Innovation4Alpha Se2 Ep4 – Stephan Livera of The Bitcoin Podcast

In this episode, Tobin Arthur and Dr. Jeff Ross talk with Stephan Livera. Based in Sydney, Australia, Stephan is the host of The Bitcoin Podcast. He’s quite bullish on Bitcoin, and in this episode he provides us with some education about how the currency works, as well as how it can be used for investing. Make sure to check out the extensive show notes, and subscribe to The Bitcoin Podcast to stay up to date.

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Oncology: The 900 Pound Gorilla of Startup Funding

In 2018, startups in the United States raised over $13 billion in capital. Of that, nearly 15 percent (or $1.7 billion) went to oncology-focused companies. On the surface, it’s easy to see why so many investors would want to put their funds toward cancer. Most would consider curing the elusive family of diseases as a moonshot, especially as cases continue to grow at an alarming rate.
But digging deeper, there’s more to the story of why oncology raises so much money, and a host of new technologies have come into play. Let’s dive in and see the details.

Everybody Wants to Rule the World

When thinking about the biggest ideas in medicine, it’s become almost commonplace to say “a cure for cancer.” From students to scientists, pageant contestants to investors. Even former Vice President Joe Biden feels the pull:

“I promise you if I’m elected president, you’re going to see the single most important thing that changes America, we’re gonna cure cancer.”

It’s not a surprising goal. Almost every person can name at least one person close to them affected by the disease. That prevalence means that cancer gets a lot of attention. That attention means that, for better or for worse, oncology is a major talking point.

Talk is Cheap, Cures are Expensive

If you’re a startup that sees your potential funding go toward oncology instead, that talking point is part of the problem. Between individuals, organizations, and the government, cancer gets a huge amount of attention. Some investors, swayed by the noise, choose to pass on other areas and put their money into oncology instead. That bias extends into government funding as well. The National Institute of Health, for example, spends nearly double on the National Cancer Institute as it does its next closest center.

That said, cancer is an epidemic and worthy of the money requied to study, treat, and prevent — if not cure — the diseases. But it’s worth considering whether investors are robbing Peter to pay Paul.

On the Horizon

It’s impossible to talk about cancer in 2019 without also talking about CRISPR. The genetic engineering field is relatively young. CRISPR as a term and dedicated field of study within genetics has only been around since 2002. But the gene editing idea may indeed hold our best chance at curing cancer at its source.

For those not in the know, the Cliff’s Notes version of CRISPR goes something like this: It is a gene editing technology that identifies and “cuts” certain strands of DNA, and then “pastes” replacement DNA in its place. As it relates to cancers, CRISPR should be able to target and remove germline mutations (inherited gene faults) that are tied to cancer growth.

Skirting the Edges

The up side of oncology getting so much attention is that there are many other fields that can work with the cancer while having other areas of cocus as well. Immunotherapy, pharmaceuticals, nanotechnology, and epigenetics are all specialties that see continued attention from oncology. But these fields all have larger umbrellas over them, covering many other areas of treatment as well.

For those who may think that the oncology gorilla is eating too much from the startup funding buffet, there are other fields that can benefit from the attention that cancer commands.

We’d love to hear your thoughts. Are investors ignoring other areas, opting for moonshot oncology treatments? Or does the field deserve even more attention than it gets today? Sound off via your AngelMD profile, and use the #AMDoncology hashtag. Let’s start a discussion.

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The Rise of Patient Engagement

Over the past few years, the term ”patient engagement” has risen in popularity. As payers continue their march toward pay-for-performance models, providers are looking for every advantage. Patient engagement is somewhat of a catch-all phrase that encompasses everything from medication compliance to self-service appointment scheduling (and all points in between). As such, we are seeing a wealth of upstart companies hoping to provide better outcomes for patients and providers.

What Is (And Isn’t) Patient Engagement?

As stated in the introduction, patient engagement is a big umbrella under which many activities will fall. But we should take a look at the existing players in the space to help us narrow things down somewhat. What we found is that two factors have to exist in order for an activity to fall under patient engagement:

  1. The activity must involve both the patient and the provider. Think of a conversation, not a broadcast.
  2. The activity must work toward accountability or understanding.

HIMSS defines patient engagement as “providers and patients working together to improve health.” As a collaboration focused on health information, HIMSS then goes on to define patient engagement through that lens. Everything from text messaging to wearables falls into this category for HIMMS, and much of the talk about patient engagement relies on technology for its success.

The World Health Organization shows one of its focuses on primary care as an area where patient engagement holds promise. As such, WHO tends to start on a more in-person level for engagement. The organization encourages surveys, focus groups, and informal online feedback in order to facilitate mutual accountability and understanding between the patient and the provider.

Conversely, it’s important to note that some other areas of major focus will not fall under patient engagement. EMRs, for example, are not in place to help the patient understand or to make them accountable. Likewise, outreach does not qualify as patient engagement. It is a function of marketing. As such, it does have its own potential for positive outcomes, but again, it lacks the qualifier of patient understanding or accountability.

A Focus on Quality

As much as we would all like to say that every interaction is a quality interaction, that is simply not true. Physicians today have less time to spend with patients, and they have more patients to see with an aging population. Patient engagement is not the entire answer to these problems, but it is an important part of the puzzle.

Letting the market help to guide our vision for patient engagement, we can see areas that are already getting attention. A recent acquisition by Philips aims to help hospitals communicate with patients. The company bought Medumo, which uses texts and emails to communicate with patients about their procedures, with the goals of better compliance and fewer missed appointments.

Hospital conglomerate Banner Health also made news recently. The group has deployed chatbots, powered by LifeLink, in 28 of its emergency rooms. The bots use HIPAA-compliant messaging to inform the patient about their visit, while also feeding submitted information into the hospital’s EMR. The company reports high adoption rates of the chatbots, and improved patient satisfaction ratings across the board for those who use them.

These are just two examples of how patient engagement, with a focus on quality, is moving the needle in today’s market. But a cursory glance at acquisitions headlines shows that the segment is gathering much-deserved attention. By focusing on better patient outcomes, and improved quality metrics, patient engagement has found its niche in today’s healthcare.

Points to Ponder

As we discussed in our recent article on finding success with a medical device company, having predicates and guides is critical. Can the same be said for patient engagement? What areas of expertise are most important for finding success in the segment? What can we learn from the failures in the direct-to-consumer healthcare segment?

How do we overcome patient privacy concerns? It’s safe to say that even most healthcare providers don’t have a full understanding of HIPAA. How can we expect a patient to be more (or even equally) informed? What What areas contain potential pitfalls that must be avoided?

For the healthcare investor, there is an opportunity for faster liquidity than in some other areas. Will we see traditional private equity money being driven into this segment, since it avoids some of the timing concerns that are so relevant with other forms of healthcare innovation?

We will revisit these questions, and more, in an upcoming blog post. For now, we’d love to read what you have to say. Post your thoughts to your AngelMD profile, with the #PEAMD hashtag.

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The Ethics of Investing as a Physician

The past decade has seen a stark increase in the number of private equity firms that are investing in healthcare. On the other side of that same coin are singular investors — or groups of investors — who are looking to diversify their portfolios by investing in healthcare. It only stands to reason that, by investing in what they know best, physicians stand a better chance to beat the odds. But the practice is not without its potential pitfalls, and it is important to know how to avoid them.

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The Rise of the Family Office as an Investor

Three main drivers for macro-economic growth for any country’s economy include accumulation/deployment of capital, increase in labor outputs, and technology advancement. AngelMD is focused on driving healthcare growth by both unlocking access to capital and supporting the very best healthcare technology advancements.

Family offices today are playing an increasing role in deployment of capital on a global scale. In 2008, an estimated 1,000 single-family offices were in the world. Less than a decade later,  Ernst & Young reports the number has grown to more than 10,000 family offices globally. Family Office Exchange says that, while most estimates peg the current number of family offices in the United States to somewhere between 3-5,000, the real figure could be closer to 6,000.  

Research conducted by Dominic Samuelson, CEO of Campden Wealth, suggests family offices currently hold assets in excess of $4 trillion. Family offices are now capable of making transactions that were traditionally reserved for big companies or large venture and private-equity firms, therefore making them a notable force in the marketplace.  

The Global Family Office Report shows more than a quarter of family offices (28%) report being engaged in impact investing (i.e. investments made with the intention to generate positive, measurable social and environmental impact alongside a financial return.) Two-fifths plan to increase their allocations this coming year, a push largely attributed to ethically-minded millennials moving up through the family ranks.

A major trend affecting future growth of family offices is to balance changing investment strategies for increased emphasis on direct minority-stake investments, yet more active participation in the strategic management of these investments versus rising operational costs and the need for specialist, more scarce talent.   

Impact investing by Family Offices is a natural fit on the AngelMD platform. Rather than building up staff to evaluate healthcare investment alternatives, Family Offices can rely upon the AngelMD network to source, evaluate and deploy capital to the best healthcare impact investments.

The JOBS Act created the regulatory framework for AngelMD’s syndicated investment model for accredited individuals. To be considered accredited, an investor must have a net worth of $1,000,000, excluding the value of their primary residence, or income of $200,000 each year for the past two years. In just over 24 months, AngelMD has been able to leverage our digital platform and network of accredited investors to execute 30 syndicate investments in leading healthcare startups.  

AngelMD physicians are able to play a key role in our syndicate investment vehicle by sourcing, vetting, scoring, and advising the best healthcare startups. A portion of the AngelMD physician membership also participates as investors and leaders in syndicate opportunities. This proven model, however, is materially enhanced when complemented by funds that are available to precede and/or follow-on to syndicated investments. This rationale underlies the creation of AngelMD’s Catalyst family of Funds.  

The Catalyst I LP fund leverages the network as an input to investment decisions made by each Fund Manager. Rather than investing in individual syndicates, family offices, institutional investors, and sovereign funds view AngelMD funds as the more efficient model for capital deployment. Over time, AngelMD will create a number of thematic funds that will deploy significantly more capital than our syndication model.

The AngelMD network of family office membership will continue to grow as they seek platforms that provide returns while simultaneously providing societal impact. Over time, we believe that the majority of our deployable capital will come through those relationships.

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