How Two Founders With No Health Care Experience Built a $2 Billion Oncology Startup

Successful serial entrepreneurs know how to see around corners

By the time Nat Turner and Zach Weinberg sold their company, Invite Media, to Google for a reported $81 million in 2010, they were all of 24. Eight years later, at 32, they sold their next company, Flatiron Health, to Roche for nearly $2 billion.

Flatiron Health, a data-science software company, had emerged as an unlikely power player in 2016. Former President Barack Obama and Vice President Joe Biden had just announced the National Cancer Moonshot, and Congress passed the 21st Century Cures Act, which directed the FDA to permit data separate from clinical trial data to be used in support of drug approvals. Clinical trials are often not representative of the population, potentially distorting the results. Flatiron’s technology made smaller and more tailored approaches using vastly more information than was typically available possible.

Over the years, I’ve studied “habitual” entrepreneurs — people who have started several successful businesses. The reason they are so valuable from a research point of view is that it is highly unlikely that their success has been a result of mere good luck if they’ve done it over and over again. Instead, what we find with these entrepreneurs is that they have a set of methodologies they use to gather lots of information, detect patterns, test assumptions, and bring together resources. They also have vast and non-redundant networks that they can turn to generate ideas and solutions.

Turner and Weinberg made small investments to open up new perspectives — without committing to a single point of view about the future. And that led to Flatiron.

Turner’s previous businesses had begun as hobbies and morphed into cash-generating organizations in sectors as diverse as food delivery, web design, and snake breeding. It was while Turner was running the snake-breeding business that he discovered a proclivity for the internet.

Soon after Turner met Weinberg at Wharton, the two of them wound up interning at a company called Video Egg, where they noticed the problems with the online advertising industry. This formed the genesis of a business that they anticipated could be massive.

Turner and Weinberg began by mapping out a potential arena for their new firm, charting what they called “dollar flow.” They then examined how badly the solutions available to different industry players did the job of matching an advertiser to the desired audience.

Turner described the initial idea for their business as “frankly awful.” But eventually, they realized that there was a gap in the market for advertisers to be able to identify relevant video content to advertise against, and set about creating a program that would facilitate the monetization of advertising space. The idea to create an electronically mediated advertising exchange seemed more promising, but the company “morphed,” as Turner said, taking a year and a half to go from “let’s explore this area” to “this is going to work, let’s hire people and build something.” As he recalled, his investors were very nervous during that year and a half.

The product Invite Media eventually sold to Google was called Bid Manager, and its main benefits were to allow agencies and media buyers to buy more efficiently across exchanges. Turner and Weinberg thus ended up launching the first universal buying platform for display media. That has subsequently become a critical part of the advertising-supported ecosystem that pays for the internet as we know it today.

When Google ultimately bought the three-year-old company and brought its two co-founders on board to integrate their technology with its DoubleClick offering, the two soon started scouting around for new business ideas that could be their next opportunity.

Now with a track record, they had credibility, access to funding sources, and an attractive lure for future employees. For ideas, Turner and Weinberg began angel investing. As Turner later said, “Zach and I learned by being involved with the entrepreneurs in these startups and we got a lot of insight into the health care industry.”

Turner and Weinberg made small investments to open up new perspectives — without committing to a single point of view about the future. And that led to Flatiron.

From advertising software to health care

The real impetus for the firm that became Flatiron Health was personal. Turner’s younger cousin was diagnosed with leukemia, and initial misdiagnoses, along with a host of other problems with his cousin’s care, convinced them that automating information flows in the cancer care system was a big, important problem to solve.

The duo dropped all the other ideas they were flirting with in the health care space — insurance, medical malpractice, and others — to focus on putting together a platform that could provide a unified view of all data flowing through the treatment system for cancer patients.

The insight that sparked Flatiron was that by bringing together two worlds — digital capabilities and medical training — they could create a different perspective on the entire treatment experience. The two entrepreneurs began following doctors around and meeting with all kinds of people related to the treatment experience to learn as much as they possibly could. Ultimately, they met at least 500 people, including physicians, hospital administrators, insurance companies, and clinics, before getting Flatiron off the ground.

As curious outsiders, Turner and Weinberg were able to quickly identify problems and begin theorizing solutions. What Flatiron has now created is the ability to take in both structured and unstructured data from community oncology offices. It can use that data to perform sophisticated analyses in order to better determine a course of treatment for a given patient, as well as to find larger patterns in the information.

Habitual entrepreneurs are tireless in connecting with others, particularly those who do not overlap with their own knowledge.

How entrepreneurs see around corners

Turner and Weinberg’s story has many similarities with those of other successful entrepreneurs who are also able to “see around corners.”

Habitual entrepreneurs are tireless in connecting with others, particularly those who do not overlap with their own knowledge. They are also incredibly curious. It is such an ingrained part of their personality that they may not even be conscious of it — they are simply really interested in why things work the way they do. They also do things quickly and are unafraid to change direction when new information comes in. They look for patterns in what they see: Are there underserved segments? Unmet needs? Places in which key stakeholders are working around a process because it doesn’t work? Are there areas of surplus? Scarcity? Creating a plan for fast learning is something successful serial entrepreneurs do almost by instinct.

© 2020 Rita Gunther McGrath. Columbia Business School Professor. Thinkers 50 Top 10 & #1 in Strategy. Bestselling author of The End of Competitive Advantage & Seeing Around Corners.