From First Meeting to IPO: Reflections on BillionToOne’s Journey

In the venture investment game, you never know when a connection will come along that changes everything. It was with that in mind that I took a meeting in 2019 with a precision diagnostics company called BillionToOne, who were looking to raise their series A round. Although biotech is not a major focus area for Neotribe, the wife of a fellow India Institute of Technology alumnus worked previously with BillionToOne co-founder Oghuzan Atay, so I agreed to meet with him for 30 minutes late on a Friday afternoon.

Instead, we ended up talking for a fascinating hour and a half, followed by three or four hours the very next day. I learned of the company’s truly unique capabilities for prenatal screening and disease detection. I also met a founder whose vision for success was equally matched by his integrity, authenticity and entrepreneurial hustle. Although the company had yet to earn any revenue, I was “in” —on the spot.

The deal that almost didn’t happen

Now it happened that another investor got wind of the deal and dropped a better term sheet on the table while this was happening. That investor even tried to lobby other seed round punters to edge Neotribe out of the deal. But Oguzhan never flinched. That’s how he is—a very principled man, with his eye on the twin outcomes of long-term success and genuinely making the world a better place.Since Neotribe’s investment, BillionToOne never missed a single quarterly target—not one. They grew from 10 tests per day in 2020 to over 100 tests per day in 2021 to several thousand tests per day in 2025. And after successfully raising B, C, and D rounds, the company went public on November 6, 2025.

On the eve of the IPO, I sat down with Oguzhan once again, to talk about the company’s journey, values, and formula for success. Oguzhan shared his perspectives on the importance of integrity in business, building a strong team and company culture, balancing a multi-product business, overcoming adversity, developing personally as a CEO, and the role of first principles in making tough decisions.

Below are a few excerpts from our discussion, with some edits for clarity. Or you can watch the full discussion.

On choosing Neotribe as an early investor

“We did have healthcare specialist investors that we were talking with. But at that time, there was no molecular diagnostics company that was worth 20 plus billion dollars. Most companies sold before they even hit a billion dollars market cap or valuation. So the healthcare specialist investors were thinking too small. I felt that the generalist investors could really cut through that incorrect pattern recognition and...”  Oguzhan Atay

“Think out of the box!”  Kittu Kolluri

“Yes! The other thing that I found was that really smart investors might not know molecular diagnostics, but you were asking better questions, to truly understand. ‘What can this do?,’ rather than trying to fit into a box that they already have. We would not have great alignment with that kind of investor. We had much bigger ambitions. And I think you had really big ambitions as well. So I thought that combination was perfect!” Oguzhan Atay

On integrity and principled decision-making

“Integrity is so important. People ask me, what keeps you awake at night? And I tell them nothing. I sleep really, really well. And the reason is that we are always making principled decisions. That is true when operating the company, or dealing with investors, and others as well. When you are principled, you sleep well, because you know that you made the best decision, based on the information that you had at that time.” Oguzhan Atay

On making BillionToOne his life mission:

“I had a good academic career, and I wasn't thinking of starting a company. I certainly didn't want to manage so many people. I felt that broadening humanity’s knowledge base was a very worthwhile goal. But I realized that I could actually have a really large impact in healthcare, really make a difference, and solve problems that no one else would solve. The first generation cell free DNA companies changed the standard of care, but they were looking at the problems in kind of a brute force way. I realized that if we actually applied mathematical, physical, statistical thinking, we could make a huge impact on so many people's lives today—not 100 years from now.” Oguzhan Atay

On solving hard problems

“I think approaching problems from first principles is very important. It really helps you get to the core, and allows you to out-execute your competitors. You might not know something. But being curious, asking questions, and finding the true reasons is very important. Our executives will tell you, I do not accept ‘but that is how we have always done things’ as an acceptable answer to any questions. We need to understand why something is the way it is. It might be that there are rules and regulations and laws. There can be very good reasons for something that might not immediately make sense. But approaching it from curiosity, and understanding from first principles is very important, because you cannot know everything that you don’t know.” Oguzhan Atay

On BillionToOne’s vision for the future

“We want to change the standard of care. We want to truly bring personalized medicine into reality. We want to solve really big problems. Not just prenatal genetics, but prenatal epigenetics, preterm birth, pre-eclampsia, and also to make the biggest impact in oncology care in a century. And you know that is possible, that is essentially written reach. Our goal in the next five years is to help millions of patients, both in prenatal and oncology, and become a generational company. We want to be the first molecular diagnostics company to become an S&P 500 company. When I said this three plus years ago, at that time, it sounded maybe not as believable. But now, it does look a lot like we are going to get there in the next five to seven years.” Oguzhan Atay

We at Neotribe are thrilled and delighted to be part of their journey, I believe and hope that we have added value along the way, and look forward to continuing to be part of this journey post IPO, as BillionToOne moves forward in its mission.