Where We’re Investing Now: Pivotal Personal Health

Personal health is, and long has been, big business.

The US healthcare expenditure reached $4.3 trillion in 2021 and is estimated to reach $6.2 trillion by 2028. The US spent nearly 16.8% GDP on healthcare in 2019 and that will triple to $12 trillion by 2040 or 26% of the GDP, according to Deloitte estimates. This vast expenditure has spurred sweeping innovation: individuals crave new treatments; payers want to contain costs and increase efficiency; doctors want to deliver the best outcomes to the most people. It is one of the great flywheels in investing history.

Healthtech outperformed many other life science sectors in terms of startup investment last year. But 2023 looks to be a tough time for healthcare — inflation-pressed consumers, stressed health systems, longer sales cycles, and investor reticence all conspire to slow the pace of innovation in health and flatten the trajectory of investment. We expect to encounter many more flat or down rounds with harsher terms than in many years.

As a result, while we retain our fundamental belief in health as the focus for our funds, we have done a foundational rethink of how we define this target. Previously, we centered our attention on novel science whose value to the individual was so great it could spur direct consumer adoption. In this tougher environment, we will need to shift our investment criteria to focus more on cash flow, clear paths to profitability, and favorable investment terms, alongside our ongoing attention to novel science.

We see a set of long-term and short-term trends as central to shaping health investing this year:

Long-term trends

• Innovation and growth have continued post-pandemic which will do so this year, but with shifts in profit pools toward payer and provider business models.
• Chronic condition expenditures will continue to rise, spurring more need for new, lower costs treatments.
• Payer profit pools are expected to shift towards Medicare, driven by the rising over-65 population.
• We will see ongoing movement from high-cost acute and post-acute sites toward lower-cost freestanding and non-acute sites, including increased demand for home-based services and virtual care.

Short-term trends

• Chronic disease patients put off treatments during Covid, now there will be a flood of catch-up patient activity and diminished outcomes, because the waiting time for some cases has exacerbated conditions. Alongside endemic short staffing, burnout, and inflated wage requests from healthcare team members, 2023 could be an annus horribilis for healthcare.
• CMS-adjusted rates aren’t going to be pretty this year.
• This points toward less budget capacity for innovation and longer sales cycles for new products.
• Employers, including those in healthcare, face economic challenges of their own. Many have reduced staff, siloed products, and put greater emphasis on ROI and consolidation. This slows the introduction of new products and their absorption into the marketplace.
• The savings accumulated by the consumer during Covid has supported a burst of post-pandemic spending. But that has now been largely spent. Without that cushion, we’ll see the real impact of inflation on consumer buying. Family budgets will have little room for unnecessary and even important products. If folks are choosing between heat and food, they will skip anything else they have to pay for. So having health costs covered becomes paramount.

For all these reasons, we are now looking much harder at the role of providers and payers in the growth of health startups, without dropping our understanding of consumers who benefit. We see greater potential in B2B2C business models than previously. Individual impact and user experience remain key, but the how of getting a solution in front of the people who need it quickly and efficiently looms larger for us than ever.

Regardless of funding challenges, we at Joyance continue to see healthcare as an essential and value-creating investment area. We seek startups solving significant unmet healthcare needs with innovative and highly impactful solutions with clear paths to product-market fit.

We see four pillars for our investments this year: sleep, food, exercise, and mood. Our recent investments include many such companies, Nimble Health, who just announced their $2.7M raise to collect data from previously inaccessible regions of the small intestine; Hey Jane, providing at-home abortion care that integrates clinical, emotional, and social support; and Wave, a mental health platform designed for the specific needs of GenZ, with science-backed techniques and expert coaches.

By adjusting our angle of attack and taking a more pragmatic line, we believe we can achieve outstanding investment return from personal health, however challenging the macro environment.

We’re always interested in speaking with founders developing exciting products or services that put the personal in personal health — if that’s you, get in touch!

By Investment Partner Jun Deng

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The Sorry State of American Healthcare