Video 2—Commercializing Your Healthcare Solution in the U.S. Workshop

Description

Geof Baker of VenAdvisory discusses the following topics during the "Commercializing Your Healthcare Solution in the US" Workshop at ventureLAB in Toronto, Canada.

Topics

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  • Proven GTM Approaches
  • US Health System Adoption of HiT is Slow
  • What approaches can you take to reduce your B2BC sales cycle by 30% compared to industry average?

Video 1—Commercializing Your Healthcare Solution in the U.S. Workshop

Description

Intro to the "Commercializing Your Healthcare Solution in the US" Workshop by Geof Baker of VenAdvisory sponsored by ventureLAB. This workshop took place in Toronto, Canada, on July 26, 2018, at the IBM Innovation Space, Markham Convergence Centre. 

Topics

Commercializing-Workshop-Intro.jpg
  • Where are you on your business journey? Early-stage? Growth? Enterprise? 
  • Product-market fit validates, denies or qualifies assumptions with customers. It replaces belief and propaganda with voices from industry and customer.
  • A universal problem is under-investing in the business development effort hindering the validation of hypothesizes.
  • A lack of product-market fit leads to failure. 

Who will hear the next swoosh in health tech from the mighty swish? Does Amazon’s acquisition of PillPack drive convergence with Smart Adherence?

Several of our #startup CEOs and #medication #adherence #pharmacy clients asked us about the impact of the latest Amazon acquisition on their own business models, funding, and go-to-market plans so we thought we’d share our view. This acquisition can only accelerate the convergence trend we’re already seeing between door-to-door medication delivery companies like PillPack and smart adherence. PillPack offers frictionless fulfillment, delivery convenience, Pharmacy OS, #retailhealth, and text reminders. We see that this need for convenience and supply chain fulfillment will merge with #healthcare companies offering smart blister packs, pill bottles, and pill boxes. Smart adherence solutions don’t have to rely on data entry to text questions on mobile phones (when did you take your meds?). Also, Smart Adherence collects data continuously and passively (without data entry) and allows for #Precisionprescribing interval dosing data for improved adherence. Reimbursement that pays prescribers and pharmacists to review smart packaging data insights for follow-up helps drive convergence further. Here’s the snapshot of the landscape in delivery and smart adherence. #specialtypharma

Commercializing Healthcare Solutions in the U.S.


This event has passed. You can watch segments of the workshop by clicking the part 1 video button.


Organizer

 
 
 
 

Event Details

It’s a challenge breaking into the U.S. market. Traction is hard. Competition is intense. Companies use VC funding to buy business. Pilots are hard to convert into paying contracts for sustainability (LTCV). 

Too many companies falter in the go-to-market phase, exposing themselves to lower valuations, significant financing risks, and suboptimal outcomes. These companies may lack product-market fit, business model fit, localization, proof points, and customer validation. Forty percent of all failed launches are due product-market fit alone.

Then after you jump through all those hoops, further questions and dilemmas arise:

Who pays? The consumer? Insurance? The government? Pharma? It’s hard to follow the money while simultaneously making your business case in the U.S. with the plethora of reimbursement, business model and regulatory paths.

To create paths forward, VentureLab and VenAdvisory bring you a working, collaborative session where we will offer real-world, practical tools, frameworks and tips for commercializing health solutions in U.S. markets. See how you can save 30% more time and money while getting to market.

  • Snapshot of U.S. Market
    1. Providers
    2. Payers
    3. Pharma
    4. HCIT & Service Vendors (channel)
    5. Considerations
  • Playbook: U.S. Go-To-Market (GTM) Case Study
    1. Commercialization Framework
    2. Key Questions
    3. Process
    4. Considerations
  • What NOT to Do
    1. Common Traps
  • Discussion
    1. Other Experiences Q&A
 

Agenda

  • 10:00 a.m. Registration, networking and light refreshments
  • 10:30 a.m. Workshop starts
  • 1:30 p.m. Workshop concludes
 

Who Should Attend this Session?

  • Digital health companies
  • $1M to $75M in ARR or ready to look at U.S. markets
  • CEOs, Product Managers, Chief Revenue Officers, Chief Marketing Officers, Strategy
 

SESSION FACILITATOR

Geof Baker

Managing Director @VenAdvisory

The advisors and Geof at VenAdvisory serve startup, growth-stage, and enterprise-class organizations by accelerating the adoption of innovative solutions in healthcare ecosystems. VenAdvisory has worked with over 80 healthcare CEOs with their business and go-to-market (GTM) plans, judged winning pitches at HIMSS, Mass Challenge and Health 2.0 and work with incubators. 

Geof is active in digital health leadership communities as a workshop facilitator and speaker at conferences. Previously, he founded and sold several service and software companies. He has have worked as Chief Marketing Officer for a $100M HIT company, served in executive roles at Cognizant managing a P&L of +$100M, executed transactions with corporate development teams (from $25M to $2.7BN), raised $16M in capital, founded, built then sold 2 IT companies (Optum, +$30M IQVIA). His prior work experience includes HCA, EY, and Cigna. He received his MBA from the Wharton School of Business and BA from Williams College.        


On-Site Event Location

This workshop event will be on-site at the IBM Innovation Space - Markham Convergence Centre in Ontario from 10:00 am – 1:30 pm EDT on July 26, 2018.

 

Transcript: How to Spend Less Time and Money GTM

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Host: 
We are very excited to have Purvi Gandhi and Geof Baker join us today, both of whom bring many years of investment operator and startup experience into this commercialization discussion. Let's pivot to our speakers Purvi and Geof.

Purvi Gandhi: 
Thank you Julia, and I'm looking forward to sharing all my experiences of having seen perhaps over a thousand startups and being part of investments in 200 plus startups here in silicon valley throughout us and including internationally in Asia. I'm particularly looking forward to sharing with you my CFO lens, which is: how do you raise cash, how do you manage the cash, have you get traction with the cash and how do you hit the next milestone?

Geof Baker: 
I'm fortunate to have both the experiences of the harder and successes as well as some of the failures and I'm really glad to help others today and be part of MassChallenge. Briefly, our firm helps entrepreneurs and companies grow their value by closing the gap and product market fit and gaining early proof points and sales interest. Business to business cycles can take about six to nine months at the enterprise level and that really varies depending on the solution complexity and the top bar we see that there's a 30 percent difference between the average enterprise sale and what companies do today. And the reason for that is there's some evidence-based frameworks that we'd like to share with you today.

Purvi Gandhi: 
So, you've all heard, your parents tell you ever since you were born that it's important to save money. That learning comes in very handy when you set up your own startup. And what we mean by this is that the key to validating your business idea comes when you gain early signs of customer traction and it's very critical for you to understand how you will gain that traction. Also, what level of capital is required to gain that traction. And perhaps at the early end, think through alternatives to gaining traction at the most minimal amount of cash outlay. I think are very related metric here is also when you gain that customer, what is the potential long-term value and is there anything you could do to extend that? If you could bring in that kind of discipline early into your venture I think you are set up to preserve the life of that early hard-earned capital that you will have raised.

Geof Baker: 
There’s a universe out there of different management theories, startup playbooks on sales, product management and marketing. In particular, there are two that really stand out for new launches and customer validation and a go to market theories, and that's because they're evidence based. And then down below, what's also interesting is, from INSEAD, there were about 490 authors that did an early crowdsourcing of business model design. And that was the forerunner for design thinking, which has been used by Stanford and other universities, and it was also forerunner for books like Lean Startup from Eric Ries, the many of you are familiar with and a guy named Ash Maurya who did The Lean Canvas, which is used by many entrepreneurs and incubators today. So, there are hundreds of these books out there, but one in particular we found to be very helpful in developing sales metrics and Max Altschuler’s book Hacking Sales and he talks about the different types to set up these CRM systems and these free tools and ways to get the metrics. It's very likely that you'll get trapped, you'll get trapped in time as you burn more time and cash and not get to market. And that's what is known as the Valley of Death.

Purvi Gandhi: 
These five points are critical to understand. The product market fit I think is probably closest to Geof's heart. By that what we mean is that, and I think CB insights has also pointed this out, is that when you are excited about a product, that is great. That is exactly what we want to see in an entrepreneur from an investment perspective. But is that product the right product for the market today or the market as it evolves? If it is not the right product for the market today, but perhaps right for the market as it evolves, then definitely position it that way, think it through that way and plan to have adequate cash at the front and, to also address that. I think team fit is a very, very interesting one to me.

I think the Bro Culture of hiring people like yourself who don't have the diversity of thinking can be very damaging as well. You definitely want a lot of diverse, strong opinions early on. Of course, your job as a founder is to coalesce all these ideas to converge into something executable, but to get as many different viewpoints is important. In fact, at my firm, as we focus heavily on machine learning, we went back 10 years and captured the history of every single startup in America. So yes, we do have that data of over 50,000 startups. We captured build our tools and we found a very interesting start, which is that, the companies that had more than one founder had stronger likelihood of succeeding. But more importantly, when these founders were from different schools, they graduated from different schools, the likelihood of success had even thought has gone up even higher. All the cycles where the value of death begins

Geof Baker: 
Depending on how you execute through that valley of death in terms of your, your product market fit, you're engineering prototypes. You can stay there for a long time and burn cash or you can pivot out of that and start to get earning revenues. So, it's critical as we start to discuss some of the things today, particularly around how we lower the cost of customer acquisition, and how we lower that cycle time, that we can really diminish that Valley of Death.

Purvi Gandhi: 
Identify as many risks as you can and then stack them and say which are the ones that will hit me a potentially and my business idea the hardest and what can I do to mitigate them? For example, not hitting your milestone. It's understandable that times that perhaps you didn't, but how do you develop a backup plan that when you're not hitting that milestone, then should you be a re purposing your cash another way. Also testing which financial assumptions you originally made as you kind of threw out this plan on a piece of paper and now that you're an action which of those initial assumptions are not supportable anymore. And the technology risk is the, perhaps the biggest one because we all want to be at the leading and bleeding and cutting edge of technology ideas, but often the market is just not ready for it. Keep in mind: “are there significant unproven technology risk to me?”

How should entrepreneurs save time and money going to market? We can go to market and blow through that initial investor capital as rapidly as you want. The question is how long do you want that capital to last? Remember that first capital you raised, you raised very easily. You are working hard for it and now that you have raised it, how should you extend its runway and life? I think if there are themes that I can summarize for our discussion today, those are the ones that are laid out on the slide number nine and the gap closing product market fit perhaps is definitely a very key one early on. The cost of customer acquisition is a very, very big, big point to address as well. You will of course be expecting to get gain significant traction with your exciting idea into an enterprise or into a retail segment very fast. However, nine times out of 10 that never happens and you're going to burn through cash rapidly before you acquire that first customer. So, I would definitely expect everything to work against you as you think of your customer acquisition and then say yet, in spite of that, how will I continue to lower my COA and I'm continuing to move forward and propel.

Geof Baker: 
What we really want to ensure is that the company propaganda or what you may be listening to internally is not blinding your process of going to market that is not creating the kind of biases and your assumptions or potentially influencing the way you roll out your features or your product market sets. And so it's very important to have that voice of the customer. I'm involved in this process. And so, this is I think very meaningful in terms of, in terms of getting that bias out of the group process and cutting down your cycle time.

Purvi Gandhi: 
Does one happy customer equal your heading that product market fit? And the answer is “No”. So definitely, as you sign up that first customer, even if it's a free customer, you ask yourself “Is this going to help you bring in more repeatable sales and then actually eventually be able to charge those customers and then scale and expand?” That’s an idea to accomplish.

Geof Baker: 
These are the inner loops of a harmonized process you want to think about as you start to go to market. From simply screening your screening your particular opportunity, to validating that opportunity in terms of the product market fit represented by the blue interloop, and the gray loops and then actually growing yourself over time.

It's the story of Andrus Purde who's an Estonian as he developed a marketing automation tool that was part of Pipe Drive, which is similar to some of the Salesforces out there, the CRMs systems today. It was a cloud-based solution for a small market, small, medium business market priced at $15 a user. He used many of the metrics to track progress and the tools and the hacking sales book that I mentioned from Max Altschuler, but he did this very rapidly because he was able to basically establish the metrics, understand his sales conversion and what it costs to acquire the customer. He’s gone on to advise Weekdone, which is a terrific standup tool.

It starts with those personas. Understanding who those personas are, who are those buyer influencers, those users and what are their stories? What other jobs that need to be done, understanding what is it that they do now and what do they need to do and what potentially are those pain points? Is it an easy decision or is it a complex decision? On the hypotheses and assumptions, it's important to spend some time here developing key hypotheses and assumptions for the questions and for you to go to market and typically in the hypothesis testing, you want to test one MVP at a time and you also want to gain some key learning updates in your interviews and the results from those interviews around those hypotheses. So, you would hope that at the beginning of this assumption phase, you've been able to confirm who those early adopters are. If they're interested in your solution, you've been able to validate what the top two three problems are. A, you've been able to identify the critical feature sets that are part of your minimum viable product to go to market. You've also identified the pricing and you've also identified that the customers have a willingness to pay for this solution. There's tons of mentors and MassChallenge, but there's also mentors and all these incubators across the US and UK and across the world for that matter that would be more than interested in speaking with you and may actually provide a referral or become a future member of your advisory board. So, um, the, the other thing we want to be very careful about is when you recruit, you need to also recruit those influencers if they're nurses and healthcare or if they're doctors, but also the buyers who might be the CFOs of these hospital systems.

There's definitely a science around market research for developing those open ended and close questions for the qualitative and quantitative research. So, when we think about closed questions, “Out of these five features, what is most important in what is least important?” And in developing those questions, we want to be able to weave the price sensitivity into your feature preferences, particularly if you do any kind of polls. And if you ask someone if they like the product, you should also ask them if they like it at what price point. And generally when you ask that question, the whole conversation starts to change, so it's vital to ask people not necessarily what they most prefer, but what are they likely to use and, and watch them do that. There's a great resource I want to mention. Um, it's, it's an easy read. It's called The Mom Test and one of the things about The Mom Test is that we'd never, for example, ask the question, “Do you think this is a good idea?” And the whole premise here is that opinions are generally worthless, and people will generally not tell you necessarily how they feel because they want to please you. So, you've got to be very careful in not introducing bias into those, into those types of questions. In terms of the campaigns, I think everybody has a good understanding of what a lead generation campaign is nut you want to be able to do the hypothesis testing around your messaging around your value propositions, classically in software that's called the AB test. So you want to test what people are opening, what they're reading, what they're clicking on, and for that matter, if you called up for an interview and schedule that interview, why did they come to that interview? What attracted them to you and your message that led to that interview for your customer validation process. So, through that, through that campaign in the sprints, you want to be able to optimize that messaging.

A little bit about those campaigns: generally, in the BTB environment, in the enterprise sales environment, you'll be looking at probably starting out with 100 potential leads in the universe of your, of your prospects out there. You convert those to prospects. So those are people that you touch. They opened up your email they returned your phone call and then the folks that actually schedule those interviews for those discussions, that will lead to potentially five that are interested in doing a trial, a pilot, or potentially purchasing that solution. So, five would be on the high side that range, maybe between three to five percent in terms of an enterprise sale for a $50,000 annual license, for example. The MVP interview itself is generally fairly structured. It should not last more than an hour. You can start the conversation by understanding the person's role, getting to know them, what they do, what their story is and then once you understand their role and their use cases and how they work in their environment and how they would potentially use your solution, it's helpful to provide some artifacts of that. Maybe it's a click through PowerPoint or it's a quick demo of your particular solution and to get that feedback and then you can use a poll using Likert scales a to basically get the feature feedback and the price and feedback and then you can close that out with a Net Promoter score question, which might be “Are you willing to refer this to another person?” And that's a good indicator that there's a high level of interest in this or there's not. And what typically also happens out of that question is you start to identify what the objections are. “Well, I would give this a higher score because it would need to have these things” so that can lead to your next step.

A design tool to understand what feature set I'm going to need to get a really high score or to knock this out of the park. The final part of this is really the whole, the whole iteration process and that's really understanding that you might be in a position now to take this to market, or in fact, that this market is no good. You've gone through all the hypotheses and the assumptions you need to add additional features or there are things that you have to test or for that matter, you have to pivot and find another way to potentially use, your feature sets in a market that's very attractive for that particular product.

So, we want to identify here is whether your problem or solution has exit criteria. So, for example, have you identified the adopters of the problem? Um, have you defined the minimum features that are needed to solve the problem? Have you identified the price that customers are willing to pay? And for that matter, have you confirmed a business around this? So, if you think about this, a stoplight dashboard, it's a set of criteria for you to move on from that market, stay in that market or potentially pivot completely.

Purvi Gandhi: 
The customer's willingness to pay is perhaps a very important one to understand. “Are you willing to pay the price points to, to acquire the product the same? The pricing thresholds become very relevant here. In working with Geof, I definitely learned and tested benchmarking those against not only the willingness but the ability to pay so that we could still gain customers at certain pricing thresholds and continue to validate our product with them and then eventually expand those thresholds with additional benefits and insights like pitching a very generic, very simple model. Don't make it complicated, keep it simple, and as you gain the interest, even perhaps at a lower price point, the question is, can you extend that customer's LTV and their interest by adding in things that they would want and then being able to charge them incrementally.

That gets you in the door in front of them at a very low pricing threshold perhaps, but then allows you to upcharge over time. The solution has to be something that solves a major problem. An incremental solution to an average problem is a very, very difficult sell, especially at the enterprise level. And if you are going to do that, if you are going to solve just a slight problem in an incremental manner, perhaps another option is to consider a channel partner very early on so that you are not pounding the pavement, convincing the customer that your company is going to solve a major issue for them.

Geof Baker: 
Those proof points are critical. So, these are: testimonials, this is the ROI calculator, this is the belief in your value proposition. Proof points are 40 percent more important than benefits in predicting the success of any innovation. So that's where the value proposition comes in. This is your claim that you do something and it's believable and it's provable and there's this whole process is that your sales team can have better conversations and in doing this, this product market fit you can actually reduce your outside agency costs for websites, customer ROI calculators, branding and so on. Because a lot of the content, a lot of the results that you generate from this process can be used directly. And this is a concrete example of what the product market fit lean validation process does for you. And there are these many spinoff benefits. So, we've described the customer interview, we've described some of the results in terms of the stoplight dashboard. We've talked about some of the insights that you've gained from that process through these validation interviews. Will all that information can then be condensed, be purpose. It can be purposed in terms of the micro sites that you were testing, the features that you are testing into a new landing page and it can create the web and the case studies by some of the quotes that folks are happy to be quoted on. You can create those sales decks, you can actually simplify your sales contract, and for that matter, you can put an ROI calculator on your website. And most importantly, you have now a super explainer video to cut down that sales process. Those phone calls, the customer can go to that explainer video and understand exactly what is it that you do and what makes the proof points in that particular video very compelling because you collected that evidence through your conversations and through your interviews. And then finally, after you've made these repeatable sales as Purvi was describing, you're in a position to do a press release and make announcements on LinkedIn and other places.

We hope that by going through the PMF process, you've been able to identify what your sales like sales cycle looks like, the duration of that sales cycle, the mix of marketing and the mix of sales in that process. It shows the kind of sales people and the kind of cost I'm going to incur in order to sell my product. So, if I'm on the right-hand side of this, I'm going to need a field staff team. Getting this right, understanding this mix can make a dramatic difference.

Another key aspect of all of this is really the sales conversion rate. Understanding what that conversion rate looks like. If you can get at that through the product market fit discussions of what that might look like, that can really help inform your total addressable market. It can evolve your financials and all of the assumptions that your investors were looking for. “What is that sales conversion rate? What kind of service mix do you have? How long is the duration of your sales cycle? How can you cut that down? How can you do that very efficiently?”

Purvi Gandhi: 
Market size and the TAM are very important. Segmenting the market is also very helpful early on. Some of our most sophisticated entrepreneurs tend to not only understand the TAM, but they segment the TAM out and try to understand the willingness and the ability for each of these segments to pay them. And then also the sales cycle for each of these segments. Pricing, of course, I believe that that first opportunity to get in the door is very relevant and you might have to price down in some cases as you enter. I know a lot of entrepreneurs who say that “My product is so exciting, I'm not going to sell the low price point period. The customers will have to understand its value” and unfortunately, the enterprise side of the world doesn't work that way. They have to see something, prove out and then you can make it very sticky and price up and in fact, increase LTV as you introduce your product in phases to an enterprise.

Geof Baker: 
Well, we would expect to see things like strong usage patterns over time by our customers. We would see adoption, we would see activation. We see lower retention, lower churn rates. We would actually see an improved sales conversion rate as our brand is established. We would expect to see that improve over time rather than a lot of investment that that may take. We will actually start to see a repeatable growth and more bookings and more importantly, annualized recurring revenues, which is a metric that many will watch.

The other thing we want to see is we want to see profitability as we start to come out of the trough, we want to ensure that, that, the long-term value of the customer, whether it's three years or four years, if we look at the revenue that that customer generates, it exceeds the cost of customer acquisition by at least 3X. How long does it take us to actually recover, uh, the cost of that customer acquisition over time? And then by doing these, um, things that we described around lowering your cost of customer acquisition and by going through the product market fit process to identify what is it that we need to do we can achieve that, that 20 to 30 percent delta that's been borne out by 1200 companies and more from Steve Blank's experience at Stanford as well as MITs.

Always understand the situation before you take the action. We certainly don't want to have you stay within the Valley of Death, but rather get out of that as quickly as possible and climb the trees as you need to and, and, and find new forest so that you can build your house and be successful with your strategies.

That concludes our session. We'd like to open up the floor to questions. The first question was: “How do I know when to pivot?”

Purvi Gandhi: 
As a startup you have to have the agile mentality and a pivot can be pivotal. Very good idea. They could not monetize it. They could not get the mass market traction. And very interestingly, as they were running out of money, they came to us and said that we are really low on money and we have not gained customer traction, so time to, for us to fold up the company or pivot and we decided to pivot and here's what we want to do. They had done the analysis around how, much more money they would need to continue to push that technology through and who their customers would be. So, we did another round in them and today this company is at $400,000,000 valuation and I'm just blown away that in three years that it went from a wedding registry to a vested search company because they were so agile, the earliest indicators of course being that the cash was running out and they had to survive. There are other, other approaches of identifying when to pivot too but, one of the shortest measure as early on as you set a benchmark for how you want your cash to stretch and what milestones you want to hit and halfway through your execution, you're not hitting any of those milestones and you have a certain amount of cash left, you might want to think of where else you can pivot with what you've developed.

Geof Baker: 
The next question is: “What's the, a prototypical example of a channel partner?” There are several types of channel partners. So obviously we've seen in the retail sector the distribution of goods through whether it's Best Buy, Amazon and so on. The one I can speak or articulate to is, is the enterprise the enterprise channel that are part of the ecosystem that seek the professional services that actually want to do the implementation of that particular solution. So, they get a lot of revenues and it’s part of their client base, their long-term client base to create those professional dollars around the configuration of these systems. So that's one example. Another example in the physician practice market where they're small practices and there's something like 800,000 doctors in the United States and about half of them are salaried or employed by large health systems. So how do I actually sell to those practices? How do I reach those practices? A good channel for that might be detailing channels by pharmacy Reps. If you have a particular device or solution that is sold by a representative for a drug that benefits from your particular device, that might be a very good channel partner to work with. Another one might be to go through a supply chain company that actually sells the office supplies or the medical supplies to that particular customer. So these are small customers. That's an easy way to reach these folks by developing a partnership or a revenue sharing arrangement, a with that particular distributor. So, you might have a wholesale cost and you give them anywhere between 30, 40, or 50 percent or more you reduced the retail cost of the wholesale cost and that delta is what incentivizes that particular channel, uh, to work for you. But in order to do that, you'll need to develop a business case how big the market is, why it's in their best interest to sell this, why it's not difficult to sell. So this is the kind of homework it takes in order to bring a, a channel partner on,

Purvi Gandhi: 
I’d like to add an example from our portfolio companies, one on the retail side and one on the enterprise side about how they leveraged channels. On the retail side, we have a very exciting smart oven that cooks meals, artificially intelligent, you can put anything in it and it senses what it is, and it cooks it to your desired point and alert you through your iPhone when it's ready. And this is a brilliant idea of course for the market and the millennials and, and the, the food market as you know, Blue Apron and hundreds of other companies trying to solve this issue of meals at home for one very, very interesting thing that entrepreneur has done is a find a channel partner in a very, very large prominent grocery chain and basically working with the grocery chains to this chain to design meal kits. So that on my way home I could go in, look through this rack of options, what I want to cook. I can literally go home and throw in the oven as they are, and I've got a meal at home that is fresh, and I can go for a walk and it tells me when it's ready or I can go have a drink and a neighborhood bar with a friend and it tells me your food is ready at home. This channel partner I think is going to be very pivotal for the company to hit the hit the larger market. They don't need to be out there spending a lot of money marketing directly to the customer at this point and they're partnering with this grocery chain.

Host: 
Fantastic. I think we have about time for one more question.

Geof Baker: 
Okay, sure. The question is, “Are there some key metrics, which might be misleading?” and I think that's a, that's a very good question, I mean metrics likes statistics have been used in ways that can mislead us if not confound what the reality is of, of your actual performance. And I think the metrics of that folks use sometimes they're very specific to the industries that they're in. But I think the, the, the COCA metric that we have used, the sales conversion metric, the long-term value metric are very, very good metrics to identify how you're actually doing and they had this sort of relationship between the duration and the time as well as what's happening. So, I think looking at the metrics over time, looking at the interplay of these metrics with others, provide the insights to really guide your business.

So, in looking at this, we really want to understand what's the quality of those revenues, do we have a lot of churn in those revenues? Are the type of customers that we're acquiring going to cost us a lot to maintain? Are we getting instore growth with those customers? Are we running out of market for those customers? So, I would focus on those one or two that I think are of importance to your investors into your board or if you're in a large company, to your managers into the P and l for your nonprofit that drive outcomes for example in healthcare. Um, but there are definitely some metrics that can mislead. And I think it's, it's sort of a basket of metrics that can really provide the visibility and insights into what's going on in those relationships.

Purvi Gandhi: 
The ones that can be misleading is ones that show that, “hey, we kept our cash and burn very low. We were spending very little money as a startup. “I think it's irrelevant to track cash but want to eat or the ROI on the cash against calls made customers interviewed technology progress on the product side and so as, as much as I like, I like to see cash saved, I don't like to see it preserved at the compromise of both either. I think another, another misleading one could also potentially be the overall market size and as a number of uniques, that you may be getting are less relevant as more customers that you are able to convert. You have a very high conversion rate early on and then you are turning up your unique visitors. That's when, but just getting a lot of people to visit your site and not being able to convert even a half a percent of them early on is a, is a very metric unless you believe that down the road that high volume of visitors are our recurring visitors that can be monetized.

Host: 
Alright. Well thank you so much. Purvi and Geof, that marks the end of our hour together everyone. Thank you everyone for joining today and thanks again to our sponsor, MassChallenge and have a great day!


How To Spend Less Time and Money GTM Webinar

How to Spend Less Time and Money Going-to-Market:
A Commercialization Chat With VenAdvisory.
As part of a June 6th MassChallenge Texas event, this webinar was edited from its original 60-minute length. Available transcript is here

 

THE GTM CRAWL-WALK THAT BURNS YOUR PRECIOUS CAPITAL

It's a challenge launching your solution. Only 10% of all launches make it. Markets are overcrowded, VC over funding hasn’t helped, enterprise (B2B2C) sales cycles are long, customer adoption requires change, and business cases are hard to make. 

Too many companies falter in the middle, go-to-market phase, exposing themselves to lower valuations, significant financing risks, and suboptimal outcomes. These companies lack product-market fit, localization, and need for proof points, and customer validation. 

 

WHY YOU SHOULD VIEW THIS SESSION

This session offers practical tools and tips for commercializing tech solutions. We will wear our product manager, business development, and investor hats.

  • Quick fundamentals (no lectures, just context) 
  • Insights and Learnings (case studies) 
  • Questions & Discussion
 

TAKEAWAYS

How to close the product market fit gap, confirm sales interest and scale. 

  1. Pitfalls to Avoid
  2. Closing the Traction Gap
  3. Accelerate GTM™ framework for faster customer validation
  4. Go-to-Market Plan
 

SPONSOR

MassChallenge is a global network of zero-equity startup accelerators. Headquartered in the United States with locations in Boston, Israel, Mexico, Switzerland, Texas, and the UK, MassChallenge is committed to strengthening the global innovation ecosystem by supporting high-potential early-stage startups across all industries, from anywhere in the world. To date, 1,495 MassChallenge alumni have raised over $3 billion in funding, generated over $2 billion in revenue, and created over 80,000 total jobs.

 

PANELISTS

Purvi Gandhi

Chief Financial Officer/Partner, @Hone Capital, Advisor to VenAdvisory 

Purvi is an advisor for VenAdvisory and works at Hone Capital. In the past 18 months, Hone Capital has invested over $100MM in over +350 early to growth stage startups in the technology sector (healthcare, consumer, fintech, AI, B2B, B2C). Hone capital network has provided a deal flow of more than 1,000 quality opportunities in just the past 12 months.

 

Geof Baker

Managing Director @VenAdvisory

For the past 20+ years, Geof has driven topline revenue growth in IT services ($165M in 3 years). He managed a P&L of +$100M, raised $16M in capital, executed transactions with corporate development teams (from $25M to $2.7BN), and built and successfully sold 2 companies (Optum, +$30M IQVIA).

Reducing Post-Acute Care Costs With Wearable Technology—Part 1

SUMMARY

In Q4, 2016, VenAdvisory®, a digital health commercialization firm, evaluated the product-market fit for an innovative, first-to-market wearable mobile solution for patients recovering from total-knee and total-hip replacement surgeries.

The solution called Breg Flex is designed to accelerate patient recovery anywhere, anytime for total joint replacements. Flex supports conservative therapy before surgery and recovery from sports injuries. Unique to Flex is the use of visual coaching and gamification. The visual coaching relies on a real-time avatar; a likeness of the patient performing exercises that are displayed on a mobile tablet. Under watchful observation, patients are motivated to perform their daily exercises. Outcome results are captured automatically and reported to a patient panel progress dashboard for care team review. 

VenAdvisory interviewed over 50 organizations, key opinion leaders, physicians, physical therapists, and patients to determine the proof points for this innovative, wearable recovery solution. We reviewed over 100 peer-reviewed publications for strategies to reduce Total Joint Replacements (“TJR”) costs while improving outcomes. We identified that Flex can reduce post-acute care costs. These costs account for approximately 40 percent of all total knee (TKA) and hip replacement (THA) spending during the 90-day episode period.1

The VenAdvisory study found that approximately $1,500 to $2,000 can be saved on average, with Flex for each $20,000 THA and TKA Medicare patient (i.e., Comprehensive Care for Joint Replacement (“CJR”).2,3 The interview results also identified that Flex addresses remote patient monitoring needs, particularly patient adherence to prescribed home therapy treatments, management of pain and avoidance of potential complications that leads to emergency department (ED) visits and readmissions. The study was sponsored by Breg.

 


POST-ACUTE CARE SAVINGS OPPORTUNITIES

Medicare’s Bundled Payments for Care Improvement (“BPCI”) and CJR programs have made significant progress in reducing implant costs and the average length of stay. Similarly, commercial payer payment models for TJR have incentivized providers to shift patients (under age 65) away from inpatient surgeries to 24-hour ambulatory surgeries and discharge.4

Still in 2017, significant opportunities remain to save further cost and optimize outcomes in post-acute care (“PAC”) discharge services. How then, can these PAC costs be further reduced? How can patients benefit from accelerated patient recovery in the comfort of their home while provider confidence in patient adherence is addressed in near real-time?

As episode of care reimbursement and incentive models evolve and clinical pathways change quickly in response, what emerges is a delicate balance that must weigh patient risk factors.5 How to safely balance - reductions in length of stay, steerage to ambulatory surgery, shifts in discharges away from skilled nursing facilities to home and reductions in home health and physical therapy visit costs without spikes in ED visits and readmissions.

 
 


DISRUPTIVE INNOVATION

Reducing Post-Acute Care Blind Spots With Smart Wearables For Total Joint Replacement Surgeries

Clayton Christensen talks about disruptive innovation in healthcare when technology shifts care outward; when care is decentralized, scalable, evidence-based and personalized. VenAdvisory evaluated one such disruptive innovation for orthopedic episodes of care. The firm found that while a variety of wearable sensors, such as watches, devices, patches, and monitors, have been adopted by individuals, their use to support personalized rehabilitation treatments by providers has been much more limited. The firm sought to validate the product-market fit potential for Flex, a new wearable sensor technology for orthopedic episodes that combines a mobile application, gamification, behavior change, telehealth, care coordination and augmented reality with current orthopedic episode pathways. VenAdvisory sought to validate proof points and test go-to-market assumptions. These assumptions included whether Flex and its business and clinical process models could:

  1. Simplify patient transitions to the home
  2. Work within existing provider workflows, including EMR usage
  3. Accelerate patient recoveries while also improving outcomes and avoiding readmissions and ED visits
“Sensor technology is the wave of the future"
—SVP, Academic Medical Center


OUR FINDINGS

Equally important is the patient perspective. Can the patient experience be improved by reducing the out of pocket expense, time and commute to outpatient therapy? 

At three independent sites, orthopedic surgery practices prescribed a prototype (wearable device and mobile application) to 25 patients undergoing either a hip or knee replacement surgery. Detailed patient interview feedback was collected in 2016 and early 2017 regarding their recovery experience using Breg Flex.

 
 

Higher high functional improvement

Number in percentage (%)
 

Patients had 20% higher high functional improvement scores at discharge compared to the national average 6


Physical therapy visits

Number in percentage (%)
 

Wearable device wearing patients resulted in 25% fewer physical therapy visits 6


Patients compliant with home exercise

Number of percentage (%)
 

75% vs. 30%

75% of wearable patients were compliant with home exercise programs, compared to 30% for non-wearable patients 6

 

To better understand patient motivations and preferences, we also uncovered the following findings for patients from survey, interview and published data:

 

TOP BENEFITS:

  1. Instructional Videos
  2. Guided Home Exercise
  3. Flexibility in Exercise Programs (e.g., pause, restart, skip)
 
 

KEY FEEDBACK:

Would suggest wearable to a friend

Number in percentage (%)
 

100% of patients with wearable devices would suggest the solution to a friend

 

Motivation

Number in percentage (%)
 

95% of wearable users found the solution increased their motivation

 

Top priority

Number in percentage (%)
 

75% of wearable patients identified speed of recovery as their top priority

 


REFERENCES:

  1. Keswani, A., et al. Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. Journal of Arthroplasty. June 2016. Volume 31, Issue 6, Pages 1155–1162.

  2. Centers for Medicare & Medicaid Services. Comprehensive Care for Joint Replacement Model. Web. Accessed 1 February 2017.

  3. Alliance for Home Health Quality Innovation, “Distribution of Post-Acute Care under CJR Mode of Lower Extremity Joint Replacements for MS-DRG 470”. 2011-2014 Standard Analytical Files (SAF) Limited Data Set (LDS); 5% and 100% sample of Medicare beneficiaries, All Part A and Part B Care Settings.

  4. Harris Meyer, Replacing joints faster, cheaper and better? Modern Healthcare, June 4, 2016

  5. Yao, Dong-han, et al. Home Discharge After Primary Elective Total Joint Arthroplasty: Post discharge Complication Timing and Risk Factor Analysis. Journal of Arthroplasty. February 2017 Volume 32, Issue 2, Pages 375–380.

  6. Breg. Breg Flex: Mobile Patient Therapy Monitoring for Value Based Care. Results of observational studies of patients. Carlsbad: Breg, 2017. Print.

  7. Wang, Li., et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomized controlled trials. BMJ Open. 2016 Feb 2;6(2): e00985.

  8. D. Santa Mina, et al. analysis. Physiotherapy 100 (2014) 196–207.

  9. Brown K., et al. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Perceptual & Motor Skills. 2012;115(3):765-774.

  10. Snow R., et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. The Journal of Bone and Joint Surgery. 2014 Oct 1;96(19): e165. Web. Accessed 12 Feb. 2017. 

To be continued: This insight is Part 1 in a series of four parts.

A full download of the article will be available at the end of the series. 

 

Reducing Post-Acute Care Costs With Wearable Technology—Part 2

MAKING FAST RECOVERY A GAME PATIENTS WANT TO WIN

Providers need to be confident that patients will follow their treatment plans. Once patients leave their practice site, providers have no automated way to monitor the patient’s levels of pain relative to exercises completed, complications, functional status and compliance to recommended exercises. If patients do not follow their treatment plans, providers may be challenged with unsatisfactory patient outcomes. 

We interviewed several Physical Therapists (PT) and identified that the hardest part of physical therapy is often that patients simply do not understand the exercises or how to perform them in a nuanced way. Also, many factors are at play in patient adherence to exercise regimens:6

  • Patient motivation
  • The exercise’s role in overall rehabilitation
  • The physiotherapist’s “verbal” and “visual” explanation
  • The quality of physiotherapist’s explanation and patient interaction
  • The physiotherapist’s reassessment of home exercises and patient satisfaction.

With the wearable device and app, not only were patients able to view their data, but patients received real-time visual coaching via an avatar or likeness of themselves. 

Many interviewees spoke to the “Hawthorne Effect.” When we told the story of how the solution brings the know-how and the watchful eyes of the PT and doctor into the patient’s home, patients responded that they felt encouraged, supported and held accountable, particularly when pain levels (VAS) were high. Furthermore, PTs also commented that sensors could save data entry time by automating the capture of vital functional outcomes data used in Hoos, Koos, WOMAC surveys that were required for quality reporting purposes. Also, PTs felt that mobile communications, including telehealth chats could help patients stay motivated and compliant. PT’s felt this form of communication would be effective for patients requiring multiple visits when annual therapy caps were reached. Reactions to the “avatar” likeness of the patient on tablets and real-time visual coaching was favorable; viewed by patients as a way to guide them to correctly perform exercises in their homes without the need for special equipment or large TV screens. The transparency of the data and patient status dashboard meant that patient recoveries could be monitored by the entire health team, including updates to the Orthopedist before a post-operative visit. As star players with coaches watching over them at any moment, patients were held accountable. The gamified experience coupled with motivational check-ins and encouragement led patients and PT’s alike to respond with “who wouldn’t want to play to impress?”. The most significant motivation was for patients to see and experience tangible progress, reinforced by a wearable application, in getting their activities of daily living back in order.

SECTIONS

Making Recovery a Game

Preparing for Success

References

 
 Breg Flex wearable

Breg Flex wearable

 


PREPARING FOR SUCCESS: PRE-REHABILITATION AND PATIENT EDUCATION

Benjamin Franklin famously said, "by failing to prepare, you are preparing to fail.” Providers are finding this statement holds true for CJR episodes, particularly when pre-rehabilitation (“Prehab”), can be performed before surgery. Prehab involves patient education, pre-operative PT and home exercise services. 

VenAdvisory spoke with organizations that used inter-disciplinary care teams and clinical pathways for TJR. Several organizations also require patient enrollment in education classes before surgery. The classes level set patient expectations effectively and lay out a plan of preparatory activities leading up to and following surgery. The classes also create opportunities to assess patient risk factors before surgery. Several of these organizations were using Prehab, some were not. 

Published, peer-reviewed studies show varied results for Prehab.7,8,9 In these instances, it was helpful to review meta-analyses that consider account sample sizes, risk of bias and study quality to weigh the net result of an intervention. A meta-analysis of 21 studies published in Physiotherapy in 2014 concluded that Prehab not only reduced length of stay, pain, complications and improved function, but it reduced cost.8

 

Resulting post-acute care use

Numbers in percentage (%)
 

A 2014 study published in the Journal of Bone & Joint Surgery (JBJS)10 found that “the use of preoperative physical therapy was associated with a significant 29 percent reduction in post-acute care use,” including the use of skilled nursing facilities, home health agencies and inpatient rehabilitation. This shows that prehab can and should be a valuable part of a CJR services package. While prehab services can increase costs (they are outside the CJR index event period), they can generate a positive return by reducing post-acute services and create a foundation for successful patient recoveries.

“The ability to see patient functional status before surgery would be key. It would inform the risk assessment with greater confidence in functional status than the patient interview.”
—Orthopedic Service Line Manager, Health System
 
 


REFERENCES:

  1. Keswani, A., et al. Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. Journal of Arthroplasty. June 2016. Volume 31, Issue 6, Pages 1155–1162.

  2. Centers for Medicare & Medicaid Services. Comprehensive Care for Joint Replacement Model. Web. Accessed 1 February 2017.

  3. Alliance for Home Health Quality Innovation, “Distribution of Post-Acute Care under CJR Mode of Lower Extremity Joint Replacements for MS-DRG 470”. 2011-2014 Standard Analytical Files (SAF) Limited Data Set (LDS); 5% and 100% sample of Medicare beneficiaries, All Part A and Part B Care Settings.

  4. Harris Meyer, Replacing joints faster, cheaper and better? Modern Healthcare, June 4, 2016

  5. Yao, Dong-han, et al. Home Discharge After Primary Elective Total Joint Arthroplasty: Post discharge Complication Timing and Risk Factor Analysis. Journal of Arthroplasty. February 2017 Volume 32, Issue 2, Pages 375–380.

  6. Breg. Breg Flex: Mobile Patient Therapy Monitoring for Value Based Care. Results of observational studies of patients. Carlsbad: Breg, 2017. Print.

  7. Wang, Li., et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomized controlled trials. BMJ Open. 2016 Feb 2;6(2): e00985.

  8. D. Santa Mina, et al. analysis. Physiotherapy 100 (2014) 196–207.

  9. Brown K., et al. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Perceptual & Motor Skills. 2012;115(3):765-774.

  10. Snow R., et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. The Journal of Bone and Joint Surgery. 2014 Oct 1;96(19): e165. Web. Accessed 12 Feb. 2017. 

To be continued: This insight is Part 2 in a series of four parts.

A full download of the article will be available at the end of the series. 

 
 

Reducing Post-Acute Care Costs With Wearable Technology—Part 3

PROVIDER MOTIVATIONS 

In our interviews with executives from 20 different top-tier provider organizations, we asked how wearable technology might support their patient care models and businesses. Below are highlights from these interviews. 

 

Key Provider Motivations:

  • Optimize Outcomes
  • Gain Visibility into Patient Recovery
  • Provide Excellent Patient Experience

 

During our product-market fit interviews and research, we identified several key benefits for a wearable mobile solution among various stakeholder groups involved in TJR surgeries.


TOP BENEFITS FOR PHYSICIANS:

  1. Outcomes Reporting/Dashboard (based on objective data)
  2. Remote Care Monitoring
  3. Patient Reported Outcome Measures


TOP BENEFITS FOR PHYSICAL THERAPISTS:

  1. Patient Compliance/Accountability
  2. Care Coordination
  3. Consistent Patient Education


TOP BENEFITS FOR ORTHOPEDIC SERVICE LINE ADMINISTRATORS:

  1. Outcomes Reporting/Dashboard (based on objective data captured from sensors)
  2. Patient Reported Outcome Measures
  3. Syncing of patient outcomes results and patient clinical data with the EMR to provide a more complete picture


TOP BENEFITS FOR PATIENTS:

  1. Instructional Videos, Visually Guided Home Exercise, Telehealth Connection to Provider
  2. Convenience—Can be used anywhere, anytime
  3. Flexibility in Exercise Programs (e.g., pause, restart, skip)


TECHNOLOGY SOLUTIONS MUST SOLVE IMPORTANT PROBLEMS

During the interviews, we consistently heard the need for proof points to demonstrate new technologies and processes. We heard that sales teams approach healthcare organizations and orthopedic practices with new technologies every day. Yet, providers are reluctant to adopt new technology unless it can solve a critical problem, integrate with clinical workflows, save time and money and has a pre-existing business model (i.e., reimbursement). And rightly so, since new solutions involve changing how some clinicians are doing their jobs today. Providers do not favor treating patients differently or practicing differently due to different reimbursement models. The investment in changing protocols or caring for patients outside the hospital and practice site must save time and be worthwhile. Integrated solutions, via wearable sensors and smart mobile devices, that aid patient recovery while automating the reporting of results and events (complications, pain scores) can pay off when scaled across multiple orthopedists and broadly adopted by patients. This applies to both episodes of care and traditional fee-for-service reimbursement models.

 
 


REFERENCES:

  1. Keswani, A., et al. Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. Journal of Arthroplasty. June 2016. Volume 31, Issue 6, Pages 1155–1162.

  2. Centers for Medicare & Medicaid Services. Comprehensive Care for Joint Replacement Model. Web. Accessed 1 February 2017.

  3. Alliance for Home Health Quality Innovation, “Distribution of Post-Acute Care under CJR Mode of Lower Extremity Joint Replacements for MS-DRG 470”. 2011-2014 Standard Analytical Files (SAF) Limited Data Set (LDS); 5% and 100% sample of Medicare beneficiaries, All Part A and Part B Care Settings.

  4. Harris Meyer, Replacing joints faster, cheaper and better? Modern Healthcare, June 4, 2016

  5. Yao, Dong-han, et al. Home Discharge After Primary Elective Total Joint Arthroplasty: Post discharge Complication Timing and Risk Factor Analysis. Journal of Arthroplasty. February 2017 Volume 32, Issue 2, Pages 375–380.

  6. Breg. Breg Flex: Mobile Patient Therapy Monitoring for Value Based Care. Results of observational studies of patients. Carlsbad: Breg, 2017. Print.

  7. Wang, Li., et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomized controlled trials. BMJ Open. 2016 Feb 2;6(2): e00985.

  8. D. Santa Mina, et al. analysis. Physiotherapy 100 (2014) 196–207.

  9. Brown K., et al. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Perceptual & Motor Skills. 2012;115(3):765-774.

  10. Snow R., et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. The Journal of Bone and Joint Surgery. 2014 Oct 1;96(19): e165. Web. Accessed 12 Feb. 2017. 

To be continued: This insight is Part 3 in a series of four parts.

A full download of the article will be available at the end of the series. 

Reducing Post-Acute Care Costs With Wearable Technology—Part 4

ORTHOPEDIC EPISODE TAKEAWAYS: REMOVE THE BLIND SPOT

 “It’s nice to know in real-time which patients are the outliers.”
—Physician Orthopedic Surgeon
“The ability to monitor patient progress, post-surgery is compelling
—Chief Medical Officer, Health System
 “Pain very key. Today it is captured through EMR by nurses during patient encounters, because there is a care team member to record it. If the patient is at home, there is no way to document.”
—Executive, Leading Health System
 “SMART wearables in the Home remove our blind spot.”
—Executive, Leading Health System

  • Optimize Outcomes

    Support prehab, motivate and involve patients, transition more recovery to in-home settings, speed recovery times, and avoid re-admissions.
 
  • Gain Visibility into Patient Recovery

    Make patient progress visible to providers and patient caregivers at any time, and enable appropriate interventions whenever necessary.
 
  • Deliver Excellent Patient Experience

    Involve patients as a key partner in their recovery, give them tools that will help them succeed, and instill confidence that patients will be monitored every step of the way.
 

SECTIONS

Takeaways

Conclusion

References

 
 Breg Flex Wearable

Breg Flex Wearable


CONCLUSION

Orthopedic, Sports Medicine, Rehab and Physical Therapy providers want TJR patients to get their lives back. Yet under episodes of care models, readmissions, ED visits and complications, and the cost of health are borne by providers; putting their profit margins are at risk. It does not have to be that way. With the addition of wearable technology coupled with telehealth, mobile and patient event dashboards, providers can now better care for their patients without losing their bottom line, particularly in the post-acute care blind spot. 

From pre-screening all the way through to complete recovery, wearable mobile technology keeps both the patient and the provider in the know. No longer are doctors and PTs uninformed of a patient’s progress outside the practice walls and no longer are patients uninvolved in their own health. With wearable technology, patient recovery is a team effort where motivated patients, personalized recovery plans, live visual coaching can pay off. With pre-rehabilitation and post-acute care monitoring throughout the 90-day event, wearable mobile technology helps to conquer the most important factors in provider profitability in post-acute care services: avoiding readmissions, ED visits, shifting care away from SNFs to the home, and reducing outpatient PT and home health visits. 

With increasing adoption of value-based reimbursement programs on the horizon, we anticipate provider organizations will be looking for more innovative solutions such as the wearable mobile technologies that come to market.

 
 


REFERENCES:

  1. Keswani, A., et al. Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. Journal of Arthroplasty. June 2016. Volume 31, Issue 6, Pages 1155–1162.

  2. Centers for Medicare & Medicaid Services. Comprehensive Care for Joint Replacement Model. Web. Accessed 1 February 2017.

  3. Alliance for Home Health Quality Innovation, “Distribution of Post-Acute Care under CJR Mode of Lower Extremity Joint Replacements for MS-DRG 470”. 2011-2014 Standard Analytical Files (SAF) Limited Data Set (LDS); 5% and 100% sample of Medicare beneficiaries, All Part A and Part B Care Settings.

  4. Harris Meyer, Replacing joints faster, cheaper and better? Modern Healthcare, June 4, 2016

  5. Yao, Dong-han, et al. Home Discharge After Primary Elective Total Joint Arthroplasty: Post discharge Complication Timing and Risk Factor Analysis. Journal of Arthroplasty. February 2017 Volume 32, Issue 2, Pages 375–380.

  6. Breg. Breg Flex: Mobile Patient Therapy Monitoring for Value Based Care. Results of observational studies of patients. Carlsbad: Breg, 2017. Print.

  7. Wang, Li., et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomized controlled trials. BMJ Open. 2016 Feb 2;6(2): e00985.

  8. D. Santa Mina, et al. analysis. Physiotherapy 100 (2014) 196–207.

  9. Brown K., et al. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Perceptual & Motor Skills. 2012;115(3):765-774.

  10. Snow R., et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. The Journal of Bone and Joint Surgery. 2014 Oct 1;96(19): e165. Web. Accessed 12 Feb. 2017. 

This post is the last in a series of four parts.

To download the complete PDF of this article, please click here to complete a quick form. 

 Complete article download (362 KB)

Complete article download (362 KB)

What questions should your GTM efforts answer?

Question.jpg

HOW will you stay relevant? Do you have a defined growth strategy?

WHAT opportunities exist in the near, intermediate and long-term for your solution(s) given healthcare and IT trends by customer market segment (provider, payer, life sciences, consumer)?

WHAT is the addressable market size, degree of competition, adoption, investment and level of execution required to pursue these opportunities?

WHAT is your proposed solution for targeting customers and how does it solve major customer problems (i.e., business value and outcomes)? WHO should you actively target (buyer/decision-maker personas, channels)? 
WHAT are the priority opportunities? 

WHY are you excited about these opportunities (game changer)?

WHAT is your POV for each proposed market segment? WHY are they unique?

WHAT will it take (resources, investment, IP, capabilities, CSFs, GTM strategies) to execute on these opportunities and acquire customers? WHAT are the risks? HOW will your competitors respond? 

WHAT market and financial scenarios (entry, exit, customer segment, geography, sales targets, timing, channels, business case, key assumptions) are anticipated?

WHAT proof points (customer insights) validate the GTM strategies before commitments are made? Have you validated key hypotheses and assumptions with at least 10 representative customers?

WHAT are the 60/90/180 day plans for GTM execution (priorities, objectives, activities and KPIs)?

Accelerating New Product Development with Customer Lean Validation

New Product Development (NPD) is a systematic framework for guiding processes from ideation to solution launch. The process can be represented by a funnel with many new ideas entering the discovery stage, narrowing to the most viable few for development and ultimate launch and go-to-market (GTM).

A common approach is for teams to generate solutions, rank them then build them. This assumes the teams are experts, know their customers and competition. However, it’s critical not to shortcut customer validation. Particularly, the work required to 1) gain a deeper understanding of your customer’s needs, 2) customer jobs to be done and 3) testing of the hypotheses and assumptions for your solution.    

With pressures on teams to shorten time-to-market, faster realization of value occurs when teams use lean customer validation before they launch a solution. Customer validation leads to better product market fit and higher likelihood of GTM success.

 
NPD Picture 1.png

According to a 2011 Booz, Allen Hamilton study, sources of innovation apply to many enterprise initiatives. Under step 1, business model tools such as Lean Canvas and inputs such as market analysis help winnow these efforts.  

 
NPD Step 1 Picture.png

In step 2, the teams and management can score the opportunity using several criteria. 

 
NPD Step 2 Picture.png

In step 3, teams can experiment efficiently by creating a short storyboard or brief that articulates Maximum Value Propositions and Use Cases. The storyboard should demonstrate how the solution will solve the customer Jobs to be Done and pain points. The storyboard should also incorporate key assumptions and hypotheses to be tested during the lean customer validation phase.  

 
NPD Step 3 Picture.png

In step 4, organizational understanding of the solution blueprint (what you can build) and go-to-market strategies should start to emerge as customer conversations provide greater clarity on the storyboard. At this stage, it’s critical to validate your proof points, market segments, customer benefits (unique value propositions), sales process, customer adoption cycles and pricing. Equally as important is an early business case. If feasible, a business case should be developed before any further investments in resources or funding are made (i.e., “what if” modeling of pro-forma sales assumptions and revenues).  

 
NPD Step 4 Picture.png

In step 5 to shorten your time-to-market and time-to-value, alternatives to coding from scratch should be evaluated, including assembly and integration of third party assets. The software architect, design, product management and engineering teams are now working side-by-side in testing and making prototypes a coded reality. Throughout this process, customer validation (deep context) continues to drive what you can build rather than a team’s strongly held beliefs or assumptions that may be lacking in evidence. A strong link should exist between testing iteratively and validation of deep customer insights.

 
NPD Step 5 Picture.png

Step 6 captures the remaining steps required for full deployment and general availability (GA) of your solution. If a de novo solution, this step may include customer pilots before GA to test customer acceptance, work out corrections and to build early testimonials and net promoter scores. When pilots validate your proof points, your organization is now well positioned to make further investments, raise capital and move into full GA release. Investments can be made to ramp and scale, execute go-to-market strategies, expand sales and distribution efforts, increase customer success, roll out developments and plan for future enhancements. 

 

Getting Your Digital Health Venture Ready for Due Diligence: Checklist

Yes-No.jpg

We’ve seen too many early stage ventures and their teams unprepared for the due diligence process, whether to be acquired or to get funded. It’s been a painful process for many of the companies we meet and it takes tons of CEO and executive time. It involves a rigorous review of your operations, products, technology stack, sales, customers, team/management and financial condition. It also takes you away from your customers, running your business and placing you at risk with your stakeholders.
 
To help you here, we went through several due diligence investigations by investors ourselves when funding our previous companies. We prepared a checklist of 15 items you might expect. There is a wide range of investor asks and focus areas. While you may not need to cover the waterfront with all the items on this list, it should help prepare you for the basics. Basics that are likely to be covered in your conversations with disciplined angel and venture funding groups.

The Due Diligence List and Questions includes these topics:

  1. Organization and Good Standing
  2. Financial Reports, Tax Returns
  3. Business Plan & Valuation
  4. Indebtedness
  5. Human Resources
  6. Professional Services
  7. Organization Information
  8. Contingent Liabilities
  9. Contracts, Agreements and Other Arrangements
  10. Proprietary Rights
  11. Plant, Property and Equipment
  12. Insurance
  13. Product Development/Management
  14. Sales/Marketing
  15. Operations

Your Stage: Preparing for Investor Discovery

Before you start your discussions with investors or business partners, consider staging. Realizing greater value for your business is like staging your real estate for sale. When you want buyer to invest in your business, a major clean-up is required before opening the doors to potential investors.

We’ve been fortunate to help many technology companies, including some of our own, prepare for investor and partner discussion. To help you, we created this actionable, stoplight dashboard tool. It sets the stage for preparing your enterprise, team, processes and technologies for more favorable terms and in more favorable light.