Everyone is talking about Forward, the US HealthTech company that raised $500M to reinvent primary care by introducing AI-powered care pods - only to go bankrupt. Nevertheless, it is clear that #outpatient care will change significantly in the next 10 years across all regions. I wrote down a few thoughts, focusing on Germany. 1️⃣ 𝐈𝐧𝐜𝐮𝐦𝐛𝐞𝐧𝐭𝐬 𝐰𝐢𝐥𝐥 𝐧𝐞𝐞𝐝 𝐭𝐨 𝐫𝐞𝐢𝐧𝐯𝐞𝐧𝐭 𝐭𝐡𝐞𝐦𝐬𝐞𝐥𝐯𝐞𝐬 CompuGroup, the top EHR provider for outpatient care in Germany, has seen its stock price fall sixfold in three years (from €82 in September 2021 to €14 today). By keeping their systems closed, incumbents are setting themselves up for a slow decline. 2️⃣ 𝐓𝐡𝐞 𝐧𝐮𝐦𝐛𝐞𝐫 𝐨𝐟 𝐬𝐲𝐬𝐭𝐞𝐦 𝐢𝐧𝐬𝐭𝐚𝐥𝐥𝐬 𝐰𝐢𝐥𝐥 𝐬𝐡𝐫𝐢𝐧𝐤 𝐢𝐧 𝐯𝐨𝐥𝐮𝐦𝐞 𝐛𝐮𝐭 𝐢𝐧𝐜𝐫𝐞𝐚𝐬𝐞 𝐢𝐧 𝐯𝐚𝐥𝐮𝐞 Today, there are 110k installs of EHR software in outpatient care in Germany. This number is expected to shrink, as single medical practices are being replaced by bigger offices, employing (part-time) physicians. However, it will be much easier for physicians to purchase SaaS solutions with proven ROI directly from a curated marketplace, hence increasing overall software sales in €. 3️⃣ 𝐓𝐡𝐞𝐫𝐞 𝐚𝐫𝐞 𝐬𝐭𝐢𝐥𝐥 𝐦𝐚𝐧𝐲 𝐯𝐚𝐫𝐢𝐚𝐛𝐥𝐞𝐬 𝐨𝐧 𝐭𝐡𝐞 𝐦𝐚𝐫𝐤𝐞𝐭 I mapped 15 players in Germany, but there are many more (and this analysis could be replicated for every country, each with its own unique list of players). Some focus on excelling in reactive care, while others prioritize proactive care models. Some pursue a national go-to-market strategy, while others build very localized ecosystems. Ultimately, as is often the case in #healthcare, regulators will determine who wins, who loses, and how long it will take for the sector to fully transform. 4️⃣ 𝐈𝐭 𝐰𝐨𝐧'𝐭 𝐛𝐞 𝐚 "𝐰𝐢𝐧𝐧𝐞𝐫𝐬 𝐭𝐚𝐤𝐞 𝐚𝐥𝐥" A local ecosystem, where a HealthTech player owns the medical practices of a micro-region and is fully integrated with all local healthcare stakeholders, is highly defensible (even with 10 practices only). So we might see many "Asterix Villages" saying no to the biggest #HealthTech players. Will these Asterix villages be 10% of the landscape? Or 50%? 5️⃣ 𝐖𝐡𝐨 𝐰𝐢𝐥𝐥 𝐰𝐢𝐧? 𝐃𝐨𝐜𝐭𝐨𝐥𝐢𝐛 𝐨𝐫 𝐌𝐞𝐥𝐢𝐯𝐚? Among the 15 players I identified, Doctolib (Europe's largest HealthTech with a $6B valuation) and Meliva (part of Mehiläinen, a Finnish health system that recently raised $2B to grow) are the two giants. Doctolib uses a national approach, sending a large sales team to convince medical practices to join. Meliva, in contrast, is buying medical practices directly and expects to own over 100 by the end of the year. This approach is more cash intensive and more difficult to scale... but also highly defensible (as mentioned before). Meliva (obviously) uses its own tech stack, not Doctolib's. If private equity steps in and more "Meliva-style" players enter the market, Doctolib would be at risk.
Katrin Siems
1mo
Very inspiring! How do you see the hospital care market developing in this context?
Kai Hankeln
1mo
In disruptive times, big players are always at risk and new ones are successful. The fact that the German healthcare industry was spared for a long time and supposedly protected by regulatory market entry barriers is over. The problems are too big!
Gillian Tachibana de Llull , telehealth as a key element of healthcare, as you been saying for years. Hope you don’t mind I tag you, it’s just, this graph seems to have all the key words. ☺️
Quite observative and some valid points there. Plus some not very obvious action points for possible road maps there. Good read!
Thanks Thomas Hagemeijer and I agree, the "empires" may either adjust or the " Asterix Villages" will grow. With OptiMedis AG we are already developing these local "Asterix Villages".
Dr Rishi Pathak
1mo
Interesting
Dr. Simon Gordon
1mo
What's interesting about doctolib is the network effect of it being a tool for both clinicians and patients.
Leitung Plattform- und Geschäftsentwicklung bei medatixx GmbH & Co. KG
3wThomas Hagemeijer Thanks for your thoughts. A few thoughts from me on the subject: I'm with you that the established providers need to reinvent themselves in the face of the transformation taking place and, for example, embed open APIs and AI-based solutions into their EHR solutions. The mentioned market consolidation in the EHR market is also already recognizable, only that the purely SaaS-based solutions are currently not yet winning over the majority of changing customers. (See the list of growing providers in the KBV installation statistics). It will be interesting to see what the future brings and it is certainly helpful that the latest regulations have also clarified what cloud-native EHR providers have to take into consideration. Where exactly do you see the aforementioned simplification in the purchase of SaaS solutions versus the on-premise solutions that are often used today?