"The honest answer?" Akshay Agrawal laughs. "I hate being told what to do."

This isn't the founder story you so often hear. There's no childhood business, no dramatic moment of inspiration, no single event that made him decide to become an entrepreneur. In fact, Akshay jokes that he “always needs to disappoint investors as they like this kind of storytelling”.

Instead, he spent a decade preparing to build his company at the right time.

"I always wanted to build something impactful," he says. "To set the vision, set the standard."

Born and raised in Arizona to immigrant parents, Akshay studied chemical engineering, convinced he would one day build a company in solar technology.

It didn't take long to realize engineering wasn't the destination.

Healthcare was.

The apprenticeship

Together with Josh Levitan and Suhaas Prasad, Akshay founded Onos Health, bringing together three very different but complementary skill sets. Akshay brought a decade of healthcare experience, Josh the product expertise to turn that vision into a customer centric product, and Suhaas the experience of a repeat technical founder, having spent a decade building his previous company, Aspire.

The combination gave Onos something rare from the beginning: deep knowledge of healthcare, product instinct and experience building technology companies from scratch."Healthcare is one of the few areas where you can build a big business that actually drives impact on people's lives," he says. "Everyone deals with healthcare at some point in their life, and always when they're at their most vulnerable."

Rather than rushing into entrepreneurship, Akshay spent the next decade deliberately learning every side of healthcare.

At Bain Capital Ventures, he learned how investors evaluate healthcare companies, reviewing hundreds of businesses before one stood out: mPulse, a digital engagement platform for health plans.

He took it to the investment committee.

It was rejected.
But Akshay couldn't shake the feeling they had gotten it wrong.
Instead of moving on, he left venture capital and called mPulse founder Chris Nicholson.
There wasn't even an open role.

"I don't have a position for you," Nicholson told him. "But I want you on."
Akshay joined the team.

Over the next four years, he worked alongside Nicholson, who quickly became one of his most influential mentors. Together, they grew mPulse's revenue by more than 10x before its sale, while Akshay learned firsthand what it takes to build and scale a healthcare company. In his mid-twenties, he was leading sales to some of the largest health plans in the U.S., among the toughest customers in healthcare.

Following mPulse's successful exit, Akshay became Chief Strategy Officer at Presence, where he applied those lessons while helping lead another phase of growth.

After years spent understanding how health plans worked, how providers operated, and where the industry's biggest pain points lay, advances in AI finally made it possible to rethink healthcare in ways that hadn't been possible before.

For Akshay, his time had finally come.

Building his life work

Today, Onos is building clinical intelligence for health plans, starting in behavioral health. The platform turns unstructured clinical documentation into actionable intelligence, helping health plans make better clinical decisions while reducing administrative burden.

But when Akshay talks about Onos, he rarely talks about software.

He talks about fixing healthcare.

His argument is simple: America's healthcare system isn't expensive because clinicians provide too much care. It's expensive because of administrative complexity.

"Payers, in trying to reduce waste, inadvertently created the biggest category of waste in the system," he says. "Administrative waste."

Most AI companies are trying to make today's processes faster. Akshay wants to eliminate many of those processes altogether.

"What if denials didn't exist? What if prior authorization didn't exist? What if medical coding didn't exist?" he asks. "That's what AI can really do."

His vision is to help payers and providers operate as a single clinical team, replacing paperwork with real-time, evidence-based decision making. Behavioral health is simply the starting point.

Fittingly, the company's name is inspired by ONOS, the Open Network Operating System, reflecting Akshay's ambition to build the operating system connecting healthcare.

"We're really shooting for something pretty big here," he says. "Shoot for the stars, you land on the moon."

When we at BHI first met Akshay, Onos was little more than an ambitious vision and a deck.

We backed Akshay and the team at pre-seed, doubled down at seed, and are proud to continue supporting them as they enter their Series A chapter.

"There's never been an instance since founding Onos where I've thought I shouldn't be doing this," he says. "Truthfully, it's just been so much freaking fun."

The old rule still holds: never bet against someone who's enjoying the fight.