Venture Capital Coast to Coast – February 2019

VC WATCH

• Early 2019 Continues 2018 Record Pace
• Technology Convergence = Rx + Dx
• 2018 Stats and Trends
• Takeaways and 2019 Outlook

VC PLAYERS

• Life Science VCs Close Outsized Series A Rounds and Early Therapeutics IPOs
• Big Pharma Doubling Down on Oncology
• Foreign Investment in U.S. Healthcare: China

VC HUBS

• Healthcare and Middle America — Think Pittsburgh, Nashville and University Research Hospital Towns

VC VERTICALS

•  Healthcare Industry Challenges = VC Investment Opportunities

VC TIPS

• What Healthcare Entrepreneurs Might (Should) Learn from Investors

VC WATCH

Early 2019 Continues 2018 Record Pace

January 2019 saw the highest January venture capital (VC) investment in healthcare and life sciences startups on record since Pitchbook began tracking funding in 2008. And this month is just as impressive. While outsized Series A rounds (several followed by quick IPOs) grabbed the 2018 headlines, more traditional Series B to F rounds are getting closed in early 2019. 

• Oncology -genetic disease drug platform BridgeBio (Palo Alto) topped January fundraising, with close to $300 million from a consortium of existing private equity fund and other crossover investors.
• Kalamazoo (Michigan) raised a $77 million Series D while still in clinical trials for its hypertension-reducing catheter device.
• Digital therapeutics startup Pear Therapeutics (Boston) closed its Series C for $64 million.
• Health Catalyst (Salt Lake City), whose hospital software links data for tracking insurance, patient satisfaction and electronic health records, just raised $100 million in debt and Series F equity financing from OrbiMed and incumbent investors which include a top private equity fund, university medical center, and national health managed care consortium.
• KenSci (Seattle), an AI-enabled healthcare predictions startup, raised $22 million from an existing group of venture capital funds.
• CathWorks, which developed non-invasive technology for imaging of arteries during angiography, recently announced the completion of a $30 million Series C financing round led by life sciences fund Deerfield Management.
• Despite talk about whether the strong 2018 IPO market can continue, Avedro, which sells ophthalmic medical systems used for treating corneal disorders, announced terms for its $75 million IPO.

Even though it is a non-correlated investment class, VC investment always surges in a hot IPO market. And notwithstanding the government shutdown and stock market swings, many commentators expect the IPO pipeline will remain open for now. But more bullish observers warn that such a frothy market needs a break at some point.Regardless, stock market and macro-economic volatility are not likely to stop the healthcare VC train, and may only cause a shift of VC dollars to smaller, earlier rounds from specialist healthcare VCs. After all, healthcare is a defensive investment sector that can withstand whatever Wall Street swings (and any narrowing IPO window), Washington, D.C., gridlock and even an economic downturn may serve up. And savvy VC investors seize VC opportunities in down public markets characterized by less competition and more reasonable valuations.

Sources: Healthcare Venture Capital Funding is off to a Record Start in 2019, www.forbes.com/sites/michelatindera/2019/02/05/healthcare-venture-capital-funding-is-already-off-to-a-record-start-in-2019 (“Forbes”); Experts Predict Strong 2019 For IPOs Amid Gov’t Uncertainty, www.law360.com/articles/1125711; www.forbes.com/sites/michelatindera/2019/02/07/cloud-unicorn-health-catalyst-reaches-1-billion-valuation-sifting-through-hospitals-data/#2027260048e0.

Technology Convergence = Rx + Dx

“Biotech” used to mean life sciences, more lab biology than digital or efficiency-enhancing technology, and more about the preclinical, clinical and regulatory gauntlet of proving drugs and devices. It was the darling of, and perhaps the reason for, the development of the VC investment model and ecosystem, well before the internet, software and healthcare IT. Today, in the innovation economy, technologies conceived not only in medical schools, but in computer science and engineering schools, have expanded biotech beyond the pure science of drug and device development to technology-enabled solutions that make the discovery, testing, approval and delivery of, and diagnosis of indications for, drugs, medical devices and therapies more cost-effective and patient-effective. Data, AI, robotics, smart machines, IoT and mobility are making healthcare IT and software yesterday’s news. And this convergence of technology and healthcare has attracted non-traditional investors to VC, including traditional technology players and opportunistic “crossover” investors such as hedge funds, family offices, foundations, sovereign wealth funds and public-minded and new direct-investing pension funds.

Source: “Health IoT will drive digital health market to $535B by 2025,” Tech Republic, www.techrepublic.com/article/health-iot-will-drive-digital-health-market-to-537b-by-2025 (focusing on the increased use of smartphones, laptops, and tablets by healthcare providers).

2018 Stats and Trends

• U.S. VC investment reached $130.9 billion in 2018 (surpassing the 2000 all-time high).
• U.S. healthcare VC (including biopharma, healthcare IT and AI-enabled solutions for diagnostics, delivery and testing, or “Dx”) exceeded a record $13 billion (biopharma, $6.4 billion; Dx $4.4 billion; and medical device, $2.5 billion).
• Biopharma oncology and drug development platform deals led the way, but Dx (tools and testing), devices and surgical robotics continued strong growth trends.
• The trend of fewer but larger (mega or $50+ million) deals continued, fueled by healthy IPO and M&A exit activity, although seed and early-stage (pre-Series B) deals were strong — Moderna Therapeutics (biotech/analytics) raised $300 million in VC, then closed the largest IPO on record at $604 million.
• Total biopharma IPO value set its own record (70 percent of total exit value) and M&A exits remained steady. Oncology also dominated exits, although platform company exits also increased.
• U.S. healthcare VC fundraising responded, reaching a record $9.8 billion.
• Biopharma Series A deals almost doubled to $4.1 billion, driven by the inflated size of seed and Series A rounds (some of which were followed by early IPOs).
• Non-healthcare/traditional technology fund investors dominated Dx investment and fueled the mega-round environment, causing a likely-temporary decline in corporate VC investment.
• Investor migration was twofold: (1) tech funds continued moving into healthcare where their domain experience allows them to understand the technology, and (2) crossover investors like hedge funds, sovereign wealth funds, pension plans and public-minded institutional investors moved into late-stage VC to grab soon-to-be-public healthcare stakes.

Sources: Silicon Valley Bank, Trends in Healthcare Investments and Exits 2019 (“Silicon Valley Bank Report”); money.usnews.com/investing/stock-market-news/slideshows/9-sectors-that-investors-should-watch-in-2019.

Takeaways and 2019 Outlook

• Biotech companies took a “dual path” exit approach, either raising larger dollars and going public, or raising smaller dollars and pursuing an early M&A exit.
• Commentators generally expect 2018 trends to continue (fundraising and investment), albeit with some normalizing and acknowledging the potential adverse impacts of continued stock market volatility or an economic downturn.
• Technology buyers may increasingly acquire early-stage Dx tools and analytics companies, and biopharma M&A may increase if the IPO window starts to close.
• Any cooling of the IPO market may shift VC dollars to earlier-stage opportunities and cause crossover investors to pull back, but the demand for Rx and Dx solutions and available capital should nonetheless support VC investment and healthcare M&A.

VC PLAYERS

Life Science VCs Close Outsized Series A Rounds and Early Therapeutics IPOs

• Third Rock Ventures invested $58.5 million in Casma Therapeutics’ Series A.
• Atlas Venture launched Generation Bio with a $25 million Series A investment, and a $100 million Series B quickly followed.
• OrbiMed funded 89Bio’s Series A with $60 million.
• Allogene Therapeutics (engineered cell therapies) and Grail (data analytics-driven oncology blood test) each raised $300 million rounds, and Allogene went public.

Sources: MedCity News, Breaking Media, Inc. medcitynews.com/2018/11/life-sciences-vc-investment-trends-similar-to-tech-but-there-are-differences (“MedCity News”); Forbes, infra; PitchBook and National Venture Capital Association, nvca.org/pressreleases/us-venture-capital-investment-reached-130-9-billion-2018-surpassing-dot-com-era/#130-9-billion-2018.

Big Pharma Doubling Down on Oncology

• Pfizer Inc. (along with Bristol-Myers Squibb Co., Eli Lilly & Co., and other big pharmas) is making a big push into cancer-treating drugs. In fact, Pfizer is expected, for the first time in 2019, to make cancer treatment the biggest portion of its drug revenue, through internal development and acquisitions.
• Pfizer also announced it was increasing its VC arm pool by $600 million.

Sources: Wall Street Journal, Pfizer Delves Deeper Into Cancer Drugs, Monday, January 28, 2019, B1; Barron’s, Pricing Pressure a Hard Pill for Pharma to Swallow, February 4, 2019, p. 15.

Foreign Investment in U.S. Healthcare: China

• Chinese and other Asian investors such as Taiho Ventures (the VC arm of drug-maker Taiho Pharmaceutical) significantly increased their activity in the U.S. life sciences sector in 2018.
• Observers question whether the Committee on Foreign Investment in the United States (CFIUS) will put the chill on Chinese biotech investment in the U.S.

Sources: Silicon Valley Bank Report, infra; MedCity News, infra; Forbes, infra.

VC HUBS

Healthcare and Middle America — Think Pittsburgh, Nashville and University Research Hospital Towns

• The migration of healthcare entrepreneurs and investors from Boston, California and New York continues its slow trend. Quality of life for talent, proximity to university research and incubators, and a desire for differentiation from competitive VC fundraising hubs appear to be the main drivers.
• Pennsylvania, with Pittsburgh being a formidable biotech (and hospital research) ecosystem, had 15 biopharma deals in 2019 bringing in $721 million, and seven Dx deals totaling $36 million.
• Minnesota (home to several large health systems) had 12 medical device deals totaling $217 million.
• Healthcare startups continue to look to a true healthcare hub — Nashville, Tennessee, which is anchored by some 18 publicly traded healthcare systems.
• We have featured university towns like Austin, Texas, and Charlottesville, Virginia, in prior editions of “Venture Capital Coast-to-Coast,” highlighting the growth of incubators, local angel investors and tech talent in these mini-VC ecosystems.

Sources: Silicon Valley Bank Report, infra; Venture Capital Journal, The Big Advantage Middle America Offers Innovators: Time, Buyouts Insider, www.pehub.com/vc-journal.

VC VERTICALS

Healthcare Industry Challenges = VC Investment Opportunities

VC investing in general, and life sciences investing in particular, have historically been characterized by high development risk, high R&D spend and a long gauntlet of preclinical, clinical, and regulatory and commercial milestones. Today, the politics and pain of skyrocketing healthcare (and drug) costs and the uncertainty around reimbursements and FDA approval of (and new risks inherent in) rapidly evolving technologies providing interoperability and data analytics demand disruptive technology solutions and public-private cooperation and collaboration. These unique challenges within healthcare are driving its convergence with digital technologies, including information technologies, data analytics, artificial intelligence, robotics and even telemedicine. This convergence is driving healthcare’s dominance in VC, where investors look for outsized returns from tech-enabled products and services serving significant needs in large markets.

VC TIPS

What Healthcare Entrepreneurs Might (Should) Learn from Investors

• “Every Company is a Tech Company.” The Carlyle Group’s CEO, Kewsong Lee, recently said, “Every deal is a tech deal.” As with energy, food, manufacturing, transportation and other core investment sectors, technology is not only changing the way healthcare solutions are assessed, developed and delivered, it is also expanding the universe of VC investors in the healthcare sector. (See www.pehub.com/buyouts, Carlyle’s Kewsong Lee: “Every deal is a tech deal,” January 22, 2019.) Technology “generalist” funds and strategic technology-company investors are moving downstream to healthcare VC deals. So life-science-specialists funds and big pharma VC arms have more competition.
• Healthcare VC’s Resilience. The demand for healthcare innovation and solutions and even healthcare’s financial and regulatory headwinds will continue healthcare’s dominance in VC fundraising and investment. While alternative and crossover investors focus on larger Series A-to-IPO scenarios and unicorns, the ecosystem for smaller and earlier-stage VC investments by life sciences funds and impact investors (angels, family offices, incubators, foundations and corporate VCs) appears strong, and may even benefit from stock market declines and lower valuations. Seasoned technology and life science investors now understand the benefit of earlier, smaller investments providing more control over the uncertainties of economic and regulatory hurdles and cycles. They understand that innovation and game-changing technologies (and data and AI), and proactive communication with industry partners, insurers and regulators, will more effectively mitigate risks and enhance potential returns.
• A Roadmap for Healthcare Startups and VCs. The challenges of healthcare investing, particularly in the higher-risk and potentially higher-return sectors of biopharma and digital technology solutions, reveal a roadmap for creating the best companies for attracting VC investment. Greg Dombal, COO of Halloran Consulting Group, recently made the following compelling observations: Early investments in biotech companies will allow investors to derisk the investment process by releasing money in small tranches. Leveraging preclinical and clinical trial data will enhance investor due diligence and visibility into the risks and potential returns associated with particular health products, solutions and technologies. Mapping out a regulatory pathway and “increasing touchpoints” with biotech consultants and regulatory bodies such as the FDA will minimize investment losses and increase success in early-stage investments.
• Early investments in biotech companies will allow investors to derisk the investment process by releasing money in small tranches.
• Leveraging preclinical and clinical trial data will enhance investor due diligence and visibility into the risks and potential returns associated with particular health products, solutions and technologies.
• Mapping out a regulatory pathway and “increasing touchpoints” with biotech consultants and regulatory bodies such as the FDA will minimize investment losses and increase success in early-stage investments.

Sources: R&D Magazine, www.rdmag.com/article/2018/05/three-ways-venture-capital-firms-maximize-their-biotech-investments; Navigating the Life Sciences Fund Landscape, commercial.jpmorganchase.com/pages/commercial-banking/industry-expertise.

Even when the currently hot market for healthcare VC investment cools, innovative startups that can identify the right early-stage VC investors, leverage technology and data, and develop a flexible roadmap for product development and company exit will continue to get funded. Choosing the right investors for the right stage of company development and the desired exit will optimize returns for founders and investors alike. Healthcare startups must also align themselves with dependable technology solution providers (e.g., proven, legally compliant and data-secured platforms), VC funding sources providing not just money but strategic direction and industry connections, and legal, accounting and technology advisers that understand the new regulatory and legal challenges presented by innovation.