Paul English

The (Healthcare) Ground Beneath Our Feet… This year it is likely that over $10 billion will be invested in the digital health sector – a robust amount, no doubt, but inconsequential when compared to the amount of capital tied up in healthcare real estate assets, which is estimated to be $1.2 trillion by Jones Lang Lasalle. Of that amount, approximately $790 billion is in the hospital sector while the remaining $490 billion is in medical office assets. It is estimated that there are 48.6k facilities with 3.4 billion square feet of healthcare real estate, 42% of which are owned by REITs and another 33% held by other private investment vehicles. Much of the digital health investment is meant to make the physical healthcare infrastructure more productive: greater operating efficiencies, greater patient throughput, more relevant personalized care models with better outcomes. As the healthcare system is being pushed to be more distributed to lower cost sites of care, accelerated now by the rapid proliferation of automation and AI capabilities, the potential impact on healthcare infrastructure assets will be profound. Thoughts on what that might look like... https://lnkd.in/eTfAdUbS #digitalhealth Flare Capital Partners

113

6 Comments

What do you think about AI in senior care? Personally, I think we have to be careful with it. When AI presents itself as human, it can be confusing for seniors who may not have strong digital literacy skills. In fact, if they think they're talking to a person and not an AI chatbot, it can be dangerous if they're having a medical emergency or issue. However, there are some helpful use cases. I think Kristen Fischer's exploration of AI here is really interesting. "Artificial intelligence may be a useful communication tool to help older adults with cancer communicate with their doctors and have more of a say in their treatment," she says. AI can provide more context or explanation about certain treatment plans and translate the patient’s needs to clinicians in situations where the patient doesn't feel understood or heard. AI will never replace professionals, but it could help patients and clinicians better understand each other. Feel free to share your thoughts on this—I'd love to know if you think AI would be an effective tool for these situations. #AI #SeniorCare #FutureOfHealthcare

3

1 Comment

Some VC investors believe that brick and mortar - referring to a physical presence of some kind - should be avoided at all costs. Yet, the track record of clinic and hybrid care businesses in health care indicates otherwise. ==> One Medical (sold for $3.9 billion to Amazon), Oak Street (bought by CVS for $10.6 billion), Lifestance (IPO at $7.5 billion market cap), and PE-backed Premise Health (acquired by OMERS Private Equity for $1.1 billion) If a clinic is indicated as the optimal way to deliver care for that patient population, there are creative ways to build and operate them. Full article below with advice and strategies on how to build and operate hybrid clinics from my teammate Anarghya Vardhana from Maveron, Amir Dan Rubin from OneMedical Group, Steven Eidelman from Modern Animal and more!

13

1 Comment

Someone broke down the estimated costs of a $15 Sweetgreen salad. We need these cost graphics for digital health to help future founders. Especially for tech enabled cos, the greatest cost is labor. Much of the "value created" is in curation and matching, which means the gross margins are reliant on labor arbitrage. Pay someone $X, but get paid $X+Y% per visit. The challenge with healthcare is that you often have to pick one of two business models: 1. specialized, low volume, high cost, low gross margin % 2. generalized, high volume, low cost, high gross margin % I'd argue founders should focus on gross dollars over the lifetime of the customer (like Jeff Bezos said) instead of gross margin %'s, but we'll leave that for another time. The challenge is that many tech enabled digital health cos have high cost of goods sold (labor) and moderately high product, design, and engineering budgets. We must build differentiated solutions for patients, clinicians, and clients to be out incumbents, however, we're realizing that companies are ultimately valued on the discounted value of future cash flows. And the high SG&A costs at most organizations might be inbalanced to the unit economics of the business. I'm not sure the math pencils out for everyone unfortunately. But I'm just a guy on the internet, would love to hear the thoughts from those smarter than I (you!). Comment below. --- p.s. I have no idea the accuracy of the graphic and not an investor in Sweetgreen. Cheers. Credit: David Crowther

112

27 Comments

To all the new or #expecting #parents, Ubenwa Health has developed a unique #AI-powered app designed for those who are still learning how to intuit their infant’s emotions. Through listening/studying to various different baby cries, #NanniAI is here to help you distinguish between their wants and needs, and which decisions is the most likely to soothing them in the meantime. Yes, it is named "Nanni," and yes it is AI powered — however it’s not intended to replace parents, it’s more of a #supplement to help support and encourage good #parenting skills. Nanni AI is the culmination of years of research and data collection in Nigeria, Montreal, Canada and Brazil, which was used to train an algorithm that sorts "thousands and thousands" of cries and tries to categorize your baby's needs accurately. The developer mentioned earlier, Ubenwa Health raised a $2.5 million pre seed financing round led by AI-focused funds. What do you think of this app? If you are a parent, would you consider using Nanni AI?

13

1 Comment

Reimagining Healthcare Workforce Platfforms: Turning Capital Into Labor The future isn’t just about filling shifts. It’s about scaling labor intelligently, driving better outcomes for systems, staff, and patients alike. Andreessen Horowitz and Alastair (Alex) Rampell reinforced this Vision in a recent post and it applies to the next phase of healthcare workforce evolution. Healthcare workforce marketplaces plus AI are at the tipping point of transformation, evolving into systems of record that don’t just manage labor—they optimize it. Much like EHRs centralized patient care data, these marketplaces can centralize workforce operations, aligning talent supply with clinical demand. But there’s a bigger opportunity here: turning capital into labor. Here’s what I mean. Historically, industries (including healthcare) have focused on enterprise computing tasks—streamlining data entry, compliance, and back-office functions. While valuable, this approach often stops short of transforming the real-world, repetitive processes that make up the bulk of work in healthcare. Think beyond enterprise software. The next frontier lies in leveraging embodied AI and workforce marketplaces to automate and enhance labor-driven processes, transforming capital investments into productive labor outputs. For healthcare, this means turning staffing costs into scalable, dynamic systems that deliver value far beyond filling shifts: 1. Dynamic Labor Matching: Capital invested in marketplace platforms enables real-time matching of labor supply with patient demand, replacing outdated scheduling models with predictive, automated systems. 2. Workflow Automation: From credentialing to compliance and shift bidding, embodied AI can streamline traditionally manual tasks, freeing human resources for higher-value work. 3. Labor as a Strategic Asset: Workforce marketplaces shift the focus from static staffing budgets to proactive labor deployment, ensuring that every dollar invested in labor drives outcomes and efficiency. It is about the billions of repetitive, planned tasks that AI can improve. In healthcare, that means automating everything from staffing logistics to clinical task assignments, creating a horizontal system of engagement for labor (think Zendesk) that integrates seamlessly with vertical, workflow-specific platforms (think Toast for staffing operations). The result? Hundreds of billions in untapped market potential—and a healthcare workforce model that transforms how care is delivered. By turning capital into labor through smarter marketplaces and automation, we don’t just solve staffing challenges; we redefine what’s possible in healthcare operations and ShiftMed is leading the way with health systems moving beyond tired models. #capitalintolabor #systemsofrecord #healthworkforce #aiworkforce #healthsystems #hospitals #cno #hospitalceo #healthcareinnovation

11

2 Comments

Excited to announce Frist Cressey Ventures' investment in Qualified Health and privileged to partner w/ SignalFire, Healthier Capital, Town Hall Ventures and others!   Healthcare costs are increasing at a faster rate than ever before, with the US spending nearly twice as other wealthy countries and still ranking bottom in outcomes. It's a story you've all heard - - US healthcare is known for astronomical inefficiencies, waste, workforce supply constraints, fragmented access, appalling patient experiences, and driving patients and businesses into debt.   Yes these problems present opportunities. But opportunities are limited to the system's appetite for change, desire and incentive to try something new and the innovation available. At FCV we believe we've hit the trifecta with Generative AI. Generative AI has given us truly transformational tools in the toolkit and the healthcare ecosystem is demanding to absorb its benefits. This perfect collision of supply and demand means healthcare is poised for big change.   Generative AI is everywhere, it's buzzy, it dangles hope and opportunity. But many things need to be true for the Gen AI transformation in healthcare to take hold, such as but not limited to:   💡 Patient lives and data need to remain safe: We believe in a highly regulated and human life-touching sector such as healthcare we must ensure Gen AI can drive to unrivalled savings and improvements in the quality of care WHILE not putting patient lives or data at risk.   💡 Systems need to own their utilization of Gen AI: We believe systems will use some hybrid of external partners and homegrown solutions but importantly will want full control of data provisioning and utilization as well as the ability to solve an unlimited number of nuanced issues and not cookie cutter algorithms.   💡 Costs need to be looked at on an enterprise level: We believe the speed of innovation in Gen AI means costs will continue decreasing dramatically but at an enterprise level this will still not be a small detail. Systems will want the ability to understand costs and delegate as needed for the outcomes desired at the organizational level.   Enter Qualified.   We knew when we met Justin Norden, MD, MBA, MPhil and team we were standing in front of changemakers. These individuals have lived and breathed the true application and implementation of Generative AI far before we were asking ChatGPT to write our emails. In fact, if you’ve ever driven in a Waymo you’ve benefited from past products this team has built.   Qualified Health is on a mission to enforce governance in Gen AI, allow systems to rapidly build for their needs, monitor and make decisions for all GenAI (homegrown and external) and accelerate the value the sector can glean from these new technologies.   Huge shout out to William T., Tommaso Auerbach and Jamie Kuntz for their hard work!

235

14 Comments

Great insights shared by Dr. Christopher Haley at Startup Genome on the vital connection between a region's assets and the appropriate accelerator stage. This article underscores how aligning these elements leads to remarkable outcomes in ecosystem development. A great read for all of my friends in ecosystem development. From my personal experience I'll add that misalignment, however, can have long-lasting effects. When startup programs or organizations backed by private or public funds falter, the recovery period for regions can extend from 3 to 8 years. This delay significantly impacts founders seeking mentorship, knowledge, and funding opportunities. #EcosystemDevelopment #StartupGenome #AcceleratorPrograms #FounderSupport

15

2 Comments

A SAFE and convertible note had a baby and Wilson Sonsini Goodrich & Rosati was the midwife- out popped the D-SAFE! 👶🏽🎉 A new #climatetech funding instrument was announced by Elemental Excelerator last week. One of the company’s main goals is to support smaller, up and coming companies during the awkward “Scale Gap” phase between #VC funding and natural growth. It’s called the #DSAFE (Development Simple Agreement for Future Equity) and it aims to aid the process by giving companies a small amount of cash to overcome initial risks and expenses during the developmental stages of a product launch or company. How does it work? D-SAFE has a redemption clause meaning companies can choose to have their payments offered as a loan or convert to equity at the investor’s discretion. Funders and companies will have clear communication and expectations about where the money is going and how it will be applied to either the company or the projects at hand. Financiers and companies will work together with more #transparency, and that’s a great boon for #startups and VC alike. As of this month, Elemental has already invested using D-SAFE in eight different companies, including Dimensional Energy and Origen — both companies investing in innovative and out-of-the-box solutions to environmental issues! Seems like a win-win on the surface. What do you all think about the D-SAFE? Alfredo Coppola Momoka Ueda Tim Wagner Stephen D. Torres Olya Irzak Natsuho Toyama Noriya Tarutani Shin Ogawa

15

6 Comments

Severe mental illness remains one of the most underserved areas in mental health, possibly because it is difficult to address with the type of virtual, easy-to-scale models that VCs love to back. We're so excited that Sonia Priscilla García and Stas Sokolin at Amae Health have been able to break the mold, bringing better in-person solutions for patients and families dealing with SMI, and attracting strong venture partners to do so cc: Lisa Jacobs Blau, Alison Ryu, Claire Akkan Quiet Capital, Healthier Capital, Jan Ellison Baszucki, Karin Kissane, Mike Volpi

50

2 Comments

What's been happening in mental health? ⏺ Vitalic Health raised a $4M seed round for its geriatric behavioural health care platform. ⏺ Kooth Digital Health landed a $1.45 million pilot contract to provide their Soluna platform to over 50,000 students across New Jersey. ⏺ Peer support startup Fello , led by former Uber Eats executive Alyssa Pollack, raised $10.4M for virtual, app-based peer support designed to combat the loneliness epidemic. ⏺ Oceans Healthcare acquired Haven Behavioral Healthcare , expanding to 5 new U.S. states and adding 7 new locations. ⏺ Mabel raised a €600K pre-seed round to help improve women's mental health through microdosing programs and mushroom-based supplements ⏺ Wysa published a paper on the impact of their early stage digital mental health interventions for Singaporeans. ⏺ Applications for the KHP Ventures Mental Health immersion programme close tomorrow (Jan 7th) (All links below) __ If you liked this and want insights on the mental health industry in your inbox every week, subscribe to The Hemingway Report newsletter and follow me Steve Duke 📩 #MentalHealth #BehavioralHealth

100

10 Comments

Insightful look into bioplatform strategy, and what it takes to raise a Series A from my partner, Omri Amirav-Drory: https://lnkd.in/dFv7GbF6

19

Last week, I had the pleasure of moderating a discussion on navigating FOAK in climate tech at the Greentown Labs Summit in Boston (which had >600 people!!). Here’s a quick rundown of what was shared by Katherine St. James of Spring Lane Capital, Paris Smalls, PhD of Eden GeoPower, and Hannah Friedman of Planeteer Capital: 🌱 What is the definition of FOAK? We discussed how the term can be controversial - it's almost too general because it doesn't identify what kind of "First" FOAK refers to - first team project? First geography? First of a technology in a sector? First time for the integration of a system? It's also too specific because it has the word "first" in it, which can be anathema to later stage / project finance investors. 💰 Partnerships for Funding FOAK Projects We discussed how important it is to build a blended capital stack & use off-balance sheet capital for a project so you're not using the most expensive equity dollars to fund an infrastructure project with low-ish IRR. We also talked through being creative about using corporate partners to provide in-kind services or ink some agreement (at least an LOI) to attract this funding. 🏛 Role of Government We talked about how government capital is seen by investors & how it can be catalytic for FOAK. Government capital can provide validation that a startup has passed a rigorous diligence process by a third party - and incentives like grants or credits can help improve returns for the first project- but it's important to be doing this in conjunction with getting customer validation and to be able to present line of sight to competitive economics without concessionary capital. 👥 Advice for FOAK startups The panelists offered some very specific pieces of advice for startups going through FOAK: how to get creative with things like revenue sharing agreements or convertible notes, getting smart with project development early on (like with DeveloperU), being careful about using FOAK too liberally with certain investor groups, getting the right commercialization / FOAK talent in and around you early Huge thanks to the panelists and the team at Greentown Labs (Jill Kirkpatrick, Julia Travaglini, Aisling Carlson, etc you rocked it!!) for hosting this discussion on bridging the FOAK gap. Also immensely enjoyed the rest of the agenda. Check out the full recap & videos here: https://lnkd.in/d9ApYe9Y #ClimateTech #FOAK #ClimateFinance #ProjectDevelopment #GreenTech #CleanEnergy

55

5 Comments

🛑 Another free webinar for #digitalhealth #founders #scaleups and #startups. This one however, brings together some critical strands of expertise into one conversation... fundraising, commercialisation and regulation 💥 Sign up below 👇 Would love to see you there 😊

5

Hot take on a lot of early-stage digital health companies out there: You're not a tech company. Most tech-enabled care companies I've seen over the past two years are only tech-enabled in the sense that they use telehealth as their delivery mechanism for care. There are exceptions to this, of course - companies who build computer vision and applied AI tools to better the doctor-patient experience, companies who build tooling around risk scoring and stratification to enable more personalized medicine, companies who build truly novel intakes to better route patients to the appropriate care, etc. These companies have real technology chops and, if they sell it right to the market, can get credit for this from investors. But if you're truly a telehealth provider, you need to realize now that the goal post has shifted dramatically from 2021 and you're going to be valued at maturity at something like 3x EBITDA. That's profit. Not revenue. Throw a revenue multiple out the window. That's not the world we live in if you're a virtual doctor's office. Think of how that impacts venture math. If you're raising a seed round at $15M post-money (or $12M pre-money), it means you'll have to generate something like $150-200M in annual EBITDA to be a fund returner for your seed investors. Maybe even more with dilution, since telehealth businesses are not traditionally capital efficient and will likely need to raise material additional capital to reach that scale. You need to be ridiculously profitable (probably on $800M-$1B in annual revenue since you're likely going to be a 40% gross margin business). Here's the good news: you can set yourself up well (and probably be a contrarian founder relative to your peers), by talking about EBITDA growth and how you can grow into a fund-returning outcome based on realistic mature market comps. This will stand out for the investors you're pitching, even at the early stage. This is how you can beat the malaise of the tech-enabled care market. Focus on the right metrics and the right type of growth. You don't have to have all the answers (no founder does), but you need to make sure the ship is headed in the right direction. A focus on profitability for "tech-enabled care" (*ahem* telehealth) businesses is a good first step.

26

3 Comments

A little late, even though this process started in July.... Excited to share our latest investment in Heads Together Health!! We met Steve DeVrieze in October last year, and we think they are poised for impressive growth! Read more here: https://lnkd.in/ecYcqqkn #earlystagestartup #earlystageinvesting #VCinvestment #ncstartups #nctechstartups

22

Today marks a groundbreaking moment for BLCK VC and our fellow collaborators—Diversity VC, All Raise, 2Gether-International, SomosVC, StartOut, and VetsinTech—as we proudly announce the launch of the Diversity Data Alliance. This important alliance underscores our unwavering commitment to nurturing a venture capital and entrepreneurial ecosystem abundant in equity and inclusiveness. By standardizing and linking our data, we empower ourselves with the essential tools to track deeper trends that have, until now, eluded us to identify and fill funding gaps for historically excluded investors, founders, and operators. We can’t change what we do not measure, and now with the Diversity Data Alliance, we're now equipped to do both. Join us in this mission. Learn more and get involved: https://lnkd.in/eEZKdrac #DiversityDataAlliance #BLCKVC #VentureCapital #MeasureToChange

112

1 Comment

Really interesting conversation between Meghan McCarty Carino and Casey Ross about AI in senior care and the potential role that algorithms can play in determining care plans. I think using AI or algorithms in this way has benefits and challenges that come along with it. One positive effect it could have is increased personalization. Instead of giving everyone with a specific illness or medical issue the same treatment, it can help determine a more personalized solution that could improve patient outcomes. However, algorithms aren't always foolproof. In some instances, they can perpetuate bias and bad decision-making. If you're not working with unbiased, high-quality data, it could have major ramifications for a large number of patients. That's why I think if healthcare facilities use algorithms for patient care plans, humans still need to be active in developing the treatment plan. #SeniorCare #PatientCare #AIPersonalization

3