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AQP Book Club | Pale Rider: The Spanish Flu of 1918 and How it Changed the World

By: Jessica Horn and Emily Bak

Part 1 | History Repeats Itself

We knew that selecting a book about the Spanish Flu for the second installment of our book-club series in the midst of a current global pandemic was going to be unsettling. What we could not have possibly braced ourselves for was just how scary it was to read about a time, more than a century ago, that so closely mirrors what we’re living through today. Curious to learn more about how our past would relate to our present, “Pale Rider: The Spanish Flu of 1918 and How it Changed The World,” written by Laura Spinney, left us spooked and wondering what could have been learned to avoid similar mistakes today.

Why hasn’t this epic event infecting one in three people on earth (500 million people at the time), with casualties surpassing World War I and World War II – and possibly both combined (anywhere between 50-100 million deaths from 1918-1920) – been emphasized more in our approach to this pandemic? Measures taken such as school and church closures, suspension of public gatherings, and social distancing were put into effect during the Spanish flu, but later on in the pandemic and after many casualties. After knowing that these control measures worked, how could we have not acted faster when it would have resulted in saved lives? It’s infuriating! Spinney acknowledges this by dedicating a whole section of her book to reasons why pandemics are often forgotten. “Two world wars, the rise and fall of communism, perhaps some of the more spectacular episodes of decolonization,” are the events that we see when looking back at the twentieth century. While the impact of these events is more concrete, the Spanish flu was truly the most dramatic event of them all. Spinney asks, “…who wants to rehearse the details of a pandemic? A war has a victor, but a pandemic has only vanquished.”

While we don’t want to belabor how shameful it is that we didn’t learn from our mistakes sooner, we do want to highlight parallels we’ve found to be most striking because the learnings from this book have allowed us to understand our own experience better. Further, after digesting the book together, our feelings of frustration evolved into ones of hope. We realized that we see innovations in healthcare every day through the work that we do, and rather than focus on what we could have done differently, we look to the promise of the future. Covid-19 has highlighted a lot of gaps in our system and drawn attention to companies that have been striving to fill them, even before this all began. When we inevitably face another pandemic somewhere in the (hopefully very distant) future, innovations and changes in our industry will prepare us to meet those challenges.

Part 2 | Parallels Between 1918 and 2020:

Topic 1918 2020
Social Determinants of Health
  • Highest death rates are in impoverished populations, mostly made up of ethnic minorities and immigrants. This population lived in crowded conditions, with bad diets and poor access to healthcare, and were said to be
    more susceptible to illness because they lacked drive and self-discipline, and were already prone to these diseases
  • According to the CDC, racial and ethnic minority groups have an increased risk of severe illness due to Covid-1.9
  • Hispanics or Latinos have a rate of .4 times, and Non-Hispanic American Indians and African Americans have a rate of about 5 times that of non-Hispanic white people
Government Preparedness
  • Cities were “totally unprepared for the tidal wave of sickness that now overtook it” (pg.50)
  • Doctors were overwhelmed with patients that would show up at their homes
  • Lack of food, attacks on bakeries and warehouses
  • Hospitals are overwhelmed as they experience a lack of resources, equipment and beds
  • Lack of testing
  • Government offers PPP Loans to small businesses to help them retain their employees
  • Grocery stores are also experiencing shortages of items likes toilet paper and hand sanitizer
Behavioral Health
  • Both mandatory and voluntary structure was put in place to contain the disease
  • Sense of fatigue among the population as people weren’t able to live their normal lives
  • Restrictions felt difficult to understand and follow
  • Isolation and other factors have contributed to more awareness and conversation around mental health
  • More companies are implementing mental health initiatives, and mental health resources are becoming more readily available
Controlling the Spread
  • Methods used to prevent the spread included using a handkerchief to cover one’s face and opening windows at night
  • There would be a severe punishment if one broke quarantine or sanitary regulations (pg.101)
  • States have shut down,store have closed,there are limits to how large groups can be in a public setting,masks are required in public,and people are forced to socially distance
  • A study conducted in 2007 using data from 1918 recognized that some of the tactics being used today such as “banning mass gatherings and imposing the wearing of masks collectively cut the death toll in some American
    cities by up to 50 percent” (pg.205)

Part 3 | A Closer Look

Social Determinants of Health

Sadly, this public health emergency, just like the Spanish flu, has brought to light that populations living in low-income areas without access to safe living conditions, healthy food, and proper healthcare, are at higher risk of Covid-related illness and death. For example, Black people account for 24% of Covid-19 deaths, even though they make up 13% of the population. In the wake of Covid-19, companies like Cityblock Health have really emerged as leaders in addressing the needs of complex populations through technology and personalized care. This value-based care company meets patients where they are by opening clinics in low-income urban communities.

Solera Health, a company that builds programs to improve health and well-being, understands the key to better health is through community. They raised a substantial Series C round in 2019 enabling them to expand their offerings and majorly focus on addressing behavioral and social determinants of health like food insecurity, tailored food programs, and social isolation, specifically for individuals managing diabetes. It is clear to us how, by approaching healthcare holistically, we can help to reduce the disproportionate impact of Covid-19 – and all future pandemics – on underserved populations. In a post Covid-19 era, it’s promising that companies like these will limit the barriers that inhibit access to care, and hopefully remove them completely.

Telemedicine

The pace of telemedicine adoption has skyrocketed since the onset of the pandemic, as patients and providers alike have had no choice but to find ways to engage virtually. What acted as a major roadblock before, reimbursement policies for virtual care in the wake of Covid-19 have changed and allowed for telemedicine companies to finally see their solutions surge in adoption and engagement. Changes in policies have broadened access to care by the sheer fact that doctors can now provide treatment across state lines and at the same reimbursement rate as an in-person visit, removing an obstacle that prevailed in the past. Take Boulder Care as an example of a company that existed pre-Covid: a platform tackling opioid addiction completely virtually. They recognized the need for people to receive Medicated Assisted Treatment from the comfort of their homes and were already partnering with innovative health plans who understood that gap. Upon the arrival of Covid-19, Boulder’s solution has become even more of a necessary resource for people who can’t physically go into these treatment facilities.

Another example of a company that saw a major opportunity in this new climate is Curve Health. Curve offers a virtual hospital solution to limit avoidable ED visits by facilitating remote care and its reimbursement while creating a data bridge between healthcare systems and SNFs. With some of the most vulnerable to Covid-19 residing within the SNF population, Curve’s technology helps to reduce the strain and destructive effects the virus has had on these facilities. Now that people have been forced to realize the benefits of telemedicine and have seen the immediate impact this technology can offer patients requiring high touch care, it’s likely the demand for at-home treatment will continue to rise and hopefully remain prevalent.

Behavioral Health

The time we’re living in now is terrifying. What once seemed like mundane tasks, whether it was going to the grocery store or grabbing a cup of coffee in the morning, are now inundated with the risk of infection and the unknown severity associated with contracting the virus itself. Even if our own physical health has not been affected, the constant fear and guilt that people we love could get sick because of our actions is constantly in the back of our minds. Not only is there a fear of getting sick, but the economic impact from the pandemic has touched us all, whether we’re one of millions of people who have lost their jobs, have faced salary reductions, or are experiencing a lag in business growth. On top of everything, we’re quarantined and cannot rely on friends or colleagues for support and comfort in the ways we’re accustomed to. This feeling of isolation and loneliness all leads to huge amounts of stress and trauma that can stay with us for years to come. It has become clearer now than ever before how our mental wellbeing directly impacts our overall health. It’s not just a comorbidity, but a full-blown illness like any other chronic disease.

Companies like AbleTo and Quartet, leading providers of virtual mental health treatment, have already been scaling, but continue to grow to meet the larger demand of patient needs during this time. Newer teletherapy solutions like Alma Health are flourishing as not only is there a greater demand for therapy, but also a greater need for that therapy to be virtual. Employers recognize the importance of supporting their employees and adopting solutions like Eden Health to keep employees healthy, happy, and motivated.

Furthermore, in light of discussions around racial inequalities, it’s important to acknowledge some of the amazing companies and organizations that are building new behavioral health resources or partnering with existing organizations to address the specific needs of diverse populations. The Loveland Foundation, which is raising a therapy fund for black women and girls, has partnered with well-known virtual behavioral health provider, Talkspace. Another example is Henry Health, a provider of “culturally intentional” mental health treatment, aiming to increase the life expectancy of black men by 10 years through their services.

After even the first few pages of reading “Pale Rider,” we were eager to write and expose the similarities between the world we live in now and the world 100 years ago. Despite feeling discouraged initially, we have come to believe that Covid-19 will act as a catalyst to fully realize a forever-changed healthcare world because of the innovations in technologies we are forced to adopt during this pandemic. Virtual care and telemedicine in conjunction with heightened awareness around mental health and breaking down barriers to care access – the next pandemic doesn’t stand a chance!

Why We Do What We Do: Diversity, Equity & Inclusion

By: Tim Gordon

2020 has not been the year that anyone expected. At most, it has destroyed lives, families, companies, industries, futures, and dare I say, hope. At least, it has changed the way almost everyone thinks about everything. It’s a lot for 5 months. It pales in comparison to the suffering that many BIPOC communities, and specifically the Black community, have faced for decades, so the last 5 months have felt like a planetary revolt to me. Mother Nature finally got tired of waiting for us to figure this all out on our own, and said ‘enough.’ The national outcry, and subsequent protests of the murder of George Floyd had a visible impact on our team. At the same time, quarantine had forced us into these perceived personal “bubbles,” where watching these events unfold on TV and social media seemed like a bizarre, detached experience – a continuation of the disaster flick that Covid unleashed on us. It took more than a moment for me to realize that this is happening. With that realization, we talked about it. First, about how it made us all feel, and second, about what we were going to do about it.

I’ll admit, having grown up comfortably in the suburbs – not spoiled, but not wanting for anything I needed – while also going to high school in West Philadelphia, I struggled with this issue. I never fully understood what I was supposed to do about racism, besides not be racist. Be nice to people, treat them fairly, respectfully. At the same time, when I saw successful people of color, I frequently thought to myself, ‘they undoubtedly had to work harder and overcome more than I would have to find myself in the same place’ – and not because I’m so awesome. Was that racist? Or was that an acknowledgement of the stacked deck that I inherently knew existed. Either way, what could I actually do about it? That uncertainty about what action to take or what real impact I could even have, made entering into our open team discussions about the state of race relations in our country both exciting, and extremely uncomfortable.

As we unpacked our personal perspectives on this, and then transitioned into what we can and want to do about it as a company, that trepidation has given way to energy. The more we talked about it as a team, the more I realized that there are things that we can actually do to make a difference. As an executive search firm, we have the opportunity to elevate people of color, women, and other marginalized communities, by displaying for our clients all of their glory and competency.  If we can change the composition of leadership for the better in the organizations we partner with, we can make a tangible difference. I don’t want to overstate this, and we are coming to this endeavor with humility, open hearts, and open minds. We have a lot to learn, and know that the things we do will not change the world. But they might change the world for a family and therefore a generation. We find ourselves in a unique position where our day-to-day work demands that we expose talented people to opportunity, and in doing so, also fine tune our own expertise, that, when shared with the next generation of talent, has the potential to change their trajectory. We can change the way we execute on, and deliver our work, and we can be deliberate in elevating and exposing talent of color to opportunity. We can also leverage our expertise to give back to marginalized communities, volunteering our time and know-how to prepare individuals earlier in their careers for the road ahead.

Search, Invest, Give Back. Those are the 3 pillars that we’ve built our company around, and so create a framework for injecting DEI efforts into our core infrastructure. ‘Aequitas’ is Latin for Integrity and Equity. Up until now, that provided a nice dual meaning for how we approach our work, and our willingness to take equity in our clients for doing it. As we enter our 7th year of operation, that Equity translation holds new meaning, and requires that we turn inward to dissect how we do things.

Search

We created an additional layer of transparency with our clients at key milestones in the search process to show them (and us) how we’re doing, and will be setting clear metrics internally around diversity and inclusion targets for each of our engagements. We refactored elements of our database to make research efforts more effective as we aim to hit these targets, while ensuring that search cycles remain on track, and that we can approach each search with the same sense of urgency that we always have. We’re also being deliberate in seeking out diversity in our networking conversations, understanding that if referrals don’t come from a new place, the results won’t change. Our scorecards are being reworked to measure “Culture Add” as opposed to “Culture Fit,” as we’ve come to recognize that this is a distinction with a critical difference. On one hand, diversity among the leadership of our clients is excellent, with multiple female Founders, and CEOs of color – sometimes both. This is exciting. Diversity among our placed leadership, however, is not where it needs to be. We are working internally to determine if this is due to our unrecognized biases, a particular skill set, how our process is structured, the industry as a whole, or some measure of all of those things. As we unpack the drivers and underlying issues, we hope to see a shift in the diversity of our candidate slates, and resultantly, the executives our clients hire. We’ll have more to share on this as we continue to develop a longer-term roadmap as a team, but we’re already implementing a number of best practices.

Invest

We are not a traditional active investor, in that we don’t write checks to fund companies. We’re willing to convert our search fees into equity, and we’re approaching our 10th portfolio company in that fashion. We are working on some exciting things related to DEI and traditional investing, but those are further off, so in the near term, we’re thinking about investing in different ways. We have held a number of Virtual Roundtables on DEI, attended by top talent leaders from healthcare companies across the country. They have been fascinating, and we – as well as the participants – have learned a great deal in a short time. We want to continue to democratize knowledge in that way so that we can all get better. We have also launched a private Slack community for those talent leaders to share resources in service of their respective DEI goals and initiatives. Similarly, we launched The Health Talent Exchange as a way to create more visibility for people from all walks of life into a robust, active job market. We are engaging with a handful of academic institutions that have respected healthcare programs to find ways to support the next generation of entrepreneurs, with a specific focus on underrepresented communities. So while this may not be invested capital, it is an investment of time, money and expertise that builds some momentum.

Give Back

Our team has gotten a great deal of joy from donating our time to a handful of local organizations in NYC, largely with underserved youth. As a core component of our business however, we have not been engaged enough, nor have we looked creatively at how to make sure that our volunteerism doesn’t just impact a point in time, but rather has sustained, long term impact. We are talking internally about organizations that will allow us to bring some of our expertise to young leaders from underrepresented communities to help them gain an edge earlier in their careers. We are also restructuring our content going forward to include more diverse voices, and considering ways to convert work with clients of color into an investment into the cause. We are being thoughtful in sharing specifics, as these things take time to do responsibly, and I want what we choose to do to be sustainable, lest this be a couple of pages of virtue signaling, without much to back it up.

Integrity and equity within a process can and does lead to the feeling of integrity within every client and candidate we work with. We may not be tweeting about it, we hope our actions speak for us. We will fumble along the way, probably put our feet in our mouths, and be humbled throughout the process. But real change is necessary, and we know it won’t be easy. We have come to understand that, while well-intended, our objective focus on competencies and accomplishments doesn’t get the full picture. There are a litany reasons why we don’t see more leaders of color, and none of them have anything to do with competency. So we’re digging deeper into the data, changing the way we think about research and where we source talent from, and structuring our processes accordingly.

At the end of the day, we help people rise to positions of leadership, and what better way for us to contribute to this cause, than to tap into that unique ability to help executives from marginalized communities rise to leadership.  Will it end racism in our country?  No.  But it’s a start.  And it’s a real tangible thing that makes us part of the solution.

When Teams Go Remote: Tips on Scaling in a Distributed Environment

By: Steven Berman

Long before COVID-19 reared its ugly head, there was already a massive shift towards distributed workforces, and it only seems to have been accelerated by the need to remain socially distant. As we gain momentum in fighting this terrible virus, and companies look to reopen their headquarters, there is a sentiment that this shift to a remote workforce is here to stay. Last quarter our Managing Partner, Tim Gordon, wrote a fascinating piece on how companies were starting to react to this rapidly changing landscape. This sparked my curiosity about the tangible approaches companies have been taking in an effort to attract talented employees and keep their current ones engaged and happy. Over the past few weeks, I’ve sat down (virtually of course!) with leaders at six different digital health companies – Cohere Health, ConcertHealth, Eden Health, Stellar Health, Virta Health, and Wellth -to get their take, soup to nuts, on hiring and maintaining culture in this new environment.

The themes that emerged closely mirrored those we reflected on last quarter: Interviewing & Hiring, Onboarding & Training, and Establishing & Maintaining Company Culture. While some of these insights might seem obvious, the leaders I spoke with emphasized that it’s often the most obvious things that you need to ensure don’t slip through the cracks while trying to scale and run a business during such a strenuous time.

Interviewing & Hiring

In speaking with Eden Health’s leadership team, they made it clear to me that Eden’s brand and company culture reputation was established before candidates ever connected with their team. As a result, the interview process starts long before the Eden Health team first chats with a prospective employee. In order to get out in front of all this, Eden proactively established their presence on “Built in NYC.” They explained that a strong brand not only attracts potential candidates, but also helps the advocates in your network easily soft-introduce your company to people they think would be interesting candidates or clients.

In a virtual hiring process, it can be difficult to spend time getting a feel for a candidate’s fit with your company culture. Therefore, sourcing people from your network becomes a more sure-fire way to ensure that they align with your mission. In particular, Cohere Health emphasized how they’ve been leveraging their network more than ever during these times. When it comes to the actual interviewing, having a consistent process with outlined criteria will allow every candidate to have the same opportunity and equal chance at being selected for the role. Virta Health has found that the easiest way to achieve a uniform virtual interviewing process is to write down the criteria you’re going to evaluate candidates on as soon as you decide to open the role. Get granular! These are not just the top three of four objectives this hire will have to accomplish, make sure you dive into the nitty-gritty as well. While this seems table-stakes, it’s an easy step that is often overlooked!

Upon first glance, you might expect limited benefits from a purely virtual interview process. However, all the company leaders I spoke with found it to be a more crisp way of interacting with candidates. They described how virtual hiring eliminates the lag time between meetings to coordinate calendars, allowing for more touch points in a shorter timeframe. These extra touch points are valuable, as they give more members of your team an opportunity to interact with a potential hire and vice versa.

The way both the candidate and hiring company follow up post-interviews is a great way to gauge and show interest. Wellth stressed something that seems obvious but is overlooked more than you would expect. Handcrafted thank you notes versus boilerplate emails can give you insight as to how a candidate operates, and their attention to detail. The Wellth leaders also emphasized the importance of companies sending sincere follow-ups to candidates. This can help to reinforce the importance of the role they’re filling, creating a sense of purpose for candidates and helping to keep them engaged throughout the interview process.

Cohere Health also spoke about how it’s imperative to recognize the level of seniority you’re hiring for and tailor your virtual interview process accordingly. Recent graduates who have not yet had the opportunity to go through a couple of interview cycles will require a different process than more senior executives. It’s important to keep this in mind when developing a hiring process for a specific role.

Onboarding & Training

Once you’ve come to an agreement and hired someone for your team, you need to make a deliberate effort from day one to empower the new employee and set him or her up for success. At Stellar Health, this process starts with ensuring there are clear expectations of what short-term and long-term success looks like from the outset. A common theme with all the companies I spoke with was how having open lines of communication directly correlated with a higher probability of a new hire working out. How do you work towards open lines of communication? One of the oft-mentioned tips that came up was that companies must reinforce the importance of asking questions early and often. The leadership team must also set a good example by asking questions themselves and being transparent, especially during open company forums and town hall meetings.

In remote settings where there are no coincidental “water-cooler” run-ins, happy hours, or non-work related social interactions between teammates, companies must find new ways to generate interactions between new employees and their coworkers. Stellar Health sets up virtual coffee meetings for new employees with a range of co-workers across different departments as part of the onboarding process.

The relationship between a manager and their direct report is even more important in a remote work setting. It is imperative that the time managers spend with their team members be structured, with an established cadence for communication and not simply ad-hoc. One way that Stellar Health has had success establishing this structure, even before Covid, was by creating bi-weekly meetings for managers and all the folks on their team individually. However, it is important that the time carved out in these meetings is not just used to catch up, but also to share bi-directional feedback and gauge how both parties are tracking against their onboarding, training, and ongoing goals.

Establishing & Maintaining Company Culture

The goal of creating a great culture remains largely unchanged no matter what type of office (or lack thereof) environment you have. Culture is the driving force that unites people to work towards seemingly unachievable goals; it’s the fabric that allows for accretive ecosystems where the whole is greater than the sum of its parts.

Lost in the fray of not working day-in and day-out in an office are the personal bonds you build with your teammates. While you’re all aligned with the common goal of scaling a successful business, people need to feel personally empowered to work to the best of their ability. Being remote, it is critical that leaders build environments where people feel comfortable showing their personality and creating personal bonds within the organization. These bonds don’t all have to be work-related, in fact they shouldn’t be! Establishing personal rapport often comes as a result of discovering that people share something in common outside of what they do for a living. ConcertHealth offered a useful example of an uncomplicated activity that creates bonds while working virtually. Every week on Slack, they conduct a company-wide small activity aimed at offering insight into their colleague’s lives. One person starts the chain each week. In a recent week, the starting employee asked a colleague to send a picture of their home office to the team and tag another colleague to do the same. Another week they asked people to share a small thing they have appreciated in their lives. These small activities humanize teammates to each other, allowing people to be recognized for things outside the context of work.

This doesn’t mean leaders should ignore their employees’ workplace achievements though. After all, everyone joined your company for a specific purpose, especially in healthcare – to tackle big problems. Anyone who has worked in an office environment can likely recall the buzz generated internally from closing a big contract or finally hitting a stretch goal. There are small actions you can take to make people feel appreciated and united. For instance, we at Aequitas recently celebrated our 6th birthday and all of us received the same cake delivered on the same day (our birthday!). Eating that cake together, even virtually, oddly made me feel more connected to the team. A program Eden Health has used to create a connected and inclusive team environment is carving out time during all-hands meetings for employees to be highlighted in a “missions moments segment.” In these segments, employees share why they joined a health-tech company. Allowing people to tell personal stories brings the team closer together, highlighting the uniqueness and the similarities among their peers.

While working remotely certainly has its challenges, there are different ways it can be advantageous. The common themes that shone throughout all the conversations I had are easy to talk about, yet hard to implement and maintain. Effective processes don’t differ much, regardless of whether you’re building a centrally located or fully distributed team. The big difference comes with how little room for error there is as companies grow their remote workforces, requiring leadership to develop clearly defined goals and be deliberate in the actions they take towards achieving them, no matter how basic they may seem. Lines of communication must remain wide-open, and an inquisitive culture must be fostered, where everyone feels empowered to speak up and ask questions early and often. Only time will tell if this shift in office dynamics will catch on permanently, however the principals discussed remain true across any environment.

In Search of Silver Linings: Opportunity in Chaos

By: Tim Gordon, Managing Partner, Aequitas Partners

“Work wherever you feel safe and comfortable.” That’s what I said to our team over a month ago, and I haven’t seen any of them in person since. We didn’t mandate anything because this was before New York City effectively shut down, but everyone understandably opted to head for more square footage and stocked kitchens in the suburbs. Overnight, the world changed. It felt…sad. There was a solid week of culture shock and change management as we adapted to being a distributed company, but as we adjusted, I encouraged everyone to change their perspective. There is opportunity in here somewhere – let’s find it. What’s the silver lining?

I believe strongly that there also remains tremendous opportunity for companies in our space. Organizations have raised capital over the last 6-9 months, and there is an unprecedented amount of talent available, motivated, and looking to make an impact. Well-capitalized companies might be revising their hiring plans and sales forecasts, but they still need to grow. What if this environment isn’t temporary? What if much of the country remains remote through the end of the year, or longer? It’s unclear when sales leaders will be hopping on planes to go see prospects or existing customers. If more business is being conducted remotely, is there an advantage to building an interview and hiring process that can achieve success virtually, knowing that those hires might be conducting most of their work that way anyhow?

Just this week, someone on our team spoke to a VC who had just done two things that excite me and give me hope. First, they led and closed a Series B round for which the entire deal cycle was virtual. They never met in person. Second, they are running a search for a CFO of a portfolio company, and doing it remote, end-to-end. They will hire someone they’ve never met into a C-suite position. Most wouldn’t have fathomed either of these things in the middle of Q1, but I think this is where opportunity lies. That being said, in order for this to work, two things need to be executed on with relentless precision – your interview process and your onboarding process.

On a good day, a lot of companies struggle with constructing and adhering to a well-defined interview process. And one of the staples of that process has always been the “in-person interview,” where a person is brought in to meet the team, or taken to lunch or dinner where you can be in a more casual setting. Most will tell you that the in-person interview is integral to determine cultural fit. But it’s much more than that – it’s a way for you to determine what that person’s presence does to your already-existing gut instinct on whether they should be hired or not. So in a world where in-person interviews no longer exist, how do you fill the “Intuition Gap” that results?

This new world is a reality check on that, so it’s critical that a new process be thoughtful, creative and acknowledging of the difficulty and vulnerability of our various situations.

  1. Communicate your process clearly to candidates. It’s imperative that someone entering an interview process right now, with all of the unknowns, gets a sense of confidence that a hiring company has their act together. Lay out the steps on the front end.
  2. Get creative on your video interviews and calls. Sure every interview can easily be turned into a Zoom call, but so can social interactions. If you’re hiring senior execs, get the candidate and their spouse together with you and yours for a virtual happy hour, and make it last longer than 60 minutes. Have a virtual dinner meeting, or a “working virtual lunch.” Try to replicate the time you’d spend in person.
  3. Turn off your computer notifications during the interview. Frankly a good reminder for any interaction, but particularly interviews. If you’re distracted with emails, text messages and Slacks , you’re missing valuable opportunity to pick up on non-verbal cues that will help you close that Intuition Gap.
  4. Over-rotate on references and backchannels to fill in the gaps created by a lack of in-person face time. These are always important, but need to be done in greater quantity and depth if they’re going to successfully close your Intuition Gap.
  5. It’s also a strong argument for a collaborative “deliverable.” Not free work, but something that allows you and a candidate to really unpack the way you’d work together, and seek strong alignment before a hire is made. It’s a good opportunity to involve more team members in an efficient way, and will likely be required, as candidates try to get comfortable with the prospect of joining a team they’ve never sat in a room with.

Figuring out the hiring process is only half the battle. Where things get really interesting is onboarding. Onboarding remote hires – when it’s not your traditional method – is difficult. We just lived through this, bringing our most senior hire to date on board on March 16th – the same day our office effectively closed because of COVID-19. We benefited in a few ways: first, Polina is a total pro, and has worked all over the world remotely, second, we all had spent time together planning for her onboarding before she started, and third, she and I have a nearly decade-old relationship. Bit of an unfair advantage.

That said, similar to the hiring process, many of the same principles apply to onboarding:

  1. Fully schedule out the entire week. It’s a bit odd working from home when you don’t know what your work actually is. On that first day at 9am, what happens? Maybe it starts off with a virtual team breakfast, or with someone doing a demo on how your Slack account and CRM work. Did you even set up those logins in the first place?
  2. Create some internal accountability. Write out clear weekly goals for progress, and they should be tracked somewhere centrally with a great deal of transparency. Have proactive check-ins with the individual that are more than “how are you doing today?” There are few new hires that will tell you exactly where they are having trouble, so make sure your check-ins are tactical and include training.
  3. Recreate osmotic learning. Because you’re not in an office together, there is no way for your new hire to learn passively by overhearing conversations. So have the person shadow and listen in on as many calls as possible in the first few weeks. Proactively explain why you responded to an email in the way you did.
  4. Make things extremely high touch, but with a purpose. Leverage Slack to communicate throughout the day, and make yourself and your team available to folks that are trying to learn your ways and culture. Do as much of it as possible over video, trying not to leave a new hire with long periods of solo work without interaction.

Organize virtual team happy hours much the same you would if you were back in the office and taking the new guy out at the end of his first week. And please cut the newb in on the jokes / watercooler Slack channels so they can experience and subsequently add to the culture of your team.
With the wave of layoffs happening, many employers who are still hiring have fallen into a false sense of confidence that it’s a “buyer’s market.” Meaning that they’re going to have a plethora of candidates to choose from, and they can also take their time. That is a big misconception. The onus is much more on you to meet the candidate (and hopefully your new team member) halfway. Let me be clear – an unfocused hiring and subsequently uncoordinated onboarding process are the first and second impressions of how things work in your company. And a stellar candidate – which let’s be honest, you’re not out there trying to hire mediocrity – will take immediate notice and appropriately socially distance themselves from you.

Ultimately, there’s three choices. You can build a process that gets you right up to finalists, and then wait out the travel ban to see when you can get them on site. You can build an even better process, that allows you to get conviction and make a hire in a virtual format that’s uncomfortable, but might not be changing any time soon. Or, you can do nothing. It’s clear that many organizations and their investors are seeing a great deal of opportunity in adapting to the situation on the ground. The silver lining, if you’re searching for it, is that a process forged under duress stands to perform exceedingly well during happier days.

The Shift to Value-Based Conversation

Interview by Polina Hanin, Principal, Aequitas Partners

For the better part of a decade, I’ve had the unique privilege of working with 300+ companies and 500+ entrepreneurs to solve some of the biggest health challenges of our time as the Portfolio Director at StartUp Health.

In that same time span I had the opportunity to work with Tim Gordon, who as the readers here know, is the Founder and Managing Partner of Aequitas Partners, a firm that builds leadership teams for high growth health companies. Entrepreneurs find themselves in a vulnerable spot when they’re bringing in senior execs – you’re putting your trust, and your company, in the hands of someone new. And in my humble opinion, there are few who understand and empathize with that position better than Tim.

Example? It starts with the company name. Stemming from Latin, Aequitas stands for fairness and integrity. In fact, it’s where the English word “equity” comes from. It is these values that make Aequitas a great partner for not just new folks like me, whose first day was literally the day NYC announced its shelter-in-place order, but for each of the entrepreneurs with whom we partner.

This is why I am particularly excited to have sat down with Tim virtually and reflected upon the last month together.

Polina: Tim, you have a lot going on. In the two week span of when shelter in place in New York City was instituted, you kicked off a number of brand new searches, brought in a brand new team member (hi!), moved your family, and then celebrated your son’s first birthday. Explain yourself.

Tim: It turns out I’m a glutton for punishment. The crazy thing, too, is that it seems like a long list, but there were actually even more things than just what you mentioned going on at the same time. I think historically I do better when I’m busy, but even I can admit that this was kind of bananas. Ultimately, it was about rising to this challenge on two fronts: do whatever it takes for your family, and also at the same time do whatever it takes your other family, for the company. I probably blacked out a little bit for the last two weeks of March, but we made it through all that and got the team distributed, and got you up and running very quickly, which I don’t know that we had as much to do with that as you did. But I’m grateful, frankly, that March is behind us.

Polina: It literally was a light switch of Aequitas being a team that was in one office, always together, to all of a sudden being dispersed across the entire country. As a founder, how was it for you to make that transition?

Tim: To be honest, it was hard. It was hard for everybody. It was very abrupt. To your point, one day we were all sitting together and getting ready for you to join us, and by the next day, no one was there, and everybody was in these unfamiliar working environments or trying to adapt their living environment to also be a working one. In New York City, me included, I was living in a one-bedroom apartment with my wife and a one year old…that’s not optimized for work-from-home. So the first week of that was an exercise in change management, and managing the distractions that came with it. It took us about a week, and then it felt like we were all settled. I think we were all sad, but optimistic that we could all be back together in the not-so-distant future, and in the meantime, there was work to be done. I was really proud of the way the team came together, and how much of an impact frankly you had on that in light of your experience working remotely from all over the world over the years. I think we benefited greatly from that.

Polina: Adaptability is key for any organization, coupled with a bit of reflection. Almost a year ago, you penned a great retrospective on the lessons that you learned along the way to Aequitas turning five. And one of the first ones was “always be selling like you’re going out of business.” You wrote about the nuance of selling a service, and the urgency with which you need to approach dialogues and relationships. In light of what’s going on today, has your perspective shifted?

Tim: In some ways it’s changed completely, and in others it’s exactly the same, but there’s some weird irony probably buried in that bullet from that retrospective. For now, if you take the thesis behind “always be selling like you’re going out of business,” we’re really swapping “selling” for “adding value.” That’s not to say that adding value isn’t always one of our primary objectives, but I think traditional “business development efforts” are – I won’t go as far as to say inappropriate – but not conducted the way they were on March 1st. And so, we’re a little bit less worried about selling like we’re going out of business, and more interested in driving value for our partners like we’re going out of business. It’s not really about new business and new clients right now, as much as it’s about being great partners to our current clients and making ourselves and our expertise available to virtually anybody that needs it.

Polina: In this environment, how do you define “value”?

Tim: In some ways it follows over a longer period of time what our search process follows over a shorter period of time, which is that sometimes you need to go back to the beginning based on whatever market forces you’re dealing with. I have, in some ways, dusted off the playbook from when it was just me, which is that you’re not going to win everything, and the best you can do, the most important thing you can do is be there for people, with no strings attached. The way that would apply to an existing client would be counseling them on how to run virtual interview processes, or giving them guidance on whether or not it even makes sense to follow a search through right now or whether they should sit and wait, or ‘hey, don’t rush this through because you’re afraid you’re going to lose somebody, trust the process.’ That’s the client side. The candidate side is the same as it’s always been: have a conversation with anybody who wants to talk to us and needs our help. More people than ever probably need our help, and that could be market intelligence on who’s hiring, it could be how to think through a transition when you’re laid off, it could be how to rewrite a resume, whatever that might be, just help people. Similarly, something I’ve done for as long as I’ve been doing this, is continue to connect. Make connections for people that don’t come with any expectations other than “I hope someone benefits from this.”

Polina: One of the things that initially attracted me to Aequitas is the dignity that you bring to the hiring process for both the organizations and founders with whom we work, and the candidates. It seems like both sides of that equation are in a really vulnerable position. In such an uncertain time, how does dignity and choice play itself out today?

Tim: I truly believe that we’ve infused a different kind of ethos into the way we partner with clients and candidates. And so, I hear integrity – which is effectively the translation of our company’s namesake – defined as ‘what you do when no one is looking,’ which for me translates into doing the right thing even when it’s the hard thing. It’s easy to second- guess when and how you’ve done that in hindsight when we’re all under siege right now, but I wouldn’t change a thing. That’s exactly why we’re launching the Health Talent Exchange – it just seems like the right thing to do. It’s not about us right now, it’s about everyone. People are struggling, relationships are being stressed, there’s a lot of fear, and if building something like this helps some people get back to work, put food on the table for their families, get health insurance, that’s a big win. As a team, we’ll feel like we’ve done our small part, and it’s the least we can do because there’s just a bigger picture goal now. This is a humanity thing and if we do those things and if we focus on those things, it’s why we’ve built the company the way we did and built the culture the way we did. If we stick to that and stay true to that, everything will be fine when all of this is over.

Polina: Can you describe the Health Talent Exchange?

Tim: What we’re creating is an intellectually honest and democratized platform to connect people. The underlying principle for this exchange is what we’ve all been doing for a living as Aequitas Partners for so long, which is connecting. Connecting people. None of this will cost anybody a thing. It’s completely free, pro bono, and we just hope that it helps people. There are a few things at play. Firstly, certain companies are still growing and hiring right now, but they’re hard to find, or harder to find than they should be or would be under normal circumstances. We want to elevate them. We want to make them more visible to people who are looking, because they have growth objectives and they’re making an impact on healthcare. How do we help facilitate that? The first part is to aggregate the real opportunities that are out there, get them all into one place, and make them very searchable and very easy for people who are looking for new things.

The second piece is that there are a lot of people who have been displaced. And unlike other times, many of them are total rock-stars and their performance on the job had absolutely no bearing on being a part of a reduction of force. There are also lots of people who might see the writing on the wall and are worried that that’s coming for them too, and are starting to think about how they get out in front of that. There’s going to be an opportunity for those folks to announce themselves.

The third piece is that there are a lot of companies that are going to get squeezed here. They were getting ready to raise capital, or were in the middle of it, and those raises aren’t happening. But they still need to invest in certain things. Maybe they need marketing, and were going to hire a VP of Marketing with their Series B funds, but those aren’t available any longer.  What we want to create is a place where either volunteers or contractors or consultants can offer up their capabilities. So maybe the near-term solution for that Series B company is to grab a three-month consulting engagement from a really strong marketer and it bridges the gap.

Polina: As a veteran in the health-focused, executive recruiting space has your perspective on hiring processes and the recruiting industry changed?

Tim: I think if it’s changed my perspective, it’s changed it at a higher level. Maybe less specific to those things, but on the way we think of work, life, and family. I lived through the 2008/2009 recession as a twenty-something and I was laid off because I was in financial services. In my mind, I thought well, I’m glad that that black swan event happened when I was young, single, had no kids, and frankly had very little responsibility. This feels an order of magnitude worse, and only a decade has passed. So to me, this is a stark reminder that we really only have the illusion of being in control of anything. Mentally, the best thing for my general perspective through all of this has been to take a couple minutes every single day and think about what I have vs. what I don’t, and to be very, very grateful – out loud – for those things, because a lot have way less. That’s been one of the more acute impacts on my general perspective. I don’t think that there was a way to prepare for this. Shit happens sometimes. But what’s unique here is that this is happening to everybody, and I don’t know that there have been many events in the world where you can say that. The general empathy that this has created in the world is something that I hope we can hold on to when this is over.

Polina: It’s Rahm Emanuel’s “never allow a good crisis to go to waste” quote, right? I like that we quickly instituted “Silver Linings” happy hours and saying the things we’re grateful for out loud. And while there’s no way to plan for any of this, we can plan for the next time if something like this happens again. What are some of the other methods that the organization is implementing to come out of this stronger than we went into it?

Tim: Right from the get go – and most of the folks on the team would tell you – while also taking a real view on what was happening, I tried to harp on the fact that even though these are kind of crazy and wild times, there’s opportunity here. Obviously we have to keep delivering for clients, but we’re using any available time that’s not already dedicated to that to unpack, refine, and institutionalize our process, our workflows, our database integrity, general company infrastructure – the things you tend to kick the can down the road on when you’re growing and busy delivering for clients. I think it’s forcing us to think about how we communicate with each other. There are some illusions too, when you’re in an office. It’s open, you sit right next to people, and you think you communicate well, but it’s not always the case. We’re revisiting that and we’re being forced to be better communicators because without that, we’d be in trouble. And then obviously we’re thinking through how we train and onboard people. If we use this time to level up all of these things, the new versions of them that perform under duress will perform exceedingly well when we’re back in an office together, and I think that’ll be powerful and I’m really excited about it.

Why We Do What We Do: The Health Talent Exchange

By: Nina Mermelstein & Jessica Horn

As a team whose daily work revolves around building teams for high growth healthcare companies, Aequitas Partners has been closely tracking the effects of the Coronavirus pandemic across the digital health industry. We’ve watched our clients step up and do incredible work during this crisis, quickly responding by adapting their technology to address patient needs and the larger healthcare community. Unfortunately, we’ve also seen this pandemic result in budget cuts and layoffs for healthcare organizations regardless of whether they are established businesses or new startups.

Not surprisingly, the health startup space is amongst the many industries suffering a wave of recent layoffs. Founders and CEOs who are at the precipice of growth had to reverse their plans and make difficult decisions, team members who’ve been committed to big causes are asked to make impossible sacrifices, while others have been galvanized to roll up their sleeves and join the fight against a looming pandemic. Through it all, our team speaks daily to people who share a unified purpose in health, as they remain vulnerable to uncontrollable forces. In each of the conversations, the first question is the same – How do I even begin?

We recognize that the job search process is overwhelming during normal circumstances and that it is only further exacerbated given the current state of the world. At the same time, we know there are many healthcare companies that are still actively growing, and therefore hiring, to fuel that growth. As a team of people who pride themselves on being “professional connectors,” we were inspired to leverage our expertise to launch the Health Tech Talent Exchange.

This intellectually honest and democratized platform is built on Aequitas Partners’ principles of bringing authenticity and integrity to the job search process. This will serve as a real-time hub for positions that are actually open today, connecting organizations that are actively hiring with people who are committed to making a meaningful impact in the health industry. We hope that this pro-bono initiative will support people who might feel uncertainty during this time, help them recognize the breadth and choice of opportunities available to them, give them dignity during this next step, and ultimately find that perfect role that fuels their purpose.

We invite all companies involved in the healthcare industry to participate by sharing their active hiring needs. Participating companies can range in size from 5 to 1,000 employees, seeking talent across the US market. We understand the time and resources necessary to find the best talent, and our hope is for healthcare companies to leverage this exchange to help support their growth. For job seekers, we encourage people who are looking for full-time or part-time work to share this resource with their larger professional network. Whether you are committed to staying in the healthcare industry or you feel mobilized by a sense of urgency to enter the field, we hope this exchange presents you with opportunities to take that next step.

AQP Book Club Being Mortal: Medicine and What Matters in the End, by Atul Gawande

By: Jessica Horn & Emily Bak

We are so excited to make our first contribution to Aequitas’ quarterly newsletter! As the newest additions to the team, we’ve spent some time over the course of our first year here trying to further educate ourselves on our industry to add value to our clients and candidates alike. Both avid readers, we decided to choose a healthcare related book to book-club internally. We settled on Being Mortal by Atul Gawande. For those of you who are unfamiliar with the book, first of all, READ IT! It’s excellent. Atul Gawande is a general surgeon, and the CEO of Haven, and does a deep dive into the evolution of our country’s approach to treatment and care for the elderly and dying population. As science and medicine have advanced, people are living longer, but more often than not, suffering more. Treatment has become very institutionalized and he illustrates what care looks like today through personal stories and those of his own patients and peers. Needless to say, this sparked a lot of interesting dialogue between us and our team. We talked a lot about our own healthcare journeys and realized how fortunate we are to be exposed to so much innovation in our work. We feel grateful to work with companies that are striving to create opportunities for the future of healthcare and we want to open up the conversation to all of you.

Emily: As an intern, I always thought that what we did was really interesting, but now working here full time, I realize how applicable and valuable what we do is to the real world. While in college, whenever I got sick or had to go to the doctor, I would hand them my parents’ insurance card and never see a medical bill, getting the care I needed and thinking that this magical little card made going to the doctor easy and free. Post-graduating college, I’m realizing how challenging navigating the healthcare world can be. I no longer have the flexibility I did in college, a relationship with a doctor I trust, or the convenience and time to wait an entire month to see a doctor. One of my first weeks after moving to the city, I felt sick and went to the Urgent Care near my apartment. After waiting for a couple hours, getting to see the doctor for only ten minutes, and then getting prescribed medication, it led to me receiving a $1,000 bill in the mail, with charges for things like “going at night,” something that seemed ridiculous to me as the only time I could have gone was after work. When I came into work the next day upset, one of our coworkers reminded me that I should have used Slingshot Health. The platform allows individuals to see doctors in a low cost, convenient way. This creates the balance of getting treatment even with time constraints, something that would have been great in that situation, and pretty much any time, as I adjust to professional life. He told me that he’s met doctors that he now sees regularly and interacts with directly rather than going through admin to book appointments. I’m excited about this option of building more trustworthy relationships with my doctors, having the reassurance that if I do ever get sick, the process of getting better won’t be a burden.

Jess: I totally remember how overwhelmed I felt when I first graduated from school and experienced similar pressure when it came to prioritizing my budget, health, and time, no longer having the luxury of free time like I did in college. I think I’ve finally started to figure it out. As I’ve moved through different phases in life and career opportunities, it has become more and more important to me to find a balance, especially living in New York City. While New York is charged with energy and much fun to be had – it’s also crazy and overwhelming. A few years back I completely hit a wall, finding myself pulled in many different directions, and an opportunity to move to Denver presented itself. I love to ski, spend time in the mountains, and felt that living in another city could give me some perspective. After living there for a couple of years, I walked away with a greater sense of self and a better understanding of what I need to incorporate in my life to make me feel healthy. Now that I am back in New York, I’ve carried these lessons with me, and make it a priority to create time for myself, allowing me to be efficient at work, manage my time, and be the best version of myself for the people I love. I try to say “no” to things that don’t serve me, spend time with the people who share the same values, and create opportunities to leave the craziness of the city and spend time outside. I’ve learned that the times when I have low energy or stress, it’s often because I’m burnt out and not fully supporting my well-being and mental state.

Emily: There were a lot of examples in Being Mortal that demonstrated exactly what you’re talking about. When people are treated in a way that serves them as individuals, they find purpose and meaning in their lives, ultimately changing their overall wellbeing. In one example, animals, plants, and even a children’s daycare were placed into a nursing home. Just these few additions did more for the residents than the antidepressant drugs they were given prior. According to the book, compared to an average nursing home, the total cost of drugs fell by 38%, and deaths fell by 15% of the control facility. By bringing personalized care and attention to these people, and surrounding them with things that brought them joy, the overall desire to be alive and present increased. Whether it’s spending time outside in the mountains of Denver or caring for a bird within a nursing home, it’s important to consider that healthcare isn’t solely about the physical body, and that finding that greater sense of self increases overall happiness. As exciting as the city can be, it can feel lonely if you’re not taking the time to stabilize your mental health and do the things that make you feel connected to others. Purpose, meaning, and connection can be more valuable to quality of life than taking a pill.

Jess: I love that part of the book. It’s such a simple concept – to encourage individuality – that it’s hard to believe how revolutionary it is. I guess it is easy for us to take this for granted because we are exposed to people and organizations that are trying to instill this mindset every day. In our universe, we’re constantly speaking to execs or working with companies that are working towards elevating the human experience when it comes to taking control of our own health and having transparency. Even the most general form of care is being revolutionized. We see it with companies like Eden Health, for example, that is building a Primary Care platform to help people seamlessly navigate through their healthcare journeys. Not only do they make it easy to book appointments and make insurance costs more transparent and less stressful for patients to understand, but each person is assigned to a designated care team that will learn about his or her individual health and is available to them at any time. I imagine it’s such a relief to talk to a clinician that actually knows you and your story. I feel like I’m constantly having to explain my medical history over and over again or having to gather my past records. I never know whether I’m painting an accurate picture. This emphasis on building a relationship and having an option to speak to my own team through an app on my phone or even see them in person if I need to is so valuable.

Overall, you’re right, Em. There is a clear shift in mindset industry-wide in care delivery. Companies like Eden are emphasizing the benefits of primary care to prevent problems before they begin. Another one of our clients, T1D Exchange, is building a platform to help individuals living with Type I diabetes better manage their disease by leveraging real world data to improve outcomes for this population, along with educating the people that are caring for them. After reading Being Mortal, we’ve learned that there’s even a shift in what treatment looks like for terminally ill patients.

Atul Gawande talks about how very sick patients are gravitating towards living out their days in their own home and choosing hospice versus opting for treatment (whether it’s chemo, radiation, a new drug trial, or surgical procedures) where there is no guarantee that it will extend their lives and more often than not the treatment will decrease the quality of life.

There’s a study conducted in the book where researchers compare patients with stage IV lung cancer receiving two different approaches to treatment. One group received the usual oncology care (chemo), the other half received the usual care plus visits with a palliative care specialist. The group who saw a specialist stopped chemotherapy treatment sooner, entered hospice earlier, suffered less, and lived longer (by up to 25%). I think that this increase in awareness and move towards allowing people to make decisions about their own health, helps them figure out what is most important to them, no matter how scary. I’m witnessing this firsthand as I see how my parents and their siblings are approaching care for their parents who are sick. As my grandmother’s health is declining in her old age, it’s hard not to hope that a new drug or treatment might prolong her life. I doubt that when she was younger and healthier she was asked how she’d like to live out the end of her life. Despite how uncomfortable this conversation probably is, I can’t help but think that I would like to learn from this and broach this topic with my own parents. I would rather hear what’s important to them. We should all be able to make these decisions for ourselves.

Emily: I completely agree, and also felt that I would want to have this sort of conversation with my parents sooner than later. I think painful situations could become more tolerable if we educate ourselves and talk about what matters while we still can. Atul Gawande shows us how educating patients has become extremely important, we see evidence of this in some of the solutions our clients are building. Doctors are putting more of an emphasis on offering options, not just delivering treatment. Providing a well-rounded education on the consequences and options in treatment is necessary for the patient to make informed decisions. In Being Mortal we see many examples of how patients have better outcomes when their doctors spend time giving options rather than giving orders. When working with a client like CarePort Health, it isn’t difficult to convince people of their mission, as most people have come into contact with a situation where they, or someone close to them, feel lost and uninformed within the healthcare system. CarePort collects data to allow patients to make more educated decisions about post-acute care facilities. The product suite helps patients to understand that they can make choices and have more control over their own care rather than being handed a list of rehab centers at discharge and expected to choose at random. With a patient’s ability to see all of the options and information laid out, they have a say in their care journey that will lead them to making decisions that align most with what they hold valuable in their lives. It’s important to recognize that more people want to have a voice in their care, which is why so many companies like CarePort are creating innovative products to change the traditional system.

After reading this book, and coming into contact with different innovative companies everyday, we see healthcare moving towards people customizing their own healthcare experiences around what matters most to them, which in turn is affecting the doctor-patient relationship. Doctors have to take into account the whole person, and recognize that there isn’t one right way to treat or care for someone. For example, I want the convenience and low cost way of seeing a doctor, knowing that when I get sick, I can easily see someone I trust to give me the care I need. What’s important to Jess is a doctor who sees the whole person, encompassing everything from physical to mental health. People want a say and options in their care journey, a major theme in the book as well as in the companies we work with everyday. When you have a say in your healthcare experience and are being listened to and cared for in more of a holistic sense, your health and wellness can drastically improve, experienced through two New Yorkers and through the stories told in the book.

Coffee Chats with Nina: Understanding the Entrepreneurial Mindset – Part IV

Part IV of an Ongoing Series – Heavily Caffeinated & Highly Enlightened

Two years! I truly can’t believe that I’m already approaching my two-year mark as a member of the Aequitas Partners team. It feels like it was just yesterday that I moved into my first closet-sized NYC apartment and received a phone call from Tim Gordon. He offered me an opportunity to join his team, that I now consider family. To some people, two years might not seem like a long time. However, upon reflection, I can confidently say that this has been the most transformative timespan for my own personal and professional development in my life.

My skilled colleagues, our innovative clients, and the thousands of impressive candidates I’ve interviewed have all contributed to my development in this field. But I must attribute an important part of my recent growth to the insights I’ve gained from the highly-driven healthcare technology entrepreneurs who have opened up to me during my Coffee Chats. Last year, I set out to better understand the entrepreneur’s mindset and hear stories straight from the source about what it takes to build a digital health business from the ground up – and that’s precisely what I got! I was gratified by these leaders’ willingness to participate in my Coffee Chats with Nina series and the level of genuine authenticity in their shared stories. I had the chance to dive into some pretty touchy subjects and they didn’t hold back one bit. I heard unfiltered accounts of their experiences including all the ups and downs; everything from the first moments when they knew they had novel concepts to the times they thought they were going to fail.

For this final article of 2019, I’m taking a look back at some of the key insights and highlights from my discussions over the course of this past year. I’ll also share some thoughts on what 2020 might have in store for this series.

Wrapping up 2019

Since we are all focused on this complex, highly regulated, and emotionally charged industry we know as “healthcare,” we’re also familiar with the challenges that confront us in attempting to innovate in this space. Instead of developing solutions for industries such as retail or consumer goods, the founders I met with all chose the convoluted world of healthcare technology. On top of the typical challenges facing all entrepreneurs such as fundraising and team building, these leaders have many added obstacles, spanning HIPAA regulations to longer than average sales cycles. In my first article of the series, “Taking the Leap,” I dove into what it took for these founders to actually take that first big step to build their respective companies in this trying industry. I was shocked to hear about how often they felt ill prepared to enter these life-changing journeys. Despite spending years working as venture capitalists or practicing clinicians, all of the executives shared the common sentiment that they had to do most of their learning on the job. While the path to growing their businesses has been difficult, these leaders all refused to accept the status quo and they continue to be driven by the notion that there must be a better way of doing things.

Since there is no all-encompassing playbook for the obstacles faced while growing a startup, I heard stories of some tremendous roadblocks that these founders have overcome. They told stories ranging from how they bounced back after hiring the wrong team member to how they were forced to completely change direction after losing an expected investor in a major funding round. I also heard firsthand accounts of times when founders were offered advice from people whose only intent was to get something in return and instances where there were challenges in working with relatives and close friends. In my second article, “5 Things Entrepreneurs Wish They Knew Before Building Their Companies,” I shared some of the biggest lessons they’ve learned as well as some pointers they wish they were given prior to starting their businesses.

My last article, “What They Don’t Teach You in Business School,” covered the different aspects of being an entrepreneur that you can’t train for ahead of time. While most of the executives I’ve spoken with have earned advanced degrees from the most highly regarded institutions, they all noted the aspects of being a founder that you can’t study. Many of them underscored the difficulties they encountered in assembling their teams. I heard stories about overcoming communication barriers, discovering the best ways to motivate employees, and making tough decisions around hiring and firing team members. I also had the opportunity to dig into another key topic I was curious about – time management. They offered insights on how they’ve attempted to manage competing priorities across their work and personal lives. Finally, I learned about the different resources (i.e., books, podcasts, networks) these professionals often leverage to become better leaders.

Looking at 2020

In speaking with such a wide variety of digital health entrepreneurs over the last year, I’ve heard many different perspectives on what it takes to build a business. I’ve spoken with both clinical and non-clinical executives. I also met with a number of first-time founders in addition to leaders who’ve had experience from previously growing other companies. Heading into 2020, I’m excited to have some more pointed conversations with this eclectic group of ambitious individuals while also adding new executives to the mix who will offer other fresh perspectives on entrepreneurship.

While I’ve had the chance to cover a number of interesting topics, I feel that there is a lot more to explore. Moving forward, I’m planning to tackle a host of new topics such as the challenges specifically facing female founders and the impact of major healthcare policy changes on these entrepreneurs’ business strategies. I’m also hoping to learn more about the dynamics of working with a co-founder versus going at it alone. Additionally, I’ve been increasingly curious about investors’ perspectives on many of these topics and would love the chance to connect with a variety of leaders in that space.

Moving into this next year, I welcome feedback from our readers on things you want to learn or questions you wish I had asked. Please send any thoughts directly to me at nina@aqpsearch.com. Looking forward to sharing more insights in 2020!

An Interview with Kevon Saber, CEO of GoCheck Kids

Kevon Saber is the CEO of GoCheck Kids, a digital health platform designed for the advanced screening of vision impairment in children globally. The company is based in Nashville, and is currently screening children on 4 continents. We sat down with Kevon to talk about the business, his vision, and what it’s like to scale a global digital health company.

Tim: GoCheck Kids is on a pretty incredible mission. Why don’t you tell us a little bit about the company.
Kevon: The company was started by Dr. David Huang who actually invented the most widely used diagnostic in all of ophthalmology. He recognized that most children in America weren’t being screened for the most prevalent disability in the country – vision impairment – because of the absence of an affordable screening tool. He decided he was going to leverage his expertise in biomedical engineering and ophthalmology (he’s got four degrees in those two areas) to invent a product that is actually affordable. GoCheck Kids is a third of the price of the competition and as a result has made vision screening affordable for pediatricians in the U.S. and globally. Our goal is to catch every kid with vision impairment (that’s one in five kids in the U.S.), so that they can see and learn, and ultimately fulfill their potential.

Tim: You were brought into the company as the CEO a little over two years ago from a career outside of healthcare. What drew you to this business?
Kevon: I had said to myself and to my friends for years that I wanted the rest of my career to focus on elevating human flourishing. And I hoped to bring together my background in technology and entrepreneurship for a cause that ultimately would make a big difference in the lives of many people. Preventing the most prevalent disability for children in many countries, GoCheck Kids fit my first criteria. I was also really impressed with the quality of the team. They were the kind of people I would hope to recruit to found a company, but they were already assembled, which of course makes everything go a lot faster. Thirdly, I talked to twenty of their customers, and their enthusiasm for GoCheck Kids’ affordable impact on seeing, learning, and the rest of life was galvanizing. Those three factors were intoxicating and I couldn’t help myself.

Tim: Being new to healthcare, what was the biggest challenge in navigating the healthcare landscape for you early on?
Kevon: I had many steep learning curves, but the biggest thing I underestimated was the increased complexity associated with regional variation in payors, regulatory requirements, and customer preferences. This diversity in the operating environment is also a positive – it encourages a company to practice managing change – which of course is the only constant, and especially in healthcare.

Tim: In your view, what makes GoCheck Kids different than the alternatives available for the advanced screening of pediatric vision impairment?
Kevon: There are a few pediatric photo screeners that have been available for ten years or twenty years, and they are actually very effective. The challenge is that they aren’t affordable, and they increase administrative burden due to their lack of, or negligible EHR integration. We are a third of the price, without compromising on clinical efficacy. That’s probably the biggest reason, in addition to the prevalence of vision impairment that we have skyrocketed. We have grown from about 1,700 pediatricians in the U.S. when I joined just over 2 years ago to over 6,500 today.

The second big way GoCheck Kids is different from other photo screeners that preceded us is that we are a fully digital product that is in the cloud on a modern operating system, enabling us to very easily integrate with a hospital system’s electronic health record. We are already integrated with the EHRs representing most of the market today and every quarter we add additional EHRs. Ultimately, a hospital system isn’t just saving money and impacting outcomes while using GoCheck Kids but they’re also saving a lot of time. This means clinicians can spend more time with patients.

Tim: You mentioned a bit of it already but how has the company grown under your leadership, and are there some wins that you can share?
Kevon: We have grown from 1,700 pediatricians to 6,500 pediatricians which has also represented about a tripling of the company’s revenue. Our burn rate has been cut by eighty percent without any layoffs, driven purely from the growth of the business and our investments in efficiency. More than the numbers, what’s really fulfilling for us is the impact that we see. We look at a lot of big numbers around screenings and referrals but what we love, of course, is hearing the actual stories from pediatricians. Those stories fall into three different but equally fulfilling categories:

First, every day we discover children who are not seeing the chalkboard or whiteboard very well. Their learning, their confidence, even their relationships were compromised because they had vision impairment. Once this impairment is addressed their whole trajectory is changed, because seeing is learning and learning is potential.

The second category consists of kids who are actually losing their vision permanently (this isn’t just a benign issue that glasses can fix); those kids are also not learning. Stories like these are fulfilling because these are children who are going to lose twenty percent or seventy percent of their vision in one or both eyes if it weren’t for GoCheckKids.

And fortunately, this last category of issues is much more rare: retinal cancer. This disease usually spreads from the eye to the brain and will not only cause a child to lose their vision in both eyes but also their life if they aren’t caught very early. The magic of GoCheck Kids, is that we enable pediatricians to catch these issues early and while they are still treatable, which saves a child’s learning, vision or life. We believe every child deserves to see what they’re capable of.

Tim: You mentioned impact here and there’s been talk about GoCheckKids’ ability to make a global impact. Has that begun, and how do you see that evolving overtime?
Kevon: We received our CE mark, which is the FDA equivalent in Europe last year. And already about 15% of GoCheck Kids screenings are in Europe. We actually have a few pilot customers in Asia right now. We’ve also just landed our first customer in Africa, so now GoCheck Kids is being used on four continents to protect the learning and vision and potential of children. We are definitely excited to expand our global footprint and impact which of course is being made possible by the portability and the affordability of the approach we are taking: putting a proprietary advanced technology on a smartphone which has a significantly lower cost of manufacturing and distribution than a traditional medical device.

Tim: Very Cool. How do you think about company culture as the leader of an organization that you weren’t the founder of?
Kevon: You know, when I was in Belgium a few days ago, a candidate who was applying to work at GoCheck asked me what single characteristic is true for everyone in the company. We were having lunch and I didn’t even have to drop my fork, it was obvious. Everyone at GoCheck Kids is passionate about our mission. They are passionate about protecting the potential of the kids we serve and as a result, elevating human flourishing.

When I joined the company, it was tempting to take my business and life principles and kind of impose them on the company and the culture and the people. But I realized that probably wasn’t going to be as effective as just taking a more patient approach. What I did was just observe and listen to see what the principles were that people at GoCheck Kids already had. My job was actually more of a scribe as opposed to an agent of things. And then to create a discussion with the team to see ‘what are the great aspects of the culture already existing and where we can improve.’ Our work here is never done, but I feel like taking a more patient approach ultimately has resulted in a commitment to principles and a culture that is broadly shared by the company as opposed to the likely resistance that I could have experienced if I was imposing my own principles.

Tim: So with all that in mind, what keeps you up at night?
Kevon: The one thing I’m thinking a lot about right now is how to provide a product that’s disruptive (not to hospital systems or doctors): radically changing affordability and access to care. However, that’s really hard to do if hospital systems put vastly more affordable digital products through an unnecessarily long decision cycle. If so, digital health companies can’t reap the full cost advantages of being digital because they have to spend a lot of money on sales and marketing, on these really long sales cycles. That’s not something that I think GoCheck Kids or any hospital can figure out in isolation, but as we sit across the table and talk about our mutual desire to advance outcomes and lower costs, we have to find a way to compress the sales cycle if we plan to both boost outcomes and lower healthcare costs for the whole system.

Tim: Awesome Kevon, that was great.

Reflecting On Our First 5 Years: 5 Things I Wish I Knew At The Beginning

By: Tim Gordon

It doesn’t feel like five years. In fact it feels like just yesterday I was sitting down at my  kitchen table to figure out how to start a company. So much has happened since then, and without the support of my now-wife-then-girlfriend who apparently missed the memo that being an entrepreneur basically means you’re unemployed, none of this would be possible. I’ve watched in amazement as we’ve grown – bigger offices, new website iterations, the launch of this newsletter, new clients, new investments, and most importantly – more team members. The impact of adding
each and every one of the people on our team has reverberated through the entire business, taking it somewhere I never could have even flirted with on my own. Through all of that, I’ve learned countless lessons – many the hard way – but on the whole have found these challenges far more rewarding to power through than those that came before. In honor of our 5th Birthday, here’s five things I’ve learned that I wish I knew at the beginning.

  1. Always Be Selling Like You’re Going Out of Business

    This sounds obvious enough, but things are tricky in a services business when you’re an army of one. We don’t sell widgets, and we didn’t invent a better mousetrap. We don’t cold-call CEOs, suggest it’s time that they replace their CFO and offer to help them with that. Sales cycles are all over the place. The shortest has been 1 week, the longest – well I’ll know the answer when we start doing work for companies we started building relationships with the year I founded the firm. In the beginning, I was worried that I’d sell too much and not be able to deliver on the
    work without having a team to support me. In hindsight, this was bananas. This would have been a wonderful problem to have. Alas, it was not the problem I had. After some reps, I quickly learned that I always needed to have the same urgency around our business development efforts as I did around our delivery. This got easier once our team grew and I could split my focus more evenly, but the reality is, no revenue, no business. Even when things are going well, get your ass out there and sell more.

  2. Hiring The Right People is Transformational

    Duh, right? Shameless plug for a search firm? Maybe. But if you want to trace the first inflection point in our business, there’s an exact date that just happens to match up with our first hire. You have to white-knuckle your way through the productivity dip that follows, but when you come out the other side of it, the return on investment is huge. When you get it right, you see the early formation of your company’s culture, you get freed up to focus on other things (see Lesson #1), the next hire gets incrementally easier to on-board via shared institutional knowledge, and, it gets a little less lonely. Just a little. There’s a chicken and egg element to this when you’re bootstrapping the business and haven’t raised capital, but there hasn’t
    been a single thing that we’ve spent money on that has a better return on investment than our people.

  3. Understand Why People Say No To You, But Even More Importantly, Why They Say Yes.

    In the beginning, I heard “No” a lot. A lot. Turns out, starting a company is an exercise in getting your teeth kicked in every day, and coming back for more. Good thing my dad’s a dentist. When we wouldn’t win an engagement, I very infrequently knew why. I could take a good educated guess, but rarely would a prospective client tell me straight up. One-man shop, track record, etc. Over the last year, a number of our clients have told me why they said “yes” to us, and it was a strangely profound realization that that was probably more important for me to understand. I should have asked every damn client we had why they picked us, because some of the unsolicited feedback surprised me. It highlighted that they cared a lot about the
    things about us that I thought they should care about, but feared they didn’t. They chose us because of our size not in spite of it, our clear focus, and the belief that we would do anything to deliver for them. It showed me that the story about us that I wanted to tell, was in fact the one that people wanted to hear. Who would have thought? Which leads me to my next lesson…

  4. Trust Your Gut

    You know. You know you know. But you zig when you knew to zag. At what point do you start to listen to that feeling that clearly knows better than you? I should have listened more often. I’m happy I listened when I did. Instinct led me to make some bold (for me) calls over the last few years at times when all the evidence said not to. A number of those moments represent huge inflection points in our business, and frankly are why we’re still here. Other times I didn’t trust my gut, and I really should have. This one requires constant awareness on my part, because I still miss it sometimes, but I’m getting a lot better at paying attention. I think the brain subconsciously does a phenomenal job of cataloguing experiences in the form of data, and when it’s trying to tell you something based on all of that computing power, you should listen.

  5. Balance is A Key To Longevity

    I say “A” and not “The” because there are others, but this one has been hugely important for me. In the beginning, at that lonely table in my one bedroom apartment, 10 feet from my bed, it was hard to figure out when the work-day started and ended. Even sitting on the couch in the evening, being able to see my “office” led to pangs of guilt. I’m starting a company, shouldn’t I still be working? I think the answer was no. This is a marathon, not a sprint. Finding time to get above it, rest, reset and come back ready to go made a big difference. Taking the occasional vacation to realize that I could and the world wouldn’t come to an end was really important. We just aren’t meant to keep going without taking a break, and I’ve got to set a good example. Happy employees make for a happy company and happy clients, and they need to know that it’s not only OK to rest and reboot, but that it’s an expectation. As a founder, I had to be deliberate about placing boundaries (with some flexibility) for the benefit of everyone, not just me.

What I’m Working On

I, like our company, am a work in progress. I find that when I share what I’m working on out loud and with others, it helps keep me accountable to it. There are two things that I’m trying to improve on daily. The first is patience. And not the “I’m an impatient person and that’s a weakness masquerading as a strength” type of a BS answer to an interview question. I mean impatience in a form that I’m not proud of. It’s something that I’ve been working on for a long time, and probably always will be, but it’s important to me, my team, and my family that they get the best, most patient version of me so that we can continue to do amazing things.

The second thing, is stopping to celebrate the wins. I think we’re like most growing companies, in that we spend a lot of time unpacking the things that we mess up, or fail at, and very little time patting ourselves on the back for a job well done. I’ve been guilty of this my whole life, but I’m making a concerted effort to focus on our wins – big and small – because we should and it’s important. I worry that if we don’t we may forget how to have fun doing this, and if we’re not having fun, what’s the point?