Akhsar Kharebov

The (Healthcare) Ground Beneath Our Feet… This year it is likely that over $10 billion will be invested in the digital health sector – a robust amount, no doubt, but inconsequential when compared to the amount of capital tied up in healthcare real estate assets, which is estimated to be $1.2 trillion by Jones Lang Lasalle. Of that amount, approximately $790 billion is in the hospital sector while the remaining $490 billion is in medical office assets. It is estimated that there are 48.6k facilities with 3.4 billion square feet of healthcare real estate, 42% of which are owned by REITs and another 33% held by other private investment vehicles. Much of the digital health investment is meant to make the physical healthcare infrastructure more productive: greater operating efficiencies, greater patient throughput, more relevant personalized care models with better outcomes. As the healthcare system is being pushed to be more distributed to lower cost sites of care, accelerated now by the rapid proliferation of automation and AI capabilities, the potential impact on healthcare infrastructure assets will be profound. Thoughts on what that might look like... https://lnkd.in/eTfAdUbS #digitalhealth Flare Capital Partners

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Someone broke down the estimated costs of a $15 Sweetgreen salad. We need these cost graphics for digital health to help future founders. Especially for tech enabled cos, the greatest cost is labor. Much of the "value created" is in curation and matching, which means the gross margins are reliant on labor arbitrage. Pay someone $X, but get paid $X+Y% per visit. The challenge with healthcare is that you often have to pick one of two business models: 1. specialized, low volume, high cost, low gross margin % 2. generalized, high volume, low cost, high gross margin % I'd argue founders should focus on gross dollars over the lifetime of the customer (like Jeff Bezos said) instead of gross margin %'s, but we'll leave that for another time. The challenge is that many tech enabled digital health cos have high cost of goods sold (labor) and moderately high product, design, and engineering budgets. We must build differentiated solutions for patients, clinicians, and clients to be out incumbents, however, we're realizing that companies are ultimately valued on the discounted value of future cash flows. And the high SG&A costs at most organizations might be inbalanced to the unit economics of the business. I'm not sure the math pencils out for everyone unfortunately. But I'm just a guy on the internet, would love to hear the thoughts from those smarter than I (you!). Comment below. --- p.s. I have no idea the accuracy of the graphic and not an investor in Sweetgreen. Cheers. Credit: David Crowther

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Hot take on a lot of early-stage digital health companies out there: You're not a tech company. Most tech-enabled care companies I've seen over the past two years are only tech-enabled in the sense that they use telehealth as their delivery mechanism for care. There are exceptions to this, of course - companies who build computer vision and applied AI tools to better the doctor-patient experience, companies who build tooling around risk scoring and stratification to enable more personalized medicine, companies who build truly novel intakes to better route patients to the appropriate care, etc. These companies have real technology chops and, if they sell it right to the market, can get credit for this from investors. But if you're truly a telehealth provider, you need to realize now that the goal post has shifted dramatically from 2021 and you're going to be valued at maturity at something like 3x EBITDA. That's profit. Not revenue. Throw a revenue multiple out the window. That's not the world we live in if you're a virtual doctor's office. Think of how that impacts venture math. If you're raising a seed round at $15M post-money (or $12M pre-money), it means you'll have to generate something like $150-200M in annual EBITDA to be a fund returner for your seed investors. Maybe even more with dilution, since telehealth businesses are not traditionally capital efficient and will likely need to raise material additional capital to reach that scale. You need to be ridiculously profitable (probably on $800M-$1B in annual revenue since you're likely going to be a 40% gross margin business). Here's the good news: you can set yourself up well (and probably be a contrarian founder relative to your peers), by talking about EBITDA growth and how you can grow into a fund-returning outcome based on realistic mature market comps. This will stand out for the investors you're pitching, even at the early stage. This is how you can beat the malaise of the tech-enabled care market. Focus on the right metrics and the right type of growth. You don't have to have all the answers (no founder does), but you need to make sure the ship is headed in the right direction. A focus on profitability for "tech-enabled care" (*ahem* telehealth) businesses is a good first step.

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Excited to announce Frist Cressey Ventures' investment in Qualified Health and privileged to partner w/ SignalFire, Healthier Capital, Town Hall Ventures and others!   Healthcare costs are increasing at a faster rate than ever before, with the US spending nearly twice as other wealthy countries and still ranking bottom in outcomes. It's a story you've all heard - - US healthcare is known for astronomical inefficiencies, waste, workforce supply constraints, fragmented access, appalling patient experiences, and driving patients and businesses into debt.   Yes these problems present opportunities. But opportunities are limited to the system's appetite for change, desire and incentive to try something new and the innovation available. At FCV we believe we've hit the trifecta with Generative AI. Generative AI has given us truly transformational tools in the toolkit and the healthcare ecosystem is demanding to absorb its benefits. This perfect collision of supply and demand means healthcare is poised for big change.   Generative AI is everywhere, it's buzzy, it dangles hope and opportunity. But many things need to be true for the Gen AI transformation in healthcare to take hold, such as but not limited to:   💡 Patient lives and data need to remain safe: We believe in a highly regulated and human life-touching sector such as healthcare we must ensure Gen AI can drive to unrivalled savings and improvements in the quality of care WHILE not putting patient lives or data at risk.   💡 Systems need to own their utilization of Gen AI: We believe systems will use some hybrid of external partners and homegrown solutions but importantly will want full control of data provisioning and utilization as well as the ability to solve an unlimited number of nuanced issues and not cookie cutter algorithms.   💡 Costs need to be looked at on an enterprise level: We believe the speed of innovation in Gen AI means costs will continue decreasing dramatically but at an enterprise level this will still not be a small detail. Systems will want the ability to understand costs and delegate as needed for the outcomes desired at the organizational level.   Enter Qualified.   We knew when we met Justin Norden, MD, MBA, MPhil and team we were standing in front of changemakers. These individuals have lived and breathed the true application and implementation of Generative AI far before we were asking ChatGPT to write our emails. In fact, if you’ve ever driven in a Waymo you’ve benefited from past products this team has built.   Qualified Health is on a mission to enforce governance in Gen AI, allow systems to rapidly build for their needs, monitor and make decisions for all GenAI (homegrown and external) and accelerate the value the sector can glean from these new technologies.   Huge shout out to William T., Tommaso Auerbach and Jamie Kuntz for their hard work!

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One of my proudest moments as an investor occurred today as Alaffia Health announced its series A because it shows how the Aperture® Venture Capital vision of multi-level, multi-generational #impactinvesting is succeeding in the marketplace. Here’s the model in its most basic form : ✅As diverse fund managers with meaningful capital to allocate, we are changing the VC landscape every day just by doing our day jobs. ✅As Black/Brown investors with ~40 years experience collectively, Aperture GPs have access to talent /excellence that others do not, so our portfolio *organically* is more inclusive by race, gender and geography even while optimizing for financial outcomes (all about the alpha). ✅Our most successful portco’s are using financial #innovation to solve market problems that impact underrepresented demographics and underserved communities. Alaffia Health is a shining example of the impact portion of our overall fund thesis, and we couldn’t be prouder of TJ Ademiluyi and Adun Akanni, MPH, PMP - the dynamic brother-sister founder duo whose vision we have steadfastly supported on their journey. Congratulations to TJ and Adun from William Crowder and myself, as well as the whole Aperture team- Marjorie King Philip McKenzie Yves Louis-Jacques Tanvi Lal Michelle Dhansinghani Lisha Bell Katie Kelly Amy Chung Cindy Chong, CFA Brian Fernandes-Halloran Monroe France Jayden Pantel Darren Herman Evan Wladis Neal Triplett Thomas Scriven Peter Ammon Irina Bit-Babik Tim Milanich Rob Rahbari

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Incredibly excited to share our updated Healthcare AI thesis. This is not a market map – in 4,000 words, we dive deeply into the research, products, business models, and market entry points that are reimagining healthcare with AI. More specifically, we cover: • Translating AI research into real-world products • Mapping modalities (software, copilots, agents, services, diagnostics, therapeutics) to problems in healthcare • Designing AI business models that unlock billion-dollar markets • Closing current gaps in healthcare AI infrastructure • Distinguishing AI platforms from point solutions Let us know what you think ⤵️

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AI and Med Tech in Focus   AI System Developed to Identify Pathology in Tissues Engineers at Washington State University have developed an AI tool that uses images of human and animal tissue to detect abnormalities faster and more accurately than people. The AI algorithm was trained using images from past studies that involved kidney, testes, ovarian, prostate, breast and lymph node abnormalities. The new model detected disease in minutes—current processes take humans several hours and require specialized teams to check each other’s work. It was also found to be more accurate, sometimes detecting instances that humans had missed. The engineers designed the system to handle the processing load of the high-resolution gigapixel images by breaking them down into smaller tiles but still retaining the overall context of the tissue sample—akin to the zoom feature on a microscope or phone camera. Aside from getting diagnostic results more accurately and quickly, the new system also shows promise in epigenetics (the study of molecular processes that change gene behavior without changing underlying DNA). Epigenetic researchers can perform analyses and get results that used to take a year or more in just a couple of weeks. VC Investors are always adjusting their "Play Book" with a variety of options for investing. Mikal Ventures is one of those alternatives, offering curated solutions to real world problems. Reach out if you have questions on how we can be of assistance and bookmark https://mikalventures.com/ for additional insights and information.

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Reimagining Healthcare Workforce Platfforms: Turning Capital Into Labor The future isn’t just about filling shifts. It’s about scaling labor intelligently, driving better outcomes for systems, staff, and patients alike. Andreessen Horowitz and Alastair (Alex) Rampell reinforced this Vision in a recent post and it applies to the next phase of healthcare workforce evolution. Healthcare workforce marketplaces plus AI are at the tipping point of transformation, evolving into systems of record that don’t just manage labor—they optimize it. Much like EHRs centralized patient care data, these marketplaces can centralize workforce operations, aligning talent supply with clinical demand. But there’s a bigger opportunity here: turning capital into labor. Here’s what I mean. Historically, industries (including healthcare) have focused on enterprise computing tasks—streamlining data entry, compliance, and back-office functions. While valuable, this approach often stops short of transforming the real-world, repetitive processes that make up the bulk of work in healthcare. Think beyond enterprise software. The next frontier lies in leveraging embodied AI and workforce marketplaces to automate and enhance labor-driven processes, transforming capital investments into productive labor outputs. For healthcare, this means turning staffing costs into scalable, dynamic systems that deliver value far beyond filling shifts: 1. Dynamic Labor Matching: Capital invested in marketplace platforms enables real-time matching of labor supply with patient demand, replacing outdated scheduling models with predictive, automated systems. 2. Workflow Automation: From credentialing to compliance and shift bidding, embodied AI can streamline traditionally manual tasks, freeing human resources for higher-value work. 3. Labor as a Strategic Asset: Workforce marketplaces shift the focus from static staffing budgets to proactive labor deployment, ensuring that every dollar invested in labor drives outcomes and efficiency. It is about the billions of repetitive, planned tasks that AI can improve. In healthcare, that means automating everything from staffing logistics to clinical task assignments, creating a horizontal system of engagement for labor (think Zendesk) that integrates seamlessly with vertical, workflow-specific platforms (think Toast for staffing operations). The result? Hundreds of billions in untapped market potential—and a healthcare workforce model that transforms how care is delivered. By turning capital into labor through smarter marketplaces and automation, we don’t just solve staffing challenges; we redefine what’s possible in healthcare operations and ShiftMed is leading the way with health systems moving beyond tired models. #capitalintolabor #systemsofrecord #healthworkforce #aiworkforce #healthsystems #hospitals #cno #hospitalceo #healthcareinnovation

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Presenting at the Senate as part of the Coalition for Health AI (CHAI) "Day on the Hill" wasn't on my 2024 bingo card, but I'm feeling energized by the bipartisan discussions on healthcare AI. The numbers tell a compelling story: while nearly 2,000 healthcare AI startups have received funding over the last two decades, only 1 in 20 provider-facing companies reach late-stage maturity. Beyond natural market dynamics, two critical barriers are holding back AI's full potential in healthcare: unsustainable payment models and inadequate evaluation infrastructure – only 5% of research studies on LLMs in medicine utilize real patient care data, and studies advancing our understanding of performance beyond medical licensing exam benchmarks remain anemic at best. At CHAI, we're advocating for essential foundations: • Rigorous technical model performance evaluations • Comprehensive bias assessments across diverse patient populations • Thorough pre-deployment simulations and prospective studies • Robust ongoing local monitoring The path forward demands strong reporting infrastructure, advanced healthcare AI benchmarks, and meaningful public-private partnerships to drive real-world AI deployment in healthcare. Stay tuned for CHAI's upcoming initiatives in 2025 as we expand our engagements with the startup and investment ecosystem. https://lnkd.in/enw-GQcA

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Some VC investors believe that brick and mortar - referring to a physical presence of some kind - should be avoided at all costs. Yet, the track record of clinic and hybrid care businesses in health care indicates otherwise. ==> One Medical (sold for $3.9 billion to Amazon), Oak Street (bought by CVS for $10.6 billion), Lifestance (IPO at $7.5 billion market cap), and PE-backed Premise Health (acquired by OMERS Private Equity for $1.1 billion) If a clinic is indicated as the optimal way to deliver care for that patient population, there are creative ways to build and operate them. Full article below with advice and strategies on how to build and operate hybrid clinics from my teammate Anarghya Vardhana from Maveron, Amir Dan Rubin from OneMedical Group, Steven Eidelman from Modern Animal and more!

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🌟 7 Crucial Elements for Scaling Startups to Successful Exits 🌟 Reflecting on my recent experience at the OPEN Silicon Valley Forum in Santa Clara, some of us engaged in a deep discussion on what repeatedly drives startups from inception to successful exits. Our collective experience pointed to these seven essential elements: 1️⃣ Timing is Everything: Ensure the market and technology are ready for your solution. Being too early or too late can hinder success. 2️⃣ Align with Your "Why": Success requires internal motivation. Knowing your “why” keeps you resilient and purpose-driven. 3️⃣ Master the Problem, Not Just the Product: Deep understanding of the problem is far more critical than focusing solely on a product or idea. 4️⃣ Define Culture from the Start: The first five hires set the tone. Invest in "A" players who embody the culture you envision. 5️⃣ Obsess Over User Experience: A relentless focus on user experience can make or break your product’s adoption. 6️⃣ Build for Scale from Day One: Architecting for growth is not optional—it’s essential for long-term success. 7️⃣ Map Out Your Go-to-Market Strategy Early: Before building, have a clear thesis on how to generate revenue and achieve product-market fit. These principles are tried and true across multiple industries. If you’re launching a startup or scaling a business, how do these resonate with your experience? What would you add to the list? #startups #entrepreneurship #growth #scaling #productmarketfit #OPENsiliconvalley #innovation #founders Tashfeen Suleman Amer Haider Umair Khan Junaid Qurashi Wardah Inam

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To my amazing network - I am thrilled to announce the launch of Pave Health Ventures, an early-stage venture fund dedicated to broadening access to healthcare and improving the overall well-being of our communities. I’ve been very fortunate in my healthcare career. As the Founder & CEO of MedPilot, we capped off a seven-year journey with a successful exit when we were acquired by Vytalize Health. For the last three years, serving as Chief Innovation Officer, I’ve had the honor to contribute to the remarkable growth at Vytalize, impacting the lives of hundreds of thousands of patients by enhancing the quality of care they receive. I am immensely grateful to Matt Buder Shapiro, not only for being the perfect partner and co-founder but also for being an incredible friend. Additionally, I extend my heartfelt appreciation to Faris Ghawi, Amer Alnajar, and Jordan Brown for their outstanding leadership and for broadening my perspective on the significance of value-based care. This journey has not only provided me with industry expertise but has allowed me to cultivate invaluable relationships and an incredible network. As I embark on this new chapter, I am profoundly grateful to be supported by top executives and thought leaders in the investment, wellness, and healthcare industries. Within the healthcare ecosystem, we are represented by key stakeholders from health systems, insurers, governmental organizations, retail health businesses, provider groups, and value-based care organizations. At Pave Health Ventures, we believe the timing couldn't be more opportune to help support health-focused startups. With the growing prevalence of illness and chronic health conditions impacting our communities, consumers and key Healthcare Stakeholders are increasingly prioritizing proactive and preventative care. This shift in focus is fueling demand for technology, products, and services aimed at improving health outcomes, unlocking trillions of dollars in growth potential within the healthcare landscape. Pave Health Ventures is all-in. We are actively seeking solutions that tackle the root causes of illness, manage chronic conditions, and optimize care and care teams. Please support us in our mission by opening your networks and introducing us to amazing founders and entrepreneurs. Together, let's help pave the way to a healthier tomorrow. Jacob Myers

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#Longevity Tech is on the rise ✌️ -Endeavor BioMedicines raised $135M at a $795M valuation in April 2024. -Humanaut Health secured an $8.7M Seed round, valued at $52M in May. -Superpower raised $4M, reaching a $24M valuation in May as well. These are just 3 of the 90+ #longevity startups highlighted in Dealroom.co's latest report (Link in the comments). In this newsletter, I dive into the Longevity Technology Market and the emerging trends shaping the future of health! 👉 https://lnkd.in/e3EZrAPH #Longevity #HealthTech #StartupFunding #Innovation

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#hiring If anyone knows an awesome engineer that would be interested in joining an emerging #AI company doing important work in #healthcare, please drop me a line! Andy AI is backed by General Catalyst, YCombinator, Greater Ventures, and others, and they’re looking to hire a full stack engineer (US based) who's excited about using AI to improve healthcare and reduce nurse burnout. Andy is AI software that automates clinical documentation for nurses who do home visits. A nurse makes an audio recording of the visit and Andy automatically generates a form that usually takes nurses 90 minutes to complete. Nurses love the product because it potentially saves them 15 hours of charting a week! The founders previously built healthcare AI at Google Health and Apple, and are now building their vision to transform home health. More about Andy AI: https://with-andy.com/ Nurses love it: https://lnkd.in/g9XqZrUq #GenAI #digitalhealth #hiring #engineers #healthtech

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I’m optimistic about the potential of generative AI to reduce provider burnout and improve provider-patient interactions. However, that optimism is tempered by the data that indicates the technology is not quite ready yet. Bright Ventures is interested in digital health founders who understand the realities of provider-patient interactions, and the role technology can play in strengthening clinical outcomes. Which founders and teams are getting this right? Tag them in the comments below.

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“Over one million new articles are added to PubMed annually—about two per minute. No physician can keep up.” This highlights a challenge that PCPs face daily, managing countless chronic and acute conditions while adapting to ever-evolving clinical guidelines. We can’t expect our clinicians to act like machines. At RhythmX AI (https://rhythmx.ai), we address this by revolutionizing primary care with our generative AI-native precision care platform, developed collaboratively by our physicians, specialists, and AI teams. Our platform integrates advanced AI and longitudinal data to deliver patient-specific, evidence-based recommendations directly within clinical workflows. These hyper-personalized insights help physicians make informed decisions at the point of care, bridging the gap between research and practice. Trust is at our core. Our physicians rigorously validate every recommendation to ensure clinical-grade reliability, empowering clinicians to confidently rely on the insights we provide. #PioneerPrimaryCare #Hyper-PersonalizedCare #PCPBurnOut #HealthAI #ResponsibleAI

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A little late, even though this process started in July.... Excited to share our latest investment in Heads Together Health!! We met Steve DeVrieze in October last year, and we think they are poised for impressive growth! Read more here: https://lnkd.in/ecYcqqkn #earlystagestartup #earlystageinvesting #VCinvestment #ncstartups #nctechstartups

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Excited for this one. Congrats to Alex Cohen and Hello Patient on their seed round announcement. Hello Patient stands to change the communication paradigm between patients and providers forever. Their generative AI call agent technology is tackling the tremendous admin burden of patient facing comms (scheduling, follow ups, referrals, prescription refills, etc). Massive opportunity and we think Alex and his team are expertly positioned to become market leaders. Max Ventures is thrilled to co-lead the seed round with 8VC and Bling Capital A great quote below from Alex highlighting the concept of "service as a software". Healthcare is a heavily service oriented industry - so the opportunity for step change is even more profound. The startup's approach is part of a paradigm shift where AI companies are offering service as software. "I'm a big believer that the right way to do this is through a managed services business. We're not building SaaS. I believe we can do this services as software where what was traditionally a services business now has software margins because I don't have to go employ a whole bunch of people to do the services under the hood," Cohen noted. https://lnkd.in/ehNN2AmW

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