- After decades of high growth and high valuations, large diversified medical technology companies (MedTechs) are faced with low growth and challenged to create long-term value
- This is partly due to exogenous macroeconomic conditions and partly due to companies themselves eschewing broader strategic considerations and focussing on short-term performance
- MedTechs’ past period of stellar performance benefited from company concentrations in large rapidly growing wealthy markets and benign fee-for-service business models that rewarded volume
- During this time, large diversified MedTechs engaged in weak competition at a level of health plans, payers, and hospitals - an institutional level - and ignored competition at a patient level
- Creating long-term future value for all stakeholders will require companies to compete at a patient level and accelerate the adoption of value-based care programmes that remunerate patient outcomes
- To compete effectively at such a level requires vast amounts of patient data and sophisticated data handling and security capabilities, which many companies do not have
- MedTechs that respond efficaciously to the rapidly evolving healthcare ecosystem and develop data and competences to compete at a patient level will have opportunities to create future long-term value
- Companies that continue with the status quo are likely to struggle to create long-term value and shall become acquisition targets
Have diversified medical technology companies blown their competitive advantage?
In the current fiscally constrained healthcare environment, creating long term value for medical technology companies (MedTechs) is challenging and many industry leaders have accepted ~5% annual revenue growth rate as the “new normal”. It has not always been like this. Between ~1990 and the late 2010s, medium and large diversified MedTechs were high growth, high value enterprises, which benefited from weak competition, large and rapidly growing underserved wealthy markets, barriers to entry, advancing medical technologies and benign fee-for-service business models that rewarded volume. MedTechs’ recent decline in enterprise growth rates is partly due to worsening macroeconomic conditions, but a big part is due to companies themselves. Many became trapped in an outdated, narrow approach to creating value where a significant proportion of scarce corporate resources are focused on optimizing short-term financial performance. Albeit essential, this often meant that unmet market needs, and broader long-term strategic influences tended to be overlooked. We explore how this happened and what can be done about it.
In this Commentary
This Commentary describes how after ~3 decades of stellar growth many medium to large diversified medical technology companies (MedTechs) have become trapped in short-term performance-oriented cultures and struggle to create long-term value for all stakeholders. During their stellar years these companies operated at the level of payers, health plans and hospitals - an institutional level - where competition was, at best, weak, and patients’ therapeutic pathways largely ignored. Today, many diversified MedTechs struggle to create long-term value in the face of low growth rates, fiscal and regulatory constraints, vast and escalating healthcare costs, and increasing competition from giant tech companies and innovative start-ups. Further headwinds come from payers shifting away from benign fee-for-service payment models that reward volume to value-based care, which remunerates patient outcomes. To create long-term value MedTechs will need to radically change their strategies and business models. This will entail replacing legacy technology systems that hinder efficiency and innovation, tightening their security risks and improving their business process flows. If corporations do this efficaciously, they will be positioned to compete at a patient level where value is created and destroyed. However, competing at this level requires vast amounts of patient data and sophisticated data handling capabilities. Many companies neither have such data nor the capabilities to analyse and manage them. It seems reasonable to suggest therefore that, in the near- to medium-term, MedTechs that eschew retooling and competing at a patient level will struggle to create long-term value and likely become acquisition targets.
Structural challenges
As populations in wealthy economies age and shrink, due to increasing longevity and declining fertility, so healthcare headwinds increase and challenge MedTechs. Consider the US, which is an exemplar of most wealthy nations. Today, >56m Americans are ≥65, which accounts for ~17% of the nation's population. By 2030, when the last of the baby boomer generation ages into older adulthood, it is projected there will be >73m older adults, which means >1 in 5 Americans will be of retirement age. As the American population ages a growing number of people present with age-related chronic conditions, which are costly to treat. Today, in the US, ~86% of people ≥65 is living with a chronic disease. This increases the risk of insuring the average US citizen, and the higher the risk, the higher the cost of annual health insurance premiums. According to the Centers for Medicare & Medicaid Services, in 2020, the US national health expenditure (NHE) grew ~10% to ~US$4trn, which equates to ~US$12,530 per person, and ~20% of the nation’s Gross Domestic Product (GDP). By 2030, US NHE is expected to reach ~US$7trn. In 2020, Medicare spending rose by 3.5% to ~US$830bn or ~20% of total NHE. In the same year, Medicaid spending grew by 9% to ~US$671bn, or ~16% of total NHE. The largest shares of America’s total health spending are provided by the federal government (~36%) and households (~26%). The private business share accounts for ~17%, local state governments account for ~14%, and other private revenues account for ~6.5%. According to the 2022 annual Kaiser Family Foundation (KFF) healthcare survey the average insurance premium for family healthcare coverage in the US increased 20% over the previous 5 years and 43% over the past decade. The average premiums for employer-sponsored health insurance are US$7,911 for single coverage and US$22,463 for family coverage. Such changes are forcing the medical technology industry to adjust what products and services it develops and how value is created.
Stellar growth and short-term performance
During ~3 decades before ~2015, the medical device industry benefitted from unmet clinical needs, significant barriers to entry, technological advances, benign fee-for-service payment systems that reimbursed volume and industry concentrations. During this time MedTechs enjoyed stellar growth, and high valuations. Investors prioritized revenues over profit and cash flow, which encouraged enterprises to engage in portfolio moves: M&A, divestitures, and spin-offs. This had the advantage of helping companies to exit low-growth businesses and enter higher-growth segments, without engaging in years of uncertain and expensive R&D. It had the disadvantage of encouraging short-term performance rather than long-term value creation. During this period many senior leadership teams became weighed down with the demands of quarterly reporting and grew accustomed to using a variety of short-term accounting measures and ratios as their principal means to drive business and reward executives. As a result, ‘successful’ medical technology companies had high growth rates but a deficit in ideas to unlock transformative new treatments for underserved patients and plans to seize opportunities presented by technological advances. The industry’s indifference to develop and leverage digitalization is indicative of corporations overlooking broader strategic influences and unmet market needs. Consequently, by ~2015, many large diversified MedTechs had fragmented technology systems that hindered efficiency and innovation and were overburdened by legacy products overexposed in slow growth markets. This made them ill-equipped to either respond quickly to innovative trends or compete with disrupters. According to a McKinsey & Company report published in June 2022, “84% of CEOs believe that innovation is critical to growth, but only 6% are satisfied with their company’s innovation performance”. To survive and stand a chance to create long-term value MedTech functions from R&D to sales will need to change.
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