Ideas Worth Pursuing | E. 108

The Healthcare Leadership Experience

Tech startups are predicted to disrupt US healthcare in 2024. Scott Nelson, co-founder, and CEO of venture backed FastWave Medical, offers his strategies for success in innovation with Jim Cagliostro.

Episode Introduction

Scott reveals the two signs that an idea has potential, why market trumps everything in innovation, and why leaders should focus on eliminating pain points for their end users. He also advises innovators to connect with potential strategic acquirers at an early stage and explains why leaders of startups shouldn’t put all their eggs in the venture capital basket.

Show Topics

• Two signs of a good idea

• Market ultimately trumps everything in innovation

• Engage with potential strategic acquirers at an early stage

• Finding investment in your community

• Flipping the script: eliminating pain points

• Effective ways to raise capital

• Leaders of startups don’t have to be the CEO

05:49 Two signs of a good idea

Scott said there are two things for leaders to consider in innovation.

‘’I guess to answer your question in a little bit more long-winded way, I would say if you've got an idea that you can't seem to shake a little bit… It's sticky and you find yourself maybe waking up at night thinking about it or you thought about it and then two weeks ago you're still thinking about it, maybe a month goes on, you're still thinking about it, that's usually a good signal. Maybe there's something there, but the most important point from my perspective is before you go too far, before you get too latched onto this idea, you really need to think about two things primarily. One, does it solve a real glaring problem? Is it a painkiller? I remember interviewing Dan Hawkins way back in the day. He was actually the founder of Shockwave, the company I mentioned previously, was very early at Intuitive Surgical, was the founder of Avail Medsystems, et cetera, serial entrepreneur. And he phrased, this was back in, I think 2016 or 17, but he mentioned finding a painkiller, not aspirin, not Tylenol, but a real painkiller, something that really causes a lot of pain, whether that's from a cost perspective, whether that's from a workflow perspective, but something that's like, there's a lot of friction there. That's what your idea hopefully solves for, a real painkiller. And then secondarily, if you think you're onto something that solves that real pain point, secondarily, you need to think about this as early in the process as possible. Who's going to pay for it?’’

09:03 Market ultimately trumps everything in innovation

Scott explained why market is the #1 factor for potential entrepreneurs.

‘’I sort of fundamentally believe that market ultimately trumps everything else, right? Now, don't get me wrong, you could have a great product and a great team, but if it doesn't serve a huge market, you're going to have to think about other ways to fund that, right? Maybe it's a product that you can invest your own money in. Maybe it's a product that you can get to market quite quickly and use revenue and profits to support the company's growth, etc. But the reality is you need a big market to serve in order to give you optionality to capitalize and fund your idea or fund the company moving forward. So I do kind of think market trumps everything, because again, you could be working on a great product, have an awesome team, but if the market just doesn't support it, it's likely not going to have a lot of substance there. On the flip side, you could have an awesome market and maybe a decent product and a decent team, but it's probably going to do fairly well because the market supports that need. So, long story short, there's a couple of different ways to think about it. They're all important. ‘’

12:38 Engage with potential strategic acquirers at an early stage

‘’Obviously you need to be careful and cognizant about not disclosing too much, but the imperative is really to start engaging early on with those, what you perceive as potential strategic acquirers, really under the guise of just an introduction. You're not trying to sell them anything. It's a dating process. You're trying to get to know them, inform them of what you're building, what you're working on, so at least have a high-level idea. And as you continue to make progress against your idea and against your milestones, keep them informed. Not just them, but hopefully potential investors, people that... stakeholders within your community. You want to be communicating the progress that you're making against the idea or the product that you're building. So I can come full circle on your question. I just think it's really sometimes underappreciated, and it's actually a tip that I picked up on from Duke Rohlen, he's the founder of Ajax Health, serial entrepreneurs, had multiple exits under his belt, but he mentioned this, in an interview maybe close to 10 years ago now that I had with him. That was one of the things that he really focused on with some of his early wins is really an evaluation of all of the players in a certain market and what are they missing? What are the gaps in their existing portfolios? And he put together a matrix, and that helped think about how his product could potentially fit into the portfolios and where it fits with the broader space, if you will. And so that I think is sometimes maybe a little bit underappreciated from most founders and CEOs that are highly focused on their idea.’’

14:38 Finding investment in your community.

Scott said your community could be the source of potential investment.

‘’Generally speaking… you want to engage with your community as early as possible. In your community could be your end users of your product. Your community could be the payers. Your community could be investors. Your community could be those likely potential strategic acquirers. You need to be engaging with them early, having a lot of conversations early under the guise that you want to let them know who you are, what you're building, what you're working on, and you want to keep them informed on your progress, right? Because if you can demonstrate over the course of six, 12, 18, 24 months that you delivered on what you said you were going to do, that's probably the most impressive thing that you do. You could present a fancy pitch deck, you could have an awesome advisory board. Your product could actually be quite cool, but the thing that's going to stand out is your ability to execute against the things that you say you're going to execute against. That's the most impressive thing. That's always going to stand out to strategic acquirers, investors, even your end user stakeholders. So I really, really think it's important.’’

18:41 Flipping the script: eliminating pain points

Scott said the key question to ask yourself is how your idea makes life easier for your end users.

‘’I think oftentimes we might want to flip the script a little bit and not necessarily think about our idea, our technology, offering so many more benefits and so many more improvements. Actually, what does it eliminate from the workflow? What pain points, what friction does it take away from my end users to make their life more simple, more easy to use? And hopefully through that process, we're delivering on those cost savings, right? Because so many times, especially in MedTech, and rightfully so in some scenarios, we think about how to get a pricing bump, or a pricing increase. In reality, your business model might be just delivering a slightly better product, but at a very attractive price. A Costco model. So that's not a bad play. And if your wheelhouse is really more around maybe cogs optimization or supply chain management, and that's what you really know well, there could be some great ideas in there where you can just simply deliver a good enough product, maybe slightly better, but just at a very attractive price. And that could be a phenomenal idea. And so I think those are a couple of things that I would think about under the guise of how do I differentiate myself versus competition? Don't think about your product doing so many great things. Think about how it can remove friction in a process and make your end users' lives more simple, more easy, less stressful. And then maybe just as important, how can it remove costs from the equation?’’

22:30 Effective ways to raise capital

Scott said innovators need to be thinking in terms of major milestones about fundraising.

‘’ I'll probably say fairly high level, but I really would encourage everyone to think about how they're raising capital. Think about it in cycles, if you will. You want to raise enough capital, ideally, not too much per se, but not too little either. But raise enough capital where you can achieve the next major milestone in say, 12 months. And you need to make that very, very clear to all your potential investors, this is what we're raising our money for. This is the next major milestone that we're targeting. So being very, very clear about that and kind of thinking about your fundraising and tranches, if you will, like that. And again, it is really very important. Yes, you want to be in a position where you don't run out of cash for sure, but you also don't want to take so much money upfront that you get so diluted that will impact future fundraisers. So yes, think about these near-term milestones. Those are crucial, but also think about how those may impact the next fundraise as well. So I definitely want to, I'd like to start out there because I think it's a point worth emphasizing for anyone that's working on early stage technology.’’

26:03 Leaders of startups don’t have to be the CEO

‘’I think as leaders of startups, you don't necessarily have to be the CEO. If you're in some sort of leadership capacity within an early stage company, I would just keep in mind that when you're trying to direct your team and push the ball forward, but you're pushing in essence a boulder uphill with a lot of friction, momentum is crucial. So as a leader, you need to keep that in mind, is do everything within your power to keep the momentum going forward. There's always going to be trade-offs as your company evolves, but ensuring and optimizing for momentum, that's so, so crucial. So that's probably one of the things that probably stands out most as part of this broader startup idea.’’

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You’ll also hear:

Three things for every innovator to consider: ‘’As your idea begins to evolve and begins to take shape, you need to be thinking about…what product am I building? What market does it serve? And who's the best team to effectively build this?’’

One key piece of advice for startups: ‘’As a startup, if you're working on an idea, the most likely scenario for a potential liquidity event is an exit to a strategic acquirer.’’

The blurred line between payers and providers: ‘’Once my technology is approved or cleared by the regulatory body and I'm ready to sell, then I need to think about who's going to pay for it. Well, the reality is … the lines between payers and providers, is really, quite blurred… They ought to know who you are and what you've been building for hopefully months, if not maybe a couple of years.’’

Don't put your eggs all in the traditional VC basket: ‘’If you're so highly dependent upon traditional VCs, likely they're going to get squeezed…. So the onus on founders, CEOs, in terms of fundraising is to keep a lot of options on the table, go far and wide. It's a lot of work.’’

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