Healthcare At USV

Over the last five years, we have stepped up our investing in and around healthcare. About 15-20% of the early stage companies we have invested in over our last two fund cycles are working in this sector.

If you look at our current investment thesis at USV, you will see that wellness is one of the key areas of interest for us:

USV backs trusted brands that broaden access to knowledge, capital, and well-being by leveraging networks, platforms, and protocols.

So where in the healthcare sector are we focused?

Rebecca tweeted this out yesterday and I think it is a good articulation of what we find most interesting in healthcare:

Making affordable healthcare more available to everyone seems like the winning formula in this sector.

Take our portfolio company Nurx for example. They make birth control and other important prescriptions and home testing kits available to millions of people who have found them difficult to obtain through traditional channels.

I hope and expect that we will increase our investment in the health and wellness space in the coming years. It is an important sector that has immense challenges, but also immense opportunities.

#hacking healthcare

Comments (Archived):

  1. Matt Zagaja

    Healthcare is the biggest driver of cost in the MA government budget. When folks in the state pay more in taxes every year but get the same service wise and want to know why and where their money went, mostly healthcare and housing inflation is the answer. We need a healthcare moonshot and we need it today. Whether it is on the side of insurance or care, a successful start-up in this space has the possibility to help millions of people and save millions of dollars.

    1. fredwilson

      i am not sure it is a moonshot. i think it may just be a groundswell.

      1. Richard

        The same groundswell could also increase the carried interest tax rate to 70%, and the wealth tax to 10%, and limit home ownership to one house per family. That would pay for it as well.

    2. Pointsandfigures

      In Illinois, the biggest driver is pensions. You might want to check MA numbers.

      1. Richard

        It’s not even close in California – it’s educational (and we are close the the bottom)z

  2. awaldstein

    Good stuff.I wonder whether things that are really hard, demonstrably important can’t also be configured to be great investments,True for healthcare and the winner will be all three.True I think in the world of impact economies replacing traditional philanthropy though this is more inchoate than healthcare to approach but equally as important in some ways.Thanks for the food for thought here,

  3. William Mougayar

    These 3 bullets are more about optimizing healthcare, than delivering it. The big elephant in the room is the political dimension: providing universal, equitable (and affordable or free) healthcare to all Americans. It’s a right that many other governments already granted to their citizens. Why does the US continue to lag? And does the cost of US healthcare really need to be so much higher than elsewhere, for no particular reason except for the complexity it is based on?

    1. awaldstein

      You don’t really expect a concise coherent answer to those questions, do you ;)Of course the answer is no of course not. The action is where the complexity is.

      1. William Mougayar

        I know I’m rubbing on a soft spot.

        1. awaldstein

          Obviously!It gives me great pleasure (and hope) to see this topic front and center, along with the connection between climate change, infrastructure rebuilding and income gaps all woven into the core discussions around the upcoming election.This simply needs to be surfaced and it is.That’s an important step!

    2. DJL

      One of the real issues is to untangle the insurance – care cycle that has self-propagated over decades. I just recently went through a personal situation where BCBS would NOT pay for the cheaper, less invasive treatment. They would pay for a more expensive one because it fit some model. To think that the government would run this any better is naive in my opinion.It is much more complex that just saying “healthcare for all” Both political parties have very strong lobbies in various camps that make change nearly impossible at a “global” level. I like the tactical market solutions.

      1. William Mougayar


      2. ShanaC

        the insurance model would be better on a larger set of data….and there wouldn’t be certain strange incetives that exist with the insurance system we have today

    3. Richard

      Free healthcare ? How do smart people say such dumb things? When the ignorant start healthcare conversations with the, the solution is Free Healthcare, you know just how clueless they are about the subject.

      1. William Mougayar

        You seem to enjoy taking these cheap shots, so I will ignore your baseless statements.

  4. Pointsandfigures

    free markets and entrepreneurs will make health care a lot more affordable to everyone than any centrally planned government controlled idea. Go Nurx.

    1. William Mougayar

      But the bulk of healthcare costs is in providing it as a service. The cost of health care products is only one small factor.

    2. awaldstein

      Will take both. Neither on its own will be sufficient to turn the tide.Gonna take generations but starting is a notable virtue in its own right.

    3. DJL

      I agree. Show me one industry where costs went down and results went up when government took over. It is pure fantasy.

    4. Michael Elling

      Seriously? I started working for the top ranked hospital and healthcare supply analyst on the street in 1983 when the total share of GDP was 4%. It’s now 18%, and that’s exactly because the pro-competitive nonsense you are talking about really began to take off. Know your stuff!

      1. Pointsandfigures

        Mandates changed. Regs changed. Get rid of it all and compete tgereisno competition in health insurance like tgereisno slot of other services

        1. Michael Elling

          Nonsensical reply. What is this word, tgereisno? Healthcare is actually not a “private” good. It is a public or social good, when ~50% of expense is around the first 10 and last 10 days of an individual’s life. To boot, there are a large number of moral and ethical issues. And lastly there is no real choice on the part of the buyer. It’s a totally inefficient market.Insurers are brokers; they have no incentive to reduce costs or make things more efficient. Moreover they prefer prices to rise, rather than fall as they make money off of volumes.Lastly, healthcare is impacted by a lot by exogenous factors; like the corn and sugar and tobacco and fast food industries. All “competitive” industries. If we regulated the latter, there would be a lot less chronic disease. Government has done good and bad things on that front; but certainly things that private industry would never ever undertake. So it gets down to growth and winner takes all.Winner takes all in medicine has driven costs from 4 to 17% of GDP. Can you point out how the competitive market has any desire to reduce costs from a vendor or provider perspective? That’s why government needs to be the buyer; or set up system of better incentives and disincentives on the part of the real buyer.

          1. Pointsandfigures

            We disagree 100%.

  5. DJL

    I was at a local (Houston) startup event last night and there were two medical-tech startups solving two very different, but very tactical medical problems. The first was using AI to help read scans (a nearly perfect application.) The second was using materials science to improve wound treatments. But like every other business, they still need to get to market and sell.The advantage of health-tech versus others (social media, gaming) is there is built-in social value. Saving lives and providing better care is a train everyone can be on.

  6. leigh

    My stepfather (respirologist, GP, worked in Chronic complex care) had his own data base of symptoms and how things presented themselves and treatments that he would use for his patients particularly in complex care. He was creating his own version of a digital brain based on his notes, annotations and how patients described their symptoms in their own language which is oddly more consistent then you would imagine and yet most medical and health systems don’t recognize it. There isa HUGE opportunity to take that concept and build a healthcare super brain. It’s totally exciting.

  7. Tom Labus

    ACA was established in 2010. It should have been embellished and made better over time. What we had was all out warfare and political gibberish about top down health care. We have top down extortion run by insurance companies instead.

  8. Mike

    With close to 20% of the economy and an aging population a lot of opportunity. But a complex system so new entrants will need to work hard for their position and to get their value proposition through to various stakeholders. A ripe field for the best problem solvers. Or at least the most determined.

  9. Adam Parish

    For the past two years, I’ve shown my doctor my eating and exercise by showing her my Lose It app and Google Fit data. I really wish my doctor had this data without me showing it to her my little phone screen. If she had the data should could send me pointers throughout the year. Health care providers need more consumer data and stat.

  10. Pointsandfigures

    third party payer and all kinds mandates along with central planning causes price not to be transparent which doesn’t let the market work.

  11. William Mougayar

    yup. that would be a start. and btw- it’s a part that many misunderstand about Canada. The government doesn’t run healthcare, nor do they dictate how it’s delivered, and it’s not socialized medicine. The gov just allocates various budgets. Hospitals are run (from an admin point of view) just as US hospitals are run, with efficiency and quality in mind.

  12. Richard

    This is not an analysis. Competition drives down prices. What makes you think that the cost of administering a program of this magnitude wouldn’t be as large as the military budget.

  13. JamesHRH

    Ever lived in Canada? Or the UK?Doctor shortages – esp Obstetrics & small centre GPs. Tear a rotator cuff – ‘see you in 18 months, sorry you can’t lift your arm above your shoulder’ is typical response to non-urgent need for a specialist.Nearly 30 years ago my first employer wanted the very best healthcare in the world. So, every 2 years, he did a full workup at the Mayo Clinic in Scottsdale. Doing that workup in Canada was illegal. Not unavailable, against the law.You live in the country with the best health care in the world.Making it more accessible is one thing.Making it single payer could destroy it.Easy Hoss.

  14. Pointsandfigures

    we disagree. Socialism or socializing never works.

  15. awaldstein

    Interesting.A bit ignorant here.Who is talking about this with intelligence and detail?

  16. Tom Labus

    I noticed all those adjustments were made in the Republican health care legislation. Now what year was that done???

  17. Salt Shaker

    It isn’t a political issue? Well, i guess one can attempt to spin it that way. Truth be told, it’s really about money…and money and politics are inextricably linked. Look how much money healthcare providers and drug manufacturers are invested in K steeet lobbying firms? So much of our gov’t’s intransigence is rooted in money. A serious discussion on how to solve a lot of this stuff, including healthcare, can’t begin w/ out campaign finance reform.

  18. William Mougayar

    You like talking to imaginary spammers ?????

  19. William Mougayar

    It sounds complicated and expensive. You just proved it. Cheaper universal healthcare shouldn’t be a partisan issue.

  20. ShanaC

    Wouldn’t it be easier for you to hire if the employer didn’t pay for healthcare? If there is this ideal person at a bigco, and they need the health insurance, wouldn’t you not be able to hire because there is no way that person will switch

  21. ShanaC

    1st off, I hope you are ok.Theoretically, there should be no problem with the data issue. In practice, ehrs don’t interconnect. There are outs to fix this data issue, but it would mean aiming at consumers first and having them pay to bypass HIPAA, and from there aiming at doctors to make their lives easierUniversal healthcare in the US also would help, because ti would a unified data standard just to understand payments

  22. Salt Shaker

    “When I go to the doctor…”. Many can’t and healthcare is the leading cause of bankruptcy. Somehow campaign finance contributions have been framed around free speech (Citizens United), which is a nice cover when pols subsequently engage in illicit or immoral behavior. It’s not a whole lot different than college admin accepting money for a third-party kid’s acceptance. When the system makes it so easy for people to be bought and sold, then bad and unconstructive things happen. Maybe you can’t eliminate the money in its entirety, but there certainly needs to be stronger safeguards against abuse.

  23. William Mougayar

    ok 🙂

  24. Richard

    Exactly. The hubris of this USV investment thesis is astounding.

  25. Richard

    Short term thinking? Want to make it more difficult for the government to attract new talent to its agencies? Take away one of its competitive hiring advantages – healthcare.

  26. Richard

    From someone who has NO practical experiences with US healthcare – you sure do have a lot of opinions on the subject.

  27. JamesHRH

    William, this is just not true. Hospitals are run by provincial governments.Copeman clinic tried to provide high end care for those willing to pay and is constantly fighting off legal and PR attacks.Tall poppy syndrome.

  28. Richard

    Even the govt understands that competition is a net saver of lives. If you want to reduce healthcare costs in the US, 1) for those over 75, have 50% of healthcare costs in the final 5 years of one life be paid from the estate 2) limit oncology drugs that can’t deliver at least 5 years of additional life.

  29. Richard

    Want a healthcare crisis – take away the private insurance reimbursement rates from hospitals and physicians that essentially subsidize (which is ok – as it’s just a hidden tax) Medicare and medicaid.

  30. awaldstein


  31. Adam Parish

    This has not been my experience in Florida. Every provider starts with no data about me and I don’t have the option to share it. My PCP is in the same hospital as another doctor I see and their systems have nothing in common except a shared scheduler.

  32. Donna Brewington White

    The thing about benefits is that it is not always about the usability of the actual benefits, but often the message that providing (or not providing) certain benefits sends to current and prospective employees.

  33. sigmaalgebra

    Never been to Mayo. When I was in Ohio, went to Cleveland once — they looked really good. Of course, I went to Hopkins for this and that little thing.When I went to Cleveland, my wife came along. So, we were The Drs. …. Got treated like royalty.I had a sore Achilles tendon and saw the head bone guy for one of the Cleveland NFL or NBA teams! Bright guy. My wife’s social skills, social situational awareness, acting and role playing ability, insight into what others were thinking and feeling, ability to manipulate effortlessly but effectively were world-class stuff, poor Queen of England couldn’t hope to compete, and with her there I looked almost civilized!!!Had some friends in Ohio with a potentially serious problem. The Cleveland Clinic was just a not very long trip east for them, but they’d never been there. I suggested the place, and last I heard the family got some fantastic treatment and the Clinic a nice donation!

  34. sigmaalgebra

    I was going to post a reply to Fred: My experience is that, broadly, and Trump seems to agree, health care delivery should be divided into roughly routine in many small clinics and the rest, usually in hospitals, maybe the best in some of the research hospitals. But your post is much better than I could have done.So, from my experience, and yours is the same or much better, is that the clinics now often are really good with laptop computers, etc. and have digital in good shape. I’ve been surprised at how fast and good that digital roll-out has been.For the money, a guess is that maybe individuals have a relatively large percentage of co-pay for the clinics and essentially full coverage for the rest, the $50,000 a case stuff. So, for the simple stuff, people don’t over use it, don’t take little Patsy to the pediatrician for each sniffle, but for anything really serious but overall rare the family gets great care and insurance coverage at about what it costs with a small or 0% co-pay.

  35. William Mougayar

    James, your statement is incorrect.Each hospital has their own CEO and they are not government employees.I worked in healthcare for 10 years.

  36. William Mougayar

    Lol. You are misinformed about me. I worked for 10 years in the healthcare industry in the US and Canada. So, my comparative insights are very pertinent.

  37. JamesHRH

    In Alberta, for example, the province manages all health services through a single BoD. In the most recent decade, a minister of the Alberta Government FIRED THE ENTIRE BoD over a single decision –… .They have tried decentralized & centralized but the results are always the same – inefficiencies and low satisfaction. You can’t provide goos service when staff know that firing them is a near impossibility.But yes, you are right, each hospital has its own CEO. But they cannot increase the revenue line and are completely hamstrung by powerful unions on the cost side.But, sure. They run things for quality and efficiency.It is like Vincente Fox being President of Coke in Mexico. He’s got the business card with the title on it, just none of the actual responsibilities or powers for the title.If you are in sales for a startup and you are calling on the CEO but you find out the CEO can’t make a buying decision without the BoD approval…..the CEO isn’t in charge.It has taken us 2 years in TX to appreciate the world class nature of US healthcare for level of care. It is absolutely the world standard. No universal health care system can touch it.

  38. JamesHRH

    Did you ever live in the US?

  39. JamesHRH

    The Tom Baker Clinic in Calgary is world class. But, getting in is the trick.No one wants to tell people like @disqus_AsyAYSvW65:disqus that access is STILL a huge problem in universal systems.Maybe a hybrid system can be built in the US or even in Canada. But universal systems are not a panacea.

  40. William Mougayar

    I have actually.But more importantly, have interacted w US hospital administrators, doctors and health care providers.

  41. JamesHRH

    I thought you had but was not 100% sure.In the 1990’s, in Calgary, I personally knew 4 highly trained specialists who moved to the USA to work at the highest levels with the latest tools.It’s better in Canada now. But, I am still struck at the quality of care we are receiving in Houston ( and we were Copeman Clinic patients in YYC).

  42. William Mougayar

    I’ve also researched the US / Canadian healthcare systems in-depth and wrote an internal paper on the comparatives…back in the day.

  43. Michael Elling

    As I’ve said before what is good regulation and government service? Military and police? Leave it at that?BTW, we are all social creatures. You are nothing without your fellow womankind.You’re on a slippery slope when you try to be so black and white.