Healthcare Startup in the Pandemic

This article was published in the Summit 2021 issue

by Stephen Fabiano, CEO, Fia Care

Starting a new business right before a pandemic was an incredibly foolhardy endeavor, but it has taught me some of the most valuable lessons for running a business and for running my life.

Choose your people like you’d choose a spouse

There is nothing more paramount than making sure that you have chosen the right team. Conversely, if you are new into the startup, you better make very sure that you are throwing your lot in with the right people. When I say “the right people,” I mean that you need to be working with people that bring out your best, whose opinions and judgments you respect and value, and who you are happy working for. Make no mistake in thinking that you’re the only one to benefit from being in a startup. The other people- the core team- those are the people that you’re going to spend the next several years of your life working for. If you do well, then your efforts will make them wealthy. So, if there is resentment, envy, discord, or senses of undue entitlement, then steer clear of the enterprise. You do not want to work for someone for five years only to make them fabulously wealthy while you resent them bitterly.

Some time after starting this business, I was advised by a friend and prospective business partner to bring someone onto the team that my friend thought would be fantastic. After meeting this person, I was wowed and concurred strongly with my friend’s recommendation. This person was bright, ambitious, motivated, and seemed cut from a similar personality cloth as myself. I quickly rushed to optimistically divide the company’s equity between my friend, this new recruit, and other early individuals. I had been working on the business that became Fia Care for years and I quickly became eager to please new entrants and make plans of ownership prior to vetting personalities and skills (as many start-up founders are wont to do). The price of the hasty decision of bringing people into the team without longer-term vetting ended up being quite sizable several months later.

Eventually, I ended up parting ways with a number of these friends over the succeeding months as various conflicts arose. One member of the group expected a sizable chunk of the company despite ceasing any sort of work. Another, that friend’s recommended member, decided to contest for leadership of the company. It was that person, particularly, that forced me to realize that despite all of the things that I thought I had known about that person, there was a fundamental mismatch of personal objectives and ideas about the value brought to the company. I wrestled with what to do for a couple of months before ultimately initiating a parting of ways. It was difficult to do, given the personal friendship, but I realized that with such profound differences between us it would be impossible for us to continue working together. It would be better to divorce now rather than continuing in a marriage that was destined for resentment and, likely, a greater and costlier divorce down the road.

Advice that I had unfortunately heard after this series of fallouts was that VCs deem partnerships forged over a weekend (as I had done) as one of the most serious red flags for an enterprise seeking funding. A lesson learned late, but not too late for me.

If you don’t know your weaknesses now, you soon will

There is nothing like leading a group of people into the unknown of a brand-new company. The journey of a startup makes painfully clear your strengths and weaknesses. When I started what would become Fia Care, I thought I was a competent salesman, an excellent analyst, and a great product/idea man. Turning the idea and cheerleading it into a breathing, functioning company, however, has shown me exactly where I am weak. One of the most persistently biting weaknesses of mine has been a naivete towards people and their motivations. As someone who doesn’t mind helping out other companies just to be helpful, I have often assumed that other people are the same way. I’ve had a number of awkward encounters with those eager to “help out.” Many of those engagements have come with a surprising and sizable invoice a month or two later. I’ve learned that it’s much safer to assume that almost no one just wants to help you or your company out. Unless the person you’re talking to is from a non-profit or had a contributing role in your birth, you can expect a bill in the mail for any “help” that is rendered.

You’ll probably make bad hires, struggle to stay organized, and your product might not appeal to everyone. It’s part of the ride.

At a certain point, there’s no going back

Once you lift off- whether that’s defined by getting your first customer, hiring your first employee, or taking a big sum of money from investors, you are now in a new world and there is no going back: life as a clock-in/clock-out employee is over.

Two weeks before the lockdowns started I decided to launch our company into the thick of competition. We had a successful pilot, a great team, and all the chutzpah money can’t buy. Our product was sure to reduce the cost of healthcare for swathes of patients and we had figured the perfect market entrance strategy: on-site employer visits. Unfortunately, the lockdowns began and all of our willing employer clients shifted priorities substantially and moved their employees to full remote status. Our dream of slashing healthcare costs required a steady flow of on-site employer visits and our employers had vanished. At this point, there was no turning the train around and we had to figure out what to do. We shut operations down for several months and eventually settled on a new product where we could, conceivably, utilize our already built solutions in the future.

With no small amount of drama and sweat, we reconfigured the whole operation. We rejiggered our team, found new clients, and launched our service with relatively little fanfare. We launched in November of 2020 and gathered a small, but loyal patient base.

It’s a bumpy ride, with unexpected twists and turns. Buckle your seatbelt and hang on.

Don’t be scared, join the larger community

It can be intimidating to meet other startups, and it’s so tempting to compare yourself to others. You may not want your idea to get poached, you may be scared your business isn’t as cool as others, or you may think you have nothing to gain from associating with other startups. All of these are, mostly, wrong. Since applying to and making it through some of the stages of various pitch competitions, I’ve made loads of friends from different companies in the Utah startup scene. Some, like my friends Miguel Villalobos and Edgar Carreon from Dree, have become real friends and have been generous enough to help us forge new partnerships and find new business. In fact, I’ll have to update what I said earlier about not being able to trust the naked goodwill of others. You can often find it in the abnormally generous community of other startups. As comrades in the same trenches of building companies from nothing, there is a certain esprit de corps that engenders cooperation and support. Once you engage with the start-up community you’re going to find a resource or friendship that can help you no matter what stage you are in.You have a lot to learn at every stage of your startup, and a lot to talk about. Sharing is caring.

Know when to Hold or Fold

Focus on your business, don’t get distracted by everything that you could be, focus on what you need to be now and what you need to be next. It’s easy to get distracted by every new, possible pivot that you can make in your business. There’s something about a shiny penny that can take a founder’s eye off the ball. We’ve experienced this as we’ve opened up different lines of business and become infatuated with that which is new and particularly alluring. We’ve been selling our at-home and virtual Primary Care services to employer groups, but have had advisors and other people point out additional opportunities that seem exciting when initially considered.

Shortly after launch we had quite a bit of interest from prospective clients in other states outside of Utah. We made attempts to register, license, and commence operations in those states but quickly found ourselves stretched far too thin to adequately meet client needs and expectations. We ended up pulling back our ops to markets where we were strong and have foregone overeager expansion into other geographies. There’s no easy way to know when it’s time to pivot or when success is right around the corner. Your P&L will tell you whether it’s working today, but it’s going to be your team and your own intuition that will help you know when to stick to what you’re doing and when to pivot, change, or fold.

There’s no start-up community like that of Utah - no place where you’re going to find the confluence of talent, gumption, and decency that you find here. To my fellow founders I wish success in whatever state of the start-up journey you find yourselves.

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