Anthony Faulise

Hot take on a lot of early-stage digital health companies out there: You're not a tech company. Most tech-enabled care companies I've seen over the past two years are only tech-enabled in the sense that they use telehealth as their delivery mechanism for care. There are exceptions to this, of course - companies who build computer vision and applied AI tools to better the doctor-patient experience, companies who build tooling around risk scoring and stratification to enable more personalized medicine, companies who build truly novel intakes to better route patients to the appropriate care, etc. These companies have real technology chops and, if they sell it right to the market, can get credit for this from investors. But if you're truly a telehealth provider, you need to realize now that the goal post has shifted dramatically from 2021 and you're going to be valued at maturity at something like 3x EBITDA. That's profit. Not revenue. Throw a revenue multiple out the window. That's not the world we live in if you're a virtual doctor's office. Think of how that impacts venture math. If you're raising a seed round at $15M post-money (or $12M pre-money), it means you'll have to generate something like $150-200M in annual EBITDA to be a fund returner for your seed investors. Maybe even more with dilution, since telehealth businesses are not traditionally capital efficient and will likely need to raise material additional capital to reach that scale. You need to be ridiculously profitable (probably on $800M-$1B in annual revenue since you're likely going to be a 40% gross margin business). Here's the good news: you can set yourself up well (and probably be a contrarian founder relative to your peers), by talking about EBITDA growth and how you can grow into a fund-returning outcome based on realistic mature market comps. This will stand out for the investors you're pitching, even at the early stage. This is how you can beat the malaise of the tech-enabled care market. Focus on the right metrics and the right type of growth. You don't have to have all the answers (no founder does), but you need to make sure the ship is headed in the right direction. A focus on profitability for "tech-enabled care" (*ahem* telehealth) businesses is a good first step.

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I used to spend 2-3 hours daily on clinic notes, skeptical of AI scribe technology. However, I've been impressed with RevMaxx, a generative AI company transforming clinical note creation by listening to physician-patient conversations and automatically generating comprehensive notes. This platform accurately captures crucial ICD-10 codes, saving valuable time ⏰. 👉 Why This Matters: - **Reducing Physician Burnout:** Administrative tasks are a significant contributor to physician burnout. Innovations like RevMaxx alleviate this burden effectively. #HealthcareInnovation #AI #PhysicianBurnout #MedicalDocumentation #HealthTech #RevMaxx

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The (Healthcare) Ground Beneath Our Feet… This year it is likely that over $10 billion will be invested in the digital health sector – a robust amount, no doubt, but inconsequential when compared to the amount of capital tied up in healthcare real estate assets, which is estimated to be $1.2 trillion by Jones Lang Lasalle. Of that amount, approximately $790 billion is in the hospital sector while the remaining $490 billion is in medical office assets. It is estimated that there are 48.6k facilities with 3.4 billion square feet of healthcare real estate, 42% of which are owned by REITs and another 33% held by other private investment vehicles. Much of the digital health investment is meant to make the physical healthcare infrastructure more productive: greater operating efficiencies, greater patient throughput, more relevant personalized care models with better outcomes. As the healthcare system is being pushed to be more distributed to lower cost sites of care, accelerated now by the rapid proliferation of automation and AI capabilities, the potential impact on healthcare infrastructure assets will be profound. Thoughts on what that might look like... https://lnkd.in/eTfAdUbS #digitalhealth Flare Capital Partners

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Is Epic the Apple of electronic health records? You can see some similarities: - dominance among a premier market segment - a "walled garden" style ecosystem with strong control over third-party plugin development - occupies a strategic and brand position focused on user data privacy HTD Health's Interoperability and Data Liquidity Practice Lead Brendan Keeler was quoted today in POLITICO on feisty dispute within the world of health data exchanges. Brendan Keeler, interoperability practice lead at HTD Health, said in the bigger picture, it doesn’t matter whether Epic, Particle and Intregritort are right or wrong. As long as data exchange is limited to treatment but workarounds are available, he said, people will use the workarounds to achieve business goals. “It’s so lucrative to do so today,” Keeler said. Under TEFCA, organizations that sign a data-sharing agreement and adopt the necessary infrastructure can become qualified networks permitted to share patient health data. Keeler said that TEFCA, which is run by the HHS Office of the National Coordinator for Health IT’s nonprofit partner, the Sequoia Project, is supposed to have stronger governance than Carequality and create a unified network pushing data to organizations in addition to groups pulling it from others. Full article here (warning paywall): https://lnkd.in/gkrQK6Fm

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🌟 Boston’s Trailblazing Health Tech Startups! 🌟 I thought it would be nice to give a little shout out to some of the health tech startups in Boston putting in work. PathAI – Leveraging artificial intelligence to enhance the accuracy of pathology diagnoses, PathAI is paving the way for more precise and efficient disease detection. Akili Interactive – Bridging healthcare and digital therapeutics, Akili is developing video game-based treatments for cognitive disorders, bringing a unique approach to mental health and wellness. Biofourmis – This predictive health analytics leader offers remote patient monitoring solutions, allowing healthcare providers to offer personalized care and anticipate patient needs. Ginkgo Bioworks, Inc. – Specializing in synthetic biology, Ginkgo Bioworks is transforming drug development and diagnostics by creating custom organisms, fueling innovations in biotechnology Omada Health – A pioneer in virtual care, Omada Health provides digital health solutions to manage chronic conditions like diabetes, hypertension, and mental health, bringing healthcare directly to patients. Buoy Health – Powered by AI, Buoy Health offers personalized health guidance and telehealth support, helping users make informed decisions about their health from home. Eqrx R – Focused on affordable drug development, EQRx is working to make essential medicines accessible, addressing one of healthcare’s biggest challenges—affordability. #BostonHealthTech #InnovationEcosystem #DigitalHealth #HealthcareInnovation #Startups

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💰🎓VALUATION CAP💰🎓 Setting a valuation cap in fundraising is crucial as it limits the maximum valuation at which a SAFE (Simple Agreement for Future Equity) converts to equity. This helps founders manage equity dilution and provides investors with a clear understanding of their potential ownership percentage, ensuring informed decision-making during fundraising rounds. Source: Peter Walker Great post! #valuationcap #investors #founders #raisingcapital #safes #fundraising #womenshealth #femhealth #medtech

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Suppose you are a VC, Early investor, or CIO trying to keep your eye on the industry trends. In that case, you’ve probably heard already about hallucinations, context shifts, and accuracy measurement problems in LLMs. These scary concepts kill motivation to invest in LLM-based projects and build RnD departments. Are they really so scary? Yes, but just for now, you have a good strategy to cope with them. Is this strategy already known? Yes, old but still one of the most effective approaches- knowledge graphs in combination with fresh new RAGs will allow you to keep your models free of hallucinations, stable in accuracy, and easily adaptable for context change. Btw, do you know that knowledge graphs are seeing as one of the most impactful AI enables during this year?🙌🏻 How big companies like Deutsche Telekom and Microsoft are seeing the future of LLMs adoption you can find here https://lnkd.in/d4B3t56z

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Have you ever looked for theory that can answer - how to approach investors - what kind of product to build first - how you’ll defend the company against competitors This new article from CDA partner, Kevin Maney extends Steven Johnson's writing from the book Emergence to #CategoryDesign. All #Startups and #VentureCapital teams should dig in. (link to article in comments)

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A second order effect of unlimited, free, and personalized AI medical advice will be a massive surge in "direct access" diagnostics – i.e., paying cash for lab or imaging tests without the need for a physician's prescription or referral. While this trend isn't new, AI-powered self-triage will accelerate it dramatically. Potential third order effects: – Greater strain on diagnostic resources - Continued hyper-specialization of medicine It will be interesting to see which medical specialties survive and thrive under this paradigm.

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Incredibly excited to share our updated Healthcare AI thesis. This is not a market map – in 4,000 words, we dive deeply into the research, products, business models, and market entry points that are reimagining healthcare with AI. More specifically, we cover: • Translating AI research into real-world products • Mapping modalities (software, copilots, agents, services, diagnostics, therapeutics) to problems in healthcare • Designing AI business models that unlock billion-dollar markets • Closing current gaps in healthcare AI infrastructure • Distinguishing AI platforms from point solutions Let us know what you think ⤵️

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A little late, even though this process started in July.... Excited to share our latest investment in Heads Together Health!! We met Steve DeVrieze in October last year, and we think they are poised for impressive growth! Read more here: https://lnkd.in/ecYcqqkn #earlystagestartup #earlystageinvesting #VCinvestment #ncstartups #nctechstartups

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A ton of work that created a ton of value: check out our report below in which we spoke with 60+ C-suite leaders at payors and providers across the country about AI. Great takeaways for anyone wanting to understand what the healthcare industry really thinks and especially for founders targeting those industries. Proud of our team for pulling this together!

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While there are numerous pros and cons to consider when raising a seed round, I generally agree with Gary Tan’s assessment: companies succeed when they create products that solve problems and meet customer needs, not because of the size of the check VCs write. I understand the frustration for VCs who have been raising larger seed-stage funds and need to deploy more capital per deal, but I support the founder’s decision to limit dilution early on. My advice to founders is to stay strong, be bold, hustle and take a chance on yourself, if you can solve customer problems, the same VCs who are upset about your decision to raise and dilute less during the seed round will come knocking on your door. #startups #founders #dilution #believeinyourself #venturecapital https://lnkd.in/gdmKsUje

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Of note: Your health records are coming to new apps This in an interesting change, and a somewhat Epic change. All puns intended. If you don’t know, the leading medical record storage solution in the US is operated by Epic. A rather critical problem is that if you walk (well drive) between two hospital in the US, the medical records tend not to follow you, unless you carry a large Manila envelope. Having Epic (and others) via TEFCA allow export of records arguably allows you to only carry your phone, which is a very siginificant change. This also (arguably) opens up a huge new innovation sector. Epic is one of the organizations that has been helping the US federal government establish the Trusted Exchange Framework and Common Agreement, or TEFCA. The goal being to iron out both the legal and technical requirements for sharing patients' data at scale. Health-care data in the U.S. has historically been siloed and difficult to move around. Clinics, hospitals and health systems can store their information in a variety of formats across dozens of different vendors, and there hasn't been a trusted nationwide mechanism in place for transporting it securely. This means if a patient moves to a different state or visits a new hospital, their medical records tend not follow. PS. If you want appreciate how profitable the US medical sector is, Epic HQ has a restantant designed to look like Kings Cross from the Harry Potter movies. https://lnkd.in/g8NaWza8

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This week Mikal Ventures brings you a 4-week breakdown of the US capital market with an emphasis on the Mikal verticals. Over the 4-week period ending September 16, 1,245 new companies were added, resulting in just under 98,450 companies included in the US Health Tech, Med Tech, Fin Tech, AI Tech, and Ed Tech verticals. US AI Tech again saw the greatest percentage growth in new companies at 30%, vs. the vertical average of 13% for the period. AI Tech also led the group in transactions and news articles. US Med Tech led in SEC Filings. Mikal Ventures publishes these stats on a rolling 4-week basis to provide a perspective on how the verticals and new startups move through time. We hope you find them informative and thought-provoking. VC Investors are always adjusting their "Play Book" with a variety of options for investing. Mikal Ventures is one of those alternatives, offering curated solutions to real world problems. Reach out if you have questions on how we can be of assistance and bookmark https://mikalventures.com/ for additional insights and information.

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One of my proudest moments as an investor occurred today as Alaffia Health announced its series A because it shows how the Aperture® Venture Capital vision of multi-level, multi-generational #impactinvesting is succeeding in the marketplace. Here’s the model in its most basic form : ✅As diverse fund managers with meaningful capital to allocate, we are changing the VC landscape every day just by doing our day jobs. ✅As Black/Brown investors with ~40 years experience collectively, Aperture GPs have access to talent /excellence that others do not, so our portfolio *organically* is more inclusive by race, gender and geography even while optimizing for financial outcomes (all about the alpha). ✅Our most successful portco’s are using financial #innovation to solve market problems that impact underrepresented demographics and underserved communities. Alaffia Health is a shining example of the impact portion of our overall fund thesis, and we couldn’t be prouder of TJ Ademiluyi and Adun Akanni, MPH, PMP - the dynamic brother-sister founder duo whose vision we have steadfastly supported on their journey. Congratulations to TJ and Adun from William Crowder and myself, as well as the whole Aperture team- Marjorie King Philip McKenzie Yves Louis-Jacques Tanvi Lal Michelle Dhansinghani Lisha Bell Katie Kelly Amy Chung Cindy Chong, CFA Brian Fernandes-Halloran Monroe France Jayden Pantel Darren Herman Evan Wladis Neal Triplett Thomas Scriven Peter Ammon Irina Bit-Babik Tim Milanich Rob Rahbari

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This week Mikal Ventures brings you a 4-week breakdown of the US capital market with an emphasis on the Mikal verticals. Over the 4-week period ending July 8, 728 new companies were added, resulting in just under 96,400 companies included in the US Health Tech, Med Tech, Fin Tech, AI Tech, and Ed Tech verticals. AI Tech maintained its most active status, seeing the greatest percentage of growth in new companies, transactions and news articles. The US Fin Tech vertical led the way in SEC Filings. Mikal Ventures publishes these stats to provide a perspective on how the verticals and new startups move through time. We hope you find them informative and thought-provoking. VC Investors are always adjusting their "Play Book" with a variety of options for investing. Mikal Ventures is one of those alternatives, offering curated solutions to real world problems. Reach out if you have questions on how we can be of assistance and bookmark https://mikalventures.com/ for additional insights and information.

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