Startup CEOs and Investors: Brian Weiss

Common CommonWell Thoughts (or, Who is Working on A National Social Being Identifier?)
By Brian Weiss

Did you read the CommonWell piece on HIStalk?

Mr H. did us all a great service in providing a platform for directing HIStalk reader questions to the CommonWell alliance from Cerner and company. Yes, I know that only 60 percent of the panel responding to the questions actually works at Cerner, but my articles are too long already without listing the full membership of CommonWell. I hope you’ll forgive me if Brightree isn’t the first vendor that jumps to mind when I think about CommonWell.

Given the fact that CommonWell is not consistently spelled “Commonwell,” we need to be especially appreciative that Mr. H gave them publishing space. I’m only allowed to write this article because I named my company “Carebox” even though I’m still waiting for the first person not related to me to spell it that way rather than “CareBox.”

Now, if you’re reading this article (clearly you are) and you still didn’t read that one (and you’re not related to me), you need to do a better job prioritizing what parts of HIStalk you read. We’ll all wait for you here while you go read that piece.

The Alliance

CommonWell is an “alliance.” I’m pretty sure that was selected over “empire” in the tight balloting in the CommonWell name-calling subcommittee because of the whole “Star Wars” context. For those who slept through the relevant decades, the “Alliance” is what you call the good guys, and if you’re reading this article and never saw “Star Wars” (even if you’re related to me), you really need to work on overall life balance.

By the way, I’m not 100 percent sure they have a formal name-calling subcommittee at CommonWell and, yes, I’m aware that the term “name-calling” has other connotations that have little do with HIT (OK, maybe a little).

From the questions that appeared in that article and the comments building up afterwards, it appears that there’s a bit of debate among some readers of HIStalk as to whether this alliance really gets to wear the orange jumpsuits and fly the Y-wing fighters. I’m not interested in getting into that debate. However, given my recent self-appointment as the voice (representing nobody) of innovative (self-labeled) startup companies that are seeking to leverage consumer healthcare data in various applications and services, duty calls! Give me just a minute here to adjust my cape. OK, ready …

Is a Patient in HIT a Subordinate Clause of Their Provider?

The quote I want to focus on from the CommonWell article is this one:

A single connection to the CommonWell network will enable providers and the patients they serve to access to [sic] their health information at all those various systems and organizations and won’t require peer-to-peer contracting for each provider you need to reach.

I was busy doing my math homework when we were in English grammar class so I don’t know if “and the patients they serve” is actually a subordinate clause or not. I’ve got a sinking feeling, though, that the high-sounding “serving the patient” expression doesn’t change the fact that whoever wrote that sentence views patient access to their own data as “subordinate” to the healthcare IT vendors and their healthcare provider customers. And nobody can mistakenly think that the “you” in “each provider you need to reach” from the quote above, refers to the patient/consumer.

The Missing Patient Service

I went to the CommonWell services page and I couldn’t find the service whereby a patient can request a copy of their healthcare records from everyone on the CommonWell network.

Interestingly, the word “patient” appears seven times on that page. There is talk of how to “link patients across organizations” and “patient identification” and even “patient-authorized.” But as far as I understood, that all seemed to be in the context of how providers exchange information with each other behind the patient’s back.

In both the body of the article and the comments section, there was quite a bit of back-and-forth about payment models and how the revenue pie should be shared among CommonWell members (vendors), the doctors who contribute the data, and McKesson (the company that got picked to provide the service).

There were also some interesting analogies made to financial transactions. Indeed, I believe there is a whole world of “behind the consumers’ backs transactions” that take place across financial institutions and in other EDI contexts. But at the end of the day, as a consumer, I can get a (free) copy of all of my transactions from all of my financial providers. And I can use a service like mint.com to act on my behalf and make it easier and more valuable for me to do that.

I’m not saying that’s the ideal model, is consumer-centric enough, or (conversely) is directly/fully appropriate for healthcare. But it’s interesting to think about how it works relative to how things are intended to work – and not only in CommonWell – when it comes to healthcare networks.

Curiously, I don’t recall that there was a need for Congressional involvement in order to establish a National Banking Identity for everyone. If I want to establish a mechanism to transfer money from my checking account to my mutual fund account, I set that up and provide the authorizations. As far as I know, the mutual fund company and the bank aren’t part of an “alliance” that provides “identification and linking services” to make sure they correctly match my bank account with my mutual fund account so that they can move information about me between them once they get me to sign a consent form I don’t fully understand while I’m at the bank teller.

What’s Your National Photographer ID?

Given how tough it is to do patient matching (I have a little MPI experience and it really is pretty tough), I’m amazed that Instagram has manage to get as far as they have without a National Photographer ID. How come LinkedIn doesn’t need my National Employee ID and Facebook doesn’t need my National Social Being ID (or my National Annoying Communicator ID for WhatsApp?)

It seems that by some miracle, armed with nothing more than an e-mail address, I can securely and reliably authorize any sharing network I want about my most sensitive information. Oh, wait, there is one catch — I have to be a little involved in process.

If my mom and my wife want to share information about me without me being involved (scary thought) then I suppose they would indeed need some kind of ID and matching process to ensure they aren’t sharing information about someone else when they use their “record locator service” to access each other’s database of information about me. But if I have my information stored with each of them in my e-mail-keyed (and easily validated) account that I maintain with each of them (hey, it’s an analogy, relax) and I authorize the sharing, it doesn’t need an act of Congress to get the information flowing.

This is Not Just a CommonWell Issue

Now if it sounds like I was being disingenuous above about not taking sides on CommonWell while adjusting their Darth Vader helmets, that’s a mistake. As far as I can see, CommonWell is mostly providing a more practical and commercially effective model for what the US government said it wanted to do all along in terms of national health networks – with the usual vendor politics and dynamics in play, as is to be expected.

Whether it’s FHIR as per my previous article, CommonWell in this one, Epic openness debates, or evaluation of data interoperability strategic roadmaps, I think one of the litmus-test questions has to be something like this:

How does your (standard, service, alliance, network, system, strategy, roadmap) empower a consumer to exercise their HIPAA-mandated right to get an electronic copy of their healthcare data and share it with (family, caregivers, providers, research groups, pharmacist, clinic, employer, people who will pay them for it, whoever) whenever they want?

CommonWell may have a better answer to this question than most, but it isn’t shining through yet clearly enough for me in their article on HIStalk or on their web site.

Is that a question from the noble, bright, and good part of the Force? Not necessarily. It’s as self-serving as anything in the CommonWell materials or anything else. I have a smaller company than Cerner to try and make successful, so if anything (deliberately using that word a third time in this paragraph – and breaking the flow of the paragraph – again – so I can generate some loyalty from the commenter who critiqued my problematic writing style in my last article), I can afford to be even less altruistic.

In the interest of transparency, I’m working on a draft resolution for my upcoming board meeting to have our name-calling committee allow me to swap out “CEO/Founder” for “Emperor.” I’ll let you know how it goes.

Brian Weiss is founder of Carebox.

Startup CEOs and Investors: Brian Weiss

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

Are We On Fire Yet? (Or, Where’s the Data?)
By Brian Weiss

A Star(tup) is Born

Healthcare IT startups can often trace their origins to an “Aha! Moment” when a tech-savvy entrepreneur-to-be experiences the healthcare system in a significant way (often, sadly, due to the illness of a loved one) and decides, “There has to be a better way to …” (avoid allergic reactions, make sure medications are taken properly, keep track of blood sugar readings, avoid filling out the same forms over and over in the waiting room, have this doctor know what that other doctor already did, make sure they amputate the correct limb …)

Eureka! A mobile app / web application is born. It will be “just like …” (Facebook, Instagram, Google, Uber,or any other multi-billion-dollar Internet wonder) – except, “It will  be perfect for …” (patients, doctors, caregiver moms,  hospitals, home care …) Not to mention that it rhymes with “ACO” and runs … (on a smartphone, in a cloud, directly on your retina in the next version …)

A related family of startups, loosely termed “healthcare analytics,” often starts with an entrepreneur who is a bit older and more seasoned, has enough business savvy to “follow the money trail,” and whose neighbor’s daughter is in her last year of grad school for the third year in a row. Said neighbor’s daughter says that given a standard blood test kit, a strand of hair, and the first and third letters of someone’s last name, we can “predictive analytics” (yes, it’s a verb — I say so) anything you want about someone’s future medical conditions with proven accuracy of at least 98.7 percent on all predictions for the time period following their death.

Now Let Me Explain …

These great ideas of my younger and hipper friends are predicated on a surprisingly problematic assumption. Namely, that patients (more broadly, “consumers”) have reasonable access to electronic copies of their own healthcare data. If you’re reading HIStalk, I probably don’t need to explain to you what a silly notion that is. Why do entrepreneurs assume this is the case?

First, some of them saw the hip-HIPAA video (or something similar) from Uncle Sam Productions stating that every person in America has a right to get an electronic copy of their records from anybody that maintains such an electronic record (which I think right now is almost everyone involved in healthcare in some way, with the possible exception of Aunt Emma and her world-famous chicken soup, and it’s just a matter of time before she attests for MU Stage 1.)

Throw into the mix some intuitive modern consumer expectations and you can begin to understand (not condone, of course, just relate to in a non-judgmental way) why some of our misguided youth are jumping to the wrong conclusions.

The result is cool apps that work great, as long as everyone either (a) has the actual same clinical data as in the sample data they used in development, or (b) wants to spend a few hours every weekend updating their clinical data manually from whatever scraps of it they can get their hands on.

But fear not! Fortunately for all of us, I now have this prominent published column that one or two of these lost souls might actually read, so here’s my chance to step up to the pulpit and set everyone straight.

My Friends! Salvation is Just One Committee, Acronym, and Decade Away

So, listen up, my young, big-idea friends.

The umpteenth committee in a series that began running before most of you were born is taking care of this problem even as we speak. Like every committee in the series, it includes multiple leading vendors, multiple leading standards organizations, and multiple very experienced (from previous committees – I wonder how the first one was formed?) leading experts.

This is not your father’s Oldsmo-committee. This one (did I mention it was “leading” and “multiple?” Yes, that’s an adjective for real, so I can use it any way I want) is dedicated to one of the principles our great country was founded on (whenever the public funding well runs dry): “More acceleration without regulation.” The original cry of the Boston Tea Party before a focus group said “taxation” and “representation” worked better.

This latest committee is hipper than most, as evidenced by a name taken from Greek mythology. They’ve published a charter that makes it clear they plan to work very, very quickly, so that by 2016 we’ll have a shiny new accelerated standard and then we can figure out if and how consumer data is actually going to be made ubiquitously available with it sometime in the 2020s (is that going to be a hip decade, with a name like that, or what?) for your cool apps.

You’ve got enough seed funding to carry you until then, right?

The new standard (OK, it was actually new quite a few years ago – but not enough people were paying attention back then) is called HL7. No, ASTM CCR. No, HITSP CCD. No, SMART. No, Blue Button Plus. No, C-CDA. No,C-CDA R2.0. No, no, no — it’s called FHIR (rhymes with “liar,” but that’s the honest truth).

The Lessons of Blue Button Plus

I (virtually) know a few Argonauts and some of the other folks who have been working on FHIR for many years. They are incredible folks who are smarter, more experienced, more capable, and more all kinds of stuff than me.

Then again, so were/are the folks who worked on something called Blue Button Plus (it had a bunch of other names like ABBI — I forget more easily at my age) back in what seems like just a few months ago.

Two years ago at HIMSS, there were some slick PHR startups showing off their Blue Button Plus capabilities for fetching data from Blue Button Plus-enabled sites.

I wasn’t personally involved, but I’m told that Blue Button Plus integration meetings were a bit like dating sites with members of only one gender registered. Lots of folks wanted to be Blue Button Plus clients, but nobody was offering to be a server (you can see why I didn’t want to pin down the gender in the dating site analogy – that could get me in trouble with the whole client-server thing).

One of the poster children for Blue Button was (and still is, I believe) MyMedicare.gov. You know what special next-generation data format they use when you Blue Button (yup, another verb I created) your records for re-use? FHIR? C-CDA? CDA? CCD? JSON? XML? If you guessed “ASCII text files,” you’re our lucky winner.

And you know what? That’s actually a whole lot better than what you (can‘t) get from most sites using Blue Button Plus or SMART or any of the other standards and frameworks that promised to deliver MU2-aligned C-CDA (or similar) data with push delivery, notifications, security and authentication, and an App Store-like ecosystem.

It’s Not (Just) the Data Format, It’s the Data Availability

Now I actually know a little bit about some of these standards. Once upon a time, HL7 even contracted me to help write some of their knowledge base articles on CDA and C-CDA.

I’ll send you my rubber stamp so you can add my signature to any learned commission or task-force reports listing what’s wrong with C-CDA. It’s complicated, ambiguous, overly academic, insufficiently documented, lacking examples, has too low a validation bar in MU2. Did I mention complicated?

There’s lots more work to be done on standards. FHIR sounds great. My FHIR friends assure me that in due time it will replace HL7 v2 and CDA, and might even shorten the coffee lines at HIMSS. And I’m told that if you can figure out how to play Candy Crush, you can write a great healthcare app with FHIR.

Don’t misunderstand my feeble attempts and rancorous wit. We definitely need better standards, better guidelines for MU Stage 3, and a better 5-10-50 year strategic data interoperability roadmap for posterity.

Just sayin’ that is not what I think we need most. That honorary title belongs to…. DATA ACCESSIBILITY.

Despite all its flaws, the M2 C-CDA standard we already have is all my fellow startupers (plural noun, yup) and I need right now to do all kinds of cool stuff. Actually, we would do fine with the MU1 CCD (aka “HITSP C32 CCD”). Or the CCR that came before that. Or even the HL7 v2 messaging before that. Or Blue Button Plus, or SMART, or whatever.

But wait. Don’t developers need simple RESTful APIs for their apps (as FHIR will provide)? Of course, but we don’t need another year or two (and I’m not even getting into the debate if those are human years, dog years, or ICD-10 years) to wait for FHIR, just for that.

The translations between whatever other formats are out there and actually available today and the mobile app-ready formats developers will adopt are not the real barrier or issue. My company and many others will try to kill ourselves outdoing one another to provide those more quickly.

The main issue is what is really out there and actually available today in terms of real patient clinical data. And without belittling the importance of how many steps you took today on your way from your desk to the restroom, I mean the clinical data in the myriad of EHRs and similar that contain your more traditional health records, not the stuff from your neon fitness bracelet or your mood ring.

If application developers could reasonably get the “C-CDA over DIRECT” data promised by MU2 and Blue Button Plus from every hospital, doctor, pharmacy, lab, clinic, we’d be flying.

How can I be so sure? Because we’re almost managing today, with a lot less.

If my friends at HL7 and FHIR were shown the minimalistic JSON being returned by early-stage commercial APIs that provide patient portal data to PHR developers, they’d have a heart attack (though they probably wouldn’t know it without the correct SNOMED codes for that condition , which aren’t provided).

The data available today is a hodgepodge of formats, coding standards, semi-structured text, and whatever else you can think of. It’s not pretty, but it’s a whole lot better than what we (can’t) get (yet) from “future standards.”

It’s Not Either-Or

If you ask me (you don’t really have to, it’s my column, so I get to make up both the questions and the answers), getting ubiquitous access to data now is as important to FHIR itself as whatever else is being worked on in Argonaut projects and similar.

“Build it and they will come” works in the movies. Everyone else has to get real-world feedback and iterate to the right solution. Lessons learned from real-word smartphoning (yes, it’s a verb) by consumers with apps running off of C-CDA document data as mandated for delivery by MU2 is as important to the future of FHIR as API connectathoning (ahem) with like-minded geeks.

Of course, focusing exclusively on data accessibility with existing problematic standards, flawed policies, undefined authentication APIs, incomplete code system alignment, and all the other myriad of gaping holes still open isn’t a good idea, either. We need to be working on these issues from all angles simultaneously: standards developers, established vendors, policy organizations, regulators, providers, industry leaders, payers, consumer groups, government agencies, startups, public opinion influencers, and more.

But the funny thing about the future is that you get there a whole lot quicker if you start now.

I think we need a lot more energy and focus on just getting vendors, portal providers, MU2-attesting providers, and everyone still playing hide-and-seek with consumer clinical data to align with both the letter and the spirit of the law. Let consumers get electronic copies of their data in the app(s) of their choice — today.

With apologies to Dickens, I think I might be speaking for a few of the other orphans in the room when I humbly ask, “Please, sir, I want some more consumer-centric clinical data, now.”

Brian Weiss is founder of Carebox.

Startup CEOs and Investors: Bruce Brandes

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

Why Your Pitch Makes You Sound Like Charlie Brown’s Teacher
By Bruce Brandes

Mr. HIStalk was kind to offer me this opportunity to periodically share anecdotes, observations, and insights from my career at the intersection of healthcare and information technology. My goal in writing for HIStalk is two-fold: to support  life-long healthcare folks charged with transitioning from a fee-for-service to a fee-for-value healthcare proposition, and to encourage young tech entrepreneurs who are building important solutions that accelerate healthcare transformation by giving them the best opportunity to succeed, given an array of unique challenges and historical realities.

My first job out of business school, over 25 years ago, was as a sales rep at IBM, which just so happened to assign me to the healthcare vertical. I thought then, “Healthcare is really screwed up. Certainly technology should be able to fix this mess.” While over the past quarter-century we have made some progress moving around the deck chairs on the Titanic, for the first time ever, it is clear that long-awaited, meaningful disruption is beginning to happen.

Subsequent to IBM, I have held sales, strategy, and leadership positions at early and growth stage companies including ESI, Eclipsys, HealthStream, AirStrip and Valence Health. Recently I joined Charlie Martin, a lifelong hospital operator and the founder and CEO of Vanguard Health Systems (now Tenet) to develop Martin Ventures. The Nashville-based firm invests in ideas and innovations that apply integrative approaches that simultaneously improve care, improve health, and reduce the cost of healthcare. Being a part of Martin Ventures has lifted the curtain for me on the venture capital and provider mindsets, which entrepreneurs must appreciate to build a successful business.

Having delivered thousands of presentations over the years, I am now on the other side of the table. I sit in the audience with my "investor hat" alongside long-time healthcare executives. The first observation I feel compelled to share is about your pitch deck (this also applies to sales presentations from vendors to prospects). 

To you, your message is unique and compelling. To your audience, this is the 20th presentation they have sat through this week with people who look just like you and are saying the same thing. Add to that, they have had a history of being misled by exaggerated claims, so skepticism is in the air even if they manage to stay awake while you read your slides.

At a recent conference with rapid-fire presentations from aspiring and emerging digital health entrepreneurs, Charlie (who has been building bricks-and-mortar hospital systems for 50 years) leaned to me and commented, “I don’t understand why anyone in the US still has diabetes. All these people have already solved the problem.” That is my point — you all sound the same!

My favorite TED Talk is a popular one from Simon Sinek, who reminds us that, “People don’t buy WHAT you do, they buy WHY you do it.” Reflecting on and embracing this idea may help set you apart.

When I was at AirStrip, shortly after our founders presented behind Steve Jobs at the 2009 Apple Worldwide Developers Conference, we had the opportunity to meet leading investors as we searched for our first round of growth capital. Prestigious Silicon Valley venture capital firms had a placeholder for several years for a portfolio company to address mobility in healthcare, having passed on everything before AirStrip.

As we built a relationship with the partners of a prominent Sand Hill Road firm, I later learned that it was not the content of our presentation (which we painstakingly developed for weeks) that attracted them to the company. Our allure was less about how we had built a broad platform for mobility specifically for healthcare or that we had proven the concept in obstetrics with a compelling value proposition.  

The investors were more interested in investing in the technical and clinical credibility, passion, and commitment of the founders to eliminate the geographical and informational boundaries that had historically hindered doctors, nurses, and patients from delivering and receiving the best possible care. People don’t buy what you do, they buy why you do it.

As a call to action, focus on how to set yourself and your organization apart from others – at your core, not just in your presentation – but, good grief, for the sake of your audience, at a minimum step up your game in how you present!  

A little guidance: 

• Understand your audience well enough to meet them at a common baseline so you do not waste time telling them information which they already know.
• Cut the number of slides in your deck in half (if you must use them at all) and ensure their purpose is to support your having a conversation with your audience, not to distract from it.
• Tone down wildly speculative claims about the market, potential ROI, forecasted revenues, etc.
• Be honest and realistic. Sincerity, insight, and integrity make a much stronger impression than telling your audience what you think they want to hear

Most importantly, read your audience to see if they are hearing what you are trying to convey, or if instead you are coming across as Charlie Brown’s teacher: “Wah, wah wah, wah wah wah."

Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

Startup CEOs and Investors: Marty Felsenthal

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

The JPMorgan Healthcare Conference
By Marty Felsenthal

It’s bigger than the Super Bowl, the World Series, the World Cup, and the Winter and Summer Olympics. It’s more important than the BCS Championship game (particularly if you’re from Florida or Alabama) and maybe even the Famous Idaho Potato Bowl, the Scottish Highland Games, and the Cooper’s Hill Cheese Rolling and Wake Competition combined (unless you are from Idaho, Scotland, or, of course Gloucester, England).   

My name is Marty Felsenthal. I’m a middle-aged, workaholic healthcare venture capitalist with thinning hair and a thickening mid-section. Mr. HIStalk asked me to write a little bit about the JPMorgan Healthcare Conference taking place this week in San Francisco and to describe it for readers who have never attended. 

My life’s greatest joys and accomplishments are increasingly defined by (a) finding great post-holiday sales online; (b) the "sports" achievements of my nine-year-old, boy-girl twins, and occasionally, my seven-year-old daughter; and (c) by the nights my wife actually laughs at a joke I make rather than thinking I’m a workaholic, balding, overweight man who she periodically tries to pull a Chief Bromden on and pillow-suffocate for snoring in my sleep.

Since that is increasingly my life, the JPMorgan Healthcare Conference is actually a big deal for me. But it wasn’t always that way.

The conference has been taking place for decades. In fact, it used to be called the Hambrecht & Quist Healthcare Conference prior to H&Q being acquired by JPMorgan. But for decades, it was really dominated by drug companies, biotechnology companies, and medical device companies. On a relative basis, there was just less growth and innovation in healthcare services and healthcare information technology and, as a result, less investor interest.  

For clarity’s sake, I should point out that I’ve been a healthcare-focused venture capital investor for 18 years and work exclusively with what we hope are innovative healthcare services and healthcare information technology companies. This year, our firm will be hosting a reception during the conference for other venture capital firms who invest in healthcare services and healthcare information technology.  

This will be my twelfth consecutive year of co-hosting this reception. There were years when we had fewer than 30 venture capital investors show up. There was just nothing sexy about investing in venture-stage healthcare services and healthcare information technology. I was like the Kevin James of the JPMorgan Healthcare Conference.  

This year, however, we have over 150 venture capital investors attending and had to turn a number people away at the threat of the fire marshal. This year, I’m like the Kate Upton of the conference — actually, let’s say the David Beckham of the conference (and maybe with a lot of help from Photoshop, that could actually be the case). 

When did it change and why? That’s easy.  2009 and 2010 when the HITECH Act and Affordable Care Act were passed. They were catalysts for innovation in "my" sectors unlike anything I’ve experienced since I first got involved in healthcare in 1992.

The conference itself is held at the Westin St. Francis on Union Square. It’s a forum for hundreds of public healthcare companies and an increasing number of not-for-profit healthcare systems and health plans with public debt to present to mutual fund and hedge fund investors. These companies include drug and biotechnology companies, diagnostic companies, medical device companies, healthcare services companies, and healthcare information technology companies.  

JPMorgan is also increasingly inviting a number of still-private companies to present. My firm is fortunate to have a few of these — Teladoc, Redbrick Health, and Vet’s First Choice. I unfortunately don’t have a chance to actually go into the conference and listen to these companies present any more. I wish I did.  

The presenting companies are among the largest and most influential players in the US healthcare ecosystem. They include UnitedHealthcare, Wellpoint, Aetna, Cigna, Centene, and all the major health plans. They include large health systems such as HCA, Tenet, Geisinger, and Banner; pharmacy chains and PBMs such as Walgreens and CVS Health; and most of the country’s most influential health information technology companies, such as Cerner and Athenahealth.  

These companies are talking about much more than their financial performance. They are talking about their strategies and how they are evolving in the face of the huge changes sweeping across our health care system. They are talking about their efforts to help reduce healthcare costs in our country, to improve quality, to improve the consumer experience, and to help lay (or take advantage of) the healthcare information technology backbone so we can transition to a more value-based environment. They understand that, in the current environment, they have to adapt and innovate to survive and thrive, and this is what some of the largest players in the US healthcare ecosystem are presenting and discussing.

Unfortunately, I don’t have time to go into the conference any more. I won’t even have a chance to see our portfolio companies present. As the customers of our portfolio companies (broadly speaking, health plans, hospital systems, pharmacy chains, HCIT companies, distributors, etc.) have started needing and demanding more innovation, more innovative companies have formed to address these needs. These companies need capital. They need investment bankers. They need management teams. They need executive recruiters.

All of these constituents — many of whom are old friends from my days as "Kevin James" and many new to the industry as we became cool — descend upon San Francisco during the conference to network, to catch up, to search for new jobs, to craft business partnerships, to look for capital. There is as much if not more action taking place outside the Westin St. Francis as there is taking place in the actual conference.

At Mr. HIStalk’s suggestion, I took a look at my calendar. This is my week. I start at 5 p.m. on a Sunday, and from there, I am booked solid every hour on the hour, breakfast through dinner, until Friday at 10 a.m. 

I am meeting with seven investment bankers. These investment bankers know and represent many wonderful entrepreneurs and companies who are in need of capital (capital that we can provide). They are also looking to represent companies we invest in when they need more capital and/or want to sell their businesses or go public.  

I am meeting with six other venture investors/firms. These are organizations that we co-invest with already or that we would like to co-invest with. We talk about opportunities to work together within our existing portfolios, companies we are currently evaluating where there might be an opportunity to invest together, and areas of innovation of mutual interest.  

We have more than 20 meetings with executives from some of the largest health plans, pharmacy chains, distributors, HCIT companies, and hospital systems in the country. We’ll talk about innovation. We’ll discuss our portfolio, trends we’re seeing in the marketplace, and interesting companies we’re seeing. 

I have meetings with three entrepreneurs who just want to network or who are looking for new opportunities. I’m getting together with Pete Hudson, the very talented founder of iTriage/Healthagen, with someone who was formerly a senior executive at McKesson, and with a former senior executive from HCSC. 

We also have an opportunity to meet with more than 10 innovative companies that are seeking capital. For obvious reasons, I can’t name them, but they are providing analytics for health systems and provider groups, and they are developing novel insurance exchange platforms. They are developing tools that deliver better provider quality information to consumers. They are helping health plans manage patients with certain types of high-cost chronic diseases (in one case we’re particularly excited about, a very large problem that no one has previously tried to target), and they are helping hospitals lower labor and equipment costs and are also facilitating better patient collection efforts.  

Unfortunately, the meetings during the conference are always too rushed, but there are two highlights of the week for me. The first is getting to sit down with these great entrepreneurs seeking capital and learning about their businesses. Occasionally this leads to an investment, as was the case with a digital pathology company called Aperio that we met with at the conference in 2007.  

The other highlight is getting together with the large healthcare companies and learning about where they are looking for innovation. One of the most satisfying aspects of our job is when we actually help young companies develop relationships with these large players. It’s a lot of fun to try to marry the young, nimble, aggressive (and sometimes naive) startups with the large, sophisticated, complex, highly influential (and sometimes slower-moving) titans of our industry.  

Unfortunately, there are also lots of people and companies I don’t get to meet with during the conference. People have started reaching out to schedule meetings during the conference as early as November now (for a conference that takes place in January). This leads to a lot of calls the first and third weeks of January with the people I couldn’t meet.  

So in short, it’s a hugely productive week of networking. We learn a lot. We get to help drive revenue to our portfolio companies on occasion. We reacquaint with old friends. We meet new friends who might someday work with our portfolio companies or partner with them. If we’re lucky, we find a new investment.

When the week is over, I go home feeling like the rock star that is David Beckham. I grab a drink. I crack a joke to my wife, I get ready for my Posh Spice, and then I usually fall asleep and start snoring, which often coincides with her trying to suffocate me.

Marty Felsenthal is a long-time venture capital investor who invests in and works with growing healthcare information technology and healthcare services companies and has been attending the JPMorgan Healthcare conference since the 1990s.

Startup CEOs and Investors: Brian Weiss, Carebox

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

Delivering Opening Lines
By Brian Weiss

My name is Brian Weiss and I’m the founder of a healthcare IT startup.

I’ve got these really great ideas about how to make everyone healthier, solve healthcare data interoperability, enable payment reform, advance clinical research, leverage big data to fix the US healthcare systems, make the world a better place, and create a billion-dollar company. Oh, and did I mention it all runs in the cloud?

You’re not really buying that, are you? I don’t blame you. It’s not a very good opening line.

Opening Lines

I’ve spent much of the last few months delivering opening lines – to (potential) investors, team members, strategic partners, pilot customers, editors of healthcare IT publications with proper-capitalization fetishes …

It’s not like I’ve never delivered an opening line before I became a startup founder. In everything we all do, there’s always a first line, a first slide, an opening paragraph, a first impression, a useless abstract class at the top of the object model hierarchy (what, I’m the only former software engineer in the room?)

I’ve had to pitch ideas, sell things, present solutions, and introduce myself many hundreds of times. No, I haven’t ever written a column in a publication like HIStalk (is there even such a thing?) But I’ve delivered really bad opening lines countless times! I’m even experienced enough to know it’s not the end of the world. At various times in my past, I’ve somehow managed to get hired, promoted, selected in an RFP, invited back to a conference, and even married, despite being opening-line-challenged.

So why am I having such a hard time writing this column’s opening?

Matchmaker, Matchmaker, Make Me A Match …

Today, I’m attending a “Matchmaking Session” in New York as part of the ONC Market R&D Pilot Challenge. To help encourage innovation around some of its strategic priorities, ONC is sponsoring a contest that will select six winning pilot projects. Each pilot proposal has to be presented jointly by an innovator (an early-stage healthcare technology company) and a host (an established healthcare organization operating in a clinical environment). To help match up hosts and innovators, there are three of these matchmaking events taking place over the next few weeks.

If “matchmaking session” sounds like something from “Fiddler on the Roof,” you’re on the right track. The format here is speed dating for startups, commonly used at events that bring together startups and investors. I will have 13 minutes to woo my date(s).

They also sent me a colorful one-page tip sheet to help me prepare. It seems they think I will do a better job if I make an effort to have a clue in advance about the company I will be meeting with, make my presentation engaging, explain what I do, and say something about my team and business model. And, they suggested that I practice in advance.

I’m being a tad cynical about their tip sheet. I suppose it’s pretty good advice… for presentation beginners.

My Kindergarten Artwork

My memory from when I was five years old is probably flawed, but I think this is close to being a direct quote from my kindergarten teacher to my parents about my artwork: “Brian is trying hard and we don’t want to discourage him. The important thing is to keep at it.”

A couple of weeks ago, I was in a meeting with a senior executive at an important partner of ours. It was a preparation meeting in advance of a larger meeting she had coordinated in which I would be presenting my startup to other leaders at her company.

I showed her what I had prepared. In a very polite and cheerful way (curiously reminiscent of the disposition of my aforementioned kindergarten teacher), she told me (in not so many words) that what I had prepared for the meeting clearly showed I was trying hard and she didn’t want to discourage me, but the important thing was …

… to just say very concisely what the problem was we were trying to solve, what our solution was, why it was good for her company, why we could do a good job, and “then just show them the demo.”

I dusted off my ego, did my best to do exactly what she suggested, and I thought it went pretty well.

I’ve coached others with similar advice countless times. Why did I need to be told that now?

Introductory Presentations

Last week I had a call with the CMO of a very large healthcare organization, which I can barely allow myself to dream might one day be a partner of ours. The call lasted less than 15 minutes.

Just as I was concluding my build up to Slide 1, he said he was already on Slide 8 and asked me a couple of short questions. Then he told me it all looked pretty clear, sounded interesting, he would do some checking internally, and get back if they were interested in hearing more. He got back to me the next day about setting up a follow-up meeting to go into more detail. We’ll see where it goes.

I’ve done 10s of similar calls before that one. They run 30-60 minutes and my results generally weren’t as good. I now have a much better presentation than I had before and the obvious advice I got a few weeks ago was clearly something I needed to hear.

What’s Different/Special About That?

My column will only be worth reading if I have unique and valuable perspectives to share with you that emanate from the fact that I’m a healthcare IT startup CEO, not just some guy who has to get better at introductory presentations and opening lines.

Can I do that? I’m not really sure – and this might be a very short-lived column.

For now, I just want to share with you why (I think I’ve figures it out) I am now having experiences like the ones above that sound like something out of “my first days a junior salesman” – when I am quite certain I knew how to do an effective introductory presentation many, many years ago.

Starting Up Means Starting Over

Each step in our career generally lets us build on the previous ones. When I was EVP/SVP/pick-your-favorite-letterVP of products, my title, the company and organization I represented, the many people working for me, a ton of support infrastructure — all came through the front door with me.

But it’s even more than that.

Once you get your degree, you don’t have to pass your mid-term exams anymore. But could you if you had to? On the way to the where you are today in your career, you probably paid your dues on many rungs of the ladder. But could you go back and do a good job at each level again, now?

When you are given a new challenge today, is it really all that new? Or is it a natural evolution of what you do today that lets you relatively easily carry over your skills, expertise, experience, and credentials?

I’m no longer the exec who gives good advice to others about how to structure their presentations. I am the junior salesman getting better at making a pitch. I’m the guy at the ONC matchmaking event who needs the tip sheet. I’m the guy working on the template, the web site, the demo, the story. Everything I do starts with a blank piece of paper. I’m the guy who now needs the feedback that people who do that kind of stuff get.

The fact that I could do a good job presenting as a corporate exec doesn’t mean I can do a good job presenting in this context. The fact that I could give advice to others about the kinds of presentations I am now making doesn’t mean I don’t need to hear that advice myself from others, now.

Whatever I think I’ve learned or accomplished in my career to this point only matters if I can translate it into something concrete that helps me better do the stuff I need to do now. That’s always a true statement for all of us, but it takes on a whole new meaning when you have to do something that isn’t a natural evolution of what you did yesterday.

What Is This?

Two weeks ago, Mr. H put out a call for a "startup CEO or a venture capitalist who wants to share their keen insight and sharp writing skills with the world."His intent, I believe, is that this column provide interesting and different insights and perspectives for the many HIStalk readers who are employees in established companies and interested in getting an insider view of the world of healthcare startups.

I told him I qualified as, “A startup CEO who wants to share” and we could see about the rest.

The column I’m planning to write (exact frequency to be determined) will draw from both agendas – the healthcare IT topics we’re focusing on and the ups and downs of the stages in the growth (I hope) of a startup – with a special emphasis on where the two meet.

I’m a beginner column writer. I hope to not completely disappoint relative to Mr. H’s objectives. If you’re able to suggest topics, approaches, improvements, etc. that can help me do that – I’d be most grateful. You can write to me directly.

Brian Weiss is founder of Carebox.