Whitepaper	by	Dr.	Tamas	Ban,	PhD,	MBA	©2017.	
The strategy of identifying
solid investment
opportunities in healthcare
Whitepaper	by	Dr.	Tamas	Ban,	PhD,	MBA	©2017.	
The	 absence	 of	 regulatory	 and	
reimbursement	 requirements	 makes	
inves...
Whitepaper	by	Dr.	Tamas	Ban,	PhD,	MBA	©2017.	
	
Service	platform	technologies	link	healthcare	and	lT	to	fuel	development	
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Whitepaper	by	Dr.	Tamas	Ban,	PhD,	MBA	©2017.	
	
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Whitepaper	by	Dr.	Tamas	Ban,	PhD,	MBA	©2017.	
	
About	the	Author	
Dr.	 Tamas	 Ban,	 PhD,	 MBA	 is	 an	 entrepreneur	 and	 ...
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The Strategy of Identifying Solid Investment Opportunities in Healthcare

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Consumerism in the healthcare industry is an inescapable growing trend. Patients are increasingly taking an active role in their care experience and are ever more empowered to choose their own care alternatives.

The key to driving a more consumer-based healthcare experience is to devise a cost-effective method to capture and analyze such information.

Healthcare is transforming into value-based healthcare, requiring investors to adjust their investment risk measures.

At the crossroads of healthcare and innovation lies service platform technologies. Hardware and service technologies will finally meet in 2016 to enable patient-centered healthcare services.

New key performance indicators (KPls) are necessary to measure patient outcomes, and new service platform technologies will use these new KPls.

Successful investments in healthcare ventures must show a positive impact on healthcare. The impact can be measured by cost, outcome, and alignment of incentives across payers, providers, and patients.

The 100-year-old methods used to measure the effects of medicine do not allow for personalization. Service platforms will bridge this gap.

Continuity of care relies on increasing the number of touch points, which service platform technologies will expand. They will also lead to connecting patients, providers, and payers to increase efficiency of patient care.

This paper will highlight a Quick Healthcare Value Assessment Tool for the investor.

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The Strategy of Identifying Solid Investment Opportunities in Healthcare

  1. 1. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. The strategy of identifying solid investment opportunities in healthcare
  2. 2. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. The absence of regulatory and reimbursement requirements makes investments in healthcare service platforms profitable. Combined with short development cycles, they are ideal venture and PE investments. v Consumerism in the healthcare industry is an inescapable growing trend. Patients are increasingly taking an active role in their care experience and are ever more empowered to choose their own care alternatives. v The key to driving a more consumer-based healthcare experience is to devise a cost-effective method to capture and analyze such information. v Healthcare is transforming into value-based healthcare, requiring investors to adjust their investment risk measures. v At the crossroads of healthcare and innovation lies service platform technologies. Hardware and service technologies will finally meet in 2016 to enable patient-centered healthcare services. v New key performance indicators (KPls) are necessary to measure patient outcomes, and new service platform technologies will use these new KPls. v Successful investments in healthcare ventures must show a positive impact on healthcare. The impact can be measured by cost, outcome, and alignment of incentives across payers, providers, and patients. v The 100-year-old methods used to measure the effects of medicine do not allow for personalization. Service platforms will bridge this gap. v Continuity of care relies on increasing the number of touch points, which service platform technologies will expand. They will also lead to connecting patients, providers, and payers to increase efficiency of patient care. v This paper will highlight a Quick Healthcare Value Assessment Tool for the investor. “If you think about how healthcare is delivered [today], it’s on an ad hoc basis. Someone comes into a hospital, someone comes into a pharmacy, someone comes into a doctor. But beyond those touch points, the patients are on their own. There is no real continuity of care.” Christopher A. Viehbacher, CEO, Sanofi, 2015
  3. 3. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. Service platform technologies link healthcare and lT to fuel development of patient-centered healthcare and healthcare platform technologies. 1 Value-Derived Incentives The banking industry has embraced technology and has transformed into a customer-centric industry. Customers can access their financials 24/7 using the internet and mobile technologies. This personalized service experience does not exist in the U.S. healthcare industry. Healthcare service platforms can bridge the gap between personalization and extension of care, leading to better patient outcomes and lower total healthcare cost. Misaligned Incentives Pharmaceutical companies are in business to provide medical solutions to health problems. They get paid at the point of sale, no matter what the outcome of the patient’s use of that product is. This is just one of many examples of misaligned incentives in the healthcare industry. The "dotcom" era created many great technologies, the integration of which now enables the creation of patient-centric solutions. Now is the time to recalibrate how we measure outcomes, which can be accomplished using platform technologies that will provide data to measure and engage the desired outcomes. Value Driven Incentives & Outcomes Economy Smart investors know to invest in IT, health, and consumer products. Smarter investors invest in companies whose products fit all three criteria. 2 Who Benefits? Everyone benefits! Patients, providers, payers, and companies will all benefit from value-derived incentives. Patient engagement will increase in preventative care, resulting in an overall increase in quality of life. Providers will see shorter hospitals stays and more effective treatments. Payers will see lower cost treatments with better outcomes. Companies will profit as they provide products and services that lead to better health treatments/diagnoses. Products that do not measurably improve outcomes will diminish, which benefits the healthcare industry. Successful investors will see improved ROl with their investments in healthcare-related platform technologies. The Alternative The broad effects of information platform technologies will lead to silos in the current healthcare system. These technologies will not only improve the outcome economy, but they will meet the demand for personalized healthcare experiences. Adapted from Preqin: Venture Deals, 2015
  4. 4. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. 11 1 Adapted from Patient Engagement and the Healthcare Ecosystems 2.0, March 2014. Current U.S. Healthcare System1 Lack of personalized experience Consumerism in the healthcare industry is an inescapable growing trend. Patients are increasingly taking an active role in their care experience and are evermore empowered to choose their own care alternatives. 1 therefore - - is soon 2 As a result, are all the required necessary
  5. 5. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. 2016: Cross Roads of Innovation Government mandates will enable smart ventures to create patient-centered healthcare. Integration of hardware and software must include assessment of health outcomes. Service platforms with an emphasis on outcomes will succeed. 1 the I - the - The 90’s also saw the the Personalized experience in health care is finally possible Infrastructure and healthcare are finally aligned to extend care beyond the hospital. Mobile technologies serve as a platform to bring healthcare into the home. 2 This by the emerged
  6. 6. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. 12 23 2 Porter, M. E., Lee T. H. (2013, October). The Strategy That Will Fix Health Care. Harvard Business Review. 3 Van Biesen, T., Weisbrod, J., Sawhney, R., Coffman, J. (2015). By the numbers: The shifting US healthcare landscape. Front Line of Healthcare Report, Bain & Company. Value-based healthcare requires new measures that incorporate outcomes. These measures will arise from interfacing new hardware, software and information platforms technologies. 1 At its core, value based medicine strives to provide a high quality of care at the lowest cost possible. Supply-driven healthcare is losing to patient-centered healthcare, which is planned around the patients' needs. New hardware and software clinical solutions must show an improvement in patient outcome; new solutions must show a solve for a health problem. Outcomes Economy Measured by life expectancy, the U.S. is in the top tier amongst developed countries. Furthermore, hospitals are well-equipped to address the delivery of healthcare. This comes at a high cost to the healthcare system. Individuals in the U.S. spend 90% of their lifetime healthcare cost in their last year of life, yet continuity of care is subpar in the U.S. compared to other developed countries. Prescription/OTC Oral Medication Monetization of pharmaceuticals occurs at the point of sale. The value-based intent is to take the medication and have a positive clinical outcome. A company called Proteus Digital Health (Redwood City, CA), has a small chip that can be placed on a pill. When the chip is exposed to stomach acid it creates a small electric field, which can be monitored remotely to determine if the pill was ingested. This is actionable information that can be useful for pharmaceutical companies. Direct and accurate usage information is important to both the physician and pharmaceutical company. This kind of actionable information leads to patient education and reminders to take their medication, not to mention that drug prescription patterns of in- network physicians is of value to the insurance company. Big data analytics and methods help to design medical, hardware, and software revisions that improve patient outcomes. Such improvements drive technological innovations, which nudge 2 toward service platform technologies. Soft Data is the key to the other 50% of healthcare ln the world of Big Data and the internet of things (lOT), there are two basic types of data: hard and soft. Hard data is quantitative data based on numbers and graphs, also known as structured data. Soft data, or unstructured data, is in the form of text and multimedia content. Unstructured data does not fit neatly into a database. Healthcare today uses structured data, mostly in the hospital environment for documentation purposes. Hospital lnformation Systems (HlS) software such as Epic, McKesson, Allscripts, Cerner, and Athena Health utilize structured data to create performance metrics to enable monitoring and identification of bottle necks in their respective medical groups. Although unstructured data, such as radiology scans, do exist on the HlS and EMR, they still accompany a textual report by a radiologist, which is then used to make clinical decisions by the attending physician. Clinicians know the patients well during their stay at the hospital, but do not monitor or know the patient before or after the hospital visit. New ventures that offer solutions to knowing the patient after discharge can use structure and unstructured data gathered by hardware and software technologies to enable clinicians and insurance companies to learn the real value of the care that was provided. Care delivery is also shifting toward a more integrated, systemized model. Providers have invested in new tools to support more systemized care. These tools cover telemedicine, transparency initiatives, remote patient monitoring, predictive analytics, comparative effectiveness data, wellness programs, patient adherence initiatives, and care coordinators.
  7. 7. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. VC Seed/Angel round participation is still leading over early stage and late stage; the time is ripe for service platform investments. Founders demand larger seed rounds to reach the metrics Series A investors now require. Seed round investments must cover the requirements of Series A investors. General requirements are market fit, proof of repeatable business, and a clear path to scale. The management team and customer acquisition costs are primary sources of concern. Product and market fit are essential components of any new venture, and can be qualitatively validated when people who know the product want the product and are happy with it. Therefore, medical devices and platform technologies must show clinical efficacy. Some efficacy studies include human proof-of-concept studies as part of an Institutional Review Board (lRB)-approved study. lRB protocol are approved in a university setting. The market for these devices must be a large population (e.g., heart disease, diabetes, glaucoma), meaning millions of patients. The number of tests per year performed on the device yields a good measure of the market. Having a large market demand proved by data ensures proof of repeatable business. A productized solution shows repeatable business. A customized solution does now show repeatable business. By typical standards, when a medical device passes through FDA approval, it by default becomes a productized solution as it cannot be changed and altered to meet the specific needs of a specific customer. The product design must appeal to a variety of consumers, patients, and physicians. The business must be able to scale, and this must be shown to the Series A investor via analogs or a clear path to scale and growth strategy. Entrepreneurs underestimate the effort it takes to acquire customers, and this information is necessary to the Series A investor. Identified customer acquisition and customer lifetime value metrics should point to profitability. lnnovative ways to acquire the first beta customer with a minimum viable product is the key for success.
  8. 8. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. 14 4 Safavi, K., Ratliff, R. (2015). 2015 Health Tech Vision. Accenture. Successful VC firms invest in companies that have a demonstrable impact on lowering the cost of healthcare and improving outcomes while aligning incentives across payers, providers, and patients. Investments in ventures that are based on value-based and personalized experience in healthcare will fuel return on ROIs. 1 What is the solution to the user? About a decade ago a meaningful value inflection point was regulatory approval. Today, investors recognize the uncertainty and complications of the reimbursement process, which can be just as long and difficult as the regulatory pathway. Furthermore, the exit lPO strategy for venture-backed medical device ventures is virtually non-existent. Strategic acquirers don't present themselves until revenue momentum has been achieved. Typically, this happens in the $30-$50 million annual range4 . For this reason, investors have shied away from investments in early-stage ventures, which require regulatory and reimbursement approvals. Clinical decision support and dashboard ventures began to spark the interest of inventors. Most of these technologies don't require regulatory or reimbursement approvals, yet they are an integral part in the delivery of healthcare. These devices help, but they defer clinical judgment to the physician; thus, they are not considered medical devices. 2 Health apps and mobile health apps (mHealth) challenge regulatory bodies all over the globe. Although the FDA has created guidance for mHealth, many healthcare-related apps are not regulated. This allows investors to participate in healthcare investments without the regulatory and reimbursement headache. Value-based healthcare nudges toward a personalized experience in healthcare, and the extension of healthcare outside the hospital is the future, especially considering the increasing use of mobile devices by patients of all ages. Five healthcare revolutions are the lnternet of Me, Outcomes Economy, Platform Revolution, Intelligent Enterprises, and Workforce Reimagined. Investments in ventures that are value-based and offer personalized experience in healthcare will fuel the return on ROI. Participate in healthcare investments without the regulatory and reimbursement headache
  9. 9. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. The 100-year-old methods used to measure the effects of medicine do not allow for personalization. Service platforms will bridge this gap. Internet of Me We live in an instant gratification society where we can research, compare, price, and purchase airline tickets online and chose our own seats. Our TVs can suggest movies to us based on our TV watching habits. The Internet of Me has supercharged and empowered consumers in the last decade. So why have we not personalized our healthcare? DNA sequencing is available to anyone for a modest cost, and this information could be integrated and shared with our physicians to make better clinical recommendations. Drug dosing is still based on gender, weight, and family history, but genetic information is readily available and can be invaluable to drug administration. Warfarin sensitivity is just one example. Hospitals should know us before we arrive and continue knowing us after we leave. Outcome Economics We track medicine based on whether an activity occurred, not whether a benefit occurred. Pharmaceutical companies are in business to create medical solutions to health problems, yet their incentive structure is based on selling the medication, not whether those medications were taken and had a medical benefit. Technologies could be integrated to help track adoption and adherence to drug therapy regimens. The federal government has placed certain quality measures and mandates in place to evolve healthcare from payment for activity to payment for value. With the latest IT infrastructure in place, it has become easier to measure and manage such a system. Platform Revolution Platform technologies assemble various technologies to offer a comprehensive platform of care. These technologies can be sensors, computing, storage, communication, analytics, or biotechnology. Assembling a synergistic group of technologies will be the next driver of healthcare innovations. For example, Nanosphere offers targeted molecular diagnostic tests that identify infections in the bloodstream, the respiratory system, and the GI tract. Data fed today from various information sources will enable service platforms of the future. Intelligent Enterprises It is estimated that 30 billion devices will be connected to the internet by 2020. This will create a groundswell of real-time information that we have never seen before. Integrating these data sources into an infrastructure is going to be a huge milestone. Customer experience will be improved greatly by utilizing advanced data science. Physicians use a lot of their time hunting for information, but with this new technology, they will spend more time with patients and will have access to prepackaged data. Being a physician is going to be data driven, resulting in physicians and nurses spending less time gathering information. Workforce re-imagined Google knows us better than we think they do. Our internet searches using Google are customer-based and are customized using our historical preferences. Why can't this be done for healthcare? The hospital should know us and our problems before we walk into the emergency room, and they should know our medical treatment status after we leave the hospital. Improvement from the status quo does not have to be this intrusive. Suppose a hospital app allows me to locate the most convenient parking area based on where in the hospital I am visiting; this instantly improves the customer/patient experience. This may also allow the hospital to know that l am about to walk into the door before l actually do. Once at the hospital, using geosync that is already available in our smart phones, we could get turn-by- turn directions to our specific destination (patient room, labs, imaging, etc.). Security measures could be in place to prevent unwanted individuals to wander in the hospital and hospital grounds.
  10. 10. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. 15 5 Key Indicators of Well-Being, agingstats.gov, 2012. Healthcare service platforms will play a crucial role in tying stakeholders (patients, providers, technology, and payers) together. This will lead to better results for patients and providers at a lower cost. be able to otherwise investment Integrated Strategy New ventures seeking funding must include the benefits to payers and providers. Showing a benefit to patient outcome is not enough in this money-stretched economy.
  11. 11. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. 16 6 Congressional Budget Office 1 Business Case for Healthcare Investments Size of Market: A+ ln its entirety, the U.S. healthcare industry is $3 trillion. The U.S. government spends 27% of its outlays on Medicare and healthcare. Healthcare is just shy of social security at 33%, with military spending in third place at 16%. Demand for healthcare will increase due to the aging population. The conundrum is that healthcare supply is being squeezed to lower costs. Any new healthcare solution must address the benefits to patient, provider, and payer. The overall philanthropic goal is to reduce total cost of healthcare. Uncertainty: C The current regulatory and reimbursement environment is embracing value creation from their applicants. Historically, regulatory approval was the first major milestone sought by investors. Reimbursement has been assumed to be easier than regulatory approval. Today, the FDA & the reimbursement approval processes have become more complex. Uncertainty does not begin to fade until both FDA and reimbursement approvals have been secured. Successful adoption requires acceptance by consumers, payers, and providers. Technology sustainability is another key factor to consider. Customer: A- The introduction of the iPhone in 2006 created the instant gratification generation. This empowered customers to do research and read reviews right at their fingertips. This trend is slowly migrating into healthcare, changing the relationship between patients and doctors. Service platforms, like some health apps, further empower patients to take charge. Mobile health apps are a nudge toward industry-specific service platforms. Competition: B The healthcare competitive landscape is strong. New ventures that close the loop on the ACOs mandates should come to fruition. Even insurance companies are changing their risk methodologies. Physician groups and hospitals are changing the way they deliver care as patients demand value from insurers and providers. Patients are well-informed enough to take on needs they feel are not being met. Healthcare is crowded, but niche markets open up new opportunities. Entry Barrier: B The regulatory and reimbursement uncertainty creates a barrier to entry into the existing healthcare market. Entrepreneurs are discovering ways to offer healthcare solutions that do not require FDA and reimbursement approval. Creation of measureable healthcare values seems to play a major role. The regulatory nature of healthcare will never disappear, so smart entrepreneurs and investors find innovative ways to participate in healthcare without the regulatory/reimbursement headache. Suppliers: B Ventures that can't scale and have no current customers result in poor pricing with suppliers, causing difficulty in maintaining good margins. Medical devices that require specialized components might pose difficulty in sourcing and consistent costs. The key factor to consider is the use of non-specialized materials and goods and packaging those into a specialized offering/solution. 2 Substitutes: B Providing a good value to the patient, provider, and payer ensures higher switching costs, though network effects are important in healthcare. New ventures that can't clearly articulate their differentiation will not survive. Successful ventures that create real and differentiable value will exhibit the appearance of less substitution for their product/solution. Market: A The healthcare market is highly fragmented. Switching costs are high due to self-inflicted silos. Complex health care and delivery systems require many subject matter leaders, though with many decision makers, the system become more inefficient. Clinician leaders in hospital want change. IT leaders in the healthcare industry are bound to their infrastructures, which are immobile. Today any meaningful change on the surface requires deep financial investment. Model: The universality of money gave rise to Accountable Care Organizations. These organizations are able to make quicker decisions. They are nimble enough to accept change and embrace valuable service platforms and solutions. The key for a new venture is to market their solutions to nimble customers. Management: Management teams that thoroughly understand the three arms of healthcare (patient, provider, payer) will out succeed teams that don't. Investors can safeguard their success by providing and ensuring new ventures have management teams that are smart and nimble and that possess areas of expertise in all three arms of healthcare. Qualitative Factors: The healthcare market will continue to grow well beyond 2020. The baby boomer population of the U.S. (65 years and older) has begun to increase at a rate never seen before. Baby Boomers are estimated to increase to 55 million in 2020 and 90 million in 2050. The market for healthcare services is therefore bound to significantly increase as the U.S. population ages. Pressure from insurers and the government will force health technologies and services to become more efficient. The national move toward consumerism of healthcare is here to stay, and ventures and investors that realize and ride this trend will continue to be successful.
  12. 12. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. Defining value in healthcare is complex. It can be summarized by patient outcomes, safety, experiences, and costs. 2 Due to the many stakeholders in healthcare, there is no industry guideline to estimate value. It is recognized that patient outcome outweighs all other measures for value. For investment purposes, the three stakeholders are treated to have equal contribution to value. Value is then defined as the ratio of quality over costs. Stakeholders are set to contribute equality to value. By definition, there are three components to quality: quality to the patient, quality to the provider, and quality to the payer. Similarly, there are three components to cost, one for each of the stakeholders. Therefore, the usable form of the equation becomes: Status quo is defined as 1.0. The numeric value indicates whether the concept has healthcare value. A value greater than 1.0 indicates a benefit to healthcare. A value equal to 1.0 indicates no added benefit to healthcare. A value less than 1.0 indicates there is no added healthcare value and total cost to the healthcare system is unfavorable. The relative value is not indicative that the new venture solution is 12.2 times better than status quo. Relative values can compare two ventures and see which has better healthcare value. Traditional and gut feel valuations on the business side are still necessary to perform successful venture investing. However, the question of "How much value does this product/service has to the healthcare industry?" may be answered by the proposed calculation. The result of the proposed calculation may be qualitative (better, same, or worse) or quantitative. For successful venture investments it is necessary to perform risk- based analysis, analysis of fundamentals, build a business plan, market analysis, and it is proposed to perform the above healthcare value calculation to determine how the healthcare industry will perceive the value of the product/service. !"#$% = '$"#()* +,-) Quick Healthcare Value Assessment Tool for Investors Value > 3.0 “Adds Value” Value = 3.0 “Status Quo” Value < 3.0 “No Value” 1 Example: A new venture offers a healthcare solution that gives a 10% quicker recovery time, and the provider can perform tests 3x faster, readmission rates are cut in half, and it costs 50% less across the board. './01230 = 1.10, '.7891:27 = 3.0, './=27 = 2.0 +./01230+.7891:27+./=27 = 0.5 !./01230 = './01230 +./01230 = 1.10 . 5 = 2.2 !.7891:27 = '.7891:27 +.7891:27 = 3.0 . 5 = 6 !./=27 = './=27 +./=27 = 2.0 0.5 = 4.0 !B2/C0DE/72 = 2.2 + 6 + 4 = 12.2
  13. 13. Whitepaper by Dr. Tamas Ban, PhD, MBA ©2017. About the Author Dr. Tamas Ban, PhD, MBA is an entrepreneur and accomplished biomedical engineering executive with over 20 years of startup and Fortune 500 experience in medical device, healthcare, and instrumentation industries. His proven ability to drive system, technology, and business integration has led to multiple acquired ventures and startup companies. His ability to bridge technology with business needs to identify novel or disruptive technologies in the healthcare and medical device markets is unparalleled. Dr. Ban is currently the President and CEO of RetMap, an ophthalmic diagnostic start-up located in the northern suburbs of Chicago. He oversees corporate strategy, organizational development, and management and commercialization of the RetMap technologies. Previously, Dr. Ban was a Senior Member of Technical Staff at Hospira (now a Pfizer Company) at the Advanced Technology Center, where he consulted C-level executives on healthcare technologies. During his six years at Hospira, Dr. Ban patented numerous healthcare-related hardware and software technologies. He presented numerous times to the CEO, COO, CMO, CSO, and VPs of R&D, sales, and marketing and conducted a number of training seminars for the national sales teams, demonstrating novel technologies and educating the salesforce on healthcare trends. He was a key member of a cross-functional team that lead the acquisition of start-up companies in the infusion therapy industry. Dr. Ban spent 13 years at Instrument Specialist, Inc., learning the nimble operations of startups. His work on several thermal analysis instruments have been used by NASA, the U.S. military, and other major pharmaceutical and materials engineering corporations. Dr. Ban received his B.S. and Ph.D. in Bioengineering from the University of Illinois at Chicago. His thesis research at the Neural Engineering and Vision Laboratory was to construct the first complete system to measure the multi-electrode electroretinogram (meERG) with the CLEAr Lens™ System. His research discoveries led to two NlH-funded grants and the founding of RetMap, lnc. Dr. Ban received his executive MBA at The University of Chicago Booth School of Business concentrating in finance, strategy, and entrepreneurship. Venture Capitalist, Entrepreneur, Bioengineer, and Medical Device Inventor

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