SOSV

Bill Liao is a trailblazing General Partner at SOSV and co-founder of IndieBio, fueling breakthrough deep tech startups for over 12 years. With a bold vision for health innovation and sustainability, he drives transformative change through the Ki Tua Fund and WeForest’s global reforestation efforts. Leading cutting-edge AI in psychedelic medicine at NANA Heals, Liao combines entrepreneurial grit with a deep commitment to social impact and lasting change.

Through this interview, Liao highlights that med tech innovation demands patience, focus, and navigating complex healthcare systems. Success comes from building practical solutions that fit real-world workflows and regulations. He champions founders who persevere through challenges to create lasting impact.

By the time a med tech founder walks into one of our investment programs, they’re likely clutching a super early prototype, haunted by FDA acronyms, and maybe a few months from running out of grants. They have worked hard and smart and cobbled together a small team of believers and they are committed, though in need of a lot of polish.

Great! That’s all good signal that we’ve learned to trust—not polish, pressure. SOSV, through IndieBio and HAX, sometimes looks like we back misfits. Truth to tell, someone building hard science into novel solutions probably doesn’t fit in with the status quo.

The long road to med tech impact is paved with struggle, regulation, clinical relevance, arcane patent work, large funding requirements and complex team dynamics. It’s more like barriers and check points than a freeway. Those barriers while painful, are also hide something important—they are barriers to entry for competitors and that advantage can build decacorn exits if you can keep pushing.

Now, biology is not software. It doesn’t scale with clicks and a minimum viable product might get a patient killed. A beta test is called a phase one clinical trial and what works on a lab bench rarely behaves in the wild.

“Be ready to open the curtain and show broader platform potential if you can. Don’t lead with visionary abstraction. Lead with concrete results.”

All this friction is more defensibility—it’s also much more risk. While all tech startups chase growth hacks, the best med tech founders pass milestones more quietly—Proofof-concept, characterization, first in human, reimbursement, partnerships, deployment— with so many baby steps in between.

A pre-seed company crawls through clinical hell and, with a ton of effort, luck and money, perhaps emerges on the other side with FDA clearance and a waiting list of clinicians.

In such a process, non-dilutive capital—spurned by other startups—is not a bonus here; its oxygen. Small Business Innovation Research (SBIRs), National Institutes of Health (NIH) grants and global health foundations are critical and that’s why gutting the NIH is going to hold back vital health care upgrades. Also, reducing headcount at the FDA just slows the approval processes, which again can potentially set the pace of innovation back perhaps by decades.

And then there is investment capital. Pre-Seed, Seed, Seed extension, Pre-A, Series A, Series B, Series D, Series E— each new round making the cap table and the board of directors more difficult to manage, while also diluting the founders.

The more capital efficient you can be, the better. Some of our best startups are in the clinic with single-digit millions in spending!

There are big challenges in getting to revenue as well in med tech. Reimbursement is a labyrinth. Hospital procurement is glacial. Your product may save lives and still lose to inertia.

That does why embedded operators are essential from day one: clinicians, regulatory strategists, and people who’ve sold to hospitals in the dead of financial winter. Innovation doesn’t matter if it can’t penetrate the clinic’s front door.

Some later- stage investors, like Seed Healthcare, also bring medical sales, distribution and clinicians with their cash. We always look to get quality follow-on investors for our startup teams to overcome as many hurdles as possible.

On that note we do see later -stage investors trend-chasing a lot. The fashion cycles of late-stage capital. One season, it’s “we only invest in platforms” (Full-stack solutions with multi-disease potential).The next, it’s “we want single-indication focus” (one device, one indication), many exit paths. Of course everything right now is AI. Say that out loud and it’s more of a cry of despair.

Platforms offer optionality; focused plays offer clarity. And going from one investor or adviser to another can be head wrecking. The whiplash is real!

So what do we advise founders? Build sequentially. Begin with a laser focus on your indicator so well the data becomes undeniable. At the same time, be ready to open the curtain and show broader platform potential if you can. Don’t lead with visionary abstraction. Lead with concrete results. Investors may follow fashion, and it is traction that really turns their heads.

The average med tech startup will raise five to seven rounds before an exit. Each round brings dilution. That dilution is mitigated by increasing valuations and that is best served by hitting truly meaningful traction milestones. You’ll need data to clear the FDA.

You’ll need users to unlock Current Procedural Terminology (CPT®) codes. And you’ll need patience, because most mergers and acquisitions (M&A) happens late, and IPOs are rarer than ever.

This mostly isn’t software so no blitzscaling. There is only evidence, trust, and the slow arc of compounding validation.

Eventually, every clinician who trusts you becomes a referral. Every clinic that adopts becomes a market entry point. Every life positively impacted—your team’s purpose.

It’s the grind of traction, not the spark of innovation alone that wins. We’ve backed geniuses—people who could regrow tissue, reverse disease, or diagnose faster than labs. And still, they failed. Not because the tech was weak, because there tech made them feel somehow entitled to win.

And when a system resists change as hard as the healthcare one does, a sense of superiority and entitlement based on better technology does not go very far. Hospitals are overloaded. Clinicians are skeptical. Admin is broken. If your solution adds even tiny friction, it will be skipped.

The best med tech startups don’t just design for the user—they design for the system. They account for reimbursement flows, workflow integration, and procurement committees that have seen it all. They don’t just build a product—they build a company.

A great example of doing it the right way is our company Ostoform. They took a real patient problem and they figured out a better way and they engaged influential nurses and patients to get sales of their products directly to those who not only need it—they are desperate for it. Now they are building bigger global distribution and are raising a growth round with actual revenues. So refreshing!

After a decade plus in the deep med tech trenches, we know the future of med tech is being built right now by founders who aren’t waiting for perfect. They’re building with the tools they can afford, the teams they can afford, and against the clock. And they’re building things that really matter—deeply, desperately, and often invisibly.

If that’s you, keep going. Don’t flinch at the timeline. Don’t chase the fashion. Build like lives depend on it—because they actually do.