Healthtech

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Introduction

Healthtech is the fifth biggest VC investment category after fintech, energy, transportation, and biotech & pharma (which are separate from Healthtech).

In 2022, $42 billion in venture capital was invested in Healthtech companies globally.

Healthtech encompasses software-driven tech for patients (direct-to-consumer), tech for healthcare providers, (professionals, hospitals) and tech for biotech and pharma.

These are distinct categories from biotech and pharma which deal with atoms (leveraging biology and chemistry respectively) rather than bits. That said, Biotech, pharma and Healthtech are increasingly overlapping.

Combined, healthtech, pharma and biotech are the biggest VC investment category, ahead of fintech, with $85.8 billion invested in 2022. This leading position can be explained by the massive size of the healthcare and biopharma industries.

Total venture capital in health, biotech and pharma peaked at $116B in 2021 up from $30B in 2015. This was in part driven by pandemic innovation, coinciding with and a surge in overall venture capital deployment.

While Healthtech investment fell in 2022 compared to 2021, early and mid-stage investment remained largely unchanged.

Late-stage megaround of over $100M were most affected by a global pullback in venture capital.

$8 trillion market

Rising costs

Global healthcare expenditure was around $8 trillion ($2 trillion in Europe and $3.5 trillion in the US) in 2020. It is projected to grow by 5%+ per year (faster than the overall economy).

Structural trends are driving healthcare costs upwards: an aging population, chronic diseases (incl obesity), and rising drug development costs. As standards of living rise, healthcare expenditures only rise further.

Yet, higher expenditure does not equal better access. In the US, the country with by far the highest per capita healthcare expenditure, some households are driven into poverty by healthcare costs.

Providers vs. Payers

Healthcare is a complex ecosystem of multiple stakeholders and vested interests. Each stakeholder has their own set of goals & incentives, which are not necessarily aligned.

Sources of funds (payers)

  • Consumers want better, affordable healthcare and expect to interact with it more like other products.
  • Governments, insurers and employers want to control costs and improve outcomes. To achieve this, they need data transparency to follow the patient journey, have predictability and be able to measure the ROI of interventions.

Uses of funds 

  • Biotech and pharma want to find treatments for large markets and bring down the risk and cost of discovering new drugs.
  • Hospitals and other providers want to align themselves more closely with payers.
  • Professionals want to increase their productivity and reduce burnout due to admin.

Role of consumers

For households, healthcare is one of the largest spending categories (after rent/mortgage payments). But almost all spending is indirect, paid via government schemes and compulsory health insurance.

Out-of-pocket payments and voluntary insurance account for less than 20% of healthcare expenditure in most developed countries. It’s 10% in the US and 15–20% in most of Europe. As a result, consumers have historically had limited incentives and influence.

However, consumer influence is rising, as out-of-pocket payments are increasing as a share of the total funding mix. On top of that, consumers expect healthcare to become digitized, following in the footsteps of shopping, banking, and entertainment.

Another major bottleneck for consumer empowerment is the lack of data interoperability. Sharing health data has its technical, ethical, and regulatory considerations. But it allows for more coordinated and personalized care along the patient journey – even if it involves multiple different providers across different locations.

It also empowers consumers to compare different providers for things like surgeries and imaging.

The United States has been leading the shift toward patient empowerment and accessibility via data interoperability rules (e.g. 21st Century Cures Act and additional final rules). Other countries making strides include Estonia (X-Road), Finland (Kanta), and the UK (the NHS App).

In Asia, countries such as Singapore, Japan, and South Korea have implemented various nationwide electronic health record systems.

Australia has implemented My Health Record.

Private insurers and employers

In the US, a big role is played by employers. They want to control their private insurance premiums. Startups can go to market by striking deals with corporates, even with a product that does not yet have clinical evidence. For example, Omada Health, a digital platform for diabetes prevention, has struck deals with names like Walmart, despite not having strong clinical evidence for their product at the time.

Other examples include Livongo, Hims and Virta Health. Employees who use these platforms are either fully or partially reimbursed or receive a reward (e.g. Walmart offering a $25 gift card to employees who complete Omada Health's diabetes prevention program).

In most European countries, a mix of government and private providers of compulsory insurance has most of the power. They want to control costs, but coordination is required to get things done using a combination of regulatory frameworks, market incentives, and collaborative initiatives.

This means a significant time between when a technology is accepted by regulators, when it is adopted in the healthcare system and when innovators are able to generate revenue. In the UK (NHS), Nordic countries, and Spain (SNS), the state is the provider of healthcare (in Sweden, it is mostly run by county councils).

This means these healthcare systems can be progressive if they want to.

In Asia, including China, the healthcare system tends to be a mix of public and private providers.

The government plays a significant role in regulating the healthcare sector and providing financial support.

Healthcare providers

Spending goes to pharma, hospitals, and physicians. On the one hand, healthcare providers operate at the bleeding edge of tech (gene editing and AI-powered surgical robots, …), while other corners are surprisingly low-tech: 70% of American hospitals still fax and post patient records, a blocker for data interoperability.

These providers are often beholden to legacy reimbursement systems and complex regulations, which can make them slow to adopt change.

IT spending is roughly $200–300 billion globally, based on Gartner’s estimate of 3.9% of sales in healthcare and 3.3% of sales in pharma & medical. Another report estimates $208 billion in 2019, growing to $280 billion by 2021. This includes spending on legacy IT systems.

Another helpful McKinsey report talks about three layers in healthcare on which the future of healthcare will be built: engagement, infrastructure and intelligence layers. In our initiating report we’ve mapped Dealroom data against McKinsey’s conceptual framework. 

The future of healthcare

Technology can help make healthcare proactive, scalable, personalized, value-based and sustainable. Health tech companies are enablers for multiple or all of these goals, directly or indirectly.  

Proactive

Prevention is key to lower healthcare spending, given that much of it goes to predictable, preventable diseases. Chronic diseases such as heart disease, cancer, and diabetes account for 75% of all healthcare spending in the US.

Many chronic diseases are preventable through lifestyle changes such as healthy eating and exercise. A Deloitte report projects a vision for healthcare shifting from care and treatment dominated (83%) to well-being & prevention dominated (63%).

If the ultimate goal of healthcare is improving the length and quality of life, it’s pertinent to look beyond clinical care alone. Studies point to healthcare being only a 10-20% contributing factor to health outcomes (quality and length of life). Of greater impact are socioeconomic factors (employment, social care, education, neighbourhood) and health behaviours (smoking, diet & exercise, alcohol & drugs, sexual activity). The physical environment also matters. Technology plays a role in all four contributing factors (take Edtech for example).

Stimulating lifestyle changes is one way of proactive healthcare. Some startups taking this approach include Oviva, Noom, Kaia Health, BetterHelp (acquired by Teladoc), MySugr (acquired by Roche), Cure.fit, Omada Health.

Early detection via continuous monitoring and AI is another approach to proactive healthcare. Some startups taking this approach include Biofourmis, K Health, Current Health (acquired by Best Buy), Viz.ai, and Zebra Medical Vision (acquired by Nanox).

Connectivity, continuous monitoring and AI are game changers for prevention, proactive care, and recovery. All of high interest to patients, insurance and financing. 

“Digital can bend the cost curve, making healthcare affordable to more”, says Klaus Mitterer, CFO of Oviva.

Scalable

Traditional healthcare isn’t scalable, creating friction both on the provider (supply) side and patient (demand) side. 

Patients encounter long waiting lists, or treatment is completely out of reach. Scalability can be achieved by decentralized care, which means patient empowerment through self-care, home care, and tests. “Despite spending trillions of dollars each year, half the world’s population has no access to healthcare, whilst 100 million people are driven into poverty from the fees. We need to use technology to care for far, far more people than we do at the moment.” – Ali Parsa, Founder & CEO of Babylon

Meanwhile, healthcare professionals suffer from stress and are at high risk of burnout. The global health workforce shortage is estimated to be 15 million health workers in 2020. According to Medscape, burnout rates are dramatically increasing: 53% of physicians showed signs of burnout when assessed in 2023, up from 47% in 2021, and a jump of 26% since 2018. Employee turnover and unforced medical errors are on the rise. Health care shortages are the main cause behind raising levels of stress. Bureaucratic tasks and admin burden are by far the main driver of burnout. 

Technology-driven solutions to this are covered in the section on Tech for Providers. 

Personalized

Personalized healthcare happens at both the molecular level, with personalized medicine and gene editing and at the systems levels (personalization through software).

With personalized/precision medicine, genetic testing and other diagnostics are used to identify specific genes or proteins causing a patient's disease. This can then be used to tailor the treatment. The cost of gene testing has been rapidly decreasing, by ±100x in the last two decades, from $100,000 to less than $,1000 and actually some providers are offering it today for $200. Gene testing companies like Color, discussed further down, make testing widely available and contribute to the rise of precision care.

Gene editing aims to modify or correct genetic information. This involves making targeted changes to an organism's DNA using molecular tools, such as CRISPR-Cas9 (currently the most widely used gene editing technique). CAR T-cell therapy uses gene editing techniques to modify a patient's T cells to recognize and attack cancer cells. 

At the systems level, treatments can be designed and optimization by making use of continuous monitoring and companion apps, delivering digital therapeutics, such as Kaia Health, Ada Health and designing individual treatments with AI, such as Healx.

According to Precedence Research, the global precision medicine market size reached $66 billion in 2021 and is expected to reach $176 billion by 2030.

Value-based

In the US, wasteful spending has been estimated to be around 25–30%, with the biggest waste category being unnecessary care and excessive admin. In Europe, waste is similarly estimated at 20–40%. The real opportunity goes beyond waste, even.

Instead of paying providers based on the volume of services provided, value-based care rewards providers for achieving positive patient outcomes while reducing costs. Value-based care has been on a rapid rise in the US.

According to the OECD, value-based healthcare is gaining traction across Europe, with Denmark, the Netherlands, and Sweden at the forefront. However, the adoption of value-based care in Europe is still relatively low compared to the United States.

“Payers will start investing more in things that allow them to control the patient journey and gain predictability in how their care is delivered. Meanwhile, providers will more closely align with payers.”, says Robbie Hughes, Founder & CEO of Lumeon.

EIT Health has written a helpful report about value-based care in Europe: Implementing Value-Based Health Care in Europe: Handbook for Pioneers (Director: Gregory Katz), 2020.

Sustainable

The Future Health Index 2021 report found that just 4% of healthcare leaders saw implementing sustainability practices as a priority. This year's findings suggest that healthcare leaders have fast-tracked their sustainability plans. Almost one-quarter (24%) prioritize sustainability, and the same number plan to do so three years from now.

Hospitals in the United States generate approximately 6,600 tons of waste per day, according to the EPA. That’s roughly half the waste generated by New York City.

According to the World Economic Forum, health systems account for over 4% of global CO2 emissions. For most industrialized nations, that figure is closer to 10% of national emissions. Regarding climate impact of healthcare, the WEF has urged that “It is time to extend the principle of “first, do no harm” – the very foundation of healthcare – to the planet.”

Looking beyond carbon, the industry has to make strides on several other aspects from material waste (plastic waste, etc) to persistence, bioaccumulation and toxicity of drugs and much more.

Healthtech segments

AI drug discovery has become the biggest category. Digital therapeutics has been the fastest-growing segment in Healthtech since 2017. Check out this heatmap.

Digital care

Digital care refers to the use of technology to provide healthcare services remotely.  This can include a wide range of tools and services, such as telemedicine, remote patient monitoring, mobile health apps, and virtual reality therapy. Increasingly, startups provide these in combination.

Telemedicine specifically refers to the use of telecom technology to provide clinical services, such as video consultations with a doctor or nurse practitioner. This is where most of the digital care venture capital has been invested so far, peaking at almost $6 billion in 2021. 

Some digital care companies have launched as direct-to-consumer platforms using AI and even their own doctors (Babylon, Kry) while others have launched tools for doctors first, and added telemedicine marketplaces as add-on (Docplanner, Doctolib).

Mental health overlaps with both digital care and remote monitoring, and has become a big category on its own (Calm, Headspace). Landscape: 180+ Mental Health startups

Other direct-to-consumer categories include digital pharmacies and digital health. Pharmacies are not typically looked at as Healthtech. But it’s a big space (±$70B in combined enterprise value, including GoodRx, JD Health, Shop Apotheke, Pillpack) and an important consumer engagement layer, of strategic importance (hence Amazon’s acquisition of Pillpack). Digital insurance such as Alan, Wefox, Oscar, Clover Health are worth ±$65B in combined enterprise value, and this excludes Pet health and insurance startups like Manypets, which are not considered health insurance. Other startups are creating a one-stop-shop for health, such as Hims.

Remote monitoring

Remote monitoring is closely related with Digital Care and sometimes overlapping. 

$6.3 billion has been invested between 2018 and 2022.Remote monitoring can have many objectives, including:

Landscape: 60+ Remote Monitoring startups 

Testing

$13.4 billion has been invested between 2018 and 2022. Testing can be referring to the following areas: 

  • DNA testing: information about an individual's ancestry, genetic traits, and predisposition to certain diseases such as 23andMe, AncestryDNA, MyHeritage, and Color Genomics. Color Genomics is a physician-ordered service. The other examples are direct-to-consumer.
  • Cancer screening: detect cancer in its early stages. Examples include Grail, Freenome, and Guardant Health. Grail's Galleri blood test is a healthcare provider-ordered test.
  • Infectious disease testing: infectious diseases such as COVID-19 and other illnesses. Examples include Karius and Cue. Karius offers a healthcare provider-ordered blood test that can identify more than 1,000 pathogens without the need for invasive procedures such as biopsies
  • Total health testing. Examples include Q Bio, InsideTracker, and Health Nucleus. Q Bio offers a full-body scan, genetic testing, blood tests, and other assessments.

List: 100 DNA startups to watch

Digital therapeutics

Rather than taking a pill or an injection, Digital therapeutics (DTx) are software-based medical interventions designed to directly treat disease. These are tested for safety and efficacy in clinical trials, evaluated by regulatory bodies, and prescribed by healthcare providers.

Dtx is another example where Healthtech companies increasingly share characteristics with Biotech - both undergo clinical validation in a randomized controlled trial, they must demonstrate efficacy in a rigorous way that is accepted by the ecosystem.

DTx are gradually finding their place in the healthcare ecosystem as regulation and reimbursement models take shape, together with the rising engagement and adoption by physicians and patients. Digital therapeutics has been the fastest-growing segment in healthtech since 2017.

Report: Digital Therapeutics: Beyond the Pill.

Tech for providers

Making healthcare more scalable is key for both consumers and providers. A new generation of tools is emerging which can be used to help ease the burden on maxed-out medical doctors.  We identified 8 segments supporting physicians and hospitals in a recent report.

  • Front and Back Office Tools: supporting clinical and administrative staff with reporting, document management, communication, appointments management and payments. This includes: doctor’s assistance voices (Corti), communication tools (Accurx), practice management software (Medloop, Aledade, Athelas), automated consultation preparation (Bingli).
  • ​​Clinical Decision Support: evidence-based software using predictive analytics, AI, and ML, that help physicians  in providing the highest quality of care while reducing the risk of errors. Under this category there are smart triage software (Healthplus.ai), clinical workflow solutions (Infermedica), clinical data management (Medloop), automated prescription solutions (Synapse), advanced diagnosis tools (PathAI).
  • Treatment Assistance: software and hardware systems that drive improved patient outcomes through enhanced care delivery such as robotic rehabilitation (On the Mend)and surgical robotics (CMR Surgical).
  • Training & Development: tools that help healthcare professionals acquire the knowledge, skills, and competencies to effectively do their jobs. This includes cognitive simulators for surgical training (Invention Med) and medical learning solutions and platforms (Amboss).
  • Health Staffing: software tools that help healthcare facilities to manage the hiring, scheduling, and tracking of medical personnel. For example: Altrix Technology, Colivia, MyCareforce and Mediflash.
  • Data analytics & Real World Evidence: Real-world data (RWD) are observational data generated in a routine clinical practice, in a natural, uncontrolled setting – outside of conventional clinical trials. Transforming these RWD into meaningful evidence is called Real-World Evidence. Startups playing in this space include Signify Health (acquired by CVS Health), LynxCare, Flatiron Health, InnovaAccer, and PathAI.

Report on Physician tools.

Landscape: 350+ startups offering solutions for hospitals and medical professionals.

Tech for pharma and biotech

Tech for pharma and biotech refers to companies that provide software-driven solutions to accelerate and streamline the drug discovery and development process. A major category within this field is AI for drug discovery, which can be segmented across the drug development value chain, including:

  1. Initial research: startups that use AI to aggregate and synthesize information from biomedical publications, such as iris.ai, biorelate, and causaly
  2. Virtual screening: startups that use machine learning algorithms to predict how drug molecules will interact with target proteins in the body, thus identifying potential drug candidates more efficiently. Examples include Envisagenics, Atomwise, Insilico Medicine, and Numerate.
  3. Predictive modeling: startups that use machine learning to develop models that predict the safety and efficacy of drugs based on preclinical and clinical data. This can help researchers identify potential safety issues or predict which patients are most likely to benefit from a particular drug. Examples include Recursion Pharmaceuticals, Benevolent AI, and Cloud Pharmaceuticals.
  4. Drug repurposing: startups that use AI to identify new uses for existing drugs by analyzing large datasets of drug and disease information. Examples include Healx, Biovista, and Altoida
  5. De novo drug design: startups that use AI to design new drug molecules from scratch by generating millions of possible drug candidates and predicting their properties using machine learning. Examples include XtalPi, Insilico Medicine, Deepmind/AlphaFold, and Exscientia.

Other categories of tech for pharma and biotech include:

  1. Patient recruitment: Antidote, Clinerion, and TriNetX.
  2. Clinical trial management: software to help biotech and pharma companies manage clinical trials more efficiently. Examples include Veeva Systems, Medidata, and TrialSpark
  3. Drug delivery: innovative technologies, such as nanotechnology, to improve the efficacy and safety of drugs. Examples include BIND Therapeutics, Ensysce Biosciences
  4. Real World Evidence such as Flatiron Health

Covered earlier but also relevant here:

  • Digital therapeutics (covered earlier)
  • Precision medicine: apply AI on genomic data and other molecular data to develop targeted therapies for specific patient populations. Examples include Niramai, Nebula Genomics, and Tempus

This landscape helps you discover 100+ AI-based solutions making drug discovery faster and more effective.

Tech-first biotech and pharma

Biotech and pharma have traditionally been an ecosystem completely separate from Healthtech. Healthtech sells software (bits). Biotech and pharma sell a physical, biochemical formulation (atoms). They have different growth/risk profiles, regulatory paths, different talent pools and, therefore, two different investor groups – traditionally at least.

The use of tech is rapidly advancing in the pharma and biotech industry. As a result the line is blurring between a software company selling to pharma and biotech and a software company actually replacing an entire function. This is called techbio.

“In the past, IBM, Oracle or Microsoft sold technology to other companies, as a tool. They sold computers and software to GE, P&G and Citibank. Now there’s a generation of companies that both create software and use it themselves to enter another industry, and often to change it. Uber and Airbnb don’t sell software to taxi companies and hotel companies, Instacart doesn’t sell software to grocery companies, and Transferwise doesn’t sell software to banks.” – Ben Evans, on his blog, Outgrowing software

The term techbio includes AI for biotech, but goes beyond that and represents one big “tent” that includes pure biotech companies with a strong technical competency enabling them to act as a scalable platform. Examples of techbio categories include:

CRISPR/Cas9 uses biology to edit genes by cutting DNA and then letting natural DNA repair processes take over. Companies such as CRISPR, Editas, Beam, Intellia, Mammoth, and eGenesis are at the forefront of this rapidly developing field. 

CAR T-cell therapy and TCR therapy genetically modify T-cells to enhance their anti-tumour activity. CAR T-cell therapy companies include Kite (acquired by Gilead), Cellectis and Oxford Biomedica. TCR therapy companies include Adaptimmune, Immatics, TScan, and Atreca

Regenerative Medicine: startups that use stem cells and other cellular therapies to regenerate damaged tissues and organs. Examples include BlueRock Therapeutics, ViaCyte, and Celularity.

mRNA: companies such as Moderna and BioNTech use this approach to develop vaccines, gene therapies, and more.

Microbiome therapies leverage the microbiome to treat inflammatory bowel disease, cancer, and metabolic disorders. Companies include Seres Therapeutics, Vedanta Biosciences, and Second Genome.

Synthetic biology combines biology, engineering, and computer science to design and build new biological systems or modify existing ones. It involves gene editing, genome synthesis, and metabolic engineering to create new organisms, biological devices, and biochemical pathways that can be used for various applications, such as drug discovery, biomanufacturing, and environmental remediation. Examples include Ginkgo Bioworks, Twist Bioscience, Synthace, GenScript Biotech, eGenesis, Biomica, and Asimov.

Venture capital

By stage

Venture capital investment into healthtech startups has been on a long run upwards for more than a decade, accelerated further by the pandemic. From 2022, as global venture capital investment has slowed, the levels of funding of early, mid and late-stage startups has noticeably diverged. Early-stage healthtech investment - pre-Seed to Series A rounds - continued to grow in 2022. Investment from rounds up to $15M was up 12% year on year. Mid-stage rounds meanwhile were down 10%. And megarounds of over $100M almost halved.

Early stage

Early stage investment into Healthtech startups shows a steady increase in investment amounts over the past 5 years. However, figures will likely rise slightly due to some reporting lag on smaller rounds.

Breakout stage

Breakout-stage healthtech funding grew 3x from 2016 to 2021. A record setting $7.2B was raised in this category in Q2 2022 with a cool down period witnessed afterwards.

Scaleup stage

Late stage healthtech funding spiked in 2021 with over $35B in funding, a seven-time increase from 2017. Late-stage pulled back the most (the rebound in Q1 2021. The continuing downward trend for late-stage rounds is even more apparent when looking on a quarterly basis.

By geography

The US, China and the UK are the leading countries in both Healthtech and Biotech & Pharma funding globally. In all three geographies, the balance of funding is pretty balanced, while some geographies skew a little more one way than the other. Switzerland and the Netherlands lean a little toward biotech & pharma, while Brazil and Finland lean towards Healthtech.

The trend is even more pronounced when looking by city. Some cities lean more towards healthtech (Delhi), and some are specialized in biotech & pharma (Basel). Others rank highly for both when looking at VC funding. Such hubs could be well-positioned to capitalize on the convergence of software with biotech & pharma.

Patents

Beyond venture capital, patent filings, what they're being filed in and where, and give insight into frontier innovation.

Fastest-growing life science subclasses

Top life science hubs

And combining both venture capital and life science patent info can surface some geographies where innovation is happening, but where it is perhaps still underfunded.

Health VC investment vs. Life Science Patents per Hub

Corporate innovators

Of course innovation doesn't just happen at startups. Some of the biggest health and pharma companies are continuously innovating areas including surgical robotics, immumogenics, stem cells and molecular oncology.

Universities

Many healthtech emerge from leading Universities and Research Institutions. In Europe for example, we have identified over 400+ Life sciences and Healthtech spinouts, with their entrepreneurial roots in academia.

Top investors

Explore the most prolific venture capital investors into Healthtech startups. Filter by typical first round stage by clicking on the labels below.