Minding Their Own Businesses

Radiationoncologyville wasn’t quite big enough for Tim Showalter, MD, MPH, and Ben Frank, each of whom left town for a trip to Industryburg.

Dr. Showalter is the founder of Advaray, the maker of BrachyGel™, and is currently the Chief Medical Officer at Artera, with a side hustle as Professor of Radiation Oncology at the University of Virginia. Mr. Frank completed his Fellowship in Healthcare Administration at MD Anderson Cancer Center, where he served as a Program Manager and then Administrative Director in Radiation Oncology. He has served as President of Provision Healthcare, founder and CEO of Wheelhouse and Apollo Healthcare, and founder and advisor for Unity HealthTech.

Dr. Showalter and Mr. Frank graciously agreed to share insights on strategy and execution in the business world based on their years of experience.

Tim Showalter, MD, MPH

ASTROnews: Every great product starts with an idea. Where did the concept for BrachyGel™ originate, and what problem were you hoping to solve?

Dr. Tim Showalter: With a busy cervical cancer practice, I started to become frustrated with the vaginal packing options available to me. The initial inspiration for BrachyGel™ came while buying spray foam insulation at a home improvement store one Saturday morning. I wondered if I could find a material that would expand in position to provide packing during cervical cancer brachytherapy.

AN: Many academics have great ideas, but few turn them into products. What was the moment when you decided to go beyond research and build a tangible product?

TS: I initiated the project by seeking grant funding for the research and finding a polymer chemist collaborator. At that stage, I was under the impression - which I know now was naïve - that I could address this need by simply finding a collaborator who could identify the right polyurethane foam or hydrogel. I thought that it would be a quick project. I soon learned that I needed to develop a full product, including an integrated delivery system combined with a bag to contain the gel. There was no specific moment where I committed to building a tangible product, but I became more deeply committed step-by-step as I went from pilot grants to Phase I and II Small Business Technology Transfer (STTR) grants from the National Cancer Institute (NCI).

AN:  What advice would you give to someone in academia who wants to turn an idea into a product?

TS: I would encourage academic researchers with an interest in building new products to give it a shot. Industry needs contributions from experienced clinicians and researchers. If it suits your interests, there are many ways to make a positive impact on patient care as a physician in industry. The best approach is to just take the first step.

AN:  Execution is where things can get tricky. What were the biggest challenges in the early stages of developing BrachyGel™, and how did you navigate them?

TS: Although I had a lot of clinical expertise, I knew nothing about polymer chemistry or biomedical engineering. It was challenging to get connected to the right consultants and collaborators. At the start, I focused on the resources available to me at the University of Virginia and the local biotech ecosystem. It was not until I started looking into the broader world of medical device design and manufacturing that I began to find consultants with the capability I needed to work efficiently and effectively.

AN:  Startups and research projects rarely follow a straight line. Did you ever have to pivot your strategy?

TS: It wasn’t until around the time of our Phase I STTR award that we came to the messy conclusion that, based on testing of a prototype system on cadavers, it was not feasible to instill hydrogel directly as vaginal packing. This realization compelled me to rethink the strategy to envision a more complex device. I scrambled to find a medical device design consultant with experience in complex catheters and was able to include this change in our subsequent Phase II STTR application to fund some of the expanded scope of device development. The timing of this change was key to our success, as we were able to pull in a great team that was able to carry us through our FDA submission and even initial manufacturing.

AN:  You took BrachyGel™ from concept to commercialization, and eventually through an acquisition. What were the key factors in successfully scaling the product?

TS: My initial plan was for Advaray, the company that I founded to develop BrachyGel™, to develop its own sales force, to produce the product through manufacturing partners, and to develop a broader portfolio of products for radiation therapy. My primary motivation was to provide brachytherapists with an easy-to-use packing option that improves patient comfort. I wanted to be sure that was available broadly. I initially pitched to CQ Medical to see if they’d invest in Advaray.

My experience in partnering with CQ Medical has provided a lesson in going farther through partnership with others than what is possible on my own. Advaray was acquired soon after FDA clearance of the product and before any commercial sales. Our small team navigated device design and testing, establishing a quality management system, sponsoring a clinical trial, getting BrachyGel through FDA clearance in a de novo pathway, and establishing our initial manufacturing processes. We were able to accomplish this through federal and state grant funding, without raising private investment dollars.

Key factors to successfully navigating the process include 1) keeping an eye on the key milestones, like FDA submission, and systematically checking the highest priority boxes along the way, 2) engaging expert consultants early to be sure that duplicative or unnecessary work is avoided, 3) continuously reminding consultants of the clinician’s perspective and patient impact to be sure that the project stays on the right track, and 4) always focusing on scientific integrity and patient outcomes.

AN:  What do you wish you had known about strategy and execution before starting the company?

TS: I wish I knew to fully embrace the saying, “greatness is in the agency of others,” which I learned from business professor/podcaster Scott Galloway. During the early days of Advaray, I spent countless hours working to learn a wide range of topics spanning quality management, manufacturing and commercialization strategies. Now I know that I could have saved many hours by engaging advisors and consultants earlier in the process. As a physician founder, it’s significant enough to contribute the clinical perspective and leadership – and there are plenty of expert advisors available to fill in the missing pieces for your plan.

AN:  While you were in the process of building Advaray, you were also moving into a new role at Flatiron Health and now Artera. What motivated you to transition from academic practice to the industry side? What are some cultural insights you’ve observed that might be useful for others in the field?

TS: I started to realize that it was possible for me as an individual physician to potentially make a greater impact by working with multidisciplinary teams in industry to move innovation forward. Flatiron had a compelling set of core values that I continue to think about today. One of my favorite values was “Be willing to sit on the floor,” which encourages experts and leaders to take on direct projects, rolling up their sleeves to play well with others and focus on complex work. Another is “Seek feedback at 30%.”

While in academia, my tendency was to hold onto a manuscript or proposal until it was a solid final draft. Unfortunately, this often results in missing the opportunity to seek meaningful feedback from others. I think it’s a useful practice to seek input early before committing to a final concept, which can often result in a better final result. At Flatiron I learned how powerful a basic practice of setting quarterly and annual team goals can be to foster team alignment and accountability. This is something that I did not see executed well in academia, and it can be a simple, powerful force.

AN: Based on your experience across academia, startups and industry, what do you think people most often get wrong about execution?

TS: Many people assume that execution requires a pre-trained expert who seamlessly performs a series of well-established steps, following a clear playbook. That couldn’t be farther from reality, in my experience. Execution is essential to innovation, and it’s best to just get started. If you’re doing something innovative, there will generally not be a predefined optimal path to success for any given project. Generally, the best path forward is one well-intentioned step at a time, asking a lot of questions and learning along the way.

Ben Frank

AN:  Can you walk me through how you got started in prior authorizations and EMR software, and what drives your passion for this space?

Mr. Ben Frank: Early on in my work at MD Anderson, I saw how frustrating the letter of medical necessity and prior authorization processes were for physicians. As I moved up in radiation oncology at MD Anderson, I saw how these administrative hurdles impacted care across the board. Later, when I left for Provision Healthcare, I experienced it from an operator’s perspective. Ultimately my frustration turned into motivation to start Apollo Healthcare, where we built an outsourced prior authorization service. At the core, my passion comes from wanting to remove unnecessary obstacles so providers can focus on patient care instead of paperwork.

AN: Your work is so impactful in streamlining administrative burdens for providers. What’s the big-picture vision you’re working toward, and how do you ensure your team stays aligned with that?

BF: The big-picture goal is to turn prior authorization from a bottleneck into a seamless, data-driven process that empowers providers rather than burdens them. We want to get to a point where approvals are predictable, denials are minimized and appeals are almost automatic.

To keep the team aligned, we emphasize impact over activity. Everything we do must contribute to making prior authorization faster and more efficient for our clients. We track real-world outcomes — approval rates, turnaround times and revenue cycle impact — to ensure we’re moving in the right direction. We also maintain a culture of adaptability, encouraging our team to continuously refine and challenge our approach to make sure we’re solving the right problems in the most effective way.

AN: Building businesses in health care can be unpredictable. Can you share an example of a moment where you had to pivot?

BF: After Apollo, I started Wheelhouse with some of the same investors who had backed us before. The idea was born from what we had seen firsthand — patients navigating complex cancer treatment decisions were often overwhelmed, and employer-sponsored health plans weren’t structured to provide the support they truly needed. We believed there was an opportunity to bridge that gap by helping patients access the right care while reducing costs for employers.

At first, it seemed like we were on the right track. We signed multiple enterprise-level employers and built a strong operational framework. But, we kept running into a fundamental challenge: while employers liked the idea, and patients found value in the service, the tangible return — whether financial or clinical — wasn’t strong enough to justify long-term investment at scale.

We pivoted multiple times: adjusting the service offering, refining how we engaged with patients and testing different employer models. But no matter how we tweaked it, we always came back to the same core question: does this create enough impact to be a sustainable business? Ultimately, the market wasn’t ready. Shutting down Wheelhouse wasn’t a failure — it was a learning experience in market timing, business model validation and staying disciplined about when to push forward and when to pivot.

AN:  How do you ensure your team is focusing on the most impactful actions? Are there specific metrics or systems you rely on to track progress and ensure accountability?

BF: We prioritize metrics that directly impact patient access: approval rates, turnaround times and appeal success rates. If a change doesn’t move those numbers, it’s not a priority. Beyond that, we emphasize ownership. Everyone on the team understands how their work contributes to making providers’ lives easier. We use real-time dashboards for transparency, but the real key is ensuring that people feel empowered to solve problems rather than just complete tasks.

AN:  Motivating teams in high-pressure environments is tough. What’s your approach to keeping your team energized and focused, especially when facing challenges like scaling or external pressures?

BF: Clarity and transparency. People stay motivated when they understand the bigger picture and feel like they have a stake in the outcome. We keep an open dialogue, especially when challenges arise, and focus on solutions rather than just problems.

I also believe momentum is key. Prior authorization and growing a startup can feel like an uphill battle, so we celebrate progress, whether an operational improvement or a success story from a client. Keeping the team connected to the impact of their work is the best way to maintain energy and focus.

AN:  If you could go back to your fellowship days with the knowledge you have now, what advice would you give yourself about strategy and execution in entrepreneurship?

BF: First, execution beats ideas. Back then, I thought success came from having the right vision. But the best ideas in the world mean nothing without execution. You have to test, iterate and move fast. Getting something 80% right and improving it is better than waiting for perfection. That said, "good" has to actually be good. Too many people ship half-baked products or sell complete vaporware. Functional, effective and real will always win over hype.

Second, timing is everything. The best opportunities come from matching a great idea with the right moment. Lastly, I’d tell myself to get comfortable with uncertainty. The best moves in my career weren’t the ones I planned — they were the ones that emerged when I was willing to adapt. You can’t force a market to be ready, but you can build something solid so that when the time is right, you’re already ahead.