Chris Walker

I’m worried about the state of venture capital and direct-to-consumer (DTC) healthcare startups. Hims & Hers is the poster child for DTC healthcare at $1.2B proj 2024 revenue and a $3.6B valuation. By most accounts, they have been an outlier success for DTC since bottoming out in May 2022. So why is this bad news for DTC healthcare? Because the market leader (Hims) trades at a 3x forward revenue multiple. And the category leader typically gets a higher valuation multiple than smaller startups. We see this phenomenon in private equity. They “roll up” smaller companies within the same category at a lower multiples just to create one larger platform that trades at higher multiples. Now back to DTC healthcare startups. If Hims commands a 3x revenue multiple, it’s not unrealistic that smaller, unprofitable startups may be valued 1-2x revenue at exit. At 2x revenue, a startup must generate $500M to produce a $1B exit in today’s market (depending on growth and profitability). Series A/B venture capitalists must see a pathway to $1B outcomes. And if the growth-stage investors with billions under management are less interested in DTC healthcare, the future funding rounds necessary for fueling growth are not guaranteed. Juxtapose this against 2017-2022 where DTC could raise Series B-E funding. Let’s take a DTC startup doing $25M after 3-4 years of operations and has already raised a Series A. By most accounts, it would be a phenomenal accomplishment. But today, investors will question the chances of that same company scaling from $25M to $500M revenue in the next 3-4 years with unknown future funding sources from Series B and beyond. You're stuck in VC-funding purgatory. Some of these companies will shut down. Some may sell for 1-3x revenue. And some may try to transition to profitable, cash-flowing businesses. All of which are certainly not the venture-backed goal the founders, investors, and employees often had in mind when first taking capital. I say this all with friends working at or starting DTC healthcare companies, I feel bad for them. I also feel bad for the patients who enjoy those products or services. To caveat (b/c I know people will object), there will be other DTC brands that exit for $1B+ (i.e., Ro). However, they were forged and scaled during a different time period where seemingly endless venture capital was available for DTC healthcare. Now we're in a different time with no end in sight. Thoughts?

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We don't treat all leads the same. Investing in analytics pays off big. We have to get down to buyer behavior. The basic "demographic" scoring doesn't really cut it. These 10 steps will optimize your lead scoring system: Behavior Analysis → Track actions like website visits and email opens. Demographic Scoring → Assess region, job title, and company size. Data-Driven Insights → Use analytics to guide your decisions. Lead Segmentation → Group leads by their readiness to buy. Targeted Nurturing → Tailor your approach based on lead segments. Resource Allocation → Focus efforts where they matter most. Pipeline Management → Move leads efficiently through the sales funnel. Conversion Rate Optimization → Identify and act on high-potential leads. Sales Team Empowerment → Equip teams with actionable insights. Proactive Sales Culture → Foster an environment of strategic engagement. DISCLAIMER: this is not a one and done exercise. You have to revisit this constantly. The world changes so people's behavior changes. Our own included. We're driving healthier pipelines with better lead management. Your soon to be buyers will love this. Do you use multiple dimensions for scoring, Y/N?

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There’s something I hear early healthtech sales reps get wrong when they move upmarket. When you sell to SMB customers, they want to know they’re going to get the attention they think they deserve. Whether it’s customization or time talking to someone on the phone, it’s a bit of a “We’ll be there for you!” attitude. When companies move upmarket RFPs and big asks can seem like inviting opportunities to let an enterprise customer know that you’ll do anything for them. “Let us know what you want and we can build it.” Or, when health systems ask about roadmap, it can seem like the answer should be… “We’ll your our largest customer so if there’s something you want then we’ll build that for you.” Enterprise customers often don’t want to hear this. This approach takes consultative selling off the table. You’re actually asking them to consult for you on your next steps! Enterprise customers don’t want to hear that you’ll do anything for them. They want you to listen to their pain points and have the experience and expertise to confidently tell them the best ways to fix their problems. See enterprise customers aren’t just buying your tech, they’re buying the team that comes with it. While enterprise customers do want to hear your roadmap isn’t locked in for the next year, be wary how you walk this fine line of adjusting just for them. Talking about how big they are can backfire into them thinking, “Well great we’re prioritized until the next big customer signs with them.” Again, enterprise customers want to know your experts in the market. It can be tempting to go broad because an organization so big must have opportunities to use all aspects of your product, but, you’re seen in a better light the narrower you stay focused on the thing they’re begging you to solve. There’s a lot of nuance in sales and adjusting to your prospect. In fact, your pitch may even be different to the PM versus the CIO evaluating the deal. But you’re always at your best when your prospect believes you’re the team to help them. #sales #digitalhealth

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No one taught you solid GTM fundamentals It's no wonder your pipeline looks so sad right now Everyone defaults to more volume of leads. The math totally makes sense. But .... Have you revisited your segmentation and messaging? Defining your market segments can't be an afterthought. It's the most mission-critical task for revenue. Companies look generic in the market, because they're thinking generic. Here’s how to do it right: 1) Define Clear Objectives: - Why are you segmenting the market? - New logos? - Marketing efficiency? - New product launch? 2) Use Multiple Segmentation Criteria: - Demographic - Psychographic - Geographic - Behavioral - Firmographic This is a true complete picture. 3) Conduct Thorough Research to Understand: - Characteristics - Preferences - Behaviors Short on time? Use Perplexity. (seriously, 75 minutes yesterday I blew the doors off a business model) 4) Ensure Segments are Measurable and Profitable: - You can only do this when you have segments ;) 5) Test and Iterate: - Experiment on your segments and follow data. - Then, adapt or double down. Avoid these mistakes: 1) Overly Generic Segmentation: - You can't describe a segment in less than 10 words. - That's not granular enough if you can. 2) Ignoring Data and Insights: - Very few companies use data correctly. - Go take a class or hire someone to help. 3) Lack of Alignment with Business Goals: - Is this aligned with your GTM motion? - Retention is different from new logos. 4) Neglecting to Reassess Segments: - The market changes faster than ever. - This is not a set-it-and-forget-it exercise. If you really understand your market, your messaging becomes easy breezy. When your messaging is easy breezy, it's easier to buy from you. Is 75 minutes spent worth a healthier pipeline?

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Big reputation crises often cost BILLIONS in brand damage, legal fees, fines, lost contracts, remediation costs, employee departures, etc. They lead to ousted CEOs, proxy board wars, wrecked net promoters scores, investor skittishness, the whole YIKES kit and kaboodle. Reputation is 25% of a brand’s value folks. And yet, Chief Communications Officers, Chief Corporate Affairs Officers and other ‘guardians of reputation’ are still missing (in presence and influence) from a breathtakingly scary number of management teams and board rooms. There’s been some recent progress, but it needs to accelerate and be more normalized as a mandatory corporate governance best practice. The fastest way this can happen is for the communication lead to be viewed beyond their direct functional expertise and rather as a indispensable business resource leveraging a reputation and public affairs lens. The more likely this person occupies a trusted seat at the table, both in the room and in the weeds, the higher likelihood the organization can neutralize and mitigate a boatload of future pain. What can we collectively do to spread the word near and far? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PS: Feel free to reach out to me anytime if your organization could benefit from customized reputation/public affairs business counsel.

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Revenue is achieved through systems, not luck. Too many companies treat their GTM as an afterthought. Pump the brakes. Build a process to win. Skipping steps to get leads fast is a mistake. Weak value prop Wrong GTM model Rushed delivery Automating everything too soon All avoidable pitfalls. A solid system helps you know what's working and what's not. You're going to edit your system. But you need one to win. I've been building these for years. I've watched clients who adopt them win ... quick I've watched clients who don't ... fold. (unfortunately) Systems aren't complicated. They're not easy.

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MQLs vs SQLs - healthcare often forgets about the latter. Whoops. "We need more patients!" OR, marketing qualified leads (MQLs) - which "qualified" doesn't hold much water here- are what the majority of private healthcare systems are constantly looking for. This is the utilization of: More Google ads More Social media More DTM More mailers (yep they're still out there) MORE MORE MORE Is it a bad idea to use the above mentioned? Of course not! I've used it myself and I've worked with some of the most forward thinking people when it comes to this. Seth Turnoff The biggest issues? - not all the leads are going to be the ideal patient for your business - your staff's ability to close the deal when the influx occurs BUT, you know who are your ideal patients? The people who have already used your services! These people are your Sales Qualified Leads (SQLs) These people know, like and trust you, so why aren't you marketing to them? I have found that most private practices are not leveraging the enormous amounts of potential qualified referral sources from their OWN LIST OF PATIENTS. Email them, call them, send a pigeon with a note.... but for goodness sakes use them. 💢 Or you could reach out to me and I'll show you how to do it more effectively, so you save time and save some marketing dollars while you're at it. I may even have a free email template to send you that I used in my own business to generate 15 new patients.... 💢 Also, this is Kora. She's sad that you're missing an opportunity to connect with your patient list, but she brought you a safety rope for you to grab onto.

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Everyone in digital health is talking about Telehealth 2.0 right now, but what we really should be talking about is, direct to consumer (D2C) 2.0. Here's why: ⤵ - D2C 1.0 was all about 🍆 pills, hair growth, and birth control, built primarily by D2C startups like Hims or Ro. - D2C 2.0 is going to be all about GLP1's, built by physicians via fractional private practices leveraging social as their main source of distribution. Now, here's where I'm going to make a massive prediction (piggy backing off of Scott Galloway). GLP1's will be what revitalizes primary care, not any of the new CMS payment models, not value based care, not even any of the new tech. Instead it's an old drug with a new rebrand that will save the doctor patient relationship and shift the clinical workforce back to independent practice, and of course it will all powered by AI. TLDR: Every physician in the U.S. will operate a fractional private practice regardless of their FT employment. The default practice type will be D2C and the main objective will be centered on primary care. GLP1s + AI is what gets us there. What do you think of this prediction? ---- Hi, I'm Dr. Mario Amaro, Founder and CEO Ease, and I talk about all things starting, running, and growing a private practice with AI. Follow me, if you are planning to start one or are currently figuring out creative ways to grow one. #PrivatePractice #SelfEmployment #HealthcareOnLinkedin #HeyEase #IndependentTogether #Fintech #Infrastructure #AIinHealthcare #CareDelivery

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Day 1 of the Healthcare Internet Conference #HCIC24 in Austin, where the BBQ is smokin' and the healthcare insights are even hotter! 🔥 Between breakfast tacos here are key themes that are hot like the Texas sun... 1. First-party data is KING 👑 -Baptist Health's Val Lopez showed how they collected more data points than there are food trucks in East Austin (1.4M enriched profiles!) -Johns Hopkins Medicine's Aaron Watkins preaching the gospel of owning your platforms like Austin owns live music venues. Third-party cookies are going the way of affordable Austin housing - extinct! 2. AI's empowering effect 🤖 -Johns Hopkins Medicine shared AI use cases clearer than Barton Springs Pool -@UI Health Care's Max Freund showed how AI enhances clinical content (no, ChatGPT can't write your physician bios while playing guitar on South Congress) 3. Personalization is evolving faster than Austin's skyline 🎯 -Sharp HealthCare's Julie Frahm talking about digital experience integration and the organization's EPIC-hybrid-built mobile app! -Baptist Health keeping it authentic about its personalization journey - more plot twists than a special musical guest at Austin City Limits 4. Reviews & Reputation Management are the new SEO frontier 🌟 -One of the day's spiciest sessions? Sutter Health's Nolan Perry and Emily Mangini breaking down their Google review strategy like it was La Barbecue's brisket recipe! 🍖 The secret sauce? A systematic review requesting program that took their Walk-In Care locations from crickets to crushing it. We're talking massive gains in just months, and one physician going from 3 reviews to 35+ stellar ratings faster than you can say "Keep Austin Weird"! -Baptist Health revealing 73% of patients read 6+ reviews before choosing a provider The big takeaway? Healthcare marketing is evolving fast - it's all about creating seamless digital experiences that feel as natural as wearing cowboy boots to a tech conference. Heading to Rainey Street for some "networking" - who's in? 🎸 #HealthcareMarketing #DigitalHealth #HCIC #KeepHealthcareWeird #ATX #HealthcareTechnology #PatientExperience #HealthcareInnovation

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There’s a category we believe is getting too little attention when it comes to AI in healthcare: AI Clinical Documentation Integrity (CDI) While AI ambient scribes and autonomous medical coding solutions have gotten most of the headlines, we’d argue AI CDI is equally impactful when it comes to quality care and accurate billing. For those not familiar, CDI ensures that clinical documentation accurately reflects the patient’s medical condition and the provided care. Historically, CDI was a manual slog, with dedicated CDI specialists, nurses, and physicians painstakingly reviewing patient charts to ensure documentation supported the care delivered. Today, AI is reshaping this landscape. While it’s still early days, we’re seeing three primary approaches to applying AI when it comes to CDI: 1️⃣ CDI + ambient scribing—an AI ambient scribe and AI CDI assistant operate simultaneously, generating comprehensive notes and surfacing codes for physicians to review at the point of care. (Example: Ambience Healthcare’s AutoCDI) 2️⃣ CDI via real-time diagnosis support—diagnoses are suggested at the point of care based on clinical data in the EHR, with auto-generated documentation and audit trails. (Example: Regard) 3️⃣ CDI via an AI-driven post-coding / pre-billing review—the entire patient record is ingested and analyzed against what is coded, surfacing suggestions for revenue and quality opportunities. (Example: SmarterDx) To date, AI in healthcare has focused primarily on administrative use cases. With the increasing adoption of AI CDI solutions, we’re now taking a step closer to clinical workflows. As clinicians get used to AI-suggested diagnoses in the CDI context, it will be interesting to see if this increases their comfort with AI playing a role in clinical care. Here's our working list of AI CDI vendors. Anyone else we should add? • Ambience Healthcare • Brellium • Iodine Software • Regard • Semantic Health • SmarterDx   

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Top 2024 MedTech Trends (and what that means for sellers) 1. More AI and self-tests ↳ selling convenience > expertise 2. More wearable tech (Fitbits, etc.) ↳ more opportunity to sell direct to consumers 3. More weight loss drugs ↳ longer, tailored weight loss treatment plans 4. More U.S. demand for newer tech ↳ more markets (and needs) to sell into 5. More tech, more quickly ↳ more monitoring patient effects after the sell 6. More diversity ↳ better data to base recommendations 7. More sustainable ↳ standout to eco-friendly buyers 8. More 3D in manufacturing ↳ reduced production costs (and sticker price) Seems 2024 is the year of more . . . Did I miss anything?

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CVS is in trouble I mean, not really, but shareholder wise, it is -29% share price since April 1st -17% share price since April 30th Let's look at what's going on Q1 2024: $88B revenue; +3.7% YoY $2.3B op income; -34% YoY $1.1B net income; -48% YoY $4.9B cash from ops; -34% YoY Woof, what's the deal.... $27.8B health care costs; +36% YoY Pesky health care costs And what might those be, pray tell? +$6.9B in costs in the health care benefits segment 90.4% MBR (CVS's version of MLR); +580bps (Aside: bps = basis points, in other words +580 bps means +5.8 percentage points) This is pointing to a crunch in the Aetna Medicare Advantage segment In fact they say specifically that the increase was due to Medicare utilization and poor start ratings Oh, also because it was a leap year... Naturally The issue here is not the paltry $4.9B it earned in cash in a 90 days, it's the impact on Medicare Advantage members CVS will look to improve its performance by attacking the cost drivers dragging its margins In other words again, it will cut benefits, control utilization more, and probably start exiting Medicare Advantage markets Now that over 50% of Americans have the nefarious plans, what's going to happen when CVS says, "meh, we're not making enough to keep paying out billions in dividends, so we're dropping 4.2M enrollees..." Publicly traded companies have one primary duty: maximize shareholder value Talk about misalignment P.S. if you liked this breakdown, you'll love The Healthcare Breakdown, where I shout into the abyss of absurdity about healthcare business, so you can also slowly slip into insanity Check it out here: https://buff.ly/47NeASx See you out there!

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#IngredientCosts in #prescriptiondrugs - what's the right metric? That's a great question. Let's review. 💊 AWP = I think we can all pretty much agree that AWP is a inaccurate metric for establishing actual acquisition costs of drugs. The joke in the industry is that it stands for "Ain't What's Paid." It's allegedly a markup of 20% on WAC or wholesale acquisition cost. Furthermore, generics can actually be discounted up to 98% the cost of AWP when all on and off invoice discounts and rebates are said and done. 💊 WAC = WAC might be a little better, maybe, at least on brand drugs. But not on generics. Percent off from wholesalers to pharmacies can be widely variable on generics as well. 💊 NADAC = (Full disclosure, I worked on the NADAC in the past.) NADAC is probably better than AWP and WAC, at least with Brands. Brands are usually with NADAC about WAC minus 1-6% (dependent upon class of trade of the pharmacy and/or their size). But again, generics are all over the place, and NADACs can vary widely to actual acquisition costs. There really isn't a great correlation between NADAC on generics and the actual drug price to the pharmacy. Not all pharmacies participate in NADAC, and NADAC pricing does not show off invoice rebates and discounts, so it's not the actual price the pharmacy paid either. Not all drugs have a NADAC, either. 💊 ASP = Average Sales Price. Not terrible, but only is for J code drugs or drugs that can be used in the medical benefit, put out quarterly by CMS. Doesn't really solve the problem of retail community practice actual drug costs for the pharmacy, after discounts, rebates, and all the other jazz. So, what's the BEST solution then? 💊 AAC = Actual Acquisition Cost. It clears out all the smoke and mirrors and clearly states what the pharmacy actually pays for the drug - this is really critical on both generics AND brands too - as reimbursements on brands by big 3 PBMs has been BELOW a pharmacy's actual acquisition cost, and this is what is driving over 2000 independent pharmacies out of business this year alone thus far. What do we use at Mark Cuban Cost Plus Drug Company, PBC? AAC. Yes, what we're showing you is actually what we actually paid for the drug. No off invoice rebates or discounts or any of that jazz. That and we make sure before we put a drug on our drug list that we have it available at our Actual Acquisition Cost to pharmacy team ups, both with Costplusdrugs.com as well as teamcubancard.com. No WAC, AWP or NADAC. Just what we paid, period. It's time to start using actual acquisition cost of drugs and get all the gobbleygook out of the way. (I'll save my opinion on drug rebates for another post and another day....) #pharmacy

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***The $20,000 white paper***—it's a concept that gets floated around a lot by copywriters...but I think that number understates the real problem. You'll hear a few different versions, but basically, the legend goes like this: A copywriter was brought on to help with a white paper that had stalled with a company for months on end. It had been passed around, written, rewritten, edited, and started from scratch multiple times. The copywriter asked their client to calculate the number of hours they'd spend and what that translated to in terms of labor costs. The number they came up with was $20K. I think it's actually much more than that. The most common content red flag I see from hospital tech vendors is when I hear leadership is burning time creating content. The problem isn't really the time spent (you actually can justify a $20K white paper in this world)...it's the opportunity cost...especially in healthcare tech. The healthcare vertical is incredibly complex and requires strong, engaged leadership to navigate it. Leaders simply have a million better things to do than spend days knee deep in writing and rewriting content. But I see it all the time. It's why I'm always encouraging leadership past a certain level to step away from creation and instead dig deeper into strategic listening, planning, and higher-level content strategy. You have options including outsourcing, hiring (and properly training writers), and even generative AI (the kind built for enterprise content...not the generic solutions most people use). I'll also take it a step further and say...if you think this *isn't* a problem, you've underestimated the complexity of the market you're playing in. The $20K white paper is just the tip of the iceberg. #HospitalContentMarketing

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17 reasons I loved #GTM24! 17. Sonal Mane could be a standalone reason to love this event! Her future of GTM AI and automation session with John Hessinger identified things GTMers should be experimenting with and how to incorporate GenAI into existing workflows. 16. Peter Ward’s discourse on formalizing market readiness and ways to align cross-functional groups. 15. Macy Berg Mody’s example of eliminating repetitive x-team readouts and making meetings more productive with shared tech informing multiple groups on customer feedback. 14. Holly Holbrook's best practices for internal comms like creating a “front door” for cross-team conversations and ideation. 13. Emi Wayner’s practical guide to GTM launch metrics was great, but it was even better to hear how she evolves metrics while retaining focus on key impact areas. 12. I loved Candice Sparks and Lexie Knauer’s dialogue on building for parity vs. differentiation. Don’t let your product get in the way of a good story! 11. The most POV-altering moment of the conference (for me) was the fireside chat on unlocking brand growth with Maya Shah-Ceccotti, Karen Sage, and Nidhi Daga. It changed my thinking re: CLG. Build it into growth motions intentionally upfront! 10. “If you build it with them, they are already there.” - Kasey Stinson. 9. 43% of buyers desire a “seller-free” sales experience, according to Gartner (and Filip Szymanski in his session on PLG vs. SLG). I appreciated his thoughts on scaling growth loops, whether collaboration growth loops or user content growth loops. 8. More people would remotely lead successful GTM teams if they followed Paige Lapen’s “make work rock” framework or James B. Stanton’s weekly meeting cadence: Commit - “CFC” - Complete. 7. Internal messaging gets diluted with multiple communication methods, as Somesh Chablani pointed out. Don’t drop it into Slack and assume everyone knows. Overcommunicate with remote teams. 6. Daniel Kuperman’s competitive intelligence matrix and launch blueprint could have been an entire session, and I still would have wanted more! 5. Nonya Collier is the collaboration queen! Co-creation in a brain trust, codifying insights, amplifying the collective intel. 4. “Beyond the Launch” by Ed Cho may have convinced me that math can be fun and definitely convinced me of the necessity of focusing on pipeline maturation and not just pipeline creation. 3. Ariel Cai walked through how AI is redefining the go-to-market playbook. 2. I was excited to share my session on accelerating sustainable growth with ideal customer profiles. Plus, in a shocking turn of events, I got to chair the second day! 1. The number one reason to attend any event from The Alliance/GTM Alliance is to connect with the most incredible people! I can’t list everyone, but I have to mention Chase Payne, Cinthia Silva, Jan, Amy 🐆, Rohit Angle, Alisha Johnson, Catherine Knoll, Samantha, Sasha, and I finally got to meet the mastermind behind it all: Jack Debono!

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🟢 🟢 🟢 Healthcare is a MASSIVE vertical...and one of the biggest missteps I see tech vendors make is treating it like one big blob of an industry. 🟢 🟢 🟢 Healthcare isn’t a monolith. There’s an amazing amount of difference between pharma, life sciences, home health, and acute spaces. …it’s why I’m always saying, “hospitals aren’t healthcare”. Make sure your content marketing is as nuanced as the industry you’re working in. #HealthyHospitals #HospitalManagementSoftware #HospitalContentMarketing

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🟢 🟢 🟢 Healthcare is a MASSIVE vertical...and one of the biggest missteps I see tech vendors make is treating it like one big blob of an industry. Healthcare isn’t a monolith. There’s an amazing amount of difference between pharma, life sciences, home health, and acute spaces. …it’s why I’m always saying, “hospitals aren’t healthcare”. Make sure your content marketing is as nuanced as the industry you’re working in. #HealthyHospitals #HospitalManagementSoftware #HospitalContentMarketing

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