How To Open A Travel Medicine Franchise?

Here on Freelance MD we often discuss unique business opportunities for the medically inclined or interesting clinical practice models.

One of the interesting opportunities that I've come across is the possibility of opening a travel medicine clinic through a franchise model with the company Passport Health.

Headquartered in Baltimore, Maryland, Passport Health allows owners to buy into their franchise model and "own" a specific geographic region for development.  They currently have over 160 locations and their website mentions opportunities for the entrepreneurially-minded:

If you are a health care professional or entrepreneur with appropriate connections, we can help you achieve your dreams. Passport Health is an excellent business opportunity for the right individual. Passport Health is a simple, low-overhead service company, which provides immunizations to those about to travel to a foreign country. Basically, we are in the immunization business; we offer on-site services such as Flu and Hepatitis clinics. However, we also specialize in safety and security travel information. We are already a household name in many areas across the country, but there are plenty of great territories remaining.

A follow-up email from the company provided more specific information about their franchise opportunity:

We generally sell large territories, including a city and the surrounding counties, with the owner expected to open multiple offices over time.  Our franchise fee is $35,000.00, and it includes training (5 business days), videos, materials and the use of our exclusive software, Passageware.  There is no build-out and very limited start-up expenses. Owners consist of doctors, nurses, and entrepreneurs, with one hospital (Sentara in Norfolk) and one university system (University of Rochester School of Nursing).  Due to the hard work of the individual owners and our marketing team, we are constantly adding corporate accounts and our business model is ever expanding to include all areas of vaccines.

Besides being an interesting field, Travel Medicine is open to healthcare providers from a variety of backgrounds.  While many Travel Medicine providers are trained in Infectious Disease, I know physicians with many different backgrounds involved in Travel Medicine.  

For those interested in Travel Medicine and desiring increased training in this area, our ExpedMed courses are an excellent way to be exposed to this niche.  Two Executive Board members from the International Society of Travel Medicine, Dr. Alan Magill and Dr. David Shlim, will be speaking this year at our Expedition Medicine National Conference that will be held September 16-18, 2011 at the Omni Shoreham hotel in Washington, DC. A prior post here on Freelance MD described other, multi-month programs in Tropical Medicine that are also available for those with increased desire and more time to invest.

How Will You Fund This Dept, Ms. Chairwoman?

Academic departments will need to be more entrepreneurial to grow.

The other day I ran into one of my mentors outside of  the operating room. He's 93 years -old- wise and was worried about how the Department of Surgery would approach the recruitment of a new chairman.

My colleague. who was my first boss,  landed on the beaches of Normandy as a young Navy corpsman, rose to the rank of Rear Admiral, was an advisor to Presidents and the Pentagon and served as the Chairman of Surgery at 3 top-ranked academic programs. He's also climbed the tallest mountain on every continent and is beginning to write his next book. He is arguably one of the icons of academic surgery. So, when he talks, I listen.

He proposed that the search committee ask each candidate several important questions and, knowing about my interest in entrepreneurship, wondered what I thought. One question will be:

"Doctor Bigstuff, given dropping basic science research funding, dropping reimbursements, inefficiencies in the practice of academic medicine,  and the ineffectiveness of the current system gettting biomedical innovation to market, how will you fund the Department of Surgery over the next 5-10 years?"

Here's what I said.

Academic departments need leaders who are quadruple threats, not triple threats.

If any of you have served on a search committee, or interviewed for chairman jobs, you know what the job description looks like. "We are seeking a world class academic surgery leader who has won the Nobel Prize, generates a gazillion dollars in clinical revenue, has won every teaching prize known to man, and can leap tall buildings in a single bound." There is rarely any mention of entrepreneurship, ability to work with industry or networks to stakeholders outside of academia. Development and commercialization needs to be the fourth (or fifth) mission of academia along side of research, patient care, service and teaching and department heads should have the knowledge, skills, abilities and networks to get the job done.

Academic entrepreneurship begins with department heads creating an entrepreneurial ecosystem that will take many years to evolve

What do entrepreneurial departments look like? Here are 10 things to look for:

1) They have a top down driven vision and strategy

2) They have clearly defined entrepreneurship learning objectives for trainees and faculty that are diffused throughout the department

3) They have robust internal and external networks to all stakeholders

4) They have an  ecosystem that fosters a culture of innovation

5) The training program includes experiential learning and knowledge transfer opportunities

6) Recruitment, development , promotion and retention policies reward entrepreneurship

7) There are highly valued academic-industry open innovation collaborations

8) Barriers to participating in biomedical commercialization are eliminated

9) They cheer their champions and celebrate success though internal and external communications

10) They are led by someone with some industry experience

The new recruit should present a departmental entrepreneurship plan that defines timelines and milestones

Like any strategic plan, the candidate should take inventory of where the department is now, where they want to go , and how they want to get there. In answer to the question, it should define where non-clinical, non-basic research revenues will come from , how and how much.

Creating an entreprneurial university hinges on creating entrepreneurial departments led by entrepreneurial department heads leading entrepreneurial faculty and trainees. It's not liberating Europe from the beaches of France, but it is a tall but necessary order if stressed academic biomedical departments are to continue to  thrive.

Intelectual Property: Why you should care about Stanford vs. Roche

The Supreme Court will now decide who owns what.

The Supreme Court has agreed to hear Stanford v Roche. In this case, the federal circuit in September 2009 ruled against the university's claim of rights over an invention that measures the effectiveness of HIV treatments. Even though the inventor did research under a National Institutes of Health grant to Stanford, he also was working for a company later acquired by Roche and made an agreement assigning his rights to that company. Stanford claimed title to the invention under the Bayh-Dole Act of 1980, and in 2005 sued Roche, asserting the company was infringing its patent in its marketing of HIV detection kits. The circuit court ruled that Roche "possesses an ownership interest" and rejected Stanford's claim.

Why should you care about any of this? Here are two good reasons:

Because if you are an employee of a healthcare organization, your employer might make you sign an employment agreement assigning your intellectual property rights as a condition of employment

For example, when I started working for the Univeristy of Colorado, I did not sign an employment agreement. Under common law and case law surrounding Bayh-Dole, the 1980 act that gave univeristies the IP rights to research funded by federal grants, I was asked to assign my IP rights to the University as part of the inventions disclosure and patent process after the fact. But, forget academic faculties. In 2001, about 20% of US doctors were not self-employed. In my specialty, only about 5-6% of the approximately 9500 otolaryngologists in the US are academics.

The number of doctors working in wage and salary situations continues to increase. Physicians and surgeons held about 661,400 jobs in 2008; approximately 12 percent were self-employed. About 53 percent of wage–and-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. Others practiced in Federal, State, and local governments, educational services, and outpatient care centers.Physicians and surgeons held about 661,400 jobs in 2008; approximately 12 percent were self-employed. About 53 percent of wage–and-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. Others practiced in Federal, State, and local governments, educational services, and outpatient care centers. http://www.bls.gov/oco/ocos074.htm

Regardless of how the Supremes rule, the case has muddied the waters leading employers of knowledge workers to tighten the reigns.

Because now it might be harder for you to get money for your idea.

Investors, like VC's, hate uncertainty. In an amicus brief filed with the Court, the American Venture Capital Assn pointed out that the Federal Circuit’s decision would tend to discourage venture capitalists and established companies from committing the “risk capital necessary to develop [federally funded] inventions to the point of commercial application".

If you are interested in bioentrepreneurship and are an employee, whether you are in an academic or non-academic setting, keep your eyes on Stanford v Roche.

The 12 Steps To Biomedical Innovation

The 12 step path from an idea to a successful innovation or commercial venture.

We’ve all had great ideas. Whether the insight comes to you in the shower, while driving to work, or in a dream, a new concept or thought pops into your mind and begs for attention. Very few ideas, however, actually see the light of day. The difference between an idea and innovation is what happens after you think of the new idea. Innovation is about inventing something that can create economic value in the marketplace. Ideas are commodities, but innovation is about finding and validating the business opportunity that both the leadership of the organization and its culture embrace and commit to and which is connected to its business strategy.   Implementing innovation is the hard work that goes into conceptualizing an idea to take advantage of a market opportunity and executing a commercialization plan that gets results.

 Today in health care, whether it be drugs, devices, diagnostics, healthcare IT or alternative care models,  successful innovation is about both predicting and observing patients’ wants and needs and satisfying them with new products and services.

 Now, more than ever, industry and health care entities need physicians to help them innovate to stay competitive. Our post-capitalist economy is driving leaders to harvest new ideas and the intellectual capital of their knowledge workers. Success depends on using processes for creating and analyzing new ideas.  Limited time and competition for resources requires prioritization.

The 12 Step Roadmap to Innovation

The path from an idea to a successful innovation or commercial venture is lined with mine fields that can sabotage success at any step. At Venturequest (http://www.venturequestltd.com ), my colleague, Courtney Price, and I have worked with multiple organizations in industry, academia and government labs.  We have developed and applied a 12 step process to increase the success rate for implementing innovation and creating new revenue streams. http://www.ncbi.nlm.nih.gov/pubmed/16615405 The process is designed to quickly eliminate ideas that don’t have a high likelihood of market success, that don’t fit with the strategic mission of your health care organization, or that involve too high a level of market, technical, intellectual property or implementation risk for the proposed return on investment. Our 12 Step Innovation Roadmap provides a framework for screening, incubating, commercializing, and benchmarking the success of new ideas and tested including tools and protocols for health care providers.  At each step of the process, a Go or No-Go decision is made about the opportunities. Sometimes the opportunity skips some of the steps based on the market and stage of development.  Below is a brief description of each step.

Idea generation consistent with the strategic plan

Ideas are a dime a dozen.  The challenge is finding ideas that match the business strategy, connect with senior management, and are embraced by the organization’s culture.  Such ideas leverage the core competencies of the organization as well as build on its intellectual assets including intellectual property, branding, new technologies, etc.  They both build upon sustainable core competencies as well as forecast future breakthroughs. Brainstorming or collecting new ideas that don’t match your facilities culture or its strategic plan will have a limited chance of success. 

Concept development and initial testing

Once ideas are selected that meet the above criteria, it is necessary to describe their uniqueness and determine if there could be a sustainable competitive advantage. A clear value proposition, i.e. the worth, importance or usefulness to your customers, should be clear early in the process.  As you obtain more information about the opportunity, the business concept will change over time in response to newly discovered market, competitive, and patient information. The next steps involve a series of iterations designed to refine your idea.

Seven-Step Opportunity Evaluation

After the concept is developed, it is time to quickly assess the potential opportunity by using a quick Seven-Step Opportunity Evaluation which takes less than 30 minutes to complete.  It addresses the problem being solved, the potential opportunity, and the market for the opportunity, potential revenue, required funding, intellectual property creation and protection, and stage of development.  It also identifies potential customers, competitors, and commercialization viability.  This quick analysis will help you define whether the business, industry or markets you propose to enter are appropriate. It will also help you define what kinds of people you will need to make your venture successful.

Model Opportunity

Once the concept is evaluated using the Seven-Step Opportunity Evaluation, it is time to discover the inherent strengths and weaknesses of the opportunity.  This software tool is based on 24 distinctive characteristics to objectively evaluate the opportunity.  The purpose of this protocol is to identify the Achilles’ heel of the concept. It was designed to assist physicians and researchers without a business education to objectively evaluate the opportunity.  As weak areas of the concept are improved, the better chances it has for success. If you identify potential risks or threats that cannot be address, then the idea should be abandoned. 

Business Opportunity Assessment

The  Business Opportunity Assessment is a more in-depth review of the opportunity including market research and due diligence that includes IP analysis, opportunity development timing, legal liability issues, applications of the opportunity, barriers to entry, industry trends, growth potential, market positioning, competitive analysis, financial projections and pricing, resource requirement analysis, and licensing potential to name a few.   These are the important considerations to address if it looks like the opportunity has a strong commercialization potential.  This software tool is designed in a question and answer format which make it easy to complete a 360 degree assessment.

Market Validation

Once you have completed the Business Opportunity Assessment and have decided to proceed, the Market Validation process focuses on obtaining feedback on how the opportunity addresses specific market needs as well as taking a hard look at your competition. This step helps differentiate the opportunity from competing opportunities based on patient needs.  This process maximizes perceived patient benefits and eliminates extraneous features that increase costs.  This experience-based market learning is critical to market success and helps develops better business judgment for a Go or No-Go decision.

Revise Business Opportunity Assessment

Based on the results of the Market Validation, you can now revise your Business Opportunity Assessment and build a commercialization strategy.

Finalize the Commercialization Plan

By this time, you should have a good idea about whether you have a viable innovation. Since your idea will be competing for resources with other ideas, however, you will need to prioritize and decide which has the best odds for success. You will need to carefully hone your business model. You will now write your business plan that succinctly describes the story of your proposed business.   The good news is that by this time approximately 70 % of your business plan has been written.  

Write the Business Plan

Now it’s time to write your final business plan. Unfortunately, most entrepreneurs go immediately to this step first without using appropriate filtering systems.  This results in a business plan that has unvalidated assumptions and is rejected or leads to an enterprise that fails.

Solicit feedback and revise the Business Plan

After the business plan has been written, it is time to solicit feedback from respected advisors who will provide realistic options about the potential of commercializing the new opportunity.  Their opinions and suggestions should be incorporated into the final business plan. 

Present the Business Plan.

It is now time to present the Business Plan and get stakeholder approval and resources to launch new venture.

Execute the Business Plan

Congratulations. You’ve got the go ahead for your new idea. Now the work begins. Fortunately, your winning business plan based on the 12 step pathway will provide an operational road map to track and benchmark the efforts to commercialize the opportunity.  Your plan will provide you with the timelines and metrics for success. A strong Executive Summary should be distributed to the review board before the presentation and a succinct Elevator Pitch should be developed. 

Whether you are considering a product or service or process improvement, the 12 Step Plan is a useful guide to getting your idea to market quicker, for less cost and with more success.

The Pickup Line

A clearly articulated value proposition is something your grandmother could understand.

The story goes an eager entrepreneur walks into the office of a potential investor. Eager to present his pitch, the inventor sits in front of the investor’s desk and gets ready to start his well -rehearsed pitch. Before he could get out the first word, however, the investor throws a match book across his desk and quietly says, “On the back of that, describe your idea”.

While there are unique challenges and characteristics of new bioenterprises, fundamentally the elements of success are the same as any other business.

The first task is to define your position based on the target segment you intend to dominate. Too often, particularly with technologically based companies, the inventor or scientist discovers  or invents something .  They then start the process of a solution looking for a problem. Instead of being problem solvers, a more successful strategy is to be a problem seeker, design a solution that is better than what is presently offered and execute a plan to commercialize it.

Once you identify a large, growing, important, potentially profitable unmet need, the next step is to define a value proposition that describes how you intend to dominate the market  you’ve identified.  Value is the difference between the tangible and intangible benefits of buying a product or service minus (or divided by) the tangible or intangible costs.  Your value proposition is the promise you make to your customers to provide them value if they buy or use  your product.

The third element of success is to construct a business model, i.e.  provide your product or service in such a way that it costs less to make it and sell it than what people are willing to pay for it thus generating a profit and sustaining the business.

Finally, your value proposition and business model will need to be better than the competition. Otherwise, there is no reason for customers to switch or consider your product.

There are several models for articulating your value proposition and they are typically used to create an elevator pitch.

One model , described by Geoffrey Moore in his book “Crossing the Chasm”,  is to use the following template and just fill in the blanks:

• For (describe the target customers-beachhead segment only)
• Who are dissatisfied with (describe the current market alternative)
• Our product is a (new product category)
• That provides (key problem solving capability)
• Unlike (the product alternative or competition)
• We have assembled (key whole product features and benefits )

Another similar model is the NABC model:

• Define the NEEDS of the target segment
• Say what APPROACH you are taking to eliminate the market pain
• State clearly the BENEFITS /Cost of using your product
• Differentiate your product from the COMPETITION

The development of your feasibility, commercialization or business plan should result in a clearer and more precise , compelling value proposition as you go through several iterations of analysis. You’ll know you are getting close when you can tell someone your value proposition in the brief time it takes to go up a few floors in an elevator or on the back of a matchbook.

Being A Medical Entrepreneur Is Risky Business: Spotting The Landmines

Your job as an medical entrepreneur is to kill your idea early and often.

The innovation landscape is littered with buzzwords describing the impact of new ideas: earth-shattering, killer-app, disruptive, blockbuster, game-changer. Your idea, invention or discovery might be one of them. However, before you get ahead of yourself, or full of yourself, take time to do a high-level risk assessment. In this exercise, your goal is to kill your idea early and often and continually ask "Why shouldn't I kill this idea now?"

In bioinnovation, the risk categories generally include:

1. TECHNICAL RISK: Will my invention or discovery do what I claim it will do?

2. FUNDING RISK: Will I be able to get the money to do what I want to do when I want to do it?

3. INTELLECTUAL PROPERTY RISK: Will I be able to protect the intellectual property I create, control it,  and defend it?

4. EXECUTION/TEAM RISK: Will I be able to surround myself with experienced exectives who wil be able to execute our business plan?

5. MARKET RISK: Is their a large enough unmet need that will continue to grow and be profitable?

6. INDUSTRY RISK: Will the industry continue to grow and be immune from threat of substitutes, competitors, shifting supplier and buyer power?

7. BUSINESS MODEL RISK: Will your proposed business model, i.e., how you will make money, work?

8. REVENUE MODEL RISK: Are your assumptions about number of leads, conversion ratios, units sold, revenue/unit and repeat business valid, or are you betting on "only" .1% of the China market?

9. COST RISK: Are your fixed and variable cost projections reasonable?

10. REGULATORY AND REIMBURSEMENT RISK: Will you be able to get FDA approval and get someone to pay for your drug , device or diagnostic before the money runs out?

Give yourself 1-10 points for each category.

70-100: You've got a shot

50-70: Sounds like you have more work to do

<50: Don't give up your day job.

Performing this risk analysis before moving ahead with a formal feasibility plan (forget the business plan, dude, you are SO not there yet) will help you avoid spending time, effort and lots of money on an idea that was DOA from the beginning. The last thing you want to hear is your spouse telling you "I told you so".

Dancing For Dollars: Raising Seed Stage Capital

Finding the right investor is about much more than finding someone to write you a check.

Dancing with the Stars continues to get good ratings, maybe because of the the Palin factor, maybe because of the ornate, skimpy outfits or bare –chested celebrities strutting their stuff in front of millions. I don’t watch the show very often, but I’m a big fan of another extravaganza of choreography, the early stage company money dance, the money minuet, the cha-cha for cash. In this intricately interwoven , highly developed two-step , inventors and investors feel each other out, try to find the right fit and come to terms in a process that easily trumps the best fox trot, flamenco or fandango.

One takes the lead, the other follows. Eye ball to eye ball, with dramatic flair, there are moments of action, suspense, intrigue, passion , deception, and dazzling technique, all summed up with an exciting lift or a death defying twirl before the big ending. What’s more, I work on both sides of the aisle as an advisor to an investment bank, HeadwatersMB and to early stage companies looking for money, so I get a front row seat to the finals.

There are several articles and tips on what investors look for. The titles of the articles typically start with “5 Things" or “What investors look for". Like a ballroom dancer, though, let’s talk about what inventors should look for in a good investment partner.

Firstly, can they execute? Does the investment banker , private equity or money manager have a track record, connections, a client list, business process and skill sets to find the money and get the deal done within your time frame and budget. With the IPO market deader than a duet without music, target investors will come from family offices, endowments, private money and strategic partners. BioAngels, are hard to find outside of most major bioclusters. For that reason, the geographic coverage of your investment partner should be broad.

Secondly, is there a fit? Like a well matched couple performing the paso doble, you should find a partner with the same risk temperament, personality, and business savvy as you. They should have a technical background and a client list in industries similar to yours, with a thorough understanding of the investment landscape in your industry or specialty.

Finally, there are the intangibles. That certain “je n’ais sais quois” -the drama of their pitch, the energy to do the job, compatibility or having a feel for what you are trying to achieve. They just get it.

Finding the right investor is about much more than finding someone to write you a check. Anybody can move their feet when the music starts. Your job is to find a partner with whom you are in synch and who will work with you over the long term even after the music stops.

Ok. One, two, three...