Robert Coombs

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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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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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

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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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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!

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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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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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✍🏼 Codify your process for nurturing referrals It is a tough climate for agencies across the board right now, but among those that continue to win against the hardest headwinds are those that have a well-oiled referral system. For most agencies this is a critical lead source, yet many have no formalised system. This should include defined and relevant incentives, how to create triggers for referrals, how to nurture referee relationships and how to measure impact. This system should sit at the heart of your growth strategy. #agency #newbusiness #businessdevelopment #growth #NBfirestarters

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To my amazing network - I am thrilled to announce the launch of Pave Health Ventures, an early-stage venture fund dedicated to broadening access to healthcare and improving the overall well-being of our communities. I’ve been very fortunate in my healthcare career. As the Founder & CEO of MedPilot, we capped off a seven-year journey with a successful exit when we were acquired by Vytalize Health. For the last three years, serving as Chief Innovation Officer, I’ve had the honor to contribute to the remarkable growth at Vytalize, impacting the lives of hundreds of thousands of patients by enhancing the quality of care they receive. I am immensely grateful to Matt Buder Shapiro, not only for being the perfect partner and co-founder but also for being an incredible friend. Additionally, I extend my heartfelt appreciation to Faris Ghawi, Amer Alnajar, and Jordan Brown for their outstanding leadership and for broadening my perspective on the significance of value-based care. This journey has not only provided me with industry expertise but has allowed me to cultivate invaluable relationships and an incredible network. As I embark on this new chapter, I am profoundly grateful to be supported by top executives and thought leaders in the investment, wellness, and healthcare industries. Within the healthcare ecosystem, we are represented by key stakeholders from health systems, insurers, governmental organizations, retail health businesses, provider groups, and value-based care organizations. At Pave Health Ventures, we believe the timing couldn't be more opportune to help support health-focused startups. With the growing prevalence of illness and chronic health conditions impacting our communities, consumers and key Healthcare Stakeholders are increasingly prioritizing proactive and preventative care. This shift in focus is fueling demand for technology, products, and services aimed at improving health outcomes, unlocking trillions of dollars in growth potential within the healthcare landscape. Pave Health Ventures is all-in. We are actively seeking solutions that tackle the root causes of illness, manage chronic conditions, and optimize care and care teams. Please support us in our mission by opening your networks and introducing us to amazing founders and entrepreneurs. Together, let's help pave the way to a healthier tomorrow. Jacob Myers

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US healthcare system Providence has split off its investment arm, Providence Ventures, to create an independent VC firm, Allumia Ventures. #venturecapital #veteranventures

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This San Franciscan has landed in the Big Apple for #NYTechWeek! Here’s why it was important to me to be out here this week and I view NYC as a sister city. ((scroll down for 2 events The Council is hosting today!)) 🏭🏥 Reminder: The Council Fund invests at Pre-seed in Software’s Third Act, the transformation of the essential economy. Our investments span healthcare and industrial sectors like manufacturing, logistics, construction. 🐂 I’m eternally bullish on NY & SF and hate how many pit the two cities against each other. The reality is that a lot of capital and talent flow back and forth between the cities. They need each other to thrive! 🗽🌁 Cities like NY & SF attract young and mid-career talent because of their population density, transient nature, beauty, and reputations as cities where someone new on the scene can make a name for themselves. For the areas we invest in, I’m *specifically* excited about NY because of: 🏗️ Closer proximity to industrial hubs which are scattered across the Midwest / Rust Belt 🏛️ Closer proximity to DC where a lot of regulation around VC, startups, healthcare, onshoring initiatives, and industrial sectors takes place 💰 Many of the large financial institutions that are backing hard tech focused funds and major healthcare initiatives are also headquartered here in NYC 🎯 We’ve got several startups here who are hitting it out of the park, like Dirac and Siena. This has further validated my belief in this ecosystem to support young companies! Today we are kicking off with 2 events on Day 1 of #NYTechWeek 👉 AI Demo Day: The Council, Next Wave NYC, Lynx Collective, Flybridge will host 8 founders and 200+ investors and founders for a pitch competition this evening! Luma: https://lnkd.in/gbdYiJMw 🔜 Can still join the waitlist! Small & Big VCs in Hard Tech: The Council joined General Catalyst, Lux Capital, Iron Prairie Ventures, AlleyCorp, House Of Ventures, Steel Atlas for 2 back to back panels on industrial innovation & collaboration across the capital stack Luma: https://lnkd.in/gj6D4-Au ⏰ Event has passed

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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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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!

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I put down some thoughts on my disenchantment with venture studios in healthcare, quick thoughts on retail healthcare, and an open question of whether healthcare will ever experiment with dynamic pricing You can read it here: https://lnkd.in/enbBaSWC

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#Longevity Tech is on the rise ✌️ -Endeavor BioMedicines raised $135M at a $795M valuation in April 2024. -Humanaut Health secured an $8.7M Seed round, valued at $52M in May. -Superpower raised $4M, reaching a $24M valuation in May as well. These are just 3 of the 90+ #longevity startups highlighted in Dealroom.co's latest report (Link in the comments). In this newsletter, I dive into the Longevity Technology Market and the emerging trends shaping the future of health! 👉 https://lnkd.in/e3EZrAPH #Longevity #HealthTech #StartupFunding #Innovation

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Abby Levy talks about venture's role in US healthcare and what we can expect to see as technology impacts the space on TFR. Check out the rest of the conversation with Abby & Alan Patricof of Primetime Partners on Episode 433.

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It was wonderful to be in conversation with Madison Mills of Yahoo Finance at their annual Invest conference earlier this week. We covered everything from the venture outlook for 2025, impact of elections on women's health investing and innovation, and more. Full clip and summary below 👇 https://lnkd.in/gS67sc2Y

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This week Mikal Ventures brings you a 4-week breakdown of the non-US capital market with an emphasis on the Mikal verticals. The 4-week period ending November 25 saw just over 1,300 new companies added, bringing the total to 112,141 companies included in the non-US Health Tech, Med Tech, AI Tech Fin Tech and Ed Tech verticals. Non-US AI Tech again saw the greatest percentage growth in new companies at 16%, vs. the vertical average of 12% for the period. Non-US HeathTech led the group in transactions. Non-US Med Tech led in SEC Filings and news articles.   Mikal Ventures publishes these stats on a rolling 4-week basis to provide a perspective on how the verticals and new startups move through time. We hope you find them informative and thought-provoking. VC Investors are always adjusting their "Play Book" with a variety of options for investing. Mikal Ventures is one of those alternatives, offering curated solutions to real world problems. Reach out if you have questions on how we can be of assistance and bookmark https://mikalventures.com/ for additional insights and information.

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