Health Innovators
Health Innovators

Episode · 1 year ago

When no = yes! Finding invaluable insights w/ Ariel Efergan


Compared to more established organizations, healthcare start-ups experienced some of the bigger challenges during recent market crises.

With less clout, doors close faster, and the word ‘no’ can be discouraging - but not every ‘no’ is the wrong type of ‘no’. Not every ‘no’ is the same.

Learning how to power through the let-down of rejection and find your way to the prized bit of guidance hidden beneath, can be key to surviving and thriving in a volatile market.

Today, CEO and Co-Founder of Pangea Medical, Ariel Efergan, talks candidly about his start-up’s experiences during the recent international pandemic and their take on the importance of the customer discovery process.

Here are the show highlights:

  • These are some of the biggest challenges a startup can face during a crisis (2:18)
  • This is one of the most important aspects of the validation (proof of concept) process (4:49)
  • Having belief in your solution is essential, but so is the ability to take feedback (6:32)
  • Ways the buying environment has changed during the pandemic (8:57)
  • Nothing prepares an entrepreneur for evaluating a pivot process more than an international crisis (11:03)
  • A pivot away from your current strategy might uncover your ‘Eureka!’ moment (15:15)
  • Hearing ‘No’ sucks - but that doesn’t mean it’s not the ‘right’ no! (16:06)
  • 3 important lessons learned from guiding a start-up through a pandemic (21:48)

Guest Bio

Ariel Efergan is the CEO and Co-Founder of Pangea Medical, a healthcare start-up that aims data-driven actions to work with payers and providers in order to better understand patients and deliver more accurate and cost-effective care.

Ariel received his education from The University of Maryland - Robert H. Smith School of Business and had devoted his career to understanding the intricacies of how business, financing, and positive customer experiences work together to form a successful venture.

If you’d like to reach out to Ariel with questions, or for additional information about his company, he can be reached via email at, on their website at, or you can follow them on LinkedIn at Pangea Medical.


Welcome to Coiq, where you learn howhealth innovators maximize their success. I'm your host, Dr Roxy,founder of Legacy, DNA and international beath selling author ofhow health innovators maximize market success through handed conversationswith health innovators earlier doctors and influencers you'll learn how tobring your innovation from idea to start up to market domination, and now,let's jump into the latest episode of Coiq, welcome back t oyq listeners ontoday's episode. I am speaking with Areel Efrigan, who is the CEO andcofounder of Pangea Medical. Welcome to the show! Thank you for having me. Yes, it's good to have you here. So,let's start off by telling our viewers and listeners a little bit about yourbackground and what you've been innovating yeah. So I founder ofPangiamedical, which is Healtha organization that aims to work withpairs and providers to better understand patience and an effort todeliver the most accurate and cost effective care. We really took kind ofa different approach at this by focusing more on social deteraments of health,which something that I'm pretty passionate about, started pangiomedical kind of out ofSchool University of Maryland, but then really got formulized at a booth atUniversity of Chicago Wewere. In a program there we've been around for about three years, yeah, I don't know much else I can stay. I mean I'm verypassionat about healthcare, my families in healthcare. I had a lot of unfortunate encounters of health carethroughout my life, so it's been a very prevalence component of my life yeahyeah. So where are you in the innovation process? Now? So, I would say, were kind of maybe on the cust of Skilling or a growth were really kind of HA proved out. Our car deliverymodel, which is really a core of our innovation, is how we care for patience and then also the business model wecreated around that, and so we validated out of the lastthree years iterated on that consistently and obviously consistentlyare iterating on it and now we're just Aboue to startraising our first or whe prosse. Raising our first round of financething, obviously, this whole corona situation has put a bit of a detour onthat, but ultimately, Ewe were prior to corona were at the point we're about tostar steeling, Yeap Yep, so areall. Let's talk about some of the earlierdays before we move into now so kind of take us through the journey ind the last three years. What are some of the biggest challengesthat you faced and how you overcame them? Yeah, so I would say early on not having a background. An aHeutecarrand S, not knowing, which is also part of the fun right is just you know. Ignorance is BLISSD to acertain extent, but healthcare is a a very complex industry, as you know,Yeahso just being able to understand all the nuances that go along withparticularly selling and healthcare took me a while to grasp and there'sreally no good way to truthfully understand eside from US going out anddoing it. So that was one of the big challenges Ithink second to that was to understandingreally the impact of technology and healthcare and stetding reaisticexpectations for how I think technology... a meaningful role in improvingpatient outcomes. Ur there's different fascets of health. Do you can look toimprove efficiency, cosroduction quality metric Etca? For me, theprimarity outcome is patient outcomes that right quality, metrics m. It alsocost, and then I would say the third kind ofbiggest challenge early on was not fully comprehending how important ISS to have on't know for lack of better term bignames behind you right and that kind of clinical validation, also going throughthe process of both clitical and kind of peervalidation, riht wore trying to get published in academic journals, as wellas bringing in really recognized figures within the healthcare landscape,to kind of back your idea and back what you're doing, because it really istough to be. You know taken seriously, I guess by these Bahemi institutionsthat have a very particular way of doing things, but doing it for a whilegenerated billions of dollars doing it. This way. So they're very risk overseon very I guess they don't want to change theirways. So what were some of the strategies that you deployed to kind ofget through that validation or proof of concept process? Because it is, it canbe expensive and it can take a long time, and sometimes it's not just the technology solution that you havethat's going to make the difference on whether you're going to be able to evenget through that phase of the innovation process yeah. So, first andforemost, what I tell people is customer discovery is the mostimportant thing ever. I can't tell you how many times ill speak to people andthey've spent. God knows how much money on something that they never asked.Anyone if they wanted, and then they tell me this idea I' like his saido onethat already exists, and it's done really well or to there's just no needfor this right well go out and they start trying to pitch into peoplethey're, not selling, Lik. Oh, why is no one buy this? I understand what theywant so when I started Pangea Georgay a different idea, but I find asignificant amount of time. Literally just interviewing people who wereindustry axpers would be my end user. Who would be our buyers just littleinterviewd hundreds of people askin? Would you buy this? What do you thinkabout this? What would you want to see in something like this in a programlike this, so that's first and foremost iscostomer interview. I can't explain how imporant is and not with people whoyou're comfortable with right. Your friends, your family they'll, besupportive right. You have the gods to go out in the street and just walk upto random people. Who you think are your carget demographic say: Hey. Doyou have five minutes, I'm doing some research for something yeah. Why do youthink so many innorvators are, or just entrepreneurs in general or justopposed to that part of the process? I think primarily because part of beingan entrepreneur inovators, you have to have a really strong conviction in whatyou're doing an sometimes that can be clouded with arrogance. Sometimes thatcould be howtered with other things, but ultimately, if you really reallyreally strongly believe that this is the thing you know, I'm going to pushthis whatever. There's no rea in your mind, there's no doubt H, yeah, ahundred percent of what else is Goinna want this. Why would I be wrong, like Ibelieve in this, so so strongly right, right, Yep? I can see that then. Maybe another reason could be it's uncomfortable to do. You know andpeople are afraid of rejection right...

...and so being told now, when your ideasstupid or whatever it's pretty disheartening heard, you know a lot a lot of that. So it's think that's a toughest job, anEntrepreneuris to know what knows are legitimate and how to take thatfeedback and internalize that and use that versus people who don'tactually really know so much about what they're talking about, and you thinkyou know better than that because to a certain degree in some situations we dobut having that humility to know whend, you don't is possibly one of the mostimportant things. Yeah Yeah, you know, and it's so true it is such a fine line,because that persistence and, like you said conviction, is a huge driver inentrepreneurship and so there's almost a certain amount of. I have to ignorewhat people say, because I'm fighting against a statusquo and I'm trying to change behavior and change beliefs right I'm acting asthis change agent and then there's also this piece that is like, but I can't just ignore everything canignore my customers. Otherwise I might find myself in trouble yeah, I hundred percent- It's definitely tough N, you're kind ofsitting on the fence, and so it's tough to make those distinctions. But it'sjust so important. So how has covid impacted your business pretty significantly as with most people so, first and foremost, the buyingenvironment and health cares change significantly provider groups, don't have good capital flow right now, and sothey are not able to invest an innovation which you don't want to dobefore and now that sure is hol don't want to do, and so all of the conversations we werehaving e Sentra Gob pushed back significantly on the Pairside they're flushed, withCAS right now, but they're pretty apprehensive todoing new things and that no one really knows what health isgoing to look like after this already we've seen significant changes inpaynment models and healthcare particular Il Tella Medicine. Where youknow this was such a big ordeal for years and years, and literally justlike that they removed all the regulations aroundtelle medicin and now you can build for like a regular visit and everything,and so there's a pretty big indicator. I think that other pin models andhealth ar will change significantly so everone just a little bit scared rightnow. So no one's really moving Ford. wird things I mean I'll talk to myother friends and CEOS of other healthcaire companies that are muchlarger than we are a a the same organizations and they tell me the samething I mean I know pretty big organization, that's kind of on thecust of collapsing, almost because of this yeah. So I would say that that that buyingbehaviors change significantly and then also how people expect to engage withhealth care. Think itwill be really interesting. After this to see you knowour people stare to go to hospital still. What is that, due to talizationrates? How do people actually feel about Telo medicine right? What kind of impact die that actually have onsomeone's well being in care? So yeah there's definitely open outedquestion that has has made the by environment. More conservative hey it'sDr Roxy, here with a quick break from the conversation. Are you trying tofigure out what moves you need to make to survive and thrive in the new covideconomy? I want every health innovator to find their most viable andprofitable Tibit trategy, which is why I creatis a covid proof, your businessto the kid. The pipokit is a step by step framework that helps you find yourbest tivid strategy. It walks you...

...through six categories. You need toexamine for a three hundred and sixty degree view of your business. I callthem the six critical pivot lenses, as you make your way through thiscomprehensive kid, you'll be armed with the tools, tips and strategies you needto make sure you can pivot with speed without missing out on critical detailsand opportunities, learn more at legacy. Tythan DNACOM BACKSLA kid. So I thinkthat you know the market has changed for everyone in some former fashion. Insome ways it's open doors and some ways. It's closed doors, the one of the common things that we'vebeen talking about. A lot on the show has been pivoting and I think each innovator or entrepreneur kind of hastheir own pivot path or pivot journey. So how are you pivoting now? What aresome of the considerations that you are evaluating? Yeh Oi? Was it first and foremost likemost people? You know we tried to put out a covid specific program. There was a very, even though the valueprop, I think, is very strong and other people agree is very strong, just veryhard to get in front of these people right now. No, no one has time anpeople have strong relationships with that ar CFO CEOS of healsh systems andinsurers right. They just don't have time to meet with me. Yeah O we'redoing is innovative. They know it's something new and frankly, they justneed o stick to the the basics right now for us, you know we're thinking about.One of the big components here is testing right for manufactures forfrontline employees outside of the healthcare environment. How can we getthose essential workers up and running and so trying to put out a programaound?That is something that we're evaluating actually helping to distribute testingsomething we're evaluating, which does really go have to do it theur businessmodel, but you know I got to do what you got to do and then there's there's otherconversation that we're having that you know. Should we put the company onpause right now, you know how could we go about doing that? Is that somethingthat want to be consideratg, because in the funding environment right you fondrais, essentially based onexpected benchmark that you think you're goingto hit? This is completely thrown off all thoseprojections yeah, and so you really need to thinklogically and and conscientiously about what realistically can we do in thisenvironment? You know expecting that they'll be a bounce back in the winter,expecting that there won't be a significant solution until early twothousand and twenty one. Those are the kind of things that I'm thinking about,Yep and- and I think that that's arealization that many many entrepreneurs are facing right now is kind of. I say like that. FirstPivot, question around finances is, you know, do I have enough runway to carryon and does it make sense? Am I even still relevant right now? If I'm notgoing to be relevant for the next six months, then how do I need to you know pivot the business to eitherclose down appropriately with grace oh right, nd and then spend that time.Rethinking what's next right, because you know once you get the bug, it'sreally kind of hard to. Let go this whole crazy journey right, yeah, yeah, and so I think that I think that that's really importantand it's going to be different for everyone and there's. I don't thinkthat there's any shame at all with coming to that realization that my business, my market, my customers,needs, have changed, and if I- and if I pivot, I may be changing theentire DNA of my company, and so I really have a different company. Idon't just have a pivot...

...right, yeah and I think, as we kind oftalked about ittle bit earlier right, some of the greatest innovations in theworld have come out of pivoting right and what the FODER EAN set out to dohas absolutely nothing to do with their business that blew up and I'm beingable to be creative and flexible. Key Characteristics of a successfulentrepreneur and there's nothing that amplifies that more than being in a international pandomic right right,CNOMIC crisis, yeah, yeah, yeah, absolutely their storyafter story of you know, companies that were one step away from collapse. Thatthen found their Eureka moment, and I think that we will find many. Many ofthose stories come out of this yeah without question. I mean the greatestperiods of innovation throughout history have always followed some typeof catastrophe. Yeah reason for that, and it's about who you know, has thegots essentially to continue and in this type of environment and whodoesn't and there's different ways about going to do that, but it doesn'tnecessarily mean going ahead with your existing company, but Efen y have toclose out biht starting something else or picking yourself up and doing that next thing is, is really how greatcompanies and Gre actrineuers are ar made yeah yeah yeah. Absolutely so youknow, one of the characteristics are attributes of anentrepreneur in order to really be successful, is RESILIENC and, and so thisthis this you know crisis, as I think, testing all of ourresilience in ways that we're in the fire and ways that we maybe have neverbeen before, and so how are you staying motivated? What are some? You know,some things that you're doing to kind of stay, optimistic hopeful andencouraged yeah. I think one of the big things has has been just the actualjourney of this until this point of hearing, so many nos and so manyrejections and just getting comfortable with that, which you have to yeah odd or say that, and it doesn't meanthat it doesn't still suck when right right right exactly no to everyone. Listening, it's sosucks yeah, it's even at one hundred now o yeah hr Knos. I head a million nose.I want to pitch FTVC theall told me no, and this one gave me my break right,those fifty ones they suck for that person. Yeah nd suck right right, butgoing through that and being a pretty stubborn person. I whish my mom wouldgladly speak about on it yeah yeah. I think that that this is just anotherno for me, and I know that if you push past it right, offantually there'ssomething good that comes comes through, and I mean probably one of the hardestthings to discern from all F. This is thatsometimes that knows, are right: Yeah, listen to your gut and take a step backand look at your situation. Listen to your advisors, listen to the peoplearound you and, and really the knows sometimes might be right, but that'sthe the fine fine line in new balance, yeah yeah! So speaking of thoseadvisors and mentors, you know who are three people that have been mostinflumential for you in this time. Yeah so ihave been very fortunate, havereally amazing advisors, both personally and also for the companyspent a lot of time getting those people right, not work. Getting a lotof persistence with the KNO also comes to Peri, right right and Danaidadvisors.

I would say so. One person is veryinfluential. Is One of our advisors, Debri guster she's, a con founder ofactivate healse care, spretty well known figure in the healthcare worldand startup world? She, you know, is very good atunderstanding these types of situations and kind of pushing away all the fluffand getting to the core of the problem or the core of the solution. Ow, what'sactually valuable there and so helping me think through that, a little bit itsbeen very helpful. I don't know a lot of differentadvisors: Yeah Yeah, you know one of one of our very closeadbies, O tha guynamed Joe Bd Whehe, took a couple of his own starups public and he's thing of Cinical, professor atbooth, University of Chicago and was investor and whatnot, and she actuallydidn't do anything really in healthcare, but just kind of being able to talk tothose types of people outside of the health current environment. Definitelylong to understand. You know how they dealt with these types of situations,how they make those types of decisions, and things not think on these types ofproblems is very, very helpful. Don't know fo they're, just great people yeaha the you cultivated relationship where they genuinely care about. You know mypersonal success in the success of this organization, Ow, what we're doing andso being able to get that honest feedback and being open to that is veryhelpful and not just kind of shoving down people's ideals when they givingnegative feedback. Yeah Yeah I mean, I think, that those kinds of I call themthinking partners are just really critical to this journey. Oh yeah withoutquestion mean, I probably have I don't know, twelve to fifteen advisors that Italked to pretty regularly yeah yeah, which is crucial, Yeah Yep. Absolutelyso I'm going to ask you this question. It's! I think it's very interestingquestion. So if you had extra budget money to spend MMWHAT,would you spend it on Hind? Why hm that's a good question, I would say probably hiring more people yeah. I think one of the it's hard to get facetime with peopleduring Christ sees, but it's also absolutely easier to get in touch withhigher level people, because erone just freaking out and looking for a goodsolution and so they're very open to different things. Yeah. That makes sense, so I would say, hiring sales peoplehonestly, we wit on yeah, Yep, okay, yeah. I think it's an interestingquestion. You know it's it's just kind of a fun game todreambuild on on what we do, because you know eventually it will come YeahYeah Yeh, so you know you've been at this for three years as we wrap up here.You know no matter how long, even if you've been doing it for three months,I feel like there's still lessons to be learned so three years in what are somelessons that you've learned so far or some guidance that you would give toour listeners. Yeah. Let's see I cun say in noparticular order. You know. Maybe the top three things is one just consistently steak feedbackfrom people and be very open to feed back and criticism you it's it's a lot of people say it'sall about who you know right, which is a very important rule of thumb. I wouldsay in general, in life, PORTACNA BE ACTONO. It really is all bout Ho. Youknow an it's about te value. You bring... those relationships, even more sorighting so being able to deliver strong guids. Those relationships isvery important, is kind of network notwork network. It will never hurt todo that at me. I personally put a lot of time into in as helped me so so much and keeping in touch with those people-and you know, sharing interesting thoughts and you know doing favors forthem. It's it's relationships are the most valuable currency and then third, I would say that this is super hard and it's a lot harder than you couldhave ever have anticipated. Yeah there's serious psychological andmental impacts, and it's very hard to relate to people when doing something like this, and sojust to understand that you're, not the onlyperson who's gone through something like this and that it's very difficultfor you, but it's also difficult for everyone else, who's doing it and that it's really important tounderstand the stories of successful entrepreneurs, but cannot only listento those stories, because that's very few and far between and so just knowingthat there's millions ofd million of people that have tried things that havefailed and from what I can tell from talking to many people and investors atmost successful intrpreneurs are those who have felt wbut hife had thepersistence to get UPF and continue to go so, even though it's hard, eventhough you might feel sometimes just never stopping, is the number one ruleI would say so so that's why I do the show right, because here we talk aboutthe good, the bad n, the ugly no one comes on and tells the Rainbow andbutterfly story of healthcare entrepreneurship. You know we talkabout. You know when we get knocked down and how we struggle to stand backup, and you know the intention is for those stories where you see and hearyour peers in the trenches that it becomes very encouraging inspiring andyou grab a hold of some piece of wisdom that you can take on in your ownjourney. Yeah Yeah. I think that's an amazing thing to do, because you knoweveryone in their mother has a podcastor show about successfulentrepreneurs and whatever and very seldom, do we actually hear about thetough times and the real nitty gritty but yeah. It's amazing, yeah yeahexactly so are al. How can folks get a hold ofyou if they want to follow up with you after the show? Yes, you can email us or just find us on our website in fo at Pangiomedical Carecom, you can fall US someting dam, look up,pangiomedical, there's another pangymedical that I think was like afraud primary Caraclinic in Arizona. I keep goting calls or F. let's keepgetting cons about people wanting to collect money from this primary tearoffice that was called pangia medical in somewhere in arizone. I think sthuff,not the right one, your medical carecom, so definitely youknow reach out. I you address an email to me. I'll definitely respond to it.It's yeah again info at Pamgo medical carecom awesome. Thank you so much forjoining me today. T. Thank you very much this great. Thank you so much forlistening. I know you're busy working to bring your life changing innovationto market, and I vow ou your time and your attention to save kind and get thelatest episodes on your mobile device automatically subscribe to the show onyour favorite podcast APP like Apple Podcast, spotify and stitcher. Thankyou for listening and I appreciate everyone. WHO's been sharing. The showwith friends and colleagues, see you on the next episode of COI Q.

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