The 3 Trends Driving Cardiovascular Investment, M&A, and Deals in 2025+ | LSI USA '25

Lisa Boyle  0:05  
Um, so welcome everybody to our panel. I'm honored to be tasked with moderating this. We have Shai from Mayo ventures. We have Greg from Medtronic, we have Lisa from American Heart Association, and we have Brad from GE HealthCare. So welcome everybody, and Lisa, I'm going to start with you. We'll get right. So we've seen the wave of health tech companies. Is there anything unconventional flying under investors radar that you're aware of?

Lisa Suennen  0:35  
You know, the health tech Lisa was just talking about it, how much that's changed. I remember probably 15 years ago working some with Abbott on some some health tech strategy, which they promptly shelved because they weren't really ready for it. And I think a lot of med tech wasn't really ready for it. And now I think some of the biggest opportunities are really that intersection device and tech and services. I mean, if I think about the companies that I'm most excited to see, it's those that are leveraging all of those things together, and not just, you know, a one, you know, one time, surgical experience, or a home monitoring system, or, you know, any one piece of the continuum, but things that really integrate across the Healthcare System. And it's confusing to companies, and especially acquirers, because of the complexity of the reimbursement that you need to understand and get familiar and comfortable with, but it's certainly the way healthcare should be delivered, and I think those are the biggest opportunities. Cool

Lisa Boyle  1:35  
and Shai, I'm going to go to you so coming from May on task with bridging innovation with patient care. How is Mayo pushing that innovation to focus on the patient care?

Shai Ran Sapir  1:46  
So with us, it's not always about the trends, right? It's about what are the gaps in care that we realize and so coming from practice, we know what is missing. So we always try to push innovations towards what we need as Mayo Clinic, if it's a medical device, if it's software. And the way we do that, so obviously, we're very good friends with the strategics all over and a Rolodex of investors. And the idea is, let's find the gap, and then, you know, build those groups of the startups, of the investors, of the strategics of mayo Kol, and together, build those the basically the horizon of what's what's next to come. We and we know that, you know, we have to put our money where our mouth is. So we support innovation financially pretty heavily, both internally. So we have funds from ventures to put into innovation at Mayo Clinic to bridge the gap from ideation to commercialization. But obviously we work with the strategics, and we work with startups which we are able to invest in, startups so no money, no mission, basically, work together with the startups to have their product either, you know, improved or pivoted towards what we believe at Mayo is a gap in care. So we are able to invest in companies that work together with us.

Lisa Boyle  3:22  
That's super, super Greg. I'm going to come to you so with your role in business development strategy at Medtronic, could you share any insights on how M and A activities are shifting within the cardiovascular landscape, and then, what are the key factors driving those changes? In your opinion?

Greg Larkin  3:40  
Yeah, I would say the the one that I'll point to is we're taking a bit more of a tops down, beats bottoms up approach to M A oftentimes we have really, really great ideas in one individual business, and it might make sense for that General Manager to pitch a deal and try to work that up the system. We're trying to match that with where the where the space is across cardiovascular that Medtronic needs to play in and needs to win in. And so that becomes a bit of a filter criteria for what types of deals we're looking at. And then it also gives us a bit of a lens on what this what structure could we consider for those types of acquisitions or investments in? One of the things that we're really focused on these days is we have a pretty strong pipeline in Medtronic across the next three, five years. We're trying to start to plant some seeds for what happens year six to year 10. You know, we'll continue to iterate on the platforms that we have, but we recognize that there is so much unmet clinical need in cardiovascular and we're really just at the start of some of these big waves, like hypertension, with our already in our platform, to really then think about what comes next after that, and that may result in not an acquisition today for Medtronic, but maybe it's partnering with our Venture Capital Group and and focusing on an investment, really getting a seat at the table with those startups. So it's shifting a little bit, I would say, just the the takeaway for me is we're. We're trying to be a little bit more diligent about spaces, because we realize that when we dabble with small acquisitions and small spaces, they tend to be the ones that if things, if things go awry, there's a bump in the road. Those be those are the opportunities that end up being de prioritized for something else. And so we recognize that the big ones and the small ones often take a lot of the same amount of effort, and so let's focus our effort on the ones that can have the biggest impact for the company.

Lisa Boyle  5:29  
And Brad, so as Director of Strategy and corporate development at GE HealthCare, how do you anticipate Corporate Development Strategies affecting future deals? And again, same as Greg, what trends should stakeholders be most attentive to?

Brad Gu  5:44  
Surely, Lisa, I'm going to answer it from perspective that that would be most relevant for the startups and venture community in the audience here. So I think I saw a recent statistic from John Norris venture health care report, one, I think, last year, one out of every six or seven acquisitions by a strategic were done by strategics that already had a stake, minority stake, in that target. So and if you think about, you know, the company, the big companies that have been, you know, most successful in recent history, you know, Boston, Scientific is a perfect example. You know, they have a very intentional and programmatic approach of, you know, planting a ventral garden, placing multiple bets on goals in the verticals, in the categories that they care about. I think that fact pattern, the fact pattern in the last decade or so. I think that as the success, you know, proof points continue to build, I think the industry has taken notice, and I think more and more strategics will be, you know, putting more effort into thinking about and crafting a venture strategy that supports their M a pipeline. It's not, it's not easy to do, right? You need to have top to down, the top to bottom, you know, alignment, and there needs to be a strong intent, and needs to be driven by strategy, and you need to have pretty strong risk tolerance and patience, because these things never go in a straight line. But I do think the trend is, is moving in that direction. And you know, granted, there will be, you know, it is a pendulum depending on which strategic and you know, the P and L swings and mood right from quarter to quarter for public companies. But I do think that the broad direction is trending that way. And you know, when done right, strategic ventures can yield pretty strong strategic results. So you know that, and I would encourage for the startup community, adventure community here, I would encourage you to, you know, engage in those conversations with strategics early on. You know, not when you know when you're trying to raise money or trying to sell, but engage with them early on and find out what are the areas that they're interested in, what would be the milestones that they want to see in order for them to, you know, take a serious interest in in acquisition, or even, you know, funding the company. I think that will be that will go a long way in, in helping kind of the ecosystem going

Lisa Suennen  8:18  
as the former head of GE ventures, healthcare fund in its last form. I wish you luck.

Lisa Boyle  8:28  
I love it. So just touching on what you were saying. And this goes also to Greg. I've had the luxury of working in metonic, in the business unit in Ben Dickinson and corporate and yen evolve as a small company. And I've always interested, you know, to me, what I can learn and what I can what, what I can understand, and my my time at yenneve was interesting to me, like, what are, what are strategics looking for in smaller companies? Because I think some of them think, Okay, we have to have our pre clinicals done. We have to have our design history files all buttoned up. We have to have our clinical trial like on the way. But what, what do you guys look at? And I know there's probably no secret sauce, but it would be, it would be nice to hear Jan mean, what, what makes sense from a strategic and why they start looking at at smaller companies to acquire?

Greg Larkin  9:20  
I can take a step first Sure. So I think first it really starts with the strategy of the strategic of the startup, and what is the unmet need you're going after? How big is the opportunity for that? And then we recognize that no startup is going to look like the internal processes of Medtronic we often want them to. And when we send diligence request lists, and it comes with 700 questions about your 100 questions about your quality system. We apologize, but I do think there's a there's a role for the startup where the startup has a much better opportunity to move fast than some of what we can do within the strategic so you kind of have that long term vision of what is the the unmet need you're trying to solve for you. And then what is the accelerated path to get to de risking events? So it may be getting to an animal study. It may be getting to your first in human study. And for us, what we're looking for is proof points along the journey, recognizing that we're never going to be able to retire all risk in a deal across the lifestyle, the life cycle. And the last thing I'd mention is just be very intentional about some of the decisions you make, on manufacturing, on suppliers, things that we worry about a lot at the very end of the deal is, what are we gonna have to redo? What are we gonna have to revalidate? What are the test methods we're gonna have to go look at again? Because ultimately, what we want to do is be able to acquire a company and immediately get into it, get into the commercialization phase. So I'll maybe echo what Brad said that have the conversations early. We're always open, even if it's, Hey, I've got a napkin sketch, and this is what I'm thinking about. Can you get some advice? Go ahead and reach out. And it never starts to never hurts, to develop that relationship very early. And then, as you know, you start to get more details around your plan. You know, that ends up being a really good touch point for what are we going to talk talk about at our next meeting?

Shai Ran Sapir  11:09  
You know, this is actually a pain point for us at Mayo. So Mayo Ventures is both the tech sponsor office for mayo and also the investment arm. And we work with our clinician on innovation. And often time we would get this amazing innovation through our door and but we don't necessarily know how to assess the market for it. So what we do is we work pretty closely with the strategics, literally with all of them, to basically sit together and guide our in our innovators to how do we make a good fit of the innovation coming out of Mayo Clinic that eventually will be housed within the strategics? We all know that at the end of the day, to really reach the patient bedside, it has to come through the strategics. It's really rarely see those startups tapping into big distribution networks by their own, or going through regulatory approval, everything without the help of a big organization. So, I mean, I could give one example of how we do it. We have our our incubator Fund, with with with Boston. It's motion medical. When we we have IP coming out of mayo coming out of Boston. We work together to just to advance the technology. Eventually spin out the companies out of it. It's funded by Mayo in Boston. So that just just one example of how we do it. We work with all the other strategics as well. And we welcome innovation at Mayo Clinic that's not only originating from Mayo. So just a shout out. If you have some innovation that you want Mayo Clinic input on, come to us. We'll work with you. I mean, we have clinicians really, really thirsty to to work on, on, on a new innovation. And as said, we bring IP, we bring cash, and obviously the network of Mayo Clinic, so we have our investors and and our relationship with the strategics, and if it's vetted by Mayo, obviously it goes a long way. So it is a pain point to realize if this is a good business fit, and that's where we need the investors and and the strategics help to realize that and obviously communicate it back to our clinicians.

Lisa Suennen  13:23  
I think it's a really good point Shai, because one of the things that we do, we're not an acquirer, obviously, of companies, but we are a funder of companies. We have four separate venture programs, and a couple of them have medical device real focus to them, as long as they're related to cardiovascular, brain health and all the cascade of related conditions, and that can be anything from metabolic or autoimmune or, you know, even endometriosis and other things that cause elevated risk of heart attacks and stroke. We also have a venture studio, so we're interested to collaborate in the founding and creation, or co creation of companies, and because we have such a sort of broad view into the market. And, you know, most of the cardiovascular, clinical world is connected to us in some way, and the neurologic, you know, clinical world is connected to us in some way, not just in the US, but but globally. We have this amazing network of people that we can bring into the into the mix to ask questions of and help guide companies. And in addition to that, we have partnering arrangements where we can bring some of the assets that we have to bear for companies. So we have clinical trial services and clinical trial design capabilities. We have data, lots of data, you know, we have clinical guidelines and care pathways and things that people are integrating into their products. We have lots of different resources and assets that we can partner with companies to help them improve the clinical validity and scientific basis of what they do, and also the usability and since we also come with the consumer perspective of things as well, we have. Very broad set of tools to work with companies around so we're always eager to collaborate, even it's not a venture deal, which we'll do too, but interesting collaborations that we're entering into. We have a couple we're going to announce in the next

Brad Gu  15:15  
few months. So from my perspective, to add to my what my fellow panelists have said, I think in order to make a program or innovation successful and to be able to bring it to market, right, I think a number of elements are, are indispensable. The more you need, the unmet need. Number two, you need the funding, and then you need a commercial model. I think without one of the, you know, any one of these, yeah, that's not going to be a successful program. And, you know, there are a lot of, you know, innovations and products that fit those three buckets. But the, you know, there are, I was chatting, we were chatting during breakfast this morning with Shai. But no, they could be, you know, looking at a very advanced catheter in the morning, but then in the afternoon, they could be looking at, hey, we need a better bed, you know? And, and that's just, that's an example where, you know, the product category is very small, right? The market opportunity is probably small, and you probably can't attract venture funding. There isn't a mini but you probably can't get attract venture funding. But how does that going to work? So that's where I think strategics can step in and say, let's do a bill to buy or what, whatever you know, and address that fulfill that gap. So I think for strategics, it's important for us to not just work with the venture community and the startups out there, but also, you know, work closely with the other ecosystem players and Mayo Clinic or American Heart Association to understand what the MDS are and where we could plug the gaps, where there isn't venture funding, and help figure out the business model for products like that.

Shai Ran Sapir  16:47  
Yeah, absolutely. We realize that mayo, that not any innovation that comes out of mayo, is worth it for a new company formation or so. So what we do pretty often is we clinicians come up with an idea, we assess it at Mayo ventures, and we realize, all right, this might not be a standalone company, but if we take the existing product already out there on the market and work together with the commercializing company to actually make the 2.0 version of that product with Mayo Clinic IP into it will make patients life better, right? So we would approach either the strategics or a manufacturing company out there. You know, it can be like an operating table. It can be a cath lab probe or something, and we'll work with them. You know, it will come to them, with them. We have this idea. We think that we at Mayo would use it, if it, I mean, if you pivot it this way, or Don and so it's, as I said, not a standalone company, but, but, you know, an add on to an existing product. And we're really, we're here for impact. So we truly care about the patient impact, rather than ROI. It's not that we don't care about ROI. We do, but, but it's mainly impact. So if we can make patient's life better and work with an existing company to actually get their product to a different stage that we believe Mayo will use, and obviously, if Mayo uses it, then the rest of the world might so we're very open to it. And even if you guys have an idea, I mean, the companies out there that could improve an existing product from another company, work with us. We'll make it happen.

Lisa Boyle  18:26  
You're doing very well. Shai, that's twice now you've reached out. Hey, if you, if you have ideas, please comment and talk. You're willing to work. So I think that's really important. I want to shift it a little bit, because we all see the, you know, what we term as the constantly changing regulatory landscape. How does that affect, you know? I mean, how you're looking at strategic investments, or M and A, or does it, you know? Because we

Lisa Suennen  18:53  
Lisa, yeah, the regulatory landscape. Well, that's fun. I have it on my Etch A Sketch, you know? I uh, you know, it depends on the sector, right? And I think in we're seeing a lot of attempts, I think, to make it simpler, you know? But we don't, we at the Heart Association Anyway, don't ever want to lose our sight on scientific rigor. And so for us, you know the regulatory pathways, the regulatory pathway, it's, lord knows every day what it might be. But since we're dealing across the spectrum of medical devices and health tech, you know we have and also where those things come together, and that's probably the most complicated, you know, where it's a device, and it's also got some sort of you sort of algorithmic something, something. And, you know, those are very confusing, I think, for the regulatory agencies. And gather aspect of regulatory is the changes that are happening around services and licensure and all of the things about who can do this or that service, or prescribe what and do what. You know. Different types of things in different types of places, and we keep our eye pretty keenly on that, and that's very much in flux right now, how those things work. So it's part of the diligence process. It's not, I mean, if you've been in this industry a long time, like most of us have, it's it's not scary, it's just there, and you got to deal with it and prepare for it and fund accordingly, because you there's always uncertainty there. And every entrepreneur I see says, Okay, our clinical trial is going to enroll in six months on the data and then, but you know, on January 3 will be done, you're like, Yeah, okay, you know, so planning for the uncertainty, I think, is the most important thing. Yeah. Thank you. Anybody else want to comment on that?

Greg Larkin  20:38  
Let me just add that it's not new, right? I feel like everything is always in flux, and everything is changing. So constant is, sorry, changes is the constant here. I don't really think it necessarily changes our focus areas for what we're looking for. And honestly, I think, you know, I try to assume good intent. It's not like regulators are the enemy, and you're trying to, you know, find a way, creative way through everyone's trying to work on getting good technology to patients. And yes, certain geographies may look a little different than others, but I do feel like, you know, having that underlying assumption of good intent across the partners you work with tends to be an attitude that at least moves things forward, instead of just a lot of frustration,

Lisa Suennen  21:19  
super so building, just building on what you just said for a minute, which is not a regulatory comment, that different communities look different. I mean, I think that's a big focus for us is, I think a big opportunity for people is figuring out how to solve the problems of access in communities, including in the, you know, in Rochester, where it takes three weeks you were saying, to get certain appointments, or, you know, in every community, access is becoming more complicated. In rural communities, it's becoming impossible. And so what solutions are there in any form, whether they're devices, you know, that travel or their virtual services or there's some, you know, combination of things that can do work in different places, while this problem is becoming worse and worse in the US, much less the rest of the world. So we, you know, it's an opportunity to think about in your strategy, which you may not have thought about, is how you solve problems of access. And I think related to that is problems of cost. I mean, I think med tech, you know, isn't used to as it used, you know, as some of the other parts of medicine have been used to thinking about how to make it economic. Economical and reduce the price. And that is a win, you know, in today's market, as you can figure out how to do something not just better, but more inexpensively and and put your stake in that, you know, ground. It's a good thing. Yeah,

Shai Ran Sapir  22:38  
you touched on another very important point. So access to care that's all over. So most, most of the patients of the world don't live in Rochester, Minnesota, and they still need good care. And one of the things that we work really hard on is access to care at home, if that's through different devices that you could acquire automatically, either an echo test or an ECG and basically interpretation from from far those are things that are close to our heart, and if we can improve that, we're doing a good job, but not enough. I think that that's an untapped market, for sure.

Brad Gu  23:23  
So this is wrong on the point of access to care. I think the overall, you know, I'm seeing overall theme, big theme of, you know, trying to move, you know, the care center inpatient, to outpatient, outpatient, at home, right? That, generally speaking, that's a big theme that's going on. And, you know, AI is a big part of it. And we're at the nascent stages of the AI. Kind

Lisa Boyle  23:43  
Tell AI they may have to take a drink,

Brad Gu  23:46  
that's what we agreed on during breakfast. So, you know, I think AI will play a big part of it. But we're at the very nascent stages, you know, in terms of, for me, you know, CLIN, Reg, reimbursement, all tie together. I'll go hand in hand, AI. I think we're, we're seeing a lot of innovation right that address workflow improvement, you know, you know, efficiency in the care care city, and moving the care, you know, towards more democratizes the care. But I think for first strategic like we want to see, in order for us to become truly interested in owning an AI and really implying it to to to our customers broadly, you know, we want to see, you know, very clear clinical evidence that supports the value. But we also want to see, you know, a clear, regular pathway. And also there needs to be a viable path towards reimbursement. But I think we're the FDA, and I think regulatory authorities all over the world are still trying to figure out, like, what are the right ways of managing those Yeah, but you're seeing, like, early proof points of success at heart flow, you know, got their reimbursement, one of the first AI applications that got a reimbursement. So I think. We're getting there. But I would one advice that I would give to startups that leverage AI is, you know, I think we see a lot of products with, you know, innovative ideas and, you know, really good clinical proposition. But when you dig deeper, you realize that data privacy and data rights are a mess, and that fundamentally prevents an acquirer from moving forward and because when you're you know when your data privacy non compliant or you don't have the right data rights. When you're a small company, yeah, you can fly under the radar, but when a GE HealthCare or Medtronic, or, you know, big company buys them, you know, we're going to be on the hook. We're you know, we're going to draw attention, and there could be negative consequences. So make sure that you know you have the right data rights use. Get the right data privacy document signed by the patients that can send to your your trials and provide you with the data, I think that'll go a long way, you know, to making it a lot easier for the strategics. Yeah,

Lisa Boyle  26:08  
I think that's a really, really good point. I always say to my teams, is the burden of proof on a strategic is a lot higher than it is on a startup or even a mid size startup. Do you know, to me, because, again, you're able to have the interactions with the regulatory bodies. You're, you know, I mean, you're, you're working with them, you know. I mean, as opposed to the strategic that the FDA, for example, or another regulatory body would be expecting, okay, you have all your ticks and ties Dawn, you know to mean. So the burden proof is, is a lot higher. And it's interesting. Shai, knowing how you're pushing with mayo, you know what I mean to to embrace and to work with how, how are you seeing that regulatory landscape working for you guys? You think the burden of proof is higher?

Shai Ran Sapir  26:53  
That's a very good question. It's only the regulatory it's all the reimbursements. Well, saying yes, if I hear another company saying that there I can, can AI, can they their AI, can solve global warming, I'm going to lose it drink. So the thing is, and Mayo has been a trailblazer in AI, especially in ECG and in Echo, right? So, and we, when we first started getting, you know, all these inventions coming through our door. We spent so much money filing patents on AI. And you know what? It's really hard to enforce AI algorithms. It's it's not about the code, it's not about the AI, it's about the data that you train your algorithm on. Obviously, with mayo, we have pretty good data to train our algorithms on, but that at the end of the day, people will get data. All right, Mayo is not the only organization in the world with data, and there are other hospitals around the world. So when, when we assess is, is an AI solution really going to be a healthy financial model, then we have to understand a few things. One is, Does, does the development of this algorithm have a differentiator from anyone else in NYU or in Colombia? But, you know, developing another AI solution usually not. I mean, the algorithm that you develop Mayo Clinic is not much different than the algorithm you develop elsewhere. But at the end of the day, if you pair it with a company or a solution that's been, you know, completing it in terms of maybe the access to the distribution network or the acquisition of the test. And so that's the big differentiator here. Another thing that we have to make sure is that, at the end of the day, who's going to pay for this? You know, we're getting reimbursed for a third surgeon solution. But as we move forward with AI, the reimbursement landscape is going to change. We're not going to get the same reimbursement for interpretation of a test as we do as the human eye is doing it, if AI is doing it, eventually we'll get paid less. Yes, we will broaden the patient pool. We'll be able to have more access, but at the end of the day, it still has to be a healthy financial model, regulatory and reimbursement

Lisa Boyle  29:11  
sense. So I know we've 30 seconds left. Is there any final comment from any of you guys that you'd like to share?

Greg Larkin  29:18  
Just to reiterate, with working with strategics, kind of engage early, engage often, and recognize that it's okay to say, I don't know the answer. That's why they're doing the innovative work. So if it's you know, chances are that the market projections you're putting on a slide are probably not going to believe but that's okay. It's okay to say, I don't know. I'm studying that. We're trying to figure that out, and I think we can probably help push that along.

Lisa Suennen  29:43  
I think also open your mind to different business models. I think the world is really changing here, and the traditional pay for device that's disposable thing is not necessarily going to be the way it always is, and especially when the software starts integrating with devices and the like companies have to. Think about different business models that they're not comfortable with or not used to. They have much lower margin, potentially or much higher margin, depending on what they are, and the IP is different. Often there's none, I think, to Shai point on software, and that's okay too, because, you know, you may have noticed there's some big software business out there worth a lot of money, anyway, so Okay,

Lisa Boyle  30:19  
well, thank you everybody for turning up. Thank you panelists really enjoyed the conversation. Thank you. 

Lisa Suennen  30:25  
Thank you.