Is 'super-grouping' finally a viable thing for Healthtech?

Late last month in my post HETT23 musings on the state of the world, I touched upon a topic that provoked a lot of discussion: "super-grouping". I'd been part of a number of discussions with Healthtech leaders who felt that to respond to the system challenges they were going to need to work together.

Now look, this isn't a new discussion, and in my 5 years and 4 months as a bona fide advisor to healthtech companies, it has come up time and again. Actually it has probably come up in the majority of my chunkier advisory roles, and poised in many different ways.

Super-groupy tech for super-digital times?

This is unsurprising, not just because the seas are currently a bit rough, but because it makes sense technologically too.

Whilst the history of health + IT is one of walled gardens, that is just not the story of the age we're in, which is one of ecosystems, and modularity, and integration. Technology providers who hold on to the notion that they can do everything for everyone within one tidy packages are often the ones who please nobody, and are ripe for disruption. Just look at the sorry state of EPRs / EHRs - need I say more?

The technological vision of this age, and a bloody huge need in health and social care, is based on the Android or iOS ecosystems, the low-code connective interfaces like Microsoft's Power Platform, and other connective tissue like Zapier.

And yet, for a very intelligent, digitally aware and progressive market of Healthtech companies, we still see very few solutions that genuinely work together.

One argument could be that the commissioner or market isn't pushing for this enough, and still thinks in terms of walled gardens and one-product-solves-all solutions, and with outdated single supplier tenders and contracts, which keeps the status quo alive.

Regardless of the reasons (and we'll come to the big reasons stemming from Healthtech companies themselves presently), it needs to change and it will change, because the dynamics of this revolution are inevitable. The big tech companies realise this and find ways to work it to their advantage.

So what does super grouping (or an ecosystemic approach) look like in Healthtech?

?????? OK, I need to hold an intervention, I really hate the term super-grouping, I know I raised it and used it as my article title because that's what people were using. However it sounds daft and a bit elitist and arrogant, so I'm going to change it to an 'ecosystemic approach', which feels accurate, and is the term I have used in teaching before. If you don't like it tough tangerines ?? because it's my article.

Rather than explore the solution, let's just check in on the problem (s) that relate to health and social care, because if the problem isn't strong enough then taking an ecosystemic approach (see it rolls off the tongue) isn't worthwhile:

1. Access is really hard right now - everyone's super busy; lots of people you'd usually speak to have been laid off or left for various understandable reasons; ICBs are still a bit of a black whole of confusion and ongoing change; Healthtech is currently oversaturated (too many companies for the system to accommodate); the nationally assigned facilitators (AHSNs) are suboptimal and struggle with access themselves; ongoing incumbent dominance.
2. Money is tight and everyone is competing for the same few pots that have competing and varying requirements requirements.
3. Functional integration with the NHS motherships (electronic patient records) is slow, messy, draining and expensive.
4. The last round of acquisitions have led to companies who promise more than an individual Healthtech company can provide - wins, then usually underdelivers.
5. Your company possibly isn't getting enough traction and you're getting more and more desperate to try anything before you go to the wall. Being alone with that issue is psychologically tough and sharing the load with others is good for the soul (if you can make it work).

There are probably more but these are the key reasons I hear, or surmise from between the lines.

As a result of the above, the primary conversation I hear around working together and collectivising is around trying to work together to get a foot in the door, usually with companies that work in the same, adjacent or complementary areas.

Tiers of ecosystemic approaches (increasing)

This is a complex topic, and there will be lots of overlap in the below, and different ways you could but I have tried to think about what the logical tiers of this based on what I've seen before, and the conversations in the past.

Let's jump in and ratchet up the tiers.

I'm not going to talk about big companies acquiring smaller healthtech companies, as this is a very different kettle of fish, and usually more about the same old incumbency. So a different kettle of fish. Pass.

Alliance based on shared interests - Simply put, trying to align approaches and objectives to respond to a market, circumstances, specific need areas or opportunities. This is quite broad so I'll give a few examples:

• Market - e.g. Gus Kennedy and Dr Murray Ellender bringing their companies that are arguably competitors to collaborate for the perceived greater good. All signs are this is positive and construcitve, and not the other type where a duopoly goes all New York Five Families to unfairly control the market.
• Common Voice - There sadly aren't enough examples but e.g. Stephen Bourke and I were looking at whether getting all the online pharmacies to pull in the same direction in the face of national and local colleagues not recognising or supporting their emergence. I still think there is a big opportunity for pharmacy located healthtech to work together and with the big multiples to lobby and leverage reform FYI.
• Opportunity / Problem - Taking on a challenge or problem space that might be difficult to take on alone but is potentially viable together. A recent source of inspiration for this could be the UK consortium Black Pear Software Ltd , Voror Health Technologies Ltd , and Dr Julian Brown 's Eclipse - that I can't find) going for the Federated Data Platform, or UHUK 's ecosystem building fast track programme with Isla Health | B Corp? , Medwise AI , inicio health and Ummanu Health with the support of 英国华威大学 ).

On the above, given that the NHS still often puts out tenders for single catch-all suppliers, often mixing service and product offering, and doesn't seem to be looking to change that soon, this is a common tangible grouping.

Note - naturally there may be overlap and the above could also be or become the following categories.

Preferred partner (and commercial spread) - "We trust and work with these partners, and your working with us would work better if you also worked with them." This one is less of a conjoining of products but more of a commercial partnership, although knowing that you could work technically would be .

This happens a lot for services, where a recommendation might trigger some financial incentive based on a two-way agreement, and is the kind of thing that I see consultancy companies do a lot.

Taking that a step further...

Build your own bear ?? - "We work well with this supplier, and together we can help you fulfil your context specific requirements. If you combine us and them you can achieve national pathway objective X, or business objective Y".

Virtual wards does this to some degree with hardware and software layers, but it could go so much further. It just hasn't, but we'll come to why (or at least my theory why) soon.

I also really think players like 微软 could really actively do much more in this space given their back office centricity ( Anna Dijkstra ??).

Taking that a step further (dream board)...

Scale your own transformation bear (variation) ?? - "We work together to give you a transformation roadmap based on the wider needs of your service provision, or the view of how your service provision needs to transform" (e.g. according to NHS Long Term Plan Objectives).

FYI I haven't seen any good examples of this, just a few shoots, possibly because this is i) very dependent on EPRs being ecosystem oriented, rather than the current case of them being massive inhibitors and blockers, ii) this might be difficult for investors to understand and accommodate and iii) it's very complex and requires good system knowledge. But I'd love to see this, and have done some of this very informally in thinking about community health service transformation.

Perhaps unsurprisingly there a more examples of the easy tiers coming into being, and less of the more complex or later configurations. Perhaps because the further down the road you go the more likely you are to hit what founders or investors and board might feel is a clear line in the sand.

In principle I find very few healthtech companies who are not violently agreeing about the need to collaborate and work together more, but the devil is often in the detail, and very few providers currently seem to overcome them.

So what is this devilish detail that gets in the way? ??

Things healthtech companies would need to overcome to build ecosystemic approaches

In an effort to avoid this being too messy and too multifaceted, I'm going to pose a scenario - three companies in adjacent but not directly areas: remote monitoring, patient facing communication, and a pathway automation provider looking to work together. I literally have three companies in mind, but I'll leave you to guess who I have stuck in my fantasy healthtech team.

The three companies are keen to work together, and have started discussing how they could foster a joint ecosystemic approach. But like every choose your own adventure there are big perilous decisions along the way. Will they fall into the pit of isolation once again or will they make it to the top of team mountain?

Let's find out...

Contract prime who will prevail?

For three similarly sized companies looking at making joint approaches or even bids, the question will undoubtedly which company is the prime. Often I've seen companies looking to work together very quickly get into the dynamics of who is the prime bidder when there needs to be one and who gets secondary status. Realistically being the contract holder rather than subcontracted makes a huge difference, for optics, when raising, and in holding the contract and the relationships.

Naturally a consortium approach is the logical response, but that can get difficult and messy, and one company will still need to hold the contract in a multiparty arrangement.

??Now in the case I provided it may be that there are scenarios that could be explored - remote monitoring company leads if the route is through virtual ward oriented trusts; patient facing communication leads through primary care customers and relationships; automation provider leads through IT led activities in trusts etc etc.

But will that plan survive first contact?

Culling dreams on the roadmap

If like me you've seen the promises that get wheeled out in investor decks then you'll know that what healthtech companies provide now, and their BIG VISION for what they want to grow to become (everything to everyone) in the future on the sparkly rainbow that leads to unicorn status. OK I'm being facetious but many healthtech companies have already stated their longer term roadmap vision.

So what happens when patient communication company can't currently deliver automation, but wants to in the future, but then is exploring an ecosystemic approach with pathway automation provider? Trouble in dream board land.

Investors may have a word to say when they say are told that the dream board has changed, and they can't do that now.

The two companies in question, if genuinely very adjacent also might get a little jumpy around intellectual property. Detailed technical conversations may require MNDAs, but there are reasons why BOTH parties might be very jumpy on what they say, and also what they hear and then can't do.

?? If the companies are being serious about collaboration then pins need to be pulled out of the dream board. Beyond that honesty, transparency and trust, need to happen before MNDAs are properly signed. I'd also say that individual founders need to be realistic in this market that one in the hand is better than smashing into the floor like Liz Truss' governing ambitions.

Who gets to refine the oil and how?

Oh data, haven't you heard it's the new oil. And just like oil-oil everyone's willing to fight over it.

Again we're back looking at the dream board, and for equally valid reasons. Many healthtech companies are very keen to use the data they're processing to train predictive machine learning. That's obvious where the real value lies for any data driven business in healthcare in the longer term.

So what happens when two adjacent companies look to integrate technologically? There is crossover with the data, which opens a big oily can of worms:

1. Company A end sup with more data points and gets a bigger perceived net benefit over time. Company B is unhappy because it's just not fair.
2. or both companies have very similar data and (again see previous point) have to either share something that their investors may not wish to share, or end up both building something that relies upon the same well but is direct competition.
3. or both companies have different parts of the puzzle, but don't want to share more than they have to, and everyone loses.

If there is one thing that I've seen personally around working together, this might be the biggest problem. It's something I'd be interested to work through, but right now, without being in a specific real-world scenario - I don't have an answer to this one so no ??

Investor promises, incl. UK viability

Earlier this year I wrote an article about problems with the investment system in UK healthtech, which may give greater background...

As per the article, the patient communications solution company (to pick an example at random) has raised based on a series of big promises around how they're going to scale, spread laterally and cover new territories.

In the cold light of day, commonplace concerns about the UK market, and consequent discussions with the two other healthtech parties again means that they're going to have to go to their board with necessary concessions, and plans for an ecosystemic approach.

Now regardless of what those concessions are, the investors and board that may collectively hold a lot of equity, could easily take issue with a number of components of the plan, and be against the prospect of sharing the territory and the spoils if it means the slice of the pie is ultimately constrained or contained.

They may also more generally have negative outlook on the viability of the NHS, which really is a thing right now, and be already putting pressure to switch to fairer shores, OR might see this as the straw that breaks the proverbial camel's back.

Similarly if any of the solution providers is readying for another cash injection, then again there my be concerns by the founders and existing investors that this would look like a red flag. Of course, partnerships are seen favourably, but many might want to delve into the rationale behind it and what the downsides of doing this are.

Different horses (or unicorns) on different courses?

Yep, I'm banging that drum again. Many healthtech organisations have their strategy based on a number of assumptions, that doesn't really match the system, and the routes to being commissioned. If the three companies have different planned routes to market then finding a joint approach might be problematic.

It's around about this point that I plug a relevant article to... oh wait..

Getting a joint commercial strategy is always easier when it's not based on incorrect assumptions, unviable routes or fundamental errors.

Comparing and contrasting in a safe open format with your proposed collaborators MAY create better focus instead of confusion, but it may also create confusion too.

So, if you don't think you know the answer or want to be sure, then get help from someone who can help you, individually or as a group. It's critical for your business to do this anyway, so I'll keep on banging my drum.

(p.s. depending on your company, product and area of care, the author has done this kind of strategic review for a lot of heathtech companies - he's too modest to tell you so I - secret contributor - has decided to intervene and let you know.)

So is it now viable?

Desperate times call for desperate measures, and I'd argue that these are pretty desperate times. To me, the need is sorely there, and working together as a pirate fleet is much better than a solo vessel overcome by the winds alone.

But realistically, there are obstacles that need to be overcome, dreams, egos and investors to be navigated with maturity and difficult topics that will need to be openly explored (MNDA traps notwithstanding).

I would suggest the following:

1. I know that healthtech companies want to go big or go home, but instead of going for the biggest mission for collaboration, starting to ratchet up the tiers and build a partnership over time may steady weak hands, build trust and offer some small return in the short term.
2. Consider some support or pre-mediation by a trusted third party - kind of like a marriage councillor but before the marriage (I'm sure really rich people already have something like this).
3. Make sure that you've got your fundamentals right before you start mixing and matching.

Good luck with your collaborations, whatever you may choose to call them.

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p.s. quick ask - if you genuinely found this article helpful or interesting then?please do like???, comment????and re-share????- it really helps me to with my big hairy mission.

I put a lot of time and energy into creating the best content for my tribe that I can, instead of going for the other cheap tricks on LinkedIn. So if you genuinely found this article helpful or interesting then?please do like???, comment????and re-share????- it really helps me to with my big hairy mission. Thanks in advance. Liam

p.p.s. Now over to me talking about me in third person???

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Liam Cahill is a trusted adviser to frontline providers and national bodies on all things digital, with nearly two decades experience of doing tech stuff in the NHS. He has mentored and advised some of the best known names in Healthtech, and?they've usually said some nice things about his work. He regularly posts content, ideas and advice on LinkedIn. Check out his other numerous articles and videos?here, and subscribe to his LinkedIn newsletter?here.