Nina Levin

Thank you, Sumit Nagpal, for shining a light on two incredibly important movements in what can often feel like a challenging healthcare startup environment. This is a huge win for women's health and signals the dawn of a new era for consumer health. I firmly believe in moving away from a one-size-fits-all solution for men and women, and recognizing the need for a completely different approach – sometimes in obvious ways, and sometimes not. People have access to more knowledge and data about their health than ever before, enabling them to make informed decisions about their well-being. Consumer health is ripe for a comeback! #consumerhealth #digitalhealth #menshealth

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Should you sell your practice to a VC-Backed MSO Startup? tldr: - new VC-backed startups are forming MSOs to roll up independent practices - The pitch is physicians receive early liquidity from the roll up and are granted ESOP shares that can be used for retirement - Problem is the use of ESOPs with independent practices is not a new concept and has been used with large group practices since the 70's - ESOPs do not grant full ownership and in order for the shares to be valuable for retirement, the practice needs to run the same if not better post roll up - With VC-backed startups being primarily operated by non-physicians with zero clinical or medical practice experience, the likelihood of this happening is extremely low making the entire concept high risk However, there is a viable path for continued ownership + liquidity for independent practices. Check out the article to learn more. ⤵ https://lnkd.in/gmGvTYwP

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Health and Wellness is a wave, and integrated care will be (and already is!) the defining characteristic of most winners. Many DTC healthcare companies are putting money into Meta/Google, and getting patients out. Something similar is possible at a Doctor's office, with a significantly lower CAC. Put in resources, get patients out. I think this is a compelling distribution channel for a lot of wellness companies--Pharmacies, Gyms, Nutritionists, Therapists, Longevity etc. Because if you're a healthcare company, chances are the people who you can impact the most (and who may be the most motivated to use your product!) are those at the Doctor's office. Yes it will be non-trivial to set up distribution through clinics... but those nuances are just a barrier to entry for your competitors. The rise of multi-clinic operators makes this extra powerful right now.

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Tech meets tail-wagging at HLTH! 👣💻 Gearing up to represent our health tech company at HLTH next week! While my fluffy pup, Maui, won't be joining (conference floors aren't ideal for belly rubs), I'll be bringing the same enthusiasm to talk tech. On my HLTH agenda: - Showcasing our AI-driven prior auth and benefit verification solutions 🤖💊 - Connecting with forward-thinking PBMs and provider groups 🤝 - Discussing how we're fetching better healthcare processes (pun intended) 🎾➡️📈 Fellow tech enthusiasts or healthcare innovators, let's connect! I'm always ready to chat about optimizing healthcare workflows or debate the best puppy training methods. PBMs and providers, we'd love to show you how we're taking the bite out of medication management hassles! #HLTHUSA #HealthTech #AI #PuppiesOfLinkedIn

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

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"Boy this would be great if you could do this in Hindi." an Investor said on a call with Bud during a Demo. "Angela, our product manager was sitting in the background listening to the call and we went through all the details, and by the end of our call we had a Hindi version of it. AND She invested. Immediately." Healthcare AI is a huge part of the future, what does that look like? Digital Health Heavyweights Podcast brings you episode 53 with Bud Flagstad, CEO of EmpowerHealth. Bud shares his journey from a young tech enthusiast to a leader in healthcare technology, detailing his extensive experience at UnitedHealth Group and the innovations he spearheaded. He discusses the challenges of working in large organizations versus startups, the role of AI in healthcare, and how Empower Health is leveraging technology to improve patient engagement and reduce costs. Bud also opens up about his personal health journey, stress management techniques, and the importance of healthy living. Now in a whopping- 72 languages. Saved $72 million in readmission reduction across 847,000 members in a 12-month period for a company- of which $59 million was readmission fees, and $13 million in work force. They even can handle faxes, if people are still stuck in the dark ages. So much more efficient. "You won't realize what a solution like Angel can do, until you feel it." The industry is ripe for a big change. Learn about Angel, Empower Health, and the future of Healthcare and AI! 3️⃣🗝Points 🤖 Empower Health focuses on AI-driven solutions to enhance patient engagement. 🩺 AI can help reduce clinician burnout and improve care delivery efficiency. 🌐 The platform developed by Empower Health supports multiple languages and modalities. 🎧https://lnkd.in/dVxSFFQB https://lnkd.in/d6D6deJM

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If you start down the path of #enterpriseimaging – which many health systems are doing (or considering) – "there have to be some objectives and a clear understanding of what you're attempting to do," said Joseph Marion during a recent discussion with Alex Towbin and Lenny Reznik. What you don't want is to go into it with "a false expectation or limited expectation." https://lnkd.in/gg3PkCim AGFA HealthCare #itimaging #healthcareit #enterpriseimagemanagement #patientsafety #patientexperience

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Someone broke down the estimated costs of a $15 Sweetgreen salad. We need these cost graphics for digital health to help future founders. Especially for tech enabled cos, the greatest cost is labor. Much of the "value created" is in curation and matching, which means the gross margins are reliant on labor arbitrage. Pay someone $X, but get paid $X+Y% per visit. The challenge with healthcare is that you often have to pick one of two business models: 1. specialized, low volume, high cost, low gross margin % 2. generalized, high volume, low cost, high gross margin % I'd argue founders should focus on gross dollars over the lifetime of the customer (like Jeff Bezos said) instead of gross margin %'s, but we'll leave that for another time. The challenge is that many tech enabled digital health cos have high cost of goods sold (labor) and moderately high product, design, and engineering budgets. We must build differentiated solutions for patients, clinicians, and clients to be out incumbents, however, we're realizing that companies are ultimately valued on the discounted value of future cash flows. And the high SG&A costs at most organizations might be inbalanced to the unit economics of the business. I'm not sure the math pencils out for everyone unfortunately. But I'm just a guy on the internet, would love to hear the thoughts from those smarter than I (you!). Comment below. --- p.s. I have no idea the accuracy of the graphic and not an investor in Sweetgreen. Cheers. Credit: David Crowther

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Some VC investors believe that brick and mortar - referring to a physical presence of some kind - should be avoided at all costs. Yet, the track record of clinic and hybrid care businesses in health care indicates otherwise. ==> One Medical (sold for $3.9 billion to Amazon), Oak Street (bought by CVS for $10.6 billion), Lifestance (IPO at $7.5 billion market cap), and PE-backed Premise Health (acquired by OMERS Private Equity for $1.1 billion) If a clinic is indicated as the optimal way to deliver care for that patient population, there are creative ways to build and operate them. Full article below with advice and strategies on how to build and operate hybrid clinics from my teammate Anarghya Vardhana from Maveron, Amir Dan Rubin from OneMedical Group, Steven Eidelman from Modern Animal and more!

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

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If you begin with a grand vision and avoid playing "small ball," you can win in DTC in healthcare and allied health industries. In fact, I'd like to propose that eventually "all healthcare will be DTC." DTC means different things to different companies across different industries. In home security, one of my DTC heroes Jamie Siminoff proved that a category could be created or at least massively disrupted and morphed. Marc Benioff began his SFDC journey one salesperson at a time via direct marketing of a sales automation solution in a DTC way. How did they successfully disrupt stale low-margin, small-ball markets and gain scale and momentum? They built trust, leveraged user validation and word of mouth, and then went wide and deep with an ecosystem and a flywheel. And yes, they had a crackerjack, fresh and innovative product/service that worked, to earn trust, excitement and WOM virality. But that was the appetizer, not the main course. Healthcare has even more of this, as it involves risk reduction and building trust via personal-use validation and word of mouth with "reputational risk." This is one of the hallmarks of premier brand DTC product-led-growth. If you think about healthcare like a premier, aspirational brand, it begins to make more sense. It's expensive, it reflects your perceived social status (when/if you share it) and it is important to you to have value and trust in the brand. What if a healthcare brand could engender the same kind of connection and trust as, say: LVMH, Hermès, Apple, JLR, Zabar's, The MICHELIN Guide, and more. If you can build a large enterprise that can move from DTC and product-led-growth and early adoption, to scaled GTM via partners and leveraging or assembling an ecosystem to support it and build a flywheel to shift the unit economics and LCV (lifetime customer value), then you win. In fact, as we move further into outright recognition that so many Americans are essentially self-funding their healthcare via high-deductible plans.... "all healthcare will be DTC" in the sense that via price transparency, provider discovery and competition, trust and quality, all of healthcare will eventually need to be accountable to the same kinds of brand value, trust and reputational pressures as we see today in classic DTC businesses. Every consumer wants trust, value, brand reflection and quality. Especially in a high-spend, high emotional category like healthcare. #trust #value #wordofmouth #GTM #productledgrowth #Ecosystemledgrowth

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Today was a big win for consumer health, with Flo Health Inc.'s valuation at $1 billion. We're hearing talk about the market becoming frothy again, but I’d argue—without seeing the detailed financials—that this valuation could be entirely warranted. Flo has built an impressive business, with 5 million paid subscribers and 70 million monthly active users. At $60 per year for users to access the product, this business has hundreds of millions in revenue and plenty of room to grow. It's increasingly clear to me that innovators focused on healthcare have been wildly underestimating consumer business models for years, believing that patients would only opt for solutions covered by their health plans and prescribed or recommended by their doctors. That thesis needs updating, particularly given high deductible plans and soaring co-pays. Innovators building solutions that users genuinely love will win - even in healthcare. These businesses also have the potential to move into B2B channels, which is far easier to do when you have an engaged, loyal user base. I expect we’ll see many more consumer health businesses “pop” in the years to come, further proving that consumers are ready and willing to pay for such solutions. We're watching closely at Cherish Kudos to the team at Flo for this impressive milestone. Lainie Muller Charlotte Yeh Aashima Gupta Avanlee Christine Esther Dyson Alexandra Drane Jessica Kamada Vin Gupta, MD MPA Asheesh Saksena Paul Crnkovich Josh Kampel Steve Chazin Lee Wagner #agingwithattitude #independentliving #consumerdrivencare

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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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Prior auth is about to change dramatically, and adapting will cost health insurers $16.2B. Yesterday, we explored the history of prior auth and how we ended up with the frustrating system we have today. Now, let's look at the imminent regulatory changes. Here's what you need to know and how you can brace for impact: → There’s broad bi-partisan support for radically restricting insurers’ ability to conduct prior auths 1. The House of Representatives has passed bipartisan legislation demanding sweeping prior authorization reform. [1] 2. Texas, Michigan, and Louisiana have already enacted similar laws. 3. 30 more states are in the process of drafting their own legislation. → The financial impact The Congressional Budget Office estimates that complying with these new laws will cost insurers $16.2 billion. Insurers will be required to: 1. Universally adopt electronic prior authorization (ePA) 2. Maintain 24-hour response times 3. Publicly release data on all prior authorization metrics 4. Implement gold carding programs for certain providers 5. And a slew of other restrictions The industry response? Major insurers like UnitedHealthcare, Aetna, and Cigna are already preparing. They're proactively slashing their prior authorization requirements and racing to implement universal electronic prior authorization. 𝗧𝗵𝗲 $𝟭𝟲𝗕 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻: 𝗛𝗼𝘄 𝗰𝗮𝗻 𝗶𝗻𝘀𝘂𝗿𝗮𝗻𝗰𝗲 𝗰𝗼𝗺𝗽𝗮𝗻𝗶𝗲𝘀 𝗽𝗿𝗲𝗽𝗮𝗿𝗲? It’s going to cost a lot. There’s no getting around it. But by centralizing your prior authorization data, you can avoid the worst of it. Here's why: - Public data releases require a centralized repository of all your prior auth metrics. - Universal ePA adoption needs a centralized system to manage incoming requests. - Gold card programs require centralized tracking of provider performance. - Ensuring 24-hour response times necessitates centralized monitoring. Once you centralize your data, you unlock a world of possibilities. The big one? Automation. McKinsey estimates that with today's technology, 75% of prior auth can be automated. [2] Here’s what this will unlock for insurers facing these new laws: → Responses in minutes, not days → Public data releases with a click of a button → Gold Card programs that run themselves → Vast majority of auth requests handled without human intervention The pendulum is swinging back towards providers, but payers can adapt and thrive with the right approach. By centralizing data and embracing automation, you can slash costs, ensure compliance, and emerge stronger.

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✅Our healthcare report and market map are finally live✅ Over the past several months, I have shared with anyone who would listen that Michael Cardamone and I were in conversation with innovation executives across four of the top healthcare systems in the U.S. including Mayo Clinic Ventures, Hackensack Meridian Health, Cone Health Ventures, and University Hospitals Ventures to understand current strategies and priorities in order to hone in on our investment thesis. The goal was to arm healthtech founders with the inside perspective on the critical investment areas for US hospitals to help establish product-market fit and solve the industry's most pressing challenges. Links to download the report, check out the market map, and submit your company are all in the comments. Thank you to our contributing experts Shai Ran Sapir, Technology Development Manager at Mayo Clinic Ventures, Sandra Powell-Elliott, Chief Innovation and Commercialization Officer at Hackensack Meridian Health, David Heenan, Managing Director at Cone Health Ventures, and Matthew Zenker, Director of Deal Flow and Investments at University Hospitals Ventures. #healthcare #innovation #healthtech #earlystage #healthtechfounders #healthcarestartups

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Had a blast diving into Amir Dan Rubin's extensive healthcare career on Vital Signs. Amir previously served as the CEO of One Medical and Stanford Health Care, was an EVP at United/Optum and is now the Founding Managing Partner at Healthier Capital. Our conversation spanned payer-provider integrations, lessons learned from leading One Medical, applications of generative AI, and more. Some highlights: ⚡Combining care models We talked a lot about the One Medical/Iora combination. Amir argues that just because two care delivery approaches may occupy the same physical location (e.g., a clinic), that doesn’t mean they necessarily need to conform to the same economic model. For instance, One Medical and Iora were able to combine effectively despite the former being a membership model and the latter being global capitation. Amir emphasizes that much of the overhead resources (e.g., front desk staff, phlebotomy) can be shared across models. ⚡How One Medical uses generative AI to improve efficiency One Medical allows members to message the care team, and then uses NLP to read the message, figure out its content, and triage it to the appropriate team member. Amir is excited about leveraging internal knowledge graphs to get around hallucinations. This approach can point to relevant internal data in helping compose responses, creating more trust and accuracy in the outputs. ⚡Behind the Amazon acquisition One Medical was interested in expanding its direct to consumer offering. However, they recognized that customer acquisition was costly, which is why partnering with Amazon Prime’s existing membership base made sense for them. Amir explains how at their core, both Amazon and One Medical are all about using technology and logistics to create an excellent customer experience. An awesome conversation ranging from health system innovation to startup strategy to health tech investing! Listen to our full episode below: Spotify: https://spoti.fi/3Wrbnol Apple: https://apple.co/3XWOomb

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Lots of people are asking me how Midi Health is using AI. Yesterday at an event at Stanford, I was introduced to Open Evidence - and told that I could save money by having our providers use it for advice. The founders say they developed OpenEvidence to cut through all the noise and misinformation that is the modern internet and build tools that are unbiased, widely accessible, international, up to date to the day, accurate, and free. I bet it often gets things right. But not always. And I am afraid it will be that way for a long time. I asked Open Evidence whether women with BRCA could use hormone replacement therapy. At Midi Health we know that estrogen is safe for women with BRCA and I was curious about the answer. We also know that If you haven't had your uterus removed, your provider will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer. Unfortunately, in this case, the feedback from Open Evidence is just completely incorrect. As far as I can tell - the advice is completely made up - a true hallucination. When we think about how to use AI in healthcare - we are using it to make our providers more efficient and take away easy tasks - but definitely do not rely on it for medical care. You should not either. Zachary Ziegler and Travis Zack, MD, PhD it would be great to get this right!

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