How to Launch a Global HealthTech Startup: with Stanford, Veris Health, Innovator MD, & Arena Labs

Welcome everyone. Welcome to our Founder Institute event, How to Launch a Global Health Tech Startup with Stanford, Verus Health, InnovatorMD, and Arena Labs, and also other groups and startups that are represented through our speakers today. My name is Dominique Kim. I am the co-lead and co-director of the Founder Institute's brand new Health Tech Accelerator. Which was just formed over the last couple of months, and we're getting ready to recruit. We are recruiting for our very first cohort of the health tech vertical, which is a global effort. So the reason we're here today with our esteemed speakers is that health tech is a really fast-growing ecosystem. There's so many players involved, but often entrepreneurs, especially at the pre-seed stage, are unsure what resources are out there, how they relate to each other, how they can access those resources, what order to sort of start working toward those resources in. And so at this event, we've gathered some top representatives across the health startup industry, local entrepreneurs, as well as leadership of actual health tech companies, board members of health tech companies that are thriving in the Bay Area, and also globally to help us and to help you as our audience better ascertain and pinpoint how to navigate the rich resources, the rich network of resources in the startup ecosystem. So you'll hear insights tonight that I just want to stress will reflect the kind of experience and expertise that all of our mentors will be providing to our first cohort. So I'll give detail later. With my co-director, Dr. Yuli Chetapally, about how to apply for our very first cohort. But for tonight, we're really going to focus on hearing a little bit from each of our speakers and then having a really lively, hopefully, Q&A with all of you. So you're as much actors and actresses in this evening as the participants and attendees, as our speakers, and certainly as myself and Dr. Chetapally. So we'll get started in a minute. I'm going to turn it over to the speakers in just a few moments to introduce themselves, say a few words about their particular roles in the startup ecosystem. And before I do, I did want to share that we have with us in our audience tonight 3 or 4 recent— not so recent, within the last couple of years recent— FI graduates of other accelerators within the Founder Institute. And so we have François Pellier, who is the founder of Circogene. Hamza Shaikh, who's the founder of Stable, Tori Smith, who's the co-founder and CEO of Endiats, and Olu Ogunleyla, who's the CEO of LifeRhythms. And we will give you an opportunity in the audience and also speakers to reach out to them and to get to know them and to connect with them on LinkedIn or however you want to connect with them later. But I just wanted to kind of call out that We have leaders that have gone through the FI accelerator, not the health tech one, but they went on to form health tech companies, and they will be part of the network of mentors, 50 and above, 50 and more mentors that are going to be able to guide our first cohort and also are accessible to those of you that attend tonight if you want to reach out to any of our mentors represented here tonight. So let's get going. We have wonderful speakers here tonight. You probably heard us setting up a little bit for the webinar, but we're super excited to be able to have a lively Q&A. So please remember, this is a live webinar, so you're encouraged to type your questions into the chat box as we're going through either the introductions or anytime throughout the Q&A. So definitely Keep those questions coming. I know I have a few questions for our speakers, but really we're looking to all of you to use this opportunity to really tap the wisdom of our speakers here tonight. So let's see, I think we'll start with— we'll start with Dr. Shlifky. Dr. Shlifky, if you wouldn't mind giving a brief introduction and telling us a little bit about your role in the startup ecosystem as of late?

Sure.

Thanks, Dominique. So yeah, Adam Schliffke. I'm an anesthesiologist. I work, practice at Stanford as a clinical assistant professor. And I've been in and around digital health for 10 to 15 years. I started right after my residency. I trained at UCSF and then I joined an angel group based in the Bay Area, health tech capital, where I got to run the screening process for the for the group for about 2 years. So I got to see a lot of the early stage startups and this was in the early days of digital health, like around 2008, 2009. So I got to see a lot of the startups at that time and got to fund some of them through the group. And my job was to sort of coordinate all the due diligence upfront for the companies. And then we would select some of them to pitch at a meeting and I ran that meeting and then After that, they would attend a dinner and then we would potentially fund them. So my role at Stanford, I do, I'm a practicing clinician, but I also do some clinical research in digital health. I'm actually trying to start up a study right now and looking for funding. So it hasn't quite started yet, but we may be collaborating with some industry partner to look at digital health tools related perioperative outcomes in obstructive sleep apnea patients, those having surgery at ambulatory surgery centers. So I thought I'd— my expertise from the beginning has really been in sort of funding. So I thought I'd talk a little bit about funding. And if I can share my slides, let's see here. So this is my contact information. Please feel free to Call, email, text. I'm happy to talk to anybody about anything related to digital health. Always very involved in the ecosystem and happy to stay connected, be connected and stay connected. So what are financing options for early-stage entrepreneurs? Well, friends and family, obviously, probably the first place to start is, maybe you don't wanna put in your own money, You can ask your friends or family to put in a little bit of money, typically on a convertible note or a SAFE note. And we can talk about exactly what that is later if you want. But this is usually the first place to start. The second place I would say is affiliations with hospital systems and universities. If you work at a hospital or hospital system, or obviously your university, typically there's money there available. I'll talk a little bit about that more in a second. I wanted to go over just some numbers here. So Rock Health puts out a report every quarter around funding. And so this is funding from between 2011 and 2021. And you can see average deal size increased from $12 million all the way to $40 million. And the amount, the total amount spent, went from $1.2 billion to $29.1 billion. So there was actually a doubling of funding from 2020 to 2021, which part of it is related to COVID. And I think COVID really kind of accelerated the funding environment because lots of hospital systems have realized that they weren't really quite set up for the digital health tools that were necessary to to bring good virtual care to COVID patients. And so a lot of the funding, the increase in funding is probably related to that. And then if you look at the stages of funding, you can see that the most number of deals actually in the Series A side, and then as you go on down to Series B, Series C, and Series D, they're bigger rounds, but there's not quite as many deals, and that obviously makes a lot of sense. The early-stage stuff is obviously higher risk, and as companies evolve and have income, revenue, they're more likely to secure Series B and Series C and Series D funding, which are really meant to be— Series C and Series D are really meant to be growth rounds for companies that have really defined their business model, have products that are out in the marketplace or have many customers and they're really looking to scale their businesses. So Stanford just put out a report about 160 pages, this from the Center for Digital Health. And I'd encourage you, if you're interested in working with Stanford, I'd encourage you to look at this report. I can't possibly summarize everything in the report, but suffice it to say that there's a lot of work going on in digital health at Stanford, both at the Center for Digital Health Research. And then there's many other research, there's many other researchers and many other programs within Stanford that have a component of digital health. I think I was in the report, I think it says something like 2,000, Recently, there are 2,000 papers that are, since the 1980s, there are about 2,000 papers that can be cited in and around research in digital health from Stanford researchers. And the Center for Digital Health coordinates some of the outpatient studies that happen at Stanford. And so as far as angel funding is concerned, my Health Tech Capital is part of, So Gust is a website that allows you to apply to angel groups for funding. It's all— it's a web-based application, web-based portal for angel groups. And then of course, many of you probably know AngelList, which is a place you can look for independent angels, and they have syndicated deals on AngelList as well. So we talked a little bit about friends and family. I mentioned universities. I know that Stanford and UCSF have money available for alumni of the universities and for employees or people working within the universities. There's often different routes of funding through universities and hospital systems. Sorry, my— Computer. Okay. And then if you look at venture investing, NFX is a, I believe, both an incubator and a venture firm. There are, according to NFX, there are 1,800 early stage investors. So for all those that are in the early stages, we can talk about sort of what's important for early-stage investors, but there are, there are lots of places to look. So not only individual angels and angel groups, but also Series C seed investors and Series A investors as well. Finally, there are non-dilutive sources of capital. So there are SBIR grants. Typically these grants are given to entrepreneurs who have Typically in some sort of academic component, the people who are most successful in getting these grants typically have affiliated with people who have gotten grants before, who have done research in different areas. But specifically, if you're looking for digital health, it would be in digital health. Finally, there's lots of you guys have probably come across many of the digital health incubators and accelerators, but there's There are quite a few. I'd encourage you to take a look at them. There are a handful in the Bay Area as well. One of the accelerators that I'm affiliated with is Launchpad Digital Health, which tends to fund many digital health deals. Although recently it's less of an accelerator and more of a funder. So that's, That's just a little bit about funding. I'm sorry if this was pretty basic, but I wanted to keep this pretty high level, but happy to go into more detail about any of this and look forward to the discussion. I encourage you to ask questions.

Thank you, Adam. That was wonderful. I think we'll probably get into— can you guys hear me?— questions as we go through the webinar. Let's see. So thank you, Brian. I think you're next. I'm going in alphabetical order of the first names of the speakers. If you can hear us, Brian, feel free to jump in.

Yeah, I'm good.

Thanks for rolling.

Yeah, humble to be here. So yeah, of course, I— what I thought I'd do for the audience, I think— so Brian Ferguson, the founder of Arena Labs. So we're a venture-backed startup now based in Nashville. We do have a footprint in Palo Alto. And for those of you who are dialing in from the Stanford area, Dr. Andrew Huberman, who's actually at Stanford, who a lot of you may know if you're in the health tech space, is on our science advisory board. But at a basic level, we focus in providing frontline clinicians with the same tools that are given to other high-pressure performers. So you think about people in elite military units, in Olympic sport, in the creative arts, all of those people who have to perform under pressure for a living are given a set of tools to manage stress and pressure in the face of anxiety and high-demanding jobs. My background was in special operations. And so my last job in the military was collaborating with the Cleveland Clinic. And it surprised me that our frontline clinicians are not given those tools. And this is 5 years ago. So well before the pandemic, the pandemic, I think for everyone on this call has elevated that narrative profoundly. And so we ultimately aggregate data around the biomarkers related to stress, sleep, rest, and recovery for individuals. And then we do it for hospitals to get an upstream understanding of burnout. I'm glad to talk at length for anyone who's interested, and I'll drop in either the Q&A or the chat, I'll drop a link into our— for those who are interested in our site and just how the tactics of what we do, but I thought would be interesting for aspiring founders is just to share a little bit. I think what I often talk about for those of you who are interested in going to health tech, I think there's two aspects to think about. The first is, Starting a company is an opportunity to take what you believe about the world and put it in motion. And so every founder I've been around who's really inspiring and done big things has had some degree of a philosophy about the world. That can change over time, but I think having a philosophy about the state of healthcare or whatever you want to do, and particularly health tech, is vital. And oftentimes I see founders go in who are looking more at the technology than they are the philosophy of how technology can be put into play. A couple of things I was going to share. Let me see if I can still share my screen. This is for those who, when you start to deconstruct, and I'm sort of just a little bit raw real time here, but people love to throw big numbers up and admittedly this is in our deck, right? So this is, it says the cost of physician burnout is $4.6 billion. When I was in the military, I used to often think the most complex institution in the world was the national security space, but I've come to believe it's actually American healthcare, and the reason it's so— it's complex is multifold, but ultimately all of the problems are expensive. I think we're all, as entrepreneurs, we're drawn to big expensive problems, but one of the things to think about when you look at numbers this big, they're great to throw in a pitch deck, but the question is when a number is that big and it's a problem, we're probably not looking at it in the right way. And so a lot of times what we often do at Arena Labs is go back to our philosophy and say, how do we carve a niche out to reimagine a problem? And so what I want to spend just a couple minutes on is our founder's philosophy at Arena, and then in the Q&A, if folks want to jump in more, glad to. So I'm going to just share real-time behind screen. This is our Notion board that we have internally. And so this is, this is our founder's philosophy. And this is very much again, what I believe about the world, but I'm just going to hit the first 3 in the interest of time here, and then glad to go in more. What I would challenge all of you, you know, whatever vertical you're going into in healthcare, especially in health tech, is to have some version of this for yourself. So the first is micro over macro and going back to the healthcare industry for as much as we love to throw around large numbers, whether that's patient population, monetary size of a problem, the bigger the industry, the more the individual unit matters. What I mean by that is most solutions focus on the macro, but what you see is burnout as an example. Most companies that go look at burnout are looking at it as an organizational phenomena. Grounded in either financial and economic challenges or hospital efficiency metrics. At Arena, we invert that paradigm and we obsessively focus on the individual clinician. And our belief is we can provide a nurse or a physician with a toolkit to reimagine their own performance through their own physiology. That then becomes the macro over time, and that's how we reimagine industry. The second is that bureaucratic tensions cannot be eased, so circumvent them. So if we talk about bureaucracies in any industrial scale— any industrial age organization, you talk about the US military, the US education system, the US government, or the global healthcare system, all of those industries were built in the 20th century and they're ill-equipped for the 21st century. We can't tear them down and restart. So we have to create solutions that can somehow circumvent the bureaucracy. So we focus on being— the way that translates for us is being a trusted teammate. So if we can engender trust with a physician and nurse, and turn around and engender trust at the top of that hierarchy with administrators, that allows us to recreate an ecosystem in a hospital. And then the third one is double down on the human system. And I should say that if you disagree with anything here, and particularly if you disagree radically, that's probably where you should focus. So for intentionally, for the sake of provocation, I'll say that one of my critiques of many health tech solutions and startups is that they focus on the technology. I would argue that the greatest companies in the future, particularly in healthcare, are focusing on the human system, either the human provider, the physician or nurse, or the patient. But again, I think obsessing about the technological solution is where there's a lot of noise right now in the healthtech industry. For those people who have figured out a human solution that's amplified by technology, it ends up being not only a more elegant solution, but it forces us to understand the core of what healthcare is, which is a human system. So I'm going to pause there. Glad to answer any questions. Glad to go through— you're seeing here the other 5 elements of our founders' philosophy. But again, humbled to be here and glad to dive in as any questions come up.

Thank you so much, Brian. That's wonderful. I'm sure there'll be many, many questions for you both during the webinar but also afterwards as well. All right, let's move on to— we're trying to take care of the technical issue and the bug in the background. So we're doing the best we can on that. And I think I have an idea of how we'll manage the chat for the question session. Moving on, though, I'd love to welcome to the stage Dr. Cochran. Dr. Cochran, would you mind giving us a little background on your role in the ecosystem, your many roles— I know you'll have to pick one— and how you'd like to— what you'd like to share with the group just to get us started today into the Q&A? Oh, I think you're on mute, Dr. Cochran.

You auto-mute me because I didn't— anyway, possibly. Anyway, well, thank you. I was trying to think because I looked at the speakers in the general genre and I thought, what do I have to add? And so I'm going to sort of talk— I guess it would be a little bit of my experience from both ends of the equation. And as a big customer. So I was, my last job was I was the national physician chief executive for the Kaiser Permanente Physician Group called the Permanente Federation. So a lot of time in dealing with physicians and physician leadership. So I'm gonna sort of try to track a little bit about the world you live in, which I'm learning about as a third career path for me, but also about what does an organization like Kaiser mean? How do we fit? Do we fit? Do we have a role in the future and how does it look? So I'm gonna just look at 3 things. I'm gonna offer a couple of questions for you to consider. Are they the right ones? And then I'm gonna introduce myself, and then I'm going to try to sort of link my understanding of the world that you live in and the way an organization like Kaiser is structured and the way it works today as of today. And I'll say that because in point of fact, when Kaiser was founded, it's largely a West Coast organization still. I'm not quite on the frontier in Colorado. We've still got a region in Georgia and a region in Mid-Atlantic. But it was a very innovative, very disruptive, very disliked organization because it butted up right against the the history of fee-for-service medicine. We had group practices where every physician at the time was in their own office. We had prepayment where every physician was doing fee-for-service. So we did a lot of things, and we had physicians working with health insurance people in collaboration. So we were very innovative and disruptive. Fast forward 70 years, and I was being interviewed by a group of leaders when Bernard Tyson took over the health plan job, and I was his national partner, and we were in front of a group of national leaders and trying to— are we still innovative? Are we still agile? And his premise was, oh yeah, we're agile, I see it everywhere. And I said, well, let me just tell you 3 things I know for sure about us. We're old, we're large, and we're successful. And that combination doesn't classically make an organization agile, but We just have to understand that while we think we're agile, that's also exactly what we are. So the two questions are, number one, how does a large organization or a system like Kaiser's fit in and leverage this very dynamic ecosystem? And the second question is, how much integration, and by when we talk about integrated systems of care, we're talking about different definitions, but ours was largely internalization and ownership. We had the doctors, the nurses, the hospitals, the insurance. It was an integrated system including lots of bricks and mortar. And the world of connectivity and interoperability today says we can be a lot of different things that are different definitions of integrated than the old Kaiser model. And how do we take that basis that we have and start to actually interface in a meaningful way with, with the world that you guys are all championing? So those are the two big questions. To introduce me, it's pretty simple. I, I was a— I did a surgery residency at Stanford. I did a plastic surgery residency at the University of Wisconsin. I moved back to my hometown of Denver, went into private practice, loved it, great partners, loved the surgery, loved the work. I was doing a lot of pediatric care at the time, pediatric plastic surgery, a, a seed and a passion that was planted for me by Dr. Don Laub at Stanford. And then the insurance companies in the 1980s started to do something they called managed care. Which was a euphemism for getting in the way of doctors and patients and manipulating decision-making, etc. So I get, I get rather upset with the way things were. And I had these two partners, we were having a good practice, we're having a good time. And Kaiser Colorado started to internalize the tertiary care specialties, and they came to me two years in a row. The first year I said no thank you, and the second year they said, this is, it's you or somebody else, not you or nobody. So I, I moved after 10 years into Kaiser Permanente. I started their plastic surgery program in the Rocky Mountain area. Saw great opportunities inside Kaiser to get better, and that's how I got— not drafted, but I got attracted into the board of directors. Then I became the president of the Colorado region physicians, and because we did a good job and made some real differences, I was then recruited to be the national physician director for the Permanente Federation. In Q&A or sometime, I can talk a little bit about how physicians fit and whether they do or not, because As you guys know, as physicians and people who work with physicians, some of our colleagues are stuck, badly stuck and very unhappy, and some are soaring and the world is very different. So next, I just, I'll close by sort of validating the linkage between you and then how Kaiser exists and how Kaiser might be a different partner for you in the future. You know, you have a proliferation of good ideas. You talk a lot about funding. Your customers are very heterogeneous though, and you know that, and you have to sort that out. But, you know, you have a challenge sometimes with especially devices and some of those things. You have to sell in layers. You got to care, talk to the people who care about efficacy and quality, you know, the clinical people, and you have a certain thing you want to say to them. Then you have the people who care about efficiency and cost minimization. A slightly different message. And so it's a complex sale. I learned that when I became involved with Clarify Health Solutions in San Francisco. I was a founding board member at Clarify, and it was really amazing to me that how I was sort of, I was sort of the choir. I was, I believed, right? And I had to see how hard it was to get people to see the advantages of certain things. And then finally, I gave a talk at Genentech about 15 years ago before, before we were talking a lot about affordability. And I was talking to all their scientific leaders, I mean really the geniuses of the biotech world at that time, and they were doing great work. And I said, you know, the thing is that you have brilliant people that create great chemistry, you create outcomes, products that you can commercialize, sell, and change healthcare. The problem is the leverage against you is to ratchet your price down, keep making your price more competitive. 'Whereas what you would— if you could add one more filter to your genius, which is take a look at the product as a component of an end-to-end care process and say, how can this product not just add cost and quality, but how can that product actually eliminate certain other steps and improve the cost structure?' And that sounds idiotically simple. Many of them said, 'Well, we hadn't thought of that. We were just thinking about great chemistry, great products, and commercialization.' So If you get the right questions asked, you can focus people in different ways, and that's a different sweet spot. Anyway, KP is a large integrated system. It's huge. It's $60 or $80 billion now. I've been going for 5 years in 8 states, and it's still a sort of an ownership model. We have all the big assets and products. And so how are we doing on the 2 questions? Well, the first question of how we fit in, I think we're evolving. We're not sure exactly how we fit in, And on the number 2 about should we continue to try to build everything ourselves or start to create more of a collaborative ecosystem, I think we're debating that. I'm not debating it anymore, so I'm not there. But I'll close with, as the physician leader of Kaiser Permanente, I had the privilege and the exhilaration to deal with a whole building full of geniuses in terms of the clinical and academic space. And they were in the arena of clinical quality, between physicians, PhDs, etc., just some of the greatest, brightest minds you could ever deal with in the clinical quality area. They developed a culture where we embraced measurement, learning, improving, etc., and it was a cultural norm, whereas you go to some place, they go, clinical quality, we don't have time for that. That was a long time ago when that was still present. We also had it and data systems that was sort of a a little ahead of the time. I was the national sponsor when we spent $4 billion on Epic Systems. I have to own that. Bernard and I and Kathy Lancaster were the national sponsors. And then two other things. We have the Department of Research, which is a tremendous database in addition to the already existing Kaiser Permanente database. And then the Care Management Institute, which is an organizational construct, mostly PhDs and MDs who are working on some of the cutting-edge issues of healthcare sort of an academic think tank type of organizational construct. Inside of it were two committees where people like you would get invited. One is the Interregional Pharmacy and Therapeutics Committee, where they really scrutinize and go through science and applicability of new innovations in pharmacotherapy. The other was the Interregional New Technology Committee, which is a very, uh, sophisticated group of people that really look at new technologies to try to see if they they pass the muscarine to actually use internally. And I was giving a talk at the Wharton School for their MBAs in healthcare about 6, 7 years ago, and one of the senior vice presidents from Medtronic was on a speaker after me, and he came up to me at the break and he says, you know, we sell you guys. And I said, what do you mean? He says, you guys are so impossible and so impenetrable and so difficult to get into that when you finally take on one of our products, we go around and tell people Hey, we said Kaiser's buying this because you, you have set a standard. Now it may be too high, it may be too difficult, but he said we actually sell you because people know how difficult that committee is to get through. And then the last thing, you got it, you had a presentation I think a couple weeks ago from KP Ventures. And KP Ventures is a small fund that is really designed to keep us a little bit ear to the ground and linked to people like you guys because they are continuously looking at the, the the breakthroughs and the new ideas to provide sometimes funding, sometimes board support, sometimes board observers. But, uh, so those are the ways that we interface the world, trying to learn. My, uh, my knowledge there is aged, you know, I've been going for 5 years and I've been working with 4 different organizations, not in an intense level, but 2 that are medical devices. One is, uh, as I said, Clarify Health Solutions, which is data analytics, and the other one is a care management company out of Toronto.

Great. Thank you, Dr. Cochran. That was very, very helpful, especially for those less familiar with the Kaiser Permanente integrated healthcare system and plan. So thank you. We're going to move now to Dr. Mitchell. Thank you, Dr. Mitchell, for joining us. I think you're muted. We're having a little issues with mute, but let me— it looks like you're unmuted. Okay, thank you in advance.

Yeah, thank you for the invitation to be here today, and it's a real honor to be on this panel with all these great speakers. So I am a physician, I'm a radiation oncologist in the San Francisco Bay Area. I'm also a two-time startup founder and CEO. Largely in med device originally, but then expanding into digital health data and analytics. My first company, we, my co-founder, who's also a doc, an interventional radiologist, we developed some vascular access technology that we took through several iterations of development and testing and ultimately sold to Bard, which is now part of BD. Um, and so we had a successful exit from that one. Uh, in 2018, we set out to address a problem that, uh, was very common in our own practice, which is the challenge of, uh, managing risk associated with episodic outpatient cancer care. Um, anyone who's taken care of cancer patients knows that, uh, they spend far too much time in the emergency room. In the hospital, in the ICU, because we're delivering very high-risk treatment in an episodic and outpatient manner. So patients go home and largely are out of contact with the healthcare system when they're at highest risk of complications. There are myriad of complications that can happen in a cancer patient, and, you know, unfortunately we don't know that these complications have developed until it's too late and the patient's in the hospital and were taking a break from their cancer treatment in order to address that complication. Um, so we set out to address this problem, uh, through building a technology platform. So, uh, our technology platform integrates an intelligent and plannable medical device, uh, a software platform that has patient-facing and care team-facing interface. And then data analytics to extract insights from data that we're gathering both from patients and from our intelligent implantable device. So a lot of the, you know, kind of ecosystem resources that we'll hear about tonight, we've been through as part of our startup. Adam, we actually got seed financing from HealthTech Capital. We also got seed financing from the NSF through an SBIR grant. We've been through two accelerators. One is the UCSF Rosenman Institute accelerator program, and we also went through the MedTech Innovator accelerator program, which is the biggest health tech innovator, a health tech accelerator in the planet. And in 2021, our company was acquired by Verus Health, So that's— we are now Verus Health. We are a subsidiary of a company called PavMed, which is listed on the NASDAQ and was founded by two really amazing physician innovators and entrepreneurs, LeSean Acklog and Brian de Guzman. They're cardiac surgeons who have a decades-long history of developing medical technology and medtech businesses. So I stayed on as Chief Medical Officer of Verus Health, where we're continuing development of our tech platform.

Wonderful. Thank you so much, Dr. Mitchell. And Dr. Mitchell has actually been a speaker at our last event as well. So special thanks from our frequent flyer program.

Yeah, excited to be back.

Yeah, it's a wealth of information. So thanks again. Dr. Chatterpally, would you give a little overview of yourself? Last but certainly not least, my co-director of this new health tech vertical accelerator. So over to you, Yuli.

Sure, thank you very much, Dominique. It's a pleasure to be here, obviously, because number one, you know, I get to see all these amazing speakers and panelists, but also be able to address some of the potential innovators and entrepreneurs. Introducing myself, you know, my background is emergency medicine. I practice emergency medicine at Kaiser Permanente in South San Francisco. I was also involved in research, and my most important work there was designing a system where you take data from the EHR and provide decision support to physicians at the point of care in real time. I have, uh, since then, uh, retired or took early retirement from Kaiser 3 years ago, and I started, uh, InnovatorMD, my company. The idea behind InnovatorMD is that, uh, physicians and other frontline workers are facing problems, and they see the problems firsthand. And also they can come up with solutions that are unique compared to a, let's say, a technologist or a business person. So what we wanted to do was create a platform where these innovators can bring their ideas and bring their projects and showcase it for the rest of the world, mainly to create a community that can support these innovators. Through connections, through partnerships, and hopefully resource them with some financing so that they can take their innovation to the next level. So my role as the founder and president of InnovatorMD, you know, that's what I try to foster in. And we are, you know, the largest physician innovation company there. We do conferences, we do classes, master classes, And we also do meetups, so please do join InnovatorMD. You know, you don't have to be a physician to join the company, the group, but you'll be, you'll be excited to see all the new innovations that are happening. My other role is that Dominique just told you, I'm the co-director of this accelerator. It's a pre-seed accelerator in partnership with Founder Institute. Founder Institute, as you know, it's one of the largest accelerator companies, and they have accelerators in 90 different countries. And so what we did here is that is very unique in the sense that we are doing a vertical accelerator, which means it's that it's a global accelerator. So companies from anywhere in the world can join our accelerator. So this is one of those events where we are highlighting our accelerator program, and mostly in health tech, where you have scalable solutions that you can bring to the table. Please join us, uh, uh, Our staff will provide the link for you to look at and explore this option if you're interested in joining this accelerator. I'm also playing another role, which is I am an entrepreneur of a startup, and the startup is called Sirica Therapeutics. It is a digital therapeutic system, uses hardware, software, Mainly, the components are robotics, virtual reality, and video games. How can we use these technology pieces and we put together a therapeutic system for autism? I have a daughter with autism, so that's why I'm very interested in this space. And we have seen some incredible results from the exercise programs. So we want to build it into a scalable system. So one of the things I wanted to talk about today is how is digital therapeutics, you know, changing the face of entrepreneurship, and also how is it changing the health landscape. So when you look at technology, you know, we talk about you know, digital health. But digital health can be, you know, many things, right? But digital therapeutics is where you have a digital health app that can be prescribed as treatment. So that is a great, interesting category for me because, you know, all my work life I was focusing on, you know, how can we leverage digital technology to be able to improve outcomes for patients, right? So this is directly competing with medications, you know, uh, you know, one-on-one therapy. And, um, you know, this is a list I found on what are the digital therapeutics that are out there, especially in Germany. You know, they have, uh, approved and are funding these, uh, digital therapeutic companies, and most of them are for mental health issues. And so this becomes a very scalable solution if it can actually show improvement in outcomes for patients, right? You don't have to manufacture, you know, like you do with devices or like you do with pharmaceuticals. All you have to do is, you know, prescribe an app, you know, whether it is a desktop app or on your phone, and that becomes a therapeutic device. So the solutions we are, we are building is a system using advanced robotics, virtual reality, video gaming, and machine learning. So The, the idea is that if you put together these technologies, that you can build a digital therapeutic. I'll show you how it looks. I have a video of the prototype, and it's a 1-minute video. I'll play it here. So this is my daughter, you know, sitting on the device, and the device itself is a robot. You can see it moving, and what she's seeing on the VR glasses is this vehicle that is going, and she's navigating the path. And the video game responds to her actions, and she's steering with her arms and pedaling with her legs. So she also feels the road conditions, you know, if she goes over a rock Or if she hits a rock, it bumps. So she's getting that haptic feedback from the video game. And so the machine itself is collecting, you know, thousands of data points. And so you can figure out what exactly helps patients. So that is the kind of, you know, future that we are looking at where You know, you take all these pieces of technology and you can put together a system which becomes then a digital therapeutic which becomes scalable. You know, currently we are raising our seed round, but you can see where technology is going in the future. You know, these machines will become, you know, available in every clinic and also in homes, and it becomes ubiquitous. With our, you know, existence. And that's a little bit of the future, that where we look at how technology is going to improve and digital therapeutics will become a major player. So thank you very much, uh, you know, thank you, uh, Dominique, for this opportunity. I'd love to take questions or comments. You can connect with me on LinkedIn, uh, that's the best Wonderful.

Thank you, Dr. Chettipally. So now we're going to move into the Q&A. And we actually have a number of really interesting questions that have come up in the Q&A. So what I'm going to do is I'm going to read them out and try to ascertain who could best answer them. But I have a feeling that many of you are going to be qualified to answer this. So let's treat it like a panel. If you feel like the urge to press the buzzer and answer, certainly speak up. But really, I think a lot of these questions can be equally and equally answered by any or many of you. So let's get started. First question is from Hannah Tran. Hope I'm pronouncing that correctly. And I'll quote her. I run a venture— or him, excuse me. I run a venture studio focusing on health tech. We incubate and commercialize health-focused startups. But have never been in mental health. So I am interested in learning about mental health landscape and which angle we should focus on. Most startups in mental health are in the coaching space, it seems, connecting physical— I think maybe meaning connecting— I'm not sure if like physical environments and patients, maybe. But there have been so many tragedies caused by people with mental health issues. What can we do? It's a big question. And I'm going to try to paraphrase how I interpret that question. What can we do as pre-seed founders to connect with the right resources to try to address some of these really pervasive mental health issues in today's society? Big question, I realize.

Well, I would say join FI Accelerator. The slide I showed, you know, is, you know, what the government of Germany has approved as far as digital therapeutics are concerned. And half of them, you're right, half of them are in mental health space. Mental health is ideal for digital therapeutics because You know, you can constantly keep track of how the patient is doing and also be able to provide these therapeutic messages and therapeutic interventions when, you know, there is a problem. So I would say explore the digital therapeutic space.

Great.

There's been a lot of recent funding for mental health startups. I don't— I'm not quite— I mean, I don't know the whole milieu of companies, but I would say that, that they, they reach much farther than just, than just coaching. They, like Yuli is referring to, kind of, I mean, some of them would be considered, I think, you know, virtual care for mental health. So it's, it's a very interesting space. There's a hot space if, if your Venture Studio is interested in getting into mental health, I'd suggest looking at some of these companies that have gotten a lot of funding recently.

Great. Any other thoughts?

Yeah, I'll just add that one of the real challenges in mental health today that I think is largely influenced by the pandemic is just the shortage of mental health resources. There are huge wait times to get in to see a mental health professional. And this may get better as we get some distance from the pandemic, but I don't think it's gonna, the problem's gonna go away. I think this is gonna be an ongoing problem. So I think that some solution that kind of bridges the gap between some degree of access to therapy, but then bringing in the digital therapeutic aspect that can maybe supplement that and unload some of the burden from the mental health professionals so that they can care for more patients at a time.

Wonderful. Thanks, Dr. Mitchell. Okay, I think I'll move on to the next, the next question in our Q&A. So this is for you, Dr. Chetapally. Are you aware of the work that Dr. Skip Rizzo, R-I-Z-Z-O, has done via USC ICT? I feel there could be a merger of your tech with the work done there. So that's sort of a personal suggestion too. I don't know if it's a question for the group, but Maybe that person could be of interest to the rest of the group as well. Excuse me.

Yes, I do know Skip Rizzo and his work. He is a brilliant investigator and scientist, and I am a fan of his work, definitely.

Great. So maybe we'll make that resource available to others in the chat, Ruchi or Nadia. That would be helpful. Sounds like for others to benefit maybe from that resource. So, okay, I think here's one from Fadi Shanon. What makes it so hard to get a pilot installation of diagnostic AI software in a clinic? I know a few of you are more familiar with the AI space than others. But any thoughts on that?

My observation would be that pilots in general in healthcare are, for good reason, difficult because there's just a lot of people who want to pilot things to prove their technology out. I think particularly in AI, I mean, this is one of my— when I was saying there's sort of two aspects to think about, one is understanding your philosophy, but two, how are you carving a true niche? And there's just right now, Because health tech and particularly digital health are so in vogue, there's a lot of companies popping up, particularly in the AI space, who are claiming to solve a problem, and that saturation just creates— I think it's creating amazing solutions, but it's also making it harder. It makes it challenging to prove your value early on and find the right partners, which is why the messaging and the philosophy are so important to have rather than just the technology.

That's really helpful. Anyone else have thoughts? That question about the difficulty of implementing AI technology in the clinic, clinical setting.

Any technology is hard. Any new technology is hard to implement in a clinic or hospital where you have very specific workflows. So unless you spend time in the clinic, you're not going to understand. I mean, the technology is, only helpful if it works around the people that are using the technology, right? And the people that are using the technology have a million different things that they're trying to do in the clinic. And to ask them to use your solution for something when they already have a bunch of things that they're already using puts a lot of weight on those people. And so it's, so just because of that, it's hard. It's hard to implement something new. But I would say you'd have to spend time if you really are having trouble getting in the front door. I mean, spend time in those clinics that your product is being used in or potentially being used in, and then really understand how the people work, how information flows, and how your product can fit into that information flow. As well.

Very helpful.

I would say, I would say there are, there are two main reasons why a clinic would implement a technology. Number one is it should save time. Whatever they are doing, it should cut that time by, you know, it should make it one-tenth. Uh, the second reason is that it should not, you know, the business model has to fit. Now, if you're going into a clinic that is fee-for-service or going into a hospital that is run mostly as fee-for-service and you say we're going to cut down your stroke admissions, they won't like it because you're trying to find a more efficient way of taking care of patient because that will affect their income. So number one, time and effort, you know, does it decrease time and effort? Number 2, will it increase or not decrease their income? Those 2 are big factors.

Yeah, very helpful.

I always, I always say that in healthcare, it's, you know, you're who you sell to and who you get the money from, or potentially, I mean, who your customer is and where the money comes from. Those are potentially two different places. And so it's really important to create the right value proposition that speaks to those two different entities.

That's also why I alluded to the issue of the heterogeneity of customers and clients. And I think that, you know, there's a big difference between prepayment and capitation and fee-for-service, as we all know, but, you know, one person's waste is another person's revenue. And I think that's an unfortunate truth. And it would be good if we all had the highest standards on evidence-based decision-making and not wasting money. But, you know, in addition to being clinicians, they're also breadwinners and a lot of pressures on people. And I think that's why it systems have to be more than just, you know, flashing signs that said, this is what you're doing or should do. The context is very different for different types of practitioners.

It's all super helpful. So I feel like we just have such a great panel to answer any of these questions in a very multifaceted way. So thank you all. The next, the next question was, may I hear a little bit more about each of your experience with scaling what you do globally? So particularly for those that have started startups or in the process of trying to scale, what has been your experience there? Challenges, things to think about when these young founders are thinking about scaling?

I'm happy to start with that one, with the caveat that we're in the process of scaling globally. Still in the works. So our first overseas market will be in Europe. And so, in terms of looking at the EU, I think that there are two huge differences than in the US. One is the regulatory landscape is different. They regulate digital health and medical devices differently than the US. So there's a different paradigm, different set of experts and consultants that we work with that are based in the EU. And so we have to have a separate strategy, separate regulatory strategy for the EU. And then the other aspect is, you know, the, the business of healthcare is very different. You have many small markets, as opposed to one big market in the US, where each nation has their own kind of paradigm for how healthcare is delivered, how healthcare is paid. There's some countries with very strong government health programs, others that are much more free market, more like the US. And so it, it really requires a strategy for each country And so it's hard to have kind of a uniform sales and go-to-market strategy for the entire continent. And so in order to, you know, kind of break into those different markets, we're working with EU-based consultants and looking for EU-based partners that could be, you know, European-based pharma companies, med device companies, or research organizations that run programs throughout the continent and throughout the EU that can help us navigate that landscape.

I have a follow-up question to that. I would think that even within the EU, obviously within each country, there could be differences, maybe not within a country, but across countries of the EU. Is that presumably something that you're leveraging partners to figure out too, is what are those kind of those differences within the EU? I imagine each country, each country wasn't always part of the EU, and I imagine there are still some differences that are pretty salient.

Right, absolutely. So country by country, there are differences in how the health system is structured, who pays for healthcare, what fraction comes from the government, what fraction comes from private insurance. There were a lot of changes that came with Brexit that disrupted the existing infrastructure and framework. So it's very dynamic as well. And so, yeah, we really rely on experts that are in Europe that, you know, know the landscape and have boots on the ground there that can help us navigate. Almost impossible to do it from afar.

Yeah, yes, super smart to have partners there that really actually know the landscape, right? Really leverage that. That's, that's, that's awesome. Any other thoughts on challenges or considerations when trying to scale your company beyond the States, or beyond your originating country, I should say?

I, you know, I had experience with InnovatorMD when we first started 3 years ago. This was just before the pandemic, so we were, you know, happy, you know, okay, local San Francisco Bay Area. And then we, we thought, we started thinking, oh, maybe we should do some local conferences. And so we booked some spaces and, and nicely, you know, having this face-to-face experience for for innovators and entrepreneurs so that, you know, you get that, you know, collegiality and networking opportunities. And then, you know, suddenly the pandemic hit, and so we had to cancel all the events that we were doing for a few months, trying to figure out how do we do this. And then we were actually forced to go online and go virtual. And then we started doing virtual events and then realized that, oh, you know, we could do this for the rest of the world also. It doesn't necessarily have to be the US or the Bay Area. And so, you know, in a, in a fortuitous way, we were forced into by this, you know, horrific pandemic that made us go global. And that gave us a lot of experience in, okay, how do we deal with the time lag? How do we deal with different regulations in each country? How do we bring in experts from other countries to be able to speak to what the conditions are over there and different health systems and trying to understand those? And suddenly it expanded our minds and also our opportunity, which finally led to, you know, FI, Founder Institute, where it is a global accelerator. So, you know, anything we do from now on, it has to be global. It can be— I mean, you can do local events, but, you know, it's much. The pandemic has forced us to look at those possibilities, you know, like the last conference, you know, we had 100+ speakers. We were able to do, you know, wholly online with some local presence, but mostly online. So in a way, pandemic has pushed us to go global.

That's an interesting point that the pandemic The good, bad, and ugly of the pandemic has really pushed a lot of companies to grow in ways that maybe they wouldn't have. Many haven't. But on the flip side, it's really interesting to see that they've needed to innovate. And that has translated into scaling, maybe even in some unintended ways. It's really fascinating. Anyway, I want to keep us moving with the questions because there's so many other good ones that are pouring in. To the Q&A. Let's see. As a startup who may want to, who may want to plug into an ecosystem, how do you overcome entrenched large de facto data management providers and barriers around data privacy and ownership? It's a good question, I think. Does anybody want to tackle that one? You can, you can stay high in general. You can get real specific and give examples, answer it any way that you, that you feel you can.

One of the ways, you know, ultimately at Arena, we're a data company. And so we're, we're collecting physiological data on frontline clinicians that relate as it relates to stress, sleep, recovery, rest on a number of fronts. Some of it's biometric data that's collected on a sensor and some of it's subjective data that's input on a daily basis. What is really important is what we find, back to my comments about bureaucratic structures, and there's inherently usually distrust at the front lines of any organization with the leadership. When you look across healthcare, the military, and education, and the way that you solve that or that we found that is to allow people to opt in because they feel like it's there's a sense of trust that's been engendered for them to share data. So that's creating a whole new ecosystem of exchange. So if someone is willing to share data because you're going to turn around and give them insights about their own behaviors to make them more high-performing in their craft, again, that exchange is creating an entirely new environment. And then at the same time, to turn around and share that data to healthcare administration to give them insights about their frontline human capital. So at a basic level, we often talk about this idea of being a trusted teammate. I think when you start looking at regulated data, this is when we look at patient data, I think that my colleagues here will have far more insightful probably responses, but I think it's ultimately getting to how do you begin to develop solutions that create ease in the system, but that's a It's a very different challenge.

Great. Any other thoughts?

Yeah, so I, I think some of this question might also be related to electronic health records and the siloing of data within the EHR, which has been a real challenge to development of, you know, data-driven medtech solutions. But I think that there are several forces that are moving this in the right direction. One is legislation. The 21st Century Cures Act mandated that health platforms be set up for interoperability. And alongside of that, there's been development of standardized messaging protocols and data standards with things like FHIR, HL7, and SMART on FHIR. And so the culmination of these tools plus the market forces that, you know, as people realize the drawbacks of siloed data, there are market forces pushing to open this up. And, you know, if there's one thing that the, that, you know, big tech companies I think are actually doing well and healthcare is setting up the foundations for this type of interoperability. So we're building our platform on Microsoft's Azure for Healthcare platform or cloud. And AWS has very similar tools where they have a lot of the interoperability layers in addition to the security and compliance layers that, you know, as Brian alluded to, building that trust that the data is going to be safe and secure within your solution. I think Microsoft and Amazon have done a really, really solid job of putting those foundations in place so that solutions like ours can come in and add layers on top of it, but not have to build it from the ground up. So I do think it's headed in the right direction. And so if you're getting into this ecosystem right now, I think you're going to have a lot of tailwinds.

That's encouraging. Great. That was a great question. Oh, did I hear someone? Go ahead.

I can take that question. So if you are developing a product using the data, pre-collected data, you know, there's a lot of free data sources that are out there, you know, like X-rays or pathology or things like that. If you want EHR and, uh, and claims data, and if you want to build a product out of that data, go buy it. It's available on the market. So it's de-identified de-identified, and you can buy millions of records if you want to. If you're building— if you want to build a product on a specific customer's data, then you better sell your tool to the customer before they'll let you use their data. So in other words, they have to really like what you're doing so that they can share the data. And so that you can build the product or service using their own data. If you are collecting brand new data like Brian is doing, then you, you better have a customer or you better have a pilot site that is interested in, in your, in your tool. Otherwise you won't be able to do that.

Yeah, it's a great add. I like this question. It's a tough one, but I feel like everyone will have something to say about it. What are some of the most challenging operational processes and workflows in health that have not yet been solved? Kind of a free-for-all question. And notice Eddie Zhang is the author of this question. He said in health, not healthcare. So I thought that was interesting. What are the most challenging processes and workflows in health that have not yet been solved?

I think just I'll go first quickly. I'm not in this space. I think the most exciting space in health right now is the preventative health world, particularly in imaging, biomarkers in blood. I'm sure a lot of people are familiar with Grail. I mean, there's some really fascinating technologies that are doing early detection of illness and That space is fascinating.

You're here, I'm in public health, so I'm like, prevention is my jam. Anybody else?

Definitely prevention. And how do you create a business model that takes care of prevention payment? In other words, you know what Kaiser does? You know, how do you modernize that into into the current world, you know, how do you make it more efficient and more business-wise? How do you take care of that? How do you come up with a business model that is easier and tech-enabled and easily solvable? That's a big one.

I'm sorry. Sorry, it was Jack. I think Prevention is a big word. I think that there's also just to deepen the awareness of the issues around social determinants of health and how that has such broad implications for not only health but cost of care, productivity in the communities, et cetera. The social determinants have been well documented and known for decades, but only recently have become mainstream understandings that the implications are not just the right thing to do, but real in terms of community wellness, productivity, cost of living, et cetera.

Yeah.

Yeah. On the heels of that, I was going to say disparities in access to care and outcomes of care. We have here in the US very wide disparities in different populations, and we need to find ways to bring everybody up to the level of those getting the highest quality of care and the best outcomes.

Yeah, I remember we had a— we did some research in our Care Management Institute, and we looked at things like, you know, the sort of the low-hanging knowledge, which is obesity and diabetes and that sort of thing. We're doing overlay geographic distribution graphs. And then somebody said, well, let's take a look at obesity and diabetes, and let's put on top of it gun violence and see what the patterns look like. And they just absolutely overlaid on each other. It's just the pan-community issues, including nutrition, but also all the other social issues.

So maybe I'll add to that question. Sort of make it more applicable to founders or pre-seed entrepreneurs that are actually thinking about making a dent in this space and really addressing what are the long-term— what's the potential for looking at social determinants and turning that into a business idea that's research-based, that's actionable, that's technology-driven. What would you recommend to a company or a pre-seed founder that is thinking about going into that space? Space, in a space that can be quite amorphous, as Yuli mentioned, Dr. Shapali mentioned, there definitely isn't necessarily a system for operationalizing that and monetizing, frankly, you know, how do you actually, you know, do that? I mean, yeah, there's research showing, you know, that there is impact and impact can translate into cost savings, utilization, etc. But what would you say to pre-seed founders that really want to go in and really address this as sort of their mantra or their charge, prevention and social determinants? It could be in terms of funding, where to go, what resources can they leverage, maybe a little more specific.

Yeah, I think unfortunately it's going to be hard to find venture financing for a business like this where the profitability and scalability is probably very difficult to define early on. So I think that if this is your passion, you probably want to look for grant funding early on. The NIH has a lot of grant funding out there for these types of projects. And businesses, and so looking for SBIR grants from the NIH, I think, would be the best place to start.

Great. Great. All right. I have a question from a Bethany. Many of these are first names, so how would you go about asking for the opportunity? And this kind of ties back to what a few of you alluded to or said, that you really need to understand the clinic setting. I think, Dr. Schliffke, you were saying this in particular, to really understand what your product is going to do and how it can integrate into an existing workflow, right? So I see this question as related. How do you go about accessing that opportunity to observe at a clinic or a hospital? Not everybody that wants to start a startup is necessarily already embedded in that clinical space. How would you go about asking for that or getting that opportunity and at what phases of development is that most useful? If any of you have given that any thought.

I mean, I think you do the legwork and you knock on doors and I mean, that's the way to— there's no secret sauce here.

I think that's the essence of entrepreneurship.

Yeah.

Yeah.

I mean, I think that community, communities are probably going to be more responsive than large organizations. Like, I, you know, I wouldn't go to Kaiser necessarily to begin with, um, but I mean, yeah, the Steve Blank, um, you know, method of entrepreneurship is, you know, go out and talk to 100 customers. I mean, so I think the, the responding to this question, I think the, the answer is you knock on a bunch of clinic doors and You see, I mean, you're offered essentially to observe, to maybe to even volunteer. I mean, you can volunteer at some, some places. But yeah, I don't think there's any secret here.

Great.

One, one suggestion I would say is that have a physician or a nurse or a pharma co-founder who is in that space, who has a clinic, who's running it, and who is interested in making things better at that clinic. So you, you enlist these people as advisors, as consultants, or co-founders.

And we also live in a world that's very flat and very connected, and I think that, um, you know, you find out who your community is and who are other people who would be aligned or synergistic with your, your thinking. I'm blocking on the, the man's name who's now at Stanford, who came from the Mayo Clinic, and he was he was interested in physician career and physician burnout. The cure— when I was a surgery resident, the cure for physician burnout was just work harder and shut up. And that wasn't just being smug, that was exactly what the model was. So, you know, we have only recently gotten a little awareness of some of those things. But I think if you look in the world, in the literature, you'll find some either early adopters or people who are advocates for the things you care about. And maybe you have a device or something that they would love to do that. I'm seeing a colleague from Ireland right now working with somebody at the University of Colorado because they found them online as somebody who writes papers about this treatment of asthma.

Very helpful. Yeah. There's a question for you, Brian, and Dr. Cochran. Two for you. Both of you spoke to designing, designing for human interaction with a technology rather than the technology itself. Often the decision makers on sourcing a service or product are not the end users who would most immediately benefit. Can you speak a bit more on how you demonstrate or persuade value to that audience where there may be resistance or even different philosophies on what is healthcare?

Yeah, I mean, I think it's a really important question and it's the essence. I think similarly, it's the essence of what I find to be the exciting creativity of being a founder and building a solution, which is, in our case, again, we're building for frontline clinicians, so physicians, nurses, surgeons, but at the end of the day, we sell to hospitals and administrators who aren't always They equally care, but often through different lenses. That's where I always say that the best sales strategy is having a profound narrative and rooted in strong ideas and philosophy. So at the very tactical level, that means finding a way to interact with those frontline clinicians to understand what they need, how are you solving their problem? That's in, frankly, I think any technology that's being built, and then how does that narrative packaged in a way that is compelling for the person who ultimately would be purchasing it? And I think that ultimately comes back to, in our case, unequivocally, our most important work always comes from the recommendation or suggestion of a frontline clinician going to a leader saying, "I think this would be a great solution. This is what we need." So we try not to be doing any sales ourselves and hopefully have built something compelling enough that the end user is at— is making that case for us.

Yeah, I agree. And I, I think that I, I alluded to it but very, very briefly about the frame of reference of your target. And I think that a lot of people are, because of their subspecialization either in business or in medicine, are pretty hyper-focused. And they're not trying to do the wrong thing, they're not trying to have a bad day or to have you have a bad day, but they just don't have adequate context or enough knowledge. It always helps to have some real tangible data around return and what the return might be like, but I would say this, if you're talking to a savvy CFO, they rarely have somebody bring them a request that says, yeah, this is going to be an important investment that's going to lose money forever. Everybody's got a little ROI built in, and so they have to be, you know, pretty discerning about that, but I think part of it is just continuing to share context with them until they understand the breadth and the depth of the problem and the implications that may not be immediate but are certainly collaterally of great interest to the outcome of the organization. Great.

All right, so we're, uh, we're winding down toward the end of the, um, the event, um, but I did want to ask two more questions if you guys have enough juice left. What are some of the biggest challenges in connecting with investors for new technologies. Many of you can speak firsthand of this for this one, or have been on both sides, a founder or a funder. Any thoughts on that?

One of the biggest challenges that I'm facing, as you know, as I'm raising money for Circa Therapeutics, is trying to find the group or the angel group or the VC group that actually is focusing on what you're building, you know, those kinds of things, right? Each, each VC company have— will have their own philosophy, their own methodology, their own favorite areas where they invest. So there will— there is a lot of research that you have to do. There's a lot of people that you have to find and talk with them. Previous founders, you know, I've gone to James here to get his advice. So you have to go to people that, that have done this before and that know this. And then you have to do a lot of research by yourself on what are the kinds of technologies or projects that, that this group is funding. Another way to look at it is you go to your competition and see Oh, these are the kinds of people that will fund this kind of companies. So there's a lot of groundwork that you need to do as an entrepreneur.

I mean, I think part of the question is how do you stand out among, you know, investors get inundated with companies and technology. And to Yuli's point, I think part of it is a matching game, right? It's connecting the right investors with the right founders. But I mean, it's also the way that you, you tell the story. And, you know, some, some venture investors are very focused on technology. And so the technology, having deep expertise in that technology is important. Others are less focused on that and more focused on the drivers of the business. And I mean, you can learn a lot about these firms by just looking at their portfolio companies. You can see who's been successful in raising money from them and you'll get an idea of sort of what their thesis is around how they invest.

Any other thoughts?

Yeah, I'll just add that, you know, kind of similar to the comments that Adam and Brian made before about, you know, knocking on 100 or 1,000 doors for talking to customers and getting a sense of needs and workflow. I think the same is true for finding the right investors. There's, as Yuli was saying, every investor group has their own timeline. Funds typically have a 10-year lifecycle and you don't know where they are in that lifecycle. They have their own thesis. They might have prior investments that limit their ability to invest in your company. And so, so, you know, you just have to go and knock on 1,000 doors to find the right fit. But before you do that, it's just very important to have everything in order. So, you know, like Adam was saying, have your messaging locked down. Um, understand all of the details of your business, um, today and going forward. Have a professional-looking data room set up so that when the call comes in, uh, we want to see your information, it's ready to go and you can manage it. Um, and then be ready for pounding the pavement.

So I'm going to close us on this question because it's not meant to open up a Pandora's box, but I think it is an important question. And I trust that you guys can provide a succinct answer. I'm going to trust that. So this question is from TJ Ocean. He's asking, I'm a medical provider and co-founder of a digital telemedicine startup. Given the high number of uninsured and underinsured individuals in our US, What are your thoughts on self-pay versus the payer-based insurance model? Specifically, his question is, should a startup offer both options to scale faster and capture a larger market size? That's his question. I thought that was really interesting.

I would love to give an answer, but I don't feel qualified. I've not worked in that space. So I'm going to defer to— for the experts here.

Yeah, I, I, you know, we focus on cancer care. I'm an oncologist, so we don't do a lot of self-pay, um, work. But, uh, I think if you're in the right space where you have, you know, a low-cost, uh, encounters, then, um, then it seems a reasonable thing to consider because You know, getting payment from insurance companies is a huge challenge.

Very helpful. Thank you.

Especially if you're, if you're trying to define a new category, right? If you're, if you're, if you've developed a technology where you're looking for reimbursement, and it's not something that's already been thought of before, then that's going to be, it's going to be a long road. To be able to get the money from the payers.

And slow, can be slow. Yeah.

One of the advice I was getting was, you know, for my startup, you know, since it's a new category, new device, they were talking about, you know, you can go directly to the customers and they pay you if it is compelling enough. And then you go to this other model of where you go to employers who want to provide that service for their employees, and then you go to insurance. And so there are different ways, again, depending on your solution.

Wonderful. All right, well, I, I want to bring us to a close and thank all of our wonderful speakers. You all brought such a diverse array of experience and background, yet still within this ecosystem. So thank you so much. Huge thank you for your time on a Wednesday evening. You're all probably hungry for dinner or ready to sign off after a long day. So thank you. And thanks to our audience members as well for your great questions. Apologies for the snafu earlier. We are definitely going to look into that and figure out what happened and make sure that that never happens again. So I'm glad we were able to make such a productive evening out of this regardless, and that's what I think most of us will take away. So thank you all very, very much. I do have— there is a slide that Anadia, our trusty team on the back end, was going to flash up now. We do have a— there it is. We have contact information here, and we are also— Dr. Chaddapally and I are also encouraging all of you to, or friends or family, to apply to the Health Tech Accelerator Cohort 1, which is starting in May. It's starting May 15th, and the final deadline to apply is May 1st. Our early application deadline is March 27th. So please do feel free to ask us any questions about applying, about the process. We are, I believe we've put into the chat a link as to our actual Health Accelerator landing page where you can find out about the accelerator itself, about past mentors, about some of the alums from FI that have gone on to form really impactful companies. And by the way, all these companies that graduate out of FI, which there are over 5,000 since 2009, have all created their goals and made their impact in line with the UN Sustainable Development Goals. So that is a criteria for applying to the program. And there's many— there's a lot of impact that's coming out of these companies. So just wanted to give you a little framing. But, but yeah, logistics-wise, reach out to me, Dr. Chittipalli, with any questions at all about the program, about what it's like, about when, when, when, when to apply, things like that. We'll be happy to answer your questions. We've also put a link in the chat about resources for, or rather, other events that FI, Founder Institute, will be conducting both for our accelerator, Health Tech Accelerator, and also more globally for FI headquarter events which span all the different accelerators. So many of you may have interests that kind of bleed beyond the borders of health tech, and if you are, many of the events are even within health tech very relevant to starting a company and to thriving and to networking and meeting the right people to really land it. So yeah, I'm going to pass it over to you, Dr. Chatterpally, if you had anything else that you wanted to add. Otherwise, I just wanted to thank everybody for being here.

I wanted to thank Dominique. Thank you very much for an excellent session. Thank all the speakers. Thank our back office staff, Anadia and Ruchi, and also our entrepreneurs in residence Lavinia, Dr. Lavinia Herbe, and also Dr. Kendall Allred. These are, you know, super mentors, so you will be able to reach them, you know, once you join our Founder Institute Accelerator. So thank you very much. Have a good night.

Have a good night, everybody.