David Giarracco

If you’re waiting to start M&A conversations until you're ready to sell, we’ve got intel from 5 medtech CEOs with a track record of medtech exits who may tell you otherwise. They’d probably also tell you that companies that get acquired for the best valuations *start* building relationships with strategics at least 2-3 years before they even consider an exit. For an article I wrote for MassDevice, 5 CEOs who've successfully navigated M&A transactions told me this: The best exits are planned from day one. ➡️ Jennifer Fried (Flow Medical) says that before she even joined her current company, she was already calling potential acquirers. Not to pitch — to listen. "What do you really think about the pulmonary embolism space? What are the big inflection points?" Early conversations helped her understand market dynamics and have shaped the strategy at Flow. ➡️ Joe DeVivo’s (Butterfly Network, Inc.) approach is people-oriented. Joe has delivered 5 exits (!) and he knows M&A is about building relationships, not deal flow. "Simply befriend them. At trade shows, be very open. Keep the dialog going." The onus is on you to help potential buyers understand your business and why it’s worth acquiring. ➡️ James Reinstein (Conformal Medical) emphasizes market selection and timing: "Find a market that's growing fast, has few competitors, and is one that investors want to be in." The idea is to position yourself as part of a growing pie and then show acquirers you’re continually hitting key milestones. ➡️ Cary Vance (previously PhotoniCare, Inc.) says it’s important to cultivate relationships with multiple strategics, but is quick to point out that deals are never guaranteed. "Run your company as if you're going to make a go of it alone — don't count on an acquisition as your rescue plan." ➡️ Nitin Salunke (Supira Medical) says identifying an end goal as early as possible will put you at an advantage:  "Don't go fishing for deals. Make incremental progress on strategics' watch lists, rising from bottom to top." Let value guide your company’s trajectory and align your milestones with that to make the business acquisition-worthy. Simply put: You want your business to get bought, not sold. Strategics are rarely lining up to buy companies that are desperate to be acquired. But startups focused on building great businesses while cultivating the right relationships? They get bought. In short, this is what separates the successful exits from the failed attempts: - They educate potential acquirers without being pushy  - They understand that timing matters as much as value - They pick fast-growing markets with limited competition - They build companies strong enough to survive independently  - They align major conversations with their strongest milestones Check out the full article through the link in the comments. And last, big thanks to Chris Newmarker for your publishing support!

244

28 Comments

𝐅𝐫𝐨𝐦 𝐅𝐫𝐢𝐞𝐧𝐝 𝐭𝐨 𝐌𝐞𝐧𝐭𝐨𝐫: 𝟓 𝐔𝐧𝐟𝐨𝐫𝐠𝐞𝐭𝐭𝐚𝐛𝐥𝐞 𝐋𝐞𝐬𝐬𝐨𝐧𝐬 𝐟𝐫𝐨𝐦 𝐑𝐚𝐲 𝐂𝐨𝐡𝐞𝐧 I’ve been lucky to call Ray Cohen both a mentor and a friend. Recently I drove up the SoCal coast to spend an afternoon with him. We talked about fishing, life, and our families. And of course we couldn't help but chat medtech. He doesn’t just build companies — he builds teams that win, stories that raise capital, and cultures that last. Here are 5 lessons that stuck with me from our conversations — and they’re worth passing on: 🧠 𝟏. 𝐁𝐞𝐭 𝐁𝐢𝐠 𝐨𝐧 𝐚 𝐁𝐢𝐠 𝐒𝐭𝐨𝐫𝐲 Don’t waste your time on incremental tech. Find a massive TAM and build a story around a radically better solution. 🚀 𝟐. 𝐈𝐧𝐯𝐞𝐬𝐭 𝐢𝐧 𝐂𝐨𝐦𝐦𝐞𝐫𝐜𝐢𝐚𝐥𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐄𝐚𝐫𝐥𝐲 Axonics hired 100 reps a year before FDA approval — and trained them for 9 months. Sales exploded from day one. That’s what urgency + conviction looks like. 💸 𝟑. 𝐃𝐨𝐧’𝐭 𝐅𝐞𝐚𝐫 𝐃𝐢𝐥𝐮𝐭𝐢𝐨𝐧 — 𝐅𝐞𝐚𝐫 𝐈𝐫𝐫𝐞𝐥𝐞𝐯𝐚𝐧𝐜𝐞 “100% of nothing is nothing.” Raise what you need, when you need it. Execution builds value faster than ownership alone. 🧑‍🤝‍🧑 𝟒. 𝐇𝐢𝐫𝐞 𝐭𝐡𝐞 𝐑𝐢𝐠𝐡𝐭 𝐏𝐞𝐨𝐩𝐥𝐞, 𝐓𝐡𝐞𝐧 𝐏𝐚𝐲 𝐓𝐡𝐞𝐦 𝐭𝐨 𝐖𝐢𝐧 Ray personally interviewed 500+ team members. He paid top reps nearly $1M/year and gave them equity. That’s how you build loyalty and accountability. 📣 𝟓. 𝐒𝐩𝐞𝐚𝐤 𝐏𝐥𝐚𝐢𝐧𝐥𝐲. 𝐋𝐞𝐚𝐝 𝐀𝐮𝐭𝐡𝐞𝐧𝐭𝐢𝐜𝐚𝐥𝐥𝐲. No jargon. No posturing. Just real talk, clear expectations, and full transparency. It builds trust fast — especially when things get hard. Ray once told me: “You have to forecast the future — then go make it come true.” That’s what leadership looks like in MedTech. #medtech #medicaldevices #medicaldevice #medicaldevicesales #medicalsales #digitalhealth

155

10 Comments

What would you do if you were 32 years old and handed $150M in responsibility? That’s exactly the position Gary Thomas, the SVP of Manufacturing/Product Development at Onkos Surgical found himself in... leading multiple business units across MedTech with barely a decade of experience under his belt. No manual. No roadmap. Just grit, great people, and an insane amount of determination to not let it fall apart. In our recent episode of 𝐓𝐡𝐞 𝐌𝐞𝐝-𝐓𝐞𝐜𝐡 𝐓𝐚𝐥𝐞𝐧𝐭 𝐋𝐚𝐛 podcast, Gary shared how those early high-pressure years shaped the leader he is today and how the lessons from that time still serve him when product launches go sideways or when team members say, “this can’t be done.” Support. Vigilance. Determination. That’s how you lead when the stakes are high and the clock is ticking. Leadership isn’t about having all the answers. It's about having the backbone when others doubt, and the humility to lean on the people around you. If you're a MedTech leader navigating complex product launches and looking for real talk on what it actually takes to lead under pressure… this is an episode you won't want to miss! Thanks for being a valued guest on the show Gary! -MR 𝐏𝐒 Link to full episode and all the others in the comments. #podcast #medtechtalentlab #leadership #hiring #recruiting

79

11 Comments

Andrew Savarese, from PA Consulting and I discuss the endoluminal market in surgical robotics. We dig into the emerging technical challenges but also how the economics of a D&T Hybrid (diagnose & therapeutic) robotic platform will have a compelling cost benefit basis that may well drive higher adoption rates in centers of care as well as better outcomes for patients. This category is rolling very rapidly. I believe that new technologies will emerge that will represent an inflection point in surgical robotics and a revolution in end effector technologies.

96

6 Comments

The latest issue of The Lens just dropped. Stacked with insights, big ideas, and industry moves shaping the future of Medtech. This edition includes: - Cover Story: Solving Wicked Problems at the Intersection of Healthcare and Technology with Catherine Mohr - Innovator Spotlight: CardiaCare CEO Amir Soltanianzadeh - Soundbites & Hot Takes w/ Bernard Zovighian, Nick Pachuda, Diana Saraceni, Duke Rohlen, Alan Cohen, Frederic Moll, Paul LaViolette - Market Dives: Neurovascular & Cryoablation Devices Forecasts - Procedure Volume Trends: Neurosurgeries & Heart Rhythm Procedures through 2030 - Industry Winners, Capital Raises, Power Moves & More P.S. Catherine will be leading a panel at LSI USA ‘25 on Mar 18 at 9am that I’m especially looking forward to: "Staying Sexy Without GenAI or SaaS – Building Deceptively Simple but Brilliant Products," featuring panelists Rui Jing J., Sydney Robinson, and James Stone. Sure to be a good read ahead of what we’re about to see unfold next week in Dana Point. Subscribe here: https://lnkd.in/epsHbbSA

74

8 Comments

MedTech Innovation at TCT 2025 🚀 Honored to join the opening session of the MedTech Innovation Forum at TCT 2025, alongside visionary leaders Andrew Cleeland Jan Garfinkle Josh Makower Todd Brinton, MD Amr Salahieh. The session — “So, You Want to Be an Innovator: Master the Process, Channel the Genius” — offered timely reflections on how MedTech innovation must evolve to stay relevant and sustainable. 💡 Key takeaways: 1️⃣ MedTech funding is shifting. The cost of innovation is rising — driven by inflation, higher expectations, and reimbursement delays — making exits slower and returns smaller. Venture capital has shifted toward later-stage, de-risked ideas, creating new challenges for early innovators. 2️⃣ Innovation is a disciplined process, not a stroke of genius. The idea is only a small piece of the puzzle; history is written by those who show up. Unmet clinical needs are abundant, but the most promising ones are often latent—unseen yet impactful. Uncovering them is what leads to truly disruptive innovation. 3️⃣ Innovation thrives on meaning. For physicians, purpose (vs financial gain) is the most powerful motivator. However, deeper understanding and skillful navigation of the complex innovation ecosystem are needed to turn that purpose into lasting impact. In the end, meaningful innovation requires a convergence of insight, discipline, and purpose. #TCT2025 #MedTech #Innovation #MedicalDevices #Biodesign Mayo Clinic Fogarty Innovation Cardiovascular Research Foundation Juan Granada Shai Ran Sapir Lisa Carmel Charanjit (Chet) Rihal Stanford Mussallem Center for Biodesign

196

7 Comments

Kestra Medical picks former Axonics exec, Al Ford, as new Chief Commercial Officer Kestra Medical Technologies announced today that it appointed Al Ford as its new Chief Commercial Officer (CCO). As CCO, Ford will be responsible for advancing sales strategy and leading the Kestra commercial team. Kirkland, Washington-based Kestra develops the Assure wearable cardioverter defibrillator (WCD) system. Assure, a modern wearable cardioverter defibrillator (WCD) system, received FDA approval in 2021. Kestra designed Assure to provide autonomous detection and defibrillation for ventricular arrhythmias. It can also detect and record other clinically significant arrhythmias. Brian Webster, president and CEO at Kestra said, “With significant experience managing sales and commercial operations, Al brings valuable knowledge, perspective, and leadership to our organization. Al also has deep experience in the underlying defibrillation technologies that are central to the Assure system. We are confident that he will be an impactful addition as we continue to drive adoption of our lifesaving system.” Ford has 20 years of experience in MedTech, most recently serving as CCO at Axonics, Inc. There, he led the worldwide commercialization team before Boston Scientific acquired the company for $3.7 billion in November. Prior to Axonics, he served as CCO at Cardiac Science Corporation. “I am honored to join Kestra in a commercial leadership role that aligns seamlessly with my experience,” said Mr. Ford.

321

35 Comments

COMPARING HEALTHCARE QUALITY: GERMANY, FRANCE & THE US Following up on my recent post comparing the two largest healthcare systems in Europe—Germany and France—with that of the U.S., I’d like to add a few thoughts on the quality of care, particularly around mortality and access. MORTALITY Mortality rates related to childbirth, acute illness, and surgery are key indicators of healthcare quality, and the differences between these countries are stark: 🔷 Germany (~7) and France (~8) have low maternal mortality rates, thanks to strong prenatal and delivery care, while the U.S. (~33) shows significant structural gaps, particularly for vulnerable groups. 🔷 Post-heart attack mortality is lower in Germany and France (~5.6 per 100,000 over 45) compared to the U.S. (~7.9), where treatment delays and access issues are more prevalent. 🔷 Surgical complications are more consistent in Germany and France due to standardized protocols, while outcomes in the U.S. vary widely, influenced by insurance coverage and region. ACCESS 🔷 Germany leads with the shortest wait times for specialist appointments (10-15 days), while the U.S. averages ~20 days (with significant disparities) and France faces waits of ~30 days, especially outside urban areas. HEALTHCARE SYSTEM RANKING To put these insights into perspective, let’s take a look at healthcare system rankings across the world’s 11 wealthiest nations. 🔷 According to the Commenwealth Fund Germany ranks 5th, France 8th, and the U.S. 11th, with Norway, the Netherlands, and Australia leading the way. 🔷 These rankings are based on access to healthcare, care processes, administrative efficiency, equity, and healthcare outcomes. What aspects of healthcare quality do you think should be prioritized in your country? #HealthcareQuality #HealthSystems #Germany #France #USA 

87

25 Comments

Rethinking Heart Failure Management—Why Device Innovation Matters Interesting article from the Cleveland Clinic - Device-Based Heart Failure Therapies in the Spotlight. It highlights the shift in how we address heart failure in today’s clinical landscape. The piece emphasizes that despite advances in pharmacotherapy, hospitalisation and mortality rates continue to climb—and that earlier consideration of device-based therapies is essential to alter disease trajectories effectively. This aligns with the latest consensus guidance from the HFSA, advocating a more integrated pathway that pairs guideline-directed medical therapy (GDMT) with device-based options for patients not fully responding to medications alone. From my perspective at Ceryx Medical, this trend holds deep relevance. Our device, designed to optimise cardiac function, improve energy efficiency and boost cardiac output thereby treating symptoms and inducing cardiac repair, dovetails with this evolving paradigm. Here’s why: Early intervention is key: By targeting the root of cardiac inefficiency sooner, our device aligns with the Cleveland Clinic’s call to shift device therapy “earlier” in the care continuum, particularly in NYHA II–III patients. Bridging gaps in GDMT response: For patients who remain symptomatic despite medical management our approach offers a powerful tool for eliminating the debilitating symptoms of heart failure. Enhancing personalization of care: The trend toward phenotype-driven treatment decisions, as outlined in recent reviews, mirrors our commitment to developing solutions that fit the individual patient’s physiology, symptom profile, and treatment tolerance. Complementary rather than competitive: Ceryx has demonstrated our technology significant improves the clinical condition of subjects already treated with optimal pharmacotherapy. In essence, this Cleveland Clinic article reinforces that advanced device strategies are not just “nice to have”—they’re becoming essential companions to pharmacological therapy in improving outcomes and quality of life for heart failure patients. #HeartFailure #MedicalDevices #DigitalHealth #ClinicalInnovation #Cardiology #GDMT #DeviceTherapy #PatientCentricCare

34

In medtech, portability changes everything. But no matter how advanced the sensors or connectivity—𝐰𝐢𝐭𝐡𝐨𝐮𝐭 𝐨𝐩𝐭𝐢𝐦𝐢𝐳𝐞𝐝 𝐩𝐨𝐰𝐞𝐫, the device fails its mission. As a product development partner, We’ve helped clients across the globe bring 𝐛𝐚𝐭𝐭𝐞𝐫𝐲-𝐩𝐨𝐰𝐞𝐫𝐞𝐝, 𝐩𝐚𝐭𝐢𝐞𝐧𝐭-𝐟𝐚𝐜𝐢𝐧𝐠 𝐦𝐞𝐝𝐢𝐜𝐚𝐥 𝐝𝐞𝐯𝐢𝐜𝐞𝐬 to life—where runtime, safety, and regulatory readiness are all non-negotiable. 𝐇𝐞𝐫𝐞'𝐬 𝐰𝐡𝐚𝐭 𝐰𝐞'𝐯𝐞 𝐛𝐮𝐢𝐥𝐭 𝐢𝐧𝐭𝐨 𝐨𝐮𝐫 𝐩𝐨𝐰𝐞𝐫 𝐬𝐭𝐚𝐜𝐤? 1. 𝐃𝐲𝐧𝐚𝐦𝐢𝐜 𝐏𝐨𝐰𝐞𝐫 𝐒𝐜𝐚𝐥𝐢𝐧𝐠 → Firmware that adjusts MCU frequency and voltage based on real-time demand → Peripheral-level sleep/wake control tied to sensor state 2. 𝐈𝐧𝐭𝐞𝐥𝐥𝐢𝐠𝐞𝐧𝐭 𝐁𝐚𝐭𝐭𝐞𝐫𝐲 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭 → Smart fuel gauges, thermal protection, and SoC reporting → Redundant power rails for patient-critical pathways 3. 𝐅𝐚𝐢𝐥-𝐒𝐚𝐟𝐞 𝐅𝐢𝐫𝐦𝐰𝐚𝐫𝐞 𝐃𝐞𝐬𝐢𝐠𝐧 → Wake-on-interrupt logic and deep sleep modes → Power domain isolation for noisy subsystems 4. 𝐑𝐞𝐠𝐮𝐥𝐚𝐭𝐨𝐫𝐲 𝐁𝐮𝐢𝐥𝐭-𝐈𝐧 → Compliance with IEC 60601-1/1-11 during early design, not retrofitted → Patient-circuit isolation and fault-tolerant design baked into the architecture From prototyping to production, we’ve learned that 𝐭𝐫𝐮𝐞 𝐩𝐨𝐰𝐞𝐫 𝐨𝐩𝐭𝐢𝐦𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐢𝐬𝐧’𝐭 𝐣𝐮𝐬𝐭 𝐞𝐧𝐠𝐢𝐧𝐞𝐞𝐫𝐢𝐧𝐠—𝐢𝐭’𝐬 𝐟𝐨𝐫𝐞𝐬𝐢𝐠𝐡𝐭. Especially in medtech, 𝐩𝐨𝐰𝐞𝐫 𝐢𝐬𝐧’𝐭 𝐚𝐛𝐨𝐮𝐭 𝐜𝐨𝐧𝐬𝐮𝐦𝐩𝐭𝐢𝐨𝐧. 𝐈𝐭’𝐬 𝐚𝐛𝐨𝐮𝐭 𝐜𝐨𝐧𝐟𝐢𝐝𝐞𝐧𝐜𝐞. If you’re building portable devices and need a partner who designs with uptime, compliance, and scale in mind—India is ready. And so are we. #healthcare #medtech #innovation #technology

131

22 Comments