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7Wire's Jaffee on the Hard Truths Behind Health-Tech Investing · Vanguards of Healthcare by Bloomberg Intelligence

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Speaker 1: Welcome to another episode of Bloomberg Intelligence's Vanguards of Healthcare podcasts,
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Speaker 1: where we speak with the leaders at the forefront of
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Speaker 1: change in the healthcare industry. My name is Jonathan Palmer,
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Speaker 1: and I'm a healthcare analyst at Bloomberg Intelligence, the in
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Speaker 1: house research arm of Boomberg. I'm thrilled to welcome Olissa Jaffe,
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Speaker 1: partner at seven Wire Ventures, to the program today. She's
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Speaker 1: been a prominent voice in the digital health ecosystem for years,
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Speaker 1: and at seven Wires, she's at the heart of the
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Speaker 1: firm's inform Connected Consumer thesis, which is helping to build
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Speaker 1: and scale companies that are rewiring the status quo. She
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Speaker 1: sits on way too many boards for me to mention here,
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Speaker 1: and beyond her investment work, she's a frequent contributor to
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Speaker 1: the industry dialogue and a champion of a health equity
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Speaker 1: in women's health. It's been great to see you in
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Speaker 1: person at a number of different conferences, and I'm so
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Speaker 1: thrilled to have you on the show.
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Speaker 2: Welcome, thank you, thank you for having me. It's a
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Speaker 2: pleasure to be here and excited for this discussion today.
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Speaker 1: Well, why don't we just start off in level set,
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Speaker 1: you know where does seven wires sit in the venture community?
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Speaker 1: And at a high level, you know what is your
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Speaker 1: investment thesis?
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Speaker 2: Yes, so we are a venture capital firm investing in
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Speaker 2: healthcare technology companies under a thesis that we call the
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Speaker 2: informed connected health Consumer. So everything that we do is
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Speaker 2: all about how do we help people to become better
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Speaker 2: suits at their health how do we think about healthcare
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Speaker 2: technologies and services, meeting people where they are, and we're
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Speaker 2: quick thematically driven. I'm happy to chat more about the
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Speaker 2: thesis and what this means and why it's so impactful.
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Speaker 2: But we really believe that in healthcare, in order to
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Speaker 2: drive the biggest impact, the biggest outcomes, and the biggest exits,
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Speaker 2: you really have to engage be in consumer.
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Speaker 1: That was a great elevator pitch. Has that always been
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Speaker 1: the thesis from from the firm's early days. Has it
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Speaker 1: shifted at all or evolved?
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Speaker 2: It's always been our thesis. We were the early early
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Speaker 2: pioneers here, I'll say, in a time a decade ago
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Speaker 2: when not many people were talking about healthcare as it
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Speaker 2: relates to people. It's always been our true north. And look,
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Speaker 2: we're an opportunistic fund. We're always looking at and pressure
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Speaker 2: testing the thesis if this is really the right strategy
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Speaker 2: to continue to move forward. But time and time again
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Speaker 2: we continue to see why this is so important, not
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Speaker 2: only for the impact that it drives in health, but
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Speaker 2: also for the outcomes that it drives and the financial
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Speaker 2: returns as an investor.
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Speaker 1: So maybe let's do a test case. You know, what's
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Speaker 1: one of the fundamental wins that you've had, you know
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Speaker 1: through that lens and framework, So you.
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Speaker 2: Know, I know you've had my partner Glenn fulman On
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Speaker 2: who is the founder and was CEO and executive German
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Speaker 2: of a business called Labongo. That's probably one of the
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Speaker 2: most notable test cases out there as we think about
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Speaker 2: helping people started with diabetes and migrated into chronic condition management,
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Speaker 2: but that business really starting it from the ground up,
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Speaker 2: acquiring another company, building a digital platform around it, inevitably
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Speaker 2: taking up business public and then merging with Teledoc Health
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Speaker 2: and an eighteen billion dollar transaction. And so we really
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Speaker 2: believe in partnerships with the incumbents. We think that's where
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Speaker 2: there's real opportunity to drive impact and drive scale, but
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Speaker 2: ultimately never losing sight of what it means to engage
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Speaker 2: the end consumer.
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Speaker 1: Maybe tease that out a little bit more. What are
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Speaker 1: some examples and maybe how has that thinking evolved as
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Speaker 1: the technology and tools that we have available to us
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Speaker 1: today have transformed.
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Speaker 2: Yeah, it's for us. We always think about technology playing
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Speaker 2: the role as a provider in and not provider replacement,
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Speaker 2: and so AI is unbelievably transformative in what's happening in
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Speaker 2: self care right now. I don't think there's ever been
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Speaker 2: a better time for healthcare and technology to be an
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Speaker 2: accelerant for the work that we're doing. But it's really
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Speaker 2: about how do you support the existing infrastructure to move
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Speaker 2: more quickly to deliver better care and to really reduce
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Speaker 2: some of the operational baggage or financial investment that you
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Speaker 2: have to make because technologies like artificial intelligence can help
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Speaker 2: drive it. So I'm happy to get examples, but ultimately
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Speaker 2: it's thinking about it as an accelerant but not fully
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Speaker 2: removing the human from the mix.
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Speaker 1: Well, yeah, maybe let's dive into one that comes to mind.
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Speaker 1: You know, I sit here as an investment analyst, and
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Speaker 1: you know, every public company that I cover is talking
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Speaker 1: about AI in some way, shape or form, And it's hard,
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Speaker 1: I think for all of us to kind of separate
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Speaker 1: what's the hype versus the reality? How do you do
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Speaker 1: it from where you're sitting in the ecosystem.
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Speaker 2: Yeah, there's definitely a lot of hype, So I get it,
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Speaker 2: I do. But you know, in the reality, look at businesses.
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Speaker 2: So we're invested in a company called NOO, which is
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Speaker 2: formally known as no CD focused on complex psychiatric conditions
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Speaker 2: like obsessive compulsive disorder PTSD and others as they sort
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Speaker 2: of expand really focusing on kind of higher acuity, more
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Speaker 2: treatable behavioral health conditions. And that business has delivered unbelievable
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Speaker 2: quality of care in their teleotherapy and the services that
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Speaker 2: they offer. But they use AI for a number of
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Speaker 2: ways to be a more efficient and effective business. So
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Speaker 2: as we think about effective, you know, they've created digital
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Speaker 2: twins for their providers and their patients to help actually
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Speaker 2: training and so those digital twins not only reduce the
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Speaker 2: cost of training, but also significant and an improve outcounds,
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Speaker 2: which you and I both know is one of the
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Speaker 2: key ways to unlock payer rates and better payer rates.
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Speaker 2: But they're also using AI, you know, in terms of
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Speaker 2: their back office, their infrastructure, and an incredibly complex business,
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Speaker 2: say last year they had a million visits. I mean
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Speaker 2: this is you think about supply demand matching Credentially, they
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Speaker 2: want everyone to be seen new patients within seven days,
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Speaker 2: the plans that they service, bailing reb cycle, all of
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Speaker 2: the ways that historically we've used manual processes, now we
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Speaker 2: actually can use this unbelievable technology at that have fingertips
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Speaker 2: to drive more efficiencies, which obviously helps the financial profile
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Speaker 2: of the company as well.
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Speaker 1: That's great. You know, maybe taking another step back and
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Speaker 1: rewinding a little bit, I skipped over maybe my own
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Speaker 1: outline here. You know what drew you to healthcare in
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Speaker 1: this industry in the first place. I mean, you've been
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Speaker 1: now in it for a decade, but did you always
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Speaker 1: aspire to work health care and and you know, how
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Speaker 1: did you wind up here?
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Speaker 2: That's totally fair. I love all my children, my my
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Speaker 2: real children and my portfolio children. So when you get
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Speaker 2: me started, it's it's hard to stop. But it's a
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Speaker 2: super thoughtful question, Jonathan. I am am the daughter of
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Speaker 2: an orthopedic surgeon, so I definitely grew up in, you know, healthcare.
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Speaker 2: My father ended up owning his own practices and surgery center,
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Speaker 2: and so just seeing how the business of health care worked,
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Speaker 2: but also the passion for Satady, who loved medicine. And
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Speaker 2: today actually one of my sisters is a trauma surgeon now,
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Speaker 2: so you know, she she's continued that legacy in a
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Speaker 2: you know, a much more tangible way, but always you know,
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Speaker 2: gravitated towards the areas where I could spend my career
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Speaker 2: driving impact. And you know, when I inevitably found healthcare,
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Speaker 2: realized there was enough broken processes to lax me a lifetime,
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Speaker 2: and I worked for the Advisory Word Company. It was
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Speaker 2: an amazing firm, a healthcare technology company that later sold
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Speaker 2: to Optum. Spent a lot of time there really mostly
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Speaker 2: on the health system side, introducing new technology, is doing solutions, selling,
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Speaker 2: you know, working on more of a consultative approach to
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Speaker 2: what was happening in technology at the time. And this
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Speaker 2: was gosh, almost two decades ago, so a long time ago.
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Speaker 2: But you know, I had a wonderful career, still have
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Speaker 2: life owned friends from there. I ended up leaving, went
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Speaker 2: to business school, worked for some smaller funds, started a company,
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Speaker 2: sold that company. I worked for the Pritzkers, so JB
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Speaker 2: who's now Governor of Illinois, his brother Tony, and they
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Speaker 2: had a very large fund and you did venture investing
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Speaker 2: for them and a keen interest now as you see,
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Speaker 2: you know in obviously his his political and their film
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Speaker 2: throopic work as well, just really the importance of healthcare.
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Speaker 2: And then came here right when they closed their first fund,
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Speaker 2: so about seven and a half years ago and having accents.
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Speaker 1: Excellent, you know, talk to me about the process and
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Speaker 1: how you guys work with your founders and teams, you know,
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Speaker 1: can you walk me through? And I know none of
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Speaker 1: these are none of these are the same. But what
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Speaker 1: does a typical I don't know, start of a conversation
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Speaker 1: look like? And then how do you get to the
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Speaker 1: go no go on on the investment decision?
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Speaker 2: Yeah? Yeah, So for us it's you know, I guess
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Speaker 2: we'll take in two buckets, right, one is how do
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Speaker 2: we work with companies? And then two how do we
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Speaker 2: make investment decisions? How do we work with companies? Is
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Speaker 2: we tend to be the most involved board and on
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Speaker 2: every board, you know, we really care about being a
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Speaker 2: partner to entrepreneurs. We all have operator backgrounds for what
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Speaker 2: we call on operator driven models, so we only make
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Speaker 2: a few bets and really focus on ways that we
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Speaker 2: can help our companies to drive growth, and so you know,
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Speaker 2: ultimately it's we want to be the first call. We
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Speaker 2: want to know that you know, they're not alone. We
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Speaker 2: want them and to know that we're into trenches with that,
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Speaker 2: and we want to really support them as we think
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Speaker 2: about growing the business, particularly with the incumbency. So for that,
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Speaker 2: we you know, it's if you're just looking for capital,
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Speaker 2: we're probably not the right folks. You know, we really
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Speaker 2: want to make sure that we had that depth of relationship,
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Speaker 2: and I think the entrepreneurs that work with us really
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Speaker 2: value that kind of relationship and that trusted partner. It
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Speaker 2: can be very lonely. To be a CEO can be
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Speaker 2: very hard, and you know, having a thought partner or
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Speaker 2: strategic partner can be very unpeuchable. So you know that
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Speaker 2: that's sort of how we think about our relationship with
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Speaker 2: our founders and investment decisions. We have four general partners
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Speaker 2: here that somewhere, and we have to be unanimous, so
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Speaker 2: we're not incentivized on a deal by deal basis. It's
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Speaker 2: really about all of us leaning in no matter who's
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Speaker 2: on the board, to say yes, we believe in decision
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Speaker 2: and we want to help this company, and we think
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Speaker 2: that structurally that makes a lot more sense because no
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Speaker 2: matter who owns the relationship with somebody, we always want
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Speaker 2: to make sure that that person is willing to go
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Speaker 2: to bat for one of our portfolio companies and helping
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Speaker 2: to move the needle.
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Speaker 1: That's great, great summary. So maybe thinking about that a
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Speaker 1: little bit the deeper. You know, how long does a
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Speaker 1: typical process take for you guys through doing your due
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Speaker 1: diligence and making that decision? Is it? And again, I
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Speaker 1: know there's no single right answer, but I guess maybe
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Speaker 1: what's the general rule with them?
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Speaker 2: Yeah, we're quite thematically driven, as I mentioned, so we
11:28
Speaker 2: actually try to have a keen perspective on where our
11:31
Speaker 2: market is going before we even see a company, So
11:34
Speaker 2: we kind of know what we're looking for and we
11:36
Speaker 2: go out and try to find it. And because of that,
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Speaker 2: it makes us a lot more efficient. It's also very efficient.
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Speaker 2: We're healthcare specialist funds, so I don't have to go
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Speaker 2: to investment cannon and explain to anybody what a self
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Speaker 2: fund an employer is. Right, we jump in, we jump
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Speaker 2: into the need of it, so we do tend to
11:53
Speaker 2: be able to make decisions quickly. We don't you know.
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Speaker 2: We recognize though that this is a marriage. You know,
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Speaker 2: we'll sit on your board for five, seven, ten years,
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Speaker 2: and so we don't want to make the decision in
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Speaker 2: a day. We really want to spend time together to
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Speaker 2: ensure that you know, this is the right decision for
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Speaker 2: both us and for the entrepreneur and their management team.
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Speaker 1: What's an example of, you know, an area that you've
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Speaker 1: identified where you said that the healthcare system's broken, we
12:19
Speaker 1: need a solution in I don't know ABC, and and
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Speaker 1: you made that decision that and found somebody who was
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Speaker 1: building that company.
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Speaker 2: Oh my gosh, I mean, we don't have enough time
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Speaker 2: to talk about how broken the healthcare system is.
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Speaker 1: So I don't throw a rock.
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Speaker 2: Yes, yes, I think it comes in both sides. So
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Speaker 2: those things like you know, finding companies, we invest in
12:42
Speaker 2: in a business called Summer Health, which is focused on
12:46
Speaker 2: pbiatarecare market and how health family is to create the
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Speaker 2: healthiest generation. And ultimately, you know, I'm a mom, you
12:55
Speaker 2: know my kids, Even with access and privilege, it can
12:58
Speaker 2: often be so challenging to get and so how do
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Speaker 2: we think about democratizing access to care? How do we
13:03
Speaker 2: think about giving it to the masses. How do we
13:05
Speaker 2: think about, you know, creating more longitudinal support when pediatricians
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Speaker 2: are so pressed for time these days that they can
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Speaker 2: only do a ten minute visit. It's just, you know,
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Speaker 2: it's not the same as it used to be. And
13:18
Speaker 2: so finding companies like that where we the thesis in
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Speaker 2: the space, have gotten to know the founder actually was
13:24
Speaker 2: one of the Beata users just because I was so
13:26
Speaker 2: interested in the technology that she was building. And then
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Speaker 2: ultimately you know, leaned in and led the series A financing.
13:34
Speaker 2: And then there's ones where we ended up hatching a business.
13:37
Speaker 2: You know, GluN hatched a business called Transcarent, which is
13:41
Speaker 2: focused on how we can support the health and care
13:44
Speaker 2: of our population working with self funded employers. Predominantly, We've
13:49
Speaker 2: built an AI solution called Wayfinding, which is I'm sure
13:53
Speaker 2: one you know had shared more about that, but wayfinding
13:56
Speaker 2: is really kind of that front door of taking you
13:59
Speaker 2: anywhere and answering to those questions and reducing a lot
14:02
Speaker 2: of the cost out of it. And that was really
14:04
Speaker 2: came out of our work with Lelongo to say, we
14:07
Speaker 2: built this incredible business and yet somehow, you know, for employers,
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Speaker 2: costs are going up, Outcomes aren't changing, and you know,
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Speaker 2: the pressure was building and can we build something that
14:17
Speaker 2: supports them. It's a massive swing and Gone's doing a
14:19
Speaker 2: great job in his leadership, and ultimately, you know, one
14:23
Speaker 2: that we feel quite bullish on, but came out of
14:26
Speaker 2: the work that we had done building other companies.
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Speaker 1: Do you gravitate to certain business models in terms of payers,
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Speaker 1: whether it's government or employer self insured? Do you do
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Speaker 1: you have a preference one way or the other.
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Speaker 2: We tend to say that our preference is a B
14:41
Speaker 2: to B two C business model, typically monetizing through a
14:45
Speaker 2: risk bearing entities with somebody who bears the cost of care.
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Speaker 2: So that could be the health plan, that could be
14:52
Speaker 2: an integrated delivery network, that could be a self on
14:54
Speaker 2: an employer. You know, we have different views on each,
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Speaker 2: but ultimately that that's where we spend time. On the
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Speaker 2: provider side, we tend to focus more on how you
15:03
Speaker 2: can partner with health systems versus try to bunitize through
15:06
Speaker 2: health systems. Just with some of the nature of the
15:08
Speaker 2: challenges that they have with their balanceches.
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Speaker 1: Interesting and so if you took a step back and
15:13
Speaker 1: thought about you know, we're in the first quarter of
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Speaker 1: twenty twenty six. If you think about each of those
15:17
Speaker 1: kind of bigger buckets, what do you see from where
15:21
Speaker 1: you sit as maybe the biggest challenge for each of
15:24
Speaker 1: those because they're very different, I think in terms of
15:28
Speaker 1: where they're focused. But I think there's some commonalities across
15:31
Speaker 1: the bucket itself.
15:34
Speaker 2: Challenges for companies selling to.
15:36
Speaker 1: Those folks, oh or just no, I think no more, or.
15:39
Speaker 2: Challenges for the incumbents in general.
15:41
Speaker 1: I think challenges for the incumbents in general. I mean
15:43
Speaker 1: when I think about large scale employers who are self insured,
15:46
Speaker 1: you know, there's a number of things I think we
15:48
Speaker 1: could probably chat about there. You know, it's probably a
15:51
Speaker 1: little bit different on the provider front, a little different
15:53
Speaker 1: on the managed care or payer front. But I'd be
15:56
Speaker 1: interested to hear your perspective on where you think the
15:58
Speaker 1: biggest challenges are for those groups.
16:02
Speaker 2: Yeah, so, you know, I think some of it You're
16:05
Speaker 2: exactly right, there's commonalities and some of it there's differences.
16:09
Speaker 2: I think all of them are struggling with how to
16:12
Speaker 2: maintain the right level of service for their member or
16:16
Speaker 2: employee populations or patient populations without kind of getting over
16:22
Speaker 2: their skis where they can't fund it and so you know,
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Speaker 2: I think they each have uniqueness. I would hear a
16:27
Speaker 2: lot from employers just on the fatigue of point solutions,
16:32
Speaker 2: but yet they also that's one of the ways that
16:35
Speaker 2: they understand purchasing. So you know, business like transparent helps
16:39
Speaker 2: to aggregate it and creates more of a seamless approach.
16:43
Speaker 2: But still, we have so many companies that are really
16:46
Speaker 2: successful because they are vertically focused. So a business called
16:50
Speaker 2: nine AM Health, which is focused on cardio metabolic care,
16:54
Speaker 2: weight management, type one, type two diabetes population. That business
16:58
Speaker 2: has been really successful partnering with self funded employers. A
17:02
Speaker 2: business called Zuraigo, which is focus on chronic skin management.
17:06
Speaker 2: So think about chronic skin conditions like psoriasis, exama atopic dermatitis,
17:13
Speaker 2: huge costs item, huge spend item for both employers and plans.
17:16
Speaker 2: So you know, I think there's still a lot of
17:18
Speaker 2: movement and support happening for those who have driven real,
17:23
Speaker 2: real outcomes. You know, we just invest in a business
17:26
Speaker 2: called well Theory that's focused on autoimmune conditions. You know
17:29
Speaker 2: that business really you know, we're kind of always say
17:32
Speaker 2: like we're in the evidence era, right, you can't get
17:35
Speaker 2: contracts unless you really show the outcomes. And even at
17:39
Speaker 2: the earliest stage that business had done an actual real
17:42
Speaker 2: study on the data that they had and the impact
17:44
Speaker 2: that they had. So so I do think that you know,
17:46
Speaker 2: there's there's fatigue. I think for plans, there's challenge of
17:50
Speaker 2: the the balance between you know, their traditional model feed
17:54
Speaker 2: for service, the desire to try to create more bundles.
17:57
Speaker 2: But some of the challenges that we've had in value
18:00
Speaker 2: based contracts and you just trying to navigate through. But
18:04
Speaker 2: I've been very impressed. I think the incumbent execs are
18:09
Speaker 2: really are aligned with us in what we want to achieve.
18:12
Speaker 2: It's just it's hard to move ships so big. I mean,
18:15
Speaker 2: these these payers have gotten massive, you know, employers are
18:19
Speaker 2: growing like it's just I think for them there's just
18:23
Speaker 2: a lot more friction and trying to drive change. And
18:26
Speaker 2: so those who really raise their hand and say yeah,
18:29
Speaker 2: I want to partner with a healthcare technology company, and
18:31
Speaker 2: those are the real leaders that we see moving forward.
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Speaker 1: Well, it's all about friction at the end of the day.
18:37
Speaker 1: I think that's that's why we all that's one commonality
18:40
Speaker 1: we all have in focusing on the system right whichever
18:43
Speaker 1: angle it may be. But one thing I wanted to
18:46
Speaker 1: talk about. Was you guys published your predictions for twenty
18:50
Speaker 1: twenty six, and I think that maybe dovetails into some
18:52
Speaker 1: of the stuff we were just talking about at a
18:55
Speaker 1: high level. You know, what's your thesis around what we're
18:58
Speaker 1: going to see this year? Recognizing we're just a couple
19:01
Speaker 1: months in, we're recording this in I guess mid March.
19:05
Speaker 2: Yes, well, you know, thanks for the plug, because we
19:09
Speaker 2: did we did draft you know, some some pretty interesting
19:13
Speaker 2: thoughts on predictions more generally, so you know, folks that
19:16
Speaker 2: want to take I mean, take a closer look obviously
19:19
Speaker 2: can and read on our website of what that looks like.
19:22
Speaker 2: But ultimately, for us, there's there's a lot of change happening.
19:27
Speaker 2: But for the most part, and most some of that
19:29
Speaker 2: might be headwind, there's a lot of tailwind that's coming.
19:33
Speaker 2: And that's tailwind, whether it be in general May I
19:36
Speaker 2: and what we're seeing in the technology investments, whether that
19:41
Speaker 2: be tailwind and just adoption of technology companies that people
19:45
Speaker 2: are now and the incumbents are understanding that there's really
19:48
Speaker 2: no choice but to have this kind of adoption in
19:53
Speaker 2: order to survive. And then there's tailwinds as we think
19:57
Speaker 2: about servicing our you know, patient population, servicing members and
20:03
Speaker 2: what that means, particularly as we think about our population
20:07
Speaker 2: getting older and how we support better aging in place.
20:11
Speaker 2: You know, whether it's looking at dimentia, care Alzheimer's, your
20:15
Speaker 2: degenerate disorders, whether that's looking at the Sandwich generation, taking
20:20
Speaker 2: care of both kids of children, and we do see
20:23
Speaker 2: you know, I think their will. We say this a lot,
20:26
Speaker 2: so it's hard, but we are seeing consolidation. We are
20:29
Speaker 2: you know, the companies are trying to get bigger more
20:32
Speaker 2: quickly to drive bigger scale in it.
20:35
Speaker 1: When you say consolidation, consolidation for the companies that you're
20:39
Speaker 1: investing in, or or you're seeing it at the incumbent
20:43
Speaker 1: level as well.
20:45
Speaker 2: Both. I think we're seeing it on both sides. But
20:48
Speaker 2: definitely a lot of opportunity. I think there's a lot
20:51
Speaker 2: of very interesting assets in the market for our companies
20:53
Speaker 2: to merge or require in order to be an accelerant
20:57
Speaker 2: for growth.
20:58
Speaker 1: Interesting. You know, if you think about your career and
21:02
Speaker 1: I guess the different cycles you've been apart in I
21:04
Speaker 1: was trying to think about this before we sat down,
21:06
Speaker 1: and maybe there's a little bit of a recency bias here.
21:10
Speaker 1: But I think about kind of pre pandemic, a little
21:13
Speaker 1: bit of a little window of post pandemic where it
21:15
Speaker 1: was like almost like the pre pandemic era. But now
21:18
Speaker 1: we're in this AI cycle. You know, how has your
21:21
Speaker 1: thinking changed about I don't know, companies or investments, you know,
21:24
Speaker 1: through these different cycles, and I don't know if I've
21:28
Speaker 1: query to find them or if you would agree, but
21:31
Speaker 1: it seems like maybe the last tech decade or so,
21:34
Speaker 1: you know, we've had some pretty different operating environments.
21:37
Speaker 2: You know, I think there's always it's a thoughtful question, Jonathan,
21:40
Speaker 2: because there's always some hype cycle happening in some category,
21:44
Speaker 2: and maybe that's a category that's savable less savorable to
21:47
Speaker 2: what you know you use in above store are working on.
21:50
Speaker 2: For us, we try to maintain discipline. We you know,
21:53
Speaker 2: we have a core thesis. We spend a lot of
21:56
Speaker 2: time in markets where what are going We refresh these
21:59
Speaker 2: thess quite frequently to make sure we have the right
22:02
Speaker 2: frame of reference. You know, how do we think AI
22:04
Speaker 2: is affecting the market. We have a pretty disciplined approach
22:08
Speaker 2: when it comes to our you know, our ownership model
22:11
Speaker 2: and you know, our fund economics to make sure that
22:14
Speaker 2: we're doing right by our limited partners, the folks to
22:16
Speaker 2: give us capital, and so, you know, I think the
22:20
Speaker 2: nice part is I'm not based in Silicon Valley. I
22:23
Speaker 2: do have to fly to camp when I want. But
22:25
Speaker 2: I think sometimes it's actually a positive in a lot
22:28
Speaker 2: of ways. I'd say it's actually a material positive because
22:32
Speaker 2: you don't necessarily have the same kind of group think
22:35
Speaker 2: paying crazy prices for a company that you know, it's
22:38
Speaker 2: so hard to imagine how you know a business that
22:42
Speaker 2: has one hundred k pilot that the p and L says,
22:45
Speaker 2: but don't worry, this health system is going to pay
22:47
Speaker 2: US twenty million dollars. I mean, name one health system
22:50
Speaker 2: that will pay a technology company that's not up it's
22:52
Speaker 2: twenty million dollars. I mean, it's it's tough. It's tough
22:55
Speaker 2: to sort of outline that and see that. So maybe HCA,
22:59
Speaker 2: I asked in my mom. I said, no, I think
23:03
Speaker 2: it's it's it's sorry to go identify. But ultimately, you know,
23:07
Speaker 2: really having a true Norah following that, having conviction and look,
23:13
Speaker 2: sometimes we get it right, sometimes we don't. That's part
23:15
Speaker 2: of the nature of the business of a venture. But
23:17
Speaker 2: it's really about having a racial thought in our perspective
23:21
Speaker 2: on what we think is trusting that that instinct and
23:24
Speaker 2: following you, I got to deliver on the vision that
23:27
Speaker 2: we have.
23:28
Speaker 1: Well, something you said, they're always keys in with me
23:31
Speaker 1: when when somebody mentions it something similar, which is, you know,
23:33
Speaker 1: sometimes you get it right, sometimes you get it wrong.
23:35
Speaker 1: I love to ask people, you know, is there a
23:37
Speaker 1: white whale where one company you looked at and maybe
23:40
Speaker 1: you passed on, and then you look forward three years,
23:44
Speaker 1: five years and you said, you know what, I didn't
23:47
Speaker 1: actually really think about that in the right way. My
23:49
Speaker 1: thinking's change, and I think today I probably would have said, yes,
23:52
Speaker 1: is there an example out there?
23:54
Speaker 2: Oh? I think there's always examples of companies. I mean, look,
23:57
Speaker 2: I'm a big believer. I have to help a lot
24:00
Speaker 2: more companies than just my own to make an impact
24:02
Speaker 2: in healthcare. Last year we saw two thousand deals and
24:05
Speaker 2: we invested in two. So there are a million reasons
24:08
Speaker 2: we don't make an investment. We're very tech exactly, we're
24:12
Speaker 2: a concentrate portfolio. And so that doesn't mean that some
24:15
Speaker 2: of those other companies won't be successful. But maybe it
24:18
Speaker 2: was the economic structure wasn't right or the investment strategy
24:22
Speaker 2: we didn't agree with, or you know, you know a
24:24
Speaker 2: lot and we're an early stage ad Baxter. So we'll
24:27
Speaker 2: see a company that later, you know, we'll end up
24:30
Speaker 2: we'll kind of talk about a vision, maybe they're not
24:32
Speaker 2: ready to execute on that vision, and around or two
24:36
Speaker 2: later they'll they'll finally decide to pivot into that vision
24:39
Speaker 2: and you know, hit their stride. So you know, I
24:42
Speaker 2: never get worked up about companies that we really took
24:47
Speaker 2: a look at. We had a very strong view on
24:50
Speaker 2: whether it was right or wrong, and we made an
24:54
Speaker 2: kind of educated decision on why we would or wouldn't invest.
24:58
Speaker 2: The more challenging is you know a company that you
25:03
Speaker 2: met in the seed and then just forget you know,
25:05
Speaker 2: your data systems, your brain, you you know, your memory,
25:08
Speaker 2: that you forgot to kind of track them, and someone
25:11
Speaker 2: else came in and preempted. I mean that that's more
25:14
Speaker 2: of the heartbreaker to me than to say, look like,
25:17
Speaker 2: there's plenty of companies that have gone on to be
25:19
Speaker 2: really successful, and I root for their success, and I'm
25:23
Speaker 2: still very close to many of the founders. You have
25:25
Speaker 2: the eighth team out with the top female founders of
25:28
Speaker 2: twenty really six, many of whom are very close friends
25:31
Speaker 2: of mine, whether I just it or not. And so
25:34
Speaker 2: I think I'm always very celebratory for the success of
25:38
Speaker 2: people in healthcare because I often feel that we're not
25:41
Speaker 2: always just competing on dls, we're actually competing with the
25:43
Speaker 2: broader venturemarket and they're competing. Again, is when consumer was
25:47
Speaker 2: hot or these AI generalist companies are hot or descents
25:51
Speaker 2: or whatever, maybe you know, the sort of industry du jour,
25:55
Speaker 2: and so having successful healthcare companies, having two digital healthcare
26:00
Speaker 2: bings right now in the public markets, that are you know,
26:02
Speaker 2: continuing to increase in value as a win for all
26:05
Speaker 2: of us, whether word investor.
26:06
Speaker 1: Well said you reference to digital health companies, I assume
26:11
Speaker 1: is that the Hinge and Omada reference from last year? Yeah, yeah, yeah,
26:16
Speaker 1: How do you maybe that's a good segue into you know,
26:18
Speaker 1: your view on exits and public markets. You know, how
26:22
Speaker 1: are you thinking about the current I guess IPO environment today.
26:26
Speaker 1: I mean, Hinge in the model looked pretty good a
26:28
Speaker 1: year waiter. You know, I think we both lived through
26:31
Speaker 1: the scar tissue of twenty twenty twenty twenty one and
26:35
Speaker 1: what that did to I guess maybe exuberance around some
26:37
Speaker 1: of those companies or the sector and valuations. So what's
26:41
Speaker 1: your perspective today on what the right exit looks like?
26:44
Speaker 1: For I can think of so many companies that would
26:47
Speaker 1: maybe fit that same bill, But love to get your perspective.
26:52
Speaker 2: Yeah, you know, I think the public markets we all
26:56
Speaker 2: want to be more favorable to our company. Is It's
27:00
Speaker 2: hard because there's so many externalities that are out of
27:05
Speaker 2: the company's control. If something happens in the geopolitical market,
27:09
Speaker 2: if there's just certain sentiment about a sector, the public
27:12
Speaker 2: markets tend to have, you know, pretty extreme group thinks.
27:16
Speaker 2: So I think we all feel confident that the public
27:19
Speaker 2: markets are coming back. You know, what the timing of
27:21
Speaker 2: that is is questionable, but hopefully soon. What I would
27:26
Speaker 2: say is the positive is in the past, building a
27:29
Speaker 2: company for m and A to sort of sell it
27:32
Speaker 2: or merge it versus building a company to go public,
27:35
Speaker 2: we're two very different strategies, and today those strategies that
27:40
Speaker 2: merged quite significantly. So you really, you know, you need
27:44
Speaker 2: solid growth, but you need to be profitable or profitable growth.
27:48
Speaker 2: And so now I think companies can dual track much
27:52
Speaker 2: more efficiently and decide what is the right exit path
27:57
Speaker 2: for them at the time that they're ready to exit
27:59
Speaker 2: ver versus you know, versus needing you know, the public markets.
28:03
Speaker 2: I just did a panel for the SEC on Monday
28:06
Speaker 2: in Washington, d C. And you know, I think one
28:08
Speaker 2: of the other pieces is that, you know, companies used
28:10
Speaker 2: to have to go public because that was the only
28:12
Speaker 2: way to raise that kind of capital. Well, now the
28:16
Speaker 2: private markets are are much more lucrative in terms of
28:19
Speaker 2: access to capital. So you know, I think that it's
28:23
Speaker 2: created and incentive for some folks to stay private a
28:26
Speaker 2: lot longer because they have, you know, more more choice
28:31
Speaker 2: in how they can grow.
28:32
Speaker 1: Well, So speaking of capital, you know, you mentioned earlier
28:35
Speaker 1: that you're an early stage investor. How do you think
28:36
Speaker 1: about follow on rounds and what's your ownership pathway long term?
28:42
Speaker 2: Yeah, we hold a pretty heavy reserve strategy, so we
28:45
Speaker 2: like to follow on quite significantly, at least on hundred
28:49
Speaker 2: percent of our initial investment and really support those companies
28:52
Speaker 2: over time. And we do have an opportunity funds. We
28:55
Speaker 2: did raise a separate vehicle that can back our winners,
28:58
Speaker 2: so we can actually put in even more capital in
29:02
Speaker 2: order to retain rado you know, not not probably Sluvarians,
29:07
Speaker 2: but you know, much much later than you know some
29:09
Speaker 2: other early ch atveasters can, which has been very helpful
29:12
Speaker 2: for us.
29:13
Speaker 1: That's great. As you sit here today and you know,
29:16
Speaker 1: we're we're still in the first quarter, you know, all
29:19
Speaker 1: I hear about is AI again and I can't help
29:21
Speaker 1: coming back to it, And I just wonder if there's
29:25
Speaker 1: all these different AI companies that are popping up, you know,
29:28
Speaker 1: is it akin to the you know, employer solutions where
29:32
Speaker 1: there's just too many Is that the right way to
29:36
Speaker 1: think about what's happening in AI right now? And do
29:38
Speaker 1: you think we'll see you know, some consolidation around infrastructure
29:44
Speaker 1: or payments or you know, clinical decision processing. I don't
29:48
Speaker 1: know right what the right buckets are, to be honest
29:50
Speaker 1: with you. But as I sit here today, I see,
29:53
Speaker 1: like I see very narrow solutions for so many problems
29:56
Speaker 1: that it seems hard to imagine that in ten years
29:59
Speaker 1: time that these are all going to still exist, you know,
30:01
Speaker 1: focused on these narrow solutions.
30:04
Speaker 2: Yeah, I mean, I think that's there's a lot of
30:08
Speaker 2: truth in that, because that's the nature of venture. There's
30:10
Speaker 2: always too many companies, right to start a company and
30:14
Speaker 2: to make it to the end is you know that
30:16
Speaker 2: we pay a play a power log game. We're very
30:18
Speaker 2: different than private equity and kind of buy out or
30:21
Speaker 2: very different in how we think about successful companies. So,
30:24
Speaker 2: you know, I just saw a stat from Karta that
30:27
Speaker 2: only thirty percent of companies that raise a seed round
30:30
Speaker 2: end up raising a Series A. So even just there
30:33
Speaker 2: you start to seed drop offs. I do think that
30:35
Speaker 2: notion of consolidation of growing more quickly, because in order
30:39
Speaker 2: to exit today you just have to be a lot
30:42
Speaker 2: bigger than you used to. The example I always give
30:44
Speaker 2: is that able to when they sold to Optum in
30:48
Speaker 2: twenty twenty, they were fifty million top line business that
30:51
Speaker 2: sold for four hundred and fifty million. You know today
30:55
Speaker 2: Optum is three five times aside and I still at
30:59
Speaker 2: UHG it's share brace, but it's just so much bigger now.
31:04
Speaker 2: And so you can't be a fifty million top line business.
31:07
Speaker 2: You have to be a junior million top line business.
31:09
Speaker 2: And so to get there takes longer, and you can
31:12
Speaker 2: either just build them on your own, or you can
31:15
Speaker 2: partner up and try to be more of an accelerate
31:18
Speaker 2: to get there.
31:18
Speaker 1: So when when founders come to you, you know and
31:21
Speaker 1: you're having your dialogue with your your your teams. You know,
31:24
Speaker 1: what is the advice that you give them in terms
31:26
Speaker 1: of that path from the fifty million to the two
31:29
Speaker 1: hundred million? You know, just is it just stay the
31:31
Speaker 1: course or don't don't worry about it. You know you
31:34
Speaker 1: have to you'll get there eventually.
31:37
Speaker 2: No, I think it's it's usually you know, first of all,
31:40
Speaker 2: we care the most about building a great business, right
31:43
Speaker 2: that versus the exit people. The great business, you will
31:46
Speaker 2: find an exit opportunity, and if you're not building a
31:50
Speaker 2: great business, they're wunning up problems that you have. The
31:53
Speaker 2: first step is getting about fifty. I mean you sort
31:56
Speaker 2: of talk fliquidly about fifty to two hundred, but getting
31:59
Speaker 2: to fifty is it very hard for many companies and
32:02
Speaker 2: many won't make it there. And so how to have
32:05
Speaker 2: the discipline and the strategy and the approach to scale
32:09
Speaker 2: to that level. You know, we have a portfolio company
32:12
Speaker 2: that took three years to get to a million in
32:14
Speaker 2: revenue and then it went in one year from one
32:17
Speaker 2: to ten and one year from ten to fifty. So
32:20
Speaker 2: again there's massive opportunity for scale, but it does take
32:25
Speaker 2: time and it's it's hard and why we love backing
32:29
Speaker 2: founders who have passion for the mission versus just trying
32:33
Speaker 2: to make a quick buck because it's too hard to
32:36
Speaker 2: just try to get rich. But then, you know, going
32:39
Speaker 2: from that fifty to two hundred, there's a lot of
32:40
Speaker 2: ways to do it. You can do it organically, you
32:42
Speaker 2: can do it through oven a, there's ways to think
32:45
Speaker 2: about it as an accelerant. But we also want to
32:47
Speaker 2: make sure that we're doing it in a profitable way
32:51
Speaker 2: so that they were not just buying ourselves growth, but
32:53
Speaker 2: we're growing thoughtfully that the market recognizes. Well.
32:57
Speaker 1: I think you key in on something there which you
33:00
Speaker 1: to before, which is that the shift in mindset, you know,
33:02
Speaker 1: from that pandemic, grow grow grow grow grow growth, Growth
33:07
Speaker 1: can take you public versus you know this thinking of
33:10
Speaker 1: around unit economics and profitability and path to profitability? Is
33:14
Speaker 1: that is that the right way to think how the
33:16
Speaker 1: market is kind of evolved over the last couple of years.
33:19
Speaker 2: So for sure, and those were a lot of learnings.
33:22
Speaker 2: That doesn't mean that we don't want to see growth.
33:24
Speaker 2: For sure, we're venture investors. That's still something that's important
33:27
Speaker 2: to us. It doesn't mean that we're trying to be
33:30
Speaker 2: flush with cash and you know, have major epitdem margins
33:34
Speaker 2: because we you know, we want to invest in growth,
33:36
Speaker 2: but we again, we want to grow thoughtfully. And I
33:38
Speaker 2: think that level of discipline you hear across boards. Now
33:42
Speaker 2: we talk about you know, those met trips a lot
33:44
Speaker 2: more than we used to talk about them five or
33:46
Speaker 2: ten years ago because of you know what we sort
33:49
Speaker 2: of saw coming out of pandemic gears.
33:51
Speaker 1: Got it? Maybe just switching gears again. You know, when
33:53
Speaker 1: we think about building companies and building teams, what's your
33:57
Speaker 1: philosophy around team building? Whether it's within the walls of
34:00
Speaker 1: seven Wire or within the walls of some of your investments,
34:04
Speaker 1: how do you counsel your founders? And I guess what's
34:07
Speaker 1: your philosophy around team building? You know on your own?
34:10
Speaker 2: Yeah? Again always that founder market fit. Why are you
34:14
Speaker 2: or your team the right people to build this business?
34:18
Speaker 2: It is just too hard otherwise if you don't have
34:21
Speaker 2: some kind of passion for the mission. And we put
34:25
Speaker 2: a lot of trusts in our CEOs and the folks
34:27
Speaker 2: that they pick. You know, we spend a lot of
34:29
Speaker 2: time in our network helping to add talent to companies,
34:33
Speaker 2: and a lot of these folks have worked with us,
34:35
Speaker 2: have worked for us, or you know, we know them
34:38
Speaker 2: as great colleagues and so you know, shifting them around
34:42
Speaker 2: from company to company, which has been amazing to see
34:46
Speaker 2: and just see the impact that to make across the portfolio.
34:49
Speaker 2: But ultimately it's you know, back in the right leadership
34:53
Speaker 2: team and trusting that they you know, really recognize the
34:56
Speaker 2: hires that need to be made and you know, helping
34:58
Speaker 2: to up level folks, some growth folks, internal nets and
35:02
Speaker 2: meet the milestone. So we all know that they can.
35:04
Speaker 1: Well said, I alluded to it in the intro, but
35:08
Speaker 1: I know one of the things you're passionate about is
35:10
Speaker 1: the area of women's health. Can you talk a little
35:12
Speaker 1: bit about, you know, how that has changed over your
35:15
Speaker 1: career and how that market's evolved and where you still
35:19
Speaker 1: see maybe some huge gaps in terms of what's available
35:23
Speaker 1: to women.
35:24
Speaker 2: Yeah. I mean, first of all, women are half the population.
35:27
Speaker 2: They make eighty percent of buying decisions in healthcare. To
35:30
Speaker 2: not invest in women's health, to not care about it
35:33
Speaker 2: is you're doing a financial disservice to your front and
35:38
Speaker 2: so I think where things have evolved, I've been so
35:41
Speaker 2: proud of the companies that really slogged it out for
35:46
Speaker 2: the last decade for many of kind of early pioneers
35:50
Speaker 2: who Kate Ryder are a good friend at MAVIN who people
35:53
Speaker 2: didn't believe and why this was so important and now
35:57
Speaker 2: you know, has built one of the biggest women in
36:00
Speaker 2: self unicorns. Joanna Strober at MIDI also very close friends
36:04
Speaker 2: the Pamelo team, and we're now seeing newcorns of women's
36:08
Speaker 2: health that we didn't see before. So I think it's
36:10
Speaker 2: starting to prove that the category itself can not only
36:14
Speaker 2: be impactful, but also to dive real financial return for
36:19
Speaker 2: those who are making the investment. I do think there's
36:22
Speaker 2: still a lot more that. You know, many of the
36:24
Speaker 2: companies who sort of hit that status are still focused
36:27
Speaker 2: on kind of women's conditions and how do we expand
36:31
Speaker 2: that we're broadly My partner Lea Shapiro, is the chair
36:34
Speaker 2: of the board of the American Heart Association, and you know,
36:37
Speaker 2: heart disease one of the league causes of death for women,
36:40
Speaker 2: and you know it doesn't typically resumpt in the same
36:42
Speaker 2: way it does for men. Often women are getting dismissed,
36:46
Speaker 2: mist diagnosed, undiagnosed. Because of that, women's problems are being
36:50
Speaker 2: heard there's many challenges, whether it's autoimmune conditions, skin conditions,
36:55
Speaker 2: you know, we're looking at the ecology market that you know,
36:58
Speaker 2: again can affect women, mental health conditions like depression, anxiety
37:03
Speaker 2: disproportionately affects female teens, and it was you know men.
37:07
Speaker 2: So so ultimately, just I thinks a lot more to
37:10
Speaker 2: do more broadly as we thinked about how to just
37:13
Speaker 2: service this population that women are not tiny men, and
37:17
Speaker 2: so because of that, it's it's really creating unique experiences
37:22
Speaker 2: to drive better outcomes, which ultimately, you know, drives about
37:25
Speaker 2: our business.
37:26
Speaker 1: Yeah, we had Kate on a couple of years ago
37:28
Speaker 1: and it was one of the more profound discussions I
37:30
Speaker 1: think I've had. I know my wife has had some
37:34
Speaker 1: of the many of the challenges that Kate was seeking
37:37
Speaker 1: to solve with Maven, and so, you know, I think
37:39
Speaker 1: any of the work there is really admirable and there's
37:42
Speaker 1: a lot more to do.
37:43
Speaker 2: A lot more to do. That is an operative sentence there.
37:47
Speaker 2: So well said, well, one of.
37:49
Speaker 1: The ways I like to wrap these conversations up is
37:51
Speaker 1: to talk about something from the guest's personal life, and
37:54
Speaker 1: alis I was wondering if there's a lesson from either
37:58
Speaker 1: you know, your personal life or your professional life that
38:01
Speaker 1: you really see as driving what you see as your
38:03
Speaker 1: mission or north star personally.
38:06
Speaker 2: I love this question. Oh man, it's it's so hard
38:09
Speaker 2: to kick one. So let me do this.
38:10
Speaker 1: You could do top three, It's okay.
38:13
Speaker 2: No, I would say, I'm going to take a lesson
38:14
Speaker 2: from my mom, a lesson from my dad, and a
38:16
Speaker 2: lesson for myself. Is that a fair Yeah, that's a
38:19
Speaker 2: fairy to answer this. Okay. My currents are very you know,
38:22
Speaker 2: they have always isms, but I think it's it's very
38:25
Speaker 2: interesting as it translates. My mom is always always take
38:29
Speaker 2: the high road because in the end it leads to
38:31
Speaker 2: the better place. And you know, things can be really hard,
38:34
Speaker 2: and this business, we're in it for a very long time,
38:37
Speaker 2: and it's always you know, a true north to remember
38:40
Speaker 2: integrity because I've worked with people with unbelievably high integrity
38:44
Speaker 2: and people with that are lacking. And you know, ultimately,
38:47
Speaker 2: I think when when the history books are written about
38:50
Speaker 2: you and I and everybody listening today, I think we
38:52
Speaker 2: want to be seen as somebody who dropk the high
38:54
Speaker 2: road and somebody that hot high integrity. And my dad always,
38:58
Speaker 2: my dad always says when luck, because when preparation needs opportunity.
39:02
Speaker 2: I'm a big believer in craiging your own law. You know,
39:03
Speaker 2: we've done that a lot of somewhere. We've really you know,
39:07
Speaker 2: created some pretty interesting outcomes because of it, but really
39:11
Speaker 2: making sure that we're always thinking opportunistically about that work
39:14
Speaker 2: prepare and you know, my own career, and I've had
39:19
Speaker 2: a lot of moments in time where people told me
39:21
Speaker 2: I wasn't going to be successful in certain things, which
39:24
Speaker 2: truthfully is just a wonderful fuel driver for me to
39:27
Speaker 2: prove them wrong. I love to do that, but I
39:31
Speaker 2: think there's just an element of work ethic and hustle
39:34
Speaker 2: and matching that with passion and mission and vision. So
39:39
Speaker 2: you know, saying I'm gonna do all, there's no ego. Right,
39:42
Speaker 2: it doesn't matter what a CEO needs me to do
39:44
Speaker 2: it you call me, I answered, It doesn't matter what
39:47
Speaker 2: time of day it is. You know, the work week
39:49
Speaker 2: is designed in this job. You know, there's there's so
39:53
Speaker 2: much that we get to do. We're so lucky. We
39:56
Speaker 2: get to see the future every day. My life is
39:59
Speaker 2: designed to be fluid. So you can call me at
40:01
Speaker 2: any time, right, I don't I don't end. You know,
40:03
Speaker 2: my brain doesn't turn off at five pm. And so
40:06
Speaker 2: it's really about you know, again it's my job to
40:08
Speaker 2: based hostility and balance as we think about my family
40:11
Speaker 2: and my commitments. But it's really that, you know, having
40:15
Speaker 2: the work ethic paired with that vision of saying, you know,
40:20
Speaker 2: I will dedictate my whole life to healthcare. And I
40:22
Speaker 2: feel really good about that in the end that if
40:24
Speaker 2: I made if I need the need on any way, right,
40:28
Speaker 2: that is important impact.
40:29
Speaker 1: That was so well said. Thank you for sharing. I'm
40:32
Speaker 1: trying to think of a way to summarize it. It's
40:34
Speaker 1: hard work. We'll make your own luck and do it
40:37
Speaker 1: with high integrity. I think is those are the three pillars.
40:40
Speaker 2: Very good, very good, very good, perfect, I'll take it well.
40:43
Speaker 1: Thank you so much for joining us. So this has
40:44
Speaker 1: been fantastic.
40:46
Speaker 2: Thank you for having me. I really appreciate it's a
40:48
Speaker 2: pleasure to be on. Thank you for some thoughtful questions
40:51
Speaker 2: and you know, I think for bringing light to such
40:53
Speaker 2: an important topic.
40:54
Speaker 1: Thank you once again. So that's Alisa Jaffy, partner at
40:57
Speaker 1: seven Wire Adventures. Thank you so much for joining us
41:00
Speaker 1: for our latest episode, and please make sure to quick
41:02
Speaker 1: the follow button on your favorite podcast app, so you
41:04
Speaker 1: never miss a discussion with the future readers in healthcare innovation.
41:07
Speaker 1: I'm Jonathan Palmer, and you've been listening to the vanguards
41:09
Speaker 1: of healthcare podcasts by Bloomberg Intelligence. Until next time, take care,