Good afternoon, everybody. The signage here behind me, I think, is probably from a previous panel, but I want to welcome everyone to a panel entitled Investing in Cardiovascular Innovations, What Does the Future Hold? I'm not sure if we can get the slides adjusted for us, but we have a very distinguished panel here today. We'd like to make sure that we have an opportunity to get to audience questions here, so feel free to send questions in via the iPad or the app. We will pause to take a break to see if there are any questions in the audience. Do ask that you raise your hand and wait for a mic to ensure that folks are able to hear you. We kind of have three objectives for this panel. Our hope is that people can walk out of here with a view of what it takes to get funding right now, what are some of the best practices in aligning financing strategy with your overall corporate strategy, and a clear view of what investors and strategists are looking for when it comes to exits right now. I'll start by introducing myself. My name is David Roman. I lead medical technology and healthcare IT research for Goldman Sachs, and I'm joined by Stephen Flame, who's a senior special advisor and investor in residence to the Office of Innovation and Commercialization at the National Heart, Lung, and Blood Institute of the NIH. Dr. Flame is also an entrepreneur in residence with the Small Business Education and Entrepreneurial Development Office in the Office of the Director of the NIH and Emeritus Director of the Angel Capital Association. Daniel Gottlieb is the director of MedTech Portfolio Broadview Ventures and is a board observer on several companies, including CardioSense, 12 Medical, CreValve, and Nira Medical. David Kim is a managing director of Digitex Partners. Dr. Kim is a former clinician and a venture investor with two decades of healthcare investment experience now focused on digital health. Giovanni Leo joins us as a partner of Lake Geneva Ventures, a VC fund focused on early stage startups. Prior to entering VC, Giovanni held a number of leadership positions across MedTech with many companies that you probably have worked with in the past, including EndoSense, which was acquired by St. Jude Medical. He's currently on the board of a number of startups, including Hylamorph, EBA Med, Medura, Anaconda, and Terrapit. Charity Tarn joins us from Arboretum Ventures, which invests across healthcare. Prior to Arboretum, Charity was a senior manager of Medtronics Corporate Development, where she executed M&A transactions across all portfolios and led enterprise-wide strategic initiatives. And lastly, Catherine Zavala, who is the chief operating officer of MedTech Innovator, the largest accelerator of medical devices in the world. To date, MedTech Innovator has supported over 600 alumni that have gone on to raise over $8 billion in follow-on equity funding and brought over 350 products to market. So thank you all for joining us today. And why don't we kick off here with sort of a macro-level question here. I want to start by level setting for the audience the current market landscape. And I think, Daniel, it would be helpful for you to talk us through. We continue to hear the generic language that the funding environment is really challenging right now. Can you give us a little bit more context of what does it actually mean in practical terms? Yeah. Sure. Can everyone hear me? We're good? Okay. Thank you. Yeah. Just to give some context, I'm with Broadview Ventures. We typically invest in seed and series A financing usually to support late preclinical or early clinical activities. And then we have a follow-on fund called Longview Ventures to do follow-on financings, B and C rounds. So from our perspective, there's a lot of great companies out there. We see a lot of interesting technologies, great entrepreneurs. That obviously creates competition for our dollars and others. And we also do notice that some of the other investors are a little more reticent now because the amount of time and money to get a company to exit is long. It's getting more expensive. Companies are going to have to go through pivotal studies, potentially FDA approval, potentially commercialization before an exit. And so we see that definitely early stage where investors are a bit more skeptical and I think even more so in our follow-on financings where for B and C rounds, companies are having more and more challenges raising the larger rounds to fund pivotal studies, to fund commercialization. Practically what that means is when we're looking at companies, we're focused on budget and milestones. What are companies going to achieve? How much is it going to cost? Even earlier than we have I think before, thinking about regulatory path and reimbursement to understand really what is the long-term path a company is going to have to go through to get to an exit, to think about what follow-on financings are going to be required. And that affects what kind of valuations we think are appropriate at even an early stage. And we know that a lot of our co-investors will look for strategic interest in understanding how the strategic is looking at a technology even at an early stage. So getting that feedback, those relationships with strategics is I think becoming more important. I think we're perhaps a little bit less sensitive to that because of our focus on cardiovascular. We know that a lot of investors really do anchor to show us what strategics are thinking about the category, about the specific technology itself. So you've laid out a lot of criteria. It's probably a good thing for a lot of us that we stand between everyone and happy hour because I want people to hopefully leave this session encouraged about the future. But as you think about all of those characteristics, maybe, Catherine, you could help us understand what are some of the qualities or characteristics or defining elements of companies right now that investors are looking for and how has that criteria you've seen change over the past several years? Yeah. So let me give you a little background on MedTech Innovator. So we're a nonprofit accelerator. As David said in our intro, we've supported over 600 companies. And what makes us really differentiated in this space is the dialogue we have with strategic partners, investors, and other stakeholders. And to answer your question, you know, the companies that I see be successful are the ones who understand the game, which is de-risking, right? And that means different things for different people. So when you talk to FDA, it means one thing, investors, it means another thing, strategics. And the companies that are constantly checking in with their stakeholders and understanding what milestones, what evidence they want to see in order to meet certain checkpoints, those are the companies that are going to be successful. And then, of course, you know, you need your typical startup characteristics, obviously, the team, you know, is it the right team for right now? Are they solving a real unmet need and is it an unmet need that people are willing to pay for? Maybe I want to follow up on that, I'm a little off script for a second here. As I listened to kind of what you and Daniel just talked about, it sounds like companies have to be rigorously focused. And you're trying to balance this dynamic of, quote, make the cash last, but also demonstrate enough milestones that you reach a point of de-risking. So how have you seen companies or entrepreneurs adapt to really rigorous and judicious prioritization and what are some of the best practices you've seen employed to be able to really identify with sense of urgency what matters? You brought up, and I think this will come up a little bit later, about what has changed. And I think the goalpost of what a startup needs to exit has definitely changed. I think some decade ago, you know, obviously regulatory, if you've got your device cleared or approved, someone's going to scoop you up. That's no longer the case. You have to know who's going to pay for it and actually show evidence of people paying for it. And I think the companies that are doing both things, achieving their regulatory strategy and also reimbursement at the same time, can make their cash go a little bit further. That's really helpful. And maybe Jeevani, we could shift to you for a second here. Going one step farther than this, how have the expectations shifted amongst investors as it relates to progress when it comes to financing? And maybe more specifically, what types of milestones are investors seeing to justify investments at different stages of a business's operational lifecycle? Well, we do invest in early stage companies. And what we have seen is that definitely the requirements are going up. So what was before asked to companies, now there is a shift. And to be a little bit more explicit, for example, when we talk about the acquisition of the company, what we know is that the strategists, they want to see traction for the product. While before, if the project was interesting, it was good enough and they could imagine that traction would be there. Now they need proof of traction. When we speak about a product, we can think that the product is useful. But if we want to invest in this company, we wanted to have the QL opinion and we want really to have a lot of QLs. So the majority of the QL to like the product, to be able to believe in the product. When we talk about a regulatory, we don't want just to know if it will be approved, but what is the regulatory path and how expensive it will be, how many patients we will have. So all this milestone, they require much more precise and also more data compared to before. So maybe just to pull the thread there for a second, as I listened to that, it sounds like you just need a lot more money earlier. Is that not a fair takeaway from what you just laid out? I would say that for the really early stage, it doesn't change a lot in the sense that you need to have a good idea and a good team. People is extremely important, but it's absolutely true that when you start developing the company, you need to have more resources to prove all what it is being asked, both by investors at the early stage and by the strategists or the acquirer when the company exits. So one of the things that's been super interesting, if you look at some of the third party data, and I think actually one of the best sources of this is SVB does their mid-year and annual funding report. And if you look at some of the data out there, while later stage financings have been challenging, earlier stage has been less challenging. So I don't want to go as early as IDN and Napkin, but Series A, pre-Series A continues to get funded at a reasonably healthy cliff, but if you get in that D and E round and beyond, it seems like things are getting a little bit more, are still more challenging. So David, maybe you could give us your perspective on this dynamic and what you're observing in the companies that, either in your portfolio or that you see in the ecosystem. Some really interesting comments that were said already, and I hope maybe I could touch on that as talk about the financing. Well, as you know, earlier the company, more risk there's embedded in the company and therefore the expectation is earlier, more risk, then you should be rewarded with higher returns in the future. And I think that VCs, that's what we hope to do, is to invest in those companies that we hope to see potentially 10x or more returns. And having that ability to do that, much harder to do that at a later stage, right? If you're already at Series C, your $5 million investment may not give you the type of returns that you hope to see versus an earlier stage. But one of the things that I actually wanted to come back to, what was discussed earlier, is that it's, for sure, it's taking a lot more dollars to get to the point where there is an exit. Ultimately, we, the investors, we don't make anything until we see an exit. And the question is, how much do we have to help to support the company to that point? And what are funds are designed to do? The earlier stage company or earlier stage investments are, we're not going to take the company all the way to an exit. Most of the funds are not built for that. But what we're looking for are, what are those points of value creation? What do we need to get to the point of value creation that could help the company get the next round of financing, position it for potentially more strategic interest? And depending on what you're doing, it may be different from getting an FDA clearance all the way to having commercial validation. The problem has been, even the later stage investors in the medical device area, in the digital health area, they want to see that commercial proof, which, as you know, for people who've been in the industry, the most expensive part of company building is creating a commercial entity. And that's where your dollars just don't go to work. And that's one of the appeals of the earlier stage investments, is that it's more about now validating the science, product development, maybe the early stage of clinical development or the clinical proof of concept. That allows you to create a certain amount of value, and then hopefully you'll get rewarded for that. And also, smaller dollars so that you could spread your ideas around a little bit more. And I think that's the reason why you're starting to continue to see a lot more earlier stage investments versus the dollars that's required to really grow the company in the later stage. And both you and Giovanni have mentioned this, so I think it's worth diving into a little bit further before we open it up to audience questions. The whole idea of milestones that drive value inflection. And this is something that I personally struggled with. Before joining Goldman, I was a CEO of Acutis Medical, an EP company that did not make it. And our chairman would always say to me when he looked at our models, like, what is going to be the clinical data or the product launch that justifies this inflection point in revenue? But I almost think things like that are still not, quote unquote, hard enough milestones. It sounds like what you're saying is you need definitive view on reimbursement, definitive view on regulatory pathway. Am I hearing that correctly? Maybe you could sort of expand on that, David, and then go to Giovanni on that, or Daniel. It's not in the cardiology area, so it's not totally relevant. But I thought that, especially in the medical device world, historically, I started investing in medical device 20 years ago. And back then, when you get something through the FDA clearance, you created a lot of value, and then typically you get picked up by one of the larger companies, the Medtronics, Boston Scientific, you know, of the world. And then your job is done. But the goalposts have moved towards more of the, now you need to show me that commercial adoption has to happen. But if you kind of peel the layers of onion on that, well, how do you get commercial adoption? Well, you need a sales force, you need reimbursement, you need to have coverage, then you need to have payment. You start to get to a point where you have to do a lot of things before you've created that value. And that's obviously difficult for a lot of funds to support companies all the way. And therefore, we need more players to help to create value along the line until we get to an exit. So, David, I was just going to respond to your question around the specifics around regulatory reimbursement and whether you need those kind of locked in. So for early stage investors and companies, you know, we can't expect a company, a seed investment or a series A, to have their pivotal study design agreed to with the FDA or certainly have spoken to or gotten feedback from CMS on coverage, what their coding is going to be, what kind of economic evidence they're going to need, if any. So we can't have that at that stage. What we do look for are, you know, what are the analogs that the company can point to that says, well, look, this company did this pivotal study. These were the endpoints. This was the size. You know, we can take that path. And reimbursement, of course, it's, well, this company charted this path. Here's the coding that we think we fit into. Or if we don't, here's the process that we'll need to follow. So at seed series A investments, you know, we're not expecting definitive answers. That's just not possible. But what we do hope to see is we can see a path. There's a path that's been done by other companies that this company can follow. And that's what we're going to have to rely on. There's obviously risk there, but that's what early stage investing has is especially risk on regulatory path and reimbursement and coverage. And we just hope that we can find analogs that give us enough comfort at this stage to do the investment. And maybe I'll open it up to audience questions to see if there are any. I don't have any submitted through the online app. But let's see if there are any questions out there. Sure. Thanks, David. And good to see so many of you again. I remember when I pitched several of you several years ago, I didn't have a business model or, you know, a lot of these questions answered. Vancouver with an underwear, by the way. My question is, from that time period, we've all talked about how the goalposts have changed, but market conditions have changed significantly from the last two years when interest rates, you know, were very low. How much in particularly in digital is I recognize this will be a little bit of a tricky question, but how much of this is decision making on your existing portfolio companies that a lot need to be triaged at this moment in your decision on taking new investments because a lot of the marks were much higher than they are now just due to market conditions. Just curious on how each of you are thinking about that. So you've actually hit on an area that is just current and painful for me because I've been spending probably 80 percent of my time looking to help my existing portfolio companies because, you know, we've done over 20 some investments in the digital health area and I'm on the board of eight of them. So it's just, you know, I took on the responsibility to help existing portfolio companies. It's a tough funding environment. So I spend more time on that and at least I know that's different from different folks that I'm spending more time looking at that part instead of looking at new deals. I've done new deals, including one that, you know, Catherine knows very well, but it's not to say my funders might have a partner who has a lot more bandwidth. So he's devoting time and he's actually doing it. I think what you're going to see is that if there are investors out there who've been around a while and has a large portfolio, they're going to be spending a lot of time doing that. And because it's unlikely that they're going to try to squeeze out a new deal when they have to create reserves to their existing fund to actually help support the existing companies. For us, we have a third fund that we, it's about a third investor, so we have plenty of runway. But at the same time, it is the mindset, at least for me, is exactly what you point towards. And I think that's true with a lot of the investors that I've been talking to. We've been talking about how, you know, you have a company that you think is really good, but it's existing portfolio company versus a new idea that they want to. And the other thing is, just to add on to that, is because we've seen a lot of situations where companies were not successful, they've tested out different commercial models, different product lines, different use cases, it's hard to see new ideas come that does better than that. Because we see a lot of me too, incremental benefits, and nothing that is different. And so that when we see the same idea and, you know, I have to say it, if you thought of it, somebody else already have done that. We've been around the block long enough that that's usually the case. So it takes a little bit more for that next investment to happen. I am getting a couple of questions here on the iPad, but I want to switch gears just for a second and we'll probably revisit this topic. But I think given some of these dynamics in VC, Steve, you sit at a very interesting part of the ecosystem because there probably does become a larger role for places like the NIH, especially as you think about earlier stage investment. So can you maybe just sort of talk about where that fits into the overall ecosystem right now and to what extent the current funding environment is helping you get access to more investments and potentially this vehicle of funding becomes a more prevalent one. Sure, so the National Institutes of Health obviously has a small business innovation research grant program, the SBIR program. And this is over a billion dollars a year that's set aside for supporting early stage companies. And so I'm with National Heart, Lung, and Blood Institute, which is one of the 27 institutes and centers at the NIH. And we have obviously a program that's very focused on heart, lung, blood, and sleep. And so this is a very appropriate sector for us. What we have in our office is a team of individuals like myself who are experts in certain stages of company formation and in terms of things like reimbursement strategy, regulatory strategy, intellectual property strategy, and how to think about future funding opportunities. So we work with companies that apply for and are funded in the small business program. And we help them prepare to approach private capital investors like the Venture Capital Group that's here on the stage with me. But we also consider it to be successful if they attract money from angel investors. So angels actually have been investing successfully, consistently. There's really not much of a downturn in angel funding. It's obviously smaller amounts of money, but these early stage non-dilutive capital investments from NIH and angel investors are preparing companies to be able to go to the venture capital firms who have the more rigorous requirements. And we've been quite successful doing that. So I think maybe it's a very interesting area. And maybe going to one other part of the ecosystem that's been referenced here, and Charity, I definitely want to get your Arboretum perspective, but why shouldn't companies like Medtronic, where you were previously, just be salivating over this environment right now? From an M&A perspective, it seems like the capital environment is tough. The bar to achieve milestones is going higher. Founders may not be ready to give up the percentage of the company needed to achieve the funding to get to those milestones. So help us think a little bit through the way the corporate landscape evaluates opportunities and how they think about business development. Yeah, you know, I think, I think something, I mean, Catherine said earlier, the goalposts are moving, right? It used to be enough that, even in the time that I was there, you would look at companies and they have proven clinical efficacy, gotten approval, and then expect an exit there. But the goalposts have moved. And I think the name of the game is portfolio optimization. I think a lot of these large corporates and strategics are looking at their portfolio at an enterprise level. You're saying to the street, hey, we're committing to expand margins by X basis points in five years or grow top line growth by X basis points. And acquisitions are a really powerful lever to do that. But how do you do that when you are multiple billions of dollars in revenue, right? It takes scaled growth assets, acquisitions of scaled growth assets. And so what that means is companies that, when you acquire, are immediately accretive. Those are generally very large acquisitions, right? So that's really interesting because I do think, and I suspect that, the appetite for dilution has certainly gone down, right? Even if the deal model shows, hey, in the first couple of years you make 10 million in investment, 20 million in investment, and it'll eventually be accretive, that's not enough anymore. It has to be immediately accretive, right, for it to make sense. And I also suspect what that means and how that translates directly. And for med device companies is, you know, companies that are certainly pre-FDA approval just aren't interesting anymore, even from a structured deal perspective, and they really, really want to see that scaled growth asset, right? So I think those are some of the important things that the large corporations are looking at. And does that mean that the perspective from the large corporates actually isn't that different in the sense they're looking for de-risked assets where there isn't the need to absorb significant amount of earnings dilution because of commitments that they've made externally to investors? Yes. Okay, so you kind of put this all together, you're still not getting, you know, you're not getting me excited here, but the, you know, Katherine, what's super interesting, you look at MedTech Innovator, I think the number of companies you have coming in is still growing. I mean, the innovation in MedTech is quite significant. So can you maybe help us and give some context in like what's coming on the earlier side of the funnel? Like what segments of cardiovascular devices are you seeing a lot of investment in? What are some of the ones that, maybe you don't wanna give specific names, but that you're seeing that are making it across the finish line from a funding perspective? I mean, what are some of the categories of interest right now? And then I'll go to some questions I have here. Well, I definitely think we're in the right space. Cardiovascular is having a moment, you know, J&J and Edwards have made a lot of movement in the last couple of months. You know, I would say to your point earlier about excitement, where I sit, it's actually not as dire as you would think. Last month, our portfolio did 100 million in equity funding. And before that, it was 80 million. So it's, you know, our companies are still raising money. There's still money out there being deployed. And it really is important, like you said, of what gets a company across that finish line. And it's all, I mean, you pointed out it earlier, data. You know, like these people wanna see data that makes them believe in you and what you're doing. And the important part of that is you have to know what data you need to collect. And that you can't do in a vacuum. You have to talk to people, you have to talk to your strategics or your potential acquirers, your investors, any stakeholder who has interest in what you're doing. And then lastly, to talk about, you know, what innovation is coming down. Again, you know, cardiovascular, you know, PMA. It's still a very interesting space. It obviously takes much longer to get through, but then you have a bit of a moat, right, for other people. So that's still, you know, an area where we're seeing people invest in. This is one that, it's a provocative one here. Could I just add? Please, yes, go ahead, David. So I don't want to be so gloomy here, but one of the things that, that at least digital health, and you know, there's a lot of overlap between medical devices and digital health, especially what Eric called tech-enabled services. But what it brings to light is that, you know, if you just relied on the traditional commercializations, you know, model that, especially medical device had, which was, you got to get reimbursement, you got to write distribution channels, get the devices out there, you sell it, you give it to the physicians, or you sell it to the physicians. That model is not always the case in digital health. And what we are starting to see are new, innovative models of services and products being paid. And that's one thing that you didn't really know about, and that's been the learning process, at least over the last 10 years, is that, you know, employers were never a big market for medical devices, but it's a huge market for digital health. And now there are other mechanisms, other membership models. There's a lot of commercialization models that are being explored that gives, at least the investors hope that, there is ways to commercialize these products and services without just relying on the historically, which is very established, but also very slow-paced commercialization models. So Daniel, I want to get your take on this. And I think you've already started to answer one of the questions, but I want to make sure I ask it because I like the way it's phrased, very provocative, is B2C, is B2C, SaaS, and healthcare dead? And I'll just add on that. Is digital health just hocus-pocus? Like, is there actually a business to be had here? Like, you make the subscription thing, and I don't think I've met a hospital CFO who can define what PMPM means. I don't think it's in the vernacular of the customer, but maybe, Daniel, you could expand on that a little bit and give your perspective. Yeah, so I mean, our core background is more pure medtech. And we've done some new investments in digital. And this still, it still needs to be figured out because there's just not the, from a traditional medtech M&A perspective, they're looking for what coding are you getting, how are you gonna get paid by CMS? And that is unlikely to be the right model for a lot of this technology. And that other models, the ones that David talked about, aren't fully formed yet, and you don't know who the acquirer is gonna be in that. Are you gonna get acquired by a UnitedHealth or Humana or a service company? And yeah, so we have one company, and it's thinking about its reimbursement, and it's, well, maybe we're not actually selling to, or having coding through CMS, maybe we're going through Medicare Advantage and we're contracting with the Humanas and the Uniteds, and we're just selling to them and they're putting it into their heart failure service. There's certainly the clinical need. And so I'm always of the belief that if there's a clinical need, you'll figure out a way to make a business out of it. But it is still early, and those mechanisms, that path does have to be figured out. So I am optimistic that there are businesses there, but unfortunately, we are still in the early stages of figuring out what those are. And back to my earlier comment around, you need to create those analogs for here's the model we're gonna follow. We're still in early days of those analogs of the Viz AIs and the Clearleys and the Heart Flows, and you can say, well, that's a model we can follow. And as you think about your role in engaging with your portfolio companies, one of the questions that's come through here is, a lot of what you're talking about is business model, definition, and product market fit. And that requires a good amount of market research. So how do you think about, obviously a lot of it sits on the portfolio companies, but how do you think about your role in that process and helping your portfolio companies define some of those analogs or business models or doing some of that requisite market research? Maybe Giovanni, we'll start with you and then maybe Charity come to you after. Well, as an early stage investor, our fund is exploring and we look at the companies, we look at the proposal, and for the moment we are looking at how this world on these companies are evolving. Because as it has been mentioned, there is not a clear model and it is very difficult. Now it's a bit like in the IT world where there are so many different models and it is so unclear on how you will make the money that you have to invest in many, many companies and some of them will make the big win. But if you're not ready to invest in many, many companies, it's very difficult to decide today who the winner will be. So maybe I could share a little bit about Arboretum because I didn't do that before. So we invest in all sectors of healthcare with the exception of biotech and pharma. So that means we look at medtech, life science tools and diagnostics and certainly digital health and healthcare IT, which I do not think is a hocus pocus. I think it's really important when we think about the big macro themes, right? Big problems in healthcare that need to be solved, right? Value-based care models, data integration and interoperability. A lot of that requires digital health models to solve, which gets us really excited. But to a lot of the comments made, there are certain areas within digital health that I think that, at least for us, we don't need to jump feet first and right now because a lot of the business models have been unproven. When we say business models, really what we mean is who's gonna pay for it and why. And I think a lot of that is also part of the evolving regulatory environment, right? The FDA has not figured out, how do we reimburse digital therapeutics? How do we look at AI? How do we look at digital? It's my understanding that there's now a center of excellence and those discussions are being had, which are really interesting, but it's still not there yet. But it's still, I think it's a very important sector. And I think, what was your original question? Was about, how do we help our- How do you view your role in helping define the business model and ecosystem? So you, as I agree, I think your point, digital is the only way to scalably address some of the critical problems facing healthcare. Otherwise it's unattainable. But I think defining that, you can kind of put it on the portfolio company or you can take a more active role on the investor side. So maybe my question is, what are you doing to help your portfolio companies define that? I think it depends on, so for our investments, most of them and most of our successes in this space have been tech enabled services. That business model is fundamentally very, very different than what we're talking about when we say healthcare IT, SAS models. So I just want to set that up. I think on the tech enabled side, a lot of that, a lot of what scares people away is margins, obviously because there's significant labor costs, when we talk about clinicians and services. And so there are a lot of investors look at the margins, 20%, 40% margins versus SAS models, which are looking at 80 plus percent model margins. And wondering, hey, does this make sense to still invest in? And I think the answer is yes, right? That's the whole point of technology is as you scale, it makes the unit of economics work and makes it more attractive. Now in terms of how we help our portfolio companies think about that, I think an important part of that is really knowing your customers. So I'm on the board of SonarMD, it's a care coordination platform for helping payers and practices manage their GI populations in a value-based care model. And what's important is that selling into, you really have to understand selling to payers, right? You have to understand that is not a linear growth, it is quarterly. You have to understand what it takes to get into those contracts, to keep those contracts. You really understand where the major pain points are. Which payers are we going to go to? How much in savings can we save them? Do they care about the cost of their GI patients and GI population? So it all really starts there. And I think sometimes entrepreneurs have a very, obviously a lot of technical know-how and everything, but what differentiates the healthcare sector is really understanding those end customers and who you're selling to, which is very, very unique, I think, versus others. That's super helpful. And maybe Daniel, I'll come back to something you talked about earlier on analogs. And I couldn't agree with you more. I think I had an English teacher say to me once, there are no new plots, just new actors. Which I think you can sort of relate to, history finds a way to repeat itself. But how do you balance using analogs while not having everyone chase after the same category and end up with a bunch of me-too ideas? Yeah, so Broadview, we're a mission-driven investment organization. So we're focused on technologies that are going to truly change patient outcomes. So we don't, our mandate is to not invest in those kind of me-too. So it actually makes it easier for us to avoid those. I mean, the analogs I was thinking about more was that the path has been established for the type of technology. So within a heart failure space or an EP space, that there's a path that we've gone down. Yeah, I don't think I was, I wasn't referring to specifically that the technology was actually in a competitive space necessarily with other things. So I think analogs can work. And I think reimbursement is maybe one example where the company we're invested in, CardioSense, is doing a non-invasive patch for intracardiac pressure. The analogs we're looking at are not companies doing even patches necessarily, but other ones that are providing other algorithms into a hospital setting, whether it's for plaque assessment or other assessment of ejection fraction or whatever it is. So those are the analogs where, yeah, not directly tied to the product we're looking at, but are nevertheless ones that, oh, it's an algorithm, it's being sold into a hospital setting. What can we learn from the reimbursement path that those companies have followed that can track to what we're doing, even though it's a different clinical application? That's helpful. David, please go ahead. I just wanted to go back to your previous question about what we as investors could do to be helpful. So, and this may be too much information, but I got a lot of scars on my back being part of, on the boards of many companies that have tried different commercial business models and have, some have succeeded, some have failed. Many have pivoted. And learning the different things from all these actions, when you could almost create a marketplace where you can help others in your portfolio and perhaps even during discussions with pitches that, you know, yeah, you're thinking about that, but it doesn't work because of these following reasons. Not everything is applicable because climate's changed, competitors change, reimbursement, environment changes. Things change, but there are certain learnings that you could apply from one company to another. And this is where, at one point, I had, when I had only 16 portfolio companies, I would tell people, I have 16 investments and 16 different ways of selling. And you learn which are working, which are not, and why they're working. And so, one of the things that you will get by talking to people with a lot of portfolio companies, you'll get that access to that learning because you may have a great idea, but it may be that, you know, you just got the great experience in your local geographic areas with one particular provider group. And you can't create that and see that as a scalable model for the rest of the United States or even, you know, US. So, there's a lot of things that we can be helpful for. And maybe just a follow-on to that. One of the things, when I was on the corporate side, I found really, really helpful was talking to my peers at other early-stage companies. I think there's a tendency to want to keep all your ideas very close to the vest. And believe me, if they're that proprietary and great, no one's gonna be able to really copy them. So, I think there's this hesitancy to want to, like, share with your peers, but I can't underscore enough the value of engaging with other entrepreneurs and startups, even if they're in quote-unquote competing spaces and having the opportunity to share experiences. So, I think we have 10 seconds left here, so I'm just gonna take a quick impromptu poll here. I have three questions, which is, I'll start with, from your seats today as you think about the rest of 24, but more 2025, do you think your investments in cardiovascular technologies go up or down next year? So, a show of hands for up. Everybody, yeah, that's good. I'll just say one. From your perspective, how do you think, do you think the capital markets environment for healthcare equity offerings will be better in 2025 versus 2024? Mixed. I hope so, I hope so. It can't be worse. Yeah, well, okay. We hope so, too, that it's better. I guess the third would be, we've seen M&A pick up, J&J has done a string of acquisitions, you mentioned Edwards as well. Do you think M&A activity is higher in 2025 in this space? Yes or no, yes. And it should be, because you have a lot of really good companies out there at valuations that are far below, you know, I think what the perceived value should be, so. And these type of opportunities, whether we're investors or acquirers, should be explored. Yeah, it's a buyer's market, but I don't know if the exits will be good, but they'll definitely be bought. Excellent, well, thank you, everyone, and feel free to approach any of us after the panel, and look forward to engaging with you over the next couple of days.

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