First in Human Episode #23 featuring Sam Whitaker

Sitting down with Sam Whitaker for episode 23, Co-Founder & Co-CEO of Mural Health. We learn about a common feature of vertically integrated businesses that bring together different areas of expertise or skill sets to create a single product. First In Human is a biotech-focused podcast that interviews industry leaders and investors to learn about their journey to in-human clinical trials. Presented by Vial, a tech-enabled CRO, hosted by Simon Burns, CEO & Co-Founder & guest host Co-Founder, Andrew Brackin. Episodes launch weekly on Tuesdays & Thursdays.

Simon Burns: Sam, thanks for joining us on First in Human. 

Sam Whitaker: Thanks for having me.

Simon Burns: Tell us a little bit about yourself. We know your story with Mural Health, well. But, I’d love to hear the background and what got you to start the company.

Sam Whitaker: It’s hard for me not to start with my entry into the clinical trial space. I was a product manager at a payments company, a fintech business called, Ecount a long time ago. This was in 2007.

I was in my 20s, trying to figure out who I was and what I was going to do in life. I had an instinct that starting a business was the thing to do. I was a product person. I can’t say that it was a super well-thought-out idea but it just seemed something to try. 

 Me and other people that founded Greenphire wanted to create a payments product that did something additional than just moving money, and creating more value for a specific industry. This is how we would have described it at the time. Today, I think people would call this a vertically integrated payments business. But, that was not a buzzword at the time.

The way we approached figuring out what business to start was very much how a chef might enter into a kitchen and looking at its cabinets to find what ingredients were there. Then, based on what ingredients existed in the cabinets, decide on what he or she was going to make. As opposed to getting a recipe, going to the store to get the ingredients that are required to create a certain dish.

 At the time, me and my co-founder, JP, (one of my longest friends) knew a little bit about payment technology. We thought we knew more at the time than we probably actually did, but, we thought we knew enough. The third co-founder of Greenphire was my wife, Jennifer, who was a salesperson selling other services in tech into what she would have called at the time the life sciences space, but was really, clinical trials.

 This was one of the first industries that we thought, “Is there an opportunity for us to build a payments product that could do more than just move money?” I knew a little bit about clinical trials. I worked as a site coordinator when I was in college as a work study position. By a “site coordinator” I was really more the site coordinator assistant doing the administrative work that a site coordinator didn’t want to do.

Part of that was transcribing paper diaries. Putting them into Excel sheets which is just a landmine. Imagine having a hungover 20-year-old guy transcribing the clinical data. I also [00:05:00] helped process payments for reimbursements and stipends at Penn for women who are participating in this study.

 When I went to interview at Ecount, I’d never been a product manager before. I came out of transactional finance. I was an investment banking analyst and a private equity drone. Not to say that all private equity people are drones, just the junior ones I guess.

I thought, “Oh, okay, I’m going to be a product manager. This is what the job is that I’m going to interview for.” I didn’t really know what that meant. But I figured I should probably go to the interviewer with a list of new products that I could create, [laughs] which is actually, now that I’m looking back on it, if I was interviewing a product person, and they came to me with 10 new products, I’d probably be pretty amazed actually at that interview. That’s what I did. And the last product that I had put on the list was a clinical trials payments product.

 I met with one of the founders in this interview. I said, “Let me show you some of the products that I came up with.” We mentioned clinical trials. He said, ” Oh, we tried this, but it’s too difficult.” I sat there and I thought , “Okay, he obviously knows what he’s talking about. what do I know?” But, it was a good idea but I didn’t test it out or anything. I got the job.

When my wife and I were on our first wedding anniversary. We were just bumming around this town, just shopping. I came out of the store. I turned to her and I said, ” I’m going to start a payments company.” I would say things like this, periodically. She said, “You are constantly saying you’re going to do, these big things.” But I meant it this time.

And so we did. JP and I quit our jobs. We started building the ClinCard which was the first participant payment technology to ever enter into the clinical trial space. The financing story in that company was really interesting. Looking back on it, it’s absolutely legendary. This is a niche business and nobody talks about it or knows about it. The first year we financed with an app-o-rama. I’ll give you $1 if you ever heard of this before.

Simon Burns: An app-o-rama? A-P-P-O-R-A-M-A? I’ve never heard of that in my entire life.

Sam Whitaker: We ended up applying for 15 to 20 credit cards that all had 0% balance transfers. At the same exact time. I don’t even know if this is possible anymore. But it was back in early 2008. So all of the credit cards essentially queried our credit at the same time. So, none of them knew that we were applying for the other. We got all of them. We got $70,000 worth of 0% debt from these credit card balance transfers. They all came with this blank check that you’re supposed to use to pay off your credit card bill.

That was how we funded the first year. Our first angel round ended up being $300,000. 100 came from the three founders. The other 200 came from three angels. That was raised in February of 2009. This is right after the financial world came to an end. That was really difficult to raise. We were 27, trying to build a vertically integrated payments company in an industry that nobody paid attention to or knew about. It worked. The really cool thing about this whole story is that it set this insanely bootstrapped tone for what we were about to do.

 We ended up building a vertically integrated payments business in clinical trials. We started off with the ClinCard. It was wildly difficult, especially in the early stages. We were evangelizing why a generally conservative industry should try something new. There’s this HR recruiting storyline in financing. They’re all sorts of evil villains that entered this story, and some heroes, too.

We created a couple other products. Greenphire is still out there today.

 So, JP, Jennifer and I left that business on a full-time basis in 2016. Jennifer stayed on the board, and JP and I went off to do different things until that business finally exited, and all of us weren’t shareholders anymore. That happened July of 2021. This is all public. That sold for about 1.1 billion.

When we started that business, the first day that JP and I went to work was in my home office. I had a desk and JP had a desk with three legs. My home office didn’t have heat. It was middle of winter. Neither one of us ever imagined that would be the outcome. We were hoping that it would be a good company or maybe we would make some money. But nobody ever used “B’s” when we were talking about, end results.

 I can’t go into too many details about why JP and I left. Ultimately, a disagreement happened.

 When it was time for Greenphire to be sold again, I thought of that as an opportunity. A handful of investors approached me to get help understanding the opportunity in the event that they were to buy the company.

I was particularly interested in the product problem. I knew that they were targeting $1 billion. But how do you get it from 1 billion to 3 billion or 5 billion or whatever the private equity firm wanted to generate in terms of returns. I think my DNA is probably more of a product or product strategist, type of brain. I came up with a strategy. My hope was that one of my private equity friends would win this deal, and then I would get back involved, maybe at a board level, but in a way that helped to guide product strategy to see Greenphire do really well. And, just go on the adventure. That sounded like a fun thing to do.

None of my private equity friends won. I was 41. I thought, ” We’ll see what the universe has in store. Something will pop up. We’ll see where life goes.”

In the fall, one of the guys who worked for one of the private equity firms called me back. Jason Dong, my co-founder now [00:10:00] at Mural Health. He asked me if I’d be willing to start a company to build the product strategy that I had in mind for Greenphire. I agreed. 

As an entrepreneur, there is a unique opportunity for a new company to enter into this space. It’s a sizable market opportunity. It’s got relatively shallow penetration. It has a single market leader who has never been challenged which has led them to get lazy about innovating. They’ve never self disrupted.

This creates an opportunity for a worthy competitor to enter with a 10x better product. And then, go out and see if you can capture some market share. Bonus points if you can come up with a strategy that helps you to do something more than just offer a second vertically integrated payments product.

For Mural Link, we started it in January of 2001. It was me, Jason, and the third, co-founder Shawn Milochik, the first engineer at Greenphire. Shawn was the guy that I built the ClinCard with. I would scratch some things down on a napkin and he would go and build it. He’s always behind the scenes building stuff. I love the fact that he’s on this with us and working on it.

Our goal here was essentially to create a next-generation participant payments solution. This is, effectively, what we would have done if Shawn and I were still at Greenphire, and somebody said, “Hey, go self disrupt.” I would have scrapped the ClinCard and built Mural Link which is what we’re doing now.

It gave us an opportunity to essentially enter into this space with a better product in every way. I believe that there is a really valuable strategic opportunity by leveraging the participant payment in order to drive engagement with the participant. (When I say participant, I mean patients and caregivers) Which then allows us to start to deliver strategic value to the sponsor. In this case, it comes in the form of patient retention.

There’s some other interesting things that we can do with the tech in order to drive adherence, or protocol compliance. Also, a maybe less well-known way to accelerate enrollment rates by having a positive impact on the conversion of leads in the recruitment funnel.

 I was recently in a sales meeting talking about the value of leveraging the payment, touch point with the participant. I had a sponsor say, “This doesn’t apply to us. We’ve never lost a patient because we didn’t have the right payment product.” What I told her, and this is part of the core thesis is that, there are two touchpoints between the study and the participant that the participant genuinely cares about.

The first is treatment. I would imagine the vast majority of participants, come to a study, as a result of some issue, terminal or more benign. That’s obviously not true for every study. Treatment is the primary. Then, payment is the second. That could be stipends, but it will also be, in many cases, just simply reimbursement, so, ” Hey, I put out 50 bucks to participate in your study, parking, travel, bus, car, or whatever. I need that 50 bucks back.” 

This gives us an opportunity to use payments as a hook. You have their attention, now can we do something more for them that will also have a positive impact on the study. This is the core spirit of what we’ve built with Mural Link. We’ve built a tech product that is meant to deliver features and benefits to the participant. If we do a really good job, we’ll make their lives delightful. As a result, if we can accomplish that goal, we believe that a business case gets fulfilled by the buyer of the product because they receive value in the form of retention, adherence, enrollment rates. That is the simple concept. 

Simon Burns: It’s so exciting seeing you guys build and develop. It’s quite rare that someone is building in the clinical trial space with the agility you guys do and with the eye towards the high NPS experience. It seems, for whatever reason, the bar is low in clinical trials. I want to talk about the hook to patient experience and subject to participant experience. Lots of exciting stuff. I also want to talk about how hard it is. We looked to ourselves at building patient payments. It’s not easy. Your founder at Ecount said the same thing. Maybe explain a little bit why it’s so challenging, international components, compliance. Even the core for it is not the easiest thing to go build. I think a lot of people think it’s just stripe and hook it together, and we’re good to go. It’s nowhere near that, right?

Sam Whitaker: Apparently, it’s not that easy to build. [laughs] Because, if it was then Greenphire wouldn’t be the only company of scale out there. And this space would be more deeply penetrated. Part of me struggles with this. I’ve been asked this so many different times by VCs, private equity guys, and one particular corporate development guy. The answer is the big companies will just go out and build this. This isn’t that hard. 

There are two really interesting moats that exist for Greenphire and now for Mural Health that are the reason why this ends up being really difficult for different companies. At first, I was wondering if this is just a natural feature of a vertically integrated payments business. You have essentially two industry expertise or skill sets coming together in the form of a single product. In our case, it’s clinical trials and a finTech.

But it could be fintech. I know a guy that works for a vertically integrated payments business in the restaurant industry. Or, there’s another one whose name I forget, that is integrated into, I don’t know what industry this is, but the church industry. It helps [00:15:00] churches collect donations from their parishioners which is a really interesting application.

In our space, both of the industries that are being integrated are regulated. Most of the industries that have vertically integrated payments business are typically working inside of nonregulated space. Dual regulation probably is enough to prevent your typical e-clinical businesses from entering into the fintech space. It’s also why fintech businesses aren’t more commonly entering into the clinical space to effectively compete with Greenphire.

We’ve seen some fintech businesses: Payoneer is one and, Hyperwallet’s another. I was just talking with a big bank that had said, “Oh, we competed against you for some study or some sponsor.” this is one of the top three banks in the U.S. 

There’s also a component of this that you need to understand how to build, user interface that accommodates a workflow and makes the user’s life easy. Does a fintech business . Understand the patient experience? What the nuances are that are important to the buyers? Those things are really difficult for either the fintech business to learn about clinical trials or vice versa.

 As I get into building Mural Link, which, really doesn’t rely on a debit card platform at all. There’s some different challenges that we’ve uncovered when we are focused in on a variety of different payments using digital wallets and different electronic payment delivery methods. Which would surely turn off most e-clinical businesses who end up looking into this. When you get into regulations surrounding money transmission or services businesses. These are things that you won’t know about until you dig in. But, there are hurdles to overcome. I suspect that this is ultimately what turns a lot of people off.

The competitors we did see at Greenphire ended up being products that did not own or build their own fintech backend. This was ultimately, a wildly beneficial mode for Greenphire because, they were able to always beat out competitors that were just linked up with a stripe or a program manager that offered a generic reloadable debit card in their case. 

Simon Burns: Let’s talk about the second-time founder experience. There’s all kinds of stats and anecdotes you can look to. First, second-time founders, not necessarily a higher success rate than first-time founders for whatever reason. I guess it’s maybe some version of hubris, you feel like you know what product might fit in. It’s just as challenging the second time around as the first time around. But then you’ve got these anecdotes. Eric from Zoom: pretty much the same business, builds it the second time around. Huge outcome. I have to think you probably think of yourself maybe in that second camp? You’re going after space you really know. You’ve got the customer relationships, you know the product surface area well. How do you think about the second-time experience? And what have you done differently to build Mural Health for success?

Sam Whitaker: I’m not all that confident in my ability to do this a second time. Which is likely a function of my own personality, and the underlying psychology that exists in my brain. I think that there were moments of real brilliance, skill, and willpower the first time around. There were also moments of just straight luck. I can’t quantify the percentage of each of those things. 

But, without the moments of luck, it doesn’t work. It doesn’t happen. I wonder Can I do it again? We don’t know. Only time will tell. That’s how I felt going into this. I still feel that way although every day, I feel a little bit more confident as I collect data points.

If I take a step back, I’m a second-time founder. I’m building a product that’s essentially competitive to the market leader, which is a product that I built. So, I have somewhat of an advantage relative to somebody who was entering new. This is an industry I’ve also known really well. A lot of the nuances. I also have relationships. I probably underestimated when we started this business how valuable all of that experience really was.

As we went through the last year. As we continue to navigate new opportunities. Every once in a while, I will reflect on how we’re doing relative to how I remember it being at Greenphire. I can tell you it is wildly easier in every single way. From building an MVP to hiring, raising money was not a difficult, task.

What I’m most flattered about was how responsive customers and partners would be to me reaching out. We’ve had, I won’t say the names because I don’t want Greenphire to know. [laughs] But we had like a call at a top five pharma. Somebody got one of our marketing emails, and then forwarded it to somebody else. They wrote to me and said, ” We know you from Greenphire. We loved working with you. We’d really love to hear what you’re building.” This is a person that I have no idea who this was.

We don’t get an email like that every single day. But I’m sitting there thinking, “Really? you knew Greenphire or you knew what we did? Wow.” I have a lot of fear of failure. For no good reason. There’s not really a consequence.

But I really fear of letting the co-founders down, letting the early employees down, letting the investors down. All those investors will be fine if I blow it, but I’m anxious about it. It helps me to work and drive. But, in any event, the second time is super easy. Doesn’t mean that it’s going to work by any stretch. I still need to sign contracts. Once we get some opportunities, I need to deliver and make the customers thrilled to be working with us, right? So there’s still [00:20:00] work to be done before I can declare victory. We’re so early. But I’m feeling confident that we’ll be able to get there.

Simon Burns: We’re absolutely thrilled to be partnered with you guys and going to be building the future of clinical trials together. I’ve done tens of these podcasts now, and you, by far and away have beaten everyone else with the best artwork and backdrop. [laughs] Thanks for joining us on First in Human.

Sam Whitaker: Thanks for having me, Simon.

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