Testing an investment case's own assumptions before the investors do

Client

Date

European healthcare venture builder

12/2025

The challenge

A European healthcare venture builder backs medical technology ventures with a team of three. Those three carry everything an investment decision needs: the market read, the clinical case, the competitive picture and the investor deck. Each opportunity got the depth someone had time to give it, and nobody had capacity to attack the firm's own case before an investor did.

The solution

FifthRow set up an investment diligence capability the firm's own partners run. An opportunity, a company or a claim goes in; a sourced assessment comes out, built the same way each time so two opportunities can be compared, and pointed as readily at the firm's own investment case as at the market around it.

36,121

analyst-hours equivalent, 64 FTEs

9,139

research questions answered from sources

Investor-case validationEvery deck assumption tested against outside evidence

Diligence coverage199 studies across the pipeline and the portfolio

Clinical expert mappingSpecialty expert maps ranked by evidenced influence

Evidence base9,139 research questions answered from sources

Analyst-hours equivalent36,121 hours saved; equivalent to 64 FTEs

01 — INVESTOR-CASE ASSUMPTION TESTING

The most exposed document a venture builder owns is its own investor deck, and the assumptions inside it are usually the last thing anyone checks. Each claim was pulled out and tested against outside evidence before it went in front of anyone who would test it for them.

Core Activities

Extracted the assumptions inside an investment case and tested each one against outside evidence
Sized the addressable market behind the case independently, rather than accepting the figure in the deck
Rebuilt the investment thesis from evidence and set it against the version being presented
Modelled exit routes and return trajectories so the ask could be defended on numbers
Mapped the capital path and funding requirement across the venture's stages
Set up a critical-assessment pass whose job is to argue against the firm's own material

The Results

An investment case whose weakest assumptions were known to the firm before they were found by an investor, with an independently built market size and thesis to set against the version in the deck.

1,455

analyst-hours equivalent, testing the firm's own case

02 — VENTURE AND MARKET DILIGENCE

The firm sees more opportunities than three people can study properly, so the ones examined tend to be the ones with a champion. One assessment was applied to every opportunity instead, so a thin case and a strong one look different on paper.

Core Activities

Put each opportunity through the same market assessment, on one structure
Established the clinical problem and the unmet need behind each proposition separately from its market
Built the competitive picture and the positioning behind each candidate
Rebuilt each opportunity's business model and the assumptions holding it up
Read transaction and acquisition activity in the surrounding market for pricing and exit evidence

The Results

A comparable assessment across the pipeline rather than a deep read of whichever opportunity had a sponsor, with the clinical case and the commercial case built separately so one could not flatter the other.

opportunities put through the same market assessment

03 — CLINICAL EXPERT MAPPING

In healthcare, who backs a proposition matters as much as whether the market exists. Identifying the clinicians whose view carries weight in a specialty was work the firm could only do through its own network.

Core Activities

Identified the leading clinical voices in a specialty from published evidence rather than from contacts
Assessed each one's actual expertise against their visibility, so influence and authority were separated
Synthesised expertise and influence into a single ranked view per specialty
Extended the same method to further specialties as new propositions came up
Kept each map structured so it could be re-run as the field moved

The Results

A ranked, evidenced map of who matters in a clinical field, built from the published record rather than from whoever the firm already knew.

1,289

sources behind one specialty's expert map

04 — REGULATORY AND IP POSITIONING

Two questions decide whether a medical technology venture is investable at all: whether there is a route through the regulator, and whether anyone else already owns the idea. Both used to mean commissioning specialist advice before knowing whether the opportunity justified it.

Core Activities

Assessed comparable already-cleared devices to establish the likely regulatory route for a candidate
Read the reimbursement pathway alongside the regulatory one, since one without the other is not a business
Mapped the patent position around each proposition, and the trademark landscape with it
Traced how the underlying innovation had developed, to see what was genuinely defensible
Produced each read in a form the firm could take straight into a specialist conversation

The Results

A regulatory route and an IP position established before specialist advice was commissioned, so the firm could decide whether an opportunity was worth paying to investigate further.

1,300+

analyst-hours equivalent, regulatory and IP positioning

What it proved

Twelve opportunities went through the same market assessment, each with its clinical case built separately from its commercial one. Expert maps were built for individual specialties from the published record, one of them drawing on 1,289 sources. Regulatory routes were established from comparable cleared devices and set alongside reimbursement and patent position. And the firm turned the same capability on itself: every assumption in its own investment case tested against outside evidence, with a pass configured specifically to argue the other side. Across the engagement that is 199 studies answering 9,139 research questions from sources.

What the firm holds is the ability to take an opportunity seriously without clearing a week for it, and the ability to attack its own case first. Three people produced all of it, which is why the platform records 36,121 analyst-hours saved across those 199 studies, the equivalent of 64 full-time analysts. The number is that size because the same diligence was run across a whole pipeline by a team that had previously been able to give each opportunity only the depth it could spare.

Results

Metric	Benchmark	Result	Improvement
Scrutiny of the firm's own case	Assumptions defended in the room, tested when an investor pushed	Every deck assumption tested against outside evidence first	The firm finds its weak claims before an investor does
Diligence depth per opportunity	Whatever depth three partners could give it	199 studies, one structure across the pipeline	Depth no longer set by who had time
Comparability between opportunities	Each case read its own way	Same market assessment applied to every opportunity	A pipeline that can be ranked rather than argued
Regulatory and IP position	Specialist advice commissioned before the opportunity was qualified	Route and patent position established in-house first	Advice bought only once an opportunity earns it
Analyst-hours saved	Three partners carrying all the reading between them	36,121 hours across 199 studies	Equivalent of adding 64 full-time analysts over the period

ATTACK YOUR OWN CASE FIRST

The document most exposed to scrutiny is the one the firm wrote itself. Testing every assumption in an investment case against outside evidence, before a raise, means the weak claims are found by the people who can still fix them.

A DEVIL'S ADVOCATE IS A CONFIGURATION

An agent whose job is to argue against the firm's own material is a deliberate setup, not a side effect. Asking for one is what separates a team that wants confirmation from a team that wants to know.

SEPARATE THE CLINICAL CASE FROM THE COMMERCIAL ONE

Building the unmet clinical need independently of the market sizing stops one flattering the other. A large market and a real clinical problem are two different findings and a proposition needs both.

INFLUENCE IS NOT THE SAME AS EXPERTISE

Ranking clinical experts required assessing actual expertise separately from visibility. The most visible voice in a specialty and the most authoritative one are often different people, and an evidenced map says which is which.

QUALIFY BEFORE YOU COMMISSION

Regulatory and IP questions used to mean buying specialist advice before knowing whether the opportunity deserved it. Establishing the likely route in-house first reverses the order, so paid advice is spent on candidates that have already survived something.

ONE STANDARD MAKES A PIPELINE COMPARABLE

Applying the same assessment to every opportunity, rather than a deep read of the one with a champion, is what turns a set of individual judgements into a pipeline that can actually be ranked.

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