“We’ve only scratched the surface of what we can become.”
Counsyl just hit a major milestone. The number of people who’ve used one of our DNA screens has passed a half million. “This is an incredible moment,” says co-founder and CEO Ramji Srinivasan. Hitting this number is an even bigger deal when you consider that expanded carrier screening didn’t exist when the Family Prep Screen, our flagship product, was introduced in 2010. At the time, physicians were ordering carrier screens one disease gene at a time. Since then expanded carrier screening has gotten enough traction that five medical societies came together earlier this year to issue a joint statement to help clarify for physicians how to use it and who can benefit from it.
“First we created the model for expanded carrier screening,” says co-founder Eric Evans, Chief Science Officer. “We’ve been building a case for how it can help families ever since.”
“First we created the model for expanded carrier screening. We’ve been building a case for how it can help families ever since.”
How Counsyl met this milestone is also the story of how a software startup became a healthcare technology company that makes it easier for doctors to deliver high quality care. That transition can be charted in part by recognizing a few of the company’s other notable achievements.
Since its start, the Counsyl team has provided more than 10,000 hours of genetic counseling; built our own lab; introduced state-of-the-art automation for processing samples; published peer-reviewed research papers in several medical journals and presented findings at dozens of conferences world wide; ushered in next-generation-sequencing; won industry recognition for our tracking and results delivery systems; set up partnerships with almost every major insurer; introduced the Informed Pregnancy Screen to identify chromosome risk very early in pregnancy and, just this year, an expanded hereditary cancer panel, the Inherited Cancer Screen.
“It’s a solid start,” says Ramji, who took a break recently to reflect on how the company has grown since its 2007 launch, “but we’ve only just scratched the surface of what we can become.”
“The opportunity is massive and we were naïve enough to think it could be us who figures it out.”
In 2006, chips that read sections of the human genome were newly developed and Eric Evans, a molecular biologist fresh out of Stanford, couldn’t stop thinking about the science’s potential for transforming the way medicine is delivered. He shared his vision with Balaji Srinivasan, another Stanford graduate, who looped in his brother Ramji, who was working on Wall Street and eager to return to California to do something more important than, as he puts it, “pushing around pieces of paper.”
“The thinking was that the genome is going to become important because of its potential to impact health,” says Eric. “That gap, which was how to make the genome useful, was also the opportunity. Someone had to translate that promise into reality and we decided we were going to be the ones to do it.”
Rishi Kacker, now VP of Product, left Voltage, a data security company, to sign on as another co-founder. “The opportunity is massive and we were naïve enough to think it could be us who figures it out,” he says. “Why not?”
“We figured out the importance of asking people what they actually want.”
In the beginning they thought more like engineers than entrepreneurs. “We were starting with the solution and looking for the problem,” says Ramji. Their strategy for making the genome useful was to write software applications on top of genomic code. “That was before we figured out the importance of asking people what they actually want,” says Ramji.

What he, along with the rest of the Counsyl team, quickly discovered is that our target audience isn’t all that interested in genomics for its own sake. Counsyl introduced the idea that 100 genes could be screened for the price of one – and promptly ran into resistance. Physicians told us they were concerned they wouldn’t be able to handle the additional load of positive responses. “So we tried to explain our point of view,” says Ramji, “and learned pretty quickly that it’s not a good idea to argue with your customer!”
The team regrouped. Rishi, whose father, a doctor, had advised his son against going into medicine, says the early years amounted to a crash course on the complexities of the American healthcare system.  “We started thinking, can we give time back to physicians so they can spend more time with patients?” he says. Physicians may not be excited about genomics, reasoned the team, but they do care about helping at-risk couples. So why not make it easier for doctors to do the right thing?
That approach has guided the company’s development ever since. “We moved from technology for its own sake to enabling better clinical decisions,” says Ramji. “And that’s been the narrative arc for all our products.”
“It takes an insane intersection of product, technology, and science to build this.”
The startup conceived as a solution to tapping the genome’s potential set its sights on tackling modern medicine’s delivery problems. Counsyl made it painless for physicians to coordinate screening for patients, introduced an easy-to-understand tracking and results delivery system, and added on-demand genetic counseling to help explain results to patients. We built our own lab to better manage costs and quality, adopted price transparency as a goal, and began to think more aggressively about our potential impact on healthcare overall.
“It has taken an insane intersection of product, technology, and science to build this,” says Rishi. “But the benefit is substantial. Lab testing influences 80 percent of spending on healthcare. If you can improve there, it has a disproportionate impact on healthcare spending.”
“We want to be a leader in creating the kind of experience that patients like us expect from medical care.”
When Ramji anticipates the next milestone it’s no surprise he wants Counsyl to be the name people think of when it comes time to be screened. Toward that end the company encourages a culture of listening to patients and physicians to find out what they want from us. The team also relies on data for inspiration and guidance.  “We’ve built a powerful engine that generates huge amounts of data and has given us powerful insights,” says Ramji.
The founders agree that a big driver for the company over the next five years is to make screening a routine part of preventive care. “We want DNA testing to be a part of every health conversation around pregnancy, oncology, and health care,” says Rishi. A means to that end is making the Counsyl experience gratifying for the physicians and patients who use it. That thinking has been incorporated into the way every new Counsyl product and service is now developed.
“We want to be a leader in creating the kind of experience that patients like us expect from medical care,” says Rishi. For the team that has asked “why not” from the start, that might just be the next milestone to celebrate.