William Taranto, managing director and head of Merck’s Global Health Innovation Fund, a $250m fund to look at health care investment technology.
Tom Thornton, general manager of innovation alliances at Cleveland Clinic, who has just joined them from the Kansas Bio-Authority.
James Mawson (right in picture): Describe yourselves and firms and how you build partnership in healthcare, please.
Bill Taranto (left in picture): The reason Merck moved into venture is that our CEO has a vision of Merck being a broad-based health care company. If you look at the continuum of health care from pre-diagnosis to death, how does Merck participate where the pill or the vaccine is only one piece of the healthcare puzzle?
This connected healthcare framework is about asking "how do you bring multiple companies together to impact healthcare"? We want to get to the top of the stack, which is really providing some kind of solution to the community, whether that’s an outcome that’s reimbursed, reduces cost, provides better efficiencies or provides better healthcare. You can’t do it by yourself, you can’t do it as a single company or single investment. Data is the currency we’re going to use to transact in the future market – taking existing data sources for commodity data, things like claims and hospital data, and combine that with new types of data, such as monitoring, tele-imaging, molecular diagnostics, it presents an interesting longitudinal data set.
You then have to add data harmonisation and analytics layers before you begin to provide a solution to somebody out in the marketplace. But the key to this is connecting companies, and what we do is connecting companies within our portfolio, it’s connecting companies with other companies’ portfolio companies, and then companies that stand independent. We do everything, not just venture, it can be partnerships and it can be joint ventures, such as working with like the Cleveland Clinic which thinks very much in that way. It’s about making connections because it’s really the only way you can deliver anything in healthcare.
So the whole purpose of the Global Health Innovation Fund is to provide Merck with future optionality around mergers and acquisitions.
I don’t invest in traditional life science, I stay away from the pill or the vaccine involved, I invest in health information technology as well as health service and solutions, and within that things like diagnostics devices and personalised medicine.
The fund itself is $250m evergreen fund, we do mostly expansion capital, but we will do some earlier investing if it’s appropriate. Our sweet spot is $5m to $15m range though we’ve done as small as $1.5m and as big as $30m. We have done about 14 investments to date, committed about $160m, not counting reserves. We expect that fund, with tranching and follow-ons to run through 2013, but to start new investments in 2013 we are going to add an additional $250m.
Tom Thornton (centre in picture): The Clinic is a healthcare system based in Cleveland, Ohio, with $7bn in annual revenue from business in Cleveland, Florida, Toronto, Las Vegas and we are building one of the largest hospitals in the world in Abu Dhabi.
Our Innovations organisation has been around for about 12 years, so it has gone through an evolution that probably is similar in some respects to a lot of corporate venture organisations in the regard that we started out first effectively as an organisation out-licensing intellectual property developed by our employees. That’s still or our bread and butter, bringing in maybe $12m to $15m a year through that vehicle.
About five years ago we started forming and the investing in form-ups based on Cleveland Clinic technology – 48 companies created, 35 are currently active, the vast majority of them increasingly are in healthcare IT.
We are a 65-person organisation with three functions: the commercialisation of intellectual property developed by our employees; commercialising capability – increasingly developing business models, consulting models around the capability of the Cleveland Clinic physicians or administrators; and, third, to support to a certain extent the increasing emergence of merger and acquisition inside healthcare.
In the past year we have developed innovation alliances. Effectively, Cleveland Clinic Innovations is now developing partnerships with other healthcare systems, to commercialise technologies developed by their employees, effectively providing the same service to their employees as we provide to ours.
Our initial partners are MedStar Health, the largest healthcare system in the Baltimore/Washington region, the second is North Shore Long Island Jewish, the largest healthcare provider in the state of New York, and the second-largest healthcare system in the US.
You are going to see more of these alliances. It’s driven to a certain extent by real practical issues: declining reimbursement, ways to attract the best and the brightest and stakeholders asking ‘what have you done for my region lately"?
As we have got into it we’ve also seen ways that the healthcare systems can collaborate beyond simply just commercialisation as North Shore Long Island Jewish is very strong in therapeutics, while MedStar is very strong in mobile labs, for example. So, it’s bigger than just the commercial echelon.
We do have a relatively small fund creating about five start-ups a year out of the Cleveland Clinic. We have created two out of MedStar to date, and are working on a few out of North Shore, because the notion of aggregating intellectual property certainly is one element of this, but also aggregating capital among providers is another.
James Mawson: You are both almost using similar language – "common healthcare framework" and "innovation alliances" – why have you ended up at this approach now, what are the objectives you’re trying to solve for your parent organisations?
William Taranto: I think healthcare is extremely complicated to understand reimbursement, clinical pathways and how healthcare moves through the system. For example, why would we need to work with the Cleveland Clinic? Well, any one of Merck’s investments and its core business needs a place to test and pilot and learn, and the Clinic is a perfect venue.
Merck has come to the realisation that its competencies are making pills and selling vaccines, but if you move into these health adjacency businesses we have to partner, do alliances with other experts.
Tom Thornton: Our basis is excellence in clinical care. What we realised along the way is that we have an exceptionally innovative culture inside the Clinic. Our most innovative physician at the Cleveland Clinic is our current CEO, Dr Toby Cosgrove – 35 issued patents and an extremely well-regarded cardiac surgeon.
Bill’s comments are interesting, because I would take it and just do the exact opposite. We now realise we can’t carry a start-up very far as we don’t know how to manufacture, we don’t know how to market but we want to use these technologies. So alliances really are important – relationships with venture investors, companies and entrepreneurs – and conscientiously and purposely developing that ecosystem is really important and there is where organisations like the Clinic and certainly corporate venture organisations are similar.
James Mawson: What is success for you?
Tom Thornton: It’s about the money, but it’s actually the notion of empowering their employees, to build a brand around innovation, and, third, care that could be in other areas.
William Taranto: The purpose of the fund is to provide Merck with an opportunity around M&A and built a company that provides a connected framework around better healthcare for the community. But even though I’m a strategic investor, there is always a financial component associated.
James Mawson: How do you go about building the trust or the relationships?
William Taranto: Merck has being doing partnerships for a very long time and they do a tremendous amount of licencing, a tremendous amount of M&A, a tremendous amount of critical validation work for other organisations. So Merck, at the least, has a very good reputation today as a good partner, so just adding another component of venture was actually rather easy. What I think also helps is we bring a construct about how to build an ecosystem in our knowledge of healthcare, and we know we can’t do it by ourselves. I think that starts to establish a little bit of trust.
Tom Thornton: Among providers and maybe hospital systems, the whole notion of partnering has really taken the form, for the most part, of clinical affiliations within a region. They are entirely for competitive reasons fending off a competitor through some sort of affiliation.
We are talking about something totally different so, candidly, I would say that inside healthcare providers the notion of alliances of partnering in non-clinical areas is very new. To a certain extent the Clinic having done this for 12-plus years, it gives us a little bit of a reputation about how to do it, and there is a great deal of trust and respect as it relates to it. But I will tell you that there are a few key things that I think we have done very well: rapid deployment around these alliances – people on the ground within days, literally, card-carrying Cleveland Clinic employees inside the walls of another hospital, is foreign. I think it gives you a perspective then, just how much healthcare has changed, and the really amazing forces that are being exerted in healthcare that would lead to that kind of relationship.
James Mawson: Now, I turn to the floor to see if there are questions?
Andrew Gaule (Corven Network): In Europe, and in the US we have a lot of incumbents companies and legacy technologies. How do you see the high-growth countries?
William Taranto: One of the things that I do with our investments is making sure that we think we can globally transfer the technologies. But, more importantly, we are also a global fund and our goal is to invest as much capital as we can also well outside the US, because there is a lot of innovation. The US is not the only place with innovation, and trying to put as much capital as we can into other markets and help those grow, and, in reverse, bring that technology back. What we typically see, outside the US is there is a much cheaper cost model, especially around diagnostics and devices, and a much better cost model. Our main goal is to make sure that we are investing capital outside and trying to transfer as much of the technology or investment that we have, into as many geographies as we can.
Tom Thornton: On the clinical side it’s interesting – and I mean this more as an observer of some of the opportunities the Clinic has looked into – but, with the exception of Abu Dhabi, I think there has been a general understatement of the value that Cleveland Clinic can bring – in other words, they underpay!
The second comment I would make is on the commercialisation side. This is a global business, and so a lot of the organisations that we’re licencing technologies to or for that matter, looking for investors in companies, clearly that global business matters. We will soon make our first ex-US investment, interestingly enough, in this region [the UK] – without mentioning the name of the company – and we’re doing it for a very interesting reason: we are a surgically-dominated institution, devices are a big deal to us. Just very briefly, a CE mark [regulating products in Europe] is increasingly a pathway, perhaps preferable pathway to commercialisation. We have lacked the ability to actually collaborate with an organisation here in Europe, we’ve found one and lo and behold it’s a great fit for us and we’re actually going to invest in that entity.
James Mawson: Bill, you mentioned M&A to transition a company. How do you buy out a number of their portfolio companies to create a new line of, say, $1 billion of revenues?
William Taranto: That [M&A] is a general philosophy. For us the idea is to learn, we’re investing in companies, as I say, we don’t have competencies. We’ve never run a remote monitoring company, so the whole idea is to learn and bring some of the expertise that Merck can bring, things like clinical validation, we are a global company, global sales force, global marketing, global supply chain – how do those things help that company grow? But for us, we need to learn, to make sure that we understand that business well enough, then to make a decision in whatever period of time as a pitch strategically and financially, then you make the chance to acquire it. If Merck just went out and bought one of these companies right away, I think for them we would probably ruin the company because we just don’t know how to run them, they aren’t the businesses that we’re in, and we are completely different businesses. So this gives again, Merck an opportunity to re-risk their capital, just by taking minority stakes, learning and the making a decision whether or not it fits appropriately and should they maybe potentially acquire. But it’s similar to what Nestlé [did with Inventages] – the bigger difference is, we’re still in healthcare, though, we are still experts in healthcare, they’ve moved into a completely different industry for them, so for us its maybe a little bit more of an advantage, we’re not straying too far. We’re still healthcare.
James Mawson: Could you see yourselves do anything in that way?
William Taranto: I think close adjacency for us would be wellness. We have a pretty strong capability in that particular area, and there’s a real consumerisation in that particular side of the business, so there are multiple examples at least in that particular space where that stuff could happen.
James Mawson: Well, that’s a great note on which to end – wellness is perfect for the conference, so that you very much. [Applause]