Medsider: Learn from Medtech and Healthtech Founders and CEOs - Building the Beachhead Strategy: Interview with Axena Health Leaders Randy Pritchard and Erica Rogers

Episode Date: April 16, 2025

In this episode of Medsider Radio, we sat down with Randy Pritchard and Erica Rogers, leaders of Axena Health. Axena is transforming pelvic floor therapy with Leva, a device bringing clinically-proven, supervised pelvic floor muscle training into women’s homes. Randy, CEO of Axena, brings nearly 25 years of healthcare experience to the company, most recently as CEO of Pillar Biosciences and previously holding leadership positions at Roche Diagnostics, where he spent 18 years developing commercial expertise. Erica, who sits on Axena's Board of Directors, spent a decade as President and CEO of Silk Road Medical, leading the company from early clinical trials through IPO and eventual acquisition by Boston Scientific. A returning guest to the podcast after nearly half a decade, Erica previously held roles at Medicine360, co-founded two other medical device companies, and spent over 12 years at Boston Scientific prior to her role at Silk Road.In this interview, they share essential medtech commercialization insights: identify your specific patient segment, build continuous clinical evidence, and communicate consistently with investors. Their experience offers invaluable lessons for medical device entrepreneurs navigating today's complex healthcare landscape.Before we dive into the discussion, I wanted to mention a few things:First, if you’re into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You’ll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and 3 packages that will help you make use of our database of 750+ life science investors more efficiently for your fundraise and help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the latest Medsider Mentors Volume VII. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Randy Pritchard and Erica Rogers.

Certainly there are opportunities to engage patients, but I think one of the big failings, especially in the med space, is that you activate physicians and you have not brought the clinicians into the partnership already, it's not going anywhere. Because a patient that walks into a doctor that has no idea what that patient is asking them about, their first reaction is always, you know. Welcome to Medsider, where you can learn from the brightest founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious doers as we unpack the insights, tactics, and secrets behind the most successful life science startups in the world. Now, here's your host, Scott Nelson. Hey, everyone, it's Scott in this episode of MedSider, I sat down with two leaders from Exena Health, Randy Pritchard and Erica Rye. Rogers. Randy is CEO of the company and brings nearly 25 years of health care experience, most recently as CEO of Pillar Biosciences, and previously holding leadership positions at Roast

Diagnostics, where he spent 18 years developing commercial expertise. Erica, who sits on Xena's board of directors, spent a decade as president and CEO of Silk Road Medical, leading the company from early clinical trials through IPO and eventual acquisition by Boston Scientific. A returning guest to Medsider, after nearly half a decade, Erica previously held roles at Medicine 360, co-founded two medical. device companies and spent over 12 years at Boston Scientific prior to her role at Silk Road. Here for you the key things that we discussed in this interview. First, focus intensely on a specific market segment rather than trying to boil the ocean, identifying the initial beachhead before expanding

to avoid burning through capital pursuing too many opportunities simultaneously. Second, collect real-world evidence from day one of commercial launch to understand how your device performs in actual clinical settings. FDA clearance is just the beginning, not the end of your evidence journey. Third, with investors about clear, achievable milestones. Effective investor communication isn't just about sharing wins. It's about building a documented history of delivering on promises. All right, before we dive into this episode, I'm pumped to share that volume 7 of Medsider Mentors is now live.

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and future volumes, plus a treasure trove of other resources. If you're not a premium member yet, you should definitely consider signing up. We recently revamped Medsider with swanky new features, especially for our premium members. In addition to every volume of Medsider mentors, you'll get full access to our entire interview library dating back to 2010. You'll also get Medsider Playbooks, curated guides packed with actionable insights

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Learn more about Medsider mentors and our premium memberships by visiting MedsiderRadio.com forward slash mentors. All right, without further ado, let's dive in in the interview. All right, Randy, Erica, as I said, you said, Erica, welcome back. Randy, welcome to Medsider Radio. Appreciate you both covering out some time. Thanks for having me. Yeah, I think Eric has probably been maybe close to a decade, I think maybe since the last time

you're on the program. So it's been a while, but definitely looking forward to talking a little bit more about Xena and learning what you both have been up to as well as what's ahead for the company. So with that said, I recorded a very short bio at the outset of this interview. but let's start, let's start there. Maybe in like a couple minutes or less, give the folks that aren't familiar with your kind of pedigrees, a kind of an elevator style overview of what of your professional backgrounds leading up to Exena. Thanks again for having me back. It's great to be back, Scott. A few things have happened in the last 10 years, just a few. Anyway, as you know, I grew up in the med tech industry

through kind of the sales and marketing ranks, although I'm educated as the scientist. I kind of ended up in the sales and marketing side of this business. I became an entrepreneur, worked in venture for a while and then became a sea level operator. And for the last 10 years have been running Silk Road, or 11 years really, been running Silk Road medical from the very earliest clinical trials through a successful IPO. And ultimately, the company was required by Boston Scientific last year. And really what we were aiming to do is not dissimilar to what we're trying to do here with Brandy's company, which is we change the practice of medicine and we changed the standard of care in carotid artery disease management. And that's what I've been drawn to, my whole career,

are companies that have the opportunity to kind of rewrite healthcare, to sort of upset the so-called standard way for treating certain conditions and diseases. And I'm also drawn to companies with high levels of clinical evidence and real-world evidence, which we'll talk about later, I think, in this show. And then finally, and this is certainly what Randy brings to the table, are strong people and strong cultures. Tough to follow that, right? I mean, I'm very fortunate to have Erica on our board and have her as a sounding board in general, so I'm thrilled.

And yeah, so I grew up in healthcare, really what I say. Right out of college, I actually spent time in politics. I worked on Capitol Hill and worked in on campaigns, but obviously was looking for more. I was there for one person. And I went into health care. I started out as a pharma rep carrying the bag. And actually,

is my father worked, you know, 25 years in big pharma. So carrying the bag, out in the field, ultimately transitioned into marketing, various different roles, different companies. But then as I was at a small pharma company that was partnered with Lilly, I was working on Seattleis. Icos lost all the next products in their pipeline. So we were a one product company, partnered with big pharma. So for me, it was time to do something different as I've seen that movie before. And I spent the next 18 years, almost 18 years of my career, Roche Diagnostics, all of it in the Diagnostic divisions. So various different roles, commercial roles in the U.S. organization, in sales and marketing.

I spent four and a half years in Switzerland, led two of the different global businesses in the Diagnostic Division, came back to the States, spent three plus years as the chief marketing officer for the U.S. Diagnostics business. And then for me, it was time for something more and just something more challenging. and I left Roche and went to a startup called Pillar Bioc Sciences. It's a next-gen sequencing company with some very interesting IP in a library prep space. And for me, a whole new experience, right? Never raised money, never managed a board, all those different, just incredible learning experiences.

And had a heck of a roller coaster there. And then ended up here just very recently at Azina Health. And all the things that Erica talked about, why am I here? I love to be in different roles. where you're changing the practice of medicine, right? And really impacting and positively impacting patients. And we are in a space that is a, it's a huge market, which means there's a lot of patients out there that are not getting the treatments they deserve.

And for me, as Eric mentioned, the clinical evidence that we bring to this space is second to none. And really, for me, that's a foundation. If you build on that foundation, you have the chance to do something great. And that's what's, that's what has me very excited about this role. Yeah, I can see why it made sense to bring Eric on the board. But you know, you just touched on Silk Road a little bit. That's probably what most people that are listening are familiar with, at least one of the companies that maybe they're familiar most, I should say,

with that picture of company. But it's interesting, I was at Viva this past fall. And there's like a group of like net tech people on the elevator going down the elevator, the wind. And there's just like a random person that was at the wind, right? It was like, what do you guys do? And an engineer was like, oh, I'm in the T-car space. And I was thinking, that's so funny, because it's like all of us in the med tech world, no T-car now. It's this new category. I think this random consumer has an idea. I know. I know. And Scott, I'll tell you how that happened. Literally, we took one of the sort of co-founders of the company and the then vice president of marketing, and we didn't have a name for the procedure. And this is one of the themes that, you know,

we'll talk about with Liva, which is giving something a name, giving the procedure a name. branding it. And so we decided to kind of be behind closed doors. And I basically said, guys, you're not coming out. I'm going to put pizza under the door until you call it something, right? And these two geniuses came up with T-car, which is literally now written into the textbooks of medicine. And we decided to kind of open label it, if you will, which was another very smart move. Yeah. I mean, you think back at like all of the unique MedTech stories, Silk Road being one of them, you know, Fox Hollow, you know, comes to mind of like athrectomy and this idea of hawking something. It's like it is. It's like there's, you know, anytime you have an opportunity to kind of sort of

build a, build a brand around sort of a verb, right, giving, you know, something a verb. That's really quite special. It sounds like maybe, maybe some of those learnings are applied at Zena. So with that said, Erica, you mentioned Liva, right? But give us a sense for kind of, you know, people that aren't familiar at all with this, this system. What is it? And like, what's the major, what's the major problem that you're solving for? The new, the new standard of care that you're trying to ingrain in the healthcare space. Absolutely. No.

So we are squarely focused on urinary incontinence, right? I mean, whether it's various forms of stress urinary incontinence, urgency, a mixed version thereof. There's more than 78 million women in this country that are experiencing some form of urinary incontinence. And very traditional first line therapy, your doctor will give you a piece of paper and say, here's some kegel exercises. and then if we get more advanced, we send you to a physical therapist.

And then from there, I mean, following the guidelines, from there you go to medicine, and then after that is to surgery. Well, more than 40% of patients that receive treatment first line skip over first line treatment. So they're right to medicines. They've gone right past any first line therapy and then advanced to surgery. And, you know, most clinicians are just not very comfortable talking about it. It's not something that even patients are talking, you know, really excited to talk about, but they're dealing with it day in and day out.

Right? I mean, if you speak to any one of your, you know, female acquaintances, relatives, there is a group of them that are living with it and may have never spoken about it once. Because what we've been taught over the years is it's just something that happens and you should just deal with it, right? And then as you get deeper into it, you find how people are dealing with it, right? Let's start with the adult diaper category, right?

Significantly larger than the baby diaper category because people are, just dealing with it. You know, if you are an athlete and you are wanting to remain physically fit, there's special underwears that you can wear, there's all kinds of different ways people have found to cope, dark clothing, right, loose clothing. It's just all of these things so that, you know, if something happens, you know, embarrassed. You're not embarrassing yourself in public. And, you know, there's so much more that can be done. And all the dilatory side effects that come with that, right? The mental health challenges of people less and less wanting to, you know, to leave their homes, you know, those kind of things. The impact on your partners, and there are

sexual health impacts on all of those different things that people are just being told to deal with. And that is just not, you know, it's just not right when there are solutions available that can make a real difference. You know, very personal story for me. My mother spent the last six months of her life not wanting to leave her house due to urinary and fecal incontinence and was never once offered any solutions other than depends. And, you know, that turned my father into a shut-in as well as he was helping her through the end stages. It's so much more than, oh, I just have some urinary leakage every so often. You know, to me, that's the problem.

That's the opportunity that you see here. And the opportunity in itself is millions and millions of millions of people not getting the care that they should. And that's what brought me here. We have a chance. We have a well, you know, well-quantified solution. We are, you know, we're not, we're not learning as we go. We have a 510K cleared device that has reams of clinical data, both randomized control trials and, you know, real world data studies following on that show greater than 80% of

women have a response, a positive response with Leva system. And so system itself, it's a, it's a, it's a, it's a, it's a, it's an insertible device that goes into the vagina that has six motion sensors. And to give you a sense, these. are the same kind of sensors that are in your phone that tells it's whether in portrait or landscape mode. And we're looking for where are those sensors in relation to the ground? And so that device connects then to the case and the phone. And so it coaches a patient through their pelvic floor muscle exercises. So they see on the screen if they are doing it correctly because

there's a very specific motion that you're looking to see from the pelvis, from the muscles within the pelvis up and forward, so away from that pelvis. And the biggest challenge of pelvic floor muscle eyes is a lot of people do the exact opposite. They bear down, which is just further stretching it. So the woman gets a visual cue on their phone, where the movement is going, and then we track that. It's a twice a day for 12 weeks, two and a half minutes in the morning, two and a half minutes in the evening, for over two weeks, two years of resolution of your symptoms for 80% of patients that use it. So highly effective device available today for patients.

Got it. Almost like a pelvic floor coach, a personal pelvic floor coach, right? Sort of, in essence. Yeah. What drew me to it, Scott, is that it really takes the gold standard of care, which is physical therapy and puts it in the home and in the hands and the privacy of the patient. And, you know, the way I like to describe it is it is absolutely nothing related to Kegels. And trust me, if you're doing Kegels with this device, the device will tell you.

tell you you're not doing it accurately. Think about it as a bicep pearl for your pelvic floor. It really is contracting real skeletal muscles in the pelvic floor. And it tells you how strong are you contracting them? How long are you contracting them? And puts you through the paces as if you've got, you know, a weightlifting coach standing right beside you. And I think very importantly, engage with your clinician. We monthly reports to your doctor, you know, doctors see the progress. We have an entire Leva Women's Center that's partnered with that patient where we track, are they doing their exercises in various forms of reminders and engagement there?

So it's a comprehensive solution to a very complex problem. Yeah, no doubt. And for those listening that want to learn a little bit more about this therapy, it's Leva Therapy.com, L-E-V-A-T therapy.com. We'll link to it in the full write-up on MedSider. But that's, you know, you can go to Xena Health as well, X-E-N-A-Halth.com. we'll link to that too. But leave of therapy is really the website that's, that's kind of dedicated towards this specific device and this solution. But you both brought up some really interesting

voice around public health, right? And we were chatting about this before I hit the record button. But, you know, my wife's had six kids. The number one question I always get is, oh, you guys must be Catholic. Oh, you're not Catholic. You must be Mormon. It's like, no, we're from originally from the Midwest. We just had a lot of kids. But yeah, but joking aside, like, we're pretty, like, involved in the kind of longevity space, I would say, or at least maybe more so than most. and like this idea of like pelvic floor and kind of the complexities of it and like it was sort of new to us, right? And we had no idea that it was this big of a problem. I've watched her do some of these exercises without a device like Liva.

And it's like, I don't know. How do you like know if it's what you're doing is working? You know what I mean? That's kind of like the main thing that I sort of, you know, drew away from kind of watching her do some of this stuff. And it sounds like, you know, this system makes it that much easier, that much better, right? For this, for those sort of exercises to actually be efficacious. Absolutely. Right.

I mean, there's nothing like seeing it. When you're working your biceps, you see, right? And you see what's going and all of that. When you're inside the body, I mean, without these types of things, it's just a confidence that you're doing it, right? And a hope. Yeah. Right?

Well, this is, you know, hope is not a strategy. And this is very clearly visualizing what you're doing and are you doing it correctly. And then if you're not, there's a wave of resources inside the app to help you understand what and how to do it. And we have coaches and everything else. So it's really, for us, you know, we want to give that woman every chance to get her life back to normal. The other thing that's so astounding, just I think we should bring this up, Scott, is the durability that was demonstrated in the clinical trials. Yeah, I mean, just to speak to that, right?

It's a 12-week course of therapy, right? Two and a half minutes, twice a day for 12 weeks. And there's the patients reported symptom resolution, right? So it's at a point where it's no longer impacting their life. traditional Kegel therapy, a patient never gets there. We see our patients hit that generally at about week four of the therapy, and we have data now showing randomized control clinical trial data showing durability at two years. Okay.

Wow. That's impressive. Yeah. And this, I mean, you mentioned obviously urinary incontinence being a major problem or major side effects of pelvic floor issues, but there's all kinds of, you know, other issues, right, that occur, right, if you've got some of these underlying issues, which is, you know, And this whole concept of pelvic floor health is, from my perspective, is going to be quite quite big.

I mean, you're certainly on to something over the next, you know, five, ten years and beyond. Well, we do have, and look, we are also indicated in fecal incontinence, right? I mean, basically, as you say, anything that passes through that pelvic floor is impacted by various things in your life. And so we have, you know, equally good data around fecal incontinence and women as well. Got it. Yeah, it's super helpful. And then in terms of where you're at now, where the company's at now, we're reporting this in early

2025 for those listing maybe after the fact. You mentioned 5-2K clearance. You're actively commercializing. Are you just focused on the U.S.? Are you, there are other geographies that you're selling into? We are right now commercially focused in the U.S. only. You, however, have a program in sub-Saharan Africa where we are doing some studies and work to figure out the right solution to bring to that market, right? This is a universal problem. And certainly we start starting commercial here in the U.S., but an active trial going on right now in Africa looking at different solutions that may help us, you know, bring a solution to that market as well. Got it. And this is prescription required? I mean, if I'm, okay, it is.

We take a prescription from your physician. That comes into our leave of women's center. We work with your insurance to see if you have coverage and then work through the payments. And then if it's, it is through insurance, it's given to a distributor where that's fulfilled. Or if it's self-pay, we ship it right to the patient and off they go. And then, again, monitoring and looking for compliance and helping patients through that and bringing this information back to doctors to close that loop. Got it. Got it.

Super helpful. Yeah. And I like the name Leva. Certainly a good name for this sort of clinical area for sure. All right. With that said, let's maybe spend the next 20 minutes kind of covering some topics, largely maybe based on your kind of broad experiences in MedTAC. And feel free to kind of frame these around kind of what you're doing at Zina and Leva as well.

But first question on the docket is really kind of focused more on what I would consider kind of your wheelhouses, right, which is, which is, you know, commercial. And so when you think about whether it's key learnings from Silk Road or other learnings that you brought to that you're bringing to the table, Randy, when you think about building a market like this, right, like what you're doing with Lena and commercializing products, for those kind of startup founders or CEOs that have, don't really have a lot of swings at the plate here, right? They maybe have a little bit of experience, but they've never really done this or owned it for the first time. Are there, you know, one or two things that really come to mind that, that either,

you're doing now with Liva or maybe that you think are, you know, every, you know, startup CEO or founder really needs to get right in order to see a successful kind of commercial launch. I think focus becomes critical, right? I mean, there are many shiny objects that come at you, especially as you get into the clinical and the commercial stage of a company and having a clear, you know, vision of who you're trying to help, right? So you always have this patient at the center, who are the people that then impact them and control the decision making and make sure you get to them? And then it's a matter of very consistent execution, right? And that's, and I say consistent because you ultimately have to find what is that flow. And that I, you know, I always

refer to the funnel flow. What does it take to get people into the funnel and get them all the way through? And once you have that well quantified, then it's a just, it's a math story of how quickly you can move. And, you know, when you're speaking to investors, and I know we'll get into that. But it's really how well do you understand that cycle? Is it repeatable? And if it's not, keep working until it is. And at that point, then it's a sprint and just go and make it happen. To me, it's just that clear. And find that way. And that focus just gives you the opportunity to bring people along with you as well. Yeah, Scott, I completely echo that, although I want to, I confess, we did not compare notes, but it's shocking how similar my comments are going to be, which is 100%

agree with you, Randy, find a beachhead, really be focused on where can we land first and expand from there. And what I mean by that is a defined market segment where you can go to the clinician and you can say, it's not every single patient in your practice with urinary incontinence. That's too big for customers to think about. Let me focus you in on this very specific clinical profile. That's doctor where I want you to start. And I think where startups get, you know, get sideways is they try to boil the ocean. First of all, they're looking for indication expansion right out of the gate. They're looking for, you know, other markets. They want to expand the TAM. Everyone tells them you got to have a giant TAM. So I'm going to, you know, go after all these other things and I'm going to burn through

capital while I'm doing that. So that singular focus that Randy talked about is so important. And then the only thing I would add there is build the clinical evidence and publications, which Xena has done. beautifully. Be relentless about outcomes, which is another reason to focus in your efforts on a certain patient population. Be relentless about outcomes with a patient-first mentality and everything that you do and publish good outcomes. Those are really good thoughts. The two things that kind of, I heard, were find the beachhead, right, narrow in on a segment, right? And define sort of a process, right? And with the goal being, it's repeatable. I think those are really really, really two crucial things. With respect to Liva, I guess, the first thing that kind of comes to mind

as we think about commercialization is like you could approach a sort of a top of funnel going direct to patient potentially, right? But you've also, you know, this prescription device and you're obviously, your loop very much involves physicians. So how are you thinking about that? And maybe maybe frame that up for other maybe startup founders or CEOs that are kind of, you know, have a unique opportunity, right, where you can kind of pursue both. Yeah. I mean, look, first of all, again, is back to the focus area, right? For me, that that, that, that, that, prescriber becomes the gatekeeper in most senses. And frankly, it can be the very big advocate and help move this forward and engage people. Certainly, there are opportunities to engage patients.

But I think one of the big failings, especially in the med space, is if you activate physicians and you have not brought the clinicians into the partnership already, it's not going anywhere. Because a patient that walks into a doctor that has no idea what that patient is asking them about their first reaction is always no and usually fairly fairly visceral right i mean in most situations you have to have the health care community understanding what we're talking about how it works and that for us in the future yes activating more patients but right now we're still working on bringing those doctors into the tent and you know making sure they understand all the benefits how it works and that they can they can bring it to their patients first doctors they like to they like to bring

things to patients that help them. I mean, this is, this is not a thing for the socials, right? I mean, if a patient walks into their doctor's office, is, hey, I saw this thing on social media, the first thing that physician is going to say, I've never heard of it, it's not backed by clinical evidence, it's junk, they're all junk. So Randy's right, you know, this is about pull through from clinicians. I'd be the first one to say that, like, I inherently have a bias, right, towards, you know, D to C, especially when it comes to, like, health products where it makes sense. But to your point, if you're commercializing, if you've built a device that either requires prescription or requires active participation from a clinician or a physician, you could end up

in a very bad scenario where you allocate a tremendous amount of resources, right, towards awareness, only for that end user to go to their physician and it just gets squashed, right? All of that interest just gets squashed because the physician has no idea what it is, they have no idea what the evidence around it is, et cetera. So really good points. And even circling back around to something you said earlier, Erica, about finding that beach head or find that. segment. It kind of reminds me of like, you know, any, any copywriter, like a really good copywriter always tell you, don't write for everyone, right? Write for one specific person, right? One avatar. And it kind of sounds like, you know, when you think about finding that ideal segment or that

beach head, you know, to your point, Erica, find that one patient population, right, that you really want to focus on, right, where the clinical evidence ladders up and start there, right? So really, really good thoughts. I don't know for the sake of time, I want to get to a couple other topics. But let's move to fundraising. You know, Randy, you mentioned kind of one of your first gigs after Roche gave you the opportunity to kind of fundraise really for the first time. And, you know, how that laddered up to kind of board engagement. Eric, obviously, you've raised a lot of capital over the years and are involved in a number of board.

So fundraising from my perspective, I think any startup founder or CEO will tell you this might be the single biggest thing, right? There's a big, you know, challenging thing, especially coming off several years. Maybe I was going to say two to three, but really for the past feels like decade almost. It's been pretty challenging in MedTech to raise capital. So on this topic, you could probably spend a whole hour talking about fundraising and intricacies of it. But are there a few things that come to mind that you think, you know, I know this now, right? I wish I knew it, you know, 10 years ago, right? Or five years ago.

Are there points like that when it comes to fundraising that you think are especially helpful? Yeah, look, I think, first of all, let's talk about why we're raising capital in the first place. And I think, you know, folks get distracted on what we're doing with a capital raise. And it's really to achieve a meaningful and timely milestone. And I think metering out these milestones and understanding how value is created. So we're raising 10 million and we're going to do X, Y, and Z with that 10 million, and the company will have more value when we're finished, right? So it's being very clear on what those milestones are. And then recognizing that things are always harder and they always take longer than even your best model predicts. So raise enough money to weather the storms. Raise more than you

think you need to. And then finally, you know, don't get greedy. I think founders and early CEOs, they all balled up in the terms of the deal. And here's my perspective after raising literally hundreds of millions of dollars in my career, if you include all the public company raises. And what I can tell you is that the terms come out in the wash. If you're hugely successful and you meet those milestones and you build real value, you will make money, your shareholders will make money. So don't get greedy over the terms. Focus instead on the runway. I think that's absolutely it. It's that very clear, concise story about what you're trying to achieve and how it benefits all the stakeholders, which includes the financial stakeholders, right? Investors want to be a part

of doing good, right? I mean, and making a difference. And so you can't walk away from your primary story and focus just on the numbers, it is around that mission that you have. And I think the interesting thing that you run into, as Erica said, right, you know, and you're positioning the story, it's fun when you're talking to your current investors, right? They always tell you your numbers are too low. And then you go out into the market and the investors tell you those numbers are way too high, right? And it's discounted.

So it's this dichotomy of which investors you're also dealing with. And the story needs to hold for all of them. and ultimately what has the most success is a history of success. They are investing in a history, whether what's in this company, and then the people that are there that have done it elsewhere, right? So it's being able to point to that. And that's back to creating those repeatable processes that you can say that this financial plan is built on these very repeatable experiences.

You guys are familiar, David Sachs and Kraft Ventures. He, I think, is notorious for not really taking a pitch unless you have got a product, in essence, right? That's kind of what he wants to see in a pitch. Sometimes hard to do in MetTech, right? You mean, I have a very pretty looking product, right, at early stage. But to your point, Randy, if you can demonstrate something, right, some sort of milestone or milestones that you've achieved, right, that you've been able to kind of prove it, I did this,

we did this, with this amount of capital. Now we're raising this amount of capital to do this, X, Y, and Z. So, so crucial. It's like probably one of the key things that I've learned, right? Even over the past, whatever, three or four years is like that's so, so crucial to have that story nailed around what you. you've done and then, you know, where you're going with this amount of money. And I think even better, what you said you were going to do. Yeah. You've done. And then what you're going to do and then

prove it again, right? And that's where current investors become so important to future investors. We came in for these reasons. We've done that. And now we're looking forward to this and we want to bring other people into the party. Such good points. There's a few early stage companies that I'm invested in. But I'm sure you guys have not only a fair amount of investing yourself, but just know the other founders and CEOs that don't actively communicate, right? with their current investors, or it's very sporadic, or there's no sort of consistent cadence. And that's one of the things I always encourage.

It's like, you gotta have that honed in, right? Because if you're, if you sit like one email to your investors, right, about what you've done, and then you're asked, you're to ask them for more money. It's like, maybe you've got a shot at raising it, but they're gonna have all kinds of questions, right? Because you just weren't very good at like actively and proactively communicating kind of what you're up to,

wins, losses, et cetera. And then I don't, I just don't understand why people don't do that. I couldn't agree more. I think one of the very important things for me, every year, it's what are your key business results, right? We just had our board meeting yesterday. We've well aligned on what are we measuring. And then it's a monthly scorecard, right? And that goes to the whole company, you know, because I want everyone to know what we're doing.

And if you're doing it, is it impacting one of these. But at the same time, this now becomes my tool to come to my board just on a monthly basis with an update. Here's our key business results. Here's where we are. And we actually do it in this with, I mean, I do it with stoplights. and then you have just here's why we're green or here's why we're red or yellow and what we're doing right so it's that just that consistency of performance based on a great two metrics yeah i always tell founders and early stage CEOs like there should be no surprises at the board meeting the board meeting

everyone comes in there knowing basically everything about your business already which means you're communicating consistently and often with your investors and your board members and it's such a good exercise too so if you're listening to this and you're maybe just raised a pre-seed round or a seed round and you don't have maybe a sophisticated board yet and whatnot. But like that exercise of doing monthly or, you know, semi, you know, twice a quarter updates, it's such a good internal exercise to think about kind of like what did we commit to, like over the past month.

What did we actually achieve? It's like it's not wasted work, you know, even if you technically don't have to do it or your investors aren't asking you to do it or your board isn't asking you to do it. It's such a good, good practice, right, to instill for maybe, you know, your Series A and as things get a little bit more sophisticated, you know, down the road, you've already got that practice sort of like honed, you know, as a company. You just have to be careful not to take for granted any of your key stakeholders.

We're all very intentional about having our town hall meetings to bring the whole company up to speed and sharing what's going on. Well, our board and our investors are part of that community as well. And if we're not regularly giving them the picture, they can paint their own. That can also be dangerous. Yeah. Yeah. And I'll just, you know, finally on this topic, which is keep in mind that these investors, are involved in dozens of companies.

And we think that we're the star of the show, and they're going to remember every last detail about our company every minute. And you'll be surprised how you have an investor who's been around the table for five years, and they literally forget where you are in your journey, what's been accomplished. And so, you know, never assume

that these investors know anything about your company and start from the beginning and be careful and thoughtful when you're talking about. Yeah, such a good reminder. I mean, quite honestly, even for myself, because, like, as an operator, you're, you're so in the weeds, right? And you felt like, I've already said this five times right to this person. How are they asking me for it again? But it's such a good framework just to kind of level set. Like, this person has not been thinking

about this day and a day and day like I have, right? But their opinion is still matters and their advice still matters and their feedback is likely going to be important. So that's a really helpful framework. Hey there, Scott. And thanks for listening in so far. The rest of this conversation is only available via our private podcast for MedSider Premium Members. If you're not a premium member yet, you should definitely consider signing up. Here's why. First, Medsider Premium members get access to every single interview dating back to 2010. That's over 200 episodes packed with expert insights from proven founders and CEOs. Second, premium members also get free access to Medsider Playbooks. These are thematic collections of hard-won insights covering topics like

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