With yesterday’s article on how digital health funding is resuming its 2019 ‘long and winding road’ trajectory, with 2020-2022 now revealed as a complete aberration (though Rock Health is having trouble admitting it), your Editor returned to two saved articles in her ‘pinned tab file’ to glean some advice for the funding-lorn. 

Funding advice for health tech and digital health companies was the theme of this recent article in MedCityNews. Two Merck Global Health Innovation Fund executives spoke at a late June NYC conference, the fund’s president, Bill Taranto, and vice president Joe Volpe. They highlighted three key points but more between the lines. Editor’s comments follow:

Don’t be afraid of down rounds (or flat rounds) if you need to survive  This referred to the inflated valuations digital health companies received in 2021-22, whether they were profitable or not. The down-round stigma is why we are now seeing a wave of unlabeled and lower-amount rounds for companies that raised Series A and B rounds only 12-24 months prior. “Lack of cash causes bankruptcy.” Quite true, but what if the company never hits the ‘inflection point’ and putters along longer than funders expected at breakeven or mildly profitable? They admitted that unlabeled rounds are a survival tactic. As noted yesterday, they cannot go on forever or even for another 24 months. Prediction: valuations will be coming down in a second-order effect by next year, as well as more companies going private, selling lines of business or IP, or being acquired for unknown amounts.

Expect slower timelines   Startups used to plan six to eight months in advance of fundraising, now they are advised to start a year or more. This reverts back to the norm this Editor personally observed in the first hype curve of 2006-8 where early-stage companies would no sooner close a round or private financing than plan for the next. Note rounds–equity offered in return for notes convertible into shares–are popping up. Volpe described this as frustrating for larger investors like Merck because other investors are taking due diligence to the max and once committed, Merck is having to fund or bridge the company longer. This is a repeat of 2007-8. Investors have lost the fear of missing out (FOMO) that drove 2021-22 funding. They are often happier to walk away and keep their powder dry–if they have any. [TTA 5 Apr]

Get your narrative right  “The most important thing a company has to do before pitching to investors is ensure that it can clearly and honestly describe its narrative, Taranto explained.” More than that, a company has to be realistic about its future. Don’t tell a story that investors will have difficulty believing. Identify what’s the inflection point, when will it be, and is it a hockey stick or a garage lift? Here is where the old saw ‘underpromising and overperforming’ come in handy, as well as running lean. Do this enough and investors will like you a lot. You may also want to get some outside help in crafting and wordsmithing that narrative from a person not invested in the company’s future or your parents.

Now that you have the money, some basic banking and money management advice for founders and company management. We are already seeing amnesia around the events of March-April when four US (SVB, First Republic, Silvergate, and Signature) and one Swiss bank (Credit Suisse) went belly-up, putting a giant hole in the fisc of both startups and VCs. Founders and startup execs can be forgiven for concentrating on The Big Idea, though they seem to be in abundance lately and is no guarantee of success. Now, your Editor has no special financial expertise but as a marketer, has always been dependent on good relations with the financial folks for her budget. Companies come and go, whether small or large, healthcare to car rental to airlines, but there’s much in common when it comes to money.

Your little company may be better off with a big bank. Healthcare Dive looked at this while the collapses were happening. Their article’s point was that dealing with a major bank can be reassuring to investors. A big bank may be what is left in some markets. The downsides are that they move slowly and may not be agreeable to short-term cash loans or bridges. 

Nest your eggs in multiple baskets. Diversify your banking business and keep it below FDIC insurance levels. Spread accounts among a major bank and your regionals. Develop multiple relationships. It’s not being disloyal, it’s being smart. This may also affect where you locate your business. Ask your funders for contacts, but avoid what funders urged prior to March–to go to one bank like SVB or Signature and put all your business there as part of a quid pro quo. It didn’t turn out well for those who did.

Trust but verify. Expect that a bank will be an honest and skilled steward of your precious funds, payables and receivables. But your financial head/CFO should spend a fair amount of time regularly checking that they are and remain so. As to your bank, community responsibility can be positive, but it’s management time taken away from their main business which is stewarding your money. Be insistent on this. If you see their management has many unfilled spots, spends more time on ‘issues’ than on banking, plays in politics, grows too fast, has a lot of investments in crypto, is in play or taken over, execute Plan B and go elsewhere. 

Don’t skimp on your financial staff, policies, and procedures. You may be able to contract for sales, marketing, and R&D, but financial governance–probably not, unless you’re very small and willing to go fractional. Hire a good CFO and give him or her the right staff and power. Adopt rigorous budget and reporting procedures that are adhered to from top down. Don’t assume you or your partners can do it all alone, even if you have Harvard MBAs, or your accountant can do it. And watch your CFO like a hawk. One of the best combinations I’ve observed is a CFO and general counsel. 

Thoughts? Comment below.