When I struck out on my own 18 months ago, I was contemplating a few hypotheses at the same time, but the first was this question: how many of the best founders aren’t in the game or on the bench, but in fact are not founders yet? Put another way: how efficient is the startup formation process?

While mission-driven, domain expert (rather, domain insightful) technical expertise is a rare commodity, what if it is not actually the blocker for great startup formation? What if there were an activation energy at which a potential founder could turn into an actual founder, and form an interesting company?

Around the same time, Dr. Jeff Wessler, the recently established cardiology fellow at New York Presbyterian Hospital, approached me about an interest he had in tackling heart disease using technology, I’ve known Jeff for 25 years – we played soccer together in our hometown, shared a nerdy fascination with classical music, and in high school worked on biochemistry research. I knew him to have intense intelligence and ambition, but more importantly, a growth mindset – a consistent desire to learn. All the necessary ingredients for a great CEO. He was ready to launch a startup, and wanted advice on where to start. Thus the seed was planted.

As we spent more time, and I learned how urgent, expensive, and deep the heart disease problem was – $500B in reimbursement spend a year, 1 in 4 deaths, bigger than all the cancers *combined* – I realized this would be a great place for me to start my own entrepreneurial journey, as a formation-stage founder coach and mentor. After he introduced me to Dr. Paz and Dr. Gupta, I was convinced to help them build something, and we embarked on our experiment to solve for the activation energy, and to create an organization that would tackle heart disease prevention head on: Heartbeat.

Right out the gate, we called my longtime collaborator and business partner Steve Jang, who shared my interest in the formation stage of company building, and who had already been doing formation-stage coaching through a number of startups, to see if he’d be interested in joining as the first investor. (He did!) Nayan Jain was tailor-made to be the cofounding CTO, with experience as a founder, mobile engineer, backend developer, designer, and with tours of duty in D.C. health policy, Silicon Valley, health tech and finally New York. Within 4 months of our incorporation, we had launched a clinical practice in Columbus Circle, fully licensed, compliant, and ready to accept patients. We had designed a half dozen iterations of a risk assessment and coaching software, working through the ASCVD architecture, designing our own, experimenting with cluster analysis, and we began the process of integrating off the shelf EMR solutions with our own designs.

Fitness, wellness, and primary care have grown in attention across the technology innovation landscape. The care delivery models are shifting towards unbundled, direct to consumer, focused on aligning incentives for the long-term. But specialty medicine has lagged behind. For one: the muscle memory for specialty medicine is different: see your regular doctor, only if she escalates it do you visit a specialty doctor. And if you’re asymptomatic, you don’t go to the doctor at all. So for chronic illnesses, or those diseases that lay in wait under the surface for long periods, prevention is very hard to solve. And for two: the experience has not kept pace with the rest of consumption patterns. People want convenience, digital and on-demand access, and personalization. And cardiology has not exactly been the most forward-thinking industry out there. So we asked: what if you saw your cardiologist the way that more and more women see their OBGYN? What if you could book on your phone, and chat about whatever, whenever? What if you unbundled heart health, allowed for the specialists to have a direct relationship earlier, and focused on digital tools – coaching, remote treatment, a network that meets the patient where they are at, to address the challenges with prevention?

I’m excited that we are over the activation energy, and have now seen hundreds of patients in a few locations, and are growing fast. We have scratched the surface on this effort, and have been joined by amazing investors in Lerer Hippeau, Designer Fund, my former partners at Collaborative Fund, Halle Tecco, Max Ventures, Scott Belsky, Malay Gandhi, Kelvin Beachum, and others. But the journey has just begun. Cautiously optimistic about my hypothesis. 🙂

Stay tuned for much, much more.