Link to the episode:
Lisa Calhoun
Welcome to the Startup Podcast. I’m Lisa Calhoun, Founding Managing Partner at Valor Ventures in Atlanta, Georgia. We lead seed rounds across the south, and a lot of times we focus on really exciting Early Stage B to B healthcare companies, which is why I’m very excited to learn from Linda Li with the Cleveland Clinic. Linda, welcome so much to the program today.
Linda Li
Nice to see you again, Lisa, thank you for having me here.
Lisa Calhoun
Well, regarding Venture Capital, a lot of people won’t think of the Cleveland Clinic, which is famous around Venture, could you explain how your role works within the clinic’s functions, day to day?
Linda Li
Absolutely, I think you’re right. Before I got here, I had very little knowledge about the Venture effort of the clinic. It’s been in existence for over two decades. Primarily kind of helps our scientists, the physician-scientists, to translate their scientific discoveries to new companies or licensable technologies, to the strategy partners, as a team, I’m one of the Partners with the Ventures team. So as a team, we cover biotech, med tech, and some of the digital technologies to streamline the clinical workflow and also the patient experience. So we become the connection between the external world and also the clinic. Also, I think our primary mission is to focus on the IP generated by our 5600 scientists and help them to build and transform patient care.
Lisa Calhoun
5600 scientists is a lot of IP produced. How many new potential companies are Venture scale concepts? Do you work within a year?
Linda Li
Yeah, it is a dynamic number. Sometimes we have two or three companies, new companies are generated. But some years we’re probably between zero to one. We don’t have a limit number say how many numbers of companies we need to set up every year. Whenever we see opportunities, whenever we see proper technologies, we just go to the inventor and talk to them, I think the primary understanding is, what is a clinical gap, and why the patient has not been served. What is the best way to carry and improve patient care? I think that’s always the first question we ask. And once that becomes interesting, and we will do our homework on the market, on the upstream, downstream analysis, and eventually structure the whole business model around this core IP, and also incorporate other IP. Sometimes the other IP comes out of the Clinic. We partner with other people from the market.
Lisa Calhoun
Well, you’re sitting at such a renowned organization, and, healthcare organizations like the Cleveland Clinic or like Ascension and others, they’re megaliths when it comes to driving healthcare innovation forward and helping improve the standard of care. What do you like or notice about the culture of the Cleveland Clinic when it comes to innovation that might be a little different?
Linda Li
Oh, I love this question. When I first came here, I thought, this is a large organization. I was relatively new to not only the Clinic but also Cleveland as clearly, as a transplant to this area, I was very nervous to reach out to our clinicians, because I know how busy their clinical hours are. We all know that as a medical doctor, how much time is devoted lifelong to continuous learning and also to their patients easily outside of their working hours. I was quite surprised when I sent out the first emails to a clinician and just asked, what do you think about the clinical gap? What do you think about the gaps in patient care? What do you think about the new technology? And sometimes I wasn’t even confident, because new technologies always have deficiencies. They’re never perfect inn the startup world and with the founders. I was very much surprised, positively surprised, by how long their (reply) email was when they were responding to me. They don’t know much about me or our team, but they were just enthusiastic about the novel technology to take care of the patients. They replied to many of those emails. I would say in 90% of those emails, (they) would just give me a very detailed summary of how they see this type of opportunities (and) what are the pros and what are the cons? Most of them, I would say, would like to take a meeting with the entrepreneurs. I was touched by them.
Lisa Calhoun
Wow, very passionate about innovation and willing to make space for it, that’s an amazing culture, and that’s something to be so proud of.
Linda Li
Absolutely, I was shocked, and to a certain extent, I think I was spoiled by that culture.
Lisa Calhoun
Good!
Linda Li
Yeah. People would easily say that a large health system wanted other people to take on some novel technologies or novel solutions, and then it would be like a “wait-and-see” attitude. But that was not the case here. We always wanted to try something new. So, it completely changed my stereotype about large health systems.
Lisa Calhoun
Wow. Well, I don’t have a lot of stereotypes around large health systems, because a lot of my background is not in healthcare, but I’m happy to share, that I have a fairly up close and personal experience with the Cleveland Clinic because I participate in the brain study, which is something that you travel out to do, and you spend the whole day and you do a sleep study, and they take all bodily fluids and also do a very thorough mental inventory. So it didn’t make you, makes you think, Oh my goodness. How many of us can I remember in a row, right? But everyone I encounter in that fairly complex research process, which every year goes on and on, they’re passionate about what they’re doing. I mean, even the person who’s putting the electrodes on my head is like an expert. And I’ve just it’s so impressive working with that type of a team. So it’s exciting. I respect the work that you all do on so many levels. I would love to know a little bit more about you, though. How did you get into this fascinating role, and what’s your day-to-day like?
Linda Li
I was definitely a lucky bird here. Honestly, Venture Capital was not even a career when I was graduating from the National University of Singapore, where I took my master’s program. When I first came into the Venture capital, I was interviewing with my former fund called Vickers Venture. Before I came to the interview meeting, I got, of course, referred by a friend, and said, “Somebody is starting a new fund, and are you interested in taking a look?’ I was like, ‘What do you mean by fund?’ And she said, ‘Oh, I don’t know much details. Maybe just a Merchant banking firm’. This was around 2005 I think today, maybe no people, but around 2005 I would say 5% of people globally use Merchant banking. That’s just an old word that nobody was using around the time, but I was like, ‘Okay, I’ll take the meeting, and I’ll send my resume and schedule something out’. It turned out to be a great opportunity that brought me to the Venture Capital world. My former fund partner, who founded Vickers Venture, was an early investor in the Google of China called Baidu. Ever since then, I participated in his fund as a young analyst in 2005 and then as a co-founding member, later became a co-founding partner in 2009 and led investment in mainland China for a few years. And also co-developed the US market around 2011 or 2012. That’s when my previous fund set up the first footprint in the US. That’s also around the same time we (Vickers) started to become more focused on biotech and healthcare technologies in this market, and cumulatively, that fund raised $750 million across six major funds. It was a great experience. I think, as I said, I was just a lucky bird. So maybe one of my personal experiences, among a lot of messages, to the startup, to the entrepreneurs is to just try everything. Even this opportunity doesn’t sound like fancy at the beginning. Merchant banking is not a fancy word at the beginning, but it could turn out as a fancy opportunity career-wise, business partner-wise, just everything magic could happen. I think my career path moved to that point.
Lisa Calhoun
You’ve had a fascinating career path and exposure to China during the heyday of the AI boom, which was setting the pace for the world for quite some time there, and all eyes were on China. How do you apply that experience to the Cleveland Clinic? What are some of the parallels that you notice, sort of, from your unique point of view?
Linda Li
That was a great insight, Lisa. I’m glad you mentioned my experience in China. You’re right. 2005-ish was like the starting year of the Venture Capital industry in China. Sequoia set up its first office in China. And correct to say it was the beginning of the heydays. And I think, again, as a lucky bird, I harvested almost 10 years of the heydays in the Asia (VC) market. And also the best days of the US market, after the Subprime Crisis, in 2008, 2009 that’s around when we (Vickers) set up the first US footprint. I think my personal career, being a generalist at the beginning of my career, and then later becoming a health or biotech-focused investor, really gave me different pairs of lens to look at the whole healthcare industry. The consumer internet in this experience, kind of brought me always to look at our healthcare industry from a consumer angle rather than a regulatory angle. I know regulatory path is super important for most of the healthcare business. But at the end of the day, if you think about it, it’s about a user, it’s about the patient, and it’s about a clinician.Some products are probably not for patients, but they support the clinicians to improvise their work, to bring efficiency to their work, or just bring some comfort, for instance, a good ergonomic design for the surgeons in the OP room could significantly improve their performance, right? Guess how many surgeons are claiming like PTOs, just because (of the pain)? You will be shocked by the number, at least, based on my little research here at a clinic, I would say that a significant amount of their PTOs are contributed by pain management and that’s what they need for their career. So any solution is at the end of the day, it’s about the user centric. It’s about the individuals. I think that gives me, especially in this like, as you mentioned, the AI era, this is super important that how to help or improve the individual’s capability, both the clinician and patients to understand what they’re facing in terms of the big data, in terms of how to manage their own journey and workflow on the front line.
Lisa Calhoun
What an incredible insight from you know the arc of your experience, to bring that consumer lens, patient lens, user lens, to healthcare. It’s a lens that is frequently missing with all of the healthcare investors, we both know many of them are kind of regulatory first, and there are a lot of reasons for that, but it’s great to hear about Cleveland Clinic centering the patient experience with partners on the team like you. It makes me feel better.
Linda Li
Our first thing is Patient First. That’s always the thing. That’s always the first thing at Cleveland Clinic. No matter what, Patient First. So absolutely, I 100% agree with you.
Lisa Calhoun
And you brought up AI, I want to double-click on that. How are clinicians receiving AI? I mean, you and I both know it’s like as we speak, 50% of new seed dollars in Venture are going to AI. It is a craze. It is a fad. Is it a fad that is here to stay, in your opinion? And what kind of feedback are you getting on AI strategies from some of your users and stakeholders?
Linda Li
I’m really glad you asked this question because I think, again, this is probably related to the culture that we discussed earlier. Initially, I thought that large healthcare organizations probably will be, maybe not, the first batch of organizations adopting the most advanced technologies. But it’s proven that I was wrong. Again, we’re very much embracing AI technology. So I will give you a couple of examples here. One is that, guess how much time that charting is taking from the doctor’s time every day, one hour?
Lisa Calhoun
Hmm, 50%
Linda Li
Close enough. Not that because we have already developed some automation, but you might be right in some of the providers that they are less equipped with advanced IT teams and also infrastructure. It might be as crazy as 50% but generally average, across all the clinicians, and all the institutes, this could be an average 1/3 of their time every day. So if it’s eight hours, we’re talking about three hours minimum, contributed to the front.
Lisa Calhoun
It takes a lot of time for someone that has a brain to help care for and cure to be charting. That just doesn’t make sense.
Linda Li
Yeah, and based on my conversation with some of the clinicians, is as crazy as it is. Some of them need to take, to take notes when they talk to the patients, so you can see that they reduce their eye contact with their patients, they have to focus on their notes, and then when they bring back the notes to their office at the end of the day, they need to lock themselves (in the office) and make sure that they chart everything in the correct places in the system. So that became a heavy burden now for the clinicians. But you are, Lisa, you’re investing in other industries, and witness how many other industries have been really improved by AI technology. This task takes a lot of time, but it doesn’t sound that difficult if technology can help. So this is one of the major domains that Cleveland Connect introduces, ambiance listening, AI in patient summary, AI in charting, AI in coding.
Lisa Calhoun
Exciting!
Linda Li
Exactly. So all this technology will eventually benefit patients, right?
Lisa Calhoun
Absolutely, there are so many places where you can see quick wins. And I’m very excited about that future. I’m excited about being a patient in that future where there is automated support for my care team. I think that they deserve it, they need it. And in other industries, we have that support, and it’s creating a large ROI. I mean, recently, I was reading Clar and his own case study in FinTech about its like 30 to 40% better bottom line results from using just an integration into basic ChatGPT from open AI in their customer service. So, I mean, there’s a lot of low-hanging fruit in the proper mind, with the proper systems like Cleveland Clinic. Yeah, the world is changing. It’s going to be a true, brave new world.
Linda Li
Absolutely. So I think I know that part of our audience today are entrepreneurs. I encourage them to, even though I said there are so many companies in existence helping health systems, to develop AI or other intelligence in patient summary or charting. Honestly, we are still in huge demand for all aspects of solutions to support the operation here to improve the efficiency here. For instance, we are brewing another collaboration with a startup which can help us to efficiently identify the patients for the clinical trials. So this is another industry, probably overlooked by some investors or entrepreneurs, but guess what? Pharmaceuticals are struggling to get their patients, if they get patient recruitment done, completed within two years versus within six months. That’s a significant operation cost and reduction.
Lisa Calhoun
And it also, potentially slows down getting potentially life-saving products to the market when you can’t recruit enough human trial participants. Yeah, that’s also a really interesting field to be in.
Linda Li
Yeah, absolutely. So there are so many AI solutions, and even, we talk about the home hospitals, because these days we know that caregivers are caregivers in health systems, but so many caregivers, they’re “unofficial caregivers”, “family caregivers”, right? They take care of Parkinson’s patients, they take care of Alzheimer’s patients. How can we support them to complete their care duties to their family members, and their friends? So, how we can connect the information flow from the health system to the individuals, and to allow the information shared among family members. Everything kind of requires the entrepreneurs to be creative and innovative to provide solutions and help systems. We can’t do everything. And by the way, digital healthcare is the one major area that Cleveland connects and collaborates a lot with external companies. So we don’t do everything on our own, we open the door to collaborate with entrepreneurs.
Lisa Calhoun
You know, I should ask you, is there a portal where an entrepreneur who’s listening right now, and they’re like, I want to reach out to the Cleveland Clinic? You know, they will want to. What is the best way? Because I’m sure you’re contacted every day for a founder with a great young firm to reach out to the Cleveland Clinic.
Linda Li
Definitely! I appreciate you giving me this advertisement time so that I can advertise our EIR program a little bit. So Cleveland Clinic has innovation. You can go to the Innovations Cleveland Connect Innovations website and on this website, either you can go to the Ventures team, the new code team, or new companies, or you can just contact the email there. Both paths will direct you to the Ventures team or our program. We have a dedicated email address that I can leave with Lisa after this podcast, so people can reach out. So, these are the consultants, like we call them consultants or our entrepreneur in residence whom we will touch base. We’ll reach out once we have discerned a clinical gap, and then we know that there might be solutions. So we’ll talk to these people and see whether their talents or their expertise could help us to frame this up or shape this up as a standalone business. So people who are excited about some of the same opportunities you’re talking about should register with that EIR program at the website, which we will post in the show notes and the transcript and make sure that people get a chance to if they’re not already in touch with your team, raise their hand as someone who’s trying to solve some of these bigger challenges. We really appreciate that connection.
Lisa Calhoun
Oh, that’s good. So speaking about big challenges and healthcare, the world has been taken by storm in healthcare by GLP 1, Semaglutide, Wegovy, and Marnjuno. All of the different flags under which these new approaches, some of them older drugs. But now looking at obesity as the epidemic problem that it is solving, potentially obesity. What are you seeing at the Cleveland Clinic around this new frontier in tackling chronic conditions?
Linda Li
That’s a fantastic question. I think GLP1, many people said GLP1 is going to transform not only the patient care journey but also some of the drug development or drug discovery fields. I tend to agree with this. We do see that even within Cleveland Clinics or self-insured entities, so we are interested in exploring how to tackle this obesity or diabetes problem for our clinic employees. I think that so far, the cost of the GLP1 drugs, as Lisa said, is huge.
Lisa Calhoun
It’s crazy about the team itself, if I recall, and please correct me, because I probably don’t recall, but I think Cleveland Clinic employs something, Is it 130,000 people? It is a very large organization.
Linda Li
It is. We have 80,000, as of today, including our Northeast Ohio presence. And, we have a presence in Florida, and some international presence in London, Abu Dhabi, etc. So this is a large group, and GLP1 adoption is going to put a significant cost on a side. But that being said, the benefit might be also interesting here, if obesity is the root cause and is explained as part of the reason why cancer or other diseases occur. Tt’s going to be interesting if we cover or not GLP-1. I think CMS is probably also evaluating this challenge as seriously as many other health plans.
Lisa Calhoun
From what I understand as a compounded solution, the cost does go down quite a bit. So it might become more approachable. I certainly have a personal take on it, and I don’t mind sharing. I believe that these are revolutionary applications of very solid drugs. And while it’s not perfect and it’s not good for everyone, and it’s not good for all the time, it needs to be under Doctor supervision and all of those things, if we could end chronic obesity. Wow. That should be done. That should be done because as you said, a root cause of some things.
Linda Li
It’s also interesting that recently I saw another research that shows that after a patient or an individual stopped on the GLP-1 drug, their weight is actually rebouncing back to the original level after. That being said, I think we have to be cautious about the real world data, do we need to always take this drug? Can we stop the drug? (If we) stop administering the drug at a certain time point, what kind of weight growth will the patient experience after stopping?
Lisa Calhoun
It is like a real-world experiment going on right now. I know it’s so interesting, although I have to say, when we put, for example, a type two diabetic on insulin, their weight may be managed. It may change if weight is a contributing factor, not isn’t always, but if they need to take insulin for the rest of their life, that’s considered okay. People with thyroid issues, they may have to take things for the rest of their lives. I think the more we understand obesity as a disease system, the more we might be compassionate about making sure that people who have fat are able to get the treatment that the disease state requires. And I know we don’t know what we don’t know, because this has been such a new phenomenon, but I do find it, just like you do, very interesting, and it is changing the phase of healthcare. It is reshaping approaches in real-time, which is exciting, always exciting. I also really, those studies that have come out, really in the last years, when I’ve noticed them, they may be older than that, but where GLPS reduce inflammation, systemically, and also seem to reduce some cravings and addictions. Wow, that’s powerful.
Linda Li
That is it. You’re right on the spot to say that it’s obesity plus diabetes. So there’s a new word recently we use a lot – Diabesity. Um, it’s a combination. Yeah, it’s 100% right that you say that inhibiting the inflammation is the most important thing at this stage. Of course, there are many other reasons explaining a specific disease, but if you ask our oncologist from Taussig Cancer Institute, they would agree that obesity or diabesity is important to understand or control for most of the cancer patients here. And, for Neurological, Neurology Institute, will also agree that for some of the neurodegenerative diseases, it will be great if we can control the patient’s obesity or diabetic status.
Lisa Calhoun
Fascinating stuff. Well, for those who tuned in to listen to a Venture and Startup podcast, don’t worry. I’ll go right back to that. I was going to ask you if you wouldn’t mind sharing sort of the arc of a typical deal by walking us through a real deal that is in the public eye, obviously, and something that you could share about how you met the startup, how you vetted the startup, what your investment process looks like so that people who are hopeful that you might invest in them? Get a sense of what the journey looks like.
Linda Li
Well, this is a great opportunity that you brought this up, so I can share one very unique transaction that I made together with our other team members and other partners earlier this year. This is a technology spinoff from Cleveland Clinic a while ago. It is focusing on the diagnostic solution for autism or autistic individuals, we call them, neurodiverse individuals, but this is more like the autism spectrum disorder (“ASD”). This is a very interesting technology. They track a patient’s eye movement, and based on the proprietary algorithm we developed here by our inventor, we hope to diagnose whether an individual is neurodiverse on the autism disorder spectrum. This technology has been set up as a new company before I joined the Clinic, and our leadership assigned me and another partner to take care of this investment. And then we got a very unique opportunity. Again, this is an opportunity for most of the entrepreneurs who are the audience here, and we do have multiple touchpoints to collaborate with you. So we got to know another company called Floreo. Floreo is a very interesting solution. They use the VR headset, Microsoft HoloLens or other VR headsets, those kinds of VR headsets to provide a digital content / curriculum through the VR headsets to ASD individuals. So with that, they can, number one, definitely deliver easily to the patients, without having the patient or their family to drive them to the offline ABA therapy centers.
Lisa Calhoun
So, by tracking, bring the clinic to you. That’s exactly.
Linda Li
But around the time, they didn’t track the eyes yet, but they just provided the digital content so and then number two, they can provide a like remote, which means more frequent interventions with the individuals. So when we met this company, we say some, we see some. We saw some natural synergy in between. Number one, both of us are, as you mentioned, the VR headset can potentially capture eye movement. If we can link the diagnostic story with the therapeutics or therapy story, we kind of close the business loop end to end and eventually help the patient to, from the early stage all the way to monitor and eventually treat the individuals as they needed. So this ended up with a transaction that we eventually merged, or the other company, Floreo, acquired our spin-off company called Autism Eyes. Now the two solutions become one company and Cleveland Clinic put investment dollars after Floreo, together with other investors in the same round. I think this is a perfect example for me to welcome the opportunity through your platform. Thank you, Lisa, for inviting me again, but this is a perfect example to say that we were inspired by the potential collaboration with the market, with other entrepreneurs, and with their existing companies. In this case, they don’t necessarily need to become an EIR. They can bring their companies, and if we find a middle ground, then we can collaborate and make this business more successful, and Cleveland Clinic can support it with extra capital.
Lisa Calhoun
That’s exciting. And of course, know the base of patients. So I would assume, and please let me know if you can share, is Cleveland Clinic also a customer at this point.
Linda Li
We’re evaluating actually. we’re not a customer, but we bring extra value from a clinical validation or research collaboration to help propel both solutions’ development. So we definitely help the business. But we’re not a customer yet, (as that is) just because these cases have only happened about half a year ago. So we might be a customer (in the future).
Lisa Calhoun
It’s a very early stage. This, this type of technology is so early. I was just checking because I could see in some situations, there could indeed be that almost trifecta of incubated at Cleveland Clinic through real experience, combined with the right team, perhaps an EIR or an outside company, and then Cleveland Clinic able to help it with early scale as one of the leading, research hospitals and health systems.
Linda Li
You pinpoint our mission or our daily work. We want to kind of co-develop some of the solutions that can be universal solutions for everybody on the market. So if I may say it this way, we don’t want to just bring the patients to our clinic. We want to offer this as you said, we want to push the clinic to the patients so they don’t need to necessarily physically visit the clinic, but they still can enjoy the quality of care from the clinic. But novel technology created by the clinic probably echoes why we want to be a national or global presence. Again, this is not only about a clinical practice somewhere, it’s about how we generally take care of the patient cohort (or) do we have a solution more broadly adopted by the market.
Lisa Calhoun
Are there any specific sectors where you feel like Cleveland Clinic is that you’d like to call out to our listeners if they’re developing in these sub-specialties of health care that you’re particularly keen on in the next 12 to 18 months?
Linda Li
That’s a great question. I would say that people know Cleveland Clinic by reputation and cardiology is probably the first award that comes to people’s mind.
Lisa Calhoun
Oh, you do have an enormous heart hanging in the foyer. Anyway, please go ahead.
Linda Li
Right, definitely. But I would say that other than cardiology, we call them HVTI – Heart Vascular and Thoracic Institute. But other than HVTI, we have, we’re very strong in urology, Gastroenterology, and Neurology. You know, I’m not going to list every single one of them, but we look for partners, we look for talents who can help us broaden our service area. For instance, many people today still fly to Cleveland for surgeries, how do we kind of bring the identical twins, the digital twins of our surgeon? So and you do, can we find a solution that a surgeon doesn’t need to of course, we’re talking to several partners today, while I’m talking. I’m just using this as an example that potentially other partners would be interested. So can we just help them? Help the local that is less equipped, with its healthcare facility. Can we help them to guide their surgeries, and then also without moving the patient to the Cleveland Clinic, and then we can still deliver similar care and/or improve the local facilities’ surgical quality? So these are the technologies. We are interested and we want to partner with everyone in those areas.
Lisa Calhoun
Linda, I am so grateful that you shared more of the vision of your work. How you partner with entrepreneurs exciting technologies, and also the 5600 scientists and clinicians practicing and developing new techniques, new science. How can people catch up with you in person? Are there any events on your radar where Cleveland Clinic is going to be out and about, and founders, entrepreneurs, and potential partners can actually say hi?
Linda Li
We welcome people to say hi. We have footprints at all the major conferences. For instance, JP Morgan, and LSI. There was one medical device company but LSI, so these are the conferences. We have a footprint, so we normally send a team there. So if people see our name, welcome to come to our booth. But the latest and most recent one is the one called HLTH. Will have a pretty big presence in HLTH in Las Vegas in October. So if you are interested in talking to us or setting up some meetings, please drop an email to me, or come to our website and drop an email to the email that we provide on our website, or one of our colleagues will direct you to the people in the team, and look forward to seeing everybody at Vegas.
Lisa Calhoun
That’s super timely. I will make sure that all these are in the show notes and also, in the materials of the transcript so that people can just pull them out. If you’re watching this or listening to this, please go to the podcast website for some of that. And Linda, thank you again for sharing more of your story. I hope we get a chance to have you back on the program in a year or so catch up with some of your latest deals and get your take on what’s shaping healthcare.
Linda Li
Thank you again, Lisa, for giving us this platform and opportunity to share with entrepreneurs and to share more about what we have done as a team here. Look forward to collaborating with Valor VC and also all the entrepreneurs from the South.
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