What shows up once the story must survive the terms
At the outset of life sciences transactions, there is usually a strong sense of alignment. Founders and investors tend to agree on the importance of discipline, focus, capital efficiency, and long-term value. That was evident throughout JPM Healthcare Week and in conversations around RESI 2026, where many of the same themes surfaced across different rooms and discussions.
The gap shows up when you leave the story and start building the terms.
That’s when alignment shifts from theory to practice. Milestones are set, governance gets defined, control assigned, and risk evaluated. And it becomes clear whether the same words carry the same meaning.
The observations below reflect themes discussed in public sessions and side conversations during JPM, along with patterns that consistently emerge once those conversations turn into live dealmaking.
Early conversations: alignment on ambition, divergence on filters
In early meetings, founders often describe how the company operates: momentum, parallel progress, hiring plans, and the ability to move quickly without losing rigor. Investors respond positively, and those conversations move along easily.
What we heard repeatedly during JPM, particularly in mixed investor–founder settings, is that investors are filtering for something slightly different. They’re listening for how decisions get made when tradeoffs become unavoidable. What gets prioritized when capital tightens. Who has authority when plans change.
Both perspectives are rational. They just address different risks.
Diligence: execution versus sequencing
As diligence begins, the focus narrows. Investors start underwriting order rather than activity.
This came through repeatedly in JPM side conversations and in RESI-adjacent discussions, where investors pressed on sequencing: which risks come out first, what proof unlocks the next decision, and whether progress reduces uncertainty.
Founders often stay focused on runway and operational reality. Teams need to be built. Programs need to advance. Waiting on one thread while others sit idle can feel irresponsible.
This is where timing begins to diverge. When investors talk about patience, they usually mean patience between defined inflection points. When founders talk about time, they’re often describing the strain of keeping everything moving at once.
What investors are underwriting
One reason this misalignment persists is that investors are underwriting a different question than founders often assume.
They are not underwriting optimism or effort, or even scientific promise on its own. They are underwriting whether risk comes out of the system in the right order. Whether governance improves decision quality under pressure. Whether the company’s next step makes the business more legible to the next investor, partner, or acquirer.
This is why sequencing matters. A milestone only has value if it meaningfully reduces uncertainty for someone downstream. When that connection is clear, pricing discussions tend to resolve more quickly. When it isn’t, valuation often becomes a proxy for deeper uncertainty that hasn’t yet been addressed.
Understanding that underwriting lens doesn’t require founders to temper their ambition. It requires translating ambition into proof points that align with how capital gets deployed.
Governance: where confidence meets control
Governance surfaced earlier and more directly than in prior years, both during JPM conversations. Not as a formality, but as a credibility signal.
Investors focused on decision authority, board dynamics, and how companies respond when assumptions change. Founders generally agreed that governance matters, but the discussions also revealed how differently each side experiences it.
In deals, governance is not abstract. It’s how risk is allocated and managed when conditions shift. Clear governance often accelerates a process. Vague or deferred governance tends to resurface later as structural friction.
Valuation and structure: flexibility without conviction
Valuation resets were a common topic during JPM conversations. Founders acknowledged the shift. Investors welcomed the realism. What remained clear is that pricing alone isn’t the gating factor.
Lower valuation addresses price risk. It doesn’t resolve execution risk, strategic fit, or exit clarity. Investors are deciding whether an opportunity justifies internal advocacy, not just whether it’s priced attractively.
That distinction came up often in quieter conversations following sessions, and it shows up consistently once deals move forward. Momentum comes from conviction about the path, not concessions on price.
Platforms and exits: optionality versus clarity
Platform narratives featured prominently in RESI-adjacent discussions, particularly where companies described broad pipelines or multiple future applications. Investors responded most positively when those stories were anchored to a clear entry point.
Exit discussions followed a similar pattern. Long-term value was assumed. Buyer logic was not. Investors consistently pressed for specificity around who might acquire the asset, under what conditions, and why.
Optionality still matters. But it isn’t valued until focus is demonstrated. In practice, that means showing how complexity narrows before it expands.
What founders often underestimate
Founders frequently underestimate how much internal advocacy matters inside a fund.
Conviction must survive portfolio construction, reserve planning, concentration limits, and investment committee dynamics. Even strong enthusiasm at the partner level can stall if the path forward isn’t easy to explain, defend, and sequence internally.
That doesn’t make investors fickle. It makes them constrained. Clear sequencing, credible governance, and buyer-aware framing do more work inside a fund than persuasion ever could.
When founders understand that dynamic early, conversations tend to move faster and with fewer surprises.
The constraints that surface late
Some of the most consequential limits rarely are discussed on stage. Fund construction, reserve strategy, portfolio concentration, and investment committee dynamics tend to surface late, often after considerable time has already been invested.
Founders experience this as mixed signals. Investors experience it as discipline. That tension was acknowledged quietly in JPM conversations, even when it wasn’t stated directly.
Understanding those constraints earlier can save time on both sides.
What this means for founders and investors
For founders, the takeaway isn’t to change the story, but to translate it into terms earlier. Be explicit about sequencing. Treat governance as operating infrastructure. Do the work of mapping buyers before you’re asked.
For investors, being clear early in the process helps prevent drift. Naming the risk you’re underwriting—and the milestone that would change your view—creates alignment even when the answer is no.
Across JPM, one theme came through clearly: alignment isn’t proven in conversation. It’s proven in structure.
Capital remains available. Strong companies continue to move forward. The difference now is how quickly alignment gets tested once the story needs to survive the terms.
That’s where deals either gain momentum or quietly stall.