Healthcare IT & operations · Radiology
Avoca Systems
An AI layer that answers the phone, runs the booking system and chases the referral for radiology clinics. Live across more than 250 Australian clinics by the company’s own count, and now, as a 2026 Y Combinator company, pushing into the United States.
The call that goes unanswered
A patient leaves a doctor’s office with a referral for an MRI. She calls the imaging centre the front desk suggested. The line rings. The receptionist is already on two other calls. She hangs up and tries the next clinic on the list.
That is not a rare event. In its Y Combinator launch post, Avoca Systems says “up to 30% of calls into radiology centres go unanswered as patients wait on hold,” and that referrals “arrive through phones, websites, faxes and electronic systems, leaving staff to manually interpret documents, contact patients and coordinate appointments across multiple systems.” Each dropped call is a scan slot that does not get filled.
Avoca’s pitch is to sit on top of that mess rather than replace it. Its software answers the inbound call, runs outbound campaigns for rebooking and cancellations, reads faxed and electronic referrals, and walks patients through prep instructions, reminders and results, wired back into the clinic’s existing radiology information system, or RIS.
Why radiology, specifically
Scheduling a scan is not like booking a haircut. A valid radiology appointment depends on the modality, the body region, whether contrast is needed, patient history and allergies, prep instructions, which machines are free, and what the referring provider asked for. The launch post describes these rules as “fragmented across legacy systems, spreadsheets and the tacit knowledge of experienced receptionists,” which is why, it argues, “generic voice and scheduling tools struggle to bring them together.”
Avoca calls its answer “operational intelligence”: software that learns a specific clinic’s rules rather than forcing every site onto one generic workflow. The company says it is embedded directly into a network’s RIS, so a booking confirmed by the AI writes back into the clinical system in real time. Its site lists integrations with Visage, Karisma, Comrad, Epic, Oracle Health and eClinicalWorks, none of which is independently confirmed here.
The wider argument is a staffing one. Radiology providers, the company says, face “staff shortages, rising operating costs and reimbursement pressure,” and a growing network usually has to hire receptionists and schedulers in proportion. Avoca’s claim is that a network can add clinics without adding headcount at the same rate.
Founders
Max Shand, the CEO, is not new to building companies. He was the first employee at Afterpay, the Australian buy now, pay later firm that Block acquired in 2021. An Australian technology outlet, The Chainsaw, profiled him in 2022 as “a former OG employee of Afterpay, former VP of FBi Radio’s board, and former concert fence and back stage jumper,” and reported that he ran a venture syndicate called Strangelove before founding Serenade, a platform selling collectible “digital pressings” to music fans. The Sydney Morning Herald reported in June 2022 that Serenade had raised $6 million from investors including Hugh Jackman and musician Bernard Fanning. Y Combinator’s own company page describes Shand as an “exited founder of Serenade” and says Afterpay went from idea to a “$20BN exit to Block,” a figure that differs from the $29 billion exit value The Chainsaw reported for the same deal, most likely because Afterpay’s stock-swap acquisition was valued differently at announcement and at close.
Campbell Mercer-Butcher, the CTO, has an engineering background rather than a founder track record. Y Combinator’s company page describes him as a “principal engineer at Honey Insurance, Macquarie Bank, and Ailo,” crediting him with building “Macquarie’s robo-advice platform, used by 1,000+ financial advisors.” None of that history is independently verified here; it is company-stated, drawn from the YC founder bio and the directory founders.io, which lists him as having founded Avoca Systems in 2026.
From an Australian rollout to a Y Combinator batch
Extruct AI lists Avoca Systems as founded in 2026, based in San Francisco, with 11 to 50 employees; LemStudio puts the team at 8 as of mid-2026. Avoca is part of Y Combinator’s Summer 2026 batch, with Jon Xu listed as its YC partner. By the time of its launch post, the founders said Avoca was already “live across more than 250 clinics, including networks operating 150+ locations,” and named “several of Australia’s largest radiology networks” as partners, unnamed. The same post says the company is “now expanding into the United States” and describes the founders as “new to the US.”
The company’s site carries a customer quote from Jobfit, an occupational health provider, attributed to Sam Netherclift there: “About 99% of people who use the service don’t even recognise that it’s AI. They’re happy with it, they just book.” A separate line on the same page claims “the AI converted 30 bookings within half a day.” Both are company-published testimonials, not independently confirmed figures.
What is proven, and what is still claimed
| Evidence | What the record shows | Source type |
|---|---|---|
| Company existence | Registered profile on Y Combinator, Summer 2026 batch, Healthcare category. Extruct AI lists it as founded 2026, San Francisco, 11 to 50 employees. | Directory record |
| Clinic count | “Live across more than 250 clinics, including networks operating 150+ locations,” per the founders’ own YC launch post. No named customer network beyond Jobfit, an occupational health provider quoted on the company site. | Company-stated |
| Performance metrics | Call abandonment “from approximately 30% to 2%,” patient satisfaction “averaging 4.6/5,” and “more than 80% booking conversion for eligible patient calls in major deployments,” all stated in the company’s own launch post with no named methodology or third-party audit. | Company-stated |
| RIS and EHR integrations | Company site lists Visage, Karisma, Comrad, Epic, Oracle Health and eClinicalWorks as integrated systems. No customer or vendor confirmation found. | Company-stated |
| FDA record | No 510(k) or PMA filing under Avoca Systems found. The product is scheduling and communications software, not a diagnostic device, so an FDA filing would not ordinarily be expected. | Not found |
| SEC Form D | EDGAR company search for “Avoca” under Form D returns only an unrelated oil royalty trader and an unrelated software company. No filing for Avoca Systems, Inc. found. | Not found |
| Founder background | Max Shand’s role as Afterpay’s first employee and founder of Serenade is corroborated by independent Australian press (The Chainsaw, Sydney Morning Herald). Campbell Mercer-Butcher’s engineering history at Honey Insurance, Macquarie Bank and Ailo is sourced only to the YC founder bio, not independently confirmed here. | Partly independent |
Read plainly: everything specific to Avoca Systems, its clinic count, its metrics, its integrations, comes from the company itself, either directly or through its Y Combinator launch post. No regulator, filing, funder or named customer network has confirmed or disputed those numbers. The one piece that is independently checkable, Max Shand’s prior venture history, does hold up, though the two accounts of Afterpay’s exit value do not match each other exactly.
What to watch
- Whether any named Australian radiology network confirms the “250 clinics” figure or the call metrics on the record.
- A first announced US customer or pilot, given the company says it is “new to the US” and actively seeking introductions.
- Any SEC Form D or other funding disclosure, since none has been found as of this writing.
- Independent trade press coverage of Avoca Systems itself. As of September 25, 2026, none has been found beyond startup directories and aggregators.
In their words
“We’re already live across more than 250 clinics, including networks operating 150+ locations.”
Max Shand and Campbell Mercer, co-founders, Y Combinator launch post, 2026 · Company
“Up to 30% of calls into radiology centres go unanswered as patients wait on hold.”
Avoca Systems, Y Combinator launch post, 2026 · Company
“Healthcare is a chaotic mess of work that falls between systems: calls that go unanswered, referrals that sit in fax queues and operational knowledge that exists only in the heads of experienced staff.”
Max Shand and Campbell Mercer, Y Combinator launch post, 2026 · Company
“About 99% of people who use the service don’t even recognise that it’s AI. They’re happy with it, they just book.”
Sam Netherclift, Contact Centre Supervisor, Jobfit, quoted on the Avoca Systems site · Customer, company-published
“A former OG employee of Afterpay, former VP of FBi Radio’s board, and former concert fence and back stage jumper.”
Samantha Howard, The Chainsaw, September 27, 2022 · Independent
“Founded by Max Shand, a venture capitalist, music writer and the first employee at tech giant Afterpay.”
Dominic Powell, The Sydney Morning Herald, June 29, 2022 · Independent
“Co-founder of Avoca, the operating system for outpatient radiology networks. Previously, exited founder of Serenade, innovative music merchandise platform for artists like Oasis, Yungblud and Lewis Capaldi. Formerly, first employee at Afterpay, helping scale from idea to $20BN exit to Block.”
Y Combinator founder bio, Max Shand, 2026 · Company
Related companies
Sources
- CompanyAvoca Systems: The AI operating system for radiology networks, company launch post
- CompanyAvoca Systems homepage
- CompanyBooking engine product page
- CompanyCareers page
- DirectoryAvoca Systems, YC Summer 2026 healthcare startup profile
- DirectoryAvoca Systems, operational intelligence for radiology networks
- DirectoryAvoca Systems Funding, Complete Analysis
- DirectoryAvoca Systems company profile
- DirectoryCompanies founded by Campbell Mercer-Butcher
- Public recordEDGAR company search, Form D filings matching “Avoca”
- Public recordCompany research file, records.json (FDA, NIH, NSF, PubMed, Form D searches)
- IndependentFrom a $29B Startup to Music History, How an Aussie Hit the Right Notes
- IndependentHugh Jackman joins NFT craze with raising for Aussie music marketplace
Profile researched and written by Healthcare Discovery. Last updated September 29, 2026.
