Yechiel Engelhard, MD, MBA

These unique advantages in venture capital are indeed compelling, which raises the question: Why haven't they been widely adopted in the industry? We can distill the resistance down to a few key misconceptions: 1. **Overreliance on Capital Influence**: The belief that "Having capital is sufficient to drive change" often leads to an external, top-down approach that may not align with the realities on the ground. 2. **Underestimating Physician Business Acumen**: The outdated notion that "Physicians lack business prowess" has been repeatedly disproven by numerous real-world examples across generations. 3. **Overvaluing Back Office Capabilities**: The assumption that "Our back-office provides superior insights and analysis" is flawed. In reality, the same fundamental principles apply across the board: successful exits, founder intelligence, robust deal flow, and iterative processes that optimize analytical costs. These misconceptions hinder the adoption of game-changing approaches in venture capital.

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I always read Rock Health's digital health reports as they give a nice pulse feel for what is happening in the digital health funding space. Good to see funds raised in H1 2024 suggest funding in the sector seems to have stabilized at 2023 levels. Its no surprise the report emphasis the buzz around AI and healthcare. There have been clear winners in the AI healthcare space in the area of process and cost optimization and the R&D space. The impact of AI in care and treatment delivery is so far much more muted. One area I never though to look at AI was in its ability to bring together multiple healthcare pathways and digital point solutions into a more holistic seamless experience for the patient. There is a clear trend away from using stand alone digital health point solutions, and could AI address this challenge by facilitating the efficient integration of disparate processes and technology into unified care programs. I can see this happening with digital health products but this will be more tricky to do with physical care programs involving clinicians and HCPs. “AI is helping us combine multiple parts of the care journey, across all care experiences. In the future, benefits navigation, clinical guidance, and care delivery won’t be delivered by separate companies or point solutions within the healthcare ecosystem. They’ll be features that work in concert within products, and they’ll happen in under 90 seconds for a seamless patient experience.” – Glen Tullman, CEO, Transcarent and Managing Partner, 7wireVentures

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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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With $8.2B invested into digital health so far, 2024 is shaping up to be a $10-12B annualized investment year. This would make funding comparable to 2023. I suspect with continued venture investment, boards will require exits. One thing I’m particularly interested in is terms of recent acquisitions and growth equity rounds. What type of downside protection (e.g., structure) is not disclosed to media that protects the investor? Will funds who have specifically raised capital to buy stakes in VC-backed companies at significant discounts? And what revenue/EBITDA multiples are looking like for M&A in 2024/2025? Every founder has to spin their story in a positive light when speaking to media. I know this because PR agencies reach out to me about their clients (p.s. I don’t consider myself a member of the media). The private health tech market feels like it could significantly rip or drop in the next 12-24 months. Therefore, my general advice to early-stage founders is to assume you will not raise capital beyond your seed round. If the investor market heats up in 2025, you will have the option to raise a series A at that time if you’ve built a strong business. If you’ve already raised series c or beyond, then one of your goals will be to time the exit (M&A or IPO) appropriately so that you garner an attractive multiple. There are few private health tech startups that have founder board control, can reinvest positive cash flows, and stay private forever. So by necessity of the structure, exits are desired. - - - - Image Credit: Rock Health

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Q1 2024 was big for Digital Health, with $1.1B in VC funding. A large portion came from major deals like $126M for Transcarent and $108.8M for Rightway. Despite some challenges in digital therapeutics and telehealth, investments in general care ($213.4M) and health benefits navigation ($140.7M) are promising. Read what’s driving the shift from direct-to-consumer to enterprise telehealth models here: https://ow.ly/uNYs50SpXGh

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Redesign Health has launched its largest fund to date, securing $175M to support over 20 new healthcare startups. Founded in 2018, the venture builder has previously incubated more than 60 companies, including Scriptology and Vivid Health. The new fund aims to address challenges such as healthy aging, interoperability, and expanding sites of care. This funding underscores investor confidence in tackling the $4T healthcare market's persistent challenges.

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Which founders fit the mold for success in healthcare? I spoke with Anne DeGheest, Founder and Managing Director at HealthTech Capital, about the key characteristics of successful #healthtech entrepreneurs. Listen to the full conversation here: https://lnkd.in/eqwUCkPx

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The biggest topics in healthcare last year? The two Gs. GPT and GLP-1s. We’re continuing to innovate our GLP-1 care track, which includes personalized care from care teams supported by AI tools, that can help maximize outcomes for someone on a GLP-1. And what’s to come? I expect this year we’ll see: ⭐ Measuring digital health programs will shift (check out Omada’s VOI report for more on this) ⭐ Consolidation in the market - not all digital health companies will survive ⭐ An uptick in PBM and health plan partners to help employers offer GLP-1s with sustainable coverage plans Anything I missed?

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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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Health tech companies reported strong Q3 2024 earnings, driven by expanded offerings, rapid adoption of AI tools, and increased client demand. Here’s a recap of key updates: - Hims & Hers: A telehealth platform offering personalized treatments across mental health, sexual health, dermatology, primary care, and weight management. Q3 revenue jumped 77% to $401.6M, net income was $75.6M, and subscribers grew 44% to 2M. The company plans to launch a generic liraglutide in 2025 and raised its 2024 revenue forecast to $1.46B-$1.465B. - Doximity: A networking and workflow platform for medical professionals providing tools like telehealth, scheduling, and AI assistants. Revenue increased 20% to $136.8M, with AI tools leading growth and 1M prompts used in Q2. The company raised its 2024 guidance to $535M-$540M in revenue. - Waystar: A healthcare payment and revenue cycle management company serving 30,000+ clients across care settings. Revenue grew 22% to $240M, driven by rapid client adoption after a competitor’s cyberattack. The company raised 2024 revenue guidance to $926M-$934M and expects 2025 revenue near $1B.

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Excited for our webinar tonight: Investing in Healthcare Startups: An Angel Perspective When: tonight at 6 pm eastern Where: https://lnkd.in/dPUFNbhe We had had a couple last minute changes and I am very excited to have an engaging conversation with Thanasi Tsiodras, Dr. Shaun Kuan and Regina Prasad, MS. We will be discussing: 1. How to start investing in startups 2. Lessons from your winners and losers 3. What are some red flags in a startup 4. What is your diligence process like? 5. How do you get deal flow?  6. What is the ideal angel investor archetype? Who should invest in startups and who shouldn't. #healthcare #venturecapital #angelinvesting

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Here's another fundraising roundup spotted in the healthcare wilds 👀 🍃 ✅ Sword Health raised $130M (new valuation: $3B). ✅ Better Health raised $14M to deploy expanded payer partnerships. ✅ Alzheon, Inc. | Preserving Future Memories raised $100M Series E to advance development & commercialization of its Alzheimer’s treatment. ✅ CinRx Pharma raised $73M to continue its ‘Hub and Spoke’ model of startup formation. ✅ Eko Health raised $41M to scale AI-driven heart and lung disease detection. ✅ Anterior (formerly Co:Helm) secured a $20M Series A to unlock admin efficiencies for healthcare payers. ✅ SamaCare raised a $17M Series B to scale specialty drug prior authorization platform. ✅ Plenful secured a $17M Series A to streamline pharmacy operations with AI-powered workflow automation. ✅ Grayce raised a $10.4M Series A led by Maveron amid a caregiving crisis. ✅ Stitch Employment Services Inc PEO raised $8.75M in seed to support independent medical practices. ✅ Posterity Health secured $6M to fund expansion and technology acceleration. ✅ Sware raised $6M to accelerate life sciences innovation by automating FDA-mandated software validation. ✅ Keragon raised $3M, as announced in @Conno Christou’s LinkedIn post. As always, if I missed you, let me know! Each week I'm spotlighting an innovative healthcare startup. I just ask for a bit more transparency. All submissions are confidential; submit yours here 👇 https://lnkd.in/gF4DrAvJ Looking for more fundraising roundups, alongside healthcare industry news and analysis? Subscribe to Hospitalogy, my 2x/week newsletter. Join 33K+ other investors, executives, and healthcare professionals: https://lnkd.in/g-nfRqW6

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Interesting to see that digital health funding is relatively stable. Only a couple of exits. I think we'll see more deals like DarioHealth's acquisition of Twill, since from a sales perspective, the narrower the solution, the more difficult it is to acquire customers. This difficulty has nothing to do with the quality of offerings, but with the data management and administrative complexity on the customer side.

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Should you sell your practice to a VC-Backed MSO Startup? tldr: - new VC-backed startups are forming MSOs to roll up independent practices - The pitch is physicians receive early liquidity from the roll up and are granted ESOP shares that can be used for retirement - Problem is the use of ESOPs with independent practices is not a new concept and has been used with large group practices since the 70's - ESOPs do not grant full ownership and in order for the shares to be valuable for retirement, the practice needs to run the same if not better post roll up - With VC-backed startups being primarily operated by non-physicians with zero clinical or medical practice experience, the likelihood of this happening is extremely low making the entire concept high risk However, there is a viable path for continued ownership + liquidity for independent practices. Check out the article to learn more. ⤵ https://lnkd.in/gmGvTYwP

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Alot of bad actors and a few good actors. $2.5T HC capital raised & $1T invested by PE in last decade. $31B in 2013 vs. $217B in 2021. We know the story. Misaligned incentives - unrealistic multiples, short-term profit focus, aggressive cost-cutting, unrealistic scaling, misunderstood market dynamics, just to name a few. However, our industry needs money. But our industry is more infrastructure asset class than tech start-up (James Nicholls gave me that epiphany). Mic drop on the lyrical genius of Alex Fair of MedStartr Ventures as he literally gives the whole story poetic justice as he reads HIS POEM on this "On The Road at VIVE" episode of The Reverse Mullet Healthcare Podcast w/BP2 Health. This is the perfect episode for a Friday afternoon! He and Paulo J Machado donned the actual reverse mullets and joined us back in February at #VIVE2024 to talk about the need for REAL change in healthcare, startup focus and investor expectations. It was one to remember and one that is in desperate need of a full-length follow-up episode. Give us a like and a watch or a listen https://lnkd.in/e4w4mjkv https://lnkd.in/egmK3kMB

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Investing in companies that fill needs for health systems is a growth opportunity for both delivery organizations and start ups. Some systems are jumping in on their own, while others are partnering with like minded systems or with established VC firms. While this is a relatively new trend for systems, health plans have been making similar bets for many years. The benefits of becoming a health system portfolio company can be significant. Data, access to beta populations and real world coaching can be extremely beneficial. Start ups get mentoring and systems have to ability to leverage outside resources to solve relevant business problems. I predict a booming business!

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