Vishal Vasishth

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.

58

5 Comments

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

38

18 Comments

Still feeling energized from last week's roundtable on building successful relationships with hospitals. We invited 7 portfolio companies and health system leaders from Mayo Clinic, Cedars-Sinai and UCLA Health. The founders shared their questions ranging from the strategic to the nuts and bolts of closing partnerships. For example, how do you determine what measures of effectiveness help drive alignment? And how do you get all the stakeholders together to actually drive a decision. Answer: put them all in a room for half a day! “I think we're in a pivotal moment regarding how we assess AI. There are numerous risks currently dominating AI discussions, particularly those concerning bias and other associated risks. However, there's a notable absence of focus on evaluating the proactive value of AI. We need to consider what AI actually offers and what we want it to offer. It's not solely about determining whether it will cause harm; people are apprehensive about how this technology will be implemented. One perspective gaining traction involves ensuring the product's validation process is robust enough to prevent risks to various populations.” -Vladimir Manuel, Medical Director at UCLA Health From Vlad's comments above to perspectives others shared, we heard a sense of excitement for the promise of #AI and other new technologies. But we're also in a unique moment where the risks are not well understood. Still much to do here.

21

Over the years, we at GFR Fund have solidified our investment thesis, which is that we invest in "emerging digitally native communities." These communities can be built around games, social media, and any consumer applications. Now, founders have many easy-to-use tools to build user communities, such as Discord, X/twitter, Instagram, etc, and we believe the founders should start building communities even before they launch a product. The communities can help founders: - reach PMF faster - acquire users cheaper - retain and engage users longer - build better UX/UI, and - hire early employees Below, you can see how RTFKT and Omeda Studios built the community and then worked with them to create a product the users really wanted. We would love to talk to the founders who think the community is essential in building a product!

47

Amongst the most successful VCs in consumer in the past decade has been Kirsten Green at Forerunner So I asked her all about how startups can navigate the 70% reduction in consumer investing & why now might be the best time for VCs to look harder at the category. I loved this discussion. I always learn something from Kirsten. Click below to watch / listen https://lnkd.in/g3kiMPD5

106

2 Comments

It was a real honor to interview Brad Burnham co-founder of Union Square Ventures and partner Placeholder on the history of hype cycles in technology and the value they bring to capital and market formation. Brad has had tremendous success across decades investing at the frontier - when it was the frontier/ before it was obvious. Crypto is still the underdog and his views on the opportunity and its nuances are prescient. Specifically it is both a technical and financial innovation which can lead to excess volatility and a unique muscle as it relates to being a venture manager. But the returns are real. And the innovation is real despite some of the the common narratives. No one debates the breakthrough applications in AI at M13 we have been very active. It is also very clear that incumbents have massive data and distribution advantages which can make it challenging to find the right pockets to invest. AI is on its own hype cycle and as always the best teams (typically with contrarian takes) win. Very exciting times to be a venture investor.

39

An interesting article below, that demonstrates out how San Diego is punching above its weight.  And how Connect's strategy and execution over time, contintues to be central to that success. The article describes the current state of the market in Seattle.  (And i love Seattle.) It's a market that we tend to track with relative to venture fundings.  They used to kick our butts, we outraised them each of the last three years.  This despite the fact they have 3x as many funds there, and 9x the amount of resident capital there. (per pitchbook) Some key takeaways:  * They continue to compare themselves to SIlicon Valley. Instead, we leverage our proximity. *They whine there's not enough local investors (see note above - they have more than us). We bring over 200 VCs to SD annually! * They say founders are not connected with one another. We bring CEOs together regularly, in a variety of ways - private dinners and through our Springboard program. * They say they need to elevate their image on a national & international stage. Why we created and continue to build Five.Ten.Thirty (aka Inno Day).  * And the last paragraph - they need to concentrate on making their region a great place to live. Our mantra: "It's about Better, not Bigger." (See XEO, TL Fund). THANK YOU FOR ALL OF YOUR SUPPORT. WE ARE ON A MISSION TOGETHER!!!  (Comments, whining, suggestions on SD always welcome.) https://lnkd.in/g6Rq_f2Y

109

10 Comments

Fundraising has as much to do with "Team" as "Product" & "Market. Sure, VC's/PE's want to see that you have a viable product, in a large and/or growing market. But they also need confidence that the right team is in place to execute on the Mission of the company. I have a client that went out for a $30-40M series B round of funding in early 2023. They were commercial at the time, with a respectable amount of ARR, and were close to FDA approval for a next-gen system that would completely revolutionize their segment of medicine. Even though it was the most difficult funding environ of my lifetime, it was surprising when they did not receive a single term sheet. The CEO (a close friend) autopsied the situation. He was relentless in his pursuit of feedback from investors that said no. When he heard the, "it's too early for us" type responses, he dug deeper. What he realized was the lack of a full time CFO was really hurting him. Investors were reticent to invest in a company that had not set up their ERP. Whose data room was not super organized. Who did not have the proper KPI's set up to manage performance, and to drive revenue acceleration. In early 2024 we helped this client hire a CFO that could do all of this, and also sit shotgun with the CEO, helping him pitch the company during the raise. The series B kicked off again in February. The results were remarkable. In speaking with the CEO this week (5 months into the raise), I was informed they had 3 terms sheets they were considering (all Tier 1 investors). Two of which wanted to take the entire $30-35M round. Here at The Mullings Group we evaluate companies on our proprietary 4 Pillar system: Leadership, Market, Product & Mission. These are the four factors which we believe most impact the success of a early stage company in Med Tech. None are more important than any other. And each contribute immensely to results in the following activities which are critical to success: recruiting, fundraising, ARR creation/acceleration, new tech development. If companies are built with these four factors in mind, it signals that the companies is nor being built to be sold. Instead, a healthy company, is being built which may end up ultimately being purchased. Subtle nuance, but huge difference. #medtech #startup #digitalhealth #medicaldevice #medicaldevices #healthcare #medicine #ARR #recruiting #acquisition

35

2 Comments

Exciting news from Monica Chopra, Jeffrey De Flavio, MD, Samantha Adelberg, and the rest of the Auxa Health team as they officially announce their $5.2M Seed round. The team's deep industry expertise and drive for change have led them to solve critical infrastructural friction to providing quality healthcare and adoption of value-based care. Auxa's AI benefit navigation platform is simplifying the complexities of healthcare by streamlining all of the fragmented and siloed data and information to make it actionable in real-time for healthcare organizations. For the 70% of Americans who aren't getting access to the health and social care benefits they deserve, Auxa's solution will be pivotal in enabling equitable care. We're thrilled to partner with co-investors Zeal Capital Partners, AlleyCorp, Laconia, and Chaac Ventures on this journey and look to share many more milestones ahead. Cc K50 Ventures, Ryan Bloomer, Daniel Vásquez, Nick Talwar, Stefanie Ng https://lnkd.in/dPDY7-Db

44

4 Comments

#hiring If anyone knows an awesome engineer that would be interested in joining an emerging #AI company doing important work in #healthcare, please drop me a line! Andy AI is backed by General Catalyst, YCombinator, Greater Ventures, and others, and they’re looking to hire a full stack engineer (US based) who's excited about using AI to improve healthcare and reduce nurse burnout. Andy is AI software that automates clinical documentation for nurses who do home visits. A nurse makes an audio recording of the visit and Andy automatically generates a form that usually takes nurses 90 minutes to complete. Nurses love the product because it potentially saves them 15 hours of charting a week! The founders previously built healthcare AI at Google Health and Apple, and are now building their vision to transform home health. More about Andy AI: https://with-andy.com/ Nurses love it: https://lnkd.in/g9XqZrUq #GenAI #digitalhealth #hiring #engineers #healthtech

16

2 Comments

The power of three! There are three YC companies that have absolute dream teams consisting of three founders each who happened to announce their existence to the world on the same day. They are working on some of the biggest issues impacting humanity: the creation and education of healthcare providers, agtech/climate, and women’s health. I honestly could not have dreamed up better teams to tackle these massive problems. Synaptiq (YC 23) was started by three friends who have known one another since elementary school: a UCSF-trained physician, an engineer from Square, and an all-star designer. The physician dropped out of Stanford neurosurgery, the hardest residency program to get into in the country, after scoring in the 100th percentile on the board exam and realizing he could use AI to bring his studying methods to other physicians and healthcare workers. Now they have growing revenue and are on track to launch at almost every medical school in the country. Feanix Biotech (YC 23) was initially started by two geneticists who grew up on dairy farms. They came up with new genetic tests for cows and had skyrocketing revenue but realized that the farmers they were working with could make even better breeding decisions. That’s when they met their third co-founder, an MIT/Google ML engineer who was already working on agtech software of her own. Together, they’re now developing the world’s first software + diagnostic platform for agriculture. Simbie Health (YC 23) was started by a Fulbright fellow physician out of uChicago, an operations leader from Carrot Fertility, and a software engineer from Princeton. They’re working on women’s health, creating software that enables women’s health practitioners to start their own, virtual-first practices. Yes, more women’s health, please! Congratulations on your launch! Ryan Phelps, MD, Jacob Caccamo, Kevin Bastoul; Mitchell Angove, Tom Bishop, Meia Alsup;  Natalia Neha Khosla, MD, Rachel O'Driscoll, and Natalia Perina.

229

30 Comments

What I learned this week…. As the economy works to eliminate the healthcare cost of poor nutrition, there is no simple set of instructions to follow. There is an abundance of AgTech, FoodTech and HealthTech innovations touching a piece of the bigger equation. But each is driven by divergent signals (GLP-1 vs. sustainable fuels). If this were a large corporation, its R&D group would coordinate the various parts to fit a broader objective. But there is no Bell Labs of longevity or nutrition. The master architect is 350k years of human evolution encrypted in our DNA. Without a large R&D lab or a master plan, it comes down to early adopter customers as our guide. And up to capital providers to see the knowledge arbitrage and invest. We are assembling Food is Health from a pile of Lego blocks. 1) The most legitimate startup investor is a customer. Why don’t we have a tool like PitchBook to find early adopter customers? 2) Nutrient test assays, and many assays, measure a proxy attribute to estimate the target nutrient (i.e. protein). NIR and other spectroscopy are non-destruction and measure a wider array of orthogonal attributes. With the addition of AI, increasing correlations expect an acceleration of valuable insights linking soil, crop genetics, bioavailability, nutrients, health, and longevity. And ultimately, affordable nutrition. 3) Intermittent fasting plus protein pacing (consuming protein at consistent intervals), may boost weight loss and gut health. Perhaps important to GLP-1 treatment and boost to Fairlife Core Power Elite. 4) If we can monitor crops for expression of nutritional qualities (Macro and Micro) during the growing season, we could dynamically modify inputs to modulate nutritional density in season or as a training set for the next season. (John Kempf) 5) Architectural Innovation: Vogue wasn’t replaced by a fashion media company, it was replaced by 10,000 influencers. Salesforce will not be replaced by another CRM. Clayton Christensen and Rebecca Henderson are both right. 6) Taylor Swift’s tour in the US generated $5 billion in consumer spending over 6 months. Who is the Taylor Swift of nutrition? 7) The net demand from the addition of New York to California’s Renewable Diesel standards, by some estimates, would consume the entire US production of soybeans. 8) United Airlines is using the 100k seat back video screens to micro-target consumers with advertising. 9) A plane uses 15%-20% of its fuel during takeoff 10) People who majored in Journalism in the 90’s have seen social media decimate their industry. What college majors will disappear with the Creative Destruction of AI? 11) When playing with Legos, some people follow the instructions precisely, and some do not. I never did. H/T: Erin Martin Ellen Brown Brad Fruth Katie Stebbins More commentary on Creative Destruction: https://lnkd.in/g-vQpF9d

50

27 Comments

What do you do when a radical new technology puts your main product right in the crosshairs of disruption? Listen to David Okuniev — co-founder of Typeform | Ask awesomely — discuss the challenges of innovation within existing structures. David shared a game-changing insight: Radical innovation is really, really difficult to do inside your own product. He emphasized the need to break free from the constraints of familiarity and embrace change from outside the box. Henrik Werdelin and I have both seen our fair share of this in our respective careers. What struck us most was how David leveraged structure to overcome the innovator’s dilemma. By creating a culture of experimentation and providing space for bold ideas, he propelled Typeform beyond incremental improvements. What other hacks have you seen or employed to help your organization overcome the innovator’s dilemma? Share your stories below! 👇 And if you want to dive deeper into our conversation, click the link in the comments to catch the full podcast episode!

4

2 Comments

The healthcare landscape is rapidly evolving, driven by advancements in technology and a deeper understanding of patient care. I had the pleasure of speaking with Ambar Bhattacharyya, Co-Managing Partner at Maverick Ventures, on the latest episode of The Full Ratchet. Ambar has partnered with numerous billion-dollar companies like hims & hers, Cityblock Health, Devoted Health, and ConcertAI. His unique journey from rural America to becoming a prominent figure in venture capital offers invaluable insights into the future of healthcare and technology. We discuss his investment strategy at Maverick Ventures, the megatrends shaping healthcare, the impact of AI on the industry, and the importance of integrated care. Ambar also shares his thoughts on the challenges and opportunities in healthcare investment, offering a comprehensive view of what lies ahead. Check out TFR Episode 438 to catch our conversation. You'll be glad you listened.

117

8 Comments

Open-source models can be a strong lever for increasing gross margins at AI companies, especially those that have hefty cost structures (e.g., enterprise sales orgs that require significant customer success or implementation resources, as well forward-deployed AI services models common in healthcare and life sciences). One of many reasons to maintain a modular and flexible stack with minimal dependencies when building an AI company. More on the importance of flexibility in the AI stack: https://lnkd.in/eA2XATRk h/t Delip Rao #ai #artificialintelligence #generativeai #healthcare

50

6 Comments

VC funding in healthcare has been more resilient than in other industries. Here are some key takeaways from recent Carta data: 👉 At the priced seed, Series A, and Series B stages, dilution for health startups has noticeably decreased, while dilution for SaaS startups has stayed flat or increased slightly. 👉 In priced seed rounds, median dilution for healthcare companies dipped to 14.2%, compared to 20% for SaaS.  👉 The frequency of bridge rounds surged in the health sector in Q1, jumping to 44.3% from 36.9% in Q4 2023. This is the first significant increase in bridge rounds in healthcare over SaaS since early 2022. 👉 More founder-friendly terms for health startups may result from enduring VC interest since COVID. Healthcare has remained strong through economic turmoil, enabling higher valuations with smaller round sizes. What are the implications? The healthcare sector might see a rise in new ventures due to favorable investment conditions and lower dilution rates. The surge in bridge rounds suggests that certain sectors within healthcare face unique challenges that require interim financing solutions. Founders and investors in the healthcare space- what are your thoughts on this? I’d love to hear from you. If you know a founder innovating in healthcare, tag them in the comments! The Artemis Fund is especially interested in groundbreaking care tech companies. You can check out Carta’s full blog linked in the comments. If you haven’t read our latest blog on care tech, you’ll find that there too. #healthcare #caretech #fundraising

21

3 Comments

I recently sat down with Michael Batko, CEO at Startmate and Founder of Puddle Pod for Episode 11 of Insane Ambition. Startmate has invested in 230+ startups, much of it under Michael's leadership, and now has $3.5b in value across its portfolio companies. In this episode, we discussed: - Michael's journey from consulting, then living in the Amazon rainforest, to leading Australia's biggest startup accelerator - The future of Australia's startup ecosystem - The labour government's very stupid plan to make it harder for people to qualify as sophisticated investors (now thankfully shelved) - Startmate City! Startmate's plan to build Australia's first startup city. Probably the most ambitious idea I've ever heard from a startup accelerator. - The balance between visionary thinking and traditional startup advice (think Elon Musk's plan to colonise Mars, vs Y Combinator's problem/customer obsession) - "The Courage to Be Disliked", and its influence on Michael's approach to life and business. Links in the description below 👇

61

4 Comments

Advances in AI have driven remarkable progress in both product performance and (therefore?) market interest for health system and physician adoption of digital assistants. With that progress has come lots and lots of start-up noise making it very hard to differentiate amongst the players - everyone says they are awesome and can do everything...so who knows? This is where KLAS shines in the HC IT space - third party, discerning and trusted reviewer of products and services. It is awesome to see that KLAS Research has written an Emerging Company Spotlight on Suki with an Overall Performance Score of 93.2 (which is extraordinary - the 2024 Best in KLAS Software Average is 79.6 out of 100). Ignore the noise and hype - - - the dedicated and innovation driven team at Suki has created the category leader. https://lnkd.in/gYpJQQzr

73

5 Comments

Here’s a question investors are often asked: When evaluating early stage companies, how much time do you spend on due diligence around future exits? It’s not surprising we hear this question a lot. Also not surprising: it’s got a wide range of answers depending on the firm. Some don’t spend much time here at all. Others make it a point to put meaningful time in as part of their process. Our current thinking: take the time to do the work on public market comps. At Alpaca VC, we spend significant time understanding how public market investors will  realistically value a business based on margin profile, product, business model & TAM. In short, we want to know: how will this company be valued at scale when we get taken out? Yes, we can acknowledge that the journey toward exit is a windy road and that there may be pivots along the way, but there are still public market companies that have a business model similar to the early stage company you're evaluating. And you can always look at gross profit multiples if you think the margin profile will change over time. So we still do the work on the comps. Quantitative metrics we look at when making the comparison to public market comps include EBITDA multiple, revenue multiple, Gross Profit multiple or all of the above. As part of this process, it’s also important to factor in the public market company’s year-over-year revenue growth as this will also significantly impact the multiple it trades at. Simple example: if you have two public market companies with similar business models and similar margin profiles, but one's growing 100% year over year, and one's growing 50% year over year, then obviously the DCF (discounted cash flow) analysis is going to spit out a very different valuation for the one that's growing faster. Why this matters: When you take all of that information into account as you evaluate an early stage business, you can begin to create a realistic picture of how this company will be valued in the public markets at exit - or how an acquirer will value the company for an acquisition. Strategic acquirers may, of course, pay a premium, but we won’t underwrite for that. This allows us, for example, to form conviction around valuation based on revenue and gross profit predictions. If we think they can do $100M of revenue five years from now, we use this diligence process to form a thesis about whether the characteristics above (product, margin, business model, etc.) will cause the company to be valued at $200M vs. $500M vs. $1B at exit. Curious how other early stage investors think about underwriting an exit and how much time they’re spending on public market comps even though these companies are in their infancy.

39

3 Comments