French health IT developer Doctolib has unveiled plans to invest €92M this year on ‘innovation’. It is another statement of intent from a company which has, in just a few years, become a household name to hundreds of thousands of GPs, and millions of patients, in its home country.
According to the company, the investment will focus on developing solutions and strategies around seven key themes. This includes a tool to help tackle the problem of missed appointments for patients with chronic conditions, and new software allowing it to serve new healthcare specialisms.
The Signify View
Given Doctolib’s accomplishments over the last few years – making the transition from start-up to unicorn in less than a decade – it would be hard to bet against its 2023 plans paying handsome dividends.
Doctolib has a solid business model predicated on a deep (and loyal) customer base, and the skills to keep developing solutions which meet the evolving needs of that customer base. Selling new solutions to a converted audience should be relatively straightforward.
Aside from the benefits to its customers and their patients, the €92M investment will have two main impacts on Doctolib: fuel its inroads into French primary care EHR, and reignite plans for overseas expansion, one strategy where the company has yet to truly excel.
Doctolib Diaries: From Start– Up to Unicorn
Doctolib embarks on its 2023 plans in very good shape. Having established itself as a GP booking management system platform in France (where GPs pay a ‘subscription’ to be listed on the app), it acquired chief competitor, Mon Docteur, in 2018, and Doctolib became the undisputed market leader.
Twenty nineteen proved even more momentous. With a $150M cash injection, and using its booking management system as a springboard, it launched a new telehealth service, offering patients the option to book and hold virtual appointments with a GP for the first time. Doctors paid a premium (over and above the regular booking management system subscription) to accept virtual consultations.
The launch was timed to take advantage of new French government rules enabling GPs to be reimbursed for video consultations for the first time. The move proved popular among Doctolib’s customer base, and then became essential just months later as France entered Covid lockdowns. For many GPs and patients, Doctolib became a major logistical tool during the pandemic (including booking Covid vaccinations).
As of the end of 2022, Doctolib held more than half of the French booking management system market, with a solid, if unspectacular, presence in Germany and Italy. Overall, 320,000 healthcare workers were using Doctolib solutions by year-end, the app receiving 70 million patient visits every month.
$92M Shopping Spree
Doctolib unveiled its headline spending plans in the media announcement at the beginning of February. A key focus will be developing tools to help providers reduce the number of missed appointments for chronic care patients, and plug any care gaps. This will involve AI automating reminders and giving providers intelligence on how, and when, to reach patients. As the concept of value-based care and more proactive healthcare gains traction in France, such innovation will come into its own.
There is an opportunity here for Doctolib to also support wider population health management programmes in France. These are receiving significant investment at present in the form of government funding for schemes such as Ma Santé 2022 (€3.4B in funding), and the CPTSs (territorial professional health communities) organisations being set up would benefit from a sophisticated patient outreach solution.
The media announcement also revealed that Doctolib will expand its software portfolio to serve new specialities. The company has cornered the GP space, and is gaining share in primary care EHR (more on that later), but there are many other areas where it is still absent, including CPTSs, which offer preventative care. The company launched a solution for physiotherapists last year, but there are myriad other specialities in France, some with high numbers of practitioners, that remain relatively untapped.
Potential to Disrupt
One of the by-products of Doctolib’s investment plans will be market disruption in primary care EHR, in which Doctolib currently holds a 4% share, and is making steady progress (3% share in November 2022). Shrewd investment could see Doctolib start to challenge the leading vendors, CGM and Cegedim. The 2021 launch of Doctolib Medecin, its primary care EHR, supports its ambitions here, throwing down the gauntlet to a rather moribund French EHR ecosystem which typically lacks investment, ideas, functionality and sophistication. Doctolib’s large and loyal customer base of GPs would presumably welcome a new, SaaS-based, competitively-priced EHR to use for billing, its main use in fee-for-service France.
Neither CGM nor Cegedim (or the others in the long list of French primary care EHR vendors) will relinquish their positions to Doctolib easily. Both are large companies (CGM is a €1BN a year company, and Cegedim +€500M) with deep pockets to invest in companies, platforms and technology to ward off challenges.
Growing Pains
Geographical expansion is another area where Doctolib harbours ambitions, but has yet to find the key to properly unlock them (unlike European rival Livi). Beyond France, it has business only in Germany and Italy, where unseating established booking management system and telehealth vendors is hard. In EHR too, Doctolib is up against CGM (Germany) and Dedalus (Italy) should it decide to launch a primary care EHR solution in these countries. In any case, Doctolib’s EHR journey has only just begun in France, and it might want to focus on growing that business before spreading its wings.
The US, however, will always be an option for Doctolib. With the largest EHR, virtual care and booking management system market globally, it would offer a disruptive company like Doctolib new opportunities. However, competition is intense, with large, innovative vendors such as AmWell, Teladoc Health, Epic and Oracle Cerner dominating. In all three of these applications all providers and insurers already have a solution in place and replacement of entrenched vendors (particularly in relation to EHR) would be a major challenge. An acquisition or tight partnership would be the only route.
Big Picture
The company’s 2023 plans offer little insight into the company’s longer-term aims. It has historically attracted a lot of investment, so could an IPO be on the cards? Could it be a take-over target?
Doctolib would be attractive to a big US international health IT vendor with eyes on Europe. Teladoc has form here, buying large French telehealth company, MédecinDirect in 2018. AmWell has also been acquisitive in terms of international expansion over recent years. Both companies also acquired (InTouch Health and Avizia respectively) to move into higher acuity settings, something Doctolib has yet to do.
Consolidation of the highly fragmented European virtual care market is also forecast over the coming years. Growth for leading vendors in each country is likely to come from acquisition. However, on that front Doctolib is more likely the acquirer rather than target for acquisition. That said the European EHR market is slowly consolidating, and Dedalus and CGM have both acquired rapidly over recent years to expand their international footprint and cement their position in their core markets. Doctolib would be a potentially attractive acquisition, removing a competitor and enhancing their local market shares simultaneously.
Higher acuity might be a way to go for Doctolib, and its plans to expand into more specialisations in 2023 is one way. It may also want to carve a position in remote patient monitoring and chronic condition management, given that France is planning to implement an RPM reimbursement structure (it was supposed to happen last year).
Fleet-footed
Whatever its path, Doctolib has proved nimble and adept at driving growth. The company will now pour resources into building a competitive position in primary care EHR, and with new solutions in its portfolio, it may finally be able to crack the code of success beyond France.