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Lisa penned the 13 rules for Healthcare entrepreneurs in a few minutes but it was based on a lifetime of experience. We sat down at the HLTH conference to compare notes on why some entrepreneurs make it and some miss the mark. Hope you enjoy.


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 Welcome to this Week in Health IT events where we amplify great ideas with interviews from the floor. My name is Bill Russell, recovering Healthcare, CIO, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health leaders. We wanna thank our founding channel sponsors who make this content possible, health lyrics and VMware.

If you wanna be a part of our mission to develop health leaders, go to the homepage this week,, and click on sponsorship information. This week we're at the health Conference in Las Vegas, and I'm loving the conversations. Several people in my network have told me that I needed to speak with Lisa Sunan, a venture capitalist, and entrepreneur who, and we finally caught up with one another after a long game of email tag at the conference to talk about her 13 Rules for Healthcare Entrepreneurs.

Among other topics, I hope you enjoy. We're here with, uh, Lisa Soen. Hello Venture Valkyrie. And did you actually go by that? Is that your, you know, I don't like, intentionally go by Venture Valkyrie, but people call me that and it cracks me up. I didn't start off intending to be a cartoon character, but , there you go.

Have you ever had a character made, like Drawn or something of um. Mm. Yeah, I have actually, I mean, usually people draw me with like the old Viking, you know, hat type of thing on. And uh, I've had a few of those presented to me. I've walked up to speak to, you know, to the, uh, ride of the Valkyries a couple times.

It's, uh, the, uh, funny, yeah. At the health conference, obviously the, I mean, they do the character trips Right. But now they have the, the cutouts. Yeah. Are, which cutout do you think you're gonna try to take home? Try to sneak it, sneak out. I'm looking, I'm hoping that there's one of the rock. That's what I want to take home.

Otherwise, uh, I'm good. You don't want any of the healthcare? Super. Sure. I really basically wanna play like pin the tail on the healthcare executive. You know, , you don't want any of the healthcare executives. You're just looking for the rock. No, no. Mm-Hmm. That's, I don't need to take a bone with me. . Wow. Um, so give us a little background on what you're, what you do, and what you're, uh, doing right now.

Okay. Um. Well, for most of my career I've been either an entrepreneur or a venture capitalist, or both. And I'm currently working, um, at Manat Phelps, which is a, uh, multidisciplinary, uh, professional services firm, which has a strategy consulting firm. A law firm and a venture fund. Okay. Okay. So I'm running the venture fund and I'm running the digital technology practice for the firm.

And I spend a lot of my time though at the digital health side of that. That's exciting. Yeah. Well, we're you penned the, uh, 13th things Yes. That, um, health tech startups need to consider and I. It's been written about a bunch already, so, um, I, I don't know if my audience has, has really delved into it, but I like it as a, a, a framework for having a conversation.

So I, I'm just gonna, I'm gonna run through 'em and we'll just use them as sort of bullet points to jump off of, so, okay. Uh, I love the first one. So if the problem you're solving isn't keeping customers up at night, keep working. Yeah. I walk through these booths. You walk through himss, how many do you think have answered that question?

5%. Yeah. It's low. Yeah, it is low. I agree. And there's a couple of others here that I, I, I sorta of, you know, if you're not sure who will pay, you're doomed. That's the second one. When you have the conversation and they go, we're going direct to consumers. And I look at 'em and I go, I wouldn't pay for that.

Why would I pay for that? Consumer healthcare has not worked out so well. I mean, there's a lot of companies that have tried and failed and I think, I think there's a distinction between consumer fitness and, you know, things like Right. Sports and athleticism and personal best ness. People pay for that Right.

From January to like March. Yeah. Uh, true. And you know, the problem is that, um, the minute you crossover into something people think should be covered by insurance, they're not gonna pay for it. Yeah. And they don't pay for it. And that is one of the things down here. Yeah, if they, if they think it's gonna be covered, but then you have these Strat, so they, so then everybody comes in and says, Hey, we're selling to the providers, the payers.

Mm-Hmm. and pharma. Um, it's kinda hard to find somebody that's going to all three, but there are, there are some, some platform plays are going to all three. Um, and it's, uh, it's interesting 'cause it gets into one of your others, which is, uh, you know, you can't pit 'em against each other. It's not like you can be good for the payer and really bad for the provider.

'cause you can, you can get stopped at either. There's a lot of, there's a lot of gates that can stop. I think the best businesses align incentives between the patients, the payers, and the providers. Particularly financial incentives. It's not always easy, which is why 5% is the answer to the first question.

Um, yeah. , but I think those are the businesses that have the opportunity to be most successful. So what areas, what areas do you think have the most opportunity? We see a lot of, uh, we used to see a lot of patient engagement that has waned a little bit. No, thank God . It did, it did seem like everybody had an app that said, Hey, we're gonna be able to get, you know, this many, uh, people.

But now it, it, it doesn't seem like any one of 'em has taken hold and we're back to . Uh, health systems believe that the patient engagement can be done through MyChart and it's, I mean, if you think, you know, somebody started for bad MyChart as a patient engagement platform, it's kinda, I I, I question the whole concept of patient engagement.

To be honest, I, I don't think that you, you don't wanna be engaged. People wanna be engaged as a, as a sick person. Right. I mean, I think when people have like cancer, they're engaged. You know, they, they care a lot. They're desperately seeking solutions, trying to survive. I think when people have most conditions, particularly the kind that kill you very slowly, like heart disease and the like, they don't wanna think about themselves as an ill person.

They don't want to engage around illness. All of the time, they want to have a, in their perfect world and they're not gonna get it. But in the perfect world, they want a quick fix and just leave me alone. Right? And, um, to feel decent and to live their lives, you know, as they should live their lives. And most people's lives are not designed to be engaged with the healthcare system.

You know, if they can avoid it. So chronic, uh, it's not hard to get chronic conditions to buy into patient engagement, but healthy people aren't, aren't, aren't generally looking to healthcare. They're looking at their gym and other areas. Yeah, I mean, I think one of the reasons that. We're seeing so much interest in some of the new primary care models like Walmart and CVS and the like, is because patients, people who need healthcare, wants convenience.

They want predictability of pricing, right? They want, um, good customer service. And so that makes these kinds of things very attractive. That is a way of engaging patients when you need healthcare. . It's a good experience. So, um, so I think that that's sort of where I put that category. So we have Amazon care.

Mm-Hmm. , which is interesting, you know, go directly to the, your employer population. Mm-Hmm. bring the care directly to them. Mm-Hmm. , same day appointments. Those, those kind of things. You mentioned. Uh, Walmart, new, a hundred thousand square foot. Mm-Hmm. facility just for care. Um, behavioral health, dental, I mean, it's just across the board.

Yeah. Um, so that you can, you know, see all those disciplines as well as get your imaging and your drugs and whatnot. How disruptive are they going to be to health systems or are health systems going to leapfrog them and just goes directly into the home and start to create? Are they gonna be that creative and go directly to the home and, well, they're trying to, I mean, they're certainly trying to, I mean, I think, um, but not with primary care or mostly with, yeah, some of 'em, I mean, I think the challenge is that most of that relates to value-based pricing.

So if you're a general fee for service type of organization, you're not as motivated to do that because you know you get paid more by people coming to your, your right. Health system. Right? Yeah. And so until we have a lot more value-based contracting and real capitation for some of these things, I don't think they're gonna leapfrog that.

Right. I, you know, remember value-based is still a long way off. Yeah. The business model must account for that. Yeah. I think the corollary to that is, remember the sales cycle is at least a year to at least, yeah. Yeah. To 18 months. And that's people. Um, when I talk to startups, they'll say, uh, you know, we have this great idea.

Right. You know, we have our first client lined up. Mm-Hmm. . And, and, uh, you know, from the point that you say you have them lined up Mm-Hmm. to the point you get a check. Um, it's, yeah. You hope to live that long. Yeah. It's, it's, it's, it's kind of tough. And then I've heard somebody talk about really death by pilot.

Yeah. And a lot of these startups allow themselves to get pigeonholed into these pilots all over the place. Yeah. And stretch. Is their resources? I mean, are you seeing that as well? I mean, do they die? I think it's getting a little better on the sophisticated companies. I mean, I think, I always, I advise the guy today, I said, you know, if you're gonna sign up to do a pilot with this customer, A, they should pay, and B, the contract should provide for on this date certain, if these specific things have happened, it automatically converts to a, a con, a commercial contract.

And here's the pricing in it. Yeah. You know, prepare for that transition because otherwise you just go . Strung along forever. And if they like what you're doing, they're not gonna want you to walk away. So how do you coach a startup? One of the things that's happening now, Mm-Hmm. startups are going into health systems.

Every health system has a fund or an innovation group. Yep. And they look at 'em and go. , that's a good idea. In order to get into our health system, we want you to go over there and we want a percentage ownership. Mm-Hmm. . And how do you coach them in that? And by the way, I've heard that from Mm-Hmm. , I've heard that directly from health systems.

So it's like, yeah, sure. There's two doors in here. That's the easiest door, right. To give us ownership. And then the other way is just. Tooth and nail. Fight your way in. Figure out if you can do it. I either say, don't do that, or I say do that. If you can align the incentive, if you can say to somebody, if somebody says to you, I will give you a whole bunch of business and, but I want you to gimme equity.

Great. Give 'em the equity as they give you the business. Wow. So if they want 5%, you know, give them 1%. For every one fifth of the business they say they're gonna give you, don't just give it to them and hope for success because, you know, that's how people get paid. They get paid for, for performance.

Right. And they should perform for you just like you're performing for them. Otherwise, it's not a partnership. It's interesting. I've, I've, uh, I'm getting into some things I didn't really want to get into, but , uh. You know, if, if your payer, if your product hurt, helps payers but hurts providers, you need both to play.

Try again. Yeah. Have you, you still, that's the alignment of incentive. Do you still adhere to all these. Yeah. Would you add anything to 'em at this point? Um, I probably would. I, I don't remem There were a couple really great suggestions of things I missed when I, uh, there was a suggestion of, um, you know, have a, a good regulatory or clear and, and thoughtful regulatory pathway, which I forgot when I did this.

Yeah. Um, but I also think, um, you know, what's not there is, would you use this yourself? You know, and I think people forget to think about that real people are gonna touch this stuff, right? Not just patients, but providers and others. So how's it gonna affect their wanting to go to work or go to get care or go to whatever?

Would you use it yourself? And if the answer is no, then it's probably not good. Well, that, I mean, patients are the point. Don't forget to include them. Yeah. In the design and testing, uh, do you find startups still not doing that? , I can't tell you how many companies I've. I've talked to over the years that have said to me, I've said to them, how many patients have tried your product?

That's patient oriented, obviously. Well, my grandma tried it, I tried it. Or one, you know, one person, five people, whatever. Holy cow. I, I, it's so terrible. I mean, it really . There's all this buzz about user-centered design, but honestly, it works, you know? And I think, oh yeah, people should be out talking, show it to 50 or a hundred patients, you know, show it to a lot of people, get real feedback because you either do it before you launch or after and after.

It's a lot more expensive. I, I did make the mistake, so I'm, I'm not, I'm not throwing stones here. Yeah. We had, uh, we had three startups at the health system I was at, and, uh, one of 'em failed. And, uh, you know, one of the reasons was. We waited way too long. Mm-Hmm. by the time we brought people in, they were looking at us like, where were you going?

Yeah. Um, and uh, and you know, and health systems aren't really that great at engaging . . Um, they're, they're, or at least we weren't, and I, I know some others that struggle with it. It, it really engaging that patient community. I know others that are good at it. They've brought in Yeah. Some are very good at it.

Yeah. They've, they've brought in groups, uh, cohorts for periods of time. Mm-Hmm. , they're constantly iterating on the product. Um, where have you seen like really sound success stories at this point? In what respect? Health tech startups that are, um, that, that are making it, that are really starting to make it.

I actually think there's some really good examples out there. You know, I don't wanna, I don't know if it's, you know, naming name is tough. I mean, I, you know, in my past history of investment, you know, I've had very interesting, successful companies as well as not, um, . And, but I do think there's companies now that are finally getting critical mass.

We're starting to see companies get to like 20, 30, 40 million of, of revenue. That's like a company, right? And for a long time there was nobody more than five, you know, a long time. So I think, you know, that is not . Still not massively successful. It's still small, but it's certainly, um, clear that they're becoming more entrenched.

So, so not, not all money is the same. Right? Right. So there's VC money. Yeah. There's seed money, there's uh, there's private equity. I mean, do you, I do you end up coaching startups a lot on Yes. A lot. Yeah. 'cause money is, they can, they can . They can end up in a cold, dark place. If they do the wrong thing, they, they can, and I actually encourage them not to raise any money.

If they can avoid it for the longest time, they, they can possibly get away with it. Because, you know, it's not typical for companies to raise money if, if you look, if you think about it right. In history. And, and I think if you look at the, the, uh, in 500, you know, maybe something like 30 of 'em are venture backed, not a lot.

So I think you, it's good to bootstrap. It's good to raise it from your family and friends. It's good to gain it, get get it from early revenue. The longer you can go without professional money, the better off you are. Because you just, you know, you lose a lot of control. Well, isn't there? Well, you lose control, absolutely.

But isn't there a concern like, if I don't get the money, I'm not gonna be able to compete that there's always somebody else out there? I don't. No, I don't think so. Not if you're good. I don't think that the customer generally starts by asking you who your venture backers are. I think they start by asking, unless they're very strange.

I mean, I think they start by asking you what problem are you solving for them and how, and what are you gonna do for them, you know? Number 10. Wellness and prevention are essential, but no one wants to pay for them. Do employ have, have, has that shifted? Are we seeing employers start starting to say, Hey, you know what, I, I think I can make the model.

I think I could. I'm self, self-insured. Yeah. There's, look, there's a lot of money being spent by employers for wellness programs. Yeah. Not to interrupt. Not a lot of good, it's primarily, I think, my opinion oriented towards . Um, being a good place to work, right? And not oriented really towards major health, you know, prevention and the like.

There's almost no data that suggests any of these wellness programs cause meaningful impact on health. Um, pr, primary prevention, the healthcare system just doesn't pay for it. With, with a little bit of exception, things that are regulated that you must cover, you know, colonoscopies, you must cover ma uh, you know, ma uh, mammography to a certain extent, you must cover well, baby care.

Um, or well baby, you know, sort of the early, the, um, early diagnostics when they're born. So those, there are things that are preventive and primary prevention oriented. But mostly those are things that payers are forced to pay for. Women are 85% of healthcare decisions make them a key part of the team. So you just came from your panel discussion?

Yeah, yeah. Um, they're 85% of decision making of decisions, right. So they're the customer. Right. And most companies don't have any women on their teams. They are 75% of all healthcare workers. 75% of all healthcare workers are women. Wow. But by the time you get to the CEO level, it's 6%. Right. So it falls off by the time you get to the C-suite, it's like under 30%.

So it's, is that within healthcare systems or is that within all healthcare generally health in, in generally in healthcare, 6%. Six. Wow. Which is stunning really, especially if you add that to, I forgot to talk to my customers, you know. Um, are, are you saying you wonder why that a female CEO would not make that mistake?

Well, they wouldn't make the mistake of forgetting their female customers. Yeah. I. Yeah. It's, it's, it's in, it's interesting, 85% women are used to thinking about their whole family. Right. Right. The men, the women, the kids, the whole shebang. Right. Right. They think about it that way. Yes. Um, so I think No, no woman, CEO would forget to think about the female customer.

Uh, I, I think that's right. The other thing I think is, is humility. We just ran into ACA female, CEO. Mm-Hmm. . And, uh, I was talking to her the other night and, uh. She was talking about how she called a, an old friend who's also a female CEO while it's two mm-Hmm. , who were both on the podcast. Um, but she, uh, she said, you know, I, I got into the role and I realized I'm really, you know, I, I'm swimming up here 'cause it's my first CEO role and there's, there's not a huge amount of ego.

Just get on the phone, call somebody else and say, Hey, you've done this for 15 years. Help me, you know? Mm-Hmm. . And they broke down, Hey, what are you working on? What do you Mm-Hmm. . And they said, well, you know, you're still stuck in your old role. You need to become the ceo. Mm-Hmm. . And it's that, it's the lack of ego.

I think that Mm-Hmm. is another attribute that would . Uh, really help, uh, really, um, benefit female CEOs over male CEOs. Well, I don't know. I mean, there's great male CEOs. There's, there's great female CEOs. There's terrible of both as well. Yeah, they're, um, I think, you know, women actually tend to be less confident than men, and that's, you know, nice because it's, makes them more friendly and approachable.

And it's terrible because it keeps them back. Right. And keeps, you know, holds people back. I think, you know, one of the, I started C Sweetener, which was a, uh, is a mentorship platform, kind of like a match women rising women executives in healthcare with mentors for this exact purpose. Because, you know, women don't often us head to these roles and they struggle to get there and they struggle to know what to do or what to say in situations they're not familiar with because they're not there.

Right. Right. And, uh, we have both. The male and female mentors, as think I just said. And you know, it's been a really cool program 'cause people want that engagement. They wanna ask questions in a safe way. They don't wanna feel stupid, but they also recognize both men and women, I think. But in my case, I was focused on the women, you know, that um, everybody could use a little help.

You know, but it's hard to find who do you talk to? Right. So actually we're excited 'cause Health announced they were acquiring c sweetener yesterday. Right. To scale it and grow it. Um, so it'll be more, but I think, you know, there's people with Biggie egos on both sides of the gender, uh, platform. No doubt.

Um, I, I stand corrected. Yeah. Let me ask you this. The, uh, you know, people who are in the game, I like to ask if you are going to do a startup right now? Mm-Hmm. . Um, you know, somebody's gonna come alongside to you and say, Hey, let's, well actually, you're not gonna take the money. You have a great idea. What area would you focus in on?

I'm not gonna ask for like, the idea, but what's, what's the area you think is maybe underserved? That has a, a huge opportunity actually at pediatrics. I think pediatrics is, um, healthy families, you know, . Healthy children create healthy adults. Uh, by the time, you know, you're 5, 6, 7 years old, you're kind of in a blueprint for the rest of your life in some ways.

Interesting. There's not a lot of funding for pediatrics. It's very under underfunded. And, um, you know, I think there's, if I could change the dynamic of healthcare. . You know, talk about primary preventions, teaching kids how to take care of themselves and keeping them healthy. Yeah. I, I wish there was more there.

I'd love to do something there that was meaningful. Yeah. And, uh, I'm, I'm trying to figure out how to weave this in. Somebody told me I should talk to you about, uh, the infrastructure of healthcare and reliable systems and how important reliable systems are, like power grids and those kind of things. God,

Yeah. Well, you know, I, I live in Marin County in California. Yeah. We're having a massive intentional blackout right now. The pg e turned our lights out across 20 counties of California. Yeah, for five days. Second time, it's happened in a month now. We're having terrible fires right now, and that's part of why they did it, but Okay, so five, so five days in a row?

Yeah. Twice. Yeah. How. I've never thought about. And now imagine, I'm not sure how I could live, actually. Yeah, imagine So. You have to move out. So I could live, but it's incredibly inconvenient. Like even our cell phones weren't working. But now imagine somebody who's on oxygen. Oh yeah. They gotta plug into a wall.

Imagine somebody who has on insulin and needs to refrigerate it. Right. I mean, this is life threatening for a lot of people. Have they taken that into account ahead of time? I would assume somebody's taken that into account. we're just, we're just shutting off Marin County. I don't know. It's not just Marin County.

It's 20 counties. Yeah. You know, it's, it's, it's something like, uh, it's, it's literally millions in California, 3 million Californians, something like that. It's a huge swath of. Of area and no, I don't think they, I think they thought about it some, I think the state thought about it some, and some of the counties have created, you know, some, some support for this.

But fundamentally, no, because all of that stuff has been advertised through the damn internet. And if you're 65, you're 70 or 80 years old and you're living alone and you don't use the internet much. You don't know, you know, so I think it's really scary. And think the grid, uh, I think our, our, you know, sort of reliability on the electrical grid and on light and on other things is, you know, intrinsic to healthcare.

Should we, uh, do a startup around, uh, basic infrastructure across the country? Redo the electrical grid? Yeah, we probably should, probably should redo the electrical grid. It probably should. It's pretty bad in California and some other things. Any, uh, last question. Anything at the conference, um, jump out at you or.

Um, not so much yet. I've been pretty much in meetings, but I'm actually, here's what jumped out at me Last year, health was a conference that was dominated by men. There were 18% of the speakers were women, and they got a lot of flack for that, and this year they really fixed it. I mean now 38% of women of speakers are women.

It's not equal, but it's close getting there. Big, big change. And they've put together a whole bunch of programming that's focused on supporting women and they really doubled down on doing the right thing. And I'm really, I'm really impressed by that actually. Congratulations on your success. Thanks. So they're gonna take c-suite nerd.

Mm-Hmm. . And grow it out. Yeah. Are you still gonna be involved or, yeah. You are. Fantastic. Yeah. Well, thanks for your time. Thank you. Appreciate it. I hope you've enjoyed the conversation. If you would like to recommend a guest or someone to be on the show, you can do that. From our homepage, uh, recommend a guest is about three quarters of the way.

Down on the homepage. Please check that out. And don't forget to please come back every Friday for more great interviews with influencers. And don't forget, every Tuesday we take a look at the news, which is impacting health. It. This show is a production of this week in Health It for more great content, you can check out our website this week,, or the YouTube channel, which you can get to from our homepage as well.

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