By Kunal Kadiwar, Director, Results Healthcare
The private equity community’s interest in healthcare has been moulded by its perception of it being an evergreen industry that is resistant to economic cycles and driven by underlying fundamentals and undeniable long-term trends.
The fact is that we are living longer with a growing ageing population, there is an increasing prevalence of chronic diseases due to lifestyle changes and pollution; and populations are getting wealthier and wanting to use their disposable incomes to get access to the best treatments.
As long as our bodies continue to endure sickness and fail, there will always be a need to continue innovating to find better solutions. Regardless of economic and regulatory pressures, there is an opportunity for the industry to continue furthering revenues through the discovery of new treatments or devices that physicians and patients find valuable. Encouraged by this logic and coupled with the low interest rates and buoyant fundraising environment, private equity funds have been drawn to healthcare.
Particularly in periods of economic disparity, investors have turned to healthcare somewhat in the same way that they have turned to precious metals or defensive industries. If one looks at the performing funds in the ten-year period following the financial crisis of 2008, the best performing specialist funds were those that exclusively invested in the biotech and healthcare sector. Since 1994, the MSCI World Pharma, Biotech and Life Science fund has returned an annualised return of 10.8% when compared to the wider MSCI World Index delivering 7.5%. However, one cannot overlook the inherently high volatility that these stocks bring,as they are highly sensitive to drug development attrition rates, pricing pressures, and regulatory hurdles.
From an M&A perspective the last five years has witnessed incredible activity. Healthcare deal value surged in 2017 reaching US$332 billion, nearing the record levels seen a few years earlier. Private equity M&A healthcare activity is a similar story; we observed record highs in 2017 with 265 deals announced at US$43 billion, a year-on-year increase of 17% and 29%, respectively. Even, with valuations reaching an all-time highsome believe that we will continue at this level of M&A activity,at least in the short term.
One of the reasons for the high valuation is that competition has become crowded. Healthcare private equity buyout funds now face competition not just from strategic buyers but also new categories of players that have entered the scene; these include generalist private equity investors, pension funds, sovereign wealth funds and family offices. A recent study by the Boston Consulting Group showed that healthcare makes up 13%of sovereign wealth fund portfolios with 54 deals in 2017 – that’s a five-fold increase from 2012.
Despite this general trend, McKinsey believe that there is still scope for further private equity to penetrate the healthcare market, particularly in Europe where healthcare has lagged behind some other sector groups. European private equity’s healthcare investment is on average only 8% of asset under management, which is comparably lower than other industries of a similar size such as consumer and business services which are at 18% and 14%, respectively. They have cited several reasons for this subdued participation.
Many of the leading mid-market healthcare companies are privately owned and have favoured growing in their local and specialised markets, and therefore can be susceptible to slipping under the radar. Sometimes this lack of access can be highlighted by absence of dedicated healthcare teams that have the local and sub-sector expertise. The healthcare representation amongst the private equity community certainly evolved over the past decades when there were only a handful of dedicated teams. However, healthcare is a complex ecosystem that is constantly changing, and you need people who are comfortable that they understand the dynamics and underlying science to be able to invest. The scarcity of accessible and attractively priced assets has meant that when they do become available, the competition has generally been with other private equity firms. Despite the broader competition, two thirds of the private equity assets acquired above €200m have been sourced from other private equity investors. Where strategic investors are involved in the process they have shown a willingness to overpay to complete their offering, differentiate their value proposition or solidify customer relationships. In an industry where the underlying fundamentals are based on intellectual property, building something yourself is not always an option.
Results Healthcare has seen in latest research that mid-market private equity funds have increasing interest in the sector, as they believe it will fare well throughout Brexit and offers ample opportunities for quickly building value. In deals over the past five years, private equity firms have paid an average of 11.9x EBITDA for healthcare companies and assets, compared to the European average of 9.5x across all sectors.
The dynamics are changing, and we are finding that private equity is increasingly proving that it does have the sector understanding and confidence to outbid strategic players. Funds are taking a greater risk appetite to find broader ways of deploying capital, including assets which come with high exposure to re-imbursement risk. For example, in 2017 we witnessed funds take new positions in branded and generic pharmaceuticals, investing directly in research and development; areas traditionally seen as unchartered territory by regional buyout funds.
Beyond the bottom line: why brands must show they care to connect with customers
By Vadim Grigoryan, Partner, Lunu
Over the past few years, we’ve witnessed an ever-growing activism among consumers, with public opinion demanding that their concerns be heard and addressed. No industry has experienced this more than the retail sector, with brands regularly slammed by NGS or consumer-led initiatives for violating legal requirements or moral principles. Moving one step further in the experience economy, brands are not only required to provide a first-rate customer experience, but also a conscience. The product must be good quality, as should the experience of purchasing it. But now on top of that, consumers should feel positive about where they’re spending their money. This is particularly true in the crypto community, with cryptocurrencies regularly pointed out as too speculative as a product, or to energy-intensive. Is this really a surprise coming from a generation whose top concerns are collective ones such as the environment and global warming? The answer is a straight no! Brands have to face this new reality and embrace it accordingly.
This next step in the experience economy, that can be called conscious consumerism, provides an opportunity for brands to reinvent themselves and bring to the top of their agenda something that has so long been kept at the bottom, or on the side. Brands need to stand for something bigger than themselves. If they fail to do so, they will also fail to make an impact in the consumer’s mind, ultimately disappearing as a brand altogether.
- From the experience to the conscious consumerism. Today’s economy is as much about giving people the opportunity to feel good while purchasing the product or service, as it is about the feeling after the purchase. Environmental, social, and moral concerns are increasingly at the top of consumers’ minds and on the front pages. Brands need to realise this and adapt, but also accept this as an opportunity rather than a constraint. Profitability isn’t the number one priority anymore and they now have the chance to fully develop their CSR programmes without facing many of the internal/external constraints they would traditionally have faced.
- Having a meaning actually means something. Modern brands have to stand for something and if they do, they will also stand out in the consumer’s mind. Your brand won’t just be a jewellery maker anymore – it will be one that aims to make diamonds cleanly and ethically by creating them in a lab instead of digging them out from thousands of meters below the ground. Standing for something will also give you a voice and help you break through the noise, reaching out to ever more consumers.
- Having a purpose provides a valid reason to exist. By this we mean existing in the customer’s mind, as well as in stores and shops – because the truth is, both are now linked. To truly connect with your customers, brands need to go beyond their bottom line. They also need to show that this bottom line serves a purpose and isn’t a finality. Don’t be scared to embrace a cause if you want to keep a place in consumers’ hearts and minds.
The largest event in e-commerce history? ‘Tis the season
By James Booth, VP Head of Partnerships for EMEA, at PPRO
Sometimes, change happens slowly. Other times it chases you down like that boulder at the beginning of Indiana Jones. In 2020, change is fully in boulder mode. And the holiday season is when it either catches up with you or you leap triumphantly from the temple entrance, golden statue in hand.
The shopping season kicks off on 11 November, with the 11.11 Global Shopping Holiday (formerly Singles’ Day). According to analysts, Alibaba and its merchants are on track to rack up $45 billion worth of sales on Singles Day alone , up from $38 billion last year . And if last year’s results are anything to go by, a large proportion of those sales will go to non-Chinese companies. Last year brands such as Bose, Estée Lauder, Gap, Levi’s, Nike, The North Face and Apple all made over 1 billion yuan ($143 million) on Singles’ Day .
Increasingly, US and European consumers are also participating in Singles’ Day. However, both markets shift into proper holiday mode with Black Friday on 27 November. And there is every indication that this, too, will be bigger in 2020 than ever before.
Adobe Marketing Insights predicts a 20% increase in e-commerce spend over the Black Friday to Cyber Monday weekend . Looking at the holiday season as a whole, Deloitte forecasts that seasonal e-commerce — online spending is expected to grow by up to 35%, compared with just 14% last year .
But that doesn’t mean you can just relax and wait for the holiday season sales to rack up. As well as driving customers online, lockdown has also disrupted brand loyalties. During lockdown more than two-thirds of customers in some markets have tried a new product or service and of these, a quarter do not plan to return to their old habits once lockdown has ended .
Old shopping loyalties have been upended, and that means their holiday-season shopping is up for grabs.
For instance, 43% of over-65s are now shopping online compared to just 16% before lockdown . For online merchants the grandparent present budget just became accessible. But to win your share of it, you have to provide a customer experience that this demographic will love.
Making the checkout page a priority
The question then, is how to prepare your merchants’ or your own e-commerce site for the holiday shopping season. It’s only a few weeks until Black Friday, so there’s no time to lose. You need to find out where gaps are in your customer journey, and plug them, before those customers run away to someone else.
The customer experience at checkout is particularly crucial. One of the surest ways to lose customer trust at the checkout, is by not offering shoppers’ preferred payment methods. According to research by PPRO, up to 50% of customers have abandoned a transaction because the merchant did not offer their preferred payment method .
It’s a question of localisation. Except in this case, you’re not necessarily localising for customers in a particular geography. Instead, you might consider localising for consumers in a particular age group who are now shopping online for the first time. Or customers from a range of demographics who have never shopped online for a particular category.
No one size fits all when it comes to global payment preferences
If you want to succeed in global e-commerce, you must offer the preferred payment methods for every market and demographic you want to win over.
Worldwide, consumers use alternative or local payment methods in more than 70% of all consumer transactions . These are the payment methods whole markets and demographics grew up with online and trust. Fail to offer them and you can have the best possible customer journey, but you’ll still lose basket after basket at the checkout.
With the acceleration of e-commerce and the influx of online competition, anyone who hasn’t optimised their payments offering will be desperately racing to catch up. Merchants need to think now about how they are going to maximise their revenue from what looks to be the biggest online holiday season ever. And payments is a crucial part of that conversation.
9. Original PPRO research.
Why insurance needs Tesla’s autopilot too
By Christian Wiens, CEO of Getsafe
Digitization is the industrial revolution of the 21st century. What does this mean for a data-driven industry like insurance? The answer is simple: Turn everything on its head and reinvent yourself under high pressure- the future of insurance is digital.
“Hello Timo, nice to see you. I’ll be glad to help you.” Carla records claims 24 hours a day, seven days a week and takes less than two minutes to evaluate and process them. Carla works for a digital insurer and is a chatbot by profession. While she is answering Timo, she contacts the bank in the background, which pays Timo back his money – the same day. This is not a dream, but already reality.
In the digital age, intelligent machines are the new workers on the assembly line, and data is the new raw material. This applies to almost all industries and applies in particular to the insurance world as insurance is based on mathematical models and probability calculations – in short: on data. The more data on which the calculations are based, the easier it is to derive and price risk profiles. Data therefore changes the core of the product “insurance” in three essential areas; the offer phase, in the event of a claim and in the long-term customer relationship.
In the offer phase, we will experience long-term personalized product bundles that fit customer needs much better – away from standardized and inflexible policies. If the insurer can better assess the needs of the customer on the basis of his past history or behaviour, he is in a position to put together tailor-made insurance packages.
For example, it would be conceivable to automatically adjust the insurance cover as soon as the customer’s life changes, for example if the customer gets married, buys a car or a property or travels abroad.
Customer experience in the event of a claim will also change dramatically. Fraud is still the biggest problem in the system, with 2 percent of the customer base causing 40 percent of the system’s inefficiency. According to estimates by the Association of British Insurers (ABI), one insurance fraud is detected every minute – amounting to economic losses of £3bn every year. Of the estimated worth of total fraud cases a year, £2bn goes undetected.
But what if insurers are better able to assess customers on the basis of data and know which customers they can trust – and which not? Credible customers could then benefit from immediate payment of the loss incurred, while the few “black sheep” would not even be accepted as customers or would be checked more closely in the event of a claim being reported.
The computer does not act uncontrolled, but within certain parameters defined by humans. This is comparable to processes in the manufacturing industry: Here, too, people define the exact parameters that are to be checked – controls are implemented by machines that are significantly less prone to errors. The situation is similar when it comes to insurance fraud: people make value judgements and specify which indicators can point to a case of fraud. They retain sovereignty over the entire process. The smart algorithm, on the other hand, is only the tool for evaluating and linking the many individual data points. Smart algorithms will reduce employees’ workload, but will not replace them.
Finally, digitization will also change the long-term relationship between insurer and insured. Tomorrow’s insurance will not only settle claims, it could even prevent them arising. A better database will not only make it possible to calculate the probability and amount of loss more precisely, it will also make it easier to calculate the risk of loss. Digital systems and sensors can also help prevent possible claims. Telematic tariffs in motor vehicle insurance are already moving in this direction by promoting a prudent driving style.
Sensors on washing machines and industrial plants or intelligent smoke detectors are one thing – monitoring people in the health sector is another. Some health insurers reward sport activities, for example, if the customer can prove this with smart fitness watches. It remains to be seen to what extent customers are willing to exchange this personal data for premium refunds. In the long term, the legislator will also be asked to take action to ensure that the solidarity principle is not undermined.
However, the danger of increasing surveillance is countered by a clear increase in customer service, individualised services and flexibility on the customer side: Digital insurers rely on customer’s self-determination and a positive insurance experience in an industry that sometimes appears to be immobile and non-transparent.
Digitalisation has reached the insurance industry, but has not yet shaken its foundations. That will change: Tomorrow’s insurance will have little in common with today’s structures and processes. The autopilot at Tesla will also come for insurance. Not all companies will be able to master this switch to become digital insurers.
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