As a part of my series about “The Future of Healthcare” I had the pleasure of interviewing Jeff Elkins. Jeff Elkins has 30 years of medical device experience across a range of roles, most recently serving as the Chief Executive Officer and President at Veniti Endovenous Therapies, recently acquired by Boston Scientific. Previously, Jeff served as President and CEO of Aptus EnsoSystems (acquired by Medtronic Corp) and President and CEO of FlowMedica Inc (acquired by AngioDynamics). Prior to this, he held various positions within Medtronic’s Vascular Endovascular Unit and oversaw operations pertaining to Talent and ANEURX AAA & TAA Endograft platforms.
What is it like to be at the forefront of medical device innovation?
I enjoy watching emerging large-scale fields. I’ve had a lucky front-row seat to emerging markets in the heart, brain, peripheral arteries, and emerging fields that started from nothing. I often see very out-of-the-box ideas, often started by physicians, but I do not get scared off by something that may not exist. I’m very willing to see if it might emerge in the next 10–20 years.
In the early days, I was involved in aortic endografting, which is a conversion from a very invasive, very high-risk open surgery. Aortic endografting started in the early 90’s, and I got involved in ’97. You have a small group of physicians, brave innovators, and doctors willing to try this then high-risk, minimally invasive approach. It’s high risk because if or when things go wrong, you have to open up the patients and do surgery.
And that was a really interesting time. Half the world said that it would never work, the other half saying that it would. Tons of very hairy procedures, and some tough tough failures that require you to keep on going. Now, this is a 1.3–1.7-billion-dollar market worldwide. It’ s now very matured and established as a standard of care. But back in 1997–1998, it was just getting going and you didn’t know if it was going to make it or not. In the end, after all this, it’s here to stay.
You have often pitched to investors and angels. What are some important skills?
These are not in any order of priority.
• Definitely confidence. You have to be confident and you can’t be hesitant about answers or the probability of success.
• Well-rounded thought process. You need to be articulate in your materials, and you cannot have a single-issue management approach. You can’t just focus on one thing –such as on tech without thinking of the regulatory, timelines you have to focus on all things, and have a comprehensive overview of the business — its risks, upsides, competitors, patients, financials, and have a real handle on your entire business and entire plan.
• Anticipate the questions. I put a huge premium on anticipating the questions that will come up. Anticipate all the questions from the various partners of the firm. What I mean by that is, expect commercial questions, statistics, regulatory paths, and competitive questions. I will go in ready with answers to 1000 questions, but you only need 100. But you don’t know which 100, so you need to be ready for all and have it in your back pocket.
• Communication and the look of the presentation. It’s important to try to make a concise pitch, and boil down the most important message in a very digestible, visually appealing, well-produced way. The look, the layout, the format.
•Rapport. If your reputation is solid if you are coming in with general backings from a credible source. This matters hugely versus if you are going in cold, and it is your first time meeting someone.
What do you think of Shark Tank?
Very helpful! In the world of startups, we have valuations based on milestones, de-risking, certain tangible progress steps, and financials in and out. The concepts of what percentage someone owns or the investments they give. Shark Tank is a very good and realistic view.
For example, when someone sees that the venture is of value, you will have more people bidding on it, or giving you x $ for less percentage of your company. You also learn that those with a good high-quality presentation, those who are realistic, passionate, and with enthusiastic pitches, do well. Those with unrealistic views do not.
Also, the judgments and commentaries for the judges, that’s real. The ability to take that critique, and have that thick skin, is absolutely necessary for the same investor to pitch for a startup.
So, how do you stand out with investors?
1. I generally prepare so I know a little more than normal about my technology. I’ve been in the operating rooms, I can quote scientific literature, quote history, I can understand how something developed, the economics, reimbursements, engineering, margins. I try to have a strong command of my materials and the area that I’m working in.
2. Have a realistic view of your business. Never come to a pitch with a pie in the sky and dream of a lucrative and quick exit. Be positive, paint a good picture, but stay grounded and realistic.
3. Start with the background. The background helps establish credibility. Put a lot into the team around you and the experience and pedigree of your team.
Do you have a collection of advice passed down to you?
Take Calculated Risks
• It’s not ‘can something be done but ‘how can that something be done. What I mean by that is that I focus on ‘ok, it may not seem possible, but what is necessary? What resources, what time, what money?”
• Look for landmines. I constantly look for them. When I think about project spending, or the team, or the timing. I always look for landmines that will get you, kill the project, or cause a delay. I put a lot of time into risk management and looking for places that are going to fail and then creating means to mitigate it. I do a thing called ‘gross screening’. I seek to grossly figure out if something is worthwhile early and screen out the risks as much as possible
• Jump into opportunities. Get out of your comfort zone. For example, if you are an engineer, switch to field mode and engage with customers, or switch to finances or business development or marketing. Leaving that comfort zone is very important.
Paradigms
• There is a lot to be said about unconventional approaches. The term paradigm (as much as it’s a buzzword in today’s business climate) the truth is, that paradigms are very powerful things. If you get stuck in an established pattern of thinking, established constraint, it’s limiting. You have to be willing to think outside of that paradigm. Do things a little unconventional.
• Surround yourself with multi-position players. I focus a huge amount and put a lot of value on people who can do multiple roles. I value someone with multiple perspectives. For example, someone with a field perspective when designing a project. Or someone who can write the regulatory documents because they understand the risks and clinical patients. Or an engineer who has marketing experience.
Hard-work
• Insanely do whatever it takes. Whatever crazy hours, travel, out of box solutions. I’ve always said whatever it takes to get it done, you’ll kill yourself trying, but get it done. Case in point- in the startup world, it is really really hard to get an exit. You have to work insanely to get an exit, do miracle things and crazy over-the-top commitments
• Give very high quality of work in terms of exceeding expectations. If you are expected to deliver something, exceed it, whether in terms of quality or timeliness, or completeness.
• Try harder. Whatever you are doing, whether you are competing with a company or with another person, put forth more effort, more thought, and more worry to simply do a better job. Be more complete, more thorough, and think through risks.
• Immerse in whatever area of interest. If I’m working in the brain, or peripheral, or kidneys, or whatever field I’m in, I am completely immersed and try to understand everything about it — the science, all the history, who the thought leaders are, society, standards of care — so that I can be a first-hand expert. A leader sets the pace. I may not be a statistical guru or CFO, but I have to understand it enough to converse on all levels.
Handle Adversity
• In the startup world, failures are normal. I go into it understanding that it will be like a rollercoaster ride. With very high highs and very low lows. Facing adversity and failures just comes with the territory. I put my head down and work through it, describing it to your team and our culture. Know that failure will happen and have everyone ready when it does happen. In our world, examples can be running out of money, a difficulty raising funds, a patient who dies or gets injured with your product, FDA delays, and regulatory approval costs. It can be a competitor with a big victory, or the devices you are training physicians with do not show up on time. These things are absolutely a part of it. At the minimum, you have to plan for it, assume an emergency happens, and teach everyone part of it.
• Sometimes I use the term ‘consequence of being wrong. If there is not a horrible consequence, and the worst case is the company goes out of business, but there is still a lot of opportunity in that region, or the investor group has more for you, I’m always comfortable taking some big risks. But I never take an unreasonable risk on patients or patient safety.
What do you stand for?
I stand for very high integrity and a sense of responsibility. I want to set the right example. In a world where you lead and mentor, you have to lead by example. I live by the idea that by taking care of patients and physicians, the business often follows and can take care of itself. I like to do things the right way, with integrity, and with good defensibility for my actions. I do take risks, and when they go wrong, I take responsibility for it.
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