Now that President Obama has been re-elected and the Supreme Court has upheld the Accountable Care Act, healthcare reform is here to stay. So what does reform mean for healthcare investors? I believe it will usher in a new fertile period for innovative,venture‐backed companies that can navigate the brave new world of healthcare delivery and management.
The Accountable Care Act impact on healthcare IT investing is already being felt.Venture investment in 2013 is showing significant growth from last year. In 2012,according to PWC, a global accounting firm,the life sciences sector which includes healthcare IT accounted for 25 percent of all venture capital dollars invested which totaled nearly $1.2 billion in 163 deals,more than double the $480 million in 49 deals in 2011 and almost six‐times the $211 million in 22 deals in 2010.
Now is the time to make order out of chaos and to set the stage for a next‐generation healthcare system that can effectively service our nation. At Psilos Group, we have just released our fifth Healthcare Economics and Innovation Outlook and identified the following four areas as the most promising opportunities for healthcare investors in 2013 and beyond: Private health exchanges, consumer‐focused insurance programs, 21st century healthcare technologies, and innovations that reduce error and waste.
Investing In Exchanges
The healthcare insurance marketplace—and the way insurance is bought and sold—is facing massive change.Healthcare insurance exchanges, both public and private,promise to create a more organized and competitive market for buying healthcare insurance, which could moderate price increases that are currently spiraling out of control.
From our perspective, exchanges are an intelligent place to invest. Software and services will power the exchanges. Psilos envisions massive opportunities for technologies that enable operators of both public and private exchanges to build high functioning platforms, including the shopping software and back‐end administrative technology and service products needed to serve tens of millions of people efficiently.
Continue reading “The Affordable Care Act: Like It Or Not, It’s Catalyzing a Golden Age In Health Care Investing”
Filed Under: The Business of Health Care
Tagged: ACOs, Al Waxman, Health Insurance Exchanges, HIT, Innovation, Investors, Psilos Groups, The ACA, venture capital
Apr 18, 2013
Last year was a banner year for digital health, as the market saw significant growth in funding, bigger deals and new investors entering the space. So what’s in store for 2013? According to a survey of nearly 140 digital health entrepreneurs and over 50 health care information technology venture investors, conducted by my venture capital firm InterWest Partners, we are in for another exciting ride this year. In the survey, we asked which sectors will see the most love from investors in 2013; which companies (if any) will see a $1 billion valuation; where they are having trouble recruiting; and which digital health entrepreneur would win “Survivor: HCIT Island” The answers? Well, it all depends who you ask.
Continue reading “Investors Are from Mars. Entrepreneurs Are from Venus”
Filed Under: THCB
Tagged: digital health, entrepreneurship, Funding, Health Insurance Exchanges, InterWest Partners, Michelle Snyder, Practice Fusion, venture capital
Feb 20, 2013
Everyone is always asking me what it is like being an EIR and why I decided to do it after my 5+ years working on Google Health. First of all, for those of you who are not familiar with the term – an EIR stands for either Entrepreneur in Residence or Executive in Residence. In the case of Morgenthaler Ventures, they were looking for a person with extensive experience in the Health IT sector at an executive level. This differs from a more traditional EIR title (entrepreneur in residence) where you are asked to incubate a startup from scratch with some support and resources. As an Executive in Residence, I work hand in hand with the firm’s partners to author the current health IT investing thesis, map out the industry, source companies that match our areas of interest, and help with diligence. The goal of my EIR term is to find a company that Morgenthaler can invest in and then join that company as part of the executive team. I picked Morgenthaler Ventures because of their track record in health IT (invested in Practice Fusion before Health IT was in vogue) and their leadership in the industry with the creation of the first DC to VC conference.
In its 3rd year, DC to VC was initially started by Rebecca Lynn, IT Partner at Morgenthaler Ventures to bring the venture capital community together with Washington D.C. policymakers. This year, I am proud to say that I am co-directing the DC to VC event and the health IT startup contest along with Matthew Holt and Indu Subaiya from Health 2.0. The contest will take place on the last day of the 2012 Health 2.0 Annual Fall conference in San Francisco on October 10, 2012. Online applications open today, June 4, 2012 and stay open until August 3, 2012.
Continue reading “A Life in the Day of an EIR: Health IT Ain’t No Bubble for Venture Capital (…. so apply for the DC to VC Health IT startup showcase)”
Filed Under: Health 2.0
Tagged: DC to VC, Entrepreneur in Residence, Health IT, Indu Subaiya, Matthew Holt, Morgenthaler Ventures, Practice Fusion, Rebecca Lynn, venture capital, Washington D.C.
Jun 4, 2012
Venture capitalists like to use the word “traction.” It sounds all glamorous, like an ad showing a Range Rover toughing it out up some impossible incline. But when I hear a company talk about ‘early traction’ in its pitch, I’m always leery of the “First and Worst” effect.
My first customer at my first company was a grandfatherly CIO at a big hospital. Of course I wanted to please him, and was enthusiastic about doing so. But I was also very focused on taking over the world with our software. I told him, “We’ll change anything you want about the product, as long as it’ll be good for all our future [gazillion] customers.”
Of course, The Grandfather wanted lots of one-off customizations that would really only be good for him. I told him that all the time we spent doing custom work for him was going to make us less profitable, and less likely to be able to sell the product to other people. And to survive long enough to do any improvements to the product at all, we needed to be profitable. He seemed to think that made sense, and begrudgingly agreed.
In the end this arrangement was a win for both of us. Our product was a home run for his hospital. We got an evangelical reference customer, and his hospital helped make our product better. The precedent we’d set with The Grandfather gave us the courage to refuse other customers who wanted one-off changes. Sure, we could have done this for one or two hospitals, but by the time we got to hospital 300, it would have been a mess.
Continue reading “Who’s Running Your Company: You or Your Client?”
Filed Under: The Business of Health Care
Tagged: Alan Ying, Chrysalis Ventures, customers, development, First and Worst, Innovation, scaling, software, The Grandfather, traction, venture capital
Jun 1, 2012
When I entered the VC business 10 years ago, I tried to keep thinking about venture capital as a business, where the key focus area was on meeting the needs of our target customers — entrepreneurs and limited partner investors.
In the case of entrepreneurs, those needs have changed radically in these last 10 years. The surge in seed investing over the last few years has been well-reported and analyzed. With advances in cloud computing, open source infrastructure, development tools and general “Lean Start-Up” techniques, entrepreneurs need less capital than ever before. And when entrepreneurs’ needs change (i.e., requiring less capital), smart investors adjust to meet those new needs. Hence, the rise of angels, super-angels, incubators, accelerators, micro-VCs and VC-led seed programs.
But as the “Great Seed Experiment” (as my partner, Michael Greeley, calls it) matures, a new trend is emerging. Entrepreneurs are beginning to learn the difference between what I’ll call Passive Seeds and Activist Seeds. And entrepreneurs are learning that the difference between the two, although somewhat subtle, matters greatly.
Passive Seeds are when a VC invests a small amount of money (for a $200-500M mid-sized fund, typically $250k or less, for a large $1B fund, perhaps $500k or less), to achieve a very small amount of ownership (typically less than 5%) to simply create an option to participate as a more meaningful investor in the future. Passive seed programs get most of the press attention because of their sheer volume.
Continue reading “Activist Seeds – The Latest, Subtle Trend in Seed Investing”
Filed Under: Uncategorized
Tagged: Activist Seeds, Entreprenuership, Flybridge Capital Partners, Great Seed Experiment, Innovation, Lean Start-Up, Passive Seeds, Seed investors, Startups, venture capital
May 14, 2012
I am contemplating writing a book on physicians seeking venture capital to escape the fetters of practice and to launch innovative ideas.
If I decide to go ahead, I will author the book my colleague, Dr. Luis Pareras. Dr. Pereras is a venture capitalist. He lives in Barcelona. In Europe, aging populations, plummeting birth rates, and soaring costs make it hard to sustain overly generous social welfare states. I live in the U.S, where, to a lesser degree, a similar situation is emerging.
Here Medicare is approaching bankruptcy. Medicare is the single biggest contributor to our growing budget deficit. In Europe, centralized bureaucracies often smother innovation. This may soon be the case in the U.S. Europe and the U.S. are inextricably interlocked sectors of the global economy – economically. clinically, but not always culturally.
Nevertheless, both physicians in Europe and the U.S. are unhappy because government is cutting their pay and ramping up regulations to make national ends meet. Some physicians in Europe and the U.S are turning to venture capitalists to get the money required to launch start-up health –related enterprises. Others rely on their own finances or angel investors.
Continue reading “Physicians Venture out of Practice, Seeking Capital”
Filed Under: Physicians
Tagged: Startups, venture capital
Dec 30, 2011
Venture capitalists are increasingly interested in emerging markets, and in working with local funds based in those markets (despite the fact that reverse innovation in venture capital seems counterintuitive). The reason for the interest in in part because the industry has suffered from poor returns on investment over the last decade; indeed, some sectors, including biotechnology, report negative aggregate returns. China and India, in particular, offer attractive liquidity and investment opportunities VCs haven’t seen for a while.
The interesting part of this shift is that VCs are taking a more holistic or “systems” approach to investing than they typically do in developed markets. Traditionally, VCs evaluate each investment as a discrete entity; the firms in their portfolio rarely interact with one another. In contrast, emerging-market VCs such as Nadathur Holdings (established in 2000 by N.S. Raghavan, one of Infosys’ co-founders) create intentional links between firms. Nadathur’s portfolio includes firms operating in drug discovery research, companion diagnostics, pharmaceutical analytics, reimbursement claims processing, patient relationship management, and specialty healthcare delivery for running clinical trials — and they all work together. In effect, the VCs at Nadathur Holdings serve as the executive team for a miniature healthcare innovation ecosystem.
Why do VCs in emerging markets take a systems approach? Because of three significant challenges innovators face in emerging markets:
- Innovation ecosystems are not well-developed. The supporting industries that an early-stage tech start-up needs simply don’t exist locally. VCs encourage upstream and downstream, often service-based, investments. These can be exited at lower multiples, with the trade-off of higher success rates for the R&D-intensive high-multiple investments.
- Technology-intensive firms are expected to generate revenues before they make an exit; local investors are reluctant to put money into start-ups centered on intellectual property. Portfolio firms upstream or downstream can help establish commercial proof, generate retained earnings and make it easier to get additional customers.
- Few local financial intermediaries (including VCs) exist. A portfolio that contains an entire ecosystem helps to decrease risk by allowing inferior business models to be refined or killed faster. Continue reading “What Venture Capital Can Learn from Emerging Markets”
Filed Under: OP-ED, THCB
Tagged: Emerging markets, Justin Chakma, venture capital, Vijay Govindarajan
Feb 20, 2011
Recent media articles have scrutinized the use of doctors, scientists and experts by pharmaceutical companies and hedge funds, often casting them in an unflattering light. Experts can play a valuable role, but it is a case of caveat emptor – and sometimes for the expert, as well as the organization hiring him. Biotech or medical device companies that are trying to promote new products, for example, could undermine a medical expert’s perceived objectivity if financial ties are not clearly disclosed upfront. Experts providing information to hedge funds must be particularly careful not to disclose non-public information about publicly traded companies and run afoul of insider trading restrictions.
Venture capitalists also commonly rely on personal and business expert networks to help gather investment information to make smart investments in private companies. Because early-stage venture firms do not invest in public stocks or promote independent projects, experts can work with VCs and VCs can work with experts without risk of reputation or objectivity.
Here is how I and other venture capitalists use outside experts:
Personal networks, by far, tend to be most valuable. For example, sometimes I contact a childhood friend who is now an orthopedic surgeon at the Cleveland Clinic. If CCV is thinking about investing in a product related to surgery, I ask his opinion. His input is good — and it’s free counsel from a valuable source.
Like other VCs, I also look for expert guidance inside existing portfolio companies. I’m currently working on a project related to a software system for gene sequencing, for example, and I have consulted a chief technical officer at a CCV portfolio company who is highly knowledgeable in this space.
Continue reading “How VCs Use Advice From Experts”
Filed Under: OP-ED
Tagged: Insider information, John Steuart, Sources, venture capital
Dec 22, 2010
It’s the end of the year – an opportune time to forecast how 2011 will unfold in health care. We are likely to see some surprises, such as the sharply rising importance of primary care physicians.
Here are some predictions about the new year:
More consolidation is on its way in healthcare under Obamacare, which heightens the pressure to improve the efficiency of healthcare delivery. As part of this, more and more healthcare provider groups, even the small ones, will feel compelled to go electronic once and for all.
Valuable new, cost-effective medical tools will begin to become widely embraced. One is telemedicine. Just imagine how much more effective doctors can be if they interact with patients remotely via cameras. The technology exists now, has been successfully used in a number of situations, and it is not expensive. Soon insurance reimbursement models will permit and remunerate physicians for telemedicine “visits,” and then this will take off.
The use of genetic testing to segment patient populations and better target therapies will be one of the fastest growing segments of healthcare as a new wave of accurate, clinically actionable tests hits the market.
As health reform increasingly kicks in, there will be heightened emphasis on the importance of primary care physicians – a sharp contrast to the elevated importance of specialists for so many years. They will become the linchpins of health care and make more pivotal care decisions as more than 30 million more people enter the healthcare system and require access to them.
Continue reading “Year End Pondering”
Filed Under: Uncategorized
Tagged: Startups, venture capital
Dec 10, 2010
All eyes are on Toyota’s recall of 8.5 million vehicles due to faulty gas pedals and brakes. The recall has sparked congressional hearings, a probe by the U.S. Department of Transportation, possible criminal charges stemming from a federal grand jury investigation and numerous civil lawsuits, all in the name of driver safety.
This aggressive response to Toyota’s mistakes is appropriate, even though the human toll from its miscues has been, thankfully, relatively modest – 34 alleged deaths and a few hundred injuries. Not to downplay this misery, but in stunning contrast, consider this: More than 100,000 Americans die annually in U.S. hospitals because of avoidable medical errors, according to the Institute of Medicine (IOM), which also says that medical errors rank as America’s eighth leading cause of death. This is higher than auto accidents (about 45,000) and breast cancer (about 43,000). And the problems don’t end here. Studies show that approximately 19% of medications administered in hospitals are done so in error, injuring about 1.3 million each year, according to the FDA.
Continue reading “Innovation, Not Legislation: Venture Capital is the Path to Improving Patient Safety and Reducing Waste and Error in the U.S. Healthcare System”
Filed Under: OP-ED
Tagged: Lisa Suennen, Startups, venture capital
Mar 10, 2010