 Hi, and welcome, everyone. I'm Sabine Wiesander. I'm a partner at the VC firm, Kriandum. And I'm here with Johannes Schilt, CEO and founder of Kri, a multi-billion dollar healthcare company out of the Nordics. Welcome, Johannes. Well, thank you. Good to be here. Good to see you, Sabina. Good to see you. We are here to talk about scaling billion dollar companies in highly regulated markets. So some of the most regulated markets are also the industries that are the least touched by software. Education, energy, healthcare, it's just some of them. But there are entrepreneurs that are taking on these industries and that are trailblazing. And Johannes, you are one of them. I am, yeah. So I will ask Johannes to share insights of what it takes to scale a company not only in a highly regulated market, but a business that has as its core business model to be reimbursed by the public sector. And hopefully you will get some insights to take on your own journey. So let's get started. Let's get started. Let's get started. Johannes, Kri is a digital first healthcare provider. How many patients have you helped to date? We helped a bit more than 7 million patients across Europe by now. 7 million patients. And for those in the audience who is not one of 7 million patients, what is Kri? Well, to put it simple, it's a healthcare clinic in your phone where you could meet clinicians within minutes, psychologists, doctors, nurses, physiotherapists. And we operate this across Europe based in Stockholm, but also operating at scale now in France and the UK. Ambition have always been to be a mass market service, to be something for everyone. And obviously in order to achieve that within healthcare, you do have to, as you said, address the public healthcare systems and partnering with the public payers. So that's what we usually do. And then also we partner with private healthcare, private insurance, and sometimes also go directly to patients and through employers. So that's what we do. And the majority of what we, healthcare we deliver is pure digital. And then we also put a lot of effort during the latest years to knit together the patient journeys and link our digital offering to physical healthcare as well, where we're now starting to operate a light touch network of physical clinics in some key areas. So that's what we do. So digital healthcare wasn't tough enough. You're also doing, adding physical clinics to the problem. Yeah, I think it's for us it's been important that digital healthcare is not a silent system and then you have everything else. I think it's clear for us that most or all healthcare journeys will eventually start digitally. And then in the majority of the cases, we will be able to treat our patients end to end through pure digital. But obviously in some cases, we need to link patients further down the healthcare journey and also do physical healthcare. And we do that mainly through partnerships but also to some extent we do it by ourselves. Yeah, so that's what we do. And at core, we are a technology and product company but we also operate healthcare ourselves at scale. So we do employee and trainer of a lot of clinicians across Europe. Wow, impressive. And why did you start this company? Are you coming from the healthcare side of things? No, I'm not. Well, I am because I'm a patient as everyone else. So a lot of it is out of our needs. I've been a patient in the Swedish healthcare system as most we've seen being trusted on how bad part of it is structured. I think in Europe, we're in general, we're fairly spoiled with high quality of care but there's been a lack of access and a lack of efficiencies. And we thought there must be better ways of producing and delivering care. So we started building what we now have been doing for quite some time. But no, I had very little experience from the healthcare sector before starting Q. And in one way, I think it's been a positive. Yeah. I mean, I'm sure we're all curious to know how much did you know about regulation in healthcare before you went on this journey? Well, the very honest answer is that I didn't know anything about regulations in healthcare when we initially started. And as I said, I think it's, in one way, it could have been a positive because what we do is complex. It is very regulated. It's complex, but sometimes it's rather good to be a bit naive when it comes to addressing new things and just jump straight into it. I think for us, it's always been ultra clear that what we do is a big part of the future. But no, we didn't know that much about regulations when we initially started. Now we do. Now we know a lot about it. Now you know. And if you knew back then what you know now about public reimbursement, about regulation, what would you have done differently? I'm not sure that I would have done so much differently. Well, obviously, I think we have played sort of slightly different roles in different markets we've been addressing and all of the markets that we're in. And if you look into Europe now in the world, all of markets are in slightly different levels of maturity when it comes to regulations and how you structure reimbursement systems in healthcare, et cetera. And the role we played in Sweden for a long time was really trying to sort of push the system forward. And I think that we've done that in a fairly good way. Now I'm not sure that we would have done so much differently. Obviously, we've made a lot of mistakes and sometimes you could have been pushed harder, pushed less. We have sometimes, you know, addressed new segments or markets too early. But I don't have a clear answer to that question. And when you say pushing, you know, pushing the system, obvious as a startup, you know, you've all experienced how limited your resources are. Should you try to influence policy and regulation in the market that you are in and can you as a startup take that role? I think you have to. I think you definitely need to be in the conversations as you're the most, you know, large sectors. You have regulation, right? Healthcare is, you know, it's 10, 11% of GDP in all European markets and it's, you know, it's also addressing public systems. There's a lot of regulations and complexity. And I think that you, obviously, you need to be in conversations about how to push things forward. Then you can't sit back and wait until things are changing, right? I think you need to also play the role as sort of challenging the system. Our main challenge has been addressing healthcare and doing it at a scale. If you look into the healthcare systems right now, it's very local. Regulations are built around physical healthcare delivery. That's not what we do at CORE. And then sometimes you have to and you need to challenge that. But we have always taken public policies side very seriously and put a lot of time and effort and really trying to be around the table and discuss the future of how healthcare should and could look like. And that requires time and effort. It does, but I think it's definitely worth it and I don't think it's any way around that, really. So, you know, spending time on it, being in the dialogues, but maybe not expecting to move the whole European framework all at once. No, that will unfortunately not happen. But if you look back when we initially started, there was no reimbursement infrastructure for little healthcare in any European markets. When we launched in Sweden, there was no payment model for it. Now there is a lot of things have changed during the years that we have been in this industry. And a part of that is obviously us trying hard and showing that this is doable and this is a real need and it works. That was not, now it might sound like a given that what we do, little healthcare is an obvious and critical part of any healthcare system. But that was not the case when we started. That was something that was completely new and we had a lot of skepticism around what we're doing and people said, no, you can't do it. This can't be done. It's no need for it. But we showed the world and our patients and partners that what we do is actually of real value. And from us, even though we started out of a pure patient perspective, obviously what we do, we need to serve both patients and clinicians that work with us and for us. And we obviously also need to serve the needs of our partners. And as I said, that's mainly governments and public systems. And they tend to be fairly regulated and they also tend to be fairly conservative. And so you're showing the way you're showing it can be done, you're going on the forefront. And then a pandemic came. How did that affect being in a healthcare market? And has that affected the policymaker's way of looking at software, you think? Yeah, I think for us, I would argue that the biggest change during an epidemic have been on the policy and regulatory side. I think even though, even when we started, there was a clear demand for the patient side. People don't want to call a landline early in the morning and travel long distances and sit in a waiting room for a GP practice and hopefully get a time slot. You know, there are more efficient ways of solving it and that have been clear for us and it's also been clear for patients. It's been maybe less clear from the clinician side and on the payer side up until recently. This shift started long before the pandemic. It did, but the pandemic definitely accelerated it. And now I would argue that it is well anchored everywhere in all healthcare systems but what we do is a critical part of the infrastructure of healthcare moving forward. Then the pandemic has been strange because part of the healthcare system have been under severe pressure but healthcare usage during the whole pandemic actually been an all-time low and many healthcare systems have basically put everything on pause. In the UK, you almost have 10 million people waiting to get a doctor's appointment because everything was paused for a long time. Well, 10 million people waiting for a doctor's appointment. The European healthcare systems are under severe pressure. That's a fact. And you can't solve that by just continuing to do what you have been doing before and that's now finally starting to be clear to you, our partners that you do have to structure how you deliver healthcare moving forward in a different way. And that's a big opportunity for us, obviously. And do you think there are, policymakers who understand what needs to be done that are pushing the rest of their peers towards a future where software plays a bigger role in public sector or highly regulated markets? Yeah, no, obviously there are champions, obviously. And if you look back in the early days of Korea, I think we were fairly successful at identifying those individuals or regions in our first markets. In Sweden, there were less conservative or more pro-tri-new ways of delivering care and sort of juicing them as a champion. So yeah, I would argue that things definitely are moving forward. And I think there's usually, and sometimes there's a lack of understanding how technology actually works and what will mean. And we have, but in the end, there are definitely people that do understand. So there's not only a problem of will, there's also a problem of not understanding what regulation stands in the way of innovation. Yeah, I think that we have quite a lot of examples where you have regulations clearly sort of blocking innovation and demand, or not demand, but blocking innovation. And usually that is not now by bad intent from regulators, it's just lack of understanding what the decisions will lead to. Interesting. So that's also a reason why you need to be in the conversations and try to educate people. Yeah, continue to have conversations, try to get them on board, try to understand, then get them to understand what the future looks like. Yeah. We're gonna try to get vulnerable for a few minutes. Wondered if you can share with the audience any big mistake that you look back on on the journey of building this huge company and something you brought from that. Big mistakes, but we knew in this far wise, obviously we've done a lot of mistakes and it comes to regulations and policy. I think that we sometimes had a tendency of maybe pushing too hard and sometimes had a tendency of pushing, you could have pushed harder, right? And we have had, we've launched markets that have not been ready from a regulatory perspective. We've launched new services, but timing was not right. So obviously when you look back, there's a lot of things that you could have done differently. That's obviously... But it's been kind of trying to find the balance of what's pushing enough to keep moving at the startup speed, but of course within the regulatory realm that you're acting in. And I think that healthcare is very local. So part of what we do is very scalable on the technology side and operation side. What we do is very similar in the different markets, but how the healthcare systems are structured is a very different between the different markets. And when we initially launched in Sweden, there was nothing, we pushed it forward. And when we initially launched, we launched as a private service and our main argument to the public sector was like, this will happen anyhow, right? So if we don't make sure that this is a part of the public healthcare systems, this will be like a premium channel for the few that can afford to pay for better access. We don't want to do that. And that will undermine the trust of the public healthcare systems. So it's different arguments that we have used in different points in time. And as I said, the markets have been at the very different level of maturity. I would argue that the UK have been really good at this. It's been well anchored for a long period of time that digital healthcare is a part of the future. That was not the case in Sweden when we initially launched. And for those of you, I mean, I assume most people are not from Sweden here. So that's where most of the digital health in Europe started. And now we see that most of the regions that are operating public healthcare are launching their own apps. And obviously, that would never have happened unless you guys went on to show the way of what should be the first step of interacting with the healthcare system. Yeah, I think the first way for us was to show that this is actually doable, right? And now it's anchored, it's doable. Then it's like, who should do it? How should it be implemented? How should it be reimbursed, et cetera? But we crossed that first stage where, is this a real thing or not? Now it's obvious it's a real thing. There's more question about who should do it? Should you allow private companies to operate in this space or not? Or how should it be paid for and who should pay for it, et cetera? And we're all aware we need regulations in all our industry for them to function in a well manner. As a highly innovative companies, can you turn these very strictly regulated environments? Can you turn that into an advantage? Yeah, I think you can, because that is a barrier to entry. It can be frustrating to operate in a highly regulated market, but it's also certain advantages. If you're starting to be good at it, that's a part of your mode. I think we started to reach a point where it is, right? It's a strategic advantage to us. We know that very well and we can sort of, you just have to embrace it. You just have to roll up your sleeves and dig into it. I think there's no way around it. If you want to operate in healthcare and other highly regulated industries, like you can't shy away from it. Like you just have to embrace that you operate in a regulated environment and then try your best to use that to your advantage. And I mean there is some of the largest global industries are also the most highly regulated. So the price, if you do make it, it's very big, right? And I guess what you're saying is, it's not for everyone, but that also means that it will be less crowded. Yeah, if you look into what we do, we don't have that much competition upon European scale. We have local competition, all the markets that we're in and part of that is because there's quite a lot of heavy lifting to address a new market, to understand regulations and reimbursement systems and find a payer model, et cetera. And it's two sides of the coin of complexity. It's tough and it's hard, but as I said, you can also use it to your advantage. And it is a part of, it's a barrier of entry. I know another Nordic example is the scooter company, Voi, that are, you know, they're so good at managing policies in the cities that they operate in. So their main agenda is to push for more policies because they are the only company that can actually handle those kind of frameworks and the public agenda that they're pushing. So they're actually pushing for more regulation on the scooter side because they think that's one, the way for them to be able to operate period and two, of course, to have less competition in the market. So we see it also in other industries than healthcare. Many entrepreneurs in the audience, I assume, what would be your advice to entrepreneurs building, not only in healthcare, but in other highly regulated markets? An advice to founder of if you operate in a highly regulated market. I think some of the things that I've already said, I think, you know, there's no way around it. You should try to be in the conversations. You know, go out, meet the policymakers, talk to regulators. I think, again, I think you should, you know, really dig deep into it and try to use it to your advantage. I said, there's like, there's no way around it, really. So just, you know, embrace it. Yeah, become really good at it, better than everyone else. I think sort of, in the beginning, we were sort of, it was a bit frustrating. So when you realize that this is fairly tough, you're like, oh, God, this is really tough. There's a lot of things that we need to learn. It's highly regulated, and then you first get trusted about it. But I think, you know, then early on we reached that point, we're like, we will just embrace this. We will try our best to be good at it. And I think that would be my main advice would be to just, you know, don't shy away from it. Try to embrace it. Embrace it, lean into it. Yeah. Yeah, I mean, if it was easy, everyone would have done it. We would have, you know, the same amount of software in healthcare and education as we have in other sectors. Yeah, and now, in some of our core markets, as in Sweden, like we have access to the full population, we have 25% of the households that sign up with the service, you know, it's a power brand, so everyone is aware of it and people use it. And it's like, now it's painfully obvious that what we do is needed, but that was not the case before. So, yeah, just, you know, roll up your sleeves. Yeah. Think deep and try to embrace it. Yeah. And I don't know if there's any policymakers in the audience, but if there is, you know, what would you say to them? Or what do you say to them? Well, I would probably say the same thing. I try to engage with innovators and companies and startups. I think if you look into, like, healthcare, it's obvious to me and all of other people that, you know, private companies would pay a big role in solving some of the crisis within the healthcare sectors, like engage with companies and innovators and try to understand what policy and regulations can do to actually enable more innovation and not blocking innovation. Because that do happen, right? Like, you do have regulations that are actually hindering innovation. And, you know, we don't want that, like, we don't. And, you know, these conversations are happening. We've just had a big climate conference. We see it happen here, you know, big climate conference in Egypt. You know, tons of startups got to go this year and engage. Hopefully policymakers are, you know, listening and engaging as much as they can. What do you think the future holds for digital healthcare? Oh, for digital healthcare. Now, as I said, I think it's painful, obvious, and been painful, obvious since we started that healthcare is going digital. That's ultra clear. And we did that early on. If you just look into the ICD codes, the diagnosis codes of our primary healthcare clinic, you realize that the majority of those concentrations can happen digitally. And that's now slowly but steadily or in some times, it's starting to happen, right? So we believe that more of all and the majority of healthcare concentrations will start online. The majority of the things will also be treated purely digitally. And that's, you know, the macro trend is ultra clear. And it's just a matter of like how quickly can we reach that point? And that will not solve all of the problems within healthcare, but it will solve some of the problems in healthcare. And as I said, I think, you know, you can't just pour in capital in the rather ill functional existing system and hope that that will change. Nor can you just add like a thin layer of digital on top of the rather ill functional system. Like you really have to. And that's what we do. Like we combine technology with hardcore healthcare operations. And that's what you really can create some magic. So it's not the silver bullet that's gonna solve our healthcare problems, but it's an important tool for the future of healthcare in Europe. Yeah, and it is a tool. It's, you know, it's no technology for the sake of technologies, no value. But you can use technology and product to improve efficiencies and improve access and improve and remove some of the inequalities when it comes to access. That could be done. But, you know, technology for the sake of technology that doesn't serve any purpose. No. And, you know, where are we on this journey? Are we, you know, far ahead? You know, where? No, we're very much just getting started. Like very much that we've been operating this now for, yeah, since 2015. But, you know, we're still have a long way to go. Healthcare is 10, 11% of GDP in all European markets. It's just, we're very much just getting started. I think that in the next five, 10 years, we'll see an awful lot of change in all European markets in this space. That's a future we're very much looking forward to. We are near the end. Johannes, if the entrepreneurs in the audience are to bring one thing from this session, what do you think that should be? Well, if you would bring one thing and we should try two regulations, I think what I've said plenty of times now, don't shy away from it. Like, there's no way around it. Like, in some areas, there's obviously, like a lot of companies, you don't have to care too much about regulations, but if you want to go into healthcare or other highly regulated industries, then there's just the name of the game. And, you know, you have regulations that constantly change, you have to adopt to it. And that would be my best advice. Embrace it. The price is big. Less competition. Just do it. Yeah, let's do it. Yeah. Thank you so much, Johannes. Thank you, everyone, for listening. I hope you found this insightful, and I wish you a great slush. Thank you. Great slush.