Duke Rohlen On Selling 4 Companies For Over $1 Billion Following These 3 Steps

Duke Rohlen is a serial entrepreneur and founder of Ajax Health. He is the cofounder of FoxHollow Technologies (acquired by Ev3 for $780 million), CV Ingenuity (acquired by Covidien for $300 million), Spirox, Inc. (acquired by Entellus Medical for over $200 million), and EPIX Therapeutics (acquired by Medtronic for $350 million). His most recent company is Ajax Health which will source and provide operational and financial capabilities to a diversified portfolio of emerging medical device companies. The company has raised over $120 million from investors such as KKR.

In this episode you will learn:

• Changing industries and reducing the learning curve
• Following simple steps to understand the acquisition process
• Building trust with everyone around you
• Knowing when is the right time to sell your business
• Finding solutions to very complex problems
• Building and scaling in healthcare

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About Duke Rohlen:

• Linkedin

 

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FULL TRANSCRIPTION OF THE INTERVIEW:

Alejandro: Alrighty. Hello, everyone, and welcome to the DealMakers show. I’m very excited about the guest that we have today because he has a lot of experience. He has built, scaled, financed, exited many, many companies. So, without further ado, Duke Rohlen, welcome to the show today.

Duke Rohlen: Hey, thank you so much. I appreciate you taking the time to talk to me.

Alejandro: So, you went to college to Stanford. Then you got your MBA at Harvard. Did many of your classmates go out and build successful companies?

Duke Rohlen: At the time that I graduated from Stanford, starting in entrepreneurship was pretty much a novelty. Nobody was really doing it. The traditional route for people that were interested in business was either management consulting or investment banking at the time. Then the people that quite frankly didn’t know what they were going to do decided to go to law school which was where I was headed before I started my first company. So, there were not a lot of friends that had actually gone into entrepreneurship and/or started companies from my vantage.

Alejandro: How did you get the entrepreneurial bug?

Duke Rohlen: I was fortunate enough to have a friend who had gone to my high school. He had also gone to Stanford undergrad and then was graduating from the Stanford Business School. He had a traditional finance background. He had worked at an investment bank in San Francisco. He was graduating from the Business School at Stanford. I was contemplating going back to law school. He told me that he was going that he could go forward with, and instead focus on doing something entrepreneurial. In my gut, it just felt right. It felt right for a bunch of reasons. 1) I really respected this guy. He’d been sort of a class-act his entire life. 2) The thought of starting something was so exciting compared to the thought of going back to law school which I would have been doing by default by not having anything else to do, and 3) there was just—I recognized that the idea that we had at the time represented an unmet need that gave the possibility of something being successful a higher chance. So, for those three reasons, I ended up doing it. As exposed to this guy, it was one of the learning lessons of my life is make sure you surround yourself with exceptional talent. This guy, in many ways, was an exceptional talent and still is today.

Alejandro: Got it, and this was the first business that did that was FoxHollow Technologies. Is that right?

Duke Rohlen: No, actually, when I was 22 and graduated from Stanford, I started a restaurant company with this gentleman, Maurice Werdegar. We grew it to about 10 restaurants. The interesting thing is I loved the idea of being entrepreneurial. I did not like the idea of running restaurants. I’m a very picky eater. I don’t eat garlic or onions or mushrooms or celery even. But I loved the idea. So, we learned very early how to raise money. We learned how to grow a company. We grew it to about 500 employees and 20 million in sales. So, we learned an enormous amount. But one thing that stuck with me was I didn’t want to be in the retail business, so I went back to Harvard Business School with the intention of going into health care because I felt the urge and the need to want to interact with people, which is what you do in medical technologies, but I wanted to have business models, and financial opportunities that were greater than I felt could be realized in the restaurant business. So, after business school, yes, the first company was FoxHollow.

Alejandro: That’s interesting because probably when you went to HBS, to Harvard Business School, you probably knew more than some of your teachers. I mean, building a 20-million-dollar business in sales is definitely not easy.

Duke Rohlen: Yeah. We made an enormous number of mistakes, and then going back to business school helped me understand with more clarity a lot of the mistakes that I made. Business school was interesting because at a gut level, and from an instinct level, I feel like yes, I knew a fair amount about running businesses, but there were a lot of frameworks, and structures, and financial engineering capabilities that I didn’t have awareness of that business school gave me. So, I came out of business school with an entrepreneur’s sort of experience having run those restaurants, but with more practical and pragmatic skill sets that I felt could be applied to the health care industry, and that’s what I did.

Alejandro: Got it. So, then let’s talk about your immediate business right after business school, FoxHollow Technologies. Tell us about this experience.

Duke Rohlen: This was a company that was doing extraordinary things. It was focused on developing a technology that would clean plague out of hearts, and it had a little saw in a catheter that would go in and carve out plague from the arterial walls. It was interesting because, at the time, drug alluding stents which change the profile of treatment modalities for patients with cardiovascular disease had not come out. So, this company was going to try and open up arteries to prevent people from having significant chest pain and even having heart attacks. But about three years into that development drug-living stents came out and the landscape completely changed. So, the company had to really pivot from being something that was focused on the heart to something else, or it would have gone under. So, the idea was that we’re going to go and pivot to the peripheral vascular space where there are enormous number of vessels that have coronary artery disease. It’s peripheral vascular disease in this circumstance. There was really no good option because stents weren’t, at the time, an effective solution for treating calcified or plague-ridden vessels in the legs. We pivoted the company, and there was an extraordinary number of really good people there. We took that company public, and then we ultimately sold it to ev3 which became Covidien and then subsequently Covidien became Medtronic. It was a great experience. Again, an enormous number of mistakes and failures were hidden by a very positive outcome which was the sale to ev3. I think the lessons from that company are that it’s very hard to be a single product medical device company, especially as you get to the point where you’ve got 150, 175, or even 200 million in sales. The second thing is you need to have an orientation as a company about how you’re going to expand. The IPO is not the endpoint. In this case, the endpoint was either being a sustainable company which would have come through aggregating other assets which the company was not set up to do, or you were looking for a sale. And fortunately, we were able to find somebody who had a bunch of other products that they needed a high-growth product like FoxHollow to benefit them. So, we learned a lot and took those skills into my next company which was CV Ingenuity.

Alejandro: We’ll get into them in just a second. What were the terms of that transaction?

Duke Rohlen: It was a 780-million-dollar deal. It was more of a merger with ev3, which was the company that was leading the transaction, had a market capital of about a billion dollars at the time. They had a whole slew of not so differentiated products, and we had a high-growth differentiated product. So, when you put those two together and took out a lot of the infostructure cost associated with having two sales forces and then merging them into one to finance offices to quality groups. When you took a lot of the synergies and put them together, you could create a very interesting profitable company, and that was the industrial logic of that merger. It ended up working because that company ended up growing, and then selling about 2 1/2 to 3 years later to Covidien for about 3 billion dollars.

Alejandro: Nice. That’s amazing because as you probably know, with all of this same experience, in most of the cases, the acquisitions fail. That’s the tough part. Then after this, you founded CV Ingenuity in 2009. Why so quickly after the sale of the last business?

Duke Rohlen: When I was at FoxHollow, I had this idea based on some people that were in the organization’s diligence. They had found a technology out of Germany which combined Paclitaxel with a balloon. Paclitaxel is an oncology drug that is used on drug-living stents. The idea that we had was you could go and basically put the Paclitaxel together with the balloon and avoid having to have sustained delivery via stent. This technology in the science had been proven out in a very rudimentary way in Germany. Even though I was very, very fresh off of FoxHollow’s sale, I felt the time was right to jump in and start this company. It was a tough time to start a company considering the microeconomic conditions of the time. The world was falling apart. The bank crisis had hit, and the loan crisis, everything was terrible, and I was raising money to start a company that would ultimately require 100 million dollars to get to regulatory approval. But from that process and from the conviction I had and the opportunity, I was able to actually get some people that maybe felt sorry for me actually, but they ended up putting in a couple of million dollars which seeded that company and enabled us to get off the road. My feeling though, one thing I’ll say is that it’s very hard to go invent a company. It’s easy to be in a company and see where there are unmet needs and go after those unmet needs with informed perspective. So, the urgency with which I attacked CV Ingenuity was born from the recognition that the technology we were developing at CV Ingenuity had the ability to completely disrupt the technology that we had just sold to ev3 which was the FoxHollow technology. So, I felt an urgency which parleyed and translated into that company very quickly after selling FoxHollow.

Alejandro: Why was the focus here only in the U.S.?

Duke Rohlen: To me, like I said, this technology was a technology that was going to cost 100 million dollars to get to approval. To make that technology work from a financial standpoint, I needed to make tradeoffs. I needed to say we’re going to go after one therapeutic area instead of another. We’re going to focus on the United States instead of Europe. In fact, we didn’t develop our own balloon. We went and licensed the balloon from Covidien because I believed that value creation of our technology was focused on the chemistry and applying the chemistry and applying the Paclitaxel to the balloon, it was not based on the balloon. So by making strategic tradeoffs like geographic tradeoffs, not going to Europe and focusing on the United States, not going after the heart, but focusing entirely on the peripheral vascular space, not developing our own balloon catheter, but instead focusing on an existing catheter and identifying a chemistry that was great, we were able to save tens of millions of dollars and keep a very, very focused team on what I felt was the value in creating a driver which was the chemistry. When we sold that company, we had about 30 million put in, and we sold it for about 300 million within three years. When we sold it, we still only had 22 people in the company. So, we were very, very lean and that leanness came from the tradeoffs that allowed us to be hyper-focused on the value creation.

Alejandro: Got it. You were just talking that this company was sold for 300 million, and this was your third rodeo really, but I guess at this really high level probably the second one, but the question that comes to mind is you already had gone through that M&A process before with FoxHollow, and you probably had a lot of learnings that you brought with you, so what were some of these lessons that you learned that you really kept in mind during this M&A process putting this transaction together?

Duke Rohlen: Yeah. It’s a great question, and I think that the M&A process is as much art as it is science, meaning that there is an enormous amount of prework that goes into creating a transaction. You cannot sell a company. A company is a strategic acquisition by an acquirer. What that means is a lot of entrepreneurs say, “Okay, I’m going to build it to a certain point. I’m going to keep it in a black box until that point. When that point happens, I’m going to go and shop the technology to a bunch of buyers, and someone’s going to pay a lot of money. In fact, we might even get an auction going and drive the price up higher. I took a totally different approach. My feeling is I know when I start a company who the buyer is and why that buyer needs our technology. I engage with that buyer consistently over the lifetime span of our company. For example, with CV Ingenuity, in my heart of hearts, I believe that Covidien was the only real buyer for that technology. So, I went to Covidien, and contrary to a lot of opinions at the time, I focused on developing a relationship with them that was both strategic, meaning letting them know what we were doing and how we were going to do it, and then demonstrating that we would get it over time. But also, financial. So, I actually used Covidien’s balloon as the balloon catheter for our technology. People thought I was absolutely crazy. “Why would you go and shut down other opportunities to potentially sell the company by partnering with Covidien in their balloon. My feeling, again, was that I believed that Covidien was the buyer. I believed that nurturing that relationship from inception would enable them to start thinking strategically about acquiring CV Ingenuity as opposed to opportunistically assessing it at some point and time. I also felt that partnering with Covidien would not preclude me from selling the technology to a Boston Scientific or an Abbott, or a Medtronic. The reason being is that we had the ability based on the nondifferentiation of the balloon. We had the ability per the FDA to go and very easily shift from the Covidien balloon to a Boston balloon or a Medtronic balloon. Because remember, the sophistication of technology was not the balloon. It was the coding of the balloon with the excipient and the chemistry. It was relatively unique at the time, but it was based on my true and utter belief that Covidien was the logical buyer of that technology. So, that was one thing I learned. The second thing I learned, and I still use very, very extensively to this day is that you really have to focus on establishing trust. Trust with people who you work with, your employees, trust with your financial backers, and also trust with the people that are ultimately going to be the acquirers. In this case, it was Covidien. I’ve always believed that trust is the conduit of influence, and confidence is a byproduct of trust. So, if you don’t have trust first, you’re not going to be able to have the confidence that’s required to be able to go and sell a company for 3, 4, 5, 800 million dollars to a larger partner because if they don’t trust you, they’re not going to believe in you, and therefore your confidence is going to be eroded. Confidence is what enables you to sell these companies at the time that you need to sell them. I think you need to have a high level of trust, and you need to be really confident in your technology, and you can’t be in a situation where one of those is there, and the other one isn’t. You have to have both of those, and those take time. So, trust and confidence were a really critical point. The third and maybe the most important point in terms of selling companies is having optionality, and optionality means the ability to go and sell the company or not. Optionality means having the financial wherewithal from a corporate funding standpoint to be able to say, “We don’t need to sell the company. We can go forward. It’s a little bit like dating. If you really, really have just one girl that you want to go after and you don’t have any other options, she’s going to sense that, and you’re not going to be as attractive or interesting to that girl. Similarly, in a company, in a transaction mode, if you only have one option for the disposition of your company, the buyer is going to sense that there’s some desperation there. They might still buy it, but more realistically they’re not going to buy it, or they’re going to force a significant discount on the value of that asset.

Alejandro: Got it. One thing that I found really exciting about this entrepreneurial journey of yours, Duke, is that you pulled Jack Dorsey—you are kind of like running and leading two hyper-growth companies at the same time. So, in this next chapter, you were really leading Spirox and then also EPIX Therapeutics, so would you walk us through what was this chapter in your entrepreneurial journey like?

Duke Rohlen: To me, the success factor is really determinant on three things. You need to have a terrific team. You need to have a terrific technology, and you have to have a business model. The traditional business, you find a great technology, and you develop that technology, you build the team around that, and then you opportunistically identify a business model. I’ve turned that completely on its head. I will not go forward without a significantly defined business model. No matter how good the technology is, if I don’t see from day one, an opportunity to within 48 months drive that dollar-one investment to a very, very strong return on equity, I won’t do it. So, I lead with the business model. The next and most important thing to me is the team. Then finally, the third most important thing is the technology. People say, “Why would you focus on a business model and a team over the technology?” It goes back to my restaurant days. You could have an incredible dish that a chef wants to put out, but if you don’t have the infostructure and if you don’t have the capital to product that dish consistently, no matter how good that dish is, it’s never going to see the light of day because the restaurant’s going to go out of business. In the health care business, if you don’t have a very defined business model, you’re not able to recruit capital. If you can’t recruit capital, you can’t recruit the best teams. No matter how good the technology is, that technology will not see the light of day. So, the reason I have been able to drive multiple companies at the same time, and in this current incidence it was EPIX and Spirox, is because the business models of both of those opportunities were very defined, but more importantly, I had at that point incredible people that I had worked with at both CV Ingenuity and at FoxHollow that I trusted, that were best in class at what they did, and by that I mean able to turn liability opportunities, like large clinical trials, or product development, or regulatory submissions. Turn those things from liabilities into assets by being exceptionally good at what they were doing. What I really tried to do was empower leaders within those organizations to drive those technologies forward, and I focused on the business model part, raising the money, driving the strategy toward that non-creating endpoint, and then ultimately, the disposition of those assets. The opportunities are really defined by the business model, and they’re also capitalized on by extraordinary people. Not a lot of people, but people that are very, very good at what they do, have proven and demonstrated track records of winning that are driving these organizations with me.

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Alejandro: Got it. So, what was the business model of Spirox?

Duke Rohlen: The business model of Spirox was to take the combination of CV Ingenuity which was very nimble, low invested capital amounts, and very robust clinical data, and combine it with the lessons of FoxHollow. FoxHollow we didn’t have robust clinical. We didn’t have an enormous amount of technical—we had great technology, but we didn’t have the data that supported that technology. We did have great sales and marketing. So, the opportunity for Spirox was in the ear, nose, and throat space. It was to go and be very tight from a cost-development standpoint on getting a technology to approval in the United States. Then be very targeted with a sales and marketing engine that could capitalize on that clinical data to drive that product forward. We built that company. We brought in KKR, which is a large private equity firm. We had Venrock. We had Azling. We had HealthQuest. We had WT. We had an enormously strong financial backdrop, and we were planning on growing that company. The business model dictated that it made sense for us to sell that company, and we did that. But we did that because we wanted to, not because we had to. Which again, goes back to that lesson of optionality.

Alejandro: What were the terms of this one?

Duke Rohlen: This one ended up being a 250-million-dollar exit. Something like that. On about 60 million dollars invested.

Alejandro: Wow. Wow. Very impressive. I don’t know how you do this, and at what time you sleep and do it, but you combined again EPIX Therapeutics with Ajax. So, before we go into Ajax, what was the business model of EPIX Therapeutics?

Duke Rohlen: EPIX was an interesting technology. EPIX was originally a company called Advanced Cardiac Therapeutic. It’s in the electrophysiology space. The technology was focused on providing the electrophysiologists with more information about creating the lesions in the heart. More information by providing more real-time feedback, and in this case, it was using temperature which is the truest proxy for lesion formation. When you get to 50 degrees C, you know you’re making a lesion. If you’re above 70 C, you’re probably burning the tissue. So, our feeling was if we could have a technology that would know that you’re getting to 50 C and then once you got to 50 C, know that you needed to shut down the [atrial fibrillation 26:48], you could really do two things. You could illuminate extra burning, and you could also optimize the burning because, in the absence of lesion feedback, physicians are afraid to burn for too long. So, potentially, they under burn. The technology was a company that had had about 25 million dollars put into it, and the company was running out of money and failing primarily because they didn’t have a business model, and I didn’t think the team was very strong. So, I went in and bought that company with my own money for about 500,000 dollars and restructured the team with an extraordinary group of people that were a combination of people that I knew were experts in the electrophysiology space as well as people that had worked with me historically. We raised money from M&A, and we built the team, and we built the company. One of the things I said earlier is that the technology is third behind the business model and the team. In this case, that model made an enormous amount of sense because three or four months after, maybe actually six months after buying that technology, we realized that the concept of using temperature sensing was good, but the technology was too fragile to be a mainstream, high use technology in the marketplace. So, leveraging that team and the business model, we ended up developing a new and entirely new technology that did the same thing in a different way. Used temperature as the proxy for lesion creation, but restarted a new technology, and then that technology we just sold actually to Medtronic on Friday. [Inaudible 28:43] closed some, but it’s somewhere between 300 and 400 million dollars.

Alejandro: Wow.

Duke Rohlen: Again, it was the team and the business model that drove because technologies are going to have to morph, and you’re going to need a team that can be nimble to drive a technology that originally makes sense, but needs to be optimized, or to develop new capabilities around a technology that you didn’t anticipate when you started the company.

Alejandro: Absolutely. At what point, Duke, does Ajax come into the picture?

Duke Rohlen: Ajax is an entity that was formed by KKR and me. The idea for Ajax was, “Listen, there’s a bigger need for capital allocation than a smaller need.” That’s primarily driven by business models. My feeling is if you’re a venture-backed company, you’re spending an enormous amount of time as the CEO trying to find your next capital source. What I do, because I lead with a business model, is I focus on how much it’s going to take from inception to completion, to value creation, which is the completion to get that company from A to Z. Then instead of raising that money sequentially, I raised that money in one fell swoop. I take capital risk out of it. Capital risk though and the ability to do that is a function of having a high level of confidence in your team that they can execute, and we’ve been able to demonstrate that. What KKR did is they said, “Why don’t we put 100 million dollars behind you, Duke, so that you can go and leverage this model that you have. Business model first, then team, and technology over several assets, and that’s what we’ve been doing with Ajax. So, Ajax is a company, but it’s an operating company that has the ability to write pretty significant checks. We’re currently just closing on another 150 million dollars that’s going to be Ajax2 that we’re going forward with three new companies that I’m not at liberty to talk about quite yet but are very interesting and compelling along the lines of what we’ve talked about in the first five companies.

Alejandro: Got it. So, what are the type of profiles of companies, let’s say with Ajax you guys would get involved with?

Duke Rohlen: So, one of the things I talked earlier in this conversation about tradeoffs. For me, you have to be able to take an opportunity and whittle away at risks so that there’s one fundamental risk. It could be regulatory risk. It could be reimbursement risk. It could be market adoption risk. It could be capital risk. Then instead of having to solve for multiple variables that create a confounding challenge for a CEO, you’re really focusing on one significant risk. My belief is that you should be able to take an opportunity, distill it down to that one risk for less than 3 million dollars. So, for very limited amounts of money, you can address market need, you can address reimbursement risks, you can address regulatory risk, manufacturing, financial risk, etc. Then you can make a decision about, “Okay. Does the execution team that’s required to capitalize on that isolated risk support, and does the time and the money need to do that support the business model? What we’ve done with these new technologies is basically identified technologies that we’ve been able to isolate to one risk. Then we’re funding those risks, we’re funding teams that are proven with me, and with business models that are not dissimilar to the business models we’ve talked about here. And with a clear, clear, execution path to value creations. So, that’s what we look for.

Alejandro: Got it. One of the things I wanted to ask you here, Duke, is it is impressive how you have been able to manage not just doing one business, doing two, and also doing several initiatives at the same time. I see that you’re also involved with Harvard as an entrepreneurial in residence. What really was there for me in terms of a question that came up is as founders, and as a founder myself as well our biggest resource is time. Right? And the way that we’re investing time is everything. From your perspective and knowing what you know now, and being able to really manage very effectively you time, what kind of piece of advice would you give to the founders that are listening about managing their time?

Duke Rohlen: To me, time is the most important thing. I was reading a biography on JP Morgan about eight years ago, and he was basically saying that he would take two hours to think every day. So, he would take time out of his day—this guy was busy. Right? Running one of the biggest companies in the world at the time. Richest guy in the world at the time and he would take two hours to think. There’s something in that which is that people that spend all of their time doing busy work don’t have the time to step up and look over the trees and see strategically what they should be doing because they’re so focused on the minutia and the day-to-day. They’re focused on the activities as opposed to the strategic. In order to be able to focus on the strategic over the activities, you need to have people that know where the company is going and know what their responsibility is to the company’s ability to get there. If you have great direction all the sudden, you’re not having to oversee every aspect of the company on a 24/7 basis. So, you can focus on doing what JP Morgan did which was looking at where the company needs to go strategically. So, I run these companies, but I have incredible people that do the operations, incredible people that do the quality, the regulatory, and these people are best in class, better than I would ever be able to do. So, I entrust them with the companies. I always say there are three capabilities that I will have in a company. One capability is bet the company executions. So, somebody who can execute at a high, high level and that you’re willing to bet the company’s success on. The second one is someone who you can bet the company on from a technology standpoint. So, someone who invented a technology, and they understand it better than anybody else in the world. The third one is bet the market experts. So, someone who understands the market and how this fits into the market better than anybody else. If you have those three capabilities, a technology, an execution, and then a market, those capabilities understand where the company needs to go as well as you do and can execute on that. That frees me up to focus on the strategic and focusing on the value creation. That’s how you do it, and at least that’s how I’ve been able to do it, and that’s why I can do multiple things and multiple companies at the same time.

Alejandro: I love it. So, one question that I always ask our guests is if you could go back to the past, and I know that this is impossible, but if you could do it and give yourself one piece of advice, business advice, before launching a company, what would that be and why?

Duke Rohlen: My one thing that is to focus—I guess there are two things. So, I’m going to answer your question with two answers instead of one. One is do your homework up front. There’s that concept of prior preparation prevents p***-poor performance. Right? The 6P rule, and I learned that when I was a sophomore in high school, and I really didn’t understand it, but when you get to the point where you’re putting in, and you’re asking people to put their lives online to work for you. When you’re talking about developing technologies that are going to go into human beings and have the difference and outcome of the patient being healthy or dying. When you’re talking about taking tens of millions of dollars from investors, well, you know what? You’d better be prepared before you do that. It’s not a good idea to just run and start a company. It’s a good idea to really think through it. Think through the three drivers of value. Does the business model make sense? Can you build the right team to execute on that business model? Does the technology and the development of that technology support that business model? So, prior preparation is a really important piece for me. The second thing is follow your gut and have integrity. If you go back to something I said in the very early parts of this conversation, trust builds confidence. So, you can’t have confidence without trust. Trust is the framework, and it’s the basis of all communication both internally and externally. Internally with your employees. Externally with your founders and ultimately with the people that are going to buy your company. And to have that trust has to come from following your gut because you can’t sell something, you can’t believe in something unless your gut is behind it 100%. So, I would say prior preparation, and I would say follow your gut and make sure that you’re doing something that from an integrity standpoint makes sense for you.

Alejandro: That’s very powerful, Duke. So, what is the best way for folks that are listening to reach out and say hi?

Duke Rohlen: The best way to reach me is via my Ajax email, and that email is [email protected]

Alejandro: Wonderful. Well, Duke, thank you so much for being on the DealMakers show.

Duke Rohlen: Hey, thank you for having me. I appreciated the time.

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