Starting up a medtech company involves a careful balance of priorities. Improving patients’ health is all very well, but investors will only get on board if there is an economic argument for the use of the device that underpins its commercial appeal.
“The holy grail of healthcare is changing outcomes for patients but also making sure it’s cost-effective and that people have access. It’s not a simple trade-off,” says Conor Hanley, chief executive of the Irish group Fire1. The company’s message appears to be persuasive: it has just raised €40m ($49m) in a series C round to develop its heart monitor, despite details of the technology being scant.
Fire1’s device is a remote cardiac monitor designed to help track patients with heart failure. And this is all the company is saying: Mr Hanley will not even give a date for the potential release of more information. Beyond a hint in the company’s press release suggesting that it is a “digital health-enabled solution” that could allow patients to be managed at home, the technology is shrouded in mystery.
Presumably Fire1’s backers know more about the device. The €40m has come courtesy of Gilde Healthcare, Gimv and Seventure, as well as Fire1’s existing investors Medtronic, Lightstone Ventures and New Enterprise Associates.
Patrick van Beneden, a partner at the Belgian investor Gimv, which straddles the venture capital/private equity divide, says Fire1 has done animal trials and also has some initial data with patients.
“Of course it’s very preliminary, but on the other hand looking at the risk profile of the technology it’s not that invasive,” he says. “We believe that the technical objective should be achievable. It’s not as risky as some of the other plays in medtech.”
Mr van Beneden, who along with Janke Dittmer of Gilde Healthcare has joined Fire1’s board, says that if the group’s technology can be proven in the clinic potential buyers will come running.
“In general we look at companies that are quite near to CE mark, but we feel that this is one of the technologies where big medtech players should be interested at quite an early phase, so even after the first initial clinical data people should get interested in this.”
The hope is that the €40m will allow Fire1 to post clinical data “that’s good enough for an exit”.
In passing, Mr van Beneden mentions Cardiomems, the company that developed an implantable heart monitor and was bought for $455m by St. Jude Medical in 2014. Being a remote system, Fire1’s technology is clearly very different, but the Cardiomems deal makes it clear that monitoring heart failure patients can be of interest to big medtech.
|Fire1's venture rounds|
|Jan 30, 2018||Series C||49.0||Gilde Healthcare, Gimv, Lightstone Ventures, Medtronic, New Enterprise Associates, Seventure Partners|
|Apr 12, 2016||Series B||7.5||Lightstone Ventures, Medtronic, New Enterprise Associates|
|May 1, 2014||Series A (second close)||-||Lightstone Ventures|
|Jan 9, 2014||Series A||-||Lightstone Ventures, New Enterprise Associates, Covidien Ventures|
The presence of Medtronic in the recent round as well as the series B in April 2016 might be significant here, though the company’s corporate VC arm makes many investments and they do not necessarily signify a strategic interest let alone always lead to an acquisition.
Consolidation among the sector’s big players has limited the pool of potential acquirers. Medtronic and Abbott are the two most obvious candidates as possible buyers for a heart monitor, but both are already active here. Abbott now owns the Cardiomems tech thanks to its acquisition of St. Jude, and Medtronic has an implant called Reveal Linq, which is more geared towards arrhythmias than heart failure per se.
Still, Fire1’s system might be sufficiently differentiated that these groups see its appeal anyway. And there are other prospects, such as Boston Scientific or Terumo. And perhaps pharma companies in the heart failure space might be interested, particularly as outcomes-based payment models become more widespread.
As well as its investors being interested in where Fire1 is going, they were also lured by where it has come from. The company is the 15th startup – but the first European one – to have emerged from The Foundry, a medtech incubator with a pretty decent track record. Over the past decade or so at least seven of its portfolio companies have been sold to big medtech.
Mr Hanley has form here too; he co-founded Biancamed, a company that developed a remote sleep and breathing monitor and was sold to Resmed in 2011 for an undisclosed sum.
|Selected exits of The Foundry portfolio companies|
|Company||Buyer||Deal date||Deal value ($m)|
|Transcend Medical||Alcon (Novartis)||2016||Undisclosed|
Whether to maximise the chance of a takeover or simply to boost sales, Fire1 is already thinking about its commercial strategy, despite its technology being so early.
“You have to have a very strong clinical foundation, but you have to make sure that it’s sensible for the whole healthcare system,” says Mr Hanley. “You have think through workflows and payment flows – and future trends.”
He says Fire1 is well placed to benefit from these trends: “The ongoing push for value-based patient care, and measuring and paying for outcomes, is going to continue.” Connected health, and the provision of patient care in the home – a lower-cost environment than the hospital – is increasingly appealing to payers.
Fire1 has clearly worked hard to maximise the argument for uptake of its technology by healthcare payers. Naturally this same argument increases its appeal to investors – and, perhaps, buyers.