Dan Rose is a returning guest to Medsider and the former CEO of LimFlow, which was recently acquired by Inari. Dan’s roots trace back to Virginia, but he has been working in various medtech enterprises in Europe since 1999, accumulating a tremendous amount of experience across both large strategics and early-stage ventures.
Starting in 2003, Dan worked at Medtronic for three years, with three different business units, and in five different countries. This was followed by his stint at Medtronic Europe, where he took on the position of head of marketing during the heyday of drug-eluting stents. He then joined the implantable pump company Sequana Medical in Zurich as CCO, followed by a role as the Head of Commercial for Direct Flow Medical. Under his leadership, Direct Flow Medical notably generated about $30 million in just two years. In 2016, he took the helm at LimFlow and guided the company’s path for seven years until its acquisition by Inari in late 2023.
LimFlow was founded to address a major issue: blockages in leg arteries – a significant problem for people living with peripheral artery disease (PAD). The obstruction of blood flow can progress into a more severe condition known as Chronic Limb-Threatening Ischemia (CLTI), an extremely challenging disease where patients experience escalating leg pain and chronic foot ulcers. The blocked blood flow to the foot may eventually lead to lower limb amputations – roughly 100,000 to 120,000 occur annually in the US alone – and is associated with a high morbidity and mortality rate.
The LimFlow device, in simple terms, introduces a less invasive way to treat CLTI. Arteries take blood from the heart to the tissue, and veins take deoxygenated blood from the tissue back to the heart. Instead of trying to open the blocked artery, LimFlow cleverly reroutes blood flow through a nearby vein – which, unlike arteries, are typically unaffected by atherosclerosis. The LimFlow procedure involves connecting arteries and veins together using wires and catheters. Then, a covered stent is placed into the vein to redirect blood flow in the reverse direction.
Through this method, LimFlow effectively restores blood flow in the legs, facilitating the healing of the foot and averting the need for amputation. It offers a ray of hope to people suffering from CLTI and secured FDA approval in September of 2023, shortly before LimFlow's acquisition by Inari.
Today, LimFlow is poised for a new chapter. Dan says, “From our perspective of culture, market development, and infrastructure, Inari was a beautiful landing place for LimFlow.” Under Inari’s umbrella, LimFlow is set to become a dedicated business unit, capitalizing on Inari’s strengths: commercialization and therapy development.
Key Learnings From Dan’s Experience
- Vet your potential investors carefully and consider how their involvement will impact your business operations, especially if there are multiple parties involved. Limit their influence on decision-making to maintain flexibility and control over your company's direction.
- In the early development phases, design for the average user to maximize adoption rates. Always iterate towards simplicity and be prepared to pivot accordingly. Don't focus solely on cutting-edge features or only cater to experts. And don't hold onto complex elements or features simply because they were part of the original plan.
- Understanding the reimbursement landscape and how your technology fits into that is crucial to progress your conversations with VCs. Research potential investors to ensure that they have the capacity to invest and that their interests match your company's focus. Pursue those who can infuse substantial capital, streamlining your fundraising process.
Dan Rose, a leader with 25 years of experience in the medical device space, has worked in both multinational corporations and startup ventures throughout his career. He holds a BA and an MA from the University of Virginia, and an MBA from the Darden Business School. Most recently, he led LimFlow’s exit to Inari Medical as the company’s CEO and has held pivotal positions at Direct Flow Medical, Sequana Medical, Medtronic, and other medtech companies.
How Involved Should Strategics Be?
Navigating investor relationships is a big part of being the CEO of a startup. Dan’s experience taught him the complexities of working with strategics, especially when multiple parties are involved.
LimFlow had a device that was quite innovative and unique in many ways with its intricate IP and clinical data. The team was granted expedited access by FDA from the beginning, which later turned into a breakthrough device designation. This position demanded clear and consistent communication in order to convince investors that this was a ship that would float, and that’s exactly what Dan prioritized from day one. Consequently, LimFlow’s fruitful collaboration with Inari was built organically, over time, and through clear and open communication.
Transparent dialogue forms the backbone of building trust with investors. That means communicating successes and roadblocks with your board is essential. Delays and cost overruns are commonplace in medtech startups, and any experienced VC expects this. Dan shares, “Everybody's late and everybody spends more money than they said they would. It's very rare not to. The VCs are used to that.” As long as you deliver on your promises in a thoughtful, strategic way, there’s no need to try and hide the challenges in your business. He continues, “How you work through it is the testament that you can solve the next set of problems that are always going to come.”
On that note, Dan is quick to express mixed feelings on involving strategics in business operations. He knows this firsthand – at Direct Flow, having three or four different strategics invested in the company eventually led to challenging dynamics. He points out that investors may be monitoring each other’s moves, for example, which takes transparency and openness out of the picture.
Managing these dynamics effectively hinges on conducting efficient, goal-oriented board meetings. With multiple strategics’ interests at play, the meetings can feel more like “a roadshow”, Dan shares.
That’s why Dan is cautious about involving multinationals in business operations, even if the relationship looks promising. During his time at LimFlow, while constantly cultivating interest in a potential acquisition, Dan was wary of taking investments that could limit future opportunities. When Inari showed interest during their Series D round, Dan decided to involve the Inari team based on their good relationship and shared culture, but he didn’t grant them any special rights, however.
Optimizing for Simplicity
The success of a medtech startup often hinges on the delicate balance between innovation and practicality. There are many variables at play here, such as the inherent tension between financial resources, development timelines, and the pursuit of a perfect product. In that vein, Dan stresses the importance of simplicity and user-centric design. And that means you have to be ready and able to pivot when necessary. “A great outcome through a super complex fashion is not good enough,” Dan cautions. Rather, what should guide your path are practicality and usability.
The system you start with is rarely the system you end up using. Dan admits that it took a lot of refinement and stripping down to reach LimFlow’s final product. Redirecting blood flow from arteries to veins in the opposite direction was inherently complex. Naturally, the initial design wasn’t as elegant as the last. But the team managed to work on the product until it was far less complex and more user-friendly.
One thing to keep in mind during the early development phases is that you’re not designing for yourself or even for the cutting-edge surgeons that you might involve in early testing. Dan’s strategy is to aim for the average user with the basic skill set right in the “middle of the curve,” because ultimately, that’s what drives demand. To hone your product to this demographic, you need to build iteratively until you achieve a level of ease-of-use that’s acceptable for the broader medical community.
Such commitment to user-centricity can involve tough decisions. For instance, Dan speaks of how they pivoted away from ultrasound features, which were unique to the company. And by doing this, not only did the team eliminate complexities in the device but ultimately arrived at a product that reduced crossing times by an hour. Such pivots take courage, especially when you've exhausted a lot of resources and acquired intellectual property around an idea. Yet, these aren’t good reasons to keep a feature that doesn’t align with the end goal: user-centric design and widespread adoptability.
To maintain such flexibility, it’s absolutely crucial to build the right team of people with whom you can effectively debate, refine ideas, and iterate. On top of that, once again, transparent communication with your board is essential. Dan highlights, “There should be zero surprises in the board meeting. Board members should be aware of what's going on before they get in. The conversations are more fruitful when everybody's had time to marinate.” In this sense, as the CEO, you must serve as the bridge between the team and the financial realities, i.e., the board, and make sure everyone understands the nuances of your development as well as your position in the market.
Win Over Investors with Your Expertise
As you progress through the different funding stages from Series A to E, Dan reassures that fundraising gets slightly more manageable, but it’s never easy. This is because investor expectations evolve just as your company evolves.
One significant issue you should solve before looking for investors is reimbursement. The companies that have been successful in securing funding are those that found the sweet spot between clinical value and economic viability.
Dan shares, “In the Series E, at least 35 to 40% of all our discussions with VCs were about reimbursement.” So, having a robust strategy in this area can be the defining factor. Hospitals and doctors need to get paid, and if your product doesn't align with the reimbursement landscape, it might never see the light of day. Dan recommends learning how the system works and understanding the basic vocabulary before starting these conversations with investors.
In the story of LimFlow, Dan admits to having started with an undefined reimbursement pathway that evolved over time as the company worked to pioneer new territory. He explains, “We worked the system inside and out. We covered every angle – clinical trials, reimbursement, and learned every facet. We nailed down the coding and became experts. That way, when talking to VCs, we could speak confidently about how it would work, what the expected pricing would be, and the long-term potential."
To manage your time and efforts efficiently, it’s essential to target investors who actually have the capital to invest in your domain. Dan advises, “Know who you're talking to, what investments they make, and what they are looking for, as well as the successes that they’ve had in the past. Compare yourself to those successes and find the parallels.” To know all these things, you need to do your homework: understand what the investors are looking for and whether their interests align with your venture’s goals. While being polite is important, you shouldn’t spend time on those who can’t invest.
Instead, you should identify those who can infuse substantial capital. Dan explains, “One person can solve your round by writing a $30 million check. That's a lot different than trying to piece together six different investors for a few million each, even though it’s the same amount of work.”
Dan Rose is a returning guest to Medsider and the former CEO of LimFlow, which was recently acquired by Inari. Dan’s roots trace back to Virginia, but he has been working in various medtech enterprises in Europe since 1999, accumulating a tremendous amount of experience across both large strategics and early-stage ventures.
Starting in 2003, Dan worked at Medtronic for three years, with three different business units, and in five different countries. This was followed by his stint at Medtronic Europe, where he took on the position of head of marketing during the heyday of drug-eluting stents. He then joined the implantable pump company Sequana Medical in Zurich as CCO, followed by a role as the Head of Commercial for Direct Flow Medical. Under his leadership, Direct Flow Medical notably generated about $30 million in just two years. In 2016, he took the helm at LimFlow and guided the company’s path for seven years until its acquisition by Inari in late 2023.
LimFlow was founded to address a major issue: blockages in leg arteries – a significant problem for people living with peripheral artery disease (PAD). The obstruction of blood flow can progress into a more severe condition known as Chronic Limb-Threatening Ischemia (CLTI), an extremely challenging disease where patients experience escalating leg pain and chronic foot ulcers. The blocked blood flow to the foot may eventually lead to lower limb amputations – roughly 100,000 to 120,000 occur annually in the US alone – and is associated with a high morbidity and mortality rate.
The LimFlow device, in simple terms, introduces a less invasive way to treat CLTI. Arteries take blood from the heart to the tissue, and veins take deoxygenated blood from the tissue back to the heart. Instead of trying to open the blocked artery, LimFlow cleverly reroutes blood flow through a nearby vein – which, unlike arteries, are typically unaffected by atherosclerosis. The LimFlow procedure involves connecting arteries and veins together using wires and catheters. Then, a covered stent is placed into the vein to redirect blood flow in the reverse direction.
Through this method, LimFlow effectively restores blood flow in the legs, facilitating the healing of the foot and averting the need for amputation. It offers a ray of hope to people suffering from CLTI and secured FDA approval in September of 2023, shortly before LimFlow's acquisition by Inari.
Today, LimFlow is poised for a new chapter. Dan says, “From our perspective of culture, market development, and infrastructure, Inari was a beautiful landing place for LimFlow.” Under Inari’s umbrella, LimFlow is set to become a dedicated business unit, capitalizing on Inari’s strengths: commercialization and therapy development.
Key Learnings From Dan’s Experience
- Vet your potential investors carefully and consider how their involvement will impact your business operations, especially if there are multiple parties involved. Limit their influence on decision-making to maintain flexibility and control over your company's direction.
- In the early development phases, design for the average user to maximize adoption rates. Always iterate towards simplicity and be prepared to pivot accordingly. Don't focus solely on cutting-edge features or only cater to experts. And don't hold onto complex elements or features simply because they were part of the original plan.
- Understanding the reimbursement landscape and how your technology fits into that is crucial to progress your conversations with VCs. Research potential investors to ensure that they have the capacity to invest and that their interests match your company's focus. Pursue those who can infuse substantial capital, streamlining your fundraising process.
Dan Rose, a leader with 25 years of experience in the medical device space, has worked in both multinational corporations and startup ventures throughout his career. He holds a BA and an MA from the University of Virginia, and an MBA from the Darden Business School. Most recently, he led LimFlow’s exit to Inari Medical as the company’s CEO and has held pivotal positions at Direct Flow Medical, Sequana Medical, Medtronic, and other medtech companies.
How Involved Should Strategics Be?
Navigating investor relationships is a big part of being the CEO of a startup. Dan’s experience taught him the complexities of working with strategics, especially when multiple parties are involved.
LimFlow had a device that was quite innovative and unique in many ways with its intricate IP and clinical data. The team was granted expedited access by FDA from the beginning, which later turned into a breakthrough device designation. This position demanded clear and consistent communication in order to convince investors that this was a ship that would float, and that’s exactly what Dan prioritized from day one. Consequently, LimFlow’s fruitful collaboration with Inari was built organically, over time, and through clear and open communication.
Transparent dialogue forms the backbone of building trust with investors. That means communicating successes and roadblocks with your board is essential. Delays and cost overruns are commonplace in medtech startups, and any experienced VC expects this. Dan shares, “Everybody's late and everybody spends more money than they said they would. It's very rare not to. The VCs are used to that.” As long as you deliver on your promises in a thoughtful, strategic way, there’s no need to try and hide the challenges in your business. He continues, “How you work through it is the testament that you can solve the next set of problems that are always going to come.”
On that note, Dan is quick to express mixed feelings on involving strategics in business operations. He knows this firsthand – at Direct Flow, having three or four different strategics invested in the company eventually led to challenging dynamics. He points out that investors may be monitoring each other’s moves, for example, which takes transparency and openness out of the picture.
Managing these dynamics effectively hinges on conducting efficient, goal-oriented board meetings. With multiple strategics’ interests at play, the meetings can feel more like “a roadshow”, Dan shares.
That’s why Dan is cautious about involving multinationals in business operations, even if the relationship looks promising. During his time at LimFlow, while constantly cultivating interest in a potential acquisition, Dan was wary of taking investments that could limit future opportunities. When Inari showed interest during their Series D round, Dan decided to involve the Inari team based on their good relationship and shared culture, but he didn’t grant them any special rights, however.
Optimizing for Simplicity
The success of a medtech startup often hinges on the delicate balance between innovation and practicality. There are many variables at play here, such as the inherent tension between financial resources, development timelines, and the pursuit of a perfect product. In that vein, Dan stresses the importance of simplicity and user-centric design. And that means you have to be ready and able to pivot when necessary. “A great outcome through a super complex fashion is not good enough,” Dan cautions. Rather, what should guide your path are practicality and usability.
The system you start with is rarely the system you end up using. Dan admits that it took a lot of refinement and stripping down to reach LimFlow’s final product. Redirecting blood flow from arteries to veins in the opposite direction was inherently complex. Naturally, the initial design wasn’t as elegant as the last. But the team managed to work on the product until it was far less complex and more user-friendly.
One thing to keep in mind during the early development phases is that you’re not designing for yourself or even for the cutting-edge surgeons that you might involve in early testing. Dan’s strategy is to aim for the average user with the basic skill set right in the “middle of the curve,” because ultimately, that’s what drives demand. To hone your product to this demographic, you need to build iteratively until you achieve a level of ease-of-use that’s acceptable for the broader medical community.
Such commitment to user-centricity can involve tough decisions. For instance, Dan speaks of how they pivoted away from ultrasound features, which were unique to the company. And by doing this, not only did the team eliminate complexities in the device but ultimately arrived at a product that reduced crossing times by an hour. Such pivots take courage, especially when you've exhausted a lot of resources and acquired intellectual property around an idea. Yet, these aren’t good reasons to keep a feature that doesn’t align with the end goal: user-centric design and widespread adoptability.
To maintain such flexibility, it’s absolutely crucial to build the right team of people with whom you can effectively debate, refine ideas, and iterate. On top of that, once again, transparent communication with your board is essential. Dan highlights, “There should be zero surprises in the board meeting. Board members should be aware of what's going on before they get in. The conversations are more fruitful when everybody's had time to marinate.” In this sense, as the CEO, you must serve as the bridge between the team and the financial realities, i.e., the board, and make sure everyone understands the nuances of your development as well as your position in the market.
Win Over Investors with Your Expertise
As you progress through the different funding stages from Series A to E, Dan reassures that fundraising gets slightly more manageable, but it’s never easy. This is because investor expectations evolve just as your company evolves.
One significant issue you should solve before looking for investors is reimbursement. The companies that have been successful in securing funding are those that found the sweet spot between clinical value and economic viability.
Dan shares, “In the Series E, at least 35 to 40% of all our discussions with VCs were about reimbursement.” So, having a robust strategy in this area can be the defining factor. Hospitals and doctors need to get paid, and if your product doesn't align with the reimbursement landscape, it might never see the light of day. Dan recommends learning how the system works and understanding the basic vocabulary before starting these conversations with investors.
In the story of LimFlow, Dan admits to having started with an undefined reimbursement pathway that evolved over time as the company worked to pioneer new territory. He explains, “We worked the system inside and out. We covered every angle – clinical trials, reimbursement, and learned every facet. We nailed down the coding and became experts. That way, when talking to VCs, we could speak confidently about how it would work, what the expected pricing would be, and the long-term potential."
To manage your time and efforts efficiently, it’s essential to target investors who actually have the capital to invest in your domain. Dan advises, “Know who you're talking to, what investments they make, and what they are looking for, as well as the successes that they’ve had in the past. Compare yourself to those successes and find the parallels.” To know all these things, you need to do your homework: understand what the investors are looking for and whether their interests align with your venture’s goals. While being polite is important, you shouldn’t spend time on those who can’t invest.
Instead, you should identify those who can infuse substantial capital. Dan explains, “One person can solve your round by writing a $30 million check. That's a lot different than trying to piece together six different investors for a few million each, even though it’s the same amount of work.”
