Healthcare • Fractional CTO

Rupa Health scaled from $100K to $5M ARR during Seed to Series A

HyperNest Labs stepped in as fractional CTO during the early stages to harden infrastructure, lead engineering hiring, and build the technical foundation that supported Rupa Health's rapid growth.

$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
Headquarters
San Francisco, CA
Website
rupahealth.com/

Timeline

  1. Week 1

    Stabilized infra, set up observability, and triaged debt.

  2. Month 2

    Led hiring loops for full-stack engineers and implemented new sprint rituals.

  3. Month 4

    Completed technical diligence materials for Series A investors.

  4. Month 6+

    Continued scaling infrastructure and team as ARR grew to $5M.

Problem → Action → Outcome

A quick operator-level summary of what changed.

Problem

A fast-growing healthcare marketplace was experiencing 300% traffic spikes without a dedicated CTO, clear architecture ownership, or investor-ready documentation during the critical Seed to Series A phase.

Action

HyperNest embedded as a fractional CTO during the early stages, re-architecting key services, installing observability, and building the hiring + diligence playbook alongside the founders.

Outcome

Rupa Health scaled ARR from $100K to $5M, rode out the surge with 99.99% uptime, and built the technical foundation that supported future growth. The company was later acquired by Fullscript.

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 the technical foundation was set for future growth.

ARR grew from $100K to $5M with zero major incidents during the surge
Board and Series A investors received weekly engineering scorecards
Time-to-hire for senior engineers dropped from 90 to 35 days
Built scalable systems serving thousands of practitioners

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 supported us from $100K to $5M ARR, keeping us shipping through crazy growth and investor scrutiny.”

Tara Viswanathan

Co-founder & CEO, Rupa Health

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How this applies to other startups

  • •If you are an early-stage healthcare or SaaS startup facing sudden demand, you can borrow a pre-Series A CTO playbook instead of learning scaling lessons the hard way.
  • •Founders preparing for a major fundraise can use the same architecture, metrics, and diligence patterns we deployed at Rupa Health during their Seed to Series A journey.
  • •Teams without a full-time CTO can still run board-ready engineering and reliability rituals by embedding fractional leadership plus a small IC bench.