To get a founder perspective, Inventure’s Kevin Lösch sat down with Medoma’s CEO and co-founder, Johan Nordenström, to talk about his experience and insights.
Founded in 2021, the Swedish company is bringing high-acuity care to the homes of patients, having already treated more than 500 patients since onboarding their first customer. Since leading their seed round in the summer of 2022, Medoma has been executing at a phenomenal pace, successfully pioneering the care-at-home model in Sweden.
Let’s dive into the conversation!
Finding purpose and founding Medoma
Kevin: To start off, let’s talk a little about how Medoma got started. Given that you don’t come from the healthcare industry, it would be interesting to hear the background story on what initially drew you to start building in healthcare and what led you to founding Medoma?
Johan: Yeah, so as you said, my background is completely different. I went to the Stockholm School of Economics and studied finance there. Then, I got the entrepreneurial knack and started building businesses. My latest business was a company I took over from my mother, it was a small direct marketing agency firm that later grew to a mid-sized CRM data-driven marketing automation firm. We sold it to Accenture at the end of 2018.
And, to answer the question of what led me here: I mean, my whole family are doctors. My father is a doctor, both my grandfathers were doctors, my aunt is a doctor, everyone’s a doctor, and I jokingly said I was tired of not being invited for Sunday dinner, so I had to do something meaningful with my life.
My father is a professor at the Karolinska Institutet, and he’d spent some time looking at the hospital-at-home model. This was before COVID, so to a very large extent, it was a very theoretical exercise. But then came COVID and the whole world started changing. If there is a silver lining in that horrible, horrible period for the world, it’s exactly that healthcare actually had to change. So, with that I felt that, well, I have all this knowledge through my father, who spent so much time on it and my own ability to start companies. So that and the commercial drive is what led me to realize this is what I want to do.
However, one very important ingredient was lacking, right? The medical experience. To make a long story short, I met Mikael [Kastengren] and Henrik [Bjärtun], my fantastic now-cofounders, and they were luckily naive and stupid enough to leave their clinical paths to do this, and that’s how it all started basically.
Kevin: From our side, I remember meeting you and the team for the very first time in late 2021 and from the very beginning, we believed that if any team in Europe could realize this vision and navigate the complexities of regulatory uncertainty, it was this team. It was because you had such a strong vision of what Medoma would eventually become, clearly a strong passion for it, and the needed execution capabilities coupled with deep domain expertise through Mikael and Henrik.
Taking a leap of faith to pioneer European healthcare innovation
Kevin: From an investor point of view, healthcare in itself is complex; it has very long feedback cycles and is very highly regulated. We’re going to come to this a bit later on on the learnings side, but before that, what did you guys see, that others might not have, that gave you the confidence to start building? Because the model in itself has kind of like certain, let’s say, derivatives in Australia and in the US, but in Europe, you’re basically pioneering the concept.
Johan: So I think one of the superpowers of being an entrepreneur is that you need to be naive and stupid enough to do things like that. But obviously, that’s not a theoretical framework that builds businesses in itself. I think the thing we saw, and which I’ve seen with my previous company building, is that you can get inspired by companies doing something similar in a different geography. And then the innovative side of things is when you apply that to the new geography, and in that you will find that there are a lot of new ways you need to do.
So basically, on the execution side of things, we knew this was going to work because it had been tested. But it’s like the egg of Columbus, right? Somebody needs to go and travel. Somebody needs to be brave enough not just to talk.
So, I guess the combination of knowing that it worked, being brave enough to execute, and being naive enough to be the person who does that made us believe that, well, we could really do this in Europe. And you look at Sweden, and you realize that, well, technology adoption is very high, lots of great startups, well renowned for its healthcare industry, and not least, the Nobel Prize in Medicine is awarded here, just a couple of blocks from where I’m sitting. So that combination really made it attractive to have a go at this basically.
I also really want to give a shoutout to Capio St Görans Hospital in general, and the Department of Internal Medicine in particular, who became our first real client. The bravery, the energy, and the trust they put in us and in this idea when we were just starting out is remarkable. The individuals behind the scenes there, and a bare handful of them specifically, are people who are willing to not just talk about change and innovation but to put their own heads on the line to make it happen. That, to me, has been incredibly inspiring to see, and it’s an honor to continue to develop the future of healthcare together with them.
Facing the slow wheel of change
Kevin: When we look at the timeline, I mean, you guys were founded in late 2021, you signed the first pilot, I think, in March 2022, and then basically fast-forward to today, you have treated more than 500 patients. Obviously, you guys have executed phenomenally. But I’m more interested in what have been the main challenges for you in the early stages of getting to where you are now?
Johan: Thinking on a very high level, everybody told us that healthcare is notoriously slow to change, regulatory heavy, and all of that, so we were prepared for it. But I’d still say that even being ready for it, you’d sometimes be surprised how slow the system is, even when you’re doing something so provenly helpful that we do.
Maybe that’s one of the learnings: you would think that one of the key challenges is that people are against us. But to our surprise, a lot of people think this is great. Patients love it, most doctors like it, regulatory bodies are interested, and politicians love it. So what’s the problem then? Why is the adoption not quicker? Well, the biggest challenge is not the people that are against us because they’re actually quite few. It’s the ones who claim they are with us but are ready to do very little in order to make things happen. We call them innovation washers. It’s the equivalent of greenwashing, right? You don’t walk the talk.
There are plenty of people, especially in this industry, who love conferences, who love to talk about how great it is, that the future of healthcare is there, but they’re not ready to take the, you know, the blue door instead of the red door every morning when they wake up. Instead, they say, no, that’s impossible, this can only be done if I get to continue exactly like I do, you know, every day.
Kevin: I love that point of view because I think if you would look back in terms of what you would have done differently, there are definitely certain routes which you couldn’t even kind of retrospectively change because they’re so old fashioned and almost like stuck. But if you take a look back, is there anything that you would have done differently with the knowledge you have as of today?
Johan: I’m thinking about the comment that we always talk about here. We do this because it is hard, not despite that it’s hard.
But thinking about the concrete mistakes, I wish we had understood the public procurement processes on an even deeper level. That would have saved us from some headaches or maybe from excitement at times that, with our knowledge now, wouldn’t have been exciting. It would have saved us from some of the pains coming from being naive.
A call for simplified hospital processes and a larger drive for healthcare innovation
Kevin: We’ve been at a very interesting inflection point ever since COVID made a positive impact on the willingness to adopt new innovations with an effort to solve the problems at hand: the lack of beds, lack of doctors and nurses, and lack of administration efficiency and productivity. We’re also seeing more and more funds, both generalist and healthcare-focused, investing more heavily in healthcare. But, if you could decide still on two main roadblocks you wish that would be removed to create more innovation in healthcare, what would those be?
Johan: If I had a magic wand, the first thing I’d use it for is to make all the commercial decision processes at hospitals a lot less complex.
I’d like to see a way where great innovation such as this, and there are other examples, quickly gets out to those who need it the most: the patients, the taxpayers, the doctors, the nurses, et cetera. I’m a commercial person, and I’m saying this as a founder and shareholder of Medoma, but I’m also saying it because I honestly feel that we’re robbing patients and taxpayers of money and better patient experiences with loved ones every day that we are not implementing this at scale.
And then, I’d also use that magic wand to change the attitudes of some of the people involved in this industry. Sometimes you feel a bit crazy when you talk with a doctor who just wants to focus on the problems of why this shouldn’t work, while we have 500 patients and counting saying that it does.
Kevin: I think that makes total sense. As we’ve discussed a lot with you, the current healthcare landscape has a misalignment of incentives among regulators, government bodies, and payors, where regulatory complexity, risk aversion, and a focus on short-term costs over improved long-term health outcomes hinder the adoption of innovative technologies.
I think we can both agree that the key to leveraging innovation in healthcare to its full potential would be for all these stakeholders to push for the common goal of an efficient and equitable healthcare system by streamlining regulatory pathways, mitigating unnecessary risk aversion, and shifting the financial focus towards long-term benefits.
Next: moving toward patient-centricity and care settings outside of hospitals
Kevin: Shifting the focus a bit towards the future, I would be very interested in hearing from your point of view, how do you expect care provision to change in the next 10 years? And where is Medoma in 10 years?
Johan: I think all arrows are pointing in the same direction: involving the patients more, so towards patient-centricity. And that the future battleground of care will be in the home. You can’t build expensive hospital buildings and all that forever when you can just do it in a more convenient and effective way. Within that, there’s obviously a lot of levers and technology that you can apply, AI being one of them.
In terms of Medoma, we like to think that a significant portion of care will be conducted in the home, be it primary care or inpatient care that we’re doing. When that happens, because it will happen, we want to already think about how we can be smart about recording how patients are behaving in that setting. Can there be recommendations, you know, for preventive health? How do you make inpatient care better?
I would love our legacy to be an integral part of how care is being run outside of the hospital. If the definition is outside of the hospital, obviously you can think about the technology platform needed to do that. We’re talking about remote patient operations. So, the logistical part and creating all of that infrastructure in order to deliver care at the right time, at the right place, by the right person, and in the right order. All of that is magnitudes much more complex than just having a communication tool to talk with the patients. When you think about logistics and all the data you can collect, again, you get into AI and all that.
Obviously, being in a hospital does not only entail medical services, it includes food, it includes delivery of medical supplies, it includes a whole wide variety to make a hospital work. When your home becomes a hospital, you obviously need to rethink all the things that would normally be in a hospital. How do you get that into the home? To be a real enabler of that through technology and services would be an amazing legacy to leave after.
Kevin: I love that vision and that’s also one of the main reasons why we have invested in Medoma. Why do you need to go to a brick-and-mortar hospital when, let’s say, you have inflammation or you break your arm and have to recover from surgery? I think it’s setting out a large new infrastructure change and a complete tectonic shift in the healthcare landscape. So I would love to see that as well.
Johan: Yes, we will do our best!
