Mark Newman

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

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📈 Demand for fertility services is rising -> 💼 PE recognizes this and wants in -> 🏜 but opportunities are scarce (https://lnkd.in/g6zXEVZh). Highly recommend anyone who wants a deeper understanding of what's going with fertility and fertility tech read Aya Spencer's *2024 State of fertility tech report* (https://lnkd.in/gVjK_UpX) - it's a great summary

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💡Benchmarks in the investment industry serve as a standard for measuring the performance of securities, mutual funds, or investment managers. They provide a reference point for analyzing allocation, risk, and return of a portfolio, enabling investors to make informed decisions. Thanks Peter Walker for keeping us all informed!! Can’t wait for this!! Follow and get on the waitlist for this one! #benchmarks #fundraising #Capitalraise #founders #womenshealth #femhealth #medtech #wellness

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With Americans over 65 projected to grow from 58 million to 82 million by 2050, AI solutions like Foundation Capital portco SafelyYou are becoming increasingly crucial. They’re also a powerful answer to the industry’s persistent staffing shortages, acting as a force multiplier for caregivers. The benefits extend beyond individual residents and their families. For senior living homes, SafelyYou’s AI-powered fall prevention and response system translates to longer lengths of stay and higher net operating income (NOI). With AI, we are working towards a future where every individual—regardless of age or health status—receives the highest quality care, tailored to their unique needs and circumstances. Companies like SafelyYou are leading the charge in making this future a reality, and I’m immensely proud to work alongside them as they use AI to build a better world.

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Harnessing Proprietary Information for Strategic Healthcare Investments Healthcare investments offer a unique combination of financial returns and the potential for significant social impact. For family offices and discerning investors, navigating this complex landscape requires more than just capital—it demands strategic insights fueled by proprietary information. The Foundation of Strategic Investment: Proprietary Information In the investment world, knowledge is power. This is particularly true in the healthcare sector, where regulatory landscapes, technological advancements, and policy changes can drastically impact the viability and potential of investment opportunities. Access to proprietary information gives investors a critical edge, enabling them to: - Anticipate Market Movements: With insights into healthcare policies and emerging trends, investors can position their portfolios to capitalize on upcoming shifts in the market. - Enhance Due Diligence: Tailored underwriting and due diligence tools grounded in exclusive data can highlight risks and reveal hidden potentials in investment prospects. - Maximize Value Creation: By understanding the intricacies of the US healthcare economy, investors can devise strategies for long-term value creation, rather than short-term gains. Empowering Family Offices Family offices often seek investments that offer both competitive financial returns and the opportunity to create a positive legacy. By refining investment platforms to address the specific needs of these entities, such as instant diversification and upside capture, they can achieve their financial and legacy-driven goals. These platforms can provide: - Market Insights: Curated intelligence that focuses on the most promising healthcare segments. - Educational Resources: In-depth content to deepen the understanding of healthcare technology trends and investment strategies. Building Relationships and Trust Investing is not just about the numbers; it's also about people. To attract and retain high-potential family office prospects, investment platforms must foster empathy and engagement. This involves: - Offering Exclusive Rights: Providing access to follow-on deals and direct investment opportunities with board or advisory roles. - Understanding Emotions: Addressing fears of missing out on prime opportunities due to geographical limitations and dissatisfaction with average investment options. - Creating Community: Facilitating a network of like-minded investors focused on collaborative, high-impact healthcare investments. Harnessing proprietary information is critical for making strategic healthcare investments that offer significant financial returns and contribute to the betterment of society. If you like to learn more about strategic healthcare investments or discuss your specific investment goals and how proprietary information can be leveraged to achieve them? Please feel free to reach out or leave a comment below.

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This is quite incredible to see. Very few #CMMI demonstrations can point to any savings at all. And “…MSSP savings go further than savings generated by Medicare Advantage…” #ACO #VBP #Primarycare #MSSP #healthcareinnovation

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According to the latest report from Rock Health, digital health funding in Q1 2024 totaled $2.7B across 133 deals, with an average deal size of $20.6M. It doesn’t break out device-related investments, but most medtech founders I meet these days are being forced to chase tiny rounds made up of endless little checks, consuming valuable energy and slowing their progress. The benign neglect of this next generation of diagnostic and therapeutic devices is counterproductive and surprising. Given the crowded virtual care market, for example, I’d expect more such companies would be exploring medtech partnerships, investments or acquisitions that'd enable them to back integrate into delivering sharper, and more differentiated, care and treatment. This is exactly what Maverix Medical is doing from the other direction: Reshaping the entire spectrum of lung cancer care by integrating more advanced + effective approaches to screening and diagnosis, treatment and therapeutics, and even palliative care…And putting it all to work through an innovative provider network. One notable investor exception is Y Combinator partner Surbhi Sarna who’s been backing great teams like Selera Medical (YC W24) doing foundational work on ambitious medical devices. Without more support from investors like her, we’re going to increasingly find ourselves stuck with the incremental portfolio improvements from the incumbents, and that’s just not nearly enough.

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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.

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Anne Wojcicki, CEO of 23andMe, has announced plans to take the genetic testing company private. This strategic move aims to provide more flexibility in navigating regulatory challenges and to accelerate growth opportunities. The decision follows a trend of health tech companies seeking private ownership to focus on long-term objectives. Wojcicki highlighted the importance of this shift to maintain the company's commitment to innovation and customer-centric services. Taking 23andMe private reflects a bold step towards enhancing its position in the rapidly evolving genomics industry. Read more about this exciting development here: https://lnkd.in/gdrC3a64 #genomics #IPO #privatisation #23andMe

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Taking stock of primary care today and looking ahead.... Increasing presence, market share for non-traditional providers - payers, advanced primary care providers, primary care enablers. Question marks over retail's presence in primary care and what care models and patient populations they might need to focus on to be a force. #VBC #populationhealth #primarycare #caremodels

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This 👂 podcast episode and insight’s from a16z Bio + Health's Julie Yoo spoke so clearly to the fundamental challenge facing both 🩺 clinicians and 🏥 healthcare systems.  There is a huge disconnect between supply, in the availability of clinicians, and demand, in the increasing volume and complexity of healthcare needs. -     36% of physicians plan to reduce their hours next year according to the AMA -     48% of physicians reported feeling burned out in a 2024 Medscape survey At the same time, the demographic baby boomer bubble and steady increase in the prevalence of major chronic disease, which consumes up to 90% of healthcare expenditures according to some estimates, is driving demand. With this context, Yoo points to a major opportunity for AI adoption in healthcare in 2025. Yeah, a VC hyping a wave of new AI companies that will replace the decades of training and experience of clinicians, the skeptic would say.  But Yoo is thoughtful in pointing to the role AI can play, and is already playing, through solutions such as ambient, autonomous scribe solutions (of which local star Abridge is leading the pack) in not replacing, but freeing up productivity for clinicians. There is so much unstructured context in both the complexity of disease and treatment options and the social/emotional considerations that we shouldn't be looking for AI to *replace* clinicians. But companies are getting better at finding the structured, repetitive and time-consuming places where AI tools can *help* clinicians. Nearly two-thirds of doctors cited bureaucratic tasks as the leading contributor to burnout. Rigorously trained-AI driven solutions can be a force multiplier for clinicians, and I’ve seen several interviews where nurses and doctors go as far as to say some of these solutions are ”restoring their joy in practicing medicine”. Our health is precious; and we rightly want any technology engaging with it to be developed thoughtfully and thoroughly tested. This requires top AI talent and diverse and realistic training data. Pittsburgh’s strengths in both areas is why we are an emerging hub for data-driven healthcare. #AIinhealthcare #clinicianburnout #healthinnovation #digitalhealth

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What happened in mental health last week? ⏺ Anise Health raised $3 million to deliver culturally-responsive mental health care for the Asian American community ⏺ Goldman Sachs acquired autism therapy provider Center for Social Dynamics, a care provider to over 4,700 clients across 20 locations. ⏺ Lyra Health CEO David Ebersman announced that he will be stepping back from his role to care for his mental health. Ebersman will take on a new role as Board Chairman. ⏺ Substance use disorder (SUD) treatment provider BrightView is closing nine facilities in Massachusetts and Arizona citing challenging operating environments. ⏺ California introduced a bill that would require mental health warning labels on social media sites. It would be the first U.S. state to do so if the bill is passed. ⏺ The Australian Medical Association issued a position statement warning that chronic underfunding and increasingly complex patient presentations are pushing the mental health system to a crisis point. ⏺ Ukrainian startup Healthy Mind raised $1 million to launch an AI platform for mental health in the workplace. ⏺ Indian mental health platform GoodLives raised $129,000 in a pre-seed round, offering AI-driven self-directed exercises alongside expert-led therapy sessions. ⏺ We (The Hemingway Report) launched our 2024 founder survey. Link in comments to contribute. (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

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There is a misconception emerging that AI agents will lead to immediate reductions in healthcare labor costs. While AI agents can automate end-to-end workflows such as booking appointments, answering basic patient questions, and performing form completion for prior authorizations, automating a single task is not equivalent to automating an entire job. Nurses are a prime example. Certain nursing tasks, such as care coordination and patient documentation, are highly automatable by AI agents; however, there is a tremendous amount of work nurses perform on the ground that cannot be fully automated with current technologies such as direct patient care, physical examinations, medication administration, wound care, patient support, and clinical assessments. These nuances make full role elimination less likely with current technologies. When articulating the ROI of an AI agent, we need to be both precise and accurate. Automating a task is more often not automating an entire profession. For roles that encompass many functions, such as nursing, AI agents can be invaluable tools for unburdening staff, increasing efficiency, and boosting throughput—benefits that are particularly valuable given current healthcare staffing and resource shortages. The most promising job candidates for full role elimination through AI remain positions with monolithic task structures, of which there are relatively few in healthcare today—scribes, medical coders, and data entry specialists for example. It is therefore unsurprising then that the most progress has been made in these categories.

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I’m worried about the state of venture capital and direct-to-consumer (DTC) healthcare startups. Hims & Hers is the poster child for DTC healthcare at $1.2B proj 2024 revenue and a $3.6B valuation. By most accounts, they have been an outlier success for DTC since bottoming out in May 2022. So why is this bad news for DTC healthcare? Because the market leader (Hims) trades at a 3x forward revenue multiple. And the category leader typically gets a higher valuation multiple than smaller startups. We see this phenomenon in private equity. They “roll up” smaller companies within the same category at a lower multiples just to create one larger platform that trades at higher multiples. Now back to DTC healthcare startups. If Hims commands a 3x revenue multiple, it’s not unrealistic that smaller, unprofitable startups may be valued 1-2x revenue at exit. At 2x revenue, a startup must generate $500M to produce a $1B exit in today’s market (depending on growth and profitability). Series A/B venture capitalists must see a pathway to $1B outcomes. And if the growth-stage investors with billions under management are less interested in DTC healthcare, the future funding rounds necessary for fueling growth are not guaranteed. Juxtapose this against 2017-2022 where DTC could raise Series B-E funding. Let’s take a DTC startup doing $25M after 3-4 years of operations and has already raised a Series A. By most accounts, it would be a phenomenal accomplishment. But today, investors will question the chances of that same company scaling from $25M to $500M revenue in the next 3-4 years with unknown future funding sources from Series B and beyond. You're stuck in VC-funding purgatory. Some of these companies will shut down. Some may sell for 1-3x revenue. And some may try to transition to profitable, cash-flowing businesses. All of which are certainly not the venture-backed goal the founders, investors, and employees often had in mind when first taking capital. I say this all with friends working at or starting DTC healthcare companies, I feel bad for them. I also feel bad for the patients who enjoy those products or services. To caveat (b/c I know people will object), there will be other DTC brands that exit for $1B+ (i.e., Ro). However, they were forged and scaled during a different time period where seemingly endless venture capital was available for DTC healthcare. Now we're in a different time with no end in sight. Thoughts?

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One of my proudest moments as an investor occurred today as Alaffia Health announced its series A because it shows how the Aperture® Venture Capital vision of multi-level, multi-generational #impactinvesting is succeeding in the marketplace. Here’s the model in its most basic form : ✅As diverse fund managers with meaningful capital to allocate, we are changing the VC landscape every day just by doing our day jobs. ✅As Black/Brown investors with ~40 years experience collectively, Aperture GPs have access to talent /excellence that others do not, so our portfolio *organically* is more inclusive by race, gender and geography even while optimizing for financial outcomes (all about the alpha). ✅Our most successful portco’s are using financial #innovation to solve market problems that impact underrepresented demographics and underserved communities. Alaffia Health is a shining example of the impact portion of our overall fund thesis, and we couldn’t be prouder of TJ Ademiluyi and Adun Akanni, MPH, PMP - the dynamic brother-sister founder duo whose vision we have steadfastly supported on their journey. Congratulations to TJ and Adun from William Crowder and myself, as well as the whole Aperture team- Marjorie King Philip McKenzie Yves Louis-Jacques Tanvi Lal Michelle Dhansinghani Lisha Bell Katie Kelly Amy Chung Cindy Chong, CFA Brian Fernandes-Halloran Monroe France Jayden Pantel Darren Herman Evan Wladis Neal Triplett Thomas Scriven Peter Ammon Irina Bit-Babik Tim Milanich Rob Rahbari

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💰🎓VALUATION CAP💰🎓 Setting a valuation cap in fundraising is crucial as it limits the maximum valuation at which a SAFE (Simple Agreement for Future Equity) converts to equity. This helps founders manage equity dilution and provides investors with a clear understanding of their potential ownership percentage, ensuring informed decision-making during fundraising rounds. Source: Peter Walker Great post! #valuationcap #investors #founders #raisingcapital #safes #fundraising #womenshealth #femhealth #medtech

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Curious about what organizations are paying for employee referral bonuses? Here’s a snapshot based on our benchmark report (linked in the comments): Healthcare (Avg employee referral bonus: $3,200) CRNAs: $3,700 Surgical Techs: $3,000 RNs and LPNs: $1,900 Physicians: $5,000 Healthcare Avg employee referral bonus by state: California: $2,200 Missouri: $1,800 Maryland: $1,300 Minnesota: $1,100 Assisted Living (Avg employee referral bonus: $1,600) Resident Assistants: $2,000 Nutrition Services Aides: $750 Construction (Avg employee referral bonus: $1,400) Payment Timing 54% of bonuses are split into two installments, typically paid at the 1-month and 6-month marks. For more details, check out the full benchmark report in the comments! #EmployeeReferrals #EmployeeReferralProgram + Eqo | Employee Referral Solution for Frontline Teams

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