Feb 27, 2023

Noah Schwartz - Monday, February 27th, 2023 Many health systems are dipping their toes into venture capital investments, and Ballad Health is no exception. The Johnson City, Tenn.-based health system maintains a sizable venture arm and has invested in a diverse array of healthcare companies. To learn more about Ballad Ventures' strategy and healthcare VC investment, Becker's reached out to Bo Wilkes, the president of Ballad Ventures. Question: What is Ballad's 2023 investment strategy? Bo Wilkes: Like any other corporate venture capital, we're trying to produce a financial return on investment for the organization going forward. But as we think about our investment strategy, it starts with the workforce. The challenges that are going on within the industry are a big component. So how do we begin to solve some of the challenges we have from a workforce component — that could be data and analytics, artificial intelligence, digital care — there's just a number of different opportunities that that opens up there. Elsewhere, we are focusing on the digital front door, specifically cybersecurity. We just made that investment in Censinet. We are always looking into the internet of things space and being able to protect that. Then we have strategic service lines and growth from our perspective. So thinking about things like oncology, pharmacy, pediatrics and maternal health are some of the other focus areas. We want to make sure that our investment strategy has very strong ties to what we're trying to do strategically. As a rural provider in Appalachia, how do we support the system and continue to grow the system and thoughtful way to impact our patients and clinicians? Q: How are you approaching investments in artificial intelligence technology? BW: I think chatbots have been around for some time; look at Hyro and some others in the market. We're looking down into that strategy. We want to be supportive of that strategy, but it's also going to be a good investment and we just haven't found the right opportunity there. I think they need to be thoughtful and strategic and what we're doing, I think it's only going to grow. So one of our efforts early this year, myself and our managing partner, John Perez, have already started to dig in to understand just even more about the space and what's gonna come out. I think ChatGPT is an evolution of chatbots. We just need to continue to stay smarter and stay on top of it on how we're going to support those metrics. Q: How are you handling your investments during a period of economic uncertainty? BW: No doubt there have been challenges for the industry and for our health system. We're not unique here. So we want to be very supportive and accretive to what we're doing at Ballad Health. Luckily, our board and our management team are continuing to be very supportive of what it is we're doing. It's trying to produce financial ROI, but also getting that operational ROI. How can we be thoughtful in our investments to support our strategic initiatives? Because then you can almost double dip. The other thing that I'll say that we're doing from with economic uncertainty, we're really trying to partner closely with other corporate venture capital entities. Look at our investment in TailorMed. University Hospital Ventures, OSF Ventures and Providence Ventures were already on the cap table. You look at what we just did with Censinet, leading the charge there. I think, as you look at that economic uncertainty as we have invested alongside other strategic partners, we can somewhat deleverage to the best extent that we can. Even though it's still venture capital, there's still a lot of risk there, but we can deleverage the risk to a certain extent, by investing with our peer institutions to ultimately try to transform and improve care. Q: Do you try to focus on seed and early-stage investments? BW: It runs the gamut; we try to balance our portfolio from seed all the way to an early series B. I would say we write checks of an average size $750,000 to $1 million. So understanding where we sit, moving to the seed stage gives us more of that financial upside potentially, but it also brings along risk. I think from a seed perspective, you are thinking of the first contract, maybe the first couple of contracts. That's where we can really lean in and be a co-developer or a strong partner there to help them continue to refine and develop. We want it to be very aligned with what our stakeholders are already working on. I think back to some of the things we're doing in pharmacy with TailorMed, we already had 14 full-time equivalents working on a massive medication assistance program. TailorMed now allows us to take that program to the next level. We support our investment but we're also getting strong operational buy-in and support. Q: Are you worried about the drop-off in digital health financing, after the COVID-19 era explosion in funding for digital health companies? BW: Absolutely. I think the multiples and everything through 2021 and early 2022 got out of hand. We actually pulled back during that time just because we couldn't make our numbers work as far as investments were concerned. We really doubled down on our portfolio. Now that things have been reset, there's a new landscape and I think strategic investors have a leg up to really lean in, as capital is probably going to dry up a little bit in 2023. Yes, it concerns me a little bit, but I think we are well positioned. We have been able to get in on some favorable terms for later series A or early series B companies. That has been very beneficial for us. It is about working with our CEOs to make sure that valuations are in line with expectations. That's been a little bit of a challenge not only for us as board members and the portfolio companies that we're working with but also for the founders. It's a really interesting time. I think everything's kind of coming back down to the level set. We're going to start to see more normalization moving forward. Q: Does being attached to a rural health system give you a different investment strategy? BW: It's definitely a different perspective. I think you could look at it as either a challenge or an opportunity. As an opportunity, we want to become a leader in rural health innovation. That's the reason we've set up an innovation center and began to build a lot of things with East Tennessee State University. As you look at ventures, we have different challenges to access. We have different challenges to population health management, we have different challenges to specialty and subspecialty services. With that comes an opportunity, and I think it just presents itself nicely to be able to lean into that and leverage that unique aspect. A model that works in your city or Nashville or Chicago, or wherever it may be, is going to look very different than what it's gonna look like in Johnson City, Tennessee. There's still a large part of rural America that's underserved. So ensuring that we have access to quality, affordable care is huge. We think we are well positioned to be a leader in that space.