Building the Future of Clinical Research with PhaseWell | Carsten Bick

Michael Burcham: Welcome to Microcap Moments, a podcast from Shore Capital Partners that highlights the stories of founders, investors, and leaders who have taken on the challenge of transforming ideas and small companies into high growth organizations. The journey of building and scaling a business takes one down many unexpected paths. It’s a journey where we learn from our mistakes, fall down often, but have the entrepreneurial grit to pick ourselves up and persevere. 

Within this series, we will share these stories of success and failure, of the challenges and the rewards faced by those who dare to dream big. And through their lessons learned, we hope to inspire others who are on a similar journey of becoming, growing, and leading.  

Anderson Williams: In this episode, I talk with Carsten Bick, the CEO of PhaseWell Research. PhaseWell is a multi-site clinical research company that’s focused not only on increasing patient access, but also streamlining the clinical trials process to engage a larger pool of physicians in research. 

Carsten shares a couple of illuminating data points that are at the heart of their business model. There are around 9,700 standalone clinical research sites in the United States, so the industry, and therefore patient access is highly fragmented and often difficult to navigate. And even with this seemingly large number of clinical research sites, Carsten shares that only about 3% of physicians are involved in clinical research. 

So, there’s a huge opportunity for broader physician engagement, increased access, and faster learning in addressing some of the most complex and impactful diseases we face. Carsten talks about the first year of PhaseWell Research and the two industry leading partners with nearly three decades of experience each in their respective areas of expertise who chose to come together to help launch PhaseWell. 

He also talks about complimenting this depth of partner experience with building the right support team and the importance of hiring for startup as it all comes together in building a new company.  

Throughout our conversation, Carsten reinforces a critical insight from his partners to patients to Shore Capital Partners. This is all a people business, and keeping grounded in this fact will continue to be what drives their growth and success at PhaseWell. 

 Welcome, Carsten. To get us started, will you just introduce yourself and tell us what you do and where you do it?  

Carsten Bick: Sure. And first and foremost, thank you Anderson for hosting me here. 

My name’s Carsten Bick. I’m the CEO of PhaseWell Research. We are a Nashville based multi-site clinical research company.  

Anderson Williams: And tell me what that means, multi-site clinical research. I don’t know anything about that. Space, what does that market look like? What is that space?  

Carsten Bick: Sure. Well, a year ago I didn’t know much more as an outsider coming into this space either. So, I’ll do my best to try to break it down. So, PhaseWell plays on the later end of the value chain of clinical research. When people hear the words clinical research, they often think Guinea pigs or lab rats and scientists in fancy coats with microscopes. Without a doubt that exists. That’s actually the kind of top end of the continuum of how new drugs, molecules, therapeutics are designed and ideally taken to market. 

Our customers are pharma, big and small, from your mom and pop biotechs up to an Eli Lilly and what are called CROs, Contract Research Organizations. Those are typically very large third party service partners to pharma that will do everything from vendor and technology sourcing and management to finding appropriate clinical trial sites. 

So again, PhaseWell sits a little bit further downstream in that once a drug, a therapeutic, a molecule is designed and pharma businesses want to begin experimenting with how that works in the real world i.e., with humans, that is when PhaseWell Research comes into the picture. So, there’s three phases within clinical trials. 

Phase one, that’s typically gonna be the first time a drug has been put into a human. Oftentimes those will be healthy volunteers. The goal is to ensure that that drug does not do outsized harm relative to what they are aiming to do from a benefit perspective.  

Phase two is usually focusing on dosing and proving efficacy of that drug. 

Phase three, simply put as a refinement of those two goals. And phase four is what is called real world evidence. This is after a drug is approved in a phase three study, and it’s taken to market where your physician can write or subscribe or prescribe that drug for you and tries to study that drug in a wider population. 

And so, going back, simply put, we will work to be awarded a trial, and in doing so, our jobs are then to recruit patients that fit very specific criteria for how that drug should be studied. It’s called inclusion exclusion criteria. Usually it means you have to have these 10 attributes and not have these 10. 

And so, by example, you may have a thousand patients with early onset Alzheimer’s or dementia. Only three may qualify for a specific study, And so job number one is to recruit and enroll those patients into a trial. Job number two for PhaseWell is then to execute that trial, which means we will onboard that patient or enroll them, and then we will conduct study or research visits. 

Typically anywhere from six months to six years, depending on the complexity and the length of that trial and across that continuum, the most important thing is that we bring high quality and vetted data back up to our CRO and pharma, what are called sponsors, customers, and that that data is what goes back to the metaphorical guys in the lab coats, the scientists, to then understand how their molecule or their therapeutic is behaving in the trial setting. 

Anderson Williams: It’s really fascinating and sort of a look behind the curtain a little bit for what most of us don’t think about other than seeing all the ads on television with all of the disclaimers. When you think about that market, why was that a good place to invest, like from the Shore Capital perspective, from you as the CEO perspective? Why is this a good market?  

Carsten Bick: Yeah, I think it’s the right question, and it’s frankly the trillion dollar question. So, when you look at the industry today, and I had walked you through where we sit in the value chain. The problem we’re trying to solve is one of speed and one of quality. Within the United States, there are 10,000 plus clinical research sites. 3% of those sites are part of a multisite company, meaning the other 9,700 are one clinic, one research site, so to speak, owned by a business person, a set of physicians. And so, when you pair that with what is a trillion dollars of pharmacology R&D, sitting upstream in phase 1, 2, 3 trials or preclinical, as I had described earlier, this represents a choke point. 

And the data point is 85% of trials will start late and end late. Inability to enroll insufficient infrastructure to deliver increasingly complex protocols and clinical trial mandates at the site level. And so, there’s a massive problem in getting better and better research that has incredible potential impact to humanity and medicine through this choke point. 

And so, I’d say that’s the big elephant in the room or, or reason number one. When you look at Shore Capital’s historic investment record, I think they’ve proven their ability to go into these fragmented sectors or spaces and in a value added way, acquire strong legacy participants, in our world those would be independent clinical research sites, and invest in them to enable them both locally, but also part of a growing national platform so they can participate nationally in a way that serves the strategic plan or thesis of the particular platform. 

Anderson Williams: It sounds like to me, and correct me if I’m wrong, but it sounds like an added benefit given the fragmentation would be to some degree streamlining access for patients to the clinical trials as well. Is that accurate on the patient side?  

Carsten Bick: So, patient recruitment and access go hand in hand. In fact, PhaseWell Research is dedicated, in fact, it’s our mission to connecting our communities to clinical trials. We like to say that brings hope to patients today and shapes tomorrow’s medicine. And so going back to your question, Anderson. Patient access looks like a couple of different things.  

So one, we believe deeply in community access. What that means is it’s a building that is near where you live and work. Getting in and out, while that may sound simple, is actually hugely important. And so, whether it is where we acquire and partner with sites or where we will in the future, potentially build sites, I’d say that’s the first component of access. 

Two, and it’s maybe back to your question on why this is a good time to invest in this particular sector is there’s a tremendous opportunity from a technology perspective to better identify these patients and bring education as a form of access to them. The data point in our industry, and it kind of follows the fragmentation comment I made earlier, is that about 3% of patients and 3% of physicians participate in clinical research today. 

At PhaseWell, we wanna focus in the most complex and impactful TAs. For us, that’s oncology, it’s complex cardiometabolic, and it’s central nervous system, you’ll hear the term CNS. And so, when you look at complex disease states and you have an appreciation of the quality of science coming down that pike. Then the concept of bringing quality research in conjunction with quality standard of care medicine represents better healthcare. We firmly believe that, And so, our investments into technology, AI or otherwise, are squarely focused on finding more of the right patients and educating them on the opportunity that is in front of them. 

I would say the same thing goes with the physician and private practice community. I had mentioned that 3% of physicians today participate in research. Again, we view that as a massive opportunity. I have a host of programs we’ve built out in our first year here that are meant to better engage and bring quality research as an offering to these community provider groups. 

I think the listeners will understand that in most cases, patients are more inclined to listen to their physician over perhaps their spouse or anyone else. And so, we’re trying to take a multimodal approach to bring access in a host of different ways because we think it is one hugely important missionally for what we are trying to do, and two represents an organic growth avenue that is not just simply trying to receive more trial awards from our customers upstream. 

Anderson Williams: Yeah, and you mentioned this is the first year. Tell me a little bit about where the company is today in this first year. I guess just size, scope, partnerships, otherwise gimme a little sense of what the company looks like.  

Carsten Bick: So, today we are about nine months in to growing PhaseWell. We came together at the end of 2024 with the acquisition and partnership with two, what I’ll call tall tent poles in the industry. 

Our first acquired partner is a company called Gabriel Cancer Center Research. They’re up in Northeast Ohio. Gabriel Cancer, currently today has about 85 open clinical trials and has about 28 years of experience in independent oncology research. Our second acquired partnership is a company in North Central Florida called Renstar Medical Research. 

They’ve been in business for about 27 years, and they focus in central nervous system and complex cardiometabolic. Combined, those two companies have over 70 plus dedicated research professionals and represent a tremendous call it day one or year one platform and partnership base for us to learn from, for us to build from. 

When I talk to our customers and our friends at pharma, they will tell you that both of these businesses are arguably, you know, top three or five in their respective therapeutic area categories in the nation. And in addition to Gabriel Cancer and Renstar Medical Research, we have a seven site embedded site management organization dedicated to independent oncology. 

This is a network within the multi-site PhaseWell platform that came over with our Gabriel Cancer acquisition. Dr. Gabriel, the founder, largely considered one of the top KOLs. That’s key opinion leader in the oncology research space in the country, has worked over the last 10 years to propagate this network where Gabriel Cancer is taking their infrastructure, their best practice, their people, and supporting bringing research into other communities from North Carolina to California. 

And so, I’m both incredibly proud to get to join these founding companies and these founding staff. And two work with them is we embrace the vision ahead for those businesses individually as well as what it means for how we can grow this company collectively and nationally over the next couple of years. 

Anderson Williams: So, you’ve partnered, obviously with some real powerhouses in the industry, which is really exciting and impressive, but I also know this isn’t your background specifically, and you’re a first time CEO. Will you talk a little bit about your background in healthcare and then why this felt like the right move for you, given all that you’ve described with the market and the partnerships And so forth? 

Carsten Bick: Sure, so my career actually had an interesting start to it. I was a econ finance guy in college and I always thought I would go and be finance professional, whether that’s a trader or an investment banker, and it turns out jobs at Goldman Sachs in 2008 were fairly hard to come by, And so.  

Anderson Williams: Timing is everything, right? 

Carsten Bick: That’s right. Yeah. I, you know, life sometimes finds a way, right? So, while I grew up in a healthcare family, my old man’s a retired emergency physician, I never had the stomach for the practice side of it, but certainly had the business interest. I kind of fell into the industry. I started in a provider service business called R1 RCM. They’re a large national revenue cycle management partner.  

That’s where I learned to lead, to manage, solve complex problems. One of the benefits of that business is they throw you out into a client hospital, fresh out of college with a cheap suit and the mandate to go lead a 20 person team. After six or seven years there, I got into a payer services business called naviHealth, another Nashville based success story that built and led the solution for post-acute care benefit management. 

That business I built and operated our central operating capability. I think I came in as a bit of an athlete hire with no colleagues. And when we had exited that business had about six or 700 staff, physicians, clinicians, clerical staff, on and offshore.  

And so at that point, having done field operations in someone else’s house, led central operations within our own company. I wanted to then go and be an end-to-end business operator. And I joined at the bottom of the first inning, a wonderful company called IVX Health. They are a pure play provider in the ambulatory infusion space and over my time there, we built the company from about eight clinics to over a hundred clinics from California to Florida. 

And getting a little bit to your question on the why, as I look back at my career, I got increasingly closer to the patient or the direct impact of what the business was trying to do. At IVX Health, while we did not make the drugs that we infused and we treated complex chronic autoimmune conditions, Crohn’s colitis, MS, diseases that I’m confident someone in your friend or family network has. 

While we did not make these drugs, our ability to create patient access. And first class patient experience allowed for us to grow that business in a meaningful way. And the success stories that we saw on a daily basis kept call it the fuel tank, more full than maybe some of the professional achievements I had experienced or earned throughout my career. 

And so, as that business got larger, we became more and more proximate to our partners across the aisle at pharma. And that is they were preparing to take phase three drugs, as I had described earlier, hopefully into approval, and then commercialization. They would lean on us at IVX to explore adding to our drug formulary. 

And so, the way I joke internally with our team is that it’s a little bit of the, maybe the nerd light bulb went on in my head as an opportunity to do something deeply interesting and even further upstream than I had in my career before for the goal of getting closer to the patient. And I think as the listeners appreciate any great business that does right by the patient and the very complex details in front of you. 

Clinical research is a bit of an operator’s paradise from that perspective, that’s maybe the why number two. Any business that puts all of its focus on the patient and the hard details in front of you will be successful financially in the end. And I think that’s what we deeply believe is in front of us here at PhaseWell Research. 

Anderson Williams: And it’s clear, it’s actually really exciting to hear you walk through that because you’ve been a part of building companies repeatedly. I’m just curious, any key lessons learned about building and growing in the way that you described from those previous experiences that you know, you’re taking into building PhaseWell? Because you’ve built some pretty significant businesses and been part of teams building some really significant businesses.  

Carsten Bick: I’d say the first lesson is people are everything. Process and technology are very important, but they’re without a doubt secondary in what are service businesses in healthcare. 

Healthcare is human, at least it should be, and the product is the people that are working with your patients. I think my calling card, so to speak, over the last five to 10 years has been leading and driving what we do through that lens, first and foremost. Not to discount, as I had said, process and technology, but they can only enable if you have the people organization, the operating culture, and the things that matter for how you run a service business day to day. 

From there, it does get a little bit simpler and operating playbook, driving standardization. Now I know how to hire for that. I know how to bring in the right types of solutions, and so, again, I go back to focusing on building really, really strong people organizations.  

Anderson Williams: How have you thought about building your PhaseWell team, and then how have you thought about who are the right partners to align with what you’re trying to build at phase? 

Carsten Bick: Well, yeah, it’s a great question, Anderson. You know, when I came in as CEO to lead this business, Shore Capital had just acquired our founding partners, and as an employee base of one, at least at the face wall corporate level, I felt a little bit like a mule looking at a new gate. Um, And so, back to what I had described on over-indexing to people, I’d say that’s where I started first. 

It was going and ensuring I get to know the folks that we are partnering with from the front desk up to the founding site director or leader of each of these businesses. In doing that, then you can start to understand, okay, who are the right compliments to me, hire number two, hire number three, that will serve this business, these people, what they have built, that we are only just starting to learn the right way. 

And so, maybe to simplify that, one of the things I think’s important in this environment is to hire for startup. I credit a lot of my partners on the Shore Capital team for helping bringing me back to that concept. Versus being maybe a little bit anxious as a new CEO of this business and saying, Hey, I need to go get the person that’s done X for 30 years. 

And so, I think where we have landed is an incredible group of intellectually curious, I’d say largely mid-career professionals willing to bet on themselves. They have very high EQs, high empathy, a great ability to make authentic relationships, and not just because that’s part of a playbook. But that’s because what they enjoy, we like to say, have fun, no jerks. 

And you know, in doing this, I think we’ve got the right set of folks that, as I’d said, hire for startup, but have the horsepower, however you wanna define that, an intellect or otherwise energy to go the distance in this business.  

Anderson Williams: Love that. And when you think about your partners and future partners. You’ve described your founding partners and the great experience that they have and the great reputations that they have and so forth. When you’re looking for the next partner, which undoubtedly you’re already in the mix doing, like what makes a good partner for you all?  

Carsten Bick: Yeah, I’ll hit the easy one first, and it’s, they have to be conducting research in the therapeutic areas that are core to our strategy. Putting that aside, we wanna partner with folks that are like-minded from a growth orientation perspective. 

Deep commitment to the communities that these businesses serve. Patient focused similar to our, our teammates that I just described, curiosity, entrepreneurial. Ideally, they want to be part of something larger. A lot of these businesses that we see in the space, again, have been at this for 15, 20, 25 years, and maybe hitting a theoretical max of what they can do with their research site, but are still hungry to make the most out of it.  

They may have five, 10 years left in their career, particularly if they’re a founding principal, investigator physician. But if they still have that fire to continue to grow and do what got them excited about research 15 or 20 years ago, we found that as a tremendous ingredient. 

Anderson Williams: I love this image that I’m sort of conjuring as you described this, of this mix between this rich experience in your partners with still this drive and the hunger, but combining that with like the hustle of your PhaseWell team and this combination of startup mentality, startup hustle with the depth and knowledge and wisdom and experience of your partners. It’s just a really powerful combination to me.  

Carsten Bick: The soup, I would say, is coming together pretty well. We can’t get lazy or fall asleep at the wheel. This is only year one, but we’ve talked a lot about this being a people business first and foremost, and I do feel increasingly confident that as we look into year two, we’ve created the right early culture that if we make a mishire, whether it’s at the site level or at the corporate level, the organ will sort of reject, if you will, or the body will reject the bad organ if, if that makes sense.  

And so, knock on wood, we can continue to be good stewards of the culture and the secret sauce of these early businesses we’ve partnered with and continue to serve them in a way that hits their goals and our growing shared goals. 

Anderson Williams: Given that sort of idea of hustle and startup mentality, I’m curious now, nine months in, how have you had to grow or have you grown as a person, as a leader in this CEO role? And given all that you’ve described, what does that look like for you?  

Carsten Bick: I’d say the first piece is that you really have to focus on keeping a wide range of what you do on a day in, day out basis, whether that’s mentally or relationally. 

In any given day, I may be speaking to a senior executive at a pharma company or solving problems with one of our staff level colleagues. What you have to remember. Is neither one of those conversations or opportunities or problems that you’re discussing is more or less important than the other? I think one of the interesting components of the microcap or smaller end of the market is that you have to be able to solve both of those concurrently. 

Our last company was primarily a de novo based business and when you have a certain small fire burning, there’s other places of the organization you can lean on to solve it. As an example, when you are growing primarily via acquisition and partnership, early on, that small fire may be small relative to the total size of PhaseWell but it’s actually pretty large at that recently acquired site partnership level.  

And if you can’t constantly appreciate that and give the appropriate energy, then what may be small today means that a core asset or a core partnership has significant risk tomorrow. And so, I offer that as an example for how we think about range within myself and our team, because at least for me, I think that’s been a a bit of an early lesson learned. 

Anderson Williams: Yeah. Well, and it’s the trust building process, right? You’re still formulating these relationships. You’re still defining what PhaseWell means and does as a support to these really well established businesses that have chosen to partner you. So, the devil is in the detail a little bit, right?  

Carsten Bick: That’s right. 

Anderson Williams: You have to keep an eye on strategy of the larger platform, but you can’t overlook the trust you still need to build in these early relationships.  

Carsten Bick: That’s spot on. Anderson.  

Anderson Williams: Yeah. You mentioned microcap specifically, and I just want to come back and ask you to help. The listeners think about microcap investing. 

A lot of people have a lot of opinions or misconceptions on what private equity is and what it means when private equity comes into an industry or otherwise. Can you just hit quickly on your approach, Shore’s approach to investing in the microcap space that maybe runs a little bit countered to what people find if they Google private equity or otherwise? 

Carsten Bick: Sure. In fact, Shore Capital’s model for investment was one of the huge decision making components of me taking on this particular challenge. I’d say there’s a lot of great investors out there. What I have learned, and I think to answer your question, what really works with the Shore Capital model is that few really good investors can both identify good sectors and deploy capital in an intelligent way but also stay on as your operating partner from day one to day 10,000. 

I’ll offer a couple of examples here. When we kicked off the foundation of PhaseWell, and as I had joked, I was the colleague base and of one the mule looking at the new gate. I had three partners on Shore Capital’s resource team that had a primary job or mandate of helping me lead the first a hundred day plan. 

This is a lot of the stuff that is very important to run a professional business, albeit maybe a little bit more boring for an ops guy like myself, but human capital platforms, payroll, treasury management, insurance, and dotting your legal i’s and crossing your legal T’s. This represents a great capability and an asset of Shore Capital that helps new guys into the space like myself. 

I’d say secondly, if you look at our board of directors, this was a pinch me moment when I came into the business. The board was already slated from an independent director perspective, and we’ve got some of the most senior executives of very major pharma and CRO logos amongst others in the country. 

These guys could go and take a hundred other jobs at this point and Shore has done an amazing job at courting these guys and bringing them to our table in an authentic way, meaning they’re bought in on the mission and the story ahead, versus simply just paying for an attractive looking board seat or board member. 

And I’d say lastly, I’m on the phone with my partners at shore probably two to three times a week. We are not alone out here trying to build this business. There’s a host of ways of which they continue to bring additional leadership support advisory to make sure that we can make the best out of what we’re doing together.  

Anderson Williams: Yeah, and I think what’s interesting there is you go back to your describing this as a people business and what you’re describing is the same sensibility for Shore, right? That it’s finding the right partners. It’s surrounding you as an early CEO with the right people to set up your business. 

It’s finding the right board members from a people perspective who know the industry, who are still driven by the industry, who want to engage in building something. I can’t help but reflect that the things you’re describing are also people solutions as well. And in that sense, what’s implied in what you’re describing that I think is counter to a lot of narratives around PE is that you’re building something. 

You’re not acquiring companies and slashing people, you’re building. This is about growth and while some PE companies do that, that’s clearly not the angle that we are building from.  

Carsten Bick: Anderson, you hit the nail on the head. Shore Capital believes exactly what PhaseWell Research believes that we want to invest for further growth and enablement. 

I like to say sometimes that these companies we partner with were built incredibly pragmatically. But if you look, and this is with no disrespect to our founding partners or other successful independent research sites out there in the country, it is a slow and steady entrepreneurial race that is often the story of a lot of these research sites. 

And in many cases founded by physicians that are still lending an outsized amount of their time to private practice. And so, the professionality people process technology maybe doesn’t look like what a business that was purpose built to achieve a certain value proposition may look like. And so, again, that goes back to how we look at investing for continued success in really unlocking the potential of these companies locally and weaving them into national participation within PhaseWell Research. 

Anderson Williams: Yeah, and I think what’s interesting, I mean, it’s almost like with absolute respect that many of these doctors, despite also running a practice, have built businesses over time that are successful businesses, and they recognize there’s an opportunity on the horizon if they can unlock some of the value that they’ve created while really running multiple businesses sometimes, right? Like that’s an incredible nod to the kind of people that you’re potentially partnering with.  

Carsten Bick: That’s a hundred percent spot on. In fact, I often joke with both of our founding partners that one day I’d like to grow up and be them because it is really, really impressive and oftentimes these founders are entrepreneurial outside of just having gotten into clinical research, they may have other businesses in the community or otherwise and have that DNA to be successful.  

I think to put a pin in it, when you look at this type of phenotype of business builder, there can sometimes be theoretical maxes and only so much time in the day when they’ve built this much success within their practice, their research business, maybe another family business they own and are often very cognizant that embracing a partnership with a larger organization who is purpose built to continue to enable what they’ve started, it makes a lot of sense and resonates. 

Anderson Williams: If you enjoyed this episode, check out our other Microcap Moments episodes at www.shorecp.university/podcasts or anywhere you get your podcasts. Here you’ll also find our Bigger. Stronger. Faster. and Everyday Heroes series each highlighting the people and stories that make investing in the lower middle market unique. 

This podcast was produced by Shore Capital Partners and recorded in the Andrew Malone Podcast Studio with story and narration by Anderson Williams. Recording by Austin Johnson. Editing by Reel Audiobooks. Sound design, mixing, and mastering by Mark Galup of Reel Audiobooks. 

Special thanks to Carsten Bick. 

This podcast is the Property of Shore Capital Partners, LLC. None of the content herein is investment advice, an offer of investment advisory services, nor a recommendation or offer relating to any security. See the Terms of Use page on the Shore Capital website for other important information.