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Building a $3B Healthcare Tech Company: Omnicell’s 30-Year GTM Evolution
Fifteen days in a UCSF ICU watching nurses record everything on paper sparked an idea that would transform healthcare technology. That observation led Randy Lipps to build Omnicell, taking it from a prototype in his house to a $3B public company that’s still innovating three decades later.
In a recent episode of Unicorn Builders, Randy shared how he navigated the complex healthcare market, evolved from product vendor to solutions provider, and maintained growth through multiple technology cycles. His journey offers unique insights for founders building in regulated, conservative industries.
The Early Days: Building Trust in a Conservative Market
Healthcare’s inherent conservatism shaped Omnicell’s early GTM approach. As Randy explains, “Healthcare is a conservative discipline. They take years and years of trials before they put a drug into a human. And that thinking permeates the Healthcare industry before they try something new or adopt new technology.”
Instead of fighting this conservatism, Omnicell embraced it. With just $75,000, Randy and five Stanford engineers built their first prototype. Their initial customer pitch at Sequoia Hospital consisted of four industrial art drawings and a desktop prototype. Randy’s approach was direct: “If you see this system here, would you try it? And if you tried it and liked it, would you buy it?”
This simplicity worked. As Randy recalls, “VCs said, ‘How much money did you spend on this?’ I said, ‘Well, you know, like 75 grand.’ They said, ‘I want to send a check in today. Any guy that can make something with that little money that’s creating a market, we got to invest in this guy.'”
Navigating the Dot-Com Era’s GTM Challenges
The late 90s presented a unique challenge. While Omnicell had built solid products and revenue, Wall Street was fixated on dot-com stories. Randy shares, “When we’re ready to go public with the right size and the right earnings, the right growth rates, Wall Street wasn’t interested in talking to you very much.”
It took three IPO attempts before succeeding in August 2001 – as the last Silicon Valley company to go public before the window closed. The turning point came when the market sentiment shifted: “Here’s a company that’s coming along as these companies are becoming unfavorable that’s got revenues and run rates. It was kind of like we were the ugly baby twice when we tried to go out.”
The Evolution from Product to Solutions Provider
Omnicell’s most significant GTM innovation came from watching their customers struggle with their technology. While hospitals wanted automation, they often lacked the expertise to operate it effectively. Randy observed, “When we put our own people in to help run the robots, the productivity, outcomes, and safety were twice, sometimes over twice as fast as what the ownership people who own the equipment, who ran it themselves.”
This insight drove a fundamental shift in their business model. “Many of our products today come with experts and people on site to help you get the outcomes you want,” Randy explains. “Ten years ago, a lot of health systems would not let you bring your people in to do anything. That’s their core competency. They didn’t want them in there. But as the tech and the outcomes can be driven at a much higher rate, it’s been a huge transition.”
Maintaining Relevance Through Market Evolution
Randy attributes Omnicell’s longevity to a systematic approach to reinvention: “You really have to reinvent yourself every three years. What’s got me to this point isn’t going to do for the next three years.”
This philosophy extends to product strategy. Recently, Randy told his team “all our products will be obsolete in a pretty short time period. You better figure out what the next set of products is.” This forward-thinking approach keeps Omnicell ahead of market shifts, particularly as healthcare moves toward AI and automation.
The Future of Healthcare Tech
Looking ahead, Randy envisions a fundamental transformation in healthcare delivery. “We want these systems to be able to actually think on their own about getting meds to the right person at the right time, safely and appropriately and quickly and cost effectively. And that in itself is an AI application, the whole thing, not just part of the whole thing.”
This vision exemplifies Randy’s approach to long-term thinking: “If you only think in two to three year increments, you’re going to get to the end of one of those nodes and then you’ll have nowhere to go. You need to at least have some thesis on what 5 and 10 years looks like.”
For founders building in regulated industries, Omnicell’s journey demonstrates that success comes not from fighting industry constraints, but from understanding them deeply enough to innovate within them. The key is balancing short-term execution with long-term vision, while continuously evolving your service model based on real customer outcomes.
Actionable
Takeaways
Build trust through personal connection and domain expertise:
Randy's background in healthcare and industrial engineering, combined with his personal experience in hospitals, helped him build credibility with early customers. He emphasized the importance of personally visiting customers and sharing his story to create trust in a conservative industry.
Find the right milestone that creates value:
Randy's team built a working prototype with just $75,000, which immediately attracted VC interest. He notes, "The key in winning in any of these games is get to the right milestone that creates value. It's not the ultimate finished product... but it's a milestone someone can look at and say, 'Wow, this company is going to make an impact.'"
Make complex technology accessible through familiar comparisons:
When marketing their solution, Omnicell found success by comparing themselves to established players: "Because we compare it to their story, to our story, that just allowed people to easily understand." While Randy didn't love referencing competitors in his pitch, it helped quickly establish credibility and understanding.
Evolve your service model based on customer outcomes:
Omnicell discovered that having their experts onsite led to twice the productivity compared to customer-operated systems. This insight drove their evolution from a pure product company to a solutions provider: "Many of our products today come with experts and people on site to help you get the outcomes you want."
Think in decade-long horizons while executing in three-year cycles:
Randy emphasizes the importance of having both short and long-term vision: "If you only think in two to three year increments, you're going to get to the end of one of those nodes and then you'll have nowhere to go. You need to at least have some thesis on what 5 and 10 years looks like."
Embrace constant reinvention:
Randy attributes his longevity to continuous personal and professional development: "You really have to reinvent yourself every three years. What's got me to this point isn't going to do for the next three years." He recommends seeking feedback from board members and advisors who will challenge you to improve.
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