Transcription
Scott Huennekens 0:05
Thank you, Henry. Yeah, that's kind of a nice way of saying you've got four older guys with over 30 years of experience in the medical device industry. So we can talk about, you know, the internet crash and late 90s. You want to talk about that? Or 911? Or, 08-09 crisis, COVID crisis, post COVID crisis, we got it all covered up here. But no, it's a great panel. And we figured we'd jump into questions versus go through detail of our background. But what you have here is, you know, three entrepreneurs, who have over 30 years of experience each, I think, collectively, hundreds of millions of dollars of seed to be financing between myself and Todd, and Michel is entrepreneurs, and then, you know, billions of dollars really, and capital raised through IPOs, and exits, as well through all those tumultuous 30 years that we we mentioned, and then a Assaf, a great investor out of Israel and has a perspective, you know, having also invested through a number of those, those cycles. And so I'd like to just maybe jump right in with questions. And we really want to just have an open dialogue. And if there, if there's questions, as we get a little further in, we'll we'll ask for participation as as well. So guys, you know, how do you perceive the environment? Is it as bad as kind of Henry laid out? Was I right, that there have been worse times? You know, is it different between Israel? Europe, US, we got a little geographic distribution here, as well. So Assaf, how do you assess the environment today?
Assaf Barnea 1:41
Not just in Israel, I think globally, we all been facing. Not just difficult times, I think the atmosphere the dynamic, you know, it's not just the specific parameters of the economy or the rebate, the interest. It's a totally different ballgame. And in that sense, I think, you know, we we've been seeing, we're doing Sanada, we're doing both seed, A, and B rounds investment. By the way, in digital Health's medical devices and bow convergence technologies we're having now 24 portfolio companies, and most of them are looking for funding, most of them are looking for capital. Now it is different, we may touch about it, it's different to do a seed stage, A round, B round, then growth capital or private equity capital. Nonetheless, the atmosphere in the dynamic is totally different. And it's hard to get I mean, every $10 million $20 million was so hard to get.
Scott Huennekens 2:32
But you say a different game. It's a different it's a different game from a historical 30 year game are different than the last five?
Assaf Barnea 2:39
No, it's a cyclical nature. I think we all been there. It's a cyclical nature, we know that. But nonetheless, you know, when it happens, we still we have Sonova still see companies every now and then come to us, you know, with no revenues. Maybe they got an FDA with 40-$50 million pre money valuation, this, this will not fly anymore, this will not fly anymore, right. And this is this is when I'm saying it's a different ballgame. In some cases, the mindset, this should be a paradigm shift, both from the management team, the intrapreneurs, as to the acknowledgement, that these are different types. And when if there's a need to go to a downbound doesn't need to go to a downline with all the right outcomes and consequences. But I think it will be another quarter or two before they all capture that, you know, valuations eventually will go down, it will be those who still have capital from 2021. They are okay somehow. But nonetheless, in the VC side, you know, typically raised for two years. And if you're not accumulating enough capital, you don't have enough resources, non dilutive no credit line, whatever it may be. Companies will stumble into difficulties, and they need to act now, immediately now, not to wait for the next quarter or two.
Scott Huennekens 3:47
about from your perspective, you're on a number of startup boards. Plus you're running a public company, but you came from active which raise money through the chair, this last tumultuous cycle, how do you assess things?
Todd Usen 3:58
So I look at it. I mean, we heard money was easy to get five years ago, thing COVID hit and it was really hard. And I think the best companies raised money. And today, the best companies are going to raise money. I think it's yeah, it's tough cycle. But I think it's great. It's level setting. It's not just free anymore, because someone has a robot, we're just gonna give him money and you know, or someone had outcomes matter. Leadership matters teams matter. And I actually think it's there won't be a great company that doesn't survive this. There's going to be a lot of average companies or average leadership teams that that won't survive us. But I think it's a great time because I look at it as you have LPS that give you money to invest not to put in your bank. That's you have to go find great companies and put that money to work and so I think it's a great challenge for the team. Yes, you have to manage money really carefully and your burn rate, but I don't look at it as a down thing. I just look at it as the cream rises, it's find out how good you are. So be selfish and I'm either good or I stink. I'm gonna find out real fast.
Scott Huennekens 5:02
Michel, you're on a number of digital companies here in Europe, startups earlier stage you also chairman of public companies on public boards, but more of a Euro European centric view any anything different that you see? And you've been involved?
Michel Lussier 5:22
Yeah, exactly
Scott Huennekens 5:22
here with, with global medical device growth companies.
Michel Lussier 5:25
So it's, I think, building a bit on what what Todd was was sharing with the group. These are rough, but very interesting times. I think some of us with gray hair, I've seen those those cycles. And I think, this time, not unlike the previous cycles, it's back to basic economics. And back to fundamentals. Did that point, for example, in digital health, not so long ago, VCs were giving money, and not only not regarding so much of time to profitability, time to be cash, creative, it was known all about land, grab and grow your market, geographic expansion, and so on. And don't worry about that, you know, you'll raise the hundreds of millions and 2 3 5 years. Well, now VCs are more prudent, there's money, but they're more good and so so perfect execution under promise over deliver and have a clear unmet need. And and try to shorten your time to profitability. I think those companies will succeed in, in raising money in good conditions. But it's it's not easy at the moment.
Scott Huennekens 6:40
Yeah, what you guys have all kind of mentioned this theme about back to normal or back to basics and good companies. Given the your experiences through these cycles, we've got a lot of first time CEOs here who've raised some money, likely here because they're raising want to raise more money. What advice are you giving those those people in your portfolio?
Assaf Barnea 7:04
Think just relating and acknowledging what we'll just say that back to basic, I would say back to question marks. Honestly, we've been working with excellent explanation marks for you know, the last few years, putting deploying capital and thinking, you know, growth is sacred, and all of those cliches to some extent, which are rightfully so been put. But these times, I think we need to go back to question marks as to, you know, specifically early stage companies, what is the right use cases? In some cases, we see a core technology is a fascinating core technologies that can adapt and that and that, is it the low hanging fruit? Is it something else? What justifies a scalable, sustainable, and scalable business model? Like sometimes when I'm talking about the business model, the crucial specifically, by the way, we shared in terms of digital health companies, this is not medical devices, companies where you have, you know, kind of a routine, it's tough, but still, in digital health, everything is about a business model, despite whatever the best technologies that you may have the best technologies, but it's the business model that defines that. And then it has to be scalable, scalable, sustainable, like a Superman, like the three S's and
What are the three S's again? Let's make sure they get that
First of all sellable, like, I've been seeing dozens of technologies, which are not saleable, the intrapreneurs, they fall in love with that technology, but it's not a product. And definitely, it's not a saleable, it will look into the use
Scott Huennekens 8:28
Has to have a product market fit or it's a product models in a problem.
Assaf Barnea 8:31
Exactly, exactly. Those are the basics. Those are the basic, but nonetheless, even if you do you have a team, the executive team, the board, we need to ask yourself in these times, again, and again, these are the question marks that I was referring to, is this the right business model? Could this be scalable, in such a way that it will be attractive enough for VCs to step in, in these specific times? Because it's always a matter of opportunities. And I think as to distinguish those times from, you know, from two years ago, those are the question mark that we should look into, and not to be afraid to, you know, to do some pivots, kind of a thinking or to explore other ways. Otherwise, you know, in some cases that have saved so many companies the ability to stop looking to reality as ease and say, Could we make enough money out of this? Should this be the first product with there'll be a reimbursement in that, and maybe take a company to pivot the company to something else? What, what, spin off or whatever, but those are the time to do so.
Todd Usen 9:30
You know, I think about what would your question of as a first time, CEO or entrepreneur, one of the things to think about is I think it's not that different than if you're running a big company. One thing you should always be asking your team is how would I sell against me right now on our device? So if you're a first time entrepreneur and I'm coming to an investor, what problem are you solving? Do you have a solution searching for a problem? Because you fell in love with your technology? Or is there a real problem out there that you have a solution for, and they're willing to pay for it. And there's a real market for it and the market opportunity. And I think that's the same thing you always so I would go into it, you don't have to first time entrepreneur, what's the market conditions, what's the problem that I'm solving that my product will make a difference, there's no other option, or the options available, don't deliver. And here is our business model. If it's digital, whether it's a subscription, whether it's whatever that's going to be, and be brief, the whole story of well, in five years, we're going to get our FDA clearance, we're running these clinical trials. And that's really important in biotech and different things, because it's different. But with medtech, I just get to the point, demonstrate you have great team leadership, you also make sure that you're balanced. If you're a commercial leader, make sure you have technical expertise on your team. If you're a physician or an engineer with technical expertise, make sure you have commercial leadership on your team that knows how to operationalize because that's very difficult to think, well, I know how good this product is, because I've been a surgeon for 10 years. It's that's not doesn't do a thing for the business market and investors will see right through that.
Michel Lussier 11:16
Yeah, great, great points. And, you know, if if I look at ourselves, so many early stage companies survive and thrive by reinventing themselves, yeah.
Scott Huennekens 11:29
You know, you're changing, right?
Michel Lussier 11:31
You're thrown out the door to come back by by the window. And and that's particularly true today for CEOs is be ready to reinvent yourself. In digital health, you may have to change your business model, but be proactive. And and, and maybe for the investors on the board, and so on. Trust your management, and don't don't put too much pressure, but that they should focus on execution, but also have the courage to reinvent themselves, the business models will going to change are going to change and in digital health because of the economics of the environment. Yeah,
Scott Huennekens 12:10
I think this is a point I would really emphasize it that I've found here over the last few years, is that a lot of times as a first time CEO, you've you've gone out and raised money based upon a vision, you're going to do this, then you get feedback that it's not this probably should be that and then I encourage them change, you need to change the financing strategy as the product change changes is fine. They're like, but I promised to do this. And this is failure, no failure to not change is the problem. All venture capitalist wants is return on their capital. I mean, it's pretty much that simple. So if there's a better option, let's pursue it. So, you know, like at volcano, Michelle, and I were going to be a vulnerable Black Company, we do our big thermography, you know, clinical study, the data is terrible. I go to the VCs and say, Hey, you want your $30 million back? No, we want you to change and figure something out. And, you know, we went and figured something completely different out using some of the technology in a different area. Same thing at Digiret, we basically failed to develop a solid state gamma camera for for all of nuclear medicine, we had to take a different technology to create it for nuclear cardiology was a complete restart. But we created a, a different model. And I find that I'm, I'm keep like just with anchoring with with value, a lot of times people anchor to their idea. And so any any thoughts on how to coach and help some of these CEOs, whether it's anchoring to valuation and changing their financing strategy, anchoring to anchoring to a strategy and willingness to change? And is it true that you just want to return? Not? You know, no, no, I mean, we're
Assaf Barnea 13:56
very proactive. We're very proactive with our companies. I hope not not to be too much of a threat, so called. But one thing that I think it's came to me in the last two years, this is an analogy we've been using, I mean, everybody's using it the Valley of Death. This is not just one, typically, to do a video of the past, you know, before we get revenues, and then you don't have enough, you still need to have external funding. But there are valleys of that. And this is like a three dimensional play, if you will, all of the sudden, you may stumble into lack of being able to get your reimbursement on time your clinical data is not enough. Even if you have like two or three providers hospital that you know, bought the technology or went through a you know, a validation process. This This does not yet rings, a justified business model. So there's, it's like a game that you need to play in any given moment, multiple dimension of the valleys of deaths, who might be as a threat, and to consider again and again and again the assessment while progressing with companies. Just to illustrate we have one In our companies, which is on a device side, medical device company called leaders, which is doing small blood vessels anastomosis for microsurgery, we have two strategics investing one from the US one from Asia. You know, we've been thinking that instead of instead of a long, long switching process, this will be a plug and play device that cuts down from one hour to maybe five minutes, when a child cuts his hands or whatever it may be. But this it's a matter of time is it does it then you ask the question, the question mark, is it saving time will there be more procedures will the physicians use it, the surgeon would its turn surgeons might into microsurgery because you have to have a specialist capabilities and expertise doing that. So all of those bits and bytes with cancer patients, for instance, when they potentially in other when they have your blood vessels potentially collapsing because of certain therapeutic procedures and others, those are questions that should be asked. And then eventually, when you surface them, you can truly truly come up with something which is quite robust as to that, as you said, or this is this is a true market need those redundant when we say but it's a true hardcore market need that someone is willing to pay for that. And it you need to bring a lot of questions before you are able to address that and validate it properly.
Michel Lussier 16:19
I think without going to pragmatic or tactical, you know, so many early stage companies now they're struggling to raise their money. So where did they go to they go to with one bridge to bridge? Well, you live on on bridges. And, and therefore in terms of business model and coming back to realities. Few years ago, it would be off in 2028-2030, we'll have 100,000 patients out of our digital health platform, and don't worry about profitability there. Well, no, no longer I believe today. So how about Google Drake go to a more monopolistic niche? How about not maybe 100,000 or 5000 10,000? How can you get 2 3 4 5 million revenue, a creative and and basically how to get ahead of the curve again, because as soon as you reach a lower cash burn profitability, basically, you regain control of your company, because then raising money becomes an opportunity based on a project standpoint, not so much an obligation to survive for the company, it's easier said than done to get ahead of the curve. But I think that's why being careful and under promise over deliver to do use the old adage,
Todd Usen 17:42
and it's not your it's not a founder, entrepreneur. The second you get funding, it's not your company anymore. You're now the leader, that the investors need you to lead the company. And if you can do that, that's great. But the thought is my company I know what we're doing. I know what's right. If you're asking for funding, you can't have both feelings because you have to be willing to change so you don't if you have that feeling this is my baby, this is my company, you should believe that as a leader anyway. But you have to be willing to because it's not your company anymore.
Scott Huennekens 18:16
So I think all the companies we built companies you've you've financed and helped build we've we've all used various financing sources, government programs and funding strategics debt, VCs strategic partners off selling, can you tell, like I found in the last periods were capitals so easier freer flowing, you don't have to explore those seven or eight other things. Can you give examples or ideas you know how you've used alternative sources to help get you through periods of time get to milestones get to value inflection, before you raise conventional venture?
Michel Lussier 18:58
Well, I started a number of companies in Belgium and Belgium is one of the programs were on both sides of the linguistic barrier the governments have been really partners and in investing either via non dilutive funding or as well as diluted funding but with a another different scope. Quebec is the same thing with ABC small Quebec. So I think it's all of the above. And but I think selecting the right partner remains important. You know, if you're struggling for money, you tend to take the money wherever it comes from, but but the strategic alliance you know, and aligning on the mission remains important so or it'll free mind or other other approaches, I think are very valuable sources of non dilutive funding.
Todd Usen 19:53
I mean, obviously, early stage NIH funding and different things like that. But I think even even local subsidies and to run your business not always going to be cash in the door, but you can save a lot of money if you take advantage of people facilities and, and are subsidized to certain by staying in a certain town a certain area. Geographically I think those are those are options. So it's not just always the the dollars and cents that you have to think about in this case to try to fund your company. Because the longer you keep it alive, if you save money, too, you're also funding it in downtimes, in addition to the cash that comes in, and the one thing I would bring up in a great time, I remember when I was starting to raise money, I had a group of VCs, they're wonderful partners, but they told me it's a sign of weakness if you use a bank to help you raise money. So if it right, but the way I look No, that I look at it right now that I'm what's my objective? I need money. Okay, I'm gonna figure out how I'm going to get money? I don't you know, so if someone's going to help me bring more people to the table? I'm going to do that. So I just think we have to be open to take advice from everybody. But at the end of the day, what is your objection? Objective? What do you need? And how else can you go get it, I'm not saying go run to the banks, but use all your options. And especially in this environment.
Assaf Barnea 21:13
What we typically do and advise companies is to map initially map the landscape of investments, like those kind of seven, eight verticals, as you mentioned. And then you know, try to identify more. First of all, I think these times strategics are becoming much more important. It may take longer, there may be a different due diligence, they may have different sets of requirements for such a such product in order to be able to invest in it, but it's even if we're looking to the angels arena now, you know, say that we would have had like, I don't know, 200 300 of those in Israel, just investing in medical devices, now they are gone the vanish. Nonetheless, if this is like let it be a FinTech company, one of our companies is a FinTech, I've been telling them you know, go to gynecologist for those who made some kind of money, they will relate to them, they will be willing, if you're trying to raise five raise now one and a half, like interim round you safe mechanism, do whatever means that you need to, but in terms of who to approach is you need to approach those who truly understand. So they did not, you know, they did not vanish for good, those investors, the angel investors, but if you're trying to approach you know, plastic surgeons in one cases, or others, try to make it as a niche specifically, and niche to be synergistic with the product that you're developing. And it could be any other area oncology or whatever it may be. But those would be one meaning to more willing to support the company. Because there's an attachment over there. It's like the strategics on a different layout. strategics, you know, will be investing. So at least in my eyes, companies should be able to and will, would be doing wisely. So if they would approach more strategic partners now these days for funding, rather than to look for, you know, VCs, the typical VCs is a typical process. These are not the typical,
Scott Huennekens 23:04
Speaking of strategics, every every deal I've done as a CEO has had strategic investors, whether it's GE or j&j, Boston, Medtronic, etc. And I often get the question, yeah Philips, you know, should I take strategic money? Should I not? What should be the conditions of when I do or or don't any thoughts or advice? Because I think they are great partners, you got to protect certain things, you know, first right of refusal, you know, most of the time certain instances, you might, you don't want to give up distribution, certain instance, you might or a particular geography, but any, any thoughts that you guys have that worked well, for you?
Todd Usen 23:46
Yeah, I think, you know, I came to the when I was raising money, I came from a different perspective, because I came from after I was the president of Olympus, and the President of Smith and Nephew. So I was offered a take strategic money, great partners, wonderful people. But I also realized that timing it, you know, then the advice was maybe not an n/a round, because you're going to scare off everybody else that if you ever want to be sold. But again, you know, I've always played if you don't you don't
Assaf Barnea 24:14
Even if there's no strings attached.
Todd Usen 24:17
Yeah, well, that is yes. But the thought is, I don't want to, I don't think it should be building a company or at least communicating that to sell it. You building a company for it to be bought, or to grow, it is a very different way you run the company. So if it's strategic, I think it can give you some cachet. You know, if you get them early, because it demonstrates as probably a product market fit, which is the number one thing we need to prove, because they know the market better than every one of us, because they've been out there, right and doing it and selling it and have had success. So but I think the timing is when if you don't need them early, I would say wait, and they get a little more anxious and get more they want to get in earlier but if you can push them off a little I think that's the best. But if the I don't think there's a downside to bring in the right ones in early. earlier. Yeah, absolutely. Yeah.
Scott Huennekens 25:03
I sense that you didn't want them early because it might scare people off. Yeah that doesn't happen in my experience.
Todd Usen 25:09
Right. It scared people that were never worked for one before.
Scott Huennekens 25:13
Okay. Gotcha. It didn't mean Yeah. You're
Todd Usen 25:17
off other visa. Yeah, yes. Yeah,
Scott Huennekens 25:19
I found that
Todd Usen 25:20
It was other strategics that I was saying what scare off and other strategic so I'm coming into to buy you later on. If this if this strategic was on your cap table. That's what I meant. So not other VCs scared off from investing, I think it usually might be a nice thing, because they realize, like I said, there's a product market fit, you got Phillips on your cap table.
Scott Huennekens 25:36
My advice, take my money and live to fight another day.
Todd Usen 25:39
Yeah, you got that problem in the feed. That's my point. I agree.
Michel Lussier 25:42
With the caveat, though. And I agree, you know, Scott and I were a bit from the same mold here. So we've done it successfully. But what I've also seen is early stage seed money, early stage, founders on upon looking at one of the big strategic knocking at their door, and then they got giving the jewels of the family prematurely. So I think coaching of the entrepreneur to do it right, and be very careful of what you're getting into. Once you pass that and you have a modus operandi with too many, not too many strings attached, go for it, because those people will bring so much expertise on on on on the board. And they may or may not eventually acquire your company, but in the process, it will establish your credibility as well. So
Scott Huennekens 26:30
I'm okay. Any more quick thought? I think, you know, Todd, you you said it's a quote that a lot of people use you don't, you know, sell companies, companies are bought, elaborate on that a little more. Do we all agree with that general concept.
Todd Usen 26:43
I, you know, I'm in a unique position. And even in a publicly traded company, I'm following someone that was brilliant at selling technologies and forgot more than I'll ever know, he really had a great career. It just didn't happen at this company, because it was being built to sell. You focus on different things investors know you focus on different things, I believe you lose all your leverage, if you start running around saying, we're going to do this. And in these I've seen decks, you know, investor deck, say and I expect these three or four companies will be the right buyers. For us. That's just my opinion. Again, that's silly to put on your deck. Because it just shows that you're focused on one thing, and you're looking to get a main focus on building the company. And then if you're ready to be bought, even if you can't wait to be bought, be bought, don't focus on selling. And I think it's a better way to run a business and you'll run the business, in my opinion, smarter, you'll focus on costs, you'll focus on efficiency, you'll focus on cogs, you won't just focus on getting a product in the market and proving that everyone wants to use
Scott Huennekens 27:48
Target it, then yeah, you're building something to buy. You're building something that's available and exactly in the long run, and someone comes along during that process, which sure happens, because there's only so many.
Todd Usen 28:00
It's happened to you guys. I mean, it's just my opinion, but I believe that's one of the most passionate things about being and I can't say it as clean as you I just say entrepreneur, I don't say entrepreneurial. So it's, but I, I absolutely believe, even
Scott Huennekens 28:17
if you're going to take away from this panel, I'm gonna go back to the US and yeah, and say entrepreneurs,
Todd Usen 28:22
If you just tell people you're looking to sell your company, I actually think you've lost all your leverage today, you say that, every bit of it.
Assaf Barnea 28:29
But it's to building up the companies this is this is the perfect time when you know, when we do come when we come up typically now and saying or protecting our investment, you know, towards LPS or whatever saying, you know, wait, and don't wait or whatever, but you do need to deploy your capital. But it is a good time, or maybe one of the best times to really build the company in terms of then again, from my perspective, with early stage companies seed, A, sometimes in some cases, B rounds. This is the layers that should be brought into the board position into the advisory board position executives with expertise like you guys, you know, the entrapreneurs and they need you guys, they need you guys to be part of the board part of the advisory board, you know, there's so much value in terms of the build up of the company. It's not just the product product and the product market fit internally, they should be looked and see what are the components, the ingredients and create those assets after assets. In one of our companies we brought you know, if homology space, we brought some of the best words of the ophthalamologist, and then another executive from San Diego and another one from on the neurovascular. One of a different company on the vascular side, we brought some executives from the US to be part of it. It's always a matter of time because in some cases, you know KOLs would not come if the company is premature. If you don't have enough data, you know, they don't want to risk their reputation, but there will be a point of time for those intrapreneurs of yours that you know when you get To a certain stage when you're mature enough, and this is up to your discretion to define when try and bring those as early as you can, there's a tremendous value also in fundraising, but in the in the processes in the buildup internally built up, and not just just the product market fit.
Scott Huennekens 30:15
So what what are they? We've been focusing a lot about financing, and the the kind of tumultuous time we're in. But one of the topics that came up over and over when we were meeting beforehand was, you know, we've all been in this industry for over 30 years. And we're more excited now than we ever been in our career for the plethora of opportunities that are possible because of everything that's going on with technology and innovation, from computing power to AI to cloud to sensors that and I can name 30 Things that are, you know, computational biology and all that, you know, proteomics, genomics, it just, there's so many incredible things to create new products as well as service models. Here I, touch on that I want to leave with some optimism says, well, because we optimist, you know, we were all excited about the next five years and great companies and solutions that we're going to come well,
Michel Lussier 31:10
if I may, I think I'd have kind of two suggestions of of message or messages, a message to entrepreneur CEOs, but also to board is go for it. It's a great time COVID In the digital health. So many countries in Europe have gained 10 years in terms of psychological adoption of digital health therapies. And it's only the beginning to take advantage of that. Now, to the management I'd say, you know, under promise over deliver execution, execution, cogs, accountability, now, maybe to the VCs investors, the older investors or larger funds, maybe have weathered the storms over the years, they've seen those cycles, so that they know it's a cycle. But maybe for the younger, smaller funds or younger VCs. Don't put too much pressure on on the management. I think what the management needs right now is tough love. Meaning Yes, tough, because the CEOs CFOs have to focus on execution. But at the same time, love because putting too much pressure, panicking may just lead to you know burnouts and things like that, or just, you know, CEOs taking the wrong decisions is not in the best interests of the company. So I think we need to be take a distance here and look at this in the bigger picture,
Scott Huennekens 32:50
Kind of final thoughts Todd or, I think stuff like advice, time.
Todd Usen 32:55
I really think it's a great time to be in the med tech space. And I say that because if you believe your company is the company, and you have that technology, you're going to be funded, and you're gonna go out there and produce and you'll find out. And if you don't, and you think there's things we need go great, great people, there's so much talent in this space. People always win more than technology, people and technology never lose. But people win first, you got to get the right people on a team. And if you do that, and you believe in the people, your board included the people that are surrounding you, and your investors, I believe it's a great time and be open to change. Europe's doing everything in its power to not want medical devices in the in the on the continent, because of MDR is and all of this, but you know what? Okay, if yes, I get it, I have to fund an extra 150,000 or 200,000 as a small company. But I actually know that there's this many people here, and it's going to deliver $10 million over the next X years. But you got to do it smart. So I got to take from another place to maybe do this. But I find that people just keep pushing things off. Don't don't do that investment in Europe, and rumor has it there's patients in Europe, so we should probably treat them. Right if we can, let's get there faster than later. But I honestly I really believe in technology. And I personally believe that funds have money to invest, but they're only going to invest if you and your story are right. And if you don't believe in yourself, we're probably in the wrong space and you shouldn't be running a company. Right, but I think it's an awesome time to be in this business. Alright, Rob, what's
Scott Huennekens 34:31
up? It's off very,
Assaf Barnea 34:31
very quickly, but a different approach. I like it totally what just mentioned, but it's, at least in my eyes is the convergence. Yeah. Never in my life. Did I see something like that? I mean, maybe not 30 years, but maybe 20 years in the industry, that there's an amazing, beautiful convergence of people, technologies, companies, you know, paradigm shift in business models, you know, instead of sick care, we're moving to health care prevention prediction. Instead of you know, I'm In all of the sudden we see value based medicine, AI comes into play, even what we invest in and strongly supported by the Israeli government that the innovation authority, the bio convergence, biology and physics, biology in engineering. I mean, it brings in, it brings it all together into this is what I'm saying. Also, it's a different ballgame. Also, in that sense, there's so many integration of technologies and people and concept. This is why it's a it's an amazing game to play at this time. And I fully support that. We just need to be careful and what I'm repeatedly saying, we need to listen, truly, listen, listen to the market, truly listen to the market and adopt and change what is needed.
Scott Huennekens 35:39
Alrighty, well, thank you guys. We appreciate your time and great panel, and hopefully, you're leaving with some optimism and excitement because as we established at the beginning, we're the older group, and we're going to need your devices and your solutions here pretty quickly. Thank you enjoy the ride.
Scott is a successful Medtech CEO, Chairperson, board member, entrepreneur, and investor, having been involved in one of those roles in 20+ startup, growth and public companies with market valuations that have totaled over $20b and more importantly over 20 million patients that have benefited from the therapies & diagnostics of these companies, including 8 IPOs. Current professional affiliations include Principal Front Foot Ventures, Executive Chairperson Hyperfine (HYPR) IPO 2021, Chairperson Acutus Medical (AFIB) IPO 2020, Chairperson Envista (NVST) IPO 2019, Board Member Nuvasive (NUVA), Exec Chairperson & Invester Elucid, Exec Chairperson & Investor Wondr Medical, Chairperson of the Board & Investor Kardion, Board member & Investor, Q’apel Medical, Board member & Investor Proximie, Board member & Investor Foldax, Board Member Veranex Solutions, Advisor & Investor Genesis Healthcare, Advisor & Investor Cortica, advisor Brightinsight, Board Member & past Chairperson Medical Device Manufacturer’s Association (MDMA), and advisor to Peloton Equity, 8VC, River Cities Capital and Accelmed Equity. He completed his role as Pres & CEO of Verb Surgical in early 2019. Verb was Google & J&J’s Surgical Robotics and Digital Surgery platform start-up to revolutionize the future of surgery which J&J acquired in 2019. Previously, Scott led Volcano Corp. (VOLC), a leader in minimally invasive therapy guidance in interventional cardiology, as its first & only Pres & CEO, from start-up in 2002 to its IPO in 2006 and sale to Philips in 2015. Volcano 2014 revenue was > $400 million and its market capitalization peaked at nearly $2B. Prior to this, he was at Digirad Corp, a coronary imaging solutions provider, from 1997 to 2002, as President & CEO. Digirad went public in 2004 (DRAD). He graduated Magna Cum Laude with a BS in Bus Admin from the Univ. of Southern California in 1986 and earned his MBA from the Harvard Business School in 1991. Past affiliations include 12 other public and or VC funded medtech and biotech company boards of which 9 have had significant exits, including Chairperson of Endochoice (GI, IPO 2015, acquired by Boston Scientific), Chairperson Sonendo (SONX IPO 2021), board member Vicarious Surgical (RBOT IPO 2021), board/CEO advisor Digital Surgery/Touch Surgery (Acquired by Medtronic). Scott has also been awarded E&Y’s entrepreneur of the year award in 2010 & was recognized by Goldman Sachs in 2016, 2017, & 2018 as one of the 100 most intriguing entrepreneurs at its annual Builders & Innovators conference.
Scott is a successful Medtech CEO, Chairperson, board member, entrepreneur, and investor, having been involved in one of those roles in 20+ startup, growth and public companies with market valuations that have totaled over $20b and more importantly over 20 million patients that have benefited from the therapies & diagnostics of these companies, including 8 IPOs. Current professional affiliations include Principal Front Foot Ventures, Executive Chairperson Hyperfine (HYPR) IPO 2021, Chairperson Acutus Medical (AFIB) IPO 2020, Chairperson Envista (NVST) IPO 2019, Board Member Nuvasive (NUVA), Exec Chairperson & Invester Elucid, Exec Chairperson & Investor Wondr Medical, Chairperson of the Board & Investor Kardion, Board member & Investor, Q’apel Medical, Board member & Investor Proximie, Board member & Investor Foldax, Board Member Veranex Solutions, Advisor & Investor Genesis Healthcare, Advisor & Investor Cortica, advisor Brightinsight, Board Member & past Chairperson Medical Device Manufacturer’s Association (MDMA), and advisor to Peloton Equity, 8VC, River Cities Capital and Accelmed Equity. He completed his role as Pres & CEO of Verb Surgical in early 2019. Verb was Google & J&J’s Surgical Robotics and Digital Surgery platform start-up to revolutionize the future of surgery which J&J acquired in 2019. Previously, Scott led Volcano Corp. (VOLC), a leader in minimally invasive therapy guidance in interventional cardiology, as its first & only Pres & CEO, from start-up in 2002 to its IPO in 2006 and sale to Philips in 2015. Volcano 2014 revenue was > $400 million and its market capitalization peaked at nearly $2B. Prior to this, he was at Digirad Corp, a coronary imaging solutions provider, from 1997 to 2002, as President & CEO. Digirad went public in 2004 (DRAD). He graduated Magna Cum Laude with a BS in Bus Admin from the Univ. of Southern California in 1986 and earned his MBA from the Harvard Business School in 1991. Past affiliations include 12 other public and or VC funded medtech and biotech company boards of which 9 have had significant exits, including Chairperson of Endochoice (GI, IPO 2015, acquired by Boston Scientific), Chairperson Sonendo (SONX IPO 2021), board member Vicarious Surgical (RBOT IPO 2021), board/CEO advisor Digital Surgery/Touch Surgery (Acquired by Medtronic). Scott has also been awarded E&Y’s entrepreneur of the year award in 2010 & was recognized by Goldman Sachs in 2016, 2017, & 2018 as one of the 100 most intriguing entrepreneurs at its annual Builders & Innovators conference.
Mr. Assaf Barnea is a seasoned entrepreneur and venture professional, with extensive, multidisciplinary
experience in building innovation platforms and leading investments & commercialization processes in healthcare and life science related technologies. He leads, since its inception in 2014, Sanara Ventures, a healthcare innovation fund, backed by Phillips and Teva investing in digital health, medical devices & Bio-Convergence technologies. He is also the Founder & Managing Partner of Sanara Capital, a follow up fund of Sanara Ventures, that focuses on A&B rounds investments in healthcare related technologies.
Parallel to his role at Sanara, Mr. Barnea Chairs also the Life Science Advisory Board at the Israel Export Institute, on behalf of the Israeli government, promoting and advancing the export of Israeli technologies in the medical, biotech, pharma and digital fields in global markets. Previously, Mr. Barnea was also advising the World Bank’s IFC venture capital team and is a co-founder of the IFC’s Tech Emerge program; a unique acceleration platform that connects healthcare startups from around the world with leading corporations and hospitals in emerging economies. In 2018, Tech Emerge Health has won the world bank group president’s award for innovation.
For over a decade, Mr. Barnea was a BOD & co-founder of CardioSense, a medtech startup company.
Assaf served as CEO of Kinrot Ventures, spearheading its acquisition by Hutchison Water in 2012. Prior to this, he headed business development at Mekorot, Israel’s national water company, where he oversaw the establishment of WaTech, the Entrepreneurship & Partnership Center for Water Technologies. For his role and accomplishments in both Mekorot and Kinrot, he received the Cleantech Group’s Innovation Hero Award in 2013 (see video below).
Previously, Mr. Barnea served as a director of business development at Comverse, where he also co-chaired the Mobile Marketing Association.
A unique highlight in Assaf’s story is his former stint as a college basketball player at New Jersey’s Seton Hall University, where he won the Big East championship against Georgetown in 1991. Assaf holds LLB and Business degrees from the Interdisciplinary Center in Herzelia, a BA in political science and psychology (with honor) from Tel-Aviv University.
Mr. Assaf Barnea is a seasoned entrepreneur and venture professional, with extensive, multidisciplinary
experience in building innovation platforms and leading investments & commercialization processes in healthcare and life science related technologies. He leads, since its inception in 2014, Sanara Ventures, a healthcare innovation fund, backed by Phillips and Teva investing in digital health, medical devices & Bio-Convergence technologies. He is also the Founder & Managing Partner of Sanara Capital, a follow up fund of Sanara Ventures, that focuses on A&B rounds investments in healthcare related technologies.
Parallel to his role at Sanara, Mr. Barnea Chairs also the Life Science Advisory Board at the Israel Export Institute, on behalf of the Israeli government, promoting and advancing the export of Israeli technologies in the medical, biotech, pharma and digital fields in global markets. Previously, Mr. Barnea was also advising the World Bank’s IFC venture capital team and is a co-founder of the IFC’s Tech Emerge program; a unique acceleration platform that connects healthcare startups from around the world with leading corporations and hospitals in emerging economies. In 2018, Tech Emerge Health has won the world bank group president’s award for innovation.
For over a decade, Mr. Barnea was a BOD & co-founder of CardioSense, a medtech startup company.
Assaf served as CEO of Kinrot Ventures, spearheading its acquisition by Hutchison Water in 2012. Prior to this, he headed business development at Mekorot, Israel’s national water company, where he oversaw the establishment of WaTech, the Entrepreneurship & Partnership Center for Water Technologies. For his role and accomplishments in both Mekorot and Kinrot, he received the Cleantech Group’s Innovation Hero Award in 2013 (see video below).
Previously, Mr. Barnea served as a director of business development at Comverse, where he also co-chaired the Mobile Marketing Association.
A unique highlight in Assaf’s story is his former stint as a college basketball player at New Jersey’s Seton Hall University, where he won the Big East championship against Georgetown in 1991. Assaf holds LLB and Business degrees from the Interdisciplinary Center in Herzelia, a BA in political science and psychology (with honor) from Tel-Aviv University.
Currently the President and Chief Executive Officer of Minerva Surgical, a commercial-stage medical technology company focused on developing, manufacturing, and commercializing minimally invasive solutions to meet the distinct uterine healthcare needs of women.
Executive leader skilled in building, restructuring and growing commercial and operational organizations in both top and bottom line. Responsible for developing and directing both short- and long-term strategic vision, product development, logistics, distribution, go-to market strategy, and M&A activities. Management development advocate. Experience managing multi-billion-dollar P&L's. Current board director of Alesi Surgical, Mass Medical and Surgical Disruptive Technology Summit.
Currently the President and Chief Executive Officer of Minerva Surgical, a commercial-stage medical technology company focused on developing, manufacturing, and commercializing minimally invasive solutions to meet the distinct uterine healthcare needs of women.
Executive leader skilled in building, restructuring and growing commercial and operational organizations in both top and bottom line. Responsible for developing and directing both short- and long-term strategic vision, product development, logistics, distribution, go-to market strategy, and M&A activities. Management development advocate. Experience managing multi-billion-dollar P&L's. Current board director of Alesi Surgical, Mass Medical and Surgical Disruptive Technology Summit.
Transcription
Scott Huennekens 0:05
Thank you, Henry. Yeah, that's kind of a nice way of saying you've got four older guys with over 30 years of experience in the medical device industry. So we can talk about, you know, the internet crash and late 90s. You want to talk about that? Or 911? Or, 08-09 crisis, COVID crisis, post COVID crisis, we got it all covered up here. But no, it's a great panel. And we figured we'd jump into questions versus go through detail of our background. But what you have here is, you know, three entrepreneurs, who have over 30 years of experience each, I think, collectively, hundreds of millions of dollars of seed to be financing between myself and Todd, and Michel is entrepreneurs, and then, you know, billions of dollars really, and capital raised through IPOs, and exits, as well through all those tumultuous 30 years that we we mentioned, and then a Assaf, a great investor out of Israel and has a perspective, you know, having also invested through a number of those, those cycles. And so I'd like to just maybe jump right in with questions. And we really want to just have an open dialogue. And if there, if there's questions, as we get a little further in, we'll we'll ask for participation as as well. So guys, you know, how do you perceive the environment? Is it as bad as kind of Henry laid out? Was I right, that there have been worse times? You know, is it different between Israel? Europe, US, we got a little geographic distribution here, as well. So Assaf, how do you assess the environment today?
Assaf Barnea 1:41
Not just in Israel, I think globally, we all been facing. Not just difficult times, I think the atmosphere the dynamic, you know, it's not just the specific parameters of the economy or the rebate, the interest. It's a totally different ballgame. And in that sense, I think, you know, we we've been seeing, we're doing Sanada, we're doing both seed, A, and B rounds investment. By the way, in digital Health's medical devices and bow convergence technologies we're having now 24 portfolio companies, and most of them are looking for funding, most of them are looking for capital. Now it is different, we may touch about it, it's different to do a seed stage, A round, B round, then growth capital or private equity capital. Nonetheless, the atmosphere in the dynamic is totally different. And it's hard to get I mean, every $10 million $20 million was so hard to get.
Scott Huennekens 2:32
But you say a different game. It's a different it's a different game from a historical 30 year game are different than the last five?
Assaf Barnea 2:39
No, it's a cyclical nature. I think we all been there. It's a cyclical nature, we know that. But nonetheless, you know, when it happens, we still we have Sonova still see companies every now and then come to us, you know, with no revenues. Maybe they got an FDA with 40-$50 million pre money valuation, this, this will not fly anymore, this will not fly anymore, right. And this is this is when I'm saying it's a different ballgame. In some cases, the mindset, this should be a paradigm shift, both from the management team, the intrapreneurs, as to the acknowledgement, that these are different types. And when if there's a need to go to a downbound doesn't need to go to a downline with all the right outcomes and consequences. But I think it will be another quarter or two before they all capture that, you know, valuations eventually will go down, it will be those who still have capital from 2021. They are okay somehow. But nonetheless, in the VC side, you know, typically raised for two years. And if you're not accumulating enough capital, you don't have enough resources, non dilutive no credit line, whatever it may be. Companies will stumble into difficulties, and they need to act now, immediately now, not to wait for the next quarter or two.
Scott Huennekens 3:47
about from your perspective, you're on a number of startup boards. Plus you're running a public company, but you came from active which raise money through the chair, this last tumultuous cycle, how do you assess things?
Todd Usen 3:58
So I look at it. I mean, we heard money was easy to get five years ago, thing COVID hit and it was really hard. And I think the best companies raised money. And today, the best companies are going to raise money. I think it's yeah, it's tough cycle. But I think it's great. It's level setting. It's not just free anymore, because someone has a robot, we're just gonna give him money and you know, or someone had outcomes matter. Leadership matters teams matter. And I actually think it's there won't be a great company that doesn't survive this. There's going to be a lot of average companies or average leadership teams that that won't survive us. But I think it's a great time because I look at it as you have LPS that give you money to invest not to put in your bank. That's you have to go find great companies and put that money to work and so I think it's a great challenge for the team. Yes, you have to manage money really carefully and your burn rate, but I don't look at it as a down thing. I just look at it as the cream rises, it's find out how good you are. So be selfish and I'm either good or I stink. I'm gonna find out real fast.
Scott Huennekens 5:02
Michel, you're on a number of digital companies here in Europe, startups earlier stage you also chairman of public companies on public boards, but more of a Euro European centric view any anything different that you see? And you've been involved?
Michel Lussier 5:22
Yeah, exactly
Scott Huennekens 5:22
here with, with global medical device growth companies.
Michel Lussier 5:25
So it's, I think, building a bit on what what Todd was was sharing with the group. These are rough, but very interesting times. I think some of us with gray hair, I've seen those those cycles. And I think, this time, not unlike the previous cycles, it's back to basic economics. And back to fundamentals. Did that point, for example, in digital health, not so long ago, VCs were giving money, and not only not regarding so much of time to profitability, time to be cash, creative, it was known all about land, grab and grow your market, geographic expansion, and so on. And don't worry about that, you know, you'll raise the hundreds of millions and 2 3 5 years. Well, now VCs are more prudent, there's money, but they're more good and so so perfect execution under promise over deliver and have a clear unmet need. And and try to shorten your time to profitability. I think those companies will succeed in, in raising money in good conditions. But it's it's not easy at the moment.
Scott Huennekens 6:40
Yeah, what you guys have all kind of mentioned this theme about back to normal or back to basics and good companies. Given the your experiences through these cycles, we've got a lot of first time CEOs here who've raised some money, likely here because they're raising want to raise more money. What advice are you giving those those people in your portfolio?
Assaf Barnea 7:04
Think just relating and acknowledging what we'll just say that back to basic, I would say back to question marks. Honestly, we've been working with excellent explanation marks for you know, the last few years, putting deploying capital and thinking, you know, growth is sacred, and all of those cliches to some extent, which are rightfully so been put. But these times, I think we need to go back to question marks as to, you know, specifically early stage companies, what is the right use cases? In some cases, we see a core technology is a fascinating core technologies that can adapt and that and that, is it the low hanging fruit? Is it something else? What justifies a scalable, sustainable, and scalable business model? Like sometimes when I'm talking about the business model, the crucial specifically, by the way, we shared in terms of digital health companies, this is not medical devices, companies where you have, you know, kind of a routine, it's tough, but still, in digital health, everything is about a business model, despite whatever the best technologies that you may have the best technologies, but it's the business model that defines that. And then it has to be scalable, scalable, sustainable, like a Superman, like the three S's and
What are the three S's again? Let's make sure they get that
First of all sellable, like, I've been seeing dozens of technologies, which are not saleable, the intrapreneurs, they fall in love with that technology, but it's not a product. And definitely, it's not a saleable, it will look into the use
Scott Huennekens 8:28
Has to have a product market fit or it's a product models in a problem.
Assaf Barnea 8:31
Exactly, exactly. Those are the basics. Those are the basic, but nonetheless, even if you do you have a team, the executive team, the board, we need to ask yourself in these times, again, and again, these are the question marks that I was referring to, is this the right business model? Could this be scalable, in such a way that it will be attractive enough for VCs to step in, in these specific times? Because it's always a matter of opportunities. And I think as to distinguish those times from, you know, from two years ago, those are the question mark that we should look into, and not to be afraid to, you know, to do some pivots, kind of a thinking or to explore other ways. Otherwise, you know, in some cases that have saved so many companies the ability to stop looking to reality as ease and say, Could we make enough money out of this? Should this be the first product with there'll be a reimbursement in that, and maybe take a company to pivot the company to something else? What, what, spin off or whatever, but those are the time to do so.
Todd Usen 9:30
You know, I think about what would your question of as a first time, CEO or entrepreneur, one of the things to think about is I think it's not that different than if you're running a big company. One thing you should always be asking your team is how would I sell against me right now on our device? So if you're a first time entrepreneur and I'm coming to an investor, what problem are you solving? Do you have a solution searching for a problem? Because you fell in love with your technology? Or is there a real problem out there that you have a solution for, and they're willing to pay for it. And there's a real market for it and the market opportunity. And I think that's the same thing you always so I would go into it, you don't have to first time entrepreneur, what's the market conditions, what's the problem that I'm solving that my product will make a difference, there's no other option, or the options available, don't deliver. And here is our business model. If it's digital, whether it's a subscription, whether it's whatever that's going to be, and be brief, the whole story of well, in five years, we're going to get our FDA clearance, we're running these clinical trials. And that's really important in biotech and different things, because it's different. But with medtech, I just get to the point, demonstrate you have great team leadership, you also make sure that you're balanced. If you're a commercial leader, make sure you have technical expertise on your team. If you're a physician or an engineer with technical expertise, make sure you have commercial leadership on your team that knows how to operationalize because that's very difficult to think, well, I know how good this product is, because I've been a surgeon for 10 years. It's that's not doesn't do a thing for the business market and investors will see right through that.
Michel Lussier 11:16
Yeah, great, great points. And, you know, if if I look at ourselves, so many early stage companies survive and thrive by reinventing themselves, yeah.
Scott Huennekens 11:29
You know, you're changing, right?
Michel Lussier 11:31
You're thrown out the door to come back by by the window. And and that's particularly true today for CEOs is be ready to reinvent yourself. In digital health, you may have to change your business model, but be proactive. And and, and maybe for the investors on the board, and so on. Trust your management, and don't don't put too much pressure, but that they should focus on execution, but also have the courage to reinvent themselves, the business models will going to change are going to change and in digital health because of the economics of the environment. Yeah,
Scott Huennekens 12:10
I think this is a point I would really emphasize it that I've found here over the last few years, is that a lot of times as a first time CEO, you've you've gone out and raised money based upon a vision, you're going to do this, then you get feedback that it's not this probably should be that and then I encourage them change, you need to change the financing strategy as the product change changes is fine. They're like, but I promised to do this. And this is failure, no failure to not change is the problem. All venture capitalist wants is return on their capital. I mean, it's pretty much that simple. So if there's a better option, let's pursue it. So, you know, like at volcano, Michelle, and I were going to be a vulnerable Black Company, we do our big thermography, you know, clinical study, the data is terrible. I go to the VCs and say, Hey, you want your $30 million back? No, we want you to change and figure something out. And, you know, we went and figured something completely different out using some of the technology in a different area. Same thing at Digiret, we basically failed to develop a solid state gamma camera for for all of nuclear medicine, we had to take a different technology to create it for nuclear cardiology was a complete restart. But we created a, a different model. And I find that I'm, I'm keep like just with anchoring with with value, a lot of times people anchor to their idea. And so any any thoughts on how to coach and help some of these CEOs, whether it's anchoring to valuation and changing their financing strategy, anchoring to anchoring to a strategy and willingness to change? And is it true that you just want to return? Not? You know, no, no, I mean, we're
Assaf Barnea 13:56
very proactive. We're very proactive with our companies. I hope not not to be too much of a threat, so called. But one thing that I think it's came to me in the last two years, this is an analogy we've been using, I mean, everybody's using it the Valley of Death. This is not just one, typically, to do a video of the past, you know, before we get revenues, and then you don't have enough, you still need to have external funding. But there are valleys of that. And this is like a three dimensional play, if you will, all of the sudden, you may stumble into lack of being able to get your reimbursement on time your clinical data is not enough. Even if you have like two or three providers hospital that you know, bought the technology or went through a you know, a validation process. This This does not yet rings, a justified business model. So there's, it's like a game that you need to play in any given moment, multiple dimension of the valleys of deaths, who might be as a threat, and to consider again and again and again the assessment while progressing with companies. Just to illustrate we have one In our companies, which is on a device side, medical device company called leaders, which is doing small blood vessels anastomosis for microsurgery, we have two strategics investing one from the US one from Asia. You know, we've been thinking that instead of instead of a long, long switching process, this will be a plug and play device that cuts down from one hour to maybe five minutes, when a child cuts his hands or whatever it may be. But this it's a matter of time is it does it then you ask the question, the question mark, is it saving time will there be more procedures will the physicians use it, the surgeon would its turn surgeons might into microsurgery because you have to have a specialist capabilities and expertise doing that. So all of those bits and bytes with cancer patients, for instance, when they potentially in other when they have your blood vessels potentially collapsing because of certain therapeutic procedures and others, those are questions that should be asked. And then eventually, when you surface them, you can truly truly come up with something which is quite robust as to that, as you said, or this is this is a true market need those redundant when we say but it's a true hardcore market need that someone is willing to pay for that. And it you need to bring a lot of questions before you are able to address that and validate it properly.
Michel Lussier 16:19
I think without going to pragmatic or tactical, you know, so many early stage companies now they're struggling to raise their money. So where did they go to they go to with one bridge to bridge? Well, you live on on bridges. And, and therefore in terms of business model and coming back to realities. Few years ago, it would be off in 2028-2030, we'll have 100,000 patients out of our digital health platform, and don't worry about profitability there. Well, no, no longer I believe today. So how about Google Drake go to a more monopolistic niche? How about not maybe 100,000 or 5000 10,000? How can you get 2 3 4 5 million revenue, a creative and and basically how to get ahead of the curve again, because as soon as you reach a lower cash burn profitability, basically, you regain control of your company, because then raising money becomes an opportunity based on a project standpoint, not so much an obligation to survive for the company, it's easier said than done to get ahead of the curve. But I think that's why being careful and under promise over deliver to do use the old adage,
Todd Usen 17:42
and it's not your it's not a founder, entrepreneur. The second you get funding, it's not your company anymore. You're now the leader, that the investors need you to lead the company. And if you can do that, that's great. But the thought is my company I know what we're doing. I know what's right. If you're asking for funding, you can't have both feelings because you have to be willing to change so you don't if you have that feeling this is my baby, this is my company, you should believe that as a leader anyway. But you have to be willing to because it's not your company anymore.
Scott Huennekens 18:16
So I think all the companies we built companies you've you've financed and helped build we've we've all used various financing sources, government programs and funding strategics debt, VCs strategic partners off selling, can you tell, like I found in the last periods were capitals so easier freer flowing, you don't have to explore those seven or eight other things. Can you give examples or ideas you know how you've used alternative sources to help get you through periods of time get to milestones get to value inflection, before you raise conventional venture?
Michel Lussier 18:58
Well, I started a number of companies in Belgium and Belgium is one of the programs were on both sides of the linguistic barrier the governments have been really partners and in investing either via non dilutive funding or as well as diluted funding but with a another different scope. Quebec is the same thing with ABC small Quebec. So I think it's all of the above. And but I think selecting the right partner remains important. You know, if you're struggling for money, you tend to take the money wherever it comes from, but but the strategic alliance you know, and aligning on the mission remains important so or it'll free mind or other other approaches, I think are very valuable sources of non dilutive funding.
Todd Usen 19:53
I mean, obviously, early stage NIH funding and different things like that. But I think even even local subsidies and to run your business not always going to be cash in the door, but you can save a lot of money if you take advantage of people facilities and, and are subsidized to certain by staying in a certain town a certain area. Geographically I think those are those are options. So it's not just always the the dollars and cents that you have to think about in this case to try to fund your company. Because the longer you keep it alive, if you save money, too, you're also funding it in downtimes, in addition to the cash that comes in, and the one thing I would bring up in a great time, I remember when I was starting to raise money, I had a group of VCs, they're wonderful partners, but they told me it's a sign of weakness if you use a bank to help you raise money. So if it right, but the way I look No, that I look at it right now that I'm what's my objective? I need money. Okay, I'm gonna figure out how I'm going to get money? I don't you know, so if someone's going to help me bring more people to the table? I'm going to do that. So I just think we have to be open to take advice from everybody. But at the end of the day, what is your objection? Objective? What do you need? And how else can you go get it, I'm not saying go run to the banks, but use all your options. And especially in this environment.
Assaf Barnea 21:13
What we typically do and advise companies is to map initially map the landscape of investments, like those kind of seven, eight verticals, as you mentioned. And then you know, try to identify more. First of all, I think these times strategics are becoming much more important. It may take longer, there may be a different due diligence, they may have different sets of requirements for such a such product in order to be able to invest in it, but it's even if we're looking to the angels arena now, you know, say that we would have had like, I don't know, 200 300 of those in Israel, just investing in medical devices, now they are gone the vanish. Nonetheless, if this is like let it be a FinTech company, one of our companies is a FinTech, I've been telling them you know, go to gynecologist for those who made some kind of money, they will relate to them, they will be willing, if you're trying to raise five raise now one and a half, like interim round you safe mechanism, do whatever means that you need to, but in terms of who to approach is you need to approach those who truly understand. So they did not, you know, they did not vanish for good, those investors, the angel investors, but if you're trying to approach you know, plastic surgeons in one cases, or others, try to make it as a niche specifically, and niche to be synergistic with the product that you're developing. And it could be any other area oncology or whatever it may be. But those would be one meaning to more willing to support the company. Because there's an attachment over there. It's like the strategics on a different layout. strategics, you know, will be investing. So at least in my eyes, companies should be able to and will, would be doing wisely. So if they would approach more strategic partners now these days for funding, rather than to look for, you know, VCs, the typical VCs is a typical process. These are not the typical,
Scott Huennekens 23:04
Speaking of strategics, every every deal I've done as a CEO has had strategic investors, whether it's GE or j&j, Boston, Medtronic, etc. And I often get the question, yeah Philips, you know, should I take strategic money? Should I not? What should be the conditions of when I do or or don't any thoughts or advice? Because I think they are great partners, you got to protect certain things, you know, first right of refusal, you know, most of the time certain instances, you might, you don't want to give up distribution, certain instance, you might or a particular geography, but any, any thoughts that you guys have that worked well, for you?
Todd Usen 23:46
Yeah, I think, you know, I came to the when I was raising money, I came from a different perspective, because I came from after I was the president of Olympus, and the President of Smith and Nephew. So I was offered a take strategic money, great partners, wonderful people. But I also realized that timing it, you know, then the advice was maybe not an n/a round, because you're going to scare off everybody else that if you ever want to be sold. But again, you know, I've always played if you don't you don't
Assaf Barnea 24:14
Even if there's no strings attached.
Todd Usen 24:17
Yeah, well, that is yes. But the thought is, I don't want to, I don't think it should be building a company or at least communicating that to sell it. You building a company for it to be bought, or to grow, it is a very different way you run the company. So if it's strategic, I think it can give you some cachet. You know, if you get them early, because it demonstrates as probably a product market fit, which is the number one thing we need to prove, because they know the market better than every one of us, because they've been out there, right and doing it and selling it and have had success. So but I think the timing is when if you don't need them early, I would say wait, and they get a little more anxious and get more they want to get in earlier but if you can push them off a little I think that's the best. But if the I don't think there's a downside to bring in the right ones in early. earlier. Yeah, absolutely. Yeah.
Scott Huennekens 25:03
I sense that you didn't want them early because it might scare people off. Yeah that doesn't happen in my experience.
Todd Usen 25:09
Right. It scared people that were never worked for one before.
Scott Huennekens 25:13
Okay. Gotcha. It didn't mean Yeah. You're
Todd Usen 25:17
off other visa. Yeah, yes. Yeah,
Scott Huennekens 25:19
I found that
Todd Usen 25:20
It was other strategics that I was saying what scare off and other strategic so I'm coming into to buy you later on. If this if this strategic was on your cap table. That's what I meant. So not other VCs scared off from investing, I think it usually might be a nice thing, because they realize, like I said, there's a product market fit, you got Phillips on your cap table.
Scott Huennekens 25:36
My advice, take my money and live to fight another day.
Todd Usen 25:39
Yeah, you got that problem in the feed. That's my point. I agree.
Michel Lussier 25:42
With the caveat, though. And I agree, you know, Scott and I were a bit from the same mold here. So we've done it successfully. But what I've also seen is early stage seed money, early stage, founders on upon looking at one of the big strategic knocking at their door, and then they got giving the jewels of the family prematurely. So I think coaching of the entrepreneur to do it right, and be very careful of what you're getting into. Once you pass that and you have a modus operandi with too many, not too many strings attached, go for it, because those people will bring so much expertise on on on on the board. And they may or may not eventually acquire your company, but in the process, it will establish your credibility as well. So
Scott Huennekens 26:30
I'm okay. Any more quick thought? I think, you know, Todd, you you said it's a quote that a lot of people use you don't, you know, sell companies, companies are bought, elaborate on that a little more. Do we all agree with that general concept.
Todd Usen 26:43
I, you know, I'm in a unique position. And even in a publicly traded company, I'm following someone that was brilliant at selling technologies and forgot more than I'll ever know, he really had a great career. It just didn't happen at this company, because it was being built to sell. You focus on different things investors know you focus on different things, I believe you lose all your leverage, if you start running around saying, we're going to do this. And in these I've seen decks, you know, investor deck, say and I expect these three or four companies will be the right buyers. For us. That's just my opinion. Again, that's silly to put on your deck. Because it just shows that you're focused on one thing, and you're looking to get a main focus on building the company. And then if you're ready to be bought, even if you can't wait to be bought, be bought, don't focus on selling. And I think it's a better way to run a business and you'll run the business, in my opinion, smarter, you'll focus on costs, you'll focus on efficiency, you'll focus on cogs, you won't just focus on getting a product in the market and proving that everyone wants to use
Scott Huennekens 27:48
Target it, then yeah, you're building something to buy. You're building something that's available and exactly in the long run, and someone comes along during that process, which sure happens, because there's only so many.
Todd Usen 28:00
It's happened to you guys. I mean, it's just my opinion, but I believe that's one of the most passionate things about being and I can't say it as clean as you I just say entrepreneur, I don't say entrepreneurial. So it's, but I, I absolutely believe, even
Scott Huennekens 28:17
if you're going to take away from this panel, I'm gonna go back to the US and yeah, and say entrepreneurs,
Todd Usen 28:22
If you just tell people you're looking to sell your company, I actually think you've lost all your leverage today, you say that, every bit of it.
Assaf Barnea 28:29
But it's to building up the companies this is this is the perfect time when you know, when we do come when we come up typically now and saying or protecting our investment, you know, towards LPS or whatever saying, you know, wait, and don't wait or whatever, but you do need to deploy your capital. But it is a good time, or maybe one of the best times to really build the company in terms of then again, from my perspective, with early stage companies seed, A, sometimes in some cases, B rounds. This is the layers that should be brought into the board position into the advisory board position executives with expertise like you guys, you know, the entrapreneurs and they need you guys, they need you guys to be part of the board part of the advisory board, you know, there's so much value in terms of the build up of the company. It's not just the product product and the product market fit internally, they should be looked and see what are the components, the ingredients and create those assets after assets. In one of our companies we brought you know, if homology space, we brought some of the best words of the ophthalamologist, and then another executive from San Diego and another one from on the neurovascular. One of a different company on the vascular side, we brought some executives from the US to be part of it. It's always a matter of time because in some cases, you know KOLs would not come if the company is premature. If you don't have enough data, you know, they don't want to risk their reputation, but there will be a point of time for those intrapreneurs of yours that you know when you get To a certain stage when you're mature enough, and this is up to your discretion to define when try and bring those as early as you can, there's a tremendous value also in fundraising, but in the in the processes in the buildup internally built up, and not just just the product market fit.
Scott Huennekens 30:15
So what what are they? We've been focusing a lot about financing, and the the kind of tumultuous time we're in. But one of the topics that came up over and over when we were meeting beforehand was, you know, we've all been in this industry for over 30 years. And we're more excited now than we ever been in our career for the plethora of opportunities that are possible because of everything that's going on with technology and innovation, from computing power to AI to cloud to sensors that and I can name 30 Things that are, you know, computational biology and all that, you know, proteomics, genomics, it just, there's so many incredible things to create new products as well as service models. Here I, touch on that I want to leave with some optimism says, well, because we optimist, you know, we were all excited about the next five years and great companies and solutions that we're going to come well,
Michel Lussier 31:10
if I may, I think I'd have kind of two suggestions of of message or messages, a message to entrepreneur CEOs, but also to board is go for it. It's a great time COVID In the digital health. So many countries in Europe have gained 10 years in terms of psychological adoption of digital health therapies. And it's only the beginning to take advantage of that. Now, to the management I'd say, you know, under promise over deliver execution, execution, cogs, accountability, now, maybe to the VCs investors, the older investors or larger funds, maybe have weathered the storms over the years, they've seen those cycles, so that they know it's a cycle. But maybe for the younger, smaller funds or younger VCs. Don't put too much pressure on on the management. I think what the management needs right now is tough love. Meaning Yes, tough, because the CEOs CFOs have to focus on execution. But at the same time, love because putting too much pressure, panicking may just lead to you know burnouts and things like that, or just, you know, CEOs taking the wrong decisions is not in the best interests of the company. So I think we need to be take a distance here and look at this in the bigger picture,
Scott Huennekens 32:50
Kind of final thoughts Todd or, I think stuff like advice, time.
Todd Usen 32:55
I really think it's a great time to be in the med tech space. And I say that because if you believe your company is the company, and you have that technology, you're going to be funded, and you're gonna go out there and produce and you'll find out. And if you don't, and you think there's things we need go great, great people, there's so much talent in this space. People always win more than technology, people and technology never lose. But people win first, you got to get the right people on a team. And if you do that, and you believe in the people, your board included the people that are surrounding you, and your investors, I believe it's a great time and be open to change. Europe's doing everything in its power to not want medical devices in the in the on the continent, because of MDR is and all of this, but you know what? Okay, if yes, I get it, I have to fund an extra 150,000 or 200,000 as a small company. But I actually know that there's this many people here, and it's going to deliver $10 million over the next X years. But you got to do it smart. So I got to take from another place to maybe do this. But I find that people just keep pushing things off. Don't don't do that investment in Europe, and rumor has it there's patients in Europe, so we should probably treat them. Right if we can, let's get there faster than later. But I honestly I really believe in technology. And I personally believe that funds have money to invest, but they're only going to invest if you and your story are right. And if you don't believe in yourself, we're probably in the wrong space and you shouldn't be running a company. Right, but I think it's an awesome time to be in this business. Alright, Rob, what's
Scott Huennekens 34:31
up? It's off very,
Assaf Barnea 34:31
very quickly, but a different approach. I like it totally what just mentioned, but it's, at least in my eyes is the convergence. Yeah. Never in my life. Did I see something like that? I mean, maybe not 30 years, but maybe 20 years in the industry, that there's an amazing, beautiful convergence of people, technologies, companies, you know, paradigm shift in business models, you know, instead of sick care, we're moving to health care prevention prediction. Instead of you know, I'm In all of the sudden we see value based medicine, AI comes into play, even what we invest in and strongly supported by the Israeli government that the innovation authority, the bio convergence, biology and physics, biology in engineering. I mean, it brings in, it brings it all together into this is what I'm saying. Also, it's a different ballgame. Also, in that sense, there's so many integration of technologies and people and concept. This is why it's a it's an amazing game to play at this time. And I fully support that. We just need to be careful and what I'm repeatedly saying, we need to listen, truly, listen, listen to the market, truly listen to the market and adopt and change what is needed.
Scott Huennekens 35:39
Alrighty, well, thank you guys. We appreciate your time and great panel, and hopefully, you're leaving with some optimism and excitement because as we established at the beginning, we're the older group, and we're going to need your devices and your solutions here pretty quickly. Thank you enjoy the ride.
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