Here’s our view from the room where Oak HC/FT II happens:
A couple months ago, we began raising our second fund to further our efforts around partnering with promising tech-enabled Healthcare and FinTech companies. Today, we’re announcing the launch of this $600 million fund to continue supporting leading entrepreneurs with their attack on quality issues, inefficiencies, and poor customer experiences that persist across the multi-trillion-dollar Healthcare and Financial Services markets.
Instead of waiting for elected leaders in Washington to advance legislation around these two important sectors, we’re working with the most promising private enterprises to tackle the biggest issues head on –high drug costs, treating patients with complex medical conditions, modernizing payment systems and insurance frameworks, and reducing financial fraud/waste/abuse. Complexity is an understatement in Healthcare and FinTech, but challenge ignites the spark of so many opportunities. We’re confident our approach and the strategies of our companies will prevail regardless of political agenda or regulation.
When we founded Oak HC/FT three years ago, our mission was to build on our 15 years of experience and partner with world-class entrepreneurs using technology and data to tackle complex problems in Healthcare and Financial Services. That’s exactly what we achieved with our first fund, having backed leading companies like Aspire Health, Hometeam, and VillageMD that are improving medical care and reducing spending; Quartet Health, US HealthVest, and Axial that are better managing high-cost populations; Limeade, LDI, and Maestro Health that are improving health and spending for employers; Feedzai that uses machine-learning to reduce financial fraud; Poynt, Urjanet, and FastPay that are streamlining payment data and processing; and Trov and Insureon that are modernizing insurance delivery. With our second fund, we will continue searching across the United States and Europe to identify attractive opportunities that advance our mission in these sectors.
In addition to working with great entrepreneurs, we’ve also been fortunate to partner with talented colleagues. Since closing our first fund in 2014, we’ve assembled an amazing team of professionals to provide unparalleled support to our companies. In Healthcare, we added Dr. Zeke Emanuel, Nancy Brown, and Chris Price who all bring peerless industry expertise. That talent has been matched on our FinTech team with Anil Aggarwal, Jonathan Weiner, and Michael Heller. Add-in our long-time Technology Partner, David Black, and our next generation of professionals in Matt, Vig, Oivind, Jack, and Andy, and it’s tough for any entrepreneur to find a team better equipped to scale Healthcare and FinTech businesses and solve problems.
We are also fortunate to have assembled an exceptional group of investors – many long-time supporters of our strategy and a few new relationships that offer fresh perspectives and strategic insights.
In short, we’re bent on building strong teams and great companies. It is especially rewarding to see the businesses we’ve worked with in the past continue their growth – either as public companies or as innovation engines for larger companies, as evidenced by our recent exit, Core Informatics.
Creating Oak HC/FT and growing the firm has been an absolute blast. There is nothing better than waking up every morning to work with our unmatched team and exceptional entrepreneurs – all passionate about improving Healthcare and Financial Services. Building a portfolio and helping our companies and investors succeed will always be an adventure. We are excited to continue this journey, and we are grateful to our investors for their support with today’s Oak HC/FT II fund launch.
One company’s managers think repeal would raise its health-care costs by hundreds of millions.
America’s CEOs might not admit it in public, but the Affordable Care Act—aka ObamaCare—has been good for business. Company benefits managers have watched as the double-digit premium increases under President George W. Bush slowed to a crawl. Venture funding has flooded into health care, boosting startups and stimulating innovation. This is the progress President Obama is trying to preserve as he meets Wednesday with Democrats on Capitol Hill in a strategy session about how to protect the health law.
To take a single benchmark, look at families who receive insurance coverage through an employer. Between 2001 and 2008, their average premium jumped nearly 80%, according to annual survey data from the Kaiser Family Foundation and the Health Research and Educational Trust. Under President Obama, the increase was only 36%. This represents real money: If the Bush-era rate of inflation had continued through 2016, each of these families would be spending about $5,000 more on annual premiums. For employers, the savings open the door to hiring more workers or raising wages.
At the same time, investment in medicine has boomed. Between 2011 and 2015, venture funding for health care—including biotechnology and medical devices—totaled approximately $62 billion, according to figures from PitchBook. In the four years before the Affordable Care Act, the total was $47 billion. New companies are working to improve everything from primary care, to home palliative care, to the management of mental health. These innovations are now beginning to realize cost savings.
The Republican plan to repeal and replace the Affordable Care Act threatens to reignite health-care inflation. First, this approach produces significant uncertainty in the market. The GOP has promised immediate repeal, but the talk of what would replace the health law—and when—is vague. “I don’t want to set a time limit that this has to get done by this certain date,” Rep. Kevin McCarthy, the majority leader, said in late November.
It is easy to repeal ObamaCare’s subsidies and the mandate to buy insurance, since that can be done with only 51 Senate votes using the “reconciliation” procedure. But enacting a replacement is harder, maybe impossible, since it would require 60 Senate votes to overcome a filibuster. Insurance companies hate uncertainty and respond by raising rates to hedge their risk.
A second problem is “cost shifting.” If Republicans repeal and replace the Affordable Care Act, millions of Americans will probably lose their insurance. The replacement proposal offered by House Speaker Paul Ryan would lead to four million fewer insured people by 2026, according to a review by the Center for Health and Economy. Nine million could lose coverage under the replacement plan offered by Sen. Richard Burr, Sen. Orrin Hatch and Rep. Fred Upton, according to scholars from Rand Corp.
The bulk of these newly uninsured would be low-income Americans who can’t afford private coverage despite the tax credits built into Republican plans. But such people will still be treated when they get sick. Though they cannot pay for it, they will still receive care at hospitals, urgent-care outlets and doctors’ offices. These costs will be rolled into the line item “uncompensated care”—which is ultimately paid for by higher prices on everyone else.
The Affordable Care Act has helped minimize this cost shifting. Specifically, the law’s expansion of Medicaid cut hospitals’ uncompensated care by roughly a third from 2013 to 2014, according to a study in Health Affairs. At the University of Pennsylvania Health System, bad debt—the accounting term for bills that are written off when patients can’t pay them—decreased from 6.1% of revenue in 2014 to 3.9% last year. Taken nationally, a drop that size is worth nearly $25 billion a year.
The GOP’s plans will reverse these incentives. Republicans want to send Medicaid back to the states using block grants. More important, they want Washington’s contribution to Medicaid to grow more slowly than the actual costs. A 2014 analysis by the Bipartisan Policy Center estimated that Rep. Ryan’s plans to block-grant Medicaid would reduce federal funding for the program by $160 billion in 2022.
State legislators are likely to respond in two ways. They can tighten Medicaid eligibility to reduce the number of recipients, which will increase the ranks of the uninsured. Or they can cut the rates that Medicaid pays to hospitals and physicians, who would make up the difference by increasing prices on everyone else.
Critics of the Affordable Care Act argue that when previously uninsured people gain coverage through Medicaid, they tend to use expensive emergency-room services. But people who have just gotten coverage can’t be expected to become sophisticated health-care consumers overnight. The use of the ER suggests they have unmet medical needs. Over time they can be educated to develop standard relationships with physicians. Even factoring in this greater use of ERs, however, the per person costs of Medicaid have decreased since 2010 after adjusting for inflation.
Businesses know all this. In response to the GOP’s call to “repeal and replace” ObamaCare, one Fortune 100 company with hundreds of thousands of employees is developing two HR budgets. The first reflects the status quo. The second factors in the higher prices Americans will face if more people become uninsured. Although these estimates aren’t final, the company thinks its health-care costs could rise by tens of millions of dollars in a single year if the Affordable Care Act is repealed and replaced.
President Obama’s health law really has been good for business. Republicans’ plan to dismantle it will take the country back to an era of high health-care inflation. If only CEOs would say as much before it is too late.
Ms. Lamont is a managing partner of Oak HC/FT, a venture fund investing in health care and financial services. Dr. Emanuel is vice provost for global initiatives, as well as chairman of the Department of Medical Ethics and Health Policy, at the University of Pennsylvania.
VillageMD is a primary care management services company that enables primary care providers (PCPs) to realize the benefit of value-based care delivery. At VillageMD, we strive to be the best partner to PCPs so that they’re able to deliver the best care for their patients and in a way that dramatically improves clinical outcomes and experiences, as well as significantly reduces total cost of care.
As a result of the changing economics of healthcare, we help PCPs think about what they can do differently and provide them with a combination of resources, data, technology and intellectual property to solve patient problems.
What are the biggest issues in your space and what are the biggest challenges you are addressing?
The U.S. healthcare system costs 2.5 times other industrialized nations yet still delivers inferior clinical outcomes. This has resulted in many PCPs being forced to do more with less. What VillageMD brings is a different way of thinking about healthcare so PCPs can feel they have the resources available to them, the knowledge about their patients, and a diverse set of processes to heal and see results from a better clinical and financial model.
How does technology play a role in your company?
At the core of our business is a human relationship between a physician and a patient. We believe it is our job to continue to foster that human interaction and service, and technology plays a core role in this.
For example, we identified in one of our markets that we had 1,800 commercial patients under the age of 65 suffering from posttraumatic stress disorder. The risk profile of these patients is nearly two times that of the “average” commercial population. Their access to healthcare, in terms of emergency room visits and hospitalizations, is through the roof. Yet, they still struggle with being able to have access to a defined clinical model that allows for PCPs and behavioral health specialists to partner with them to solve their health problems.
How we first identify these patients, and how we build the digital clinical maps detailing their care delivery, is driven by technology, claim and clinical data, and care delivery know-how. This includes how we schedule patients, talk to patients, see patients and document what’s going on with them – as well how we see all the different issues they face along their healthcare journey. Technology gives us that insight and points us in the right direction to introduce solutions that enhance this human-to-human interaction.
What attracted you to Chicago? How is Chicago advantageous for startups?
In 1993, I read a journal article from Personnel Psychology titled “The People Make the Place,” which addressed organizations and the importance of people in shaping organizational culture. When you think about Chicago it’s hard not to think about the people as what makes the city an amazing place to live and an exciting environment for startups.
Chicago has an intelligent workforce that is community-driven, knows how to grind and has a level of grit. Chicago is the “City of the Big Shoulders”, after all. In a startup environment you have to have that combination of commitment to a cause greater than yourself; a desire to work hard and a level of intellect that allows you to identify problems before they manifest into something larger. The people of Chicago are truly what make it a great place for startups.
I think the financial community is starting to appreciate that. The capital deployed in Chicago has generally flowed into companies at a more mature stage with higher predictability of revenue and earnings. For startups, this has not always been ideal, but the mayor, city institutions and VCs like Oak HC/FT allow Chicago to have more entrepreneurs step out onto that ledge and know they have the right level of capital and support. Together with a friendly business community, we can make these startups successful.
What attracted me to Chicago was all of that and more. I am originally from a small town in northeast Wisconsin. I had lived in Chicago after graduate school and then went out to the west coast and, later, Texas. The idea of coming closer to home was important and Chicago was my destination. It’s a city I would encourage all people to live in and experience the best blend of what it offers: thriving culture, arts and sports scene (Go Cubs!); a beautiful location; supportive business community; and small-city feel.
What were the defining moments that led you to where you are today?
I have four. Firstly, I am blessed with an amazing family. I grew-up with parents that always encouraged me to dream big and see beyond what is in front of me. I am also ridiculously lucky to have a wife who is supportive and patient and always encouraged me to pursue things I am passionate about.
Next is my first startup, which by many definitions failed. I started a company in my mid-20s and poured every cent into it. We experienced some wonderful ups and some incredibly low lows. We were living in a worst-possible situation any startup could be in: doing well enough to keep going but not well enough to keep going. By many circumstances it was the first time in my life I looked myself in the mirror and said, ‘I failed’. But it was an invaluable learning experience – to pour 20 hours into each workday and not come out with a positive outcome. It’s humbling and only helps you sharpen what you’re doing for the next three or four go-arounds.
As it relates to healthcare and VillageMD, there are two significant defining moments. First is when I started working at Blue Shield of California and helped create a return on investment model for a business case addressing congestive heart failure. The first meeting I was ever in I fell in love with healthcare.
In that meeting, we talked about different solutions that the best and brightest minds in healthcare all over the country had developed for managing congestive heart failure. Not one solution contemplated the role that the PCP played in a successful outcome. I was surprised to see we were developing solutions that didn’t involve the PCP, and only fragmented our healthcare system. That set me on a mission to identify a model bringing the best and brightest solutions to support physicians.
The last defining moment was working with Dr. Clive Fields, VillageMD Co-Founder and Chief Medical Officer, to establish a model for engaging PCPs around the country and working with large physicians groups or solo practitioners to realize that PCPs everywhere are struggling to deliver the kind of care they know is possible for their patients. If they have people working with and for them side by side we can realize better outcomes together.
Where do you hope to be, as an executive, in 5 years?
As an organization, in five years I hope to be working with several thousand PCPs across the country, which means VillageMD will be five years into a decades-long growth model. As an executive over the next five years, there will be a big push for us to build out a leadership team that embodies the same principles and focus on driving results for PCPs. That will allow me to spend more time in the field with PCPs, working with and talking to patients and providers, as well as working with our product development teams to think differently about what VillageMD can do for both providers and patients.
If I weren’t a CEO I would be…
Home with my kids. They are truly phenomenal and a lot of fun to be around. The legacy that we leave through those little people is everything to me.
My favorite movie is…
“It’s a Wonderful Life”
My favorite musician is…
My favorite hobby is…
Playing goalie in hockey
My favorite food is…
Chipotle Sofritas Salad
Do you have any pets?
Beyond my kids, I have a mischievous goldendoodle named Ollie.
Anil Aggarwal: We believed the payments industry desperately needed a platform like Money 20/20. From the beginning, our vision has been to go beyond typical payments events by redefining the industry dialogue and looking at the future, including emerging trends like connected consumers, omnichannel commerce and open platforms.
That might all sound familiar today, but it was groundbreaking and ambitious back in 2011. When we launched, discussions on FinTech and payments were still about incremental innovation—migrating specific paper-based payment systems to more efficient electronic ones. Mobile payments and digital wallets were still nascent.
So, our objective was to rethink the entirety of payments as a hardwired industry that would eventually be disrupted by digital transformations. We believed that digital would win in every possible way over the long-term. That original thesis continues to prove right and seems like a forgone conclusion today.
Jonathan Weiner: Money20/20 was also a risky proposition because there were a ton of existing payment events already well established and attended. When we began telling people about our idea, the initial reaction was, “Do we really need another payments event?” The space was crowded, but we still felt the market lacked a single, meaningful platform serving the entire payments ecosystem. That was where we saw our opportunity to address disruptions across the broader payments value chain.
Plus, we were already attending and exhibiting at other events but never felt they delivered a return on investment. We wanted to create a new platform for industry operators by industry operators. Somewhere we wanted to participate ourselves and could extract value; where important decision-makers across the payments value chain convened and felt they had to be; and where the industry would conduct business, announce new initiatives and debate important topics. That was our vision for Money20/20.
Why the focus on FinTech?
AA: By 2011, when we founded Money20/20, Jon and I had already spent more than a decade as payments and FinTech entrepreneurs.
Our first company, which we founded in 1999 during the dot com era, was called Clarity Payment Solutions (acquired by TSYS) and was among the first companies to utilize existing payment networks outside of their traditional use cases. We later launched TxVia, which Google acquired in 2012. Jon and I then headed up business development for Google Wallet. Several of our earlier initiatives also served the industry, including the Network Branded Prepaid Card Association (NBPCA), which we launched, as well as Prepaid Expo and Paybefore, both of which we created and later sold.
JW: That’s right—our backgrounds in FinTech and as payments entrepreneurs really enabled us to understand the industry landscape and then shape a dialogue and agenda around its evolution.
At what point did you realize Money20/20 was going to be a success?
AA: From the start, actually. As industry operators, we already recognized the value Money20/20 could bring to the entire ecosystem. However, we didn’t fully realize the extent of the role Money20/20 would play in shaping FinTech until we came out of the second event, in 2013, and were planning our third event, in 2014. That’s when the industry hit its tipping point.
First, financial institutions, both large and small, began to change in the post-financial crisis world. Next, you had the rise of bitcoin and blockchain as examples of entirely new payment systems emerging and achieving widespread consumer awareness. And last, you had the broadening of entrepreneurial interest in payments, as well as the payments investment thesis for the venture capital community. These factors and more like them enabled new entrants to disrupt decades, if not centuries, of established payments practices. The rapid proliferation of mobile devices played a critical role, too.
JW: From the beginning it was essential to focus our event on senior-level attendees from leading companies across the payments value chain. People felt they had to attend because all their peers were there; it was an opportunity for organizations and individuals to meet each other. That not only enabled networking to become a critically important aspect of the event, but also spurred business development initiatives and the announcement of several significant deals on-site. That all helped drive and sustain robust media interest and attendance.
What are some notable changes you’ve seen at Money20/20 over the last four years?
JW: The biggest changes to Money20/20 were over the first three years, when we were constantly adjusting the event to meet the needs of the industry. Remember, the industry was experiencing significant transformation during that period and we wanted Money20/20 to reflect those changes. For example, we introduced new topics into the agenda and also made it easier for startups to attend and exhibit. We introduced a hackathon event that is the world’s largest for FinTech and have since expanded into adjacent formats, like StartupPitch180 and Launchpad360.
Money20/20 will continue to evolve as the payments industry evolves, but I think we expect to remain a core part of the ecosystem regardless.
AA: For any business to be successful you have to focus on your customer and their experience. Throughout our careers as entrepreneurs, we always had a customer-centric approach and invested a great deal in creating a meaningful experience—with great speakers, attendees, food and exhibitors. The complete package is important and we’re always looking at ways to improve upon that so the experience is fresh, for returning attendees as well as for new attendees alike.
What led to the decision to launch a Europe edition of Money20/20?
AA: The same fundamental and structural shifts redefining payments in the U.S. are present in Europe. There are clearly many important differences, as well. Very different regulatory environments, for example. But just as Money20/20 was needed in the U.S. to help coalesce an otherwise fragmented dialogue and disparate ecosystem, the same was true for Europe.
So, we decided to launch Money20/20 Europe, which quickly became the largest FinTech event in Europe in its inaugural year with more than 3,500 attendees. Much of the support came from international sponsors of our Money20/20 U.S. event. These individuals and organizations, with businesses spanning multiple countries and global financial centers, were incredibly supportive of our European expansion.
JW: It was also important to create a unique European experience and not clone what we do in the U.S. We have a dedicated team based in Europe and hired people from within the European payments industry to drive our expansion into that region.
And from the start, we looked at the European region holistically. Many of our competitors were focusing more narrowly on the U.K., which is a major FinTech market but not singularly representative of the entire regional ecosystem. That was one of the major reasons we chose Copenhagen as our destination.
Looking into the future, how do you see Money20/20 evolving with time?
JW: Money20/20 will continue to play an important role in the evolution of payments. It’s the only event that has the critical mass and focus to sustain that. The key will be to not lose that focus. Deciding what not to do is just as important as what you do.
AA: It served as an early catalyst for growth and development of the payments ecosystem and we see Money20/20 continuing to do so into the future. As Jon says, getting that right without getting distracted is the key.
Anil Aggarwal, Jonathan Weiner, Patricia Kemp
Anil Aggarwal and Jonathan Weiner are Founders of Money20/20 and both serve as Oak HC/FT FinTech Venture Partners.
What is FastPay? What is the biggest challenge you are addressing?
FastPay is a liquidity platform that reduces working capital friction for digital media businesses. Despite the sophistication of today’s digital ad technology, the back-end process of invoicing advertisers and receiving payment is slow and inefficient. FastPay targets this challenge by providing a platform to accelerate payments while offering a functional and streamlined process for buyers and sellers to manage these transactions.
How is FastPay disrupting the conventional payments process for media and advertisers?
In media and advertising, the invoicing ecosystem is still managed manually. We have built technology to digitize and optimize the process, which is a significant, positive change for the entire industry.
Historically, companies advertised with individual, large media sources. For example, a mega-brand like Campbell’s Soup might place advertisements on a network television channel. These advertising buys were paid upfront in full, with pricing based on the gross audience projections from data providers like Nielsen. But with the advent of online advertising, this simple formula for pricing and reconciliation doesn’t work. Online ads are sold by the impression in real-time, rather than billed up-front in one go. Online ads also involve multiple vendors for targeting, delivering and measuring the performance of each impression. This happens billions of times each day.
To reconcile that financially, despite the immense volume of data involved, all these media providers typically email Excel spreadsheets and call each other to confirm media delivery line by line to arrange for payment. Furthermore, the large buyers often leverage their powerful market positions to pay bills slowly to their thinly capitalized media providers. That’s the problem FastPay’s platform is targeting and solving.
How does technology play a role in your company?
Technology is front and center of everything we do.
For example, because we deal in an immense, data-rich environment, there is a need to access and analyze data real-time. Our platform has connections to hundreds of programmatic buyers in the marketplace, and is linked to all the financial data sources, accounting systems and bank account feeds. All that data is analyzed to power our underwriting and real-time risk management processes.
We are in a credit business. To date, FastPay has originated over a billion dollars in transaction volume and lost very little money. This accomplishment is founded in our data-driven approach: we leverage our data and connectivity to monitor the payment flow to avert fraudulent transactions and behavior. Through the use of technology, we end up with a better product; we make faster credit decisions; we provide more capital; and we offer less expensive capital with a more convenient process.
How do the rapid changes in digital media and online advertising impact your business and industry?
Stability is important for traditional capital providers. But for us, change is our ally and the digital media industry is changing rapidly.
Consider traditional capital sources and credit providers. Their metrics are premised on having been in business a long time. Traditional banks want to see borrowers with five to seven years of business history, and an applicant’s consistent profitability is very important. The way to process transactions is very focused on stability, too. On-site audits; physical inventory checks; meetings face-to-face. These are all at the center of underwriting credit policies. It’s how banks look at the world.
For us, we pride ourselves on being highly adaptable. When we started the business, mobile didn’t really exist, and now it is one of the predominant revenue drivers in the advertising world. New formats come online every day, like native advertising and virtual reality, and our platform has to be aware of the billing and cash flow cycle for all of them. Our ecosystem rapidly evolves to embrace change. I think that it’s a key component of what makes us competitive and unique.
What were a couple of key defining moments that led you to where you are today, as CEO of FastPay?
First is my grandmother, Silvia, who lived to be 100 years old. She was born in Chicago and graduated from university in 1930, which was an incredible achievement for a woman during that period. At 90 years old, she moved to LA full time from Chicago. This allowed me to see her nearly every day in the last several years of her life. I learned so much from her, and I was privileged to enjoy a robust relationship with her. Additionally, I played a major role in most of her healthcare decisions toward the end of her life. My relationship with my grandmother gave me the confidence that I could be a business manager, run an organization and be responsible for the lives and livelihoods of others.
Another occurred in high school, when I had the opportunity to play on USC’s Junior Olympics water polo team. The team itself had won the tournament three years running, and the expectation was that the team would win again that fourth year. Fast-forward to the semi-finals – toward the very end of the game, the referee called a penalty on me, causing the other team to take possession of the ball, score and win. I felt personally responsible for our loss, jeopardizing our place in the tournament, destroying our winning record and disappointing all my teammates. But later that afternoon, in the next game of the tournament, I scored the winning goal – against two future Olympic athletes no less! For me, it was an apt precursor to building a start-up; experiencing extreme lows and highs alongside a highly motivated team, often all in the same day.
Where do you hope to be, as an executive, in 5 years?
I’m enjoying the journey, and FastPay presents a new set of challenges and opportunities every single day. On one hand, I focus on recruiting and challenging my world-class team. On the other hand, I’m maintaining the unique culture we’ve put in place here. In reality, both of these go hand in hand, and they’re the two key challenges. Some of the problems we are currently solving did not even exist five years ago, which pushes my team and me to stay innovative and entrepreneurial.
If I weren’t a CEO I would be…
A music producer.
My favorite movie is…
The Godfather Part II
My favorite musician is…
My favorite hobby is…
My favorite food is…
Pizza. I rarely ever eat it but it’s still my favorite food. Especially from some of my favorite places in L.A., like Milo and Olive or Mozza.
Do you have any pets?
I don’t, but my sister is a veterinarian and I’m godfather to her dogs, Joppa and Trevor. Or maybe that makes me their uncle?