Menagerie’s Final Update

We created Menagerie to make it easy for modern couples to confidently choose their wedding vendors. We envisioned a future where every couple would be able to receive personalized virtual wedding assistance and was equipped to seamlessly discover high quality vendors that fit their budget, style and vision.

Along the way, we grew our team, launched a MVP, joined an accelerator and received funding, pitched at Demo Day on both coasts, and worked very hard to deliver our vision to our couples. While there was much success to be celebrated along the way and our second launch in November showed promising initial traction, we eventually discovered that we were struggling with product-market fit.

In this reflection, I summarize and share our biggest learnings, and express gratitude to all those who inspired and supported us along the way. I hope this can not only become a valuable read for existing and future founders, but also motivation knowing that regardless of the outcome, you will have helped people and/or businesses along the way and that this startup journey will forever be one of the most rewarding experiences and greatest learning opportunities of your life.

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Problem Solving for the People by the People

Following an unprecedented election that left Americans divided and displaced, the media in battle over facts with the Trump administration, and the security of every individual uncertain and threatened, we are now witnessing an explosion of organizations and startups focused on uniting people and leveraging the power of collaboration to collect data and build technology to secure our freedom and future.

Fears of government defunding data collection, manipulating data sets and mis-communicating politically inconvenient research have inspired the founding of organizations like Data Refuge, a distributed, grassroots effort around the United States in which scientists, researchers, hackers, students, librarians and other volunteers are collecting government data to preserve it and keep it publicly accessible. Their focus on climate and environmental data is in defense of the White House removing climate data from the EPA website and screening scientific research. Others, like Open Context are helping preserve, annotate and share archeology data.

Find out what other government data is being removed from the Internet at Sunlight Foundation, where they are actively tracking the removal or changes to data sets.

Collaborative research platforms will emerge in every industry to not only aggregate and maintain integrity of data sets but also enable individuals to accelerate the development of solutions independent of government funding and policies.

This is Wikipedia on steroids and much more. Data.world is a social network exclusively for people who want to find and collaborate on building data sets. Similarly, ResearchGate provides a professional network for the scientific community to connect, collaborate, share results and drive progress. Already, more than 11 million scientists and researchers use it and are uploading more than 2.5 million publications each month.

Beyond the civic tech and education categories, this same model of empowering individuals to organize and work together to problem solve has also been successful in transportation with Waze, financial investing with Numerai, app development with GitHub, data science with Dataiku, startup solutions with ProductHunt, and many more.

Success of these platforms have initially been driven by users who are mission-driven, motivated by gamification/monetary rewards, or seeking to build an online portfolio. These platforms crossed over the chasm from passing curiosity to active and productive engagement, enabling them to truly provide more value with each user and establish a sustainable data network to help them accelerate solutions. And as these platforms grow, they will become future leaders in their industries and many will redefine our workforce.

 

Telehealth and the Future of Healthcare

As Washington continues to war over “Repeal and Replace” of the Affordable Care Act, one thing is certain: the need for affordable and accessible healthcare that is patient-centered and personalized. Millions of women, senior citizens, employees and independent business professionals will be affected by the expected changes to Obamacare, including, but not limited to, reduced health benefits and preventative services, discontinued subsidies, and rollback of Medicaid.

Waiting for sweeping government changes is not the solution, and development of innovative health solutions have already been underway. There’s no question that the future of healthcare is digital, where individuals are equipped to self diagnose, doctor communication is remote and timely, medication is on-demand, and data is empowering prevention, drug discovery and development. Concern and curiosity motivated me to explore our current healthcare progress and available solutions.

Remote care delivery will evolve to become the first point of contact for everything healthcare

 

There have been a number of telehealth startups that have entered the space in the last ten years, spanning doctor discovery and scheduling, remote care delivery, prescription management, patient monitoring and education, and more. However, remote care delivery proves to be a unique entry point with strong network effects that will enable it to quickly scale and evolve to offer services and products across the healthcare space.

Copyright© 2014 Motivation Science Inc.
Copyright© 2014 Motivation Science Inc.

While the barriers to entry are low, new entrants’ will face a difficult and costly uphill battle as they attempt to bring on high quality providers onto their platforms, and compete to secure employers and health plan contracts in advance of leaders like Teladoc, MDLive, American Well and Doctor on Demand, who are already expending significant costs to capture market share of these customers. A robust salesforce and brand awareness are key to penetration, but also not effective without offering ease of product implementation & interoperability, billing & claim filing, and regulatory compliance (HIPAA, NCQA). The strategy to secure employers and health plan contracts is an attempt to capture mass membership quickly and establish high switching costs as many self-insured employers (ASO) and insurers may only adopt one telehealth platform; according to a 2016 analysis released by the Congressional Budget Office, ~155 million Americans have employer-based health insurance coverage.

However, there is room for certain specialist-focused telehealth startups, such as Spruce, who is primarily focused on the dermatology market, which remains untapped by incumbents and accounts for >5% of annual visits, or 56 million visits. This type of specialist visit is recurring and typically costs higher (up to 3x – 4x the cost of a primary care visit).

The existing focus among players remains client growth, but the future indicator of market dominance will be member conversion and [recurring] utilization to drive PMPM, visit fees and secure client relationships. Achieving these future indicators will rely on management, business models, consumer-centered & mobile-optimized products, and seamless integration of concentric mergers.

Why now? – Political

This future of healthcare has been accelerated because of easing regulation on telemedicine definition, reimbursements and coverage. Already in 32 states and the District of Columbia there are parity laws that require private insurers to cover telemedicine visits the same way they cover in-person encounters, and in 49 states and District of Columbia reimbursements are now provided for video visits in Medicaid fee-for-service programs.

Additionally, more states have removed the requirement for a tele-presenter to be present during a virtual consultation. Finally, 18 states have enacted laws to join the Interstate Medical Licensure Compact, which will begin to grant crossborder licenses.

Why now? – Social

Easing regulation complements today’s consumer needs. Consumers no longer want to pay high costs for healthcare and are looking for more personalized care at a time when many of the other decisions they make on a daily basis have been empowered with technology and made more affordable, accessible and personalized (i.e. food, wealth management, online streaming, transportation, travel, shopping). Early direct-to-consumer fitness trackers and health apps invited consumers to increasingly value and invest in their health, and track their own progress and symptoms.

Telehealth will continue to gain traction especially at a time when Repeal and Replace Obamacare risks exacerbating lack of access and rising costs. Approximately 1/3 of all ambulatory care visits, or 417M, are treatable via telehealth, which would result in an annual saving of $6 billion in U.S. healthcare costs. Cost saving opportunities via telehealth are also true for other specialist services.

Big 4 Telehealth

The four largest telehealth players are Teladoc (NYSE: TDOC), MDLive, American Well, and Doctor on Demand. Despite Teadoc’s current leading market position with ~17M members, it still represents only a minority of the whole market.

Teladoc Investor Presentation

Of these four, Doctor on Demand (DoD) is unique as it does not charge a “Per Member, Per Month” (PMPM) subscription fee, which typically costs $1 PMPM. Unlike the other three, DoD only charges visit fees, which they keep ~25%:

Medical Doctor:
$49 for a 15 min consultation

Psychology:
$79 for a 25 min consultation
$119 for a 50 min consultation

Lactation Consultant:
$99 for a 25 min consultation
$229 for a 45 min consultation

As telehealth platforms compete for employers, DoD offers an affordable option without the PMPM fee. While DoD’s model lacks the initial recurring revenue from PMPM fees, it is able to more easily align with the cost savings and ROI incentives of employers, drawing evidence that utilization rates are below 5% with other major players; Compared to Teladoc’s 5%< utilization rate, DoD boasts a much higher utilization rate of 25%-30%.

In other words, the cost per visit with Teladoc is significantly higher than $49 when factoring in PMPM. This strategy has had promising evidence as DoD now has about 400 employers (200% increase YoY) including Comcast and Union Bank & Trust, covers more than 45 million Americans and has secured relationships with UnitedHealth, Highmark*, Humana, and a number of Blue Cross Blue Shields.

*Highmark ended $1.5M contract last year with Teladoc to switch over to DoD and American Well. Most Teladoc contracts are only 1-year old…

Adoption goes both ways.

Slack, Dropbox, LinkedIn and many others have demonstrated that adoption goes both ways. And similarly, monetizing the B2B becomes much easier to achieve if you’re able to demonstrate success with B2C. DoD has since introduced a Per Provider Subscription Fee…(I don’t have numbers around this).

This is a defining time for healthcare – the winners have yet to take all and new entrants will need to be thoughtful about their unique entry point and resourceful with acquisition.

Tiffany’s Birthday Fundraiser for BrightEyes

Please help me celebrate my 25th birthday by joining me in contributing to BrightEyes, a mentorship program dedicated to providing college students a unique opportunity to explore different career paths.

Four years ago, I started BrightEyes in hopes to make mentorship and career opportunities more accessible to students. With your help and generosity, we will be able to send a class of students to San Francisco, where they will be able to meet with their role models and future mentors as well as tour leading companies in startup, tech and venture capital.

I’ve also decided that I would be matching the total donations made on my campaign page, up to $1,000, so please consider giving!

To be successful, we all require someone willing to invest in our potential and vision. We’ve all had someone invest in us along the way. Join me in investing in these students’ vision and potential.

Contribute to BrightEyes: http://brighteyes-students.org/donations/

If you are not in a position to donate monetarily, please like BrightEyes on Facebook and share the program with friends & family, on Facebook, Twitter, and anywhere else you’d like!

Thank you for helping me celebrate my birthday this year.

My Notes on “Notes on Startups, or How to Build the Future”

I’ve decided to share my notes and thoughts on Peter Thiel’s Zero to One. Additionally, I’ve also embedded suggested reads in my notes that are relevant to the topic or chapter. For those who haven’t read the book (read it!), here’s a preview of it and some of the more powerful takeaways for me while reading it. For those who have read it, I hope this is a helpful reminder for you and a good reference as you continue to help build our future.

Note: Comments in parentheses are my own.

Zero to One
Peter Thiel with Blake Masters

(1) The Challenge of the Future

The act of creation is singular, as is the moment of creation, and the result is something fresh and strange.

By creating new technologies, we rewrite the plan of the world.
Debate: Is there a formula for entrepreneurship?

The single most powerful pattern I have noticed is that successful people find value in unexpected places, and they do this by thinking about business from first principles instead of formulas.

What important truth do very few people agree with you on?

Conventional beliefs only ever come to appear arbitrary and wrong in retrospect; whenever one collapses, we call the old belief a bubble.

What triggered dot com bust / bubble pop?

Dot Com Timeline

(2) Party Like It’s 1999

4 Lessons from Dot Com Crash:
1 – Make Incremental Advances

2 – Stay Lean and Flexible: lean = unplanned. You should not know what your business will do; planning is arrogant and inflexible. Instead you should try things out, “iterate” and treat entrepreneurship as agnostic experimentation.

3 – Improve on the Competition: don’t try to create a new market prematurely. The only way to know you have a real business is to start with an already existing customer, so you should build your company by improving on recognizable products already offered by successful competition

4 – Focus on Product, not Sales: technology is primarily about product development, not distribution

( Did companies like Product Hunt have a market-ready product first or did they build with the market and succeed with distribution as a result of social media?)

(3) All Happy Companies are Different

Monopolists, by contrast, disguise their monopoly by framing their market as the union of several large markets:

(Examples)
Search Engine X Mobile Phones X Wearable
Computers X Self-driving Cars

Monopoly is the condition of every successful business

(4) The Ideology of Competition
Carl von Clausewitz
Sun Tzu

(5) Last Mover Advantage

A great business is defined by its ability to generate cash flows in the future.
(Bubbles form when individuals inflate a company’s ability to generate CF in the future!)

Characteristics of a Monopoly:
1 – Proprietary technology: rule-of-thumb prop. tech must be at least 10X better than its closest substitute
2 – Network effects: network effect businesses must start with especially small markets
3 – Economies of scale
4 – Branding

People then products then traffic then revenue – Marissa Myer’s rebrand of Yahoo!

(It’s a balance of first-mover advantage and last-mover advantage)

(6) You are Not a Lottery Ticket

“Success is never accidental.” – Jack Dorsey on twitter

(Most people believe getting a job in finance is impossible without previous finance experience or technical skill set. The same is true for when people think about getting a job in tech. It’s possible to create the experience for yourself by accessing the same resources, engaging in the same conversations and building the same relationships with those already in those roles in the industry. So really, nothing is impossible because nothing can’t be learned.)

(Diversification of experiences and skill sets. In my opinion, specialization is overrated. I haven’t felt the need to specialize to be successful, only to be good at what I’m currently doing. And if you’re doing what you’re passionate about, you can’t fail.)

You’ve spent a decade curating a bewilderingly diverse resume to prepare for a completely unknowable future. Come what may, he’s ready – for nothing in particular.

Indefinite Optimism

Today, “good design” is an aesthetic imperative
It’s true that every great entrepreneur is first and foremost a designer
Visual + Experiential Perfection

(Design your business)

(7) Follow the Money

Two Rules for VC:
1. Only invest in companies that have the potential to return the value of the entire fund
2. Because rule number one is so restrictive, there can’t be any other rules

People who understand the power law will hesitate more than others when it comes to founding a new venture: they know how tremendously successful they could become by joining the very best company while it’s growing fast.

(8) Secrets

What secret is nature not telling you?
What secrets are people not telling you?

The actual truth is that there are many more secrets left to find, but they will yield only to relentless searchers.

A great company is a conspiracy to change the world.

Thiel’s Law: a startup messed up at it’s foundation cannot be fixed

(9) Foundations

To anticipate likely sources of misalignment in any company, it’s useful to distinguish between three concepts:
1. Ownership: who legally owns a company’s equity?
2. Possession: who actually runs the company on a day-to-day basis?
3. Control: who formally governs the company’s affairs?

Anyone who doesn’t own stock options or draw a regular salary from your company is fundamentally misaligned

Any kind of cash is more about the present than the future.

(10) The Mechanics of Mafia

‘Company culture’ doesn’t exist apart from the company itself: no company has a culture; every company is a culture

Never outsource recruiting

Why should the 20th employee join your company?

2 Great Points of Evaluation of a Candidate:
1. Good candidates can answer why your mission is compelling or why you’re doing something important that no one else is going to get done
2. Why is your company a good match for the individual personally

Everyone at your company should be different in the same way

The early team should share a common, unique obsession/idea that relates to the company’s mission
(Value propositions must be defined early on. Essentially, you’re forming a cult. Airbnb is one of the best examples of a great culture that’s continued despite its growth in size)

On the inside, every individual should be sharply distinguished by her work

Defining roles reduce conflicts
– Most fights inside a company happen when colleagues compete for the same responsibilities; startups face an especially high risk of this since job roles are fluid at the early stages
– Eliminating competition makes it easier for everyone to build the kinds of long-term relationships that transcend mere professionalism

Every company is also its own ecosystem

(11) If You Build It, Will They Come?

The engineer’s grail is a product great enough that “it sells itself.” But anyone who would actually say this about a real product must be lying…

If you’ve invented something new but you haven’t invented an effective way to sell it, you have a bad business – no matter how good the product.

Advertising works for startups when CAC and CLTV make every other distribution channel uneconomical (i.e. The advertisements justify the method of acquisition because of users and revenue achieved…all about ROI)

A product is viral if its core functionality encourages users to invite their friends to become users too. (Network effects in The Networked Age)

Just get on distribution channel to work, then have a great business

Important to have PR strategy; selling company to media is necessary part to selling to everyone else

(12) Man and Machine

People compete for jobs and for resources; computers compete for neither

But big data is usually dumb data. Computers can find patterns that elude humans, but they don’t know how to compare patterns from different sources or how to interpret complex behaviors. Actionable insights can only come from a human analyst

(Will this statement always be true? Maybe the human role will change but will not become obsolete with new technologies that require human guidance but predictive analytics will become so powerful that patters across sources can and will be effectively interpreted by computers)

(13) Seeing Green

Seven questions every business must answer:
1. The Engineering Questions: Can you create breakthrough technology instead of incremental improvements?
* Proprietary technology significantly differentiates?
2. The Timing Question: Is now the right time to start your particular business?
3. The Monopoly Question: Are you starting with a big share of a small market?
* Identify and Own a niche market
4. The People Question: Do you have the right team?
5. The Distribution Question: Do you have a way to not just create but deliver your products?
6. The Durability Question: Will your market position be defensible 10 and 20 years into the future?
* The Last Mover
7. The Secret Question: Have you identified a unique opportunity that others don’t see?

Myths of Social Entrepreneurship:
“…corporations have great power, but they’re shackled to the profit motive; nonprofits pursue the public interest, but they’re weak players in the wider economy. Social entrepreneurs aim to combine the best of both worlds and ‘do well by doing good.’ Usually they end up doing neither.”

Great companies have secrets: specific reasons for success that other people don’t see.

(14) The Founder’s Paradox

A unique founder can make authoritative decisions, inspire strong personal loyalty, and plan ahead for decades.

Paradoxically, impersonal bureaucracies staffed by trained professionals can last longer than any lifetime, but they usually act with short time horizons.

*We need founders…a great founder can bring out the best work from everybody at his or her company

(Conclusion) Stagnation or Singularity?

“Our task today is to find singular ways to create the new things that will make the future not just different, but better – to go from 0 to 1.”

The Right Voice is Your Voice

social_media

These days, if your company doesn’t have a voice online, it doesn’t exist to people. Online presence is necessary, but even more important than being online is having the right voice and content.

Many startups outsource their social media management, and while it may work initially with creating an online presence, it is not recommended when building an online brand. A company’s online voice needs to be consistent with the overall company’s mission, vision and current initiatives. An individual outside of the company does not have that transparency into the company and especially with early stage companies, initiatives are constantly changing and emerging and direction is constantly adapting to market responses. This brings me to another point, that social media is one of the most effective ways to gage market response to your product without spending lots of money testing and collecting consumer feedback. Eventually, your social media channels will also become a form of customer service, where you will be able to respond directly and in real-time to customer concerns or feedback. You definitely need someone who understands the product and process and is up to date with the company to fulfill this role.

Not every channel is right for every business.

This is important to understand because pushing content out where your target audience isn’t will waste time, resources and content. And more importantly, the goal to increase brand awareness and engagement will not be achieved. Identifying the right social media channels requires a strong understanding of the business, vision and short-term and long-term initiatives and goals. As the company grows, channels may also be added.

While an external agency or individual may be able to provide the right type of content, it won’t be able to create personal interactions with potential users and provide transparency into the company and product, a necessary function of social media. To be clear, this is more true for twitter and instagram than for blogs. Unlike blogs, twitter and instagram are more interactive and the content shared on those channels are more frequent and require more effort to be consistent.

Each channel has its own voice and strategy.

This pretty much says everything. To build a truly strong brand on a channel and engage your audience, you must customize your voice and content to that platform to reach the right audience. On twitter you may want to reach a broader audience (across your industry) but on instagram, where the demographic and type of engagement is different than that of twitter’s, you will want to be more focused on a specific audience, which will determine the type of content shared.

Here are a few examples of social media frameworks for different types of businesses:
– Showcase Fans and Customers (e.g. Lyft shares customers’ experiences with drivers)
– Motivational/Inspirational (e.g. Nike, Gatorade, Lululemon)
– Umbrella Theme (e.g. Shapeways & 3D Hubs share all things 3D printing related)

On instagram, we are seeing many companies showcase their communities rather than share their own content (SoulCycle, Flat Tummy Tea, Lole Women, 3D Hubs).

We are seeing more and more companies become more successful as a result of their online presence (Warby Parker, Bevel, Well+Good, Peek, Wealthfront). And in some cases, companies are being formed as a result of a community that has formed online first (Product Hunt, Startup{ery). Social media can be one of the most valuable intangible assets to a company so treat it as your own and expect to create value from within not from without.

The Lesson: Don’t Oursource Social Media Management