Overview of 20VC: $5BN in Revenue, 7 to 7,000 Employees in 9 Months, 206,000 Tests in a Single Day: The Craziest Story in Startups: Curative with Fred Turner
Harry Stebbings interviews Fred Turner, co-founder and CEO of Curative, about one of the wildest startup journeys in recent memory: from cattle DNA testing to sepsis diagnostics, to building one of the largest COVID testing businesses in the U.S., and then pivoting into health insurance. The conversation explores how Curative scaled at extraordinary speed during COVID, why the business later had to contract, and how AI is now reshaping the company’s operations and future.
From Cows to Healthcare: Fred Turner’s Founder Origin Story
Fred’s startup path began in the UK with TL Biolabs, a genomics company that started by testing dairy and beef cows to predict traits like milk yield and musculature.
Key early lessons
- He says the UK startup ecosystem was much harder to raise from, especially for young founders without elite credentials.
- Moving to Silicon Valley gave him access to a more possibility-oriented investor mindset.
- He was accepted into Y Combinator in 2016 and raised an early seed round from Andreessen Horowitz.
The pivot path
- Cows → human diagnostics → STDs → sepsis
- The throughline was always DNA testing, but the market got larger and more urgent with each pivot.
- The sepsis work revealed a critical insight: even great diagnostics fail if frontline systems are too overwhelmed to use them in time.
The COVID Explosion: Building Curative at Warp Speed
Curative was originally conceived as a better way to handle sepsis in community hospitals, but COVID forced a radically different direction.
How the pivot happened
- Curative’s chief scientific officer had already developed a COVID test in spare time.
- When lockdowns hit and testing capacity disappeared, Curative moved fast to deploy it.
- Fred personally secured a new lab setup after having sold Curative’s original lab license shortly before the pandemic.
How they scaled
- They built an orthogonal supply chain, meaning they avoided the same bottlenecked suppliers everyone else was chasing.
- They sourced alternatives for swabs, extraction materials, and other consumables.
- They used a 50/50 joint venture structure at first, then bought out the partner when they realized the partner could not help scale.
The scale numbers
- Peak testing day: 206,000 tests in one day
- Employees: grew from about 7 to 7,000 in nine months
- Revenue: roughly $5 billion over three years
- Vaccinations: 2.5 million doses administered
Notable contracts
- Early testing deals were struck with local government and emergency services.
- The largest contract mentioned was a Florida nursing home testing program, worth hundreds of millions of dollars.
What Made Curative’s COVID Business Work
Fred emphasizes that most lab companies are built for efficiency at steady volume, not for explosive surge demand.
Why they won
- Traditional labs like Quest and LabCorp optimize around predictable workloads.
- Curative instead built for massive peak capacity, accepting inefficiency during lulls to be ready for surges.
- They were willing to overbuild infrastructure because public health required it.
The economics
- Testing was very profitable during surges.
- It often lost money during low-volume periods because the fixed infrastructure and staffing still had to be maintained.
- The company also lost money on vaccinations because reimbursement did not cover cost.
The Pivot to Health Insurance
Curative eventually transitioned from testing into health insurance, now valued around $1.3 billion.
Why insurance?
Fred and the team looked at several options:
- More lab testing businesses
- Hospitals
- Preventative care
- Primary care
They concluded the real control point in U.S. healthcare is the payer:
- Payers decide what gets paid for.
- That shapes what providers and patients actually do.
- Insurance offered a much larger and more durable opportunity than diagnostics alone.
The bigger thesis
- U.S. healthcare is highly consolidated and inefficient.
- The system is driven by incentives, not just care delivery.
- Curative wants to build a better payer using automation and AI to reduce administrative waste.
AI Has Rewired Curative’s Operating Model
This is the most forward-looking part of the interview: Fred argues that AI is already transforming insurance operations.
Functions being automated or transformed
- Credentialing
- Claims processing
- Underwriting
- Network contracting
- Data ingestion and cleanup
- Internal CRM and workflow tools
The credentialing example
- Previously: 2–3 months, ~$50 per doctor
- Now with an in-house Claude agent: ~12 hours, ~$0.20
The contract-negotiation agent “Gwen”
Curative built an AI agent that:
- researches providers
- finds contact info
- emails persistently
- negotiates rates
- redlines agreements
- signs contracts with Fred’s signature via DocuSign
Scale impact
- The team used to do about 100 contracts per week
- Gwen now does about 100 contracts per day
- In one recent period, the agent did 3,500 contracts in eight weeks, compared with 2,300 contracts across the prior year
Broader AI implications
Fred believes:
- Many back-office jobs will disappear or shrink dramatically.
- The most valuable human roles will be technical and relationship-driven.
- Companies will likely become smaller but more productive.
- The best use of AI is not just replacing work, but expanding volume at lower marginal cost.
SaaS Is Under Attack
Fred is openly bearish on traditional SaaS in many internal workflows.
Examples he gave
- Curative canceled a $600,000 Salesforce contract
- They are cutting about 80% of SaaS spend
- They are replacing several expensive tools with internal, AI-driven systems
- Their own claims platform is being rebuilt in-house
His view
- Many SaaS products are expensive because they are really just “administrative layers.”
- If AI can perform the workflow directly, the software often becomes redundant.
- Some infrastructure tools may persist, but many workflow tools are vulnerable.
What AI Means for Jobs and the Future of Work
Fred is unusually blunt about labor displacement.
His core view
- A lot of modern back-office work is repetitive, low-value, and ripe for automation.
- Job losses are real, especially in administrative roles.
- He believes societies will eventually need some version of universal basic income or other support structures.
But he is also optimistic
- He thinks AI will make many businesses dramatically more efficient.
- He expects humans to focus more on:
- relationships
- judgment
- architecture/supervision
- high-value exceptions
Fred’s Nuclear Startup: Subcritical
In addition to Curative, Fred has co-founded Subcritical, a nuclear fission company, with his wife.
The idea
- Nuclear is not mainly an engineering problem; it is a regulatory and deployment problem.
- Subcritical is based on an energy amplifier concept:
- The reactor runs below criticality
- A particle accelerator provides the extra neutrons
- If the accelerator is turned off, the reaction shuts down
- This makes the system inherently safer and easier to control
Why he thinks nuclear will matter more
- More nuclear power will be needed as energy demand grows.
- Coal will likely decline significantly.
- AI is also helping with nuclear design, especially in CAD and simulation workflows.
Personal Notes and Reflections
Fred also shares a few personal details:
- He and his wife shared genome files on their first date.
- He has two children.
- He says he learned that building with a spouse works because they are highly aligned.
- His advice to new parents: have kids earlier rather than later if you want the energy for it.
Key Takeaways
- Curative is one of the most extreme scale-up stories in startup history.
- Fred’s edge is not just founding vision, but the ability to scale regulated systems quickly.
- The company’s next act is being shaped by AI-native operations, not COVID testing.
- Traditional SaaS and back-office labor are increasingly vulnerable.
- Fred sees huge long-term opportunities in both healthcare infrastructure and energy infrastructure, especially where regulation slows incumbents.
Memorable Ideas and Quotes
- “The thrill of winning” is what drives him more than fear of losing.
- “It’s a lot easier to build a company the second time around.”
- “If no one ever runs the test, it doesn’t matter how good the test is.”
- “We don’t just displace labor — we do much more volume than we could before.”
- “We’re cutting about 80% of our SaaS spend this year.”