Why health care entrepreneurs need to be missionaries, not mercenaries — with angel investor Zen Chu

This week on Second Opinion, Christina Farr sits down with healthcare investing legend Zen Chu, who shares his framework for backing resilient entrepreneurs and insights from early investments in companies like Abridge and PillPack.

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LINKS: 

Zen Chu (MIT): https://mitsloan.mit.edu/faculty/directory/zen-chu 

MIT Hacking Medicine: https://hackingmedicine.mit.edu/ 

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HIGHLIGHTS FROM THE EPISODE:

• According to Zen, technology is essential to scale medicine and achieve the quadruple aim: better quality, lower cost, better access, and reduced burnout.
• When investing, Zen looks for entrepreneurs who have weathered crises and shown adaptability and resilience.
• He prefers "missionaries over mercenaries" - founders whose personal identity connects with their business mission.
• Zen believes in "founder-market fit" where entrepreneurs deeply understand the problems they're solving.
• Determined founders refuse to give up during challenging periods and find ways to pivot successfully.
• Zen highlights examples of his successful investments, including Abridge and PillPack.
• Zen recommends securing a personal "FU fund" that provides the financial security to take entrepreneurial risks.
• Investing in friends can be effective but may alter the dynamics of personal relationships.
• Zen advises investors to only put money in startups they're willing to lose entirely.
• Health systems make challenging customers because they often "pilot things to death."
• Most physicians aren't suited to be startup CEOs as they're typically trained for individual decision-making rather than collaborative leadership. The best physician entrepreneurs often come from resource-constrained healthcare settings.
• "Algorithmic care" enables automated, guideline-based treatment for patients who know what they need.
• The healthcare system frequently underestimates patients' understanding of their own health needs.
• In his rapid assessment, Zen considers AI in medicine appropriately hyped with incredible potential.
• He sees point solution care delivery businesses as likely overhyped with many failures ahead.
• Consumerization of healthcare is "about right" though possibly receiving too much funding.
• Medical devices are "under invested" with insufficient venture capital expertise in the sector.
• Many healthcare technology tools struggle as standalone products, pushing startups to vertically integrate and deliver care directly.