While 95 percent of my experience at the mHealth Summit was positive and inspiring, leaving me feeling very optimistic about the future for startups and entrepreneurs entering the space, I did hear one thing that I found very unsettling.

In fact, it was quite discouraging.

It was during a panel of venture capitalists moderated by Rob McCray, CEO of the Wireless Life Sciences Alliance, when one of the panelists (I believe it was Dan Lubin, partner at Radius Ventures) stated that in his opinion there probably will never be a $25 billion digital health startup. To my astonishment, when Lubin turned to his colleagues to give them a chance to protest this bold statement none of the other panelists disagreed with this assertion!

I suspect that if Mark Zuckburg had listened to his investors when Yahoo and MTV came offering north of $1B to acquire Facebook there wouldn’t be a $25B+ social network either.

Healthcare needs a Mark Zuckerburg-esque entrepreneur if it is to achieve its digital potential anytime in the near future. I encourage all digital health entrepreneurs, especially those raising capital from the big Sand Hill Road venture capital firms, to be bold and think bigger than their investors. Digital health will only achieve its potential if an individual, or many individuals, with a disruptive vision(s) can smash through all of the existing barriers standing in his/her way. VC support this process, but money from one investor is worth the same as money from any other investor if you as an entrepreneur believe in your product and your vision.

With that strong comment, I must say I did not wholly disagree with the panel and found much of what they contributed to be quite insightful.

Panelists universally identified the management team as the top evaluation factor, so the best entrepreneurs should be able to find investors. But a great team with a great product and technology still is not good enough without some revenue to prove their model. Radius has moved beyond investing in pre-revenue businesses and focused on companies with clearly identified customers and scalability. If you have a bulletproof return on investment (ROI) and have identified somebody who can help you scale your technology and earn a return quickly, you have found an attractive deal.

According to Mo Kaushal, MD of the West Wireless Health Institute, stats that demonstrate the need for technology are there, the key is to find the business models. We need to find a way to get ROI even if we cannot effect change in the payment system. Wellness/fitness and peace of mind is very much consumer driven and big opportunity. Chronic disease management is much more of an institutionally driven market as opposed to consumer driven.

Its probably harder to build a technology solution that returns value in the US because we have built so many walls that need to be broken through. We are already seeing medical device companies taking their products overseas first before entering the US market.

The panel generally agreed that the two largest markets, consumer paid and international, require strategic partners to effectively exploit and scale into. Traditional VC models do not work.

Building relationships with people you don’t know already is more important today, or working with other VC firms which is something that would not have happened just a few years ago. Events like the mHealth Summit have become very important for VCs, and the overflowing crowd trying to squeeze into the discussion made it clear everybody wants to hear what the VC have to say.

When you see AT&T and Verizon bringing in dedicated vertical specialists in healthcare, its clear something significant is going on and people are recognizing that. Most exit deals are under $200M, and we can all hope the IPO market comes back but the bottom line is that, today, it is moribund and that is being nice.

So will there ever be a $20B+ company in the mHealth space?

If a company can develop more than one useful product, and is guided by a bold entrepreneur with a vision beyond the stage where there is any need to troll Sand Hill Road for the best offer, why not ?

Truly great entrepreneurs should be willing to stand up to their investors to defend their vision when big money starts to pressure an earlier exit or new round of financing that could potentially undermine that vision. Venture capital doesn’t exist as a profession without great entrepreneurs, but billion dollar startups don’t make it from the garage to the Valley without risk capital provided by equity investors.