Healthcare • Fractional CTO

Rupa Health scaled 5x ARR while surviving a 300% traffic surge

HyperNest Labs stepped in as fractional CTO to harden infra, lead hiring, and prepare the technical story that supported Rupa Health’s growth through acquisition by Fullscript.

$100K → $5M

ARR scale

300%+

Traffic absorbed

<0.5s

Core web vitals

4 → 15

Engineering team growth

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Client snapshot

Company: Rupa Health
Industry: Healthcare SaaS
Stage: Seed → Series A → Acquisition
Headquarters: San Francisco, CA
Website: www.rupahealth.com/

Timeline

Week 1
Stabilized infra, set up observability, and triaged debt.
Month 2
Led hiring loops for full-stack engineers and implemented new sprint rituals.
Month 4
Completed technical diligence materials for incoming investors.
Month 6+
Supported integration planning ahead of the Fullscript acquisition.

The challenge

Demand for Rupa Health’s lab marketplace exploded overnight, but the engineering team was stuck firefighting. Systems were tightly coupled, monitoring was limited, and hiring struggled to keep up with product demand.

–Traffic tripled during seasonal spikes with limited autoscaling
–Investors requested architecture documentation that didn’t exist
–High-touch onboarding requirements slowed execution
–No dedicated leader to manage hiring pipelines or code quality

What we built

We embedded as fractional CTO, starting with an architecture deep dive and incident response plan. From there we reorganized teams into pods, implemented observability, and stood up a hiring machine.

Introduced ADRs, technical review rituals, and performance budgets

Refactored services into modular domains with shared libraries

Implemented Datadog dashboards, SLOs, and real-time alerting

Designed and ran hiring loops for frontend, backend, and data roles

Created board-ready updates and investor diligence materials

Impact

Rupa Health continued shipping new revenue lines (Lab Ordering, Telehealth) while maintaining 99.99% uptime. Engineering morale rebounded, hiring pipelines produced senior candidates, and investors gained confidence in the technical story.

Revenue grew 5x with zero major incidents during the surge

Board and investors received weekly engineering scorecards

Time-to-hire for senior engineers dropped from 90 to 35 days

Acquisition diligence completed in eight weeks with no rework

Stack & capabilities

Tools, platforms, and competencies we owned for this engagement.

Frontend

Next.js
React
Tailwind

Backend

Node.js
GraphQL
PostgreSQL

Infra & Ops

AWS
Terraform
Datadog
PagerDuty

“Aravind is in the top 1% of engineers I’ve hired. He kept us shipping through crazy growth and investor scrutiny.”

Tara Viswanathan

Co-founder & CEO, Rupa Health

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