While many entrepreneurs may have found it more challenging to fund their ventures recently, Daniel Hawkins raised not one, but two funding rounds in the middle of the 2020 COVID pandemic, totaling over $100M. His company, Avail Medsystems, has raised over $100 million from top-tier investors like D1 Capital Partners, Sonder Capital, Coatue, and Playground Global.
- In this episode you will learn:
- What Avail is doing
- Why product-to-market fit is so important
- Learning to invent
- Daniel’s top advice for other entrepreneurs
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About Daniel Hawkins:
Daniel has over twenty-five years experience in executive management, marketing, product management and business development roles in both large and emerging medical device companies including Advanced Cardiovascular Systems, Inc. (ABT), Endologix (ELGX), Restore Medical (MDT) and EnteroMedics (ETRM) and Intuitive Surgical (ISRG).
He is a Co-founder of Calibra Medical (JNJ) and Founder/CEO of Shockwave Medical (SWAV) where he led the company from concept to multiple regulatory approvals, built the company to 96 people, initiated commercialization in multiple countries and successfully raised over $100M.
Daniel holds an MBA from Stanford, a B.S. in Economics from Wharton and is a named inventor on over 140 patents and applications including the foundational patents for both Calibra Medical and Shockwave Medical. In 2017, Daniel was honored by Goldman Sachs as one of its Top 100 Most Intriguing Entrepreneurs.
Connect with Daniel Hawkins:
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FULL TRANSCRIPTION OF THE INTERVIEW:
Alejandro: Alrighty. Hello everyone, and welcome to the DealMakers show. I’m really excited about the guests that we have today. We’re definitely going to be learning a thing or two about medical devices and building and scaling meaningful companies. So without further ado, let’s welcome our guest today. Daniel Hawkins, welcome to the show.
Daniel Hawkins: Alejandro, thanks very much for the opportunity. I really appreciate it. I’m happy to be here today.
Alejandro: So born and raised in Philadelphia in an entrepreneur house. Tell us about your upbringing.
Daniel Hawkins: I’m the son of a primary care physician. The very first house that I lived in, we actually lived on floors two and three of a three-story place, and the first floor was a medical center, was my father’s office. We were in and around healthcare from day one and had an entrepreneurial bent from the earliest of my memories. My first entrepreneurial experience was at age 11. My family had a piece of property that we moved away from the city out into the suburbs. We had a piece of property that had holly trees on it. For those on the East Coast, you’re certainly familiar with these. They show up a lot, particularly in the northeast. They’re that classic green leaf with thorns on it, a tree branch that has the red berries on it. Those are holly trees. I used to have to cut those and trim them. We had really large ones in our back yard. I didn’t like taking them to the woods, so what I asked my dad one time, after visiting the grocery store with my mom and seeing them for sale outside, is if I could actually sell them door to door. So, what I did in my first year of doing that is, I took a piece of paper and drew some columns on it and wrote some addresses and names. I had a small bunch and a large bunch and then a wreath, and I made some samples. I went door to door and took orders right after Thanksgiving, and delivered all of those orders in my mom’s station wagon. I did pretty well that year. I did a little over $1,000. Being north of 40 years ago, that was a big number. That was the itch that started to get scratched. I found myself going to Wharton Undergrad with an eye toward Wall Street. When I was there, my parents had a deal with all of us. I had one brother and two sisters, and the deal was: whatever school you get into, we’ll pay for it, but you need to pay for room, board, and books, which worked out at the end of the day to be about 35-40%. The total and the way I did that was I ran some soda machines in a number of buildings on the university’s campus. So every Tuesday morning, I would meet a Philadelphia Coca-Cola bottling truck and receive what started out at about 70 cases of soda and peaked at about 150 cases of soda. I would load it with a partner, and empty the change, and go to the bank, and deliver a backpack full of change, and move on, and do that again the next week. That paid for a significant portion of my college education.
Alejandro: And that ended up being a business that you sold before going into Wall Street.
Daniel Hawkins: Yeah. I needed to exit that because I was moving from Philadelphia to New York to get on the buy-side. I got into leveraged buyouts and did that for a number of years. We needed to exit that, and we exited very well and then moved on. I didn’t realize that when I actually did that, that business when I got started in, and I got into it using what amounted to a little leveraged buyout, so I took to that world a bit.
Alejandro: That allowed you to see the full cycle of coming up with an idea, making it happen, paying your bills, which at that time is what you needed, and then getting it to the finish line. You started doing Wall Street and what ended up becoming part of JPMorgan today, but at one point, you decided to pack the bags and go to the West Coast and continue your studies. Why did you come to that decision?
Daniel Hawkins: It’s interesting, Alejandro. I realized that while I was on the deal side, and there’s a big chunk of that that I loved. I like the pace; I like being able to see lots of different technologies and industries. I realized that what I actually wanted, and after being in a number of board meetings – I was actually a surrogate board member in one of the companies in the portfolio at age 21. I was sitting across from the entrepreneur, and I found myself pining to be on the other side of the table. I realized that I was really more of an operator, and that’s what I really wanted to do. I also still had an affinity for healthcare, so I went to the West Coast to Stanford Business School and immediately came out into the medical device business in 1993. When I see medical devices – just to put it in a frame of mind for everybody, these are angioplasty balloons or stents. You might have heard of those. That’s actually where I started my career as an angioplasty. Or it might be knee implants. That’s the category of medical devices. It’s a couple of billion-dollars industry in the United States and probably 500 billion globally.
Alejandro: In this case, let’s talk about the experience at Stanford because the whole ecosystem in Stanford is all about entrepreneurial and building your own business, and that’s like sometimes it’s the final project that you do as part of the graduate degree that you get there. So why did you decide to go into corporate instead of going into startups right away?
Daniel Hawkins: It’s a great question. I actually tried really hard to get into startups in business school, Alejandro, and I couldn’t because the area I wanted to do was in medical devices. My classmates, for perspective, if you rewind the tape to 1993, Yahoo was just starting. In fact, a couple of my classmates ended up being there really, really early. One, in particular, I want to say she must have been among the first 20 people at Yahoo. Another classmate of mine was one of the first handful of people PeopleSoft, the company that was then acquired by Oracle. That guy went on to start Workday. It was a very IT-rich environment, and lots of folks were getting into the internet. It was the earliest days of the internet. Had I wanted to go into tech, I think I probably could have ended up in a startup. I wanted to go into med tech. That’s what was interesting for me. One of the challenges with med tech is that startup companies necessarily need to bring in people who are experienced because the nature of the business is pretty specialized. I just couldn’t land a role. So I thought, “Let me go cut my teeth in large caps and go from there.” So that’s what I did.
Alejandro: In this case, you did that, and then you went right away into startups. You had the experience with at least eight startups before you went at it. You had that initial expertise before you decided to go at it on your own. But in one of the startups that you were working at, literally, the founder in a weekly meeting talked about a problem, and this was about Intuitive Surgical that was quite an experience for you. Tell us about this.
Daniel Hawkins: Yeah. What you’re referring to is an extraordinary experience. I was running a marketing sales department there, and we had these weekly team meetings that were essentially meetings that were intended to bring up issues, and we could break down the barriers of them and, as a group, cross-functional. The CEO was in there, the examiner, Dr. Fred Moll, heads of each of the engineering disciplines, and I was in there. It was called the Critical Path Meeting, and by that, meaning, what’s on the critical path to get us to our goal. We were headed nicely to the complete system of a robot, and this is very complicated. This was the very first robotic surgery technology that was launched. A key component of that is what’s called the Vision System. Think of a camera on a stick, and it needs to be incredibly high resolution. Fred, Dr. Moll, came into that meeting and was visibly sort of off; he was clearly thinking about something. He paused everybody and said, “We have a problem. Our vision system, the camera, is inadequate.” Now, we were using an off-the-shelf camera. We had actually surveyed every camera from any corner of the world built for surgery. What he said was, the best of the best of the best was inadequate. What we were charged with then was: what do we do because that’s a key component of the system? There must have been 60-70 million in the deal at the time. This was back in 1999 when that was an extraordinary amount of money to put into med tech. It was a huge endeavor. So this was one of those moments that was sort of a bet-the-company kind of conversation, and that was: we can’t launch with this camera system. Now, we gnashed that problem for a couple of hours. It was one of the hardest problems to gnash. Then, finally, one of the engineers said, “Wait a minute. We don’t have to worry about how heavy this thing is because the robot is holding it.” The reason that is significant is that every camera on the market is built for a human to hold, and as soon as you could change that core assumption, you could jam all sorts of technology into a camera and make it 8 lbs. if you needed to. The regular cameras might be 1.25 lbs. or 1.75 lbs. because somebody needs to hold it for two or three hours in some cases. You can’t really do that and do it well with something that’s 8, 10, 12 lbs. That breakthrough was a meaningful one. What that showed me, Alejandro is that hard problems are hard for lots of reasons. But very often, one of the reasons they’re hard is the underlying assumptions being made. I took that forward to every hard problem I’ve had to deal with from a technical perspective in every company I’ve been involved with. The way I frame it is, really smart people with a well-characterized problem and consistent set of accurate assumptions usually can find an answer. The time periods when either the problem is not well characterized, or the assumptions that are being made are not accurate is when you run into trouble. That was a watershed of that. We were able to design our own vision system and do so in unbelievably rapid time periods. When it was launched, the vision system is one of the things that got the most attention. That was a really incredible learning experience for me and an amazing thing to be part of.
Alejandro: In your case, this was more of what you needed to learn to arm yourself with that knowledge before you would go at it. Your first rodeo was with Calibra. Your first experience was seeing the full cycle with the soda machines. But now, with Calibra, you saw another company that you build, another company that got acquired, and in this case, acquired by Johnson & Johnson in a nine-digit transaction. From this experience with Calibra, tell us in a high-level way, what was the business model and also what was your biggest lesson learned from this experience?
Daniel Hawkins: Calibra is an insulin-delivery technology for those folks who have what’s known as Type-2 Diabetes. It’s the version of diabetes that you’re not born with. It’s what’s called acquired over time, and typically, that is for folks that have obesity or some other preexisting conditions. One of the key issues with that patient population is that they need to use insulin or dose insulin more frequently than daily activities will allow them to. So this was one of those instances where a well-characterized problem can lead to creating solutions. The characterization of that problem was a simple one. If you’re a diabetic, and I’m sure some of the folks listening to this podcast either are or have family members who are since 17% of the population has diabetes in the United States. You have to dose insulin with an appropriate frequency to manage your sugar, your glucose levels. If you’re a Type 2, it’s not the kind of thing where if you don’t dose it, you risk some really dangerous, very rapid, onset kind of problems. It’s one of those things where overall, your health is going to deteriorate, you won’t feel as well, and you’ll start to have some complications over time. What that means is, Type 2 diabetics, as a general rule, have a different level of discipline. Situationally if you’re supposed to give yourself insulin 20 minutes before a meal, you might wait until an hour-and-a-half after a meal. Without getting too much into it, from the standpoint of management of the condition, that’s a real problem. Clinically, it’s a real problem. Going back to the lesson learned at Intuitive Surgical, the characterization of that problem was an extremely important one to realize that if you gave somebody a reservoir of insulin, that they could activate through their clothes without using a needle. Then you could increase the frequency of insulin dosage. That was the fundamental premise. It really broke through when we did focus groups of folks with Type 2 diabetes. We learned that there’s a gardener that didn’t dose himself with insulin regularly because his hands were dirty, so he waited – where our device with its regular design would enable him to do that. There was a truck driver that is on long hauls and used to dose only rest stops, hours and hours after he should. There’s a teacher who would dose herself in-between classes because she didn’t want students misinterpreting what a needle was. All of those things led to differences in insulin dosage, so the breakthrough there was recognizing that there’s a very humanistic side to the reasons why there’s a disconnect in when insulin was delivered, and we designed something to solve that problem. The breakthrough, I guess in many respects, for that was the idea. The real watershed was I wasn’t going to let it go, Alejandro. There’s no way I was going to let it go. I knew that this was a great idea. I couldn’t convince the venture capital firms that originally backed our effort to come up with an idea. Then, finally, one of the partners in the venture firm said – my third slide on a 10-slide deck, Alejandro, he said, “Daniel, stop.” I thought, “Oh, boy. We’re done.” He said, “I finally got it. Now, I understand why you’re so passionate about this. We’re going to fund this deal.” I never finished the slide deck.
Daniel Hawkins: He just decided right there and said, “How much do you guys think you need.” I told him, “Ten million dollars.” He said, “Okay. I’m going to take it to the partnership. This is a deal that has to get done.” So the lesson there is: don’t give up. Know what you know. Characterize the problem well; design a product for the problem and design it really well. Be militant about that design and make sure you’re solving a real problem – a pain killer, not a vitamin pill. You’ve got to solve something that’s causing pain. I don’t mean physical pain; I mean some kind of frictional pain that if you can manage to solve that with a well-characterized product, you’ll win.
Alejandro: And talking about persistence, that’s something that you also experienced with Shockwave when you actually had to put your last chip in with the college kids’ fund. Tell us about that nerve-wracking moment.
Daniel Hawkins: Yeah. That one was edgy. Both Collibra and Shockwave came out of these incubation efforts. They’re a little bit strange. Some venture firms gave me and a couple of partners 2 million dollars. All they wanted out of it was a company. They didn’t tell us what they wanted – what kind of company. They said, “Go figure out an unmet market need in medical devices, and either invent something or in-license something, create a product, and if we like what we see, we’ll give you the money to start the company. That’s how we got Collibra started. Shockwave was the second incubation effort that I did – similar model. In the first one, the engineers that I was partnered with taught me how to invent. I didn’t know; I didn’t have any technical background. We co-invented a couple of things. But I was a bag-carrier for what those guys were doing. I didn’t really know what I was doing. In Shockwave, what they taught me during the Cleaver experience, I started to come up with ideas. I started to mash up technologies. I came up with one that went all the way back to my first medical device company experience in the same clinical area, disease area, and that was in coronary angioplasty. I realized that if I combined some technologies from another disease area with angioplasty, then I could help solve the most complex and hard-to-treat cardiovascular disease there is. It’s called calcified disease. If you’ve ever heard the term hardening of the arteries, that’s what that is. It’s calcium, and it’s as hard as a bone, but it’s embedded in the wall of an artery, and it’s really hard to deal with. What I realized is if I mashed up some technologies, I could probably solve that problem. The trouble is that I came up with the idea right toward the end of 2007, the beginning of 2008, and that was a terrible time to start a company. It was really atrocious. In med tech, nothing was getting funded as early-stage. Alejandro, again, this is one of those things where I knew it was going to work. We had done some quick and dirty benchtop things, and I just knew that this was going to work. I was not willing to let it go. Under no circumstances would I let this thing go. But the venture guys didn’t agree. They didn’t like the idea. They didn’t like any of the other ideas we had. In fact, further to that, at that point, late 2008, they said, “There’s really nothing here – no way to start a company out of any of this, so we’re going to shut down the incubator.” That was my job. That was all I had. I had four kids, and that was an edgy thing for me. I was outside of the Bay Area where most of med tech is, and I realized at that moment, I can’t let this go. So, you’re right. What I did was I negotiated to acquire the intellectual property out of the incubator before we shut it down, and I paid for it using my kids’ college fund. I got another job, and nights and weekends for three years, a couple of folks and I put together some Proof of Concepts and some benchtop experiments, and that name Fred Moll came back again. Fred and I have maintained a long professional and personal friendship. I showed him the technology, and he said, “Daniel, I think you really have something here.” I said, “Fred, I know. I’ve been working on this. I haven’t told you about it, but I’ve been working on it for quite a while.” Fred led what became a 4-million-dollar Series A, and in the beginning of 2012, I went on full-time as CEO of Shockwave. That experience continued until I left that company to then start Avail, my current company, but before doing that, I turned the reins over to a guy called Doug Godshall, who is the current CEO for what is now a public company under Ticker: SWAV. It went public in March of 2019. That was definitely a full-circle one, but a very, very high-stress kind of early environment to get that thing kicked off.
Alejandro: So, Shockwave was an incredible journey. Right now, we’re talking about a company that the market cap is over 3 billion, so it’s incredible that such a persistence and not accepting a no for an answer really brought this incredible concept to life. From this journey, what would you say was your biggest takeaway?
Daniel Hawkins: I think jockeying for the biggest takeaway is going to be persistence. And frankly, I’m going to go right back to that Tuesday morning meeting when we discussed the scope all the way out to Intuitive Surgical. It’s the notion that smart people with a well-characterized problem can come up with a creative solution. We had to deal with a number of those at Shockwave, not the least of which is our technology required putting 70 atmospheres of pressure into an angioplasty balloon that was designed to burst at 12. What we had to do to be able to do that is realize how to mash up a couple of technologies properly and take a page out of physics. We went to core physics capabilities and relied on them and tuned the technology to be able to work off of core Physics principles, and it’s singularly because the problem was incredibly well characterized and the right people were around the table, and we were persistent.
Alejandro: In your situation, you gave the reins of the company to someone to take it public and become the CEO. Then, you used that time to spend more time with the family, and then also to incubate what would become your next baby, Avail Medsystems. Tell us about this one.
Daniel Hawkins: It’s exactly right. When I left Shockwave, it was because, in 2016, I traveled a quarter-million miles for the company. When my last investors were pre-public investors like T. Rowe Price and Fidelity, it became very clear that we were headed public. I did, in fact, make the family-related choice to step back a bit there – that was the first half of 2017. The second half of 2017 pulled the covers back on an idea that had been cooking a little bit. That was to create a technology that enabled what is known as clinical specialists, and then, of course, salespeople who (most people aren’t aware) spend a good 75-80% of their time in procedure rooms or being involved in procedures selling the technologies that surgeons use in the surgery rooms themselves, in the operating rooms. It’s really a technical selling type of rule supporting the surgeons through what they’re doing. The problem with that is, the requirement to physically be in the room was limiting. If you’ve got 15 customers, you can only be in one room at a time. If you’ve got to go from one room to another room across town, you waste an hour or two or three. As it turns out, those people waste 60% of their time in logistics going from one location to the next. As somebody was coming off of operating a medical company with sales teams out there and knowing the industry as well as I did, that was an untenable problem that with today’s technologies really could be soft. We launched Avail, and I got some of the same cast of characters from Shockwave’s early days of investing, including Fred Moll, to back the company in the early formation days, and then went on in early 2018 to raise a 10-million-dollar Series A. I tacked on 15 million of the Series A1 at the beginning of ’20. About seven months later, closed on a round for 100 million dollars to scale the company. The intent here and the gutsy part of this is we’re building a network of hardware that goes into operating rooms, and we’re not charging the hospitals for it at all. What we’re doing is charging a remote person a time-based fee to access the operating room, obviously with permission of the hospital and the physician. What we’re recognizing is a terrific amount of traction. We’re seeing an ability to disseminate medical technologies and medical techniques considerably faster than they can if you have to be there physically in a room to do it, which has been the norm for 40 years.
Alejandro: One thing is for sure, Daniel, is that being at the right time in history is everything when it comes to building and scaling companies. Before, we never saw nurses and doctors on front pages of magazines and newspapers, and now, especially with COVID, that’s the norm, that’s the day-to-day. Obviously, you’ve been at it for a while in the medical devices space. Would you say that maybe everything that has happened with COVID has pushed the wind behind all of the healthcare sector and perhaps even medical devices?
Daniel Hawkins: Yeah. I would say that’s right in many respects. One of the things: I’m going to tip a hat to those who deliver care every day. There’s an extraordinary amount of work, effort, and expertise leveraging to be able to treat patients in normal times – unsung heroes in the nursing and physician community. That was a daily occurrence for my career for all of it pre-COVID. Right now, I’ll broadly state that, of course, healthcare is having a moment in and around the pandemic. From an Avail perspective, what we have created certainly gets the benefit of a lot of tailwinds due to COVID, but the fundamental issue, the problem we’re solving, is a pain point. I alluded to earlier that you try to solve pain points, come up with pain killers, not vitamin pills. It’s a pain point because 50-60% of the medical industry’s field teams’ time is wasted in logistics. That means that they also can’t get to places where they’re needed, and clinical care can actually be impacted by that. We’ve created a technology that allows them to support all of their customers and for the best technical expertise to be brought to bear in every procedure across the country and ultimately around the world. I would say that overall, healthcare has some tailwinds right now that are meaningful. New medical technologies are definitely having a bit of a moment. Having said all of that, it’s got to be stated, although blindingly obvious, that as much as the tailwinds have provided in terms of lift for Avail, I would trade slower growth for no pandemic.
Alejandro: In this case, Daniel, it’s been a tremendous journey as an entrepreneur – a tremendous journey as being part of the world of startups and a journey full of lessons learned, full of the good, the bad, and the ugly, which, obviously, the journey is not a straight line. So if you had that opportunity of going into the time machine and being able to sit down with your younger self, that younger Daniel that was coming out of Stanford and thinking about a career shift and going at it and entering the startup world, what would be that one piece of business advice that you would give to yourself, given what you know now, before launching a business and why?
Daniel Hawkins: One piece of advice. It’s not something that I can put into a strip that goes inside of a fortune cookie, but what I will say is if you’re going to start a business, pay attention to the problem you’re solving. Understand it at its fundamentals. Most importantly, try to deconstruct why it’s a problem. If you deconstruct why it’s a problem, and you’ve got yourself and other smart people around it, you’ll come up with a solution that is groundbreaking. It doesn’t necessarily have to be a technology; it can be a service. But if you deconstruct a problem properly and create what I like to call product-to-market fit, what you’ll find out, be it a service or a technology or some other type of product, if you have the right product-to-market fit, so many things happen differently than when you don’t. I guess that would be the #1 lesson is it all starts at the product.
Alejandro: Very profound. Daniel, for the folks that are listening, what is the best way for them to reach out and say hi?
Daniel Hawkins: You can certainly hit me up on LinkedIn. That would be a great way to do it if your interest is to learn a little bit more about Avail. You can certainly do that via our website in the [email protected] – you can learn about Avail that way. If you’ve got interest in connecting directly, feel free to send me a note on LinkedIn, and we’ll see if we can connect there.
Alejandro: Amazing. Well, Daniel, thank you so much for being on the DealMakers show today.
Daniel Hawkins: Absolutely. Thanks very much for the opportunity, Alejandro. I’ve enjoyed it and appreciate the opportunity.
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