Lauren Makler

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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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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On the latest Vital Signs, Nikhil Krishnan and I had a ton of fun chatting with Dr. Atul Butte. Dr. Butte is a professor at UCSF, Chief Data Scientist of the UC Health System, and a co-founder of numerous healthcare startups. In our conversation, Dr. Butte shared his takes on healthcare AI opportunities, challenges, hype, and more. A few highlights: ⚡LLM use cases, data, and growth LLMs are already helping to solve the “drudgery” aspects of medicine, such as automatically drafting SOAP notes and patient messages. Dr. Butte is excited about future applications of LLMs that can help with the “cognitive” aspects: with difficult medical problems an LLM might be able to stitch together disparate pieces of information to generate a potentially novel solution. He also highlights that prompt engineering will become the next “coding language” as so much of leveraging LLMs is knowing how to ask them the right questions. Additionally, Dr. Butte discusses how since 2016, UCSF has been working to deidentify its patient notes so that it can query them to answer clinical questions and ultimately enhance patient care. ⚡The need for patient-facing AI As patients are increasingly able to access their own personal health data in nicely structured formats (e.g., EHRs, wearables), they desperately need more tools to help them interpret and make decisions using that data. Dr. Butte understands that these patient-facing solutions are challenging to get funded but he emphasizes that patients need to receive the benefits of AI sooner. ⚡Evaluating healthcare AI solutions In order to evaluate AI solutions, we often put human specialists – such as medical professionals – on the same tasks. Understanding that specialists often disagree with each other, a significant challenge arises in figuring out how we can evaluate AI considering we can’t just “average” all the specialist opinions. Dr. Butte points out that there still remains a massive gap in AI evaluation tools. Additionally, there are so many organizations that want to have a say in how healthcare AI is regulated that the landscape is uncertain. An awesome conversation with an expert on all things AI meets healthcare. Listen to the full episode below: Spotify: https://spoti.fi/3Wr3643 Apple: https://apple.co/4acwgan

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This week Mikal Ventures brings you a 4-week breakdown of the US capital market with an emphasis on the Mikal verticals. Over the 4-week period ending July 8, 728 new companies were added, resulting in just under 96,400 companies included in the US Health Tech, Med Tech, Fin Tech, AI Tech, and Ed Tech verticals. AI Tech maintained its most active status, seeing the greatest percentage of growth in new companies, transactions and news articles. The US Fin Tech vertical led the way in SEC Filings. Mikal Ventures publishes these stats to provide a perspective on how the verticals and new startups move through time. We hope you find them informative and thought-provoking. 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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Are you struggling to build traction with investors? Could it be that you actually don't fully recognise investors' own needs and objectives? Thank you Yasmin Siraj of BACKED VC for hosting such an insightful discussion with the nextGEN community and addressing so openly some of the most common mistakes you see #founders make. Join the conversation at nextGEN @LifeScience ORG. #biotech #medtech #lifesciences #venturecapital #fundraising

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Severe mental illness remains one of the most underserved areas in mental health, possibly because it is difficult to address with the type of virtual, easy-to-scale models that VCs love to back. We're so excited that Sonia Priscilla García and Stas Sokolin at Amae Health have been able to break the mold, bringing better in-person solutions for patients and families dealing with SMI, and attracting strong venture partners to do so cc: Lisa Jacobs Blau, Alison Ryu, Claire Akkan Quiet Capital, Healthier Capital, Jan Ellison Baszucki, Karin Kissane, Mike Volpi

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According to the latest report from Rock Health, digital health funding in Q1 2024 totaled $2.7B across 133 deals, with an average deal size of $20.6M. It doesn’t break out device-related investments, but most medtech founders I meet these days are being forced to chase tiny rounds made up of endless little checks, consuming valuable energy and slowing their progress. The benign neglect of this next generation of diagnostic and therapeutic devices is counterproductive and surprising. Given the crowded virtual care market, for example, I’d expect more such companies would be exploring medtech partnerships, investments or acquisitions that'd enable them to back integrate into delivering sharper, and more differentiated, care and treatment. This is exactly what Maverix Medical is doing from the other direction: Reshaping the entire spectrum of lung cancer care by integrating more advanced + effective approaches to screening and diagnosis, treatment and therapeutics, and even palliative care…And putting it all to work through an innovative provider network. One notable investor exception is Y Combinator partner Surbhi Sarna who’s been backing great teams like Selera Medical (YC W24) doing foundational work on ambitious medical devices. Without more support from investors like her, we’re going to increasingly find ourselves stuck with the incremental portfolio improvements from the incumbents, and that’s just not nearly enough.

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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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Still feeling energized from last week's roundtable on building successful relationships with hospitals. We invited 7 portfolio companies and health system leaders from Mayo Clinic, Cedars-Sinai and UCLA Health. The founders shared their questions ranging from the strategic to the nuts and bolts of closing partnerships. For example, how do you determine what measures of effectiveness help drive alignment? And how do you get all the stakeholders together to actually drive a decision. Answer: put them all in a room for half a day! “I think we're in a pivotal moment regarding how we assess AI. There are numerous risks currently dominating AI discussions, particularly those concerning bias and other associated risks. However, there's a notable absence of focus on evaluating the proactive value of AI. We need to consider what AI actually offers and what we want it to offer. It's not solely about determining whether it will cause harm; people are apprehensive about how this technology will be implemented. One perspective gaining traction involves ensuring the product's validation process is robust enough to prevent risks to various populations.” -Vladimir Manuel, Medical Director at UCLA Health From Vlad's comments above to perspectives others shared, we heard a sense of excitement for the promise of #AI and other new technologies. But we're also in a unique moment where the risks are not well understood. Still much to do here.

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"In H1 2024, U.S. digital health startups raised $5.7B across 266 deals🤑. If investment patterns continue, 2024 could exceed 2019 and 2023 year-end totals ($8.2B and $10.7B, respectively)." - sounds promising and inspiring, doesn't it? [Link to report in comments👇] As our company builds customer software solutions for various industries, including HealthTech🏥, I've been diving deep into recent reports. And I've compiled a list of some insightful HealthTech reports and resources!📈 Just drop a comment with "HealthTech"✍ and I'll send this list of useful resources to you📩 #healthtech #startup #startups #healthtechindustry #digitalhealth #healthtechsoftware #healthtechstartups

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Awesome report from Rock Health (in the comments) about H124 digital health funding. 📈 Despite broader economic challenges, the digital health sector, including mental health, has shown resilience, raising $5.7B across 266 deals. There is a strong Series A pipeline, tapering off of unlabeled funding rounds and 3 public exits in Q2 2024 indicating a revival in the exit market and a return to more sustainable funding patterns​. Key insights about the mental health market: 🧠 Mental health continues to be the leading clinical indication in digital health funding, securing $682 million in H1 2024. This consistent top ranking highlights the ongoing investor interest and the market's recognition of the critical need for mental health solutions. 🤖 The focus on mental health is driven by a combination of increased awareness, the rising demand for accessible mental health services, and the integration of tech solutions...🙄 In fact, AI has become a significant factor in digital health investments, with 34% of the total sector funding going to AI-startups. This trend is also reflected in mental health, where AI is being utilised to enhance diagnosis, personalise treatment plans, and provide scalable, efficient care solutions. Let's go!

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Ro consistently uses tech to tackle healthcare problems (often for free). 🧑‍⚕️ In March of 2020, Ro launched (completely free) COVID telehealth assessments. ❤️ In March of 2021, Ro launched (also free) in-home vaccinations for some of NY’s most vulnerable seniors. 💉 Fast forward to today, Ro is tackling the GLP1 shortage. They just launched a GLP-1 Supply Tracker that anyone can use to get real-time updates about GLP1 drug shortages and alerts when supply is available nearby. Oh, and this is completely free too. Huge shoutout to Ro, building what patients need and making it accessible to those who need it. Check out the GLP1 Supply Tracker here: https://776.vc/3X1FovB (the more who use it the better it works, so share with those who could benefit).

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Ro consistently uses tech to tackle healthcare problems (often for free). 🧑‍⚕️ In March of 2020, Ro launched (completely free) COVID telehealth assessments. ❤️ In March of 2021, Ro launched (also free) in-home vaccinations for some of NY’s most vulnerable seniors. 💉 Fast forward to today, Ro is tackling the GLP1 shortage. They just launched a GLP-1 Supply Tracker that anyone can use to get real-time updates about GLP1 drug shortages and alerts when supply is available nearby. Oh, and this is completely free too. Huge shoutout to Ro, building what patients need and making it accessible to those who need it. Check out the GLP1 Supply Tracker here: https://776.vc/3X1FovB (the more who use it the better it works, so share with those who could benefit).

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Appreciate the #LeedsDigitalHealth shoutout Vladlen Shulepov! 🙌 Some very exciting and innovative digital health businesses listed here, well worth checking out.👇

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This week Mikal Ventures brings you a 4-week breakdown of the US capital market with an emphasis on the Mikal verticals. Over the 4-week period ending June 10, just over 590 new companies were added, resulting in 95,661 companies included in the US Health Tech, Med Tech, Fin Tech, AI Tech, and Ed Tech verticals. AI Tech maintained its most active status, seeing the greatest percentage of growth in both new companies and transactions. The US Fin Tech vertical led the way in SEC Filings and news articles. Mikal Ventures publishes these stats to provide a perspective on how the verticals and new startups move through time. We hope you find them informative and thought-provoking. 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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I recently sat down with Michael Batko, CEO at Startmate and Founder of Puddle Pod for Episode 11 of Insane Ambition. Startmate has invested in 230+ startups, much of it under Michael's leadership, and now has $3.5b in value across its portfolio companies. In this episode, we discussed: - Michael's journey from consulting, then living in the Amazon rainforest, to leading Australia's biggest startup accelerator - The future of Australia's startup ecosystem - The labour government's very stupid plan to make it harder for people to qualify as sophisticated investors (now thankfully shelved) - Startmate City! Startmate's plan to build Australia's first startup city. Probably the most ambitious idea I've ever heard from a startup accelerator. - The balance between visionary thinking and traditional startup advice (think Elon Musk's plan to colonise Mars, vs Y Combinator's problem/customer obsession) - "The Courage to Be Disliked", and its influence on Michael's approach to life and business. Links in the description below 👇

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𝐓𝐡𝐞 𝐀𝐦𝐞𝐫𝐢𝐜𝐚𝐧 𝐏𝐫𝐢𝐯𝐚𝐜𝐲 𝐑𝐢𝐠𝐡𝐭𝐬 𝐀𝐜𝐭: 𝐰𝐡𝐲 𝐢𝐭 𝐦𝐚𝐭𝐭𝐞𝐫𝐬 𝐟𝐨𝐫 𝐇𝐞𝐚𝐥𝐭𝐡𝐓𝐞𝐜𝐡 𝐬𝐭𝐚𝐫𝐭𝐮𝐩𝐬 𝐚𝐧𝐝 𝐢𝐧𝐧𝐨𝐯𝐚𝐭𝐨𝐫𝐬 On April 7th, 2024, a draft federal privacy law, the American Privacy Rights Act (APRA), was announced. Below are top takeaways for HealthTech startups: The APRA would require large Tech ventures to tell consumers what data they collect, let them correct and delete data, and provide ways for anyone to opt out of targeted ads. 𝐀𝐧𝐲 𝐬𝐭𝐚𝐫𝐭𝐮𝐩𝐬 𝐬𝐞𝐥𝐥𝐢𝐧𝐠 𝐭𝐡𝐞 𝐩𝐞𝐫𝐬𝐨𝐧𝐚𝐥 𝐝𝐚𝐭𝐚 𝐨𝐟 𝐞𝐯𝐞𝐧 𝐚 𝐬𝐢𝐧𝐠𝐥𝐞 𝐢𝐧𝐝𝐢𝐯𝐢𝐝𝐮𝐚𝐥 𝐰𝐨𝐮𝐥𝐝 𝐛𝐞 𝐢𝐦𝐩𝐚𝐜𝐭𝐞𝐝: The APRA exempts small businesses that have $40mln or less in annual revenue and collect, process, retain, or transfer the covered data of 200K or fewer individuals; and (emphasis added) do not earn revenue from the transfer of covered data to third parties. It seems that Series B or below are exempted. But many Health Tech startups, even at pre-seed, may have covered data from more than 200K individuals. 𝐌𝐨𝐬𝐭 𝐡𝐞𝐚𝐥𝐭𝐡 𝐝𝐚𝐭𝐚 𝐚𝐫𝐞 𝐬𝐞𝐧𝐬𝐢𝐭𝐢𝐯𝐞 𝐢𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧 𝐰𝐢𝐭𝐡 𝐬𝐭𝐫𝐨𝐧𝐠 𝐜𝐨𝐧𝐬𝐞𝐧𝐭 𝐫𝐞𝐪𝐮𝐢𝐫𝐞𝐦𝐞𝐧𝐭𝐬: Sensitive data requires "affirmative express consent" before any transfer to a third party, unless the transfer is necessary, proportionate, and limited to one of the permitted purposes. Types of sensitive data collected by HealthTech startups: Any information on the past, present, or future physical health, mental health, disability, diagnosis, or health care condition or treatment of an individual. Genetic and Biometric information. 𝐑𝐞𝐬𝐭𝐫𝐢𝐜𝐭𝐢𝐨𝐧𝐬: The bill prevents collecting, processing, retaining, or transferring data beyond what is “necessary, proportionate, or limited” for the entity to provide or maintain a product or service. Covered entities are prohibited from transferring covered sensitive data to a third party without an individual’s express consent or, if allowed by a stated permitted purpose, including protecting data security and complying with legal obligations, among others. The bill also lets individuals opt out of targeted advertising out of certain data transfers, and out of the use of an algorithm to make a “consequential decision” with regard to housing, employment, education, healthcare, insurance, or credit. Some health tech startups — especially those in the early stages and those that offer free services to consumers — often rely on data-driven advertising revenue or reach consumers through such advertisements. Finally, the draft may impact future product development for startups, particularly those in data-driven spaces, like AI, or those looking to enhance their current offerings with AI in the future. 𝐖𝐡𝐚𝐭’𝐬 𝐧𝐞𝐱𝐭? On April 17th, the APRA will get its first legislative hearing. Stay informed and be prepared for potential impacts on your operations. #HealthTech #DataPrivacy #Innovation #Legislation

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Two weeks ago I spent 3 days with brilliant human beings discussing the state of AI investment with other angel syndicate leads, angel investors and VCs at Hustle Fund's #camphustle in Los Gatos. It was brilliant. Truly awesome to learn so much from insanely accomplished investors. But was so clear to me again is that the US and the UK are two countries divided by separate languages of ambition. Aspiration and ambition underlined by the cluster effect of successful exits, incredible talent and venture capital driven by operators and founders rather than accountants. But one reason why the US often trumps (pun not intended) the UK is they learn from failure. Run a startup that didn't reach the dizzying heights of venture-scale returns? Learn, reset and go again. What they certainly do not do is look at failure with glee and an "I told you so" attitude. Which is what I sense when I read most of the narrative around the failure of Cazoo. Alex Chesterman swung and missed. The business was flawed, unit economics didn't add up and in reality - there was very little innovation outside the vertical alignment of a well-understood business. But when we look down upon what he tried to do and 💩 💩 it all we're doing is making it harder for someone else to be equally as ambitious. Focus on what went wrong. Focus on the fundamental underlying business models that drive efficient use of capital and the push for profitability. But let's celebrate people shooting their shot and not celebrate the failures.

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We are excited to have announced our Series A lead investment in Abett. Founded by Mike Hanlon, the company provides a data layer that enables any self-insured employer in the US to receive a regular and consistent feed of their claims data so they can actually understand healthcare costs, the efficacy of their employee benefits, and how to better serve their employees (to whom they have a fiduciary responsibility). While this sounds like table stakes, it's far from the norm. After payroll, healthcare is the biggest cost consideration for American employers. A majority of Americans receive employer-based health insurance. A majority of those Americans receive insurance from a fully or partially self-funded plan (i.e., the employer is taking risk instead of the insurance company). Abett brings transparency and alignment to a thorny data problem to empower benefits leaders & CFOs. More to come on Acrew Capital's focus on the investing at the intersection of healthcare & data. cc: Mark Kraynak and Kwabena "KB" Nimo for their partnership on this investment.

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