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How to establish a health tech startup advisory board
When you enter the health tech industry as a new startup, an advisory board is a crucial foundational step. A board can guide you through industry-specific nuances, help you make important decisions and prove your legitimacy to investors looking for a strong industry background.
An advisory board will be able to give you strategic insights about both your company and the wider healthcare and technology industries.
In my experience of raising capital, the unpredictable financial situation at the beginning of the pandemic meant we nearly lost our $2 million round, but came through with a committed $250,000, which we used to bring in about $500,000 in revenue.
Something that helped this process was building our advisory board and starting small — we didn’t go for all of healthcare but instead focused on two healthcare verticals. This allowed us to prove our concept, build case studies and win contracts with specific teams in our customers’ companies.
It pays off to stay focused and prove your worth so that your advisory board members can champion you in niche markets, with the potential to expand in the future. For this reason, it’s important to identify the main intention behind your board, and exactly who should be on it.
Who to recruit
Three to five people is an ideal starting point for an advisory board, depending on the size and stage of your company. In health tech, you need more than just the healthcare perspective — you also need the insight of those who have already grown technology companies, perhaps outside of the industry. Our company’s board is an even split of two healthcare and two technology advisers, and, ideally, you want to find a fifth who is well versed in both industries.
It pays off to stay focused and prove your worth so that your advisory board members can champion you in niche markets, with the potential to expand in the future.
An M.D., a Ph.D. from a respected institution or a thought leader in your relevant field of healthcare is the most important asset to an advisory board. These are the highly decorated physicians who have strong connections and act as a reference for their peers.
They provide instant credibility for your company, help you get into the minds of both patients and healthcare providers, and can outline how various health systems work.
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Insider hacks to streamline your SOC 3 certification application
If you’re a tech company offering anyone a service, somewhere in your future is a security assessment giving you the seal of approval to manage clients’ data and operate on your devices. No one takes security lightly anymore. The business costs of cyberattacks have now hit an all-time high. Government bodies, companies and consumers need the assurance that the next software they download isn’t going to be an open door for hackers.
For good reason, security certifications like the SOC 3 really put you through the wringer. My company, Waydev, has just attained the SOC 3 certification, becoming one of the first development analytics tools to receive that accreditation. We learned so much from the process, we felt it was right to share our experience with others that might be daunted by the prospect.
As a non-tech founder, it was hard not only to navigate the process, but to appreciate its value. But by putting our business caps on, our team was able to optimize our approach and minimize the time and effort needed to achieve our goal. In doing so, we were granted SOC 3 compliance in two weeks, as opposed to the two months it takes some companies.
We also turned the assessment into an opportunity to better our product, align our internal teams, boost our brand and even launch partnerships.
So here’s our advice on how teams can smoothly reach an SOC 3 while simultaneously balancing workloads and minimizing disruption to users.
First, bring your teams on board
Because we can’t expect employees to stack those hours on top of their regular workdays, as a leader you have to accept — and communicate — that the speed of your output will inevitably decrease.
As a founder, you’ll be acting as captain steering a ship into that SOC 3 port, and you’ll need all members of your crew to join forces. This isn’t a job for a specially designated security team alone and will require deep involvement from your development and other teams, too. That might lead to internal resistance, as they still have a full-time job tending to your product and customers.
That’s why it’s so important to start by being crystal clear with your employees about what this process will mean to their work lives. However, they have to embrace the true benefits that will arise. SOC 3 will immediately raise your brand’s appeal and likely see new customers come in as a result.
Each employee will also come out the other end with well-honed cybersecurity skills — they’ll have a deep understanding of potential cyber threats to the company, and all security initiatives will carry a far lighter burden. There’s also the sense of pride and fulfillment that comes with having an indisputable edge over your competitors.
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Growth tactics that will jump-start your customer base
Five years ago, the playbook for launching a new company involved a tried-and-true list of to-dos. Once you built an awesome product with a catchy name, you’d try to get a feature article on TechCrunch, a front-page hit on Hacker News, hunted on ProductHunt and an AMA on Quora.
While all of these today remain impressive milestones, it’s never been harder to corral eyeballs and hit a breakout adoption trajectory.
In this new decade, it is possible to first out-market your competitor, and then raise lots of money, hire the best team and build, rather than the other way around (building first, then marketing).
Looks like @stripe redesigned their landing page.
How long until we see these colorful gradients on other startups’ landing pages?
https://t.co/c6DL5mEUm4 pic.twitter.com/cCh8NyXawy
— Marc Köhlbrugge (@marckohlbrugge) July 7, 2020
Outbound marketing tools and company newsletters are useful, but they’re also a slow burn and offer low conversion in the new creator economy. So where does this leave us?
With audiences spread out over so many platforms, reaching cult status requires some level of hacking. Brand-building is no longer a one-hit game, but an exercise in repetition: It may take four or five times for a user to see your startup’s name or logo to recognize, remember or Google it.
Below are some growth tactics that I hope will help jump-start the effort to building an engaged user base.
Laying the groundwork for user-generated content
Before users are evangelists, they are observers. Consider creating a bot to alert you of any product mentions on Twitter, or surface subject-matter discussions on Reddit (“Best tools to manage AWS costs?” or “Which marketplace do you resell your old electronics on?”), which you can then respond to with thoughtful commentary.
Join relevant communities on Discord, infiltrate Slack groups of relevant conferences (including past iterations of a conference — chances are those groups are still alive with activity), follow forums on StackOverflow and engage in the discussions on all these channels.
The more often you post, the better your posts convert. The more your handle appears on newsfeeds, the more likely it will be included on widely quoted “listicles.”
My list of coolest startups around today:@Replit – no more dev environments@highlightrun – understand how people use your app@DoNotPayLaw – saves
+
@Superhuman – first pleasant email app@Railway_App – what Heroku should have been@pipe – recurring revenue = assets
— Zain Allarakhia (@zallarak) May 18, 2021
Most “user-generated content” in the early innings should be generated by you, from both personal accounts and company accounts.
Build in public …
Building in public is scary given the speed at which ideas can be copied, but competition will always exist, since new ideas are not born in vacuums. Companies like Railway and Replit post to Twitter every time they post a new changelog. Stir brands its feature releases as “drops,” similar to streetwear drops.
Building in public can also lend opportunities for virality, which requires drama, comedy or both. Hey.com’s launch was buoyed by Basecamp’s public fight against Apple over existing App Store take rates.
Mmhmm, the virtual camera app that adds TV-presenter flair to video meetings, launched with a viral video that hit over 1.5 million views. The company continues to release entertaining YouTube demos to showcase new use cases.
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… or build in private
Like an artist teasing an upcoming album, some companies are able to drum up substantial anticipation ahead of exiting stealth mode. When two ex-Apple execs founded Humane, they crafted beautiful social media pages full of sophisticated photography without revealing a single hint of what they set out to build.
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The gray revolution: Fundraising within the older adult space
The technology industry is often thought of as being the domain of the young and the new. We see an emphasis on young founders (“40 Under 40”), innovative ideas and disruptive challenges to legacy brands, incumbent companies and “old” ways of thinking.
But one of the things I’ve learned on my journey in co-founding my latest startup is that technology should be enabling and accessible to all, and nowhere is this more critical than for empowering our older adults.
Older adults are one of the most underrepresented audiences for new technology products and platforms. There is a massive opportunity to provide products and services that will make life better for today’s seniors and future generations of older adults to come. Founders in every space, from edtech to healthcare, from financial services to robotics, can make a bigger impact if we recognize the opportunity of being of service to older adults.
One of the best strategies for tech companies that want to serve the older adult market is to focus your value proposition on empowering older adults.
Don’t make a product “for old people”
Older adults often get overlooked by tech companies. In fairness, it can be hard (and insensitive and uninspiring) to market products and services as being “for old people,” because people in this group don’t tend to think of themselves as “old.”
One of the best strategies for tech companies that want to serve the older adult market is to focus your value proposition on empowering older adults. Don’t make a product “for old people” — make a product that helps older adults lead a healthier, more active, more connected life.
Whether it’s the education tech space, financial services, health tech, consumer products or other innovative digital services for seniors, tech companies have big opportunities to empower older adults.
We are seeing some great examples, including:
- AgeBold is doing interesting work with at-home exercise programs for older adults to improve their balance, strength and mobility. The value proposition: Exercise for better aging. It’s a product “for” older adults, but the message is focused on empowerment and building strength, helping people live healthier, more active lives as they age.
- Eldera.ai connects children with vetted older adult mentors, for one-on-one or group conversations and remote learning activities. This concept is powerful because it helps older adults share their life experience and build relationships with other families.
Older adults have so much to offer. Instead of approaching this market as a “problem” to be solved, startups should engage with older adults as an active, curious, ready-to-learn group of people who are eager to be empowered.
Recognize the size of the opportunity of the older adult market
It often seems like so many consumer-facing apps today are created for younger people. But there’s a big disconnect between where so much of the tech industry’s attention and investment is going and the spending power and lifestyle preferences of today’s older adults.
Older adults are the most underserved demographic for the tech world. They’re also one of the fastest-growing age cohorts. The number of people worldwide who are 65 and older is expected to grow from 524 million in 2010 to 1.5 billion in 2050.
The “silver economy,” driven by the spending power of older adults, is expected to grow into the 2030s because the senior population is the wealthiest age group and their numbers are growing 3.2% per year (compared with 0.8% for the overall population).
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Perform a quality of earnings analysis to make the most of M&A
As a startup founder, there will be three scenarios in which you’ll need to understand how to properly do a quality of earnings (QofE) if you want to maximize value.
The first scenario will be when you decide to raise a Series A and subsequent VC rounds, followed by when you do a strategic acquisition, and lastly, when you sell your company.
This post is a framework for how to think and organize your QofE and go through the most common items that you’ll want to keep top of mind for every M&A and private equity transaction you may be part of.
Why perform a QofE?
The goal of a QofE is to adjust the reported EBITDA to calculate a restated EBITDA that best reflects the current state of the company on an ongoing basis. It also presents a historical adjusted EBITDA that is comparable throughout the last two or three years.
QofE can have a significant impact on a company valuation for three main reasons:
- The adjusted EBITDA will be used by a buyer/investor as the basis for valuation (for companies valued based on an EBITDA multiple).
- The adjusted revenue will be used to recalculate the effective growth rate.
- The adjusted revenue and EBITDA will form the basis of forecasts.
With that in mind, every entrepreneur must understand how to properly form a view of what is the proper adjusted EBITDA and adjusted revenue of your company. It is common for founders in an M&A process to be unfamiliar with the notion of QofE and leave value on the table.
When performed by a professional transaction service advisory team, the quality of earnings is a result of a thorough review of all the documents generally available in a data room.
This breakdown aims to ensure that you won’t be that founder and that you’ll be armed to negotiate your company valuation on equal ground with your investors. If you are in the seller’s shoes, you will get the advantage of understanding how an experienced investor or buyer thinks. If you’re in the buyer’s shoes, you’ll benefit from understanding and valuing your acquisitions better.
How is a QofE professionally performed?
When performed by a professional transaction service advisory team, the quality of earnings is a result of a thorough review of all the documents generally available in a data room. These include, but are not limited to: Legal documentation, financial statements (P&L, balance sheet, cash flow), audit reports, management presentation and contracts.
When doing a QofE analysis, it’s key to consistently ask yourself: “Can or should this information translate into an adjustment of revenue or EBITDA, net working capital (NWC) or net debt?”
Why did we include NWC and net debt? That is because they often have an indirect impact on adjusted EBITDA. Think of an adjustment to the historical level of inventory. Less inventory likely means fewer storage costs. So if you adjust historical inventory, you’ll want to also impact your adjusted EBITDA.
On top of reviewing all the aforementioned documents, your QofE analysis will heavily rely on interviewing management. No matter how long you look at the financials, if you can’t have management confirm information or explain trends, you won’t be able to draw proper conclusions and understand the numbers.
Principles for efficiently building your QofE
- Automatically link everything you read and hear to potential QofE adjustments. This has to become second nature during the engagement.
- Always think about all the ways an event or item that qualifies for an adjustment impacts the financial statements overall. For instance, if the event impacted revenue, did it impact costs in some way as well?
- Make sure that the cost you are adjusting was not already offset by another accounting entry (i.e., had no impact on EBITDA).
- Make sure that the cost you adjust for was classified above EBITDA in the first place.
- Make sure that you can quantify each adjustment in the most objective and rational way. This is sometimes not possible and you may have to come up with a range.
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How to hire and structure a growth team
Everyone at an organization should own growth, right? Turns out when everyone owns something, no one does. As a result, growth teams can cause an enormous amount of friction in an organization when introduced.
Growth teams are twice as likely to appear among businesses growing their ARR by 100% or more annually. What’s more, they also seem to be more common after product-market fit has been achieved — usually after a company has reached about $5 million to $10 million in revenue.
Image Credits: OpenView Partners
I’m not here to sell you on why you need a growth team, but I will point out that product-led businesses with a growth team see dramatic results — double the median free-to-paid conversion rate.
Image Credits: OpenView Partners
How do you hire an early growth leader?
According to responses from product benchmarks surveys, growth teams have transitioned dramatically from reporting to marketing and sales to reporting directly to the CEO.
Some of the early writing on growth teams says that they can be structured individually as their own standalone team or as a SWAT model, where experts from various other departments in the organization converge on a regular cadence to solve for growth.
Image Credits: OpenView Partners
My experience, and the data I’ve collected from business-user focused software companies, has led me to the conclusion that growth teams in business software should not be structured as “SWAT” teams, with cross-functional leadership coming together to think critically about growth problems facing the business. I find that if problems don’t have a real owner, they’re not going to get solved. Growth issues are no different and are often deprioritized unless it’s someone’s job to think about them.
Becoming product-led isn’t something that happens overnight, and hiring someone will not be a silver bullet for your software.
I put early growth hires into a few simple buckets. You’ve got:
Product-minded growth experts: These folks are all about optimizing the user experience, reducing friction and expanding usage. They’re usually pretty analytical and might have product, data or MarketingOps backgrounds.
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Founders must learn how to build and maintain circles of trust with investors
Many VCs tout their mentorship and hands-on approach to founders, especially those who run early-stage startups. But in the recent era of lightning-fast rounds closing at sky-high valuations, the cap tables of early-stage startups are becoming increasingly crowded.
This isn’t to say that the value VCs bring has diminished. If anything, it’s quite the opposite — this new dynamic is forcing founders to be extremely selective about exactly who is sitting around their mentorship table. It’s simply not possible to have numerous deep and meaningful relationships to extract maximum value at the early stage from seasoned investors.
Founders should definitely pursue big rounds at sky-high valuations, but it’s important that they recognize how important it is to manage who they allow into their mentorship circles. Initially, founders should make sure their first layer consists of the real “doers” — usually angels and early venture investors who founders meet with weekly (or more frequently) to help solve some of the most granular problems.
Everything from hiring to operational hurdles all the way to deeper, more personal challenges like balancing family life with a rapidly growing startup.
This circle is where the real mentorship happens, where founders can be open and vulnerable. For obvious reasons, this circle has to be small, and usually consist of two to six people at most. Anything more simply becomes unwieldy and leaves founders spending more time managing these relationships than actually building their company.
How founders manage their VC circles can mean the difference in success or failure for a thousand different reasons.
The second layer should consist of the “quarterly crowd” of investors. These aren’t necessarily people who are uninterested or unwilling to participate in the nitty gritty of running the company, but this circle tends to consist of VCs who make dozens of investments per year. They, like their founders, aren’t capable of managing 50 relationships on a weekly basis, so their touch points on company issues tend to move slower or less frequently.
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A blueprint for building a great startup founding team
In a company’s early days, the difference between C-level executives and the rest of the organization is simple — employees can walk away from a failure, but the leaders cannot. Under these conditions, certain kinds of people thrive in leadership roles and can take a company from ideation to production.
While there’s no magic formula for what works and what doesn’t, successful startups share common traits in terms of the way their foundational leadership teams are built.
We’ve all experienced what it looks like on the negative end of the spectrum — people making points simply to hear their own voice, leaders competing for credit and clashing agendas. When people would rather be heard than contribute, the output suffers. Members of a healthy leadership team are unafraid to let others have the limelight, because they trust the mission and the culture they’ve built together.
An honest self-assessment is necessary and this is something that only exceptional and selfless founders are capable of.
We are all imperfect human beings, founders included. There are always going to be moments that leaders can’t predict, and mistakes come with the territory. The right leadership team should be able to mitigate the unexpected, and sometimes make the future easier to predict. Putting the right people in the right roles early on can be the difference between success and failure — and that starts at the top.
Start by determining who will lead as CEO
Investors love founder-CEOs, and founders are often fantastic candidates for this role. But not everyone can do it well, and more importantly, not everyone wants to.
Startup founders should ask themselves a few questions before they lose sleep over the prospect of handing over the reigns:
- Do I even want to be CEO? If yes, for how long?
- Can I maximize the potential of the company if I’m not the CEO?
- Am I really the best person for this job at this stage?
An honest self-assessment is necessary and this is something that only exceptional and selfless founders are capable of. In many cases, founders decide they need outside help to fill the role. While a CEO may not be your first hire — or even one of the first five — the person you choose will ultimately occupy your organization’s most critical leadership role, so choose wisely.
What to look for: Ambitious vision grounded in execution reality. Your CEO should have hands-on experience that allows them to see around corners, predict pitfalls and identify opportunities.
What to watch out for: Leaders who lack respect for the founding vision or the ability to hire and balance an executive team quickly. A good CEO should be able to manage short-term cash flow and go-to-market needs without compromising the true north, while building a foundation and culture for the long term.
Then, hire a leader for your engineering team
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Avoid these common financial mistakes so your startup doesn’t die on the vine
The startup world can be a rollercoaster. While investment continues to pour in — with both founders and investors looking for the next unicorn — the reality is that 90% of startups fail, with over half of those going under in the first three years.
I’ve founded two companies that I grew and sold (Mezi and Dhingana). I encountered many of the issues that new founders face, learned on the job, and thankfully persevered. Using the knowledge that I acquired in my previous companies, I’ve founded a third — Zeni — to try and help founders make more informed, sustainable financial decisions.
For many founders, a transformative idea and initial outside investment doesn’t translate into understanding the underlying financial complexities of running a business.
Whether you’re just wrapping your seed round, or on to Series B, avoiding these common issues is the best way to ensure that you’re set on solid ground and free to focus on your vision.
Why most startups fail
Startups go under for a variety of reasons. Some fail to achieve product-market fit in a scalable way. Many others simply run out of money. While the above two reasons are often cited as the two primary reasons for startup failure, they’re also related. If you don’t solve a market problem and don’t generate customers, you’re eventually going to run out of money.
Unfortunately, many of the startups that fail shouldn’t. They’re led by bright entrepreneurs with a great idea. But for many founders, a transformative idea and initial outside investment doesn’t translate into understanding the underlying financial complexities of running a business.
When you break down the various complexities founders face in understanding business finances, there are three primary hurdles they face:
- Fragmentation of financial systems.
- Time-consuming manual tasks.
- Lack of real-time financial insights.
All of the above issues put increased workload and strain on founders, which can lead to burnout. Owners, on average, spend around 40% of their working hours on tasks like hiring, HR and payroll. While hiring is integral to a founders’ day-to-day role, other administrative tasks related to finance, HR and payroll distract founders from focusing on their overall vision and goals.
The good news is that by being aware of the above issues, you can solve them and eliminate the consequences of burnout, distraction and, ultimately, failure. Let’s talk about how.
Consolidate fragmentation
The financial decision-making and tasks of most startups start and stop with the founder. This means that bookkeeping, bill paying, invoicing, financial projections, employee payments and taxes all run into a bottleneck. Even worse, each of these functions requires another employee, vendor or third-party expert — finance firms, admins, CFOs, CPA firms — each using its own software and applications to accomplish their goals.
Each of these parties is reporting back up to the founder, who is then in charge of making sense of it all and disseminating the information to the entities that need it. This means that not only is everything slower, but often things fall through the cracks, as communication can become a serious issue.
Worse still, this creates cash flow problems, as bills go unpaid, invoices go unsent, and important financial documents are delayed. I’ve seen revenue go unreported and invoices unsent and uncollectable due to the fragmentation-bottleneck system most founders experience.
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5 factors founders must consider before choosing their VC
Though 2021 is far from over, it’s already witnessed a record level of venture capital activity in the technology sector. With larger round sizes announced daily, founders may have their pick of term sheets — but they need to think critically and strategically about which firms to add to their cap table.
So far this year, we’ve seen $292.4 billion in venture financing across the globe, of which $138.9 billion was raised in the United States. Specific to tech companies, the capital is only accelerating: In Q2, founders raised 157% more capital compared to the same period last year, according to the latest data from CB Insights.
It’s not just that more companies are raising money — they are doing so at a higher valuation. Median seed and Series A stage valuations today stand at $12 million and $42 million, respectively, up 20% to 30% from 2020. This can be partly attributed to growing exits/M&A activity in the technology sector, a record number of IPOs and a general bullishness around technology, as well as low interest rates and liquidity in the market.
Good VCs who are aligned with a startup’s vision create more value than the dollars they bring to the table.
At a time when we are witnessing record VC activity, founders would be well served to go back to the basics and focus on the principles of fundraising when determining who sits on their cap table. Here are a few pointers for founders in that direction:
1. Value > valuation
Good VCs who are aligned with a startup’s vision create more value than the dollars they bring to the table. Typically, such value is created across a few distinct functions — product, sales, domain expertise, business development and recruiting, to name a few — based on the background of the partners of the fund and the composition of their limited partners (investors in the venture fund).
Further, the right VC can serve as an authentic, objective sounding board for CEOs, which can be an asset to have as a startup navigates uncertainty and the typical challenges that come with scaling a young company. As founders assess multiple term sheets, it’s worth thinking through whether they should optimize for VCs who offer the highest valuation, or for ones who bring the most value to the table.
2. A two-way street
Running an efficient fundraising process, in part, entails holding VCs accountable to their own diligence requests. While it is unfortunately common for VCs to request a lot of data upfront, startups should share information after assessing intent and appetite on the investors’ part.
For every additional data request, founders are well within their rights (and should) check with their potential investors on where the process stands and get indicative timelines for moving forward with next steps. Mark Suster said it best: “Data rooms are where fundraising processes go to die.”
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