Global Medtech VC Trends: US & European Views | LSI Europe '22

The highly networked global medical technology community presents excellent investment opportunities across all geographies. We have gathered a panel of venture investors from around the world who are actively identifying critical unmet needs, the best technology solutions, and the most driven talent.
Ryan McGuinness
Ryan McGuinness
General Manager Commercial, Triple Rings Technologies
Irit Yaniv
Irit Yaniv
Founding Partner & CEO, Almeda Ventures
Megan MacDonagh
Megan MacDonagh
Senior Associate, SV Health Investors
Lukas Guenther
Lukas Guenther
Partner - MD Start Strategy, Sofinnova Partners
Andy McGibbon
Andy McGibbon
Managing Partner, Sonder Capital


Ryan Mcguinness  0:04  

iGood morning, everyone. It's great to see you all here. I'd like to start by thanking Scott Pantel and his crew for organizing this week's events and for giving us all an excuse to gather. Today we've assembled a panel of active venture investors from across the globe, Televiv, Silicon Valley, Paris, and Boston. To engage in a lively and open discussion about the current state of med tech and healthcare investment. We'll touch on unmet needs, markets and their generic dynamics, investment strategies, portfolio companies and the teams that drive them. I am Ryan McGuinness, commercial general manager at Triple Ring Technologies. Triple Ring is the CO development company, we stand shoulder to shoulder with innovators and entrepreneurs to solve hard problems, build breakthrough devices and launch companies. Our headquarters are in Silicon Valley. We also have offices in Boston, Copenhagen and Toronto. Triple Ring is a large group of doers with deep experience in designing and developing complex devices for healthcare, medical device and life sciences markets. So we're going to begin our session. And thank you very much with brief introductions from each of our panelists, starting with Irit.


Irit Yaniv  1:36  

Thank you. So let your name I'm the CEO of Alameda venture. I'll speak about Almeda. Later on just two words about myself. I'm a physician, many years in the operational side of metric companies. And for the last 10 years on the investment side.


Ryan Mcguinness  1:56  

Andy, please. 


Andy McGibbon  1:57  

Sure. Yeah, we'll dive in. So yeah, my own background kind of mix of business and engineering, did the biodesign fellowship if you're familiar with that at Stanford University, and that's where I got to know most of the team that I'm working with now at Sonders we raised a fund 100 million dollar fund early stage med tech can talk a little bit more about what early stage and but yeah, team of five partners. I think two of them have already had some decent airtime in Jay Watkins and Fred Mall. So those are probably our headliners. Great.


Ryan Mcguinness  2:25  

Lukas, please.


Lukas Guenther  2:27  

My name is Lucas Guenther, I work for Paris based Sofinnova specifically for the medtech accelerator called MD Start. My personal background is surgery. I've been trained in general surgery have worked clinically for a number of years, and have joined the industry about 15 years ago. Great, thanks.


Megan MacDonagh  2:44  

Great. Yeah. Yeah, thanks, Ryan. And I'm Megan MacDonough. I'm a senior associate at SP Health Investors based in Boston. Although despite the Boston accent, I'm actually originally from Ireland. I spent the first few years of my career more on the kind of product development side doing research and development engineering for a startup. And then, of course, like all startups were in a lot of different hats. Before. Once we got kind of FDA clearance for our lead product, I decided I needed to learn a little bit more about business. So that's when I moved to the US to go to business school. And then I did some life sciences consulting as well before starting my venture career with SVU a few years ago. So yeah, really excited that there's another great med tech conference that a room over the side of the pond.


Ryan Mcguinness  3:29  

Yeah, yeah. Very nice. Okay, well, we're just going to jump right in. And my first question is for Reid. And can you speak about your the unique structure of Almita? Yeah, and how the company accommodates the global collaboration?


Irit Yaniv  3:44  

Yeah, thank you. So as part of my entrapreneur life, I would say I established two companies, and I saw the pros and cons of a regular, private VC. And then when I had the chance to build up my own VC, we try to think about the different structure. So the structure that we have decided to go is a public VC. So our VCs traded in Televiv Stock Exchange, what allows us to raise more money on the go, which means that this is an evergreen fund, and we can continue and invest in our initial investment more and more, there is no end for our VC, we can always go back and raise money from the public and invest a little bit more in specific companies that we believe in. We established the company the fund two years ago, we have raised up to now $30 million invested in 10 companies, we invest in medical device and digital health. So we have about 50% medical device and 50% Digital have up to date.


Ryan Mcguinness  4:54  

Okay, yeah. Thank you. Thank you. And end, side model is very hands on. And, you know, based on these often consultative relationships with your portfolio companies, how do you maintain that? And is it a challenge to build these kinds of relationships? Especially if you're looking outside of the United States?


Andy McGibbon  5:19  

Yeah. Yeah, yes. You know, but no, you know, I think we closed the fund, January 2020. So we have really been operating in a COVID world the entire time we've been operating this fund. And so for us, I think, you know, that's been an interesting learning experience for us. I mean, for us coming out now, being in the real world, so to speak, an in person is new for us as a venture fund. So, you know, we're used to working with our portfolio companies. And I think it's interesting to hear your structure, because I think philosophically, you know, we see this gap in early stage med tech investing. And that's what we tried to solve for, we didn't necessarily start out to do a fund spend a lot of legal bills to understand that, for us, at least the fund structure was what had to work. And, you know, our goal is partnership with the companies. And part of that also is somewhat of an ecosystem play, where we're looking at our LPs who are primarily single family offices who are interested in investing directly, and trying to bring them closer to the companies. So for us, it's great because we get to partner closely do the work that we love to do is kind of operators and innovators by background, helping companies that those early stages, while also simultaneously educating a whole new group of people who shouldn't be investing and want to be invested in med tech, but just don't understand it. So we're trying to bring them along in the journey too


Ryan Mcguinness  6:42  

Yeah, interesting. And that was one of the things that struck me about this panel is we have two two groups that were born in the COVID age groups that represent some of the longest existing venture companies on the planet. So imagine we could talk a bit about that. And Lukas, so Sofinnova has a tight focus on specific products in specific solutions to unmet needs, as opposed to maybe more platform plays that you might think through. And that's an interesting approach. But how do markets and geographies factor into those that focusing process? 


Lukas Guenther  7:21  

Yeah I think first of all, it's important to mention that empty start is just one of the strategies that we have within sofinnova. I think what you just mentioned is an overarching theme that we have within all the strategies. But it's also important to mention how MD Start works, because it's, it's it's an accelerator incubator. And what we do with an MD Start is we source the most interesting breakthrough medical device technologies, and we bring them in house, we incubate them over time, and trying to reach first in human within the incubation time. And then we, you know, help these companies to raise the Series A, we slowly fade out, we bring in experienced management at some point. But it also means that with regards to where we source those technologies, we're looking globally, and we have quite a number of relationships built up over time, with TTO's from top tier universities. We have scouts out there in the field. But we also have a very, very strong network of entrepreneurs, med tech entrepreneurs that have been associated or still associated with sofinnova partners, and basically drop us a line if they see something interesting out there.


Ryan Mcguinness  8:33  

Yeah, fascinating. Okay. And then Megan SP Health Ventures has a long history of success building companies in launching products. Can you tell us more about the med tech convergence fund?


Megan MacDonagh  8:44  

Sure. Yeah. So the med tech convergence fund is actually a fund we raised just during COVID, as well, actually, but its focuses on kind of med tech, but the intersection of med tech and software more, you know, more specifically, and that's sort of 60% of the founders kind of allocated to towards that team. And it's really just this, this realization that that we had about, you know, there are a lot of unmet needs in healthcare that can actually be solved now with, with medtech that can, you know, can be kind of connected to the providers and, and different, you know, service backends to enable patients, mostly with chronic diseases, prevent kind of really negative health outcomes and, you know, solve kind of a sort of problems for the, for the patient, the clinical side, but also, you know, create value for payers in the system more broadly. And yeah, we did in terms of geography. You know, most of the funds in our most of the companies in our fund, to date have been US companies, but we definitely look internationally. And I think, you know, one good example of that is just last week, I was at a board meeting for one of our companies called Perfuse. And they've actually just got FDA clearance for a large bore catheter for the treatment of acute ischemic stroke. And they've done that on very limited capital. And I think that's something that we see a lot more, you know, we see a lot more, you know, opportunities for, you know, limited capital to get to significant milestones from companies in Europe, and sometimes this is possible in the in the US. So, you know, it's definitely, it's definitely an area that we're we're interested in, then, of course, I am probably more biased towards looking at the European startup scene as well.


Ryan Mcguinness  10:37  

Yeah, ice. Okay. So the focus this week at the conference is on medtech innovation and the companies that are driving it, our audience, there are some of the in the audience or some of the world's most promising startups and early stage companies. And many of the professionals who are here to help them on their journeys to market, I'd like to give the audience an opportunity to learn about how each of you invest, and what you require to make your investment decisions. And can we start with you, please? So how do you invest? And so give them an idea of how you invest in what you require to make your investment decisions?


Megan MacDonagh  11:16  

Oh, sure. Yeah. So I think, you know,


Ryan Mcguinness  11:19  

and also, I'm sorry, if you can think of a portfolio company that kind of exemplifies your approach to the in thesis for investment?


Megan MacDonagh  11:27  

Sure. Yeah. So I think a good good example, for us will be potty metrics. And that's the company in the in the, you know, diabetic foot ulcers space, and they basically just have a mat that yields very, very low charge for the for the patient to use. But it just basically monitors the patient's feet for the appearance of areas, which might be high risk for the development of diabetic foot ulcers. And, you know, seems like a very simple technology, it's got a little bit more complicated back end. But, you know, what's interesting about the company is that they've been able to show 90% reduction in diabetic foot ulcers. And as a lot of people know, you know, once a diabetic foot ulcer appears, you know, it can, it can be really debilitating for patients, and oftentimes leads to amputation. So the company actually showed around 90% reduction in amputations, as well. And so that's really attractive for patients. And it's also really attractive for payers, and they see like, a really near term return on investment for the, for the device, they can, you know, they've seen cost savings of $10,000 a year for these patients. So it kind of becomes an easier conversation than when you're trying to commercialize a product like that. And then anything for for entrepreneurs, and kind of, for us how we're thinking about technologies like that, it has to be something that you know, the outcomes, if you improve the outcomes, it really creates value for patients, and you have to have a team that really recognizes you know, who the customer is, what's the value that's created? How do you actually, you know, build a business model around that, so that you're providing the best value for the patient? And also, you know, for the, for the payer as well. So, I think, you know, the message probably is, you know, technology is hard. Commercial is also hard and can be very nuanced. And, you know, as much time needs to be kind of spent understanding that. So I think that's, that's kind of really what, what we think about.


Ryan Mcguinness  13:29  

Yeah, very interesting. Yeah. patients, customers and value. Yeah, sure. Okay. And Luke has a similar question. If you can kind of describe through an example portfolio company, how it is that you guys approach your investment?


Lukas Guenther  13:43  

Yeah, very happy to. So first of all, I think the medical need magnet that you just described is in the center of all the strategies that we have within Aofinnova. Just for MD Start. This is, you know, much earlier technologies, as one can imagine. And a good showcase that I can mention is Gradient DenervationTechnologies. It's a company that has presented earlier today. And this describes a little bit on how we work and how we approach things. The technology from this comes out of the Stanford program, Biodesign program, and they've been to clinician founders that at some point decided to go back to their clinical careers, and the program needed in our data to push financially but also with regards to manpower. And we have negotiated with the founders with with Stanford transition that we can in license the patents into a new coal that is now based in Paris, and we have done the initial steps. It's one of the things we do to get all the fundamentals right in a in a company and in a new medtech endeavor. And we've been going through the steps of development we currently are now in the safety study in animals and hopefully can start and we'll start the first in human beginning of of next year. And what's also typical, we at some point fade out of the operational aspects as a team and we attract external management. We've been very lucky to attract Marty Grassi, who has presented earlier today as a CEO who has experience in the field of ablation, and gradient. Just to mention, this is a company that treats patients with pulmonary hypertension, on top of heart failure. So heart failure is the is the theme here. It's a patient group that is completely underserved. There's no medical treatment available. There's no med tech based treatment available. These patients who develop the pulmonary hypertension on top of the heart failure, they go downhill very quickly. So we're developing a technology in minimally invasive endovascular technology that blades, the nerves, the sympathetic nerves around the pulmonary artery to treat this specific condition.


Ryan Mcguinness  15:56  

Yeah, I saw that presentation earlier today, right that it was one of these that was so packed with information, and it amazing to see how much information can be packed into an eight minute. It's good that it's recorded. So you can go back. And so, Andy, similar question, but also, you know, Lukas had mentioned Biodesign, you're an alum? Yeah. And that informs a lot of what you do. So again, with a portfolio company, can you describe how you go about it?


Andy McGibbon  16:25  

Yeah, sure. And maybe kind of scoping in our investable universe and kind of how we think of early stage and medtech. So for us early stage, that means typically entering it a seed or Series A, but we like to get to know the entrepreneurs and the opportunity much earlier than that. So the earlier the note the the we can get to know the opportunity, the more that we can, you know, understand it help provide input. I mean, we're free consulting, if you can get our time. Think of it that way. And then I think in the context of what is med tech to us, we focus primarily on devices, diagnostics, and health tech, within diagnostics and Health Tech, we take a fairly narrow field of view, but definitely still something that we're following. And so, you know, one more layer on that, I guess, would be we're looking for something that does have that kind of transformational impact either on patient outcomes, access to care, or how we do business in healthcare. And so that's kind of how we first start approaching that. And I know that last bucket of how we do business in healthcare might be a little bit vague. But so how does that look like in practice, what we've done is basically rolled up this ad hoc investment activity that the team had been doing for, I don't know, 10 years or so leading up to the formation of Sonder, where the model was go get to know those entrepreneurs earlier, help them raise some capital, you know, I think like reflection, medical shockwave is a great example of that type of model how that looks today. Now that we're in a fun structure, I'll pick one company from the portfolio that I will not name. But they were a couple of Stanford electrical engineering PhDs had a great idea. One of the strategic companies when a large cap saw the promise and the technology, so they are actually coming to us not in the context of hey, can you invest in us, but hey, we have this potential structure deal or acquisition from a large cap? Can you help us kind of wrap our head around what that would look like? So we we actually consulted for them, like literally consulted for them before we even consider making investment. End of the day, the deal didn't happen. And we got to know the opportunity. And we loved it. Not to mention it already did have some de risking, we'll put that aside. But so that's something where we worked very closely with them beforehand. They're first time entrepreneurs literally straight out of their PhD. So you know, we we like that we, you don't get serial entrepreneurs if there's no first time.


Ryan Mcguinness  18:45  

Yeah. Yeah. And you also,


Irit Yaniv  18:48  

yeah, so for us early stage means a little bit late than what you all spoke about. And the main reason is because we are a public fund, we have to show some results, and we have to commit to the time and the duration of those results. So we can not take a very early stage risk. So in metric, what we are looking for are companies before people don't study while they reach this stage, we can actually better assess the history, what the team achieved so far. And then we can estimate how much time it will take them to complete a pivotal study, we can better assume how much money it will take. We have done it twice and two companies just at the beginning of the fund. I must admit that although those two companies enter into the clinical during the corona phase, both of them completed it successfully. So now two years after those two companies are about to submit to the FDA, so we feel very comfy about what we have promised to our investors time money wise. And this means that those two companies will be able to raise more funds at a higher valuation, which allows us to, to write profit on our books. So early stage for us is a little bit late stage, we would like to invest in companies that have an history of capital efficiency, meaning that they fulfill all the milestone that they put to themselves in a in a way that cash was not spent. freely, I would say, so we are entering in a reasonable valuation. And what we are trying to work with the company is to build up with people to study that will make us comfortable on time and in money for this period of time.


Ryan Mcguinness  20:56  

Nice, okay. Maybe we'll stay with you read on this concept of planning for a global expansion this hits you immediately would seem coming from a fantastic innovation hub, but a relatively small med device market. And so when you are doing your planning and investing, how do you typically deal with the wide variation in reimbursement, for example, across the globe?


Irit Yaniv  21:24  

So our first market, when we look on companies would be the US. We look on the market in the US the reimbursement landscape in the US and the competitive competitive landscape. I would say we do look on Europe, but this is much more complicated now with the regulatory path and also with the rain, but with the different reimbursement in the different countries. So when we assess any opportunity, it would be US first and then Europe.


Ryan Mcguinness  21:58  

Interesting. Yeah, Andy, you have a UK portfolio company. Right? So how did that planning go? Yeah.


Andy McGibbon  22:05  

Well, oddly enough, the UK based company is squarely in the not device world and more in the Health Tech, so we didn't have to worry about that. But I think when we, when we do think about, you know, company that we're investing in, and what is, you know, their eventual market and how they're gonna get there. The US is, like, 99.9% of the time one of the markets that is there, and is going to be the one that is a huge value driver. And so if there's a strategic reason to go somewhere else first. Sure. You know, we're open to it, I think. But it has to be with the intention of really, how do you unlock this, this opportunity that you're going after? So we're, you know, I want to say we're agnostic to it. But really, at the end of the day, you know, the US is such a big market, and you don't have a lot of the challenges that you have in your recent challenges, I guess. 


Ryan Mcguinness  22:56  

Yeah, that's exactly. Yeah. It was one market at the end of the day. Yeah. Interesting. And Lukas, your your group has investments all over the world now, the new fund? Yeah. Could you describe some of the 


Lukas Guenther  23:13  

Yeah, I don't want to repeat what's what's been said? I think I can completely confirm what what what Andy needed to have been saying. So for us, it's it's the US is the market we look at first, because it's the, you know, the biggest coherent market that is out there at the moment, with all the insecurity that we had in the last couple of years with, with, with Europe, and it's specifically about regulatory questions, we have within our group, we have gained significant experience to deal with the FDA to de risk the plans. And we've been able to initiate good conversations within each and every case. So we feel that that the strategy and the development strategy within the regulatory framework is much more calculated to be calculated from from that point of view. So that's why I think us is the first case unless as Andy said, there's a strategic reason to go somewhere else.


Ryan Mcguinness  24:17  

Do you Megan, do you have anything to add to that? It is remarkable to me is the advice to the entrepreneurs find indications that will initially play well in the US? That's the best strategy today.


Megan MacDonagh  24:33  

Yeah, I think I'd Yeah, I echo everything that's been said. But also, I think for the types of companies that we most frequently look at so you know, kind of connected devices that are trying to take, you know, you know, cost and precise expensive procedures out of the system. I think it's actually easier as well to to show a benefit in the US where traditionally you know, things have been fee for service and now you're you're seeing a switch over to kind of more value based Air for certain certain payers. And so you know, you there's huge value to be had on a per patient basis that you just don't see at the same extent in other markets. And often the US market alone is is, you know, enough for for the company to be successful without, you know, necessarily thinking about expanding beyond that.


Ryan Mcguinness  25:19  

Interesting, and then just got to changing up here, want to open this question to the panel. So jump in whoever wants to start. But, you know, we've decided to base our operations in Europe, in Copenhagen, Denmark. And as we run around the region, the Nordics, southern Sweden, Denmark, we found that the valuations on the companies in those regions are very attractive. And in fact, in the case of Denmark almost maps directly to the exchange rate to the US dollar. And so they're fantastic companies in these regions, that are a bargain compared to what we're paying for in Silicon Valley and Boston and around North America. So can you guys jump in on that? And think of just how do you balance? You know, valuations, which which ran up, you know, through COVID, pretty excessively, in the states are coming down a bit, but how does that play into your decision making?


Andy McGibbon  26:18  

I'll bite on this one, just for a little bit. I think one thing, and I'm thinking of, you know, the UK based health tech company that were invested in cost of labor for, you know, programmers, software engineers, compared to the Bay Area, is I mean, it's night and day difference. So I mean, you know, that's, that's not necessarily thinking directly. Okay, what's the relative value of the underlying business? But when you think of, what are the size of the raises, what is the capital efficiency with which you can go forward? I think it's definitely a consideration. And you know, in some ways, you can kind of back solve that into some valuations. whether that's right or wrong is another question. But you know, it's true, I think there is a discount for being in Europe, on the valuation side, but I don't know, it's not right.


Irit Yaniv  27:05  

It's a discount. But on the other hand, it's an advantage because, you know, if you look for a company, and you look for the valuation, you may prefer a UK based company, because of the valuation is much less than the Bay Area companies. So I think I think it is an advantage for the companies themselves. Yeah, when they look for VCs,


Megan MacDonagh  27:30  

I totally agree with that. And I also think, in med tech, you know, things often take longer, it's very iterative, and you don't know, you know, when you're gonna have to raise more money again. And I think, you know, having a more reasonable valuation, just gives founders a little bit more breathing room as well, you know, for if things if things don't go quite to plan, especially during the early kind of more, more risky years as well. So I think it's it is, you know, benefit and certainly, certainly, you know, factors into our thinking is well,


Andy McGibbon  28:01  

yeah, and maybe I'll add add on to that, I think, because I think one of the things, you know, the problem with a mostly US based model where valuations are running away, I mean, nobody wins in that case. I mean, at the end of the day, you know, somebody's gonna come, that company has to do something, and there's an intrinsic value with which it's going to be bought. And if you've inflated that early on,


Irit Yaniv  28:26  

yeah, you just don't know. Yeah, exactly. Yeah,


Megan MacDonagh  28:30  

I think. Sorry. I was just gonna say in in the US, I think what we're seeing now, as you said, like valuations are creeping down. But you kind of end up with some companies in a bit of a zombie mode, where they're actually have enough capital to do anything. They're going around trying to raise, you know, valuations that aren't a down round. And it's just really new or difficult time for everyone and kind of a waste of everyone's time and capitalism. Yeah.


Ryan Mcguinness  28:58  

Lukas, your your penta? Yeah. I


Lukas Guenther  29:00  

mean, on the seed stage, we're not that much affected. But in the in the larger scheme of looking at many other companies, it's something that obviously we observed. And I think it's completely right to say in the end, no one really wins here in that in the under that circumstances. And it was, from our point of view, pretty clear that at some point, the end of the spiral will be reached. And this is a situation that many companies suffer from now,


Ryan Mcguinness  29:26  

it goes to these partnerships that you have to set up very, very early and build the trust with between the funders and the entrepreneurs. And really, I mean, there is an education process, by and large for people who are early in the innovation career. And explain that, yes, you do need to have the long view and you can't just hammer on valuation that the the


Irit Yaniv  29:50  

Absolutely. I think it's it is really important for entrapreneurs to understand, I would say the valuation trail in such a way If they will make at the end of the day, they will make money for the first investor is as much as to the last investor otherwise the last investor will will take everything. So,


Andy McGibbon  30:11  

yeah, which is something that has happened. And, you know, I'll come back to maybe one of the reasons why I think it's really not great for the industry as a whole, and especially med tech innovation. You know, we've literally gone to meetings with LPs where they say, Well, we're, you know, we're raising our own funds, right? I mean, we have, we have people that we have to go ask money for. And they're saying, Well, why should we invest in you, when you're doing early stage med tech, when all the late stage investors are telling me they can just wipe you out and get you get your companies for cheap? And we're just like, No, that's not right. That's not right. I mean, they're, you know, it's a continuum. And I think from an ecosystem perspective, we all benefit from really kind of thinking about how valuations should should be.


Ryan Mcguinness  30:51  

Yes, that long view. Okay, so we're backing up against the lunch hour, but there are a few minutes for questions from the audience. And I would love to take questions, if anyone has them. Do we have a mic that we can pass around? And you end with a question. Right here, please.


Audience Question  31:15  

I'm curious. I'm curious to ask mainly for the US based investors, so ND for example, how do you view an investment, say, from continental Europe, because you know, of the legal I remember back in the days, like the USBC, were very much not looking at something outside us. So how do you really view that? Or other user us visiting?


Andy McGibbon  31:41  

Yeah, well, I'll take it by just because I still have some battle scars. But But yeah, I mean, it's friction, right. I mean, you know, corporate structures are little nuanced differently. You know, I guess, luckily, or not, you know, our only international investment today is in another English speaking countries we haven't had to deal with. With that. I mean, legal costs go through the roof. So it adds friction. But I think from our perspective, you know, if it's, if it's a big enough opportunity, forget it, you know, like the legal costs are just something that you have to deal with, and you do it. So.


Megan MacDonagh  32:17  

Yeah, I agree with that. I think it's, you know, it's a cost of doing business. But I think, you know, the right, the right, team, the right technology is much more important than, than something like that. So, yeah, we're definitely open to companies in mainland Europe as well.


Ryan Mcguinness  32:35  

Other questions, please? Yeah.


Audience Question  32:36  

Just to just to build on that question. I'd be curious to know if there any advice in terms of things that people don't right or wrong? If you're an American, a US company trying to go to a European investor? Or vice versa? Where you have the opposite? Is there any kind of it's not the same, and it comes out in maybe a good or a bad way?


Megan MacDonagh  32:55  

Yeah, so I think one thing probably is, you know, sometimes this is lacking in very early stage companies in Europe is a nuanced understanding of the US kind of payer structure, and how that you know, how that can impact your eventual value of your company, the technology might be better than something in the in the US, but if you don't understand exactly how it fits in exactly who the right player to go after is, and you know exactly what the what the market, then that you're truly targeting is, then you know, you're leaving a lot of value on the table. So I think for European entrepreneurs, it's really, really important to try and understand then, you know, the US market landscape, if that's kind of where you're where you're looking.


Ryan Mcguinness  33:45  

Anyone else want to have any ideas or thoughts on that? We have another question. So


Audience Question  33:52  

it's just a comment on for a US company. It's maybe just an impression, but I have the feeling that going to raise from a European VC, continental Europe VC, at least in software, maybe you divide maybe by two or three, the valuations. So I don't know really, if it makes sense, or if it happens, but yeah. That's, I mean, I'm curious to get your thoughts


Andy McGibbon  34:18  

I have I've ever kind of a slightly I'll reach out to one of my partners experienced in raising money. And this was, you know, probably 10 years ago. And so I think things have changed a little bit. But early stage med tech funding is difficult. I mean, you're all entrepreneurs, you all know, it's not easy. And so, you know, the scarcity of capital makes it difficult. And so I think valuations are certainly a part of the equation but at the end of the day, if you have something transformational and you're trying to get it out there, like find a way to fund it, not everything is venture fundable I mean, I'm I'm gonna say that even though I kind of disagree with the premise of it, but I'm gonna say that it's I think you Yeah, valuations might be different. But at the end of the day, yeah.


Audience Question  35:05  

My experience was in Europe, there was much more strict scrutiny in Europe or strategic VC than some of the fairly informed.


Ryan Mcguinness  35:20  

Yeah, well, we could, we'll have to leave it there. And thanks everybody so much. I think, as Andy just mentioned, and all of us have, it's not easy to fund and build a med tech company. But there are good people who are very motivated to help out. And it's these partnerships in view on the long haul, that are that are most important. And so, thank you very much everyone for campus panel. And thanks to the audience. We'll see everybody in the hallways. Thank you. Thanks.


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