“I had lots of epiphanies and found that I loved high intensity, high acuity,” said Rao. “Emotionally, I can maintain equipoise in those ICU settings. So, I realized that I like the acuity of life or death situations—the more pressure, the better. That’s why I ended up going into cardiology. With heart attacks, you have to react, and there’s the intensity of surgery and procedures—but you also get relationships. You’re talking to people, and you’re hearing their stories.”

Years later, Rao is the founder and CEO of health care AI unicorn Abridge at an acute moment in health care that perhaps calls for a high tolerance for pressure: The murder of United Healthcare CEO Brian Thompson laid bare the depth of the public’s rage at U.S. health structures. Meanwhile, the future of Medicare and Medicaid under the Trump administration is in flux. It’s an uncertain time, for both clinicians and patients. 

“We clearly have a public health emergency,” Rao told Fortune. “We may or may not be acknowledging it every day. On one hand, on the professional side of the health care delivery spectrum, there’s burnout and burden. We don’t have enough doctors. We don’t have enough nurses…Then, we look at the other side, the center of health care, which is the person, the patient. And patients aren’t getting the best experiences.”

Rao, who has continued practicing cardiology a few times a month, believes both patient and doctor experiences need to be better. And Abridge, a seven-year-old company focusing on improving doctors’ clinical documentation workflows with AI, now has new mission fuel: The Pittsburgh, Pa.-based company has raised a $250 million Series D, co-led by tech entrepreneur Elad Gil and VC firm IVP, valuing the startup at $2.75 billion post-money. Other investors who participated in the round span tech and health care, including Bessemer Venture Partners, CapitalG, Lightspeed Venture Partners, K. Ventures, Nvidia VC arm NVentures, SV Angel, Redpoint Ventures, Spark Capital, California Healthcare Foundation, and CVS Ventures. 

Currently, Abridge’s technology is in place across about 100 U.S. health systems, including Kaiser Permanente. Yazdi Bagli, Kaiser’s EVP of IT and enterprise business services, said he believes their Abridge partnership is one of the largest generative AI deployments in health care, with some notable stats to back that up: The national rollout includes more than 25,000 doctors and clinicians, 40 hospitals, and north of 600 medical offices. Kaiser says 63% of its doctors are active Abridge users, and that the tech has summarized more than 6.3 million patient visits. The feedback from doctors has been effusive, said Bagli. Some examples he shared include: “It saved my marriage.” And: “You’d have to take it away from my cold, dying hands.”

“There are a lot of good quotes that can be fun to read,” Bagli told Fortune. “It feels good, because doctors are truly happy we’ve done this for them.”

Abridge has become known for its AI transcription. But to deeply succeed, it will need to become an entrenched, expansive tool that alters doctor and patient behavior, said Emory Healthcare CEO Dr. Joon Lee. (Today, Emory Healthcare is an Abridge customer, but Lee has known Rao for years—he first hired Rao out of residency as an attending cardiologist.)

“If you’re doing a follow-up article three years from now and Abridge is still seen as a transcription tool, I would argue it hasn’t really succeeded,” said Lee. “It would be like if we still thought of the iPhone as ‘a text and phone machine.’ Smartphones have transformed how we do things because of their capabilities, and the same is true of this type of technology.”

Abridge has its share of VC-backed competitors, including Ambience, Nabla, and Suki, plus Microsoft’s Nuance. But Somesh Dash, IVP general partner, has now put his money on Abridge twice, betting that the company is uniquely poised to make an impact. He believes Rao is especially engaged with a fundamental truth about tech in medicine, that “health care particularly is an ecosystem, and it’s all about how well-integrated you are,” said Dash. And then, there’s Rao himself. 

“He’s a dreamer,” said Dash. “Everything with Shiv is ‘Let’s go!’”

Rao has been traveling a lot as Abridge has grown—he jokes he lives between “12F” and “16D” on planes—but he still shows up to practice as a cardiologist one weekend each month, and is on-call on Thursdays. And his life as a doctor isn’t at odds with his life as an entrepreneur. Instead, startups and medicine have unexpected overlap. “You just have to be willing to connect the dots, and make them explicit,” said Rao. 

Consider the ICU, Rao explains: When a patient’s in crisis, “you’re asked to immediately figure out how to build a prototype, decide on which medication might work, deploy that medication, and get feedback.” Meanwhile, “in the startup world, the feedback is that the product sucks and you need to iterate.”

“You go through these build-measure-learn cycles really quickly, and you have to decide whether to persevere or pivot,” Rao said.

Today, I published a profile of Rao, exploring his perspective on tech, startups, and medicine—and how all those areas inherently demand creativity. If you’re wondering how legendary music producer Rick Rubin applies to health care, read the full story here. 

See you tomorrow,

Allie Garfinkle
X: @agarfinks
Email: alexandra.garfinkle@fortune.com
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Update, Feb. 17, 2025: After publication, Abridge disclosed that the company was now at a $2.75 billion post-money valuation.

VENTURE DEALS

- Shotsy, a Portland, Ore.-based GLP-1 tracking app, raised $2.3 million in seed funding. April Underwood of Adverb Ventures led the round and was joined by Coalition Operators, Springbank Collective, and an angel investor, according to Business Insider.

PRIVATE EQUITY

- McNally Capital acquired a majority stake in Jewett Automation, a Richmond-based automation solutions provider. Financial terms were not disclosed.

EXITS

- Bain Capital agreed to acquire Apleona, a Neu-Isenburg, Germany-based real estate and facility manager, from PAI Partners. Financial terms were not disclosed.

- Republic Services acquired Shamrock Environmental, a Browns Summit, N.C.-based industrial waste and wastewater treatment services provider, from CenterOak Partners. Financial terms were not disclosed.

OTHER

- CyberArk acquired Zilla Security, a Boston-based identity governance and administration provider, for an enterprise value of $165 million in cash.

IPOS 

- Northpointe Bancshares, a Grand Rapids, Mich.-based bank, raised $151 million in an offering of 10.4 million shares (17% secondary) priced at $14.50 on the NYSE. The company posted $175 million in revenue for the year ending Sept. 30, 2024. Castle Creek Capital Partners, Charles A. Williams, John S. Simoni, and Anne Gainey back the company.

- Turo, a San Francisco-based car-sharing marketplace, withdrew its plans to go public on the NYSE. IAC, G Squared, August Capital, and Canaan Partners back the company.

FUNDS + FUNDS OF FUNDS

- naturalX Health Ventures, a Berlin-based venture capital fund, raised €100 million ($105 million) for its new fund focused on consumer health companies. 

PEOPLE

-British Columbia Investment Management Corporation, a Victoria, Canada-based investment management firm, added Derrick Estes as a senior managing director of its private equity group in London. Previously, he was at Corsair Capital.