Vybrance has closed down — a digital health journey and some lessons
We have stopped offering Vybrance to new customers, and migrated existing customers to other vendors.
These are strange words to type, juxtaposed to my optimistic mindset and narrative of only a few months ago.
Closing a startup is one of the toughest founder decisions, but after a few weeks of deliberation and stabilisation, I’m surprisingly relieved. While typing this article I worked and reworked the title countless times with lots of fluff, before embracing the confronting four words of truth. Props to a hero of mine:
Here is a good place to thank Courtenay, who cofounded Vybrance when it was just an idea and some slides. His patience and persistence shaped our product into reality at an astonishing speed. Starting a company is a wild ride, and Courtenay built our idea into something real. I’m a better founder and friend thanks to him.
Why I’m writing this
Writing this post over a few days has been cathartic, and is the culmination of conversations with friends, advisors, customers and investors in recent weeks. Thanks to everyone who has been so supportive and forward-looking. This is a difficult process for any founder, even when you have done it before.
The optimism bias of believing you can change the world is hard to quell, and at such an early stage, you are dealing with extremely sparse data to tell if you are on the right track. The temptation to wait, “just a big longer”, rings aloud.
There are two goals of my current work:
- Contribute to the corpus of digital healthcare knowledge, so that others may use it. As I have done before, when a company closes quietly, it takes valuable insight and lessons to the grave. This is a loss for the ecosystem, because building companies is a team sport.
- Add to the narrative that failure of a company is natural part of the journey, and to encourage others to take risks and face the outcomes head on (which is also conveniently self serving).
Below is my first pass at dissecting Vybrance’s trajectory, and sharing the valuable parts for others to debate and build on.
Why we started
Vybrance tackled healthcare’s “interoperability” problem; the dizzying array of disparate, siloed and incompatible data and applications. In lay terms, Vybrance offered a common language for healthcare data and applications, joining the dots and building the links between previously incompatible systems.
Common languages are the basis on which we build efficient relationships, communities and industries. Before ethernet, computer networking was a byzantine collection of different physical connectors, cable types, protocols and configurations. Imagine a trying to build a network where nothing connects to anything, everyone is frustrated and waving their respective dongle in the air.
In gaming terms, healthcare organisations are on single player mode.
This is healthcare at the moment, EPIC somehow thinks this isn’t a bad thing, and ironically the patient isn’t even part of the conversation. The just want to get better, or even feel better. Or have sex with their partner. They couldn’t care less about your nerdy protocol problem.
Why we stopped
We had a product, but not a path to scale.
Vybrance brought a solution to market, but we weren’t able to find a business model to sustain us as founders, or to scale our impact. We wanted to improve what we saw as a broken system, but all the good intention in the world can’t overcome a negative cash flow forever.
Wanting to live in Sydney, and with Australian per-capita healthcare spend in the global top 10, we started with the local market. We looked for healthcare organisations and software companies who felt the pain of siloed data, poor visibility and manual processes.
We found plenty, both large and small. Startups naturally faced a barrier to entry to build rich products and experiences, because they couldn't access existing data and systems. However, startups could not pay enough, and were not numerous enough (at this time) to sustain us as founders.
For the larger healthcare organisations, very few were willing to eat the cost, time and risk to solve such structural problems. This wasn’t because they were bad people, but operating in an environment that did not incentivise or reward step changes. In some cases, the opposite.
Based on our trajectory, we also couldn’t see our sales conversion improving drastically in the foreseeable future. Maybe my selling ability had a role to play, but there are definitely some other learnings we would like to share.
What we learned
The challenge is human
As Grahame Grieve put so well in a recent interview and many times before,
“[Healthcare interoperability] is not a technology problem . . . It’s an information and people problem”
In our customer discovery, we found people operating within, and responding to, the incentives for their role, department or organisation. Practitioners want to treat patients, the IT manager wants to avoid breaches, and the board wants to post a profit. No-one wants to be on the front page for a data breach, and no-one ever got fired for moving too slowly in healthcare.
Individuals are a small part of a larger organisations, and we found a low appetite and ability to effect change. Even after we successfully completed pilot, for a prominent evangelist inside a progressive company, we couldn’t gain confidence of further traction.
Risk aversion was a common cause, and importantly, some risks in healthcare are very real. Lives depend on robust systems, and changes to those systems can cause interruption. In some cases, interruptions can harm patients or cost lives.
In summary we were met with an aversion to progress in case of downside, which is paralysing for everyone. This approach ignores all the negative impacts that happen each day by not making progress, but existing negative impacts are rarely born by individuals in healthcare systems, and often put down to, “this is how it is”. Incumbency at its finest.
Ironically in all of this the patient still just wants to get better, and that is the most human part of all. An industry is holding back on enormous macro progress, for the (sometimes understandable) fear of micro mistakes. The healthcare system is seemingly willing to continue its awkward lurch so that no-one needs to be held accountable.
The challenge is diffuse
Most importantly, we learnt that the absence of common data standards and interfaces was a problem felt diffusely by most stakeholders in the healthcare market. Everyone felt it, but noone felt it quite enough. We couldn’t find the chokepoint of pain, where a customer would harass us for our solution.
There is much to be said for Australia’s healthcare system, but its modularity, and government item-based remuneration has a downside. In the absence of a “single payer”, no individual organisation stood to bear the full benefit of any structural improvement, and so had limited willingness to fund it.
We spoke to a federally funded national health agency who wanted to feed diagnostic results back into the practice management systems of any general practice. Currently typed in manually, automating that data transfer would save enormous amounts of human time, and remove manual errors.
To do this, Vybrance would need to connect to all ~7,000 GP practices — which would be incredible for every other player in the healthcare ecosystem too, but understandably that individual agency couldn’t bear the entire cost, because they couldn’t capture all the upside.
Despite having a product that connects between a range of common software systems in Australian healthcare, we were at the mercy of peoples’ incentives. This looks obvious when written down, but we didn’t realise how much those incentives would combine into a fog of oppression, that made progress maddeningly slow, and unviable from our personal viewpoint.
Find a focussed pain point amongst the broad encouragement
A different product or approach or team, or time in history would surely yield different outcomes. Maybe our approach was off, or maybe we are just too early — which is as good as being wrong if you run out of cash before you are right.
Australian healthcare will eventually take up common data interfaces, so that rich applications can flourish and we vocally support those who will continue the charge.
I’m staying in healthcare, because I’m still obsessed with the opportunity; giving patients and practitioners what they want. However, I’m no longer seeking to improve or remedy the complexity at the core of the existing healthcare system — I’m going around it.
Vybrance tackled the incumbency of healthcare head on, by offering connectivity from legacy systems into the outside world. However this model relies on adoption by slow-moving organisations. Or as a CEO I admire recently put it,
“it’s not worth waiting for lazy … corps, insurers and bureaucrats to arrive in the 21st century”.
Instead I am focussing my energy on business models that can create and capture value for patients or practitioners, without handing the reins to the incumbency to decide how quickly.
To give examples, two previous roles of mine were at companies that worked around the incumbency of healthcare, and create(d) enormous value for both patients and practitioners:
- Doctus was Australia’s first DTC (direct to consumer) prescription medication platform, which gave patients access to low risk medication, and doctors a new way to engage with patients. A little ahead of its time, and unfortunately failed unnecessarily due to founder hubris.
- HealthEngine is Australia’s largest platform for healthcare bookings, giving patients that ability to book at their convenience, while bringing new business and efficiency to practitioners. I’m convinced HealthEngine will continue to play a core role in Australian healthcare, and is a natural winner as healthcare channels move online. (FD: I’m a shareholder)
The above are examples of business models that interest me, and I’m fascinated to hear more that fit the mould. Financing, scheduling, logistics and many other verticals are surely ripe for examination.
I’m currently open to businesses both new and existing, and meeting with a range of founders and funders.
As a strong generalist, the short term roles that suit me are COO, Chief of Staff (not the personal assistant version) and GM. Longer term; Cofounder.