What It's Like To Be The Immigrant Founder Of A Tech Company

Update: When we ran this interview on Wednesday, we were unfortunately not aware of the lawsuit that was filed against Shradha Agarwal and her cofounder, Rishi Shah, in November. This was a big oversight on our part. At Refinery29, we work hard to do our best as journalists and report the complete story. Sometimes we mess up, and this is one occasion. We apologize. We've made some updates to the story and reached out to Agarwal and Outcome Health for comment on the lawsuit.
Today, we had the opportunity to chat with Shradha Agarwal, cofounder and president of Outcome Health, a $5-billion tech healthcare company. Shradha, 32, founded the company with Rishi Shah in 2006 when she was still a student at Northwestern University. This year, the company reached unicorn status, making her one of just a few female founders to enjoy that kind of success.
Ahead, Shradha talks about the problems with sexual harassment in tech, her desire to become a U.S. citizen, and her wish that there were 24 and a 1/2 hours in a day.
What do you think the definition of self-made is, as it pertains to you?
“Self-made” is an idea that I get from my mother, and it’s all about taking opportunities, not waiting for an invitation, and persevering even when things are hard. My mother and her sisters all went to university in India at a time when that certainly wasn’t the norm, so they really embodied this idea. She always pushed me to dive into things headfirst, just as her mother did for her. We are stubborn in all the right ways.
What quality do you think you possess that's made you a good candidate for self-making your destiny?
Without a doubt, it’s perseverance. This idea of “self-made” doesn’t come easily or on the first try, and I’ve learned that you’ll only reach your destination if you are unfailingly persistent. It sounds simple, but in practice it can be extraordinarily difficult. If it’s not difficult, you’re not aiming high enough.
You immigrated to the U.S. in 2004, and you're still not a citizen — you've been outspoken about how the system in broken. Can you tell us a little bit about the struggles of being an immigrant running a hugely successful healthcare startup?
It can be surreal to participate in the economy and civic life in such a meaningful way — employing hundreds of people and being part of a company that is changing healthcare — and not be able to become a citizen for so long. My husband has been here since 2001 and won’t be able to get a green card until he’s been here for 25 years — just a green card! There are also financial challenges because you’re paying into the system but can’t reap the benefits that citizens do. America is my home. I love this country. The thought that some people want to make it harder to become a citizen is baffling to me, because it is already extraordinarily difficult for people who want nothing more.

My hope is that by the time the next generation comes of age, sexual discrimination will be unthinkable.

Tell us a lesson you keep trying to learn, that you hope to master at some point?
Patience, I know there are only 24 hours in a day, but I wonder what could be accomplished if we had an extra 30 minutes. I’d also love to master playing the guitar. It’s one of my favorite instruments.
You could argue that it hasn't been a great year for women in tech, with all the news of sexism coming out of Silicon Valley. What are the challenges of being a female in the male-dominated healthcare tech world?
Women in tech face tremendous challenges of discrimination and sexual harassment, and events this fall are finally making it clear that these problems exist in virtually all fields. With the #MeToo campaign, women are feeling emboldened to tell their stories, but there are many more women out there who still fear the consequences of coming forward. I hope our cultural norms are finally changing so that men will understand this behavior has no place in the world. But the point isn’t for men to resist the urge to discriminate against and harass women; it is for the thought to never even occur. My hope is that by the time the next generation comes of age, sexual discrimination will be unthinkable.
What aspect of your path do you think has been the most motivational to other young women coming up through the ranks? How do you share that part of your experience with people?
I think it can be quite inspiring when someone is able to take their pain and build something good out of it. For me, the pain was the loss of people I loved, three of my four grandparents, to diseases that should have been manageable — if only they had the proper education and knowledge. The idea for Outcome Health was born out of this pain, and that is why I am so passionate about patient education. I always tell other entrepreneurs to find that passion and never let it go. It fuels you when things get hard.
This year you were named to Fortune's 40 Under 40 List. When you first founded your company, did you have any idea it would be so successful?
I knew that our business had extraordinary potential, but I also knew that we would have to work incredibly hard to realize it. Our success was not overnight; we’ve been building this company for 11 years now. In a way, this success is not a surprise. It’s what I envisioned. But in another way, it is wild to look back and see how far we’ve come. I’ve learned that even with hard work, success is not guaranteed.
Being self-made means committing to self-care, too. How do you fuel and refresh yourself when shit really starts to get hard?
It’s critical to take a step back and remove yourself from the situation. It gives you the opportunity to think objectively and holistically about the outcomes. Things getting hard usually mean that there is an opportunity to reflect, adapt, and change.

These are difficult times for the American dream, but I am unfailingly optimistic that today’s young people are the right stewards of that dream.

What's your Self-Made Mantra for other women, no matter where they are in the process?
Focus on what matters most. The beauty of that mantra is that it’s quite flexible, and it allows for the reality that “what matters most” can be defined differently depending on the circumstances. Sometimes that may be your career. After a big project wraps up, it may be self-care. This mantra also acknowledges that you cannot be focused on all things at all times. Women feel such pressure to have it all, and I think that unrealistic expectation does real harm.
What are you generally doing at midnight?
Sleeping! I have always been someone who works harder, but as I’ve gotten older, I’ve learned to work healthier, too. I can’t work in a company that promotes positive health outcomes but ignore my own. Research reveals that sleep is critically important to overall health, energy levels, focus, mood, and brain function. Getting enough sleep at night makes me far more effective, and I’ve gotten up at 6:00 a.m. without an alarm for years.
What's the American Dream for women today?
When I was growing up in India, the American dream, to me, meant the ability to make your own path. But over the last 13 years, since I have lived in America, the meaning of the American dream has taken on more nuance. It means the ability to make your own path while knowing that your country has your back. The dream is of a country that understands how helping people succeed will make the entire nation succeed. These are difficult times for the American dream, but I am unfailingly optimistic that today’s young people are the right stewards of that dream. It will not die.
We know about the problems with the boys club. What are some of the pitfalls of the girls club?
“The boys’ club” has always referred to what happens when men help each other at the expense of others. But in our culture, men have always been on top. They don’t need help. I have never seen anything but positive outcomes when women help women, and I would not compare that to “the boys’ club” in any way. I have benefited from tremendous mentoring by other women, and I have worked hard to provide that type of mentoring, too. To both men and women. We need more of it.
You started Outcome Health when you were still in college. Do you miss those early days?
I look back on those days fondly. We couldn’t quite imagine everything that was ahead of us, but we worked as hard as we could. We were full of that youthful optimism where you don’t quite know what you don’t know — and sometimes that’s good! But I wouldn’t go back to those days. Outcome Health is in an impactful phase of growth, and we are now seeing the fruits of those early years. From day one, Outcome Health has been committed to improving the health outcomes for every person in the world. Though much has changed from the early days and creating business plans in my dorm, our mission remains the same.

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