Q&A with Cota Capital's Dr. Shuhbra Jain

Dr. Shuhbra Jain is an investor at Cota Capital, based in San Francisco. Prior to Cota, Shubhra was Associate Director of Commercial Strategy and Corporate Development at Natera. She received her MD in India, Masters in Engineering from Stanford, and her MBA from Wharton. You can follow her on Twitter: @shubhrajainmd

What drew you to venture capital and working with startups?

I am fundamentally driven by passion and impact. I enjoy working with founders who are willing to walk through walls to change the world around them in a meaningful way.

As a VC, I have a privileged vantage point of seeing startups go through their ups and downs. This fosters an accelerated learning opportunity to understand what it takes to build and run good businesses.

Why Cota Capital?

Cota Capital is a unique place - our stage agnostic approach and evergreen structure allows us a lot of flexibility to invest in companies from early to growth to pre-IPO stages. We can support the entrepreneur through their entire journey. I sought to develop discipline and analytical rigor in my investing career. Cota’s exposure to public investing while allowing me to operate and build companies on the private side was exactly what I was looking for.

Cota provided me a unique opportunity for me to get in on the ground floor and build a healthcare practice at a young and fast growing platform.

Lastly, we have a very cross disciplinary team at Cota and it has been a privilege to learn from the different strengths and investing styles of each partner. Our investment committee discussions are a rich learning opportunity - a mix of deep technical expertise, rigorous analysis, measured business perspective, and empathy for founders are brought to the table. I thrive in Cota’s culture of intellectual curiosity and continual learning.

You have an MD, MS in Eng, and MBA. How has this combination of degrees helped you as an investor?

It’s interesting - I feel that I have finally found something that leverages all the different elements of my background to help me source, diligence investments and help portfolio companies.

Deep healthcare knowledge and a clinical background has helped me develop informed viewpoints on investment opportunities. It affords me credibility when sourcing, helps win deals, and has been critical for identifying key questions and risks during diligence. I developed problem solving frameworks during my product design and engineering training at Stanford; it has helped me hone on key metrics and help with issues around product, supply chain, and engineering.

The MBA has been tremendously helpful, both for content learning and skill development as well as the network. Understanding financial markets (whether diving into and understanding a company’s financials or sizing up a market or developing competitive strategy and distribution channels) are necessary skills for an investor and board member. I’ll add that it’s extremely powerful to pick up the phone and call one of my classmates who has looked at similar opportunities or can help a portfolio company secure a partnership. A strong network is extremely valuable in this job.

You've also been a product manager working on clinical risk management tools. One of the projects you worked on surveilled and predicted sepsis (a body's deadly response to an infection), reducing mortality and enhancing treatment compliance. As someone who has worked in population health, I'm familiar with clinical alerts and how challenging it can be to effectively integrate that into a health system workflow. How did you/your team design, evaluate, and implement this intervention?

I approached it from a human-centered design standpoint: to innovate at the intersection of the unmet need, armed with the commercial scalability and desirability of the technological frontier. Approaching the problem with my designer’s toolkit of empathy, observation and experimentation, we sought to understand the incentives and concerns of different stakeholders - doctors, nurses, and administrators. While doctors wanted early detection, they were worried about alert fatigue and liability. Nurses were evaluated on responsiveness and were concerned about their inability to be tethered to a screen and knowing where to start when responding to an adverse situation. Administrators wanted a simple user friendly way to visualize the state of affairs and identify windows of opportunity to improve mortality and morbidity. We observed these users on the ground, in their usual workflows for hours and days when designing and testing the product. We solicited a group of power users to give us early feedback when prototyping and act as our champions on the ground (as they were invested and felt ownership of the process) when we launched.

For example, one of our users in the rapid response team told us that when the nurse would call them to inform about an emergency, she would give them an indication of what was wrong with the patient. While our automated alerts caught the deterioration in the patient's condition, the lack of a starting point meant it took the response team longer to resuscitate and revive the patient, which made their performance metrics look worse. We worked with the engineering team to include the trigger that led to the alert to fix this issue and drive adoption in the response team.

You've written extensively about digital therapeutics and why the time is now (tech progress, cost, awareness). Do you think these high-tech solutions (like Proteus, Akili, Pear) will effectively solve low-tech problems like adherence?

I am a believer. Behavior change is hard. Underlying ‘low tech’ problems like adherence, sleep, diet, exercise are both causative and precipitating factors in most chronic diseases. Digital therapeutics can deliver multi-modal interventions using a software platform. They don’t necessarily have to be high tech. Pear Therapeutics is taking a clinically validated protocol for substance abuse and delivering it via software. Omada is using a peer reviewed and clinically authorized Diabetes Prevention program and achieving higher engagement rates by delivering it digitally while avoiding the attrition rates experienced by in person Diabetes clinics. High tech approaches like Proteus and Akili are pushing frontiers by leveraging technological advances to drive behavior change, align incentives and improve access.

Other than healthcare, Cota has invested in a number of sectors including transportation (Uber), blockchain (basis, Oasis Labs), consumer (Bonobos), fintech (Addepar), and robotics (Bossa Nova) to name a few. Which investment spaces other than healthcare are you most excited about?

I am very excited about Space Tech. I recently had the opportunity to work on our investment in Capella Space. Capella Space is launching a constellation of satellites with the goal of imaging the earth every hour. This has numerous applications for defense, infrastructure monitoring, oil and gas pipelines, etc. One of the unique privileges of my job is the opportunity to learn about a new domain with every investment we make. With any deep tech investment, there’s a scientific and technical learning curve. It gave me plenty to geek out on and it’s been fascinating to learn about the strides startups have made in space tech.

How do you find yourself adding value to the Boards you are on? What are some of the best practices you have observed that help companies get the most from their Board?

Every Board is different. How I add value depends on the stage of the company, immediate and long term decisions that are critical for the business, the expertise of other Board members and the entrepreneur themselves. In early stages, it is valuable to spend time brainstorming around strategic decisions regarding which markets to enter, how to position the product, which channel partnerships will help achieve scale etc. I offer thought partnership to the team in and outside the Boardroom to share my perspective from having seen other companies struggle with similar issues.

As the company scales, I try to ask thoughtful questions around the need to maintain focus, fostering a culture of innovation and continuous learning and surfacing gaps in organizational capabilities or team composition that may limit them from achieving their potential. It is valuable to have diverse perspectives in the Boardroom. Given the diversity of my background, I try to present the missing perspective - this can mean wearing the hat of a physician, a patient or a payor - to ensure we have a holistic view of the challenges ahead of us.

More tactically speaking, my portfolio founders/CEOs find it extremely helpful that I share the questions that come to mind after reviewing the Board materials to help them prepare for the meeting and follow up with my understanding of the action items and an offer to help follow through on them.

What does it mean to be a valuable board member?

It really depends on the company. It varies by stage and by composition, whether you’re a Director or Observer. But what's important is being complementary to the entrepreneurs and additive to the board. Tactically, at the early stage, I find the focus to be on the team, markets, and product prioritization. Most of the value a good board member creates is outside of the meeting. Before the board meeting, I look at the board deck and set up a quick call with preliminary questions that set the stage for the board meeting. Putting the strategy into action happens after the meeting.

Strong board decks matter. It’s a fine balance in the startup world to make sure you’re not sending the deck last minute but also not too early such that critical information is missing. Ideally board members get the deck 72 hours in advance so the meetings are productive for all parties.

How would you describe "fit"and why it's important between entrepreneurs and their investors?

Many people think of “fit” as this ephemeral thing.

Early stage investors often work with the company for 7 - 10 years, and this timeline is only getting further stretched with companies staying private for longer. That is longer than an average marriage lasts in United States. Hence, you must treat this relationship as such. The analogy that I often use is the “Airport test.” How would I feel if I was stuck with this person for 7 hours in the middle of nowhere at an airport? Would that energize or drain you?

Fit encompasses everything from alignment of values. Do you value similar qualities in people and businesses when hiring and selecting partners, working styles? Where do you lie on the scale of formal vs casual, your view of the world? Do you see the world evolving in a particular way and what this means for your business to simply? How you communicate? Are you able to work through difficult situations/ potential conflicts to arrive at a constructive path forward? All of these factor into the working relationship.

What advice do you have for young women who want to enter VC - on the investing, operations, or platform side?

Start doing the job before you have the job. Learn about startups in sectors of interest, understand what it takes to build a successful business in the space and share those insights with folks in the industry. Get feedback, iterate and refine. This cycle will encourage you to think and act like an investor. How do you develop a view point on a space? How do you find startups aligned with your thesis? What questions do you ask to understand the business?

On the operations side, work at an early stage high growth startup. There is no substitute for being in the line of fire, wearing multiple hats and improvising on your feet at a fast growing company. This will help develop empathy for founders, creative thinking and resourcefulness needed to work with the limited resources at a startup.