The Future of Healthcare Revenue: Eliana Berger on Fragmentation, AI, and Financial Infrastructure

Inside Clinical Trials: Kyle McAllister on Infrastructure, AI, and Building in Healthcare

In this episode of First Builders, Amber Illig and Rachel Tsui talk with Kyle McAllister, Co-founder and CEO of Trially, about what it really looks like to build inside the clinical trial ecosystem. Kyle shares how his experience working across Epic and Cerner shaped his understanding of healthcare systems and why clinical trials remain one of the most operationally complex parts of the industry. What seems like a data challenge at first often turns out to be a workflow and coordination problem in practice. Through Trially, the team is focused on helping clinical sites identify and enroll patients more efficiently by working directly within existing systems. Instead of replacing infrastructure, the goal is to improve how teams operate day to day. Amber and Rachel also explore what it takes to build in healthcare, from establishing trust with customers to navigating long timelines and deeply embedded processes. The conversation highlights how credibility and real experience in the space can change the trajectory of a company early on. Topics covered: * What EHR implementations look like on the ground * Where clinical trial workflows slow down * Why connecting healthcare systems is difficult * How trust influences adoption in clinical environments * The role of AI in improving patient matching * Building with co-founders from different backgrounds * Selling into healthcare organizations * Why progress in healthcare takes time * Lessons from moving into entrepreneurship * This episode offers a grounded look at building in healthcare, where progress depends on understanding both the systems and the people operating within them. FOLLOW KYLE MCALLISTER Website: https://www.trially.ai/ LinkedIn: https://www.linkedin.com/in/kylemcallister FOLLOW THE COUNCIL & FIRST BUILDERS ⁠Newsletter⁠ [https://thecouncil.beehiiv.com/subscribe] YouTube: ⁠@firstbuilderspod⁠ [https://www.youtube.com/@firstbuilderspod] Instagram: ⁠@thecouncilcapital⁠ [https://www.instagram.com/thecouncilcapital/] Twitter/X: ⁠@first_builders_⁠ [https://twitter.com/first_builders_] TikTok:⁠ @firstbuilderspod⁠ [https://www.tiktok.com/@firstbuilderspod] LinkedIn: ⁠The Council⁠ [https://www.linkedin.com/company/the-council-angels/]

Building for Builders: Meagan Gamache on Craft, Platforms, and the Future of DevTools

In this episode of First Builders, Amber Illig and Rachel Tsui sit down with Meagan Gamache, VP of Product at Render, to explore what it really means to build products for the people who build everything else. Meagan shares her unconventional path from biology and academic research into engineering at Heroku, where she discovered a deep appreciation for the speed, feedback loops, and craftsmanship of developer tools. From there, she went on to help shape some of the most influential platforms in tech, including Slack, Figma, and Webflow before stepping into a leadership role at Render during the rise of AI-native development. The conversation dives into the nuances of building platforms that scale, from defining early developer ecosystems at Slack to enabling cross-company collaboration at Figma. Meagan also unpacks how product leaders evolve into company builders, what it takes to hire high-impact teams, and why clarity of thinking matters more than ever in an AI-driven world. They also explore how emerging technologies are reshaping software creation, why the “SaaS apocalypse” may be overstated, and how the next generation of tools will empower a new wave of builders while still demanding deep expertise and strong judgment. Topics covered include: * What “craft” really means in developer tools and why it matters * Lessons from building platforms at Heroku, Slack, and Figma * Transitioning from engineering into product leadership * How to design products that scale across teams and organizations * Hiring and building high-agency product teams * The evolving role of product leaders in shaping company strategy * Why SaaS isn’t going away and what’s misunderstood about AI builders * The difference between systems of record and systems of action * How ecosystems succeed (and why most fail) * The responsibility of building infrastructure used by millions This episode offers a thoughtful look at building enduring products, leading with intention, and navigating the shifting landscape of software in the age of AI. FOLLOW MEAGAN GAMACHE X: @meaganrgamache LinkedIn: https://www.linkedin.com/company/renderco/ FOLLOW THE COUNCIL & FIRST BUILDERS Newsletter [https://thecouncil.beehiiv.com/subscribe] YouTube: @firstbuilderspod [https://www.youtube.com/@firstbuilderspod] Instagram: @thecouncilcapital [https://www.instagram.com/thecouncilcapital/] Twitter/X: @first_builders_ [https://twitter.com/first_builders_] TikTok: @firstbuilderspod [https://www.tiktok.com/@firstbuilderspod] LinkedIn: The Council [https://www.linkedin.com/company/the-council-angels/]

Reindustrializing America: Zane Hengsperger on Building Nox Metals and the Future of Manufacturing

In this episode of First Builders, Amber Illig and Rachel Tsui sit down with Zane Hengsperger, Founder and CEO of Nox Metals, an AI-powered metal supplier building automated factories in Detroit. Zane grew up around manufacturing. His father owned a machine shop, and from an early age he saw how the industry actually works on the ground. After a brief stint in tech, he made a deliberate decision to return to the industrial world, driven by a belief that rebuilding America’s manufacturing base is both economically and strategically critical. Through Nox Metals, Zane is rethinking how raw materials move through the supply chain. By combining software, automation, and factory operations, his team is working to deliver metal faster, more reliably, and at lower cost. The goal is not just incremental improvement, but a fundamental shift in how industrial supply chains operate. This conversation explores what it really takes to build a hard tech company, from running a physical factory to navigating outdated systems and unlocking speed through technology. It also highlights why manufacturing is becoming one of the most important frontiers for builders today. WHAT WE COVER * Why Zane left tech to pursue manufacturing and reindustrialization * How the metal supply chain actually works and where it breaks down * Treating the factory itself as the product * Using software and AI to compress timelines from days into hours * Why U.S.-based production has a growing advantage in speed and responsiveness * Selling modern tools to industries that have operated the same way for decades * The importance of capturing tribal knowledge and digitizing factory operations * Building in public and how it impacts hiring, customers, and momentum * The realities of running a physical operation where problems cannot be solved from a laptop * Why raw capacity, not just innovation, is critical to rebuilding industry This episode is a clear look at what building in the physical world actually demands. It challenges the idea that the most important companies will be purely software-driven and makes the case that the next wave of impact will come from combining software with real-world infrastructure. Zane’s perspective also highlights a broader shift. Manufacturing is no longer just legacy industry. It is becoming a space where ambitious founders can tackle massive, unsolved problems with both economic and national significance. FOLLOW ZANE HENGSPERGER Website: https://noxmetals.co/ LinkedIn: https://www.linkedin.com/in/zanehh/ X: https://x.com/zanehengsperger [https://x.com/zanehengsperger] TikTok: https://www.tiktok.com/@noxmetals [https://www.tiktok.com/@noxmetals] Facebook: https://www.facebook.com/people/Nox-Metals/61586796136699/ [https://www.facebook.com/people/Nox-Metals/61586796136699/] Instagram: https://www.instagram.com/noxmetals.co/ FOLLOW THE COUNCIL & FIRST BUILDERS Newsletter [https://thecouncil.beehiiv.com/subscribe] YouTube: @firstbuilderspod [https://www.youtube.com/@firstbuilderspod] Instagram: @thecouncilcapital [https://www.instagram.com/thecouncilcapital/] Twitter/X: @first_builders_ [https://twitter.com/first_builders_] TikTok: @firstbuilderspod [https://www.tiktok.com/@firstbuilderspod] LinkedIn: The Council [https://www.linkedin.com/company/the-council-angels/]

The Future of Healthcare Revenue: Eliana Berger on Fragmentation, AI, and Financial Infrastructure

In this episode of First Builders, Amber Illig and Rachel Tsui sit down with Eliana Berger, Co-Founder and CEO of Joyful Health, following the company’s recent $22M raise and rapid growth. Joyful Health began with a simple but overlooked issue. Healthcare providers often have no clear way to track or recover the revenue they are owed. Financial data is scattered across systems, timelines are unclear, and significant portions of revenue go uncollected. After spending months working directly inside practices, Eliana built Joyful Health to bring that data into one place and help providers understand and recover what they are owed. As the company has grown, the experience has been less about finding demand and more about keeping up with it. The team is expanding quickly, onboarding larger customers, and building infrastructure in parallel with growth. This conversation explores what it looks like to build in a market that is shifting quickly and how that changes the pace and pressure of execution. We cover: * Why distribution came easier than expected and what that changes * What it feels like when demand outpaces internal systems * How recent advances have shortened implementation timelines * Hiring ahead of need and planning beyond the current moment * Building community as a long-term advantage, not just a marketing channel * The shift from early vision to proof and traction in later stages * Staying focused while opportunities continue to expand This episode is a look at building when conditions are moving in your favor and what it takes to keep pace without losing discipline. FOLLOW THE COUNCIL & FIRST BUILDERS Newsletter [https://thecouncil.beehiiv.com/subscribe] YouTube: @firstbuilderspod [https://www.youtube.com/@firstbuilderspod] Instagram: @thecouncilcapital [https://www.instagram.com/thecouncilcapital/] Twitter/X: @first_builders_ [https://twitter.com/first_builders_] TikTok: @firstbuilderspod [https://www.tiktok.com/@firstbuilderspod] LinkedIn: The Council [https://www.linkedin.com/company/the-council-angels/]

Trust Is the Product: Tina Hwang on Navigating Regulation, Global Growth, and Chaos

In this episode of First Builders, Amber Illig and Rachel Tsui sit down with Tina Hwang, Head of Legal at ClassDojo, whose career spans some of the most consequential moments in modern tech. From Google’s rise to WhatsApp’s global expansion, Twitter’s governance transition, and Ancestry’s privacy leadership, Tina has operated at the intersection of hypergrowth, regulation, and trust. Tina shares why legal isn’t just a safeguard but a strategic lever for growth, especially in globally scaled, highly regulated environments, and draws on her experience building governance systems for companies serving billions of users to explain how trust becomes infrastructure, not just a brand attribute. She explores how companies can navigate ambiguity, balance speed with responsibility, and design products that earn long-term trust across cultures and geographies, while also reflecting on leadership in uncertain moments and why empowering teams, not having all the answers, is what truly defines effective leaders. We cover: * Why legal strategy should be embedded into business and product decisions from day one * Lessons from scaling WhatsApp globally across complex regulatory environments * How trust is built through product design, not just policy * The myth that “good tech wins” and why global success is also political and cultural * Designing for different cultural norms, user expectations, and regulatory systems * Trade-offs between speed and safety and how to make reasoned risk decisions * Why regulation can be a foundation for growth, not just a constraint * Building industry-wide frameworks like in consumer health data to earn user trust * Leadership in ambiguity and creating context instead of providing answers * The importance of reflection, focus, and decision-making under uncertainty This episode is a deep dive into what it takes to build responsibly at scale and how trust, when treated as a core design principle, becomes a company’s most durable advantage. FOLLOW TINA HWANG Book- Careless People [https://www.amazon.com/Careless-People-Cautionary-Power-Idealism/dp/1250391237] ⁠Tina Hwang LinkedIn⁠ [https://www.linkedin.com/in/tinachwang/] ⁠ClassDojo LinkedIn⁠ [https://www.linkedin.com/company/class-dojo/] FOLLOW THE COUNCIL & FIRST BUILDERS ⁠Newsletter⁠ [https://thecouncil.beehiiv.com/subscribe] YouTube: ⁠@firstbuilderspod⁠ [https://www.youtube.com/@firstbuilderspod] Instagram: ⁠@thecouncilcapital⁠ [https://www.instagram.com/thecouncilcapital/] Twitter/X: ⁠@first_builders_⁠ [https://twitter.com/first_builders_] TikTok:⁠ @firstbuilderspod⁠ [https://www.tiktok.com/@firstbuilderspod] LinkedIn: ⁠The Council⁠ [https://www.linkedin.com/company/the-council-angels/]