This document discusses best practices for health care venture capital investing and value creation for health care startups. It provides insights from top VCs and CEOs on company growth plans, valuations, exit strategies, and fundraising. Specifically, it discusses that successful health care startups often demonstrate a unique technology with clinical impact, efficient execution to hit milestones, and the ability to establish a sustainable franchise. Franchise value and strategic need are key value drivers in acquisition exits. Early-stage valuations are often based on ownership percentages and financial models of future funding needs.
In this paper, I explore how the accelerator model could generate adequate returns by providing a hedge against risks present in the niche private equity model known as the Search Fund.
In this paper, I explore how the accelerator model could generate adequate returns by providing a hedge against risks present in the niche private equity model known as the Search Fund.
Here, we explore the Life Science Valley Funding options for research and biotech companies, ranging from early-stage venture funds that aim to invest, validate, and grow companies emerging from the UK’s research base to innovation funding options such as R&D tax credits, which a company receives after completing innovative projects.
Strategies for Conducting New Product Scientific Assessment - Yavuz SILAY - D...Yavuz Silay
Strategies for Conducting New Product Scientific Assessment - Due Diligence - New Strategies for Successful Licensing Acquisitions , DIA , Session Panel, June 22 2008,
Digital Health Success Stories (and Failures) Report - Part 2Tom Parsons
Part 2 of our report looks closely at some of the high profile failures to date in order to highlight warnings signs for projects and collaborations in the future. You’ll hear from Skip Fleshman, General Partner at Asset Management Ventures, about his perspective on the enormous investment being pumped into the market and how it should be managed. You’ll get an insider view from Cure Forward and Imperial College Health Partners about some of the reasons behind failures they have experienced and what we can learn from them. And through 2 case studies, you’ll learn more about how transparent and accurate results and trials are integral to ongoing development and success.
Pre-Launch Planning: Priming Your Pharma Brand For Profit And Success (mini)Eularis
In today’s environment, Pharmaceutical companies find themselves in a bind. Until recently, if drugs made over $500 Million in annual revenue within 3 to 5 years of launch, they were considered hugely successful. They were a support to an extensive company portfolio and a component of greater company profit.
However, things have changed. The standards for a successful drug have become much higher and much more dangerous. With so many revenue-producing drugs going off patent, companies are facing large holes in their balance sheets and sales that are increasingly slow.
Plus, with the stakes high and available funds low, pipelines are drying up. Add to this the closer scrutiny of safety issues, the rise of Generics, slower physician acceptance and adoption of new therapies, and the Pharma Industry is in trouble.
More and more, companies are expecting marketers to be instrumental at the key moment of launch, and marketers are under extreme pressure. To deliver on the high hopes of Pharmaceutical brand launch, companies must engage in comprehensive pre-launch planning.
In this report we analyze why launch is increasingly important, the issues involved in pre-launch planning, including key organizational strategies, marketing tactics, regulatory considerations, global issues, and methods for ensuring the most effective plans.
Pharmaceutical Competitive Intelligence: An Essential Pill in the Pharmaceuti...RNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements.
Competitive Intelligence: An Essential Pill in the Pharmaceutical KitRNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements.
Competitive Intelligence: An Essential Pill in the Pharmaceutical KitRNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements. Source: https://www.wns.com/perspectives/articles/articledetail/123/competitive-intelligence-an-essential-pill-in-the-pharmaceutical-kit
Competitive Intelligence: An Essential Pill in the Pharmaceutical KitRNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements.
when will pi network coin be available on crypto exchange.DOT TECH
There is no set date for when Pi coins will enter the market.
However, the developers are working hard to get them released as soon as possible.
Once they are available, users will be able to exchange other cryptocurrencies for Pi coins on designated exchanges.
But for now the only way to sell your pi coins is through verified pi vendor.
Here is the telegram contact of my personal pi vendor
@Pi_vendor_247
The secret way to sell pi coins effortlessly.DOT TECH
Well as we all know pi isn't launched yet. But you can still sell your pi coins effortlessly because some whales in China are interested in holding massive pi coins. And they are willing to pay good money for it. If you are interested in selling I will leave a contact for you. Just telegram this number below. I sold about 3000 pi coins to him and he paid me immediately.
Telegram: @Pi_vendor_247
Here, we explore the Life Science Valley Funding options for research and biotech companies, ranging from early-stage venture funds that aim to invest, validate, and grow companies emerging from the UK’s research base to innovation funding options such as R&D tax credits, which a company receives after completing innovative projects.
Strategies for Conducting New Product Scientific Assessment - Yavuz SILAY - D...Yavuz Silay
Strategies for Conducting New Product Scientific Assessment - Due Diligence - New Strategies for Successful Licensing Acquisitions , DIA , Session Panel, June 22 2008,
Digital Health Success Stories (and Failures) Report - Part 2Tom Parsons
Part 2 of our report looks closely at some of the high profile failures to date in order to highlight warnings signs for projects and collaborations in the future. You’ll hear from Skip Fleshman, General Partner at Asset Management Ventures, about his perspective on the enormous investment being pumped into the market and how it should be managed. You’ll get an insider view from Cure Forward and Imperial College Health Partners about some of the reasons behind failures they have experienced and what we can learn from them. And through 2 case studies, you’ll learn more about how transparent and accurate results and trials are integral to ongoing development and success.
Pre-Launch Planning: Priming Your Pharma Brand For Profit And Success (mini)Eularis
In today’s environment, Pharmaceutical companies find themselves in a bind. Until recently, if drugs made over $500 Million in annual revenue within 3 to 5 years of launch, they were considered hugely successful. They were a support to an extensive company portfolio and a component of greater company profit.
However, things have changed. The standards for a successful drug have become much higher and much more dangerous. With so many revenue-producing drugs going off patent, companies are facing large holes in their balance sheets and sales that are increasingly slow.
Plus, with the stakes high and available funds low, pipelines are drying up. Add to this the closer scrutiny of safety issues, the rise of Generics, slower physician acceptance and adoption of new therapies, and the Pharma Industry is in trouble.
More and more, companies are expecting marketers to be instrumental at the key moment of launch, and marketers are under extreme pressure. To deliver on the high hopes of Pharmaceutical brand launch, companies must engage in comprehensive pre-launch planning.
In this report we analyze why launch is increasingly important, the issues involved in pre-launch planning, including key organizational strategies, marketing tactics, regulatory considerations, global issues, and methods for ensuring the most effective plans.
Pharmaceutical Competitive Intelligence: An Essential Pill in the Pharmaceuti...RNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements.
Competitive Intelligence: An Essential Pill in the Pharmaceutical KitRNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements.
Competitive Intelligence: An Essential Pill in the Pharmaceutical KitRNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements. Source: https://www.wns.com/perspectives/articles/articledetail/123/competitive-intelligence-an-essential-pill-in-the-pharmaceutical-kit
Competitive Intelligence: An Essential Pill in the Pharmaceutical KitRNayak3
Discover how competitive intelligence in pharma generates insightful data highlighting the capabilities of pharma businesses to meet patient requirements.
when will pi network coin be available on crypto exchange.DOT TECH
There is no set date for when Pi coins will enter the market.
However, the developers are working hard to get them released as soon as possible.
Once they are available, users will be able to exchange other cryptocurrencies for Pi coins on designated exchanges.
But for now the only way to sell your pi coins is through verified pi vendor.
Here is the telegram contact of my personal pi vendor
@Pi_vendor_247
The secret way to sell pi coins effortlessly.DOT TECH
Well as we all know pi isn't launched yet. But you can still sell your pi coins effortlessly because some whales in China are interested in holding massive pi coins. And they are willing to pay good money for it. If you are interested in selling I will leave a contact for you. Just telegram this number below. I sold about 3000 pi coins to him and he paid me immediately.
Telegram: @Pi_vendor_247
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
Message: @Pi_vendor_247 on telegram if u want to sell PI COINS.
1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
Introduction to Indian Financial System ()Avanish Goel
The financial system of a country is an important tool for economic development of the country, as it helps in creation of wealth by linking savings with investments.
It facilitates the flow of funds form the households (savers) to business firms (investors) to aid in wealth creation and development of both the parties
how to sell pi coins in all Africa Countries.DOT TECH
Yes. You can sell your pi network for other cryptocurrencies like Bitcoin, usdt , Ethereum and other currencies And this is done easily with the help from a pi merchant.
What is a pi merchant ?
Since pi is not launched yet in any exchange. The only way you can sell right now is through merchants.
A verified Pi merchant is someone who buys pi network coins from miners and resell them to investors looking forward to hold massive quantities of pi coins before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
If you are looking for a pi coin investor. Then look no further because I have the right one he is a pi vendor (he buy and resell to whales in China). I met him on a crypto conference and ever since I and my friends have sold more than 10k pi coins to him And he bought all and still want more. I will drop his telegram handle below just send him a message.
@Pi_vendor_247
What website can I sell pi coins securely.DOT TECH
Currently there are no website or exchange that allow buying or selling of pi coins..
But you can still easily sell pi coins, by reselling it to exchanges/crypto whales interested in holding thousands of pi coins before the mainnet launch.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and resell to these crypto whales and holders of pi..
This is because pi network is not doing any pre-sale. The only way exchanges can get pi is by buying from miners and pi merchants stands in between the miners and the exchanges.
How can I sell my pi coins?
Selling pi coins is really easy, but first you need to migrate to mainnet wallet before you can do that. I will leave the telegram contact of my personal pi merchant to trade with.
Tele-gram.
@Pi_vendor_247
How to get verified on Coinbase Account?_.docxBuy bitget
t's important to note that buying verified Coinbase accounts is not recommended and may violate Coinbase's terms of service. Instead of searching to "buy verified Coinbase accounts," follow the proper steps to verify your own account to ensure compliance and security.
how to swap pi coins to foreign currency withdrawable.DOT TECH
As of my last update, Pi is still in the testing phase and is not tradable on any exchanges.
However, Pi Network has announced plans to launch its Testnet and Mainnet in the future, which may include listing Pi on exchanges.
The current method for selling pi coins involves exchanging them with a pi vendor who purchases pi coins for investment reasons.
If you want to sell your pi coins, reach out to a pi vendor and sell them to anyone looking to sell pi coins from any country around the globe.
Below is the contact information for my personal pi vendor.
Telegram: @Pi_vendor_247
where can I find a legit pi merchant onlineDOT TECH
Yes. This is very easy what you need is a recommendation from someone who has successfully traded pi coins before with a merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi network coins and resell them to Investors looking forward to hold thousands of pi coins before the open mainnet.
I will leave the telegram contact of my personal pi merchant to trade with
@Pi_vendor_247
US Economic Outlook - Being Decided - M Capital Group August 2021.pdfpchutichetpong
The U.S. economy is continuing its impressive recovery from the COVID-19 pandemic and not slowing down despite re-occurring bumps. The U.S. savings rate reached its highest ever recorded level at 34% in April 2020 and Americans seem ready to spend. The sectors that had been hurt the most by the pandemic specifically reduced consumer spending, like retail, leisure, hospitality, and travel, are now experiencing massive growth in revenue and job openings.
Could this growth lead to a “Roaring Twenties”? As quickly as the U.S. economy contracted, experiencing a 9.1% drop in economic output relative to the business cycle in Q2 2020, the largest in recorded history, it has rebounded beyond expectations. This surprising growth seems to be fueled by the U.S. government’s aggressive fiscal and monetary policies, and an increase in consumer spending as mobility restrictions are lifted. Unemployment rates between June 2020 and June 2021 decreased by 5.2%, while the demand for labor is increasing, coupled with increasing wages to incentivize Americans to rejoin the labor force. Schools and businesses are expected to fully reopen soon. In parallel, vaccination rates across the country and the world continue to rise, with full vaccination rates of 50% and 14.8% respectively.
However, it is not completely smooth sailing from here. According to M Capital Group, the main risks that threaten the continued growth of the U.S. economy are inflation, unsettled trade relations, and another wave of Covid-19 mutations that could shut down the world again. Have we learned from the past year of COVID-19 and adapted our economy accordingly?
“In order for the U.S. economy to continue growing, whether there is another wave or not, the U.S. needs to focus on diversifying supply chains, supporting business investment, and maintaining consumer spending,” says Grace Feeley, a research analyst at M Capital Group.
While the economic indicators are positive, the risks are coming closer to manifesting and threatening such growth. The new variants spreading throughout the world, Delta, Lambda, and Gamma, are vaccine-resistant and muddy the predictions made about the economy and health of the country. These variants bring back the feeling of uncertainty that has wreaked havoc not only on the stock market but the mindset of people around the world. MCG provides unique insight on how to mitigate these risks to possibly ensure a bright economic future.
how to sell pi coins effectively (from 50 - 100k pi)DOT TECH
Anywhere in the world, including Africa, America, and Europe, you can sell Pi Network Coins online and receive cash through online payment options.
Pi has not yet been launched on any exchange because we are currently using the confined Mainnet. The planned launch date for Pi is June 28, 2026.
Reselling to investors who want to hold until the mainnet launch in 2026 is currently the sole way to sell.
Consequently, right now. All you need to do is select the right pi network provider.
Who is a pi merchant?
An individual who buys coins from miners on the pi network and resells them to investors hoping to hang onto them until the mainnet is launched is known as a pi merchant.
debuts.
I'll provide you the Telegram username
@Pi_vendor_247
Poonawalla Fincorp and IndusInd Bank Introduce New Co-Branded Credit Cardnickysharmasucks
The unveiling of the IndusInd Bank Poonawalla Fincorp eLITE RuPay Platinum Credit Card marks a notable milestone in the Indian financial landscape, showcasing a successful partnership between two leading institutions, Poonawalla Fincorp and IndusInd Bank. This co-branded credit card not only offers users a plethora of benefits but also reflects a commitment to innovation and adaptation. With a focus on providing value-driven and customer-centric solutions, this launch represents more than just a new product—it signifies a step towards redefining the banking experience for millions. Promising convenience, rewards, and a touch of luxury in everyday financial transactions, this collaboration aims to cater to the evolving needs of customers and set new standards in the industry.
how to sell pi coins on Bitmart crypto exchangeDOT TECH
Yes. Pi network coins can be exchanged but not on bitmart exchange. Because pi network is still in the enclosed mainnet. The only way pioneers are able to trade pi coins is by reselling the pi coins to pi verified merchants.
A verified merchant is someone who buys pi network coins and resell it to exchanges looking forward to hold till mainnet launch.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
1. I N S I D E T H E M I N D S
Health Care Venture
Capital Best Practices
Top VCs and CEOs on Company Growth Plans,
Valuations, Exit Strategies, and
Raising Rounds of Capital
4. Inside the Minds – Published by Aspatore Books
Thought Leadership
In today’s marketplace, large cap health care companies that are looking to
expand their product line without diluting their earnings increasingly
depend on the acquisition of small, early-stage health care companies.
Venture capital (VC) investors continue to be attracted to funding early-
stage health care companies that share certain characteristics that enable
them to exit through initial public offerings (IPOs) or mergers and
acquisitions (M&As) most successfully, including the ability to develop a
unique and superior technology that is likely to have a significant clinical
impact, and/or products that offer a competitive edge in the marketplace.
However, VC investors need to keep in mind that the key to successful
investing in this area lies in knowing how much time and money a company
is likely to need to validate its business plan to the point where it can prove
valuable to another, larger company. Companies that can achieve that goal
are generally led by a management team that knows how to manage their
capital carefully, and are able to establish realistic development timelines
that enable them to hit benchmark characteristics needed to achieve
sufficient value creation—and a profitable exit.
Spotting Investment Opportunities
A look at recent exits in the medical device area of the health care industry
shows that several companies have recently been able to generate post-IPO
exit values of $225 million to $350 million on less than $50 million in sales.
The 1999 acquisition of Perclose Inc. by Abbott Laboratories for $680
million is a notable example of the way in which a medical device company
can maximize its value to achieve a profitable exit.
Perclose, which had approximately $50 million in sales, had developed a
unique suture technology that stood out in the marketplace. This
technology, which provided a novel method for closing a femoral access
wound, fundamentally challenged existing clinical thinking and standards of
care, leading to improvements in patient care, greater catheter lab efficiency,
and the creation of an entirely new market. In addition, the company ran a
5. Value Creation for Health Care Startups – By Richard M. Ferrari
highly efficient operation: during the seven years prior to its acquisition, it
raised $23 million in VC funding, as well as another $54.5 million from an
IPO and a follow-on offering. This means that after they did an initial
public offering, they went back to the public market for an additional
offering sometimes referred to as a secondary offering. Upon acquisition,
the company was able to generate an impressive twelvefold multiple of
sales.
More recently Kyphon acquired St. Francis Technologies, which offered a
novel device for treating back pain, for $700 million on $32 million in sales.
Medtronic then acquired Kyphon for $4 billion, which clearly proved its
clinical value, IP value, and franchise value.
Most health care companies that have been able to achieve similarly
successful exits have likewise been able to demonstrate their technology’s
clinical impact, franchise value, strategic need, and sustainability, as a result
of superior execution on their business plans. However, many companies
have also been able to maximize return on investment (ROI) for their early
VC investors (typically in scenarios where there was a relatively small initial
capital investment) by staging a lower-value, early-stage exit—i.e., before
demonstrating clinical impact, sales revenue, and sustainability. If it appears
that a larger health care firm that wants to expand its franchise in a certain
area is interested in an early-stage buyout deal, the management team and
directors of the target company may decide not to invest the capital or take
the time to clinically validate a technology, and pursue an early-stage,
acquisition exit instead.
Analyzing a Company’s Value Proposition: Franchise Value and
Strategic Need
The first time we sit down with a CEO to discuss a VC investment, the
number one question that I want to know the answer to is this: Where did
the idea for this company come from? Did you start the company based on
any prior work or study? I also need to know what clinical problem the
entrepreneur is trying to solve and why the company’s approach is unique
and novel.
6. Inside the Minds – Published by Aspatore Books
Additionally, I am very interested in the background of the CEO and his
team—how experienced they are, and where they have had prior successes.
De Novo focuses primarily on the clinical value of the technology. We
speak to many leading experts in the clinical area to determine whether the
technology or company we are evaluating truly is or has a technology that
would enhance clinical practice. We also spend a great deal of time
understanding the regulatory and clinical pathways that this technology or
company may need to take.
We evaluate the reimbursement strategy and dig into their intellectual
property—patents the company has filed. Finally, we develop an internal
model based on the company’s business plan to determine how many
additional rounds the company may need before either an IPO or an M&A
exit. We benchmark our internal model of future funding requirements,
pre- and post-values and exit values against our own personal experience,
our prior portfolio of like companies, and industry data relating to exits in
like areas.
The answers to these questions are significant because there are generally
two critical value drivers that we consider in any investment equation. The
first is franchise value. Franchise value pertains to whether a company’s
technology and the resulting clinical application are indeed novel and
superior. Companies with a high franchise value are usually the first to go to
market in a new category and are therefore able to establish a dominant
market presence through the creation of a new clinical franchise.
Companies with high franchise value have been CTS, Perclose, St. Francis
Technologies, and Kyphon.
The second big value driver is strategic need, which may not be viewed in
the same way by an acquirer as it is by the entrepreneur. Establishing
strategic need generally depends on a company’s ability to create a
competitive edge, typically through establishing a strong patent portfolio or
some other means of preventing others in the marketplace from acquiring
your intellectual property (IP). In some cases, a company’s strategic need is
enhanced by its ability to broaden an acquirer’s product line or increase the
efficiency of its sales force. In many cases, the value that is placed on a
7. Value Creation for Health Care Startups – By Richard M. Ferrari
technology, and the company behind that technology, is based on the fact
that the acquirer plans to use it as a way to protect and preserve its own
core businesses.
However, high premiums are rarely placed on strategic need alone. Most
frequently, a company must demonstrate a strong combination of clinical
impact and franchise value, along with strategic need, to generate significant
value at exit.
Execution and Sustainability
Two other factors are crucial to maximizing the value needed for a
company to achieve a successful exit in this industry area—execution and
sustainability.
Execution, which relates to a company’s organizational focus, is critical to
the development of an early-stage company. A poorly run organization
often wastes precious time and money—for example, a management team
fails to correctly assess the time needed for the company to reach its key
clinical and commercial milestones.
The key milestones a company must focus on and achieve to some extent
depend on the round of investment; for example, in a Series A deal, which
is generally a company very early in its development history, the key
milestones may be the proof of principle determination/method of action
proof of the company’s specific technology, safety in an animal model, or
initial prototypes based on proof of principle, and filing of their initial
intellectual property. In a later-stage financing, the key milestones may be
the achievement of the first-in-man studies or second-in-man studies
targeted at showing clinical efficacy. Other critical milestones would be the
filing of a 510(k) and approval; approval of a pivotal trial, completion of a
clinical trial, filing a PMA (Premarket Approval) to the FDA (U.S. Food
and Drug Administration), a design freeze of the product pending
regulatory approval, and initial sales.
8. Inside the Minds – Published by Aspatore Books
These startups cannot afford to waste money and miss those windows of
opportunity. Markets change; reimbursement could be altered, transforming
a novel technology into a commodity; a newer technology could enter the
market. It is important that all startups understand that markets change and
new competitors enter the market. They need to take advantage of these
windows to achieve the next round of funding at a higher value. Companies
that refuse to alter direction when needed typically miss their milestones
and come close to running out of cash.
VCs and potential acquirers also place a good deal of value on a company’s
ability to achieve sustainable, predictable sales of its technology. Simply put,
buyers want to know whether they will be able to generate long-lasting
profits by acquiring a company and its technology. Profit sustainability is
generally made possible by a large market, significant clinical impact, and
the ability to establish or bolster a franchise. Successful time and money
management is essential to sustainability; indeed, it is almost impossible to
maximize returns without adequate funding that can give a company
sufficient time to demonstrate clinical impact, franchise value, and
sustainability.
Early-stage Valuation Strategies
The most interesting fact regarding valuation-setting strategies is that there
is no real science to deriving Series A pre-money value. Rather, there are
certain rules of thumb that many VCs use that revolve around percentage
of ownership, based on their initial investment. For example, most venture
capitalists want to own a minimum of 30 percent to 50 percent of the target
company if they are the only Series A investor; if a syndicate is created, then
each syndicate player—or at least the lead or co-lead—will target ownership
in the neighborhood of 25 percent each.
Many of the top VCs, especially those firms where the partners themselves
have extensive operating experience, have a very good understanding of
how much money will initially be required to fund a target company to an
important value creation milestone, such as completion of the initial
prototype and proof of principle in a valid animal model. Furthermore, the
9. Value Creation for Health Care Startups – By Richard M. Ferrari
top VCs who have actually been CEOs themselves will generally have a
very good command of the amount of additional capital that will be
required in future funding rounds; and in most cases, they know what the
pre and posts should be, based on history, experience, and current trends in
the IPO and M&A markets.
Pre and posts relate to the pre-money value of the company prior to the
venture capital round; it is the value the venture community has placed on
the company. The post-money value is the value of the company
immediately after the venture capital round is completed. For example,
Company A in a Series A financing may have a pre-money value of $5
million raising $5 million; therefore, the post-money of Series A would be
$10 million.
Based on that knowledge, financial models can generally be developed that
provide at least a basis for what the Series A pre-money should be; and that
analysis, coupled with industry statistics on pre and post rounds, sets the
boundaries around the initial valuation price. The keys to setting value for
an early stage company generally include the answers to the following
questions:
• How unique are the technology and the clinical problem that the
company is solving?
• How much risk have they already removed—i.e., do they have a
prototype, or have they determined the method of action with initial
bench and animal tests? Method of action refers to understanding
whether the technology the company is developing has scientific proof
with respect to how it works and its response in a biological system,
generally animals first.
• How experienced is the team?
• What is their intellectual property position? IP is one of the critical due
diligence areas and one of the value drivers for a company. Medical
device and bio-tech investing places a great deal of value on the
protection of the technology. This protection comes from the filing and
receiving of the patents covering the company’s products and science.
10. Inside the Minds – Published by Aspatore Books
• What is the regulatory path—510(k) or PMA? In medical devices there
are two paths a company’s technology can be categorized into—a
510(k) or a PMA. The 510(k) path for FDA approval is a much simpler
path and is generally assigned to products that are not deemed overly
complex with respect to the clinical claims the company is making.
Generally, a 510(k) does not require randomized clinical trials for
approval, since other products on the market can serve a predicates. A
510(k) approval can usually be received in three months. In contrast a
PMA, Premarket Approval, is a more rigorous regulatory path,
generally requiring a randomized clinical trial with specific criteria and
efficacy claims with respect to the technology. A PMA is usually a two-
year process to gain approval. An NDA, New Drug Approval, is a
biotech path and is as complex as the PMA in the sense that a
randomized clinical trial must be completed, with the results from that
trial passing certain efficacy thresholds. (You may want to research the
FDA approval process for more details.)
Valuation Trends
Historically, valuations for the health care industry have been, for the most
part, relatively stable, especially for Series A funding rounds. However,
there have been several instances over the last seven years where later
private funding rounds have had higher than normal pre- and post-money
values placed on them, especially when the IPO market was more forgiving
with respect to the metrics required to go public. Such cases typically
involved pre-revenue companies in large markets.
Indeed, in the last three years, hedge fund managers and other private
equity players who have witnessed this more forgiving IPO market have bid
up values, since they are focused on the short-term gain of a potential
multiple of one or two times, or a 50 percent to 100 percent increase in
IPO value, which is quite different from the venture capital returns
targeting a minimum of three to five times their investment.
If you look at the data provided below, there are some real criteria with
respect to private companies that recently went public by using the public
11. Value Creation for Health Care Startups – By Richard M. Ferrari
markets as a financing strategy. The data shows three distinct groups of
companies, and the values placed on those companies post-IPO.
Valuation Tools and Models
Our VC firm believes that the best valuation tools and models are those
that our investors have developed over time, based on experience. For
example, we generally develop our own valuation criteria and financial
model to triangulate on the proper pre-money valuation and the correct
amount of cash that will be required to hit specific value-creation
milestones.
We typically start out by attempting to understand the market size and
opportunity for the target company’s specific product. We then evaluate the
uniqueness of that product within a specific clinical category. We also value
companies and their potential for success based on how much prior bench
and pre-clinical work has been accomplished to date in order to reduce the
ongoing risk of development. Essentially, we are interested in the proof of
principle beyond the technology. For example, a medical device is being
developed for the treatment of obesity that uses the concept of
neurostimulation. Proof of principle is the process of building a prototype
stimulator that when attached to certain areas of the stomach in an animal
trial produce weight loss in the animals, proving the method of stimulation
has the desired effect.
We also evaluate the amount of capital that will be required to bring the
technology to its full market launch, which incorporates to a large extent
the regulatory path that is required—either a 510(k) or a PMA. The 510(k)
regulatory path for most medical devices requires little if any major clinical
trial work. In stark contrast, a PMA clinical path is generally quite expensive
and comprehensive with respect to the nature of the clinical trial; generally,
such trials not only must be randomized, but they also require enough
positively impacted patients to show true clinical impact/efficacy.
Once we have determined the amount of time and capital needed to
achieve FDA approval for a company’s technology, we model the cost
12. Inside the Minds – Published by Aspatore Books
required to launch a product, including the selling price; costs associated
with manufacturing; and the product launch itself, including the revenue
ramp and time required to reach the break-even point. Once we thoroughly
understand the amount of capital and time required to reach a point where
the company can become a profitable, growing business, we can then use
market databases and experience to determine a reasonable exit value on
the company—i.e., an M&A event or an IPO.
Once we have the full picture—essentially the best approximation of full
capital requirements and time to exit—we can then determine a fair pre-
money valuation at almost any point in time with respect to the company’s
progress and history.
Timing the Exit
Benchmarking a company’s progress against the key success factors for a
company in this industry—clinical impact, franchise value, strategic need,
execution, and sustainability—is both a good measure of performance and a
useful management tool to help determine when to exit and at what price.
For example, even a company with a groundbreaking technology may exit
too early if its investors become overly concerned about its progress with
respect to certain milestones without fully understanding its technology’s
future potential and impact. In such a scenario, the company may wind up
exiting before hitting those inflection points where significantly higher
values could be created. A top management team that is able to clearly
articulate its requirements with respect to development time, as well as the
money needed to hit its development targets, is typically able to have its exit
runway extended to the proper inflection point and receive the funding it
needs to get there.
Indeed, in most cases, a company’s VC investors must be convinced that
extending the company’s time to exit will help it achieve a higher exit value.
Therefore, a management team must be able to demonstrate that their
product will ultimately have clinical value; that their market is large,
growing, and underserved; and that significant value-creation milestones
13. Value Creation for Health Care Startups – By Richard M. Ferrari
can be achieved over the next few years. If they cannot make a convincing
argument in those respects, they are unlikely to get their exit runway
extended—and will likely be forced to accept a lower-value, early-stage exit.
Exit Market Trends
Entrepreneurs and VCs alike in today’s health care marketplace are
increasingly concerned that the amount of money typically required to
achieve an exit in this industry has greatly increased over the past several
years because of current market conditions and trends. As the IPO market
has dried up, the requirements for going public largely depend on a
company’s ability to demonstrate a solid revenue stream based on
widespread marketplace adoption of its technology, and sustainable growth.
The timelines required to achieve this goal have also become much shorter.
The importance of solid execution on the part of the management team,
while always critical, has therefore become even greater. This trend began in
2000, after the Internet bubble. Today the IPO market has opened up
again; however, companies that achieve the best value at IP and post-IPO
are companies with revenue momentum.
Years ago, the surging IPO market provided many medical device
companies with enough early-stage funding to prove their models
successfully prior to exit. However, achieving the type of exit values that
most VCs are looking for these days requires much more careful planning
because the requirements for entering the public markets have become
much more stringent. Although the amount of cash required varies, since
much depends on the clinical area, the complexity of the product, and
general market conditions, it generally runs about $40 million to $100
million of invested capital.
At the same time, there are far fewer likely acquirers for early-stage
companies. The large-cap companies generally do not want to acquire an
early-stage company, since most of the early-stage companies and
technologies still require a lot of capital to finish the product and begin
generating revenue. If a large- or mid-cap company acquires an early-stage
company that still needs a lot of R&D investment, it affects their earnings
14. Inside the Minds – Published by Aspatore Books
per share (EPS) and net income. Most public large caps and mid caps want
companies that don’t impact their bottom line but can quickly add to their
revenue stream, making a management’s team ability to successfully manage
its capital and execute on its business plan increasingly important.
As for IPO versus M&A exits today, I think most venture investors would
agree that an M&A transaction would be better, assuming the value was the
same and the M&A transaction did not have any unusual back-end or earn-
out payments.
Successful Exits
Most companies that are able to achieve successful M&A exits have both
venture funding and public money. They also have solid cash positions that
enable them to run efficient operations—and avoid accepting a lower-
quality exit deal just to stay in business.
We have found that the average amount of revenue needed to achieve a
premium exit in today’s market is around $30 million to $40 million; and
those exits are typically achieved within a four- to seven-year timeframe.
Lower-value exits typically involve companies that have raised no more
than $11 million and wish to make their exit within just two to four years,
before achieving true value in terms of clinical impact and sustainability.
Simply put, companies that achieve more successful, higher-value exits are
those that have more cash and use it more effectively. They also use their
time more wisely—in most cases, poor management leads to poor
execution and direction. However, the right investors and the right
management team can typically control and prevent that outcome. Indeed,
even those companies with technologies that require complicated clinical
trials and complex FDA regulatory strategies, if well-managed, can achieve
successful exits in this industry.
15. Value Creation for Health Care Startups – By Richard M. Ferrari
Management Team Mistakes to Avoid
For a company to achieve the value levels that will allow it to exit most
profitably, it must perform successfully during its early stages of
development—which is the main reason VCs put so much emphasis on the
quality of the management team when determining whether to invest in an
early-stage health care company.
Fortunately, execution is highly controllable; an experienced management
team knows how to organize its business plan around key issues. The key
issues depend on the company’s strategy and stage, but in medical devices,
some of the key issues would be the completion of the fist-in-man cases
using the company’s technology, final design freeze on the product, filing a
510(k), completion of any clinical cases necessary to receive CE Mark
(European approval), initiation of a clinical trial, completion of a clinical
trial and submission of the PMA, and the initial pilot launch of the product.
The experienced management team plans around these key issues to
prevent such critical mistakes as program misdirection and lack of focus
with respect to development strategies. At the same time, a good
management team knows how to change direction based on new
information. New information can be many things—for example, after
initial bench models were built and bench tests completed on how the
device works, the first animal tests were done where the product did not
perform at all like the bench tests, and the new information from the animal
tests helps the engineers come up with a better design, more adapted to a
real biological system. In another example, a design for a medical device is
built, but after running it through the required engineering fatigue tests, the
material used in the product was simply not robust enough and requires a
new material with much better fatigue characteristics. The speed at which
engineering teams and management teams react to this new information is
critical to get the program back on track.
Indeed, well-run, properly managed startups are generally able to get
through the hard times that most new companies experience, simply
because they are able to re-evaluate their business model and redirect their
16. Inside the Minds – Published by Aspatore Books
engineering efforts, as required, to keep their technology development
program on track for commercialization. Such companies also know how to
stay focused to solve any problems that may arise in the product
development process; as a result, they are generally able to achieve a launch
date within a three- to four-year timeframe. The number one distraction
occurs when the team is working on too many simultaneous projects
without dedicating enough manpower and focus on the primary project.
Conversely, a management team that insists on sticking with an
unsuccessful technology or market, refusing to alter its development
approach even when all evidence indicates it should do so, will often wind
up consuming too much of its capital before coming to the realization that
its business model, technology—or even the team itself—is not what it
should be. At that point, the team may attempt to make changes in its
direction, redesign its technology, or revamp its leadership lineup; however,
by then it is often too late to change course successfully. Only those
companies that are capable of executing on their value-creation milestones
with a two- to four-year timeframe are generally able to make efficient use
of their funding, and achieve maximum value at exit.
Timeframe and achieving the key milestones are critical because venture
capitalists generally fund a company with just enough cash to reach certain
key milestones. If these milestones are missed, the timeframe expected to
hit them becomes much longer, and since every month of delay consumes
cash, the company can run out of money before it hits the key milestones
that were agreed to. Most VCs would continue to add cash generally
through an additional round, but because the milestones were not met, the
value placed on the company for that next round would most likely be a
“down round,” which means the value placed on the company from the
prior round will be lowered to accommodate for the miss and added risk.
Future Trends
One trend in venture capital health care is certain: the population of the
world is growing older and faster than at any other point in mankind’s
history. This means the demand for new medical devices and drugs will
17. Value Creation for Health Care Startups – By Richard M. Ferrari
continue to be very robust. Also, since life expectancy is on the rise and
people are living longer, new problems arise that twenty years ago were not
issues because people had already. The breakthroughs in material sciences,
stem cell research, MIMS, and new biologics are enabling medical devices
and biopharma to advance, and at an incredible rate.
Also I believe that products in the future will be much more individualized
to the patient, and the combination of new materials, MIMS devices for
sensoring biologic change, and having that information wireless-transmitted
to not only the indwelling medical device, but also the doctor, will create
great advances in medicine and patient care.
Achieving a Good Investment Track Record
To achieve the best investment track record, you invest in the best
management teams with the best technology that is solving fundamental
medical problems. This is a simple statement, but it is certainly not easily
achieved.
As a venture capitalist, you must develop an approach to evaluating and
investing in new areas. Much of the business and decisions to invest or not
is more about art than science. What I mean is that after many years as an
investor, you develop a feel for a good investment, which is based on many
years of seeing which companies and investments were successful and why.
You must develop a discipline and use your experience to develop a
template for success that at least helps sort out which investments to make
and which to pass on.
Venture capital is a long-range business model in the sense that it generally
takes six to eight years or more for an investment in a company to mature
to a point where a successful exit can be achieved at the multiple you
recognize and your firm is targeting as acceptable. As a Venture capitalist,
you cannot follow fads or trends that seem in vogue; you must stay
grounded in what you know works—technology addressing real needs in
the medical field.
18. Inside the Minds – Published by Aspatore Books
The most challenging aspect is sorting out and discerning a good
investment. Top venture capitalists may see as many as two hundred to
three hundred new ideas and companies a year, and they will fund only
eight to ten.
Advice for Entrepreneurs and VCs
For the entrepreneurs, the most important aspect of attracting VC
money is to ensure that you have a well thought-out rationale behind the
clinical problem you are trying to solve and that the technology you plan
to develop is in fact novel and protectable. All too often smart engineers
and MBS students have an idea that is not validated clinically—
essentially, it is wonderful technology looking for a clinical problem,
rather than starting with the clinical problem and working with doctors
to determine through the development of technology how that clinical
problem could be solved.
For the venture capitalists, my advice is to remember that health care
investing is a long-range game and that investing in early-stage companies
requires patience. Even with the best teams, unforeseen problems arise, and
the VC must remain supportive and not over-react. I would also encourage
VCs to thoroughly understand the development milestones a company
needs to hit and match the investment to the milestones.
19. Value Creation for Health Care Startups – By Richard M. Ferrari
Richard M. Ferrari has been a successful CEO of several medical technology companies,
both prior to and after co-founding De Novo in 2000. Following De Novo’s investment
in CryoVascular Systems, Mr. Ferrari became CEO, growing the initial five-person
startup team to a company of twenty employees. He was instrumental in developing the
clinical and product strategies and hiring the executive team.
In 2002, Mr. Ferrari led Paracor Medical, another De Novo portfolio company. He
grew the company from four to twenty-two employees, refined the product strategy, raised
its Series B financing, and hired his replacement CEO. Prior to co-founding De Novo
Ventures, he was the co-founder and CEO of CardioThoracic Systems (CTSI), a
company he led to an initial public offering in only seven months in 1996. CTSI, the
market leader in disposable instruments and systems for performing minimally invasive
beating-heart bypass surgery, was ultimately acquired by Guidant Corporation in
November 1999. Before that, Rich was the CEO of Cardiovascular Imaging Systems
(CVIS). As CEO, he orchestrated a successful IPO and ultimately sold the company to
Boston Scientific Corporation in 1995.
In addition, Mr. Ferrari founded Saratoga Ventures in 1996, a venture capital
partnership that has provided seed financing to startup medical technology companies,
including Atrionix, Oratec, Enteric Medical, Trivascular, and Endotex. At Saratoga,
he was chairman of Oratec, which was sold in 2001 to Smith & Nephew PLC.
Mr. Ferrari also co-founded the Medical Technology Group, which spun out Integrated
Vascular Systems, an early-stage femoral artery closure company that was sold to Abbott
and Angiosense, a needle-free, jet-injection, local drug delivery company.
Early in his career, Mr. Ferrari held the position of executive vice president and general
manager of ADAC Laboratories.
Mr. Ferrari sits on the boards of BenVenue, CardioMind, MyoScience, Ovalis, Paracor
Medical, Pulmonx, Simpirica, Spinal Kinetics and Spinal Modulation. His prior board
involvement includes TriVascular.
Mr. Ferrari holds a BS degree from Ashland University and an MBA from the
University of South Florida.
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