysis without regulatory mapping is fiction.
  4. Design compensation to operationalize referrals, not just request them
    Axenya's referral engine breakthrough wasn't sophisticated—they started asking customers for introductions and built CS team incentives for successful referrals. The implementation detail that matters: clients readily refer within their own industry, but those referrals often aren't ideal-fit prospects. Rather than generic "would you refer us" requests, their CS team now qualifies referral targets before making asks, ensuring introduced companies match their enterprise profile. The lesson isn't "just ask"—it's structuring your CS compensation and qualification process to generate qualified pipeline, not just introductions.
  5. Prove unit economics and recontract capability to cross the Series A threshold
    Mariano identified two factors that separated their Series A success from the seed-to-A crunch: achieving cash flow positive and demonstrating full-cycle customer proof—initial sale, retention, and recontract of the same accounts. This wasn't about hitting ARR milestones but proving economic sustainability that could survive 6-9 month fundraising cycles. For founders approaching Series A, the bar isn't growth velocity alone—it's evidence that your sales motion is repeatable, your unit economics work without endless capital, and customers renew because you deliver measurable value.

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