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A Third Way Growth Strategy for MedTechs

  • MedTechs traditionally prioritise M&A over in-house R&D yielding size without always improving quality
  • Amidst healthcare's rapid evolution, companies must explore new avenues for growth and staying competitive
  • Embracing a Third Way, MedTechs can invest in start-ups to access disruptive technologies, mitigate risks, foster growth, and competitive advantage
 
A Third Way Growth Strategy for MedTechs
 
MedTech industry leaders must welcome fresh ideas to maintain their competitive edge and ensure ongoing growth. However, the conventional avenues of development, such as merger and acquisitions (M&A) and in-house research and development (R&D), often encounter obstacles that diminish their effectiveness. As the industry advances, companies face the dual challenge of adopting new technologies while breaking down entrenched organisational barriers. In an era marked by transformative breakthroughs and turbulent market forces, adaptability and innovation are indispensable drivers of success.
 
The line separating established enterprises from agile newcomers has blurred, paving the way for potential collaboration and strategic investment. To excel in this environment, traditional MedTechs should consider recalibrating their conventional growth strategies. Rather than solely relying on M&A or low-risk tweaks to in-house R&D, they should explore a Third Way: investing in and collaborating with a range of innovative start-ups. Giant MedTech have been doing this for decades and reaping the benefits of nascent enterprises, fuelled by high-energy talent, leveraging novel technologies, and offering a fresh approach to growth and value creation.
 
Collaborating with early-stage entities empowers traditional firms to foster a culture of innovation and adaptability, thereby improving patient outcomes and strengthening healthcare systems to thrive in an era of unprecedented change. Effectively managing inventiveness becomes imperative for traditional MedTech companies to successfully navigate the evolving healthcare ecosystem.
 
In this Commentary

This Commentary emphasises the importance for MedTechs to define a clear strategic path in response to the challenges posed by rapid technological advancements, geopolitical shifts, and advancing market dynamics. We propose a Third Way that moves beyond conventional strategies of M&A and internal R&D. We advocate for investment in a varied portfolio of innovative early-stage enterprises focused on developing disruptive healthcare solutions and services. This approach aims to avoid the drawbacks associated with conventional growth strategies and set up MedTechs for long-term growth and improved competitiveness.
 
Challenges of M&A

For more than four decades, the MedTech industry has predominantly relied on M&A as its primary growth strategy, which, over time led to the financialisaton of the industry. Larger conglomerates emerged, but their size does not always translate into enhanced patient outcomes or improved operational efficiency. This pattern emphasises a tendency where short-term financial objectives frequently overshadow longer-term strategies focused on quality systems, organisational structure, and talent within the acquired companies.
In many instances, early-stage enterprises have deficiencies in their operational and human resource systems. These weaknesses are frequently overlooked or insufficiently addressed during the integration phase. While the repercussions of such oversight might not be readily apparent, they tend to surface over time, potentially hindering growth.
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The Financialization Dilemma of MedTechs

 
The fallout from prioritising financial integration strategies can jeopardise the long-term viability of the merged entity and hamper its ability to innovate and adapt to shifting market dynamics. Successfully merging disparate corporate cultures, technological platforms, and operational processes requires meticulous planning and execution across all facets of the integration process. Neglecting to allocate adequate time and resources to address these non-financial aspects can lead to disruptions in workflow, employee discontent, and diminished performance.
 
Moving forward, corporations might consider adopting a more balanced approach to growth, one that not only factors in financial gains but also prioritises the assimilation of quality systems, organisational coherence, and human capital to ensure sustained success. Strategic complacency seems to be present in many large entities, and associated with an excessive dependence on conventional M&A for growth can dampen internal innovation.
 
Challenges of In-House R&D

Traditional MedTechs encounter challenges when considering disruptive in-house R&D endeavours. The inherent risks, coupled with resource constraints, often dissuade many traditional companies from pursuing innovative avenues of development. Also, complex regulatory environments present hurdles that require expertise, investment, and stringent compliance measures. The infrastructural needs for integrating new technologies exacerbate the situation, necessitating updates to current manufacturing facilities, supply chains, and distribution networks. These conditions emphasise the demanding nature of pursuing innovative R&D in-house. 

The demands of sales and marketing add additional complexity to internal development initiatives. New offerings require educating healthcare providers and consumers regarding their benefits, alongside developing specialised sales teams and tailored marketing strategies aligned with the product's unique demands. Incentivising sales teams to prioritise new offerings over established ones can be testing, which reinforces the hesitation of traditional MedTechs to pursue disruptive R&D projects.
 
A culture of risk aversion often prevails within traditional firms, leading to a reluctance to depart from established business models and technologies. This is reinforced by corporate structures that highlight stability and predictability over innovation and agility. Executives may hesitate to invest in ground-breaking R&D projects, opting instead for incremental improvements to existing devices. The allure of legacy products, despite their age and slow growth rates, provides a sense of security that dissuades corporations from exploring new technologies.
 
A Third Way

A Third Way for achieving growth and competitiveness, involves investing in innovative early-stage enterprises. Start-up culture thrives on creativity, fuelled by agility, entrepreneurial spirit, and a focus on disruptive solutions. Unlike traditional MedTechs, new ventures are free from the constraints of legacy systems, which enables them to take bold risks and explore new ideas. The collaborative culture of emerging businesses frequently attracts top talent from diverse disciplines, promoting interdisciplinary cooperation and fresh perspectives. This convergence of talent, flexibility, and risk-taking propels start-ups to the forefront of progress, extending the boundaries of what is achievable and contributing to transformative change in healthcare delivery and patient outcomes.
 
Engagement with entrepreneurial businesses warrants larger companies access to cutting-edge technologies while mitigating risk across a portfolio of ventures. Investment in early-stage entities opens avenues for collaboration, partnership, and potential acquisitions, enabling traditional firms to capitalise on emerging trends to maintain and enhance their competitiveness. Overall, embracing a broad-based investment strategy in start-ups represents a prudent approach for traditional MedTechs aiming to reconcile progress with risk.
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Supporting a variety of new ventures that are developing novel products through off-balance sheet investments presents a strategic advantage for traditional corporations. This approach allows them to access advancements without immediately bearing the financial burden of traditional acquisitions, thereby preserving their financial flexibility, and safeguarding their core business. 
By providing tax benefits and mitigating the impact on financial ratios, these commitments contribute to the overall financial wellbeing of the company. Additionally, they facilitate low-risk incremental acquisitions. As start-ups mature and demonstrate success, traditional enterprises can acquire them, leveraging their initial investment and minimising the risk associated with unproven technologies. This model fosters an ecosystem where new entrepreneurial entities thrive with support from established players.
 
Investing in emerging businesses for MedTechs extends beyond financial contributions and can include injections of expertise and knowledge. Established firms possess the capability to offer invaluable guidance and mentorship, drawing on their experience in navigating complex regulations, executing successful clinical trials, and effectively scaling manufacturing operations. By sharing their expertise and knowhow, mature companies amplify the impact of their financial stakes and strengthen their ability and reputation to drive innovation. 
 
The Potential of Venture Arms for MedTechs

The creation of venture arms by leading MedTech companies has facilitated creativity and driven commercial success. Johnson & Johnson (J&J) and Medtronic, for example, have embraced this trend with positive outcomes. J&J's venture initiative, JLabs, was initiated in 2015 in San Francisco to nurture ~50 start-ups across a spectrum of healthcare sectors, including medical devices and digital health. Since then, it has burgeoned into a dynamic ecosystem with key incubation hubs worldwide, from New York to China.
 
While J&J typically refrains from immediate investments, its strategic commitments to enterprises like Mauna Kea Technologies, Protekt Therapeutics, Cara Care, Cala Health, and Sight Diagnostics demonstrate the company's interest in nurturing entrepreneurial solutions aligned with its strategic objectives. Similarly, Medtronic's venture arm has effectively made strategic investments in a diverse array of early-stage businesses, with Axonics as a notable example. Axonics' recent (January 2023) FDA approval for its fourth-generation rechargeable sacral neuromodulation system serves as a testament to the success that can arise from such collaborative endeavours.
 
Traditional MedTech companies can take valuable lessons from industry giants such as J&J and Medtronic, especially in establishing their own venture funds to invest in a range of start-ups. This strategic manoeuvre not only provides these companies access to cutting-edge technologies and disruptive innovations that might outstrip their internal development capacities but also allows them to diversify their product portfolio and helps mitigate risks associated with reliance on a narrow range of offerings.
 
Entrepreneurial ventures often boast agility, enabling them to swiftly bring products to market, surmount bureaucratic hurdles that larger corporations may face, cultivate a culture centred on innovation within their organisations, and inspire employees to explore fresh ideas and collaborate with external partners. However, this can only be achieved if the MedTech market offers realistic opportunities.
 
The MedTech Start-up Market

We have argued that the MedTech start-up market holds potential for traditional companies seeking to revitalise their portfolios to maintain and increase their competitiveness. However, what are the realities of this market? Recent studies shed light on its trends and opportunities, and from these, we can judge whether such investments strategies are a viable option for mature MedTechs.

A 2017 study by the Deloitte Center for Health Solutions and AdvaMed Accel suggested that venture capital investments in early-stage MedTechs were slowing because alongside lacklustre returns, investors showed reluctance towards unproven technologies, and were deterred by regulatory and reimbursement obstacles. However, findings of a similar study repeated in 2021 paint a more promising picture. Since 2017 and the onset of the Covid-19 pandemic in 2020, venture financing in early stage MedTechs surged by ~67%, suggesting a renewed investor confidence. Notably, the bulk of investments were towards late-stage diagnostic and digital companies, highlighting a shift in investor priorities towards more mature ventures. Furthermore, alternative financing avenues such as public markets and family offices have emerged as viable options, opening new pathways for entrepreneurial endeavours. Notwithstanding, amidst this surge, seed, and Series A funding continued to decline, which poses difficulties for fledgling MedTech entities.

For traditional MedTech companies contending with aging legacy products in slow-moving markets, bridging the funding gap presents an opportunity to enhance their growth prospects and strengthen their competitive position. As we have asserted, beyond financial backing, start-ups often seek guidance on regulatory navigation, clinical studies, intellectual property, and reimbursement procedures. Leveraging their wealth of experience and established networks, large firms are ideally situated to provide such valuable insights and support to emerging ventures. 
 
Takeaways

By strategically committing to a diverse range of start-ups, traditional firms bolster their capacity to navigate the complexities of the technology ecosystem. This proactive stance not only positions enterprises to shape the future of healthcare but also augments their prospects for sustained growth and competitiveness in an industry experiencing rapid evolution.
 
Collaborating with emerging businesses at the forefront of technological development empowers large corporations to respond adeptly to market dynamics and drive progress. Such strategic engagement reinforces their relevance in the market, fosters a culture of cooperation and improvement across the healthcare continuum, strengthens traditional enterprises' competitive edge and ensures their long-term viability.
 
The entrepreneurial spirit inherent in start-ups can rejuvenate the development pipelines of traditional MedTechs, enhancing their decision-making and cultivating an environment of creativity conducive to growth. Establishing a fund to invest in start-ups helps to reduce risk and maximise returns, thus protecting corporations against potential disruptions. Adaptation is crucial for survival, and the approach outlined in this Commentary provides traditional companies reliant on legacy offerings with an opportunity to adapt and thrive, reaffirming their relevance in an era characterised by constant change.

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