Four learnings from Ambler’s story to tackle the healthcare sector in France
By: Alison Imbert
Tags: Healthtech, Mobility, Medical Transportation, Healthcare, Venture Capital

Mehdi Ben Abroug (CEO), Nicolas Dumont (CPO), Thomas Bournac (CSO) and Julien Déléan (CTO), Ambler’s founders

From hospitals and clinics to the broader French social security system, all French healthcare stakeholders are under constant budgetary pressure, and are struggling to rethink their operations and processes to gain efficiency. These constraints are ultimately putting the quality of patients’ care at stake and causing a certain impoverishment of professional working conditions, as demonstrated by the recent strikes in the emergency sector.

It opens up some huge business opportunities, but several questions then emerge: how to successfully step into the healthcare sector? How can disruptive private players efficiently work with public players? How to satisfy multiple stakeholders with multiple and even somewhat conflicting interests? How to move fast in a so-called slow-moving sector?

Here are 4 learnings from my experience with Ambler, a non-urgent medical transportation platform which has enjoyed early success in the French healthcare sector. My point here is to tackle some possible pre-conceptions on how a start-up should address this challenging market.

Ambler’s story

Today booking an ambulance requires many low value-added tasks from calling several transporters to manually manage the billing. Hospitals and clinics don’t have adequate tools to manage it, resulting in a limited control of that budget (5 billion euros spent in France). Ambler connects medical staff and medical transporters through an interface to book the most appropriate transport means for patients. It strives to be the French reference for non-urgent medical transportation by bringing efficiency and top-notch services for all stakeholders.

I met Ambler’s founders exactly one year ago and invested shortly after in the company, leading their 1.5M€ seed round. At that time, Ambler was just a (brilliant) idea promoted by four ambitious, seasoned and experienced co-founders: Mehdi, Thomas, Nicolas and Julien.

Only one year after the first ride, Ambler has already onboarded 40+ medical facilities on its platform and ensured 15,000+ rides.

Learning #1: Targeting public sector from day one could be a good idea

You may think the public sector and the hyperactive startup world do not speak the same language and are on different timeframes. Well, guess what? You may be right. Public hospitals are often lagging behind when it comes to innovative processes, and their organization is sometimes a veritable maze.

Then, why should you start to address public players when you are not robust yet?

To get access to a large and defendable stronghold on that market benefiting from both growth potential and high entry barriers for your competitors. Public sector can be seen as a strong castle with deep moats surrounding it, this is not easy to enter but once you are in, you won’t be easily removed!

Ambler’s founders didn’t win on their first attempt — getting a deep understanding of the mechanics behind a tender is quite a hard job — but once they figured it out, it became much easier to replicate. And it opened up a large, challenging and sustainable market.

After less than 6 months of execution, Ambler was referenced by hospitals’ central purchasing (UniHA) and was already a step ahead of its competitors in the race to win public market, even more so when considering that each tender won is signed for at least the next 3 years. Today they have 10 public medical facilities and have attracted the attention of high officials to discuss future regulations of medical transportation.

As it takes time to grasp the public sector, you better start targeting it from day one to get access to a large and defensible market, and become the reference with a relevant know-how to scale.

Learning #2: Starting from the bottom to the top in the private sector is often the fastest way

While targeting public hospitals, you have to simultaneously target private hospitals and clinics. Private contracts are often less complex and more accessible for a young startup. To do so, you may tend to look for top management introductions thinking “if I succeed to convince top management with my amazing tech product, I will win a large contract in one shot”. Unfortunately, it often doesn’t work this way in the private medical transportation sector.

Indeed, the private clinics’ market has been consolidating over the past 10 years, but most decisions are still taken at a local level by clinic executives. Those executives are pragmatic: they buy efficiency, transparency and return on investment. But is convincing them everything? No, as for most new tech products, you need to convince every single stakeholder, from the caregiver to the executive, the driver and the patient, that your product will change their processes and organization for the best.

By making no compromise on product and services quality and by listening to healthcare professionals’ pains, Ambler has convinced more than 30 private medical facilities one after another to use its platform without a single contract at a group-level. It has succeeded in building a strong and trust-based relationship with them, and it can now leverage those sponsors to target ten times larger contracts at a group level.

Private medical transportation market requires to start from the very bottom, spends time to understand stakeholders’ needs, and only after will you be able to reach the top faster.

Learning #3: Understanding territoriality and local needs is often decisive

You may be tempted to push for a standardized product supported by a well-oiled sales process. It usually makes a lot of sense to scale fast… yet the healthcare sector may require more local considerations.

French health market is multifaceted, and beyond public and private medical facilities’ differences, healthcare is above all about territoriality. When it comes to medical transportation, for Ambler, standardization doesn’t work.

Firstly, medical transporters have different organization from one area to the other. When there is a wide offer and no dominant players, medical transporters clearly seize how Ambler can bring them more rides and see a true competitive advantage in the features (pooling, billing…), and they’re ready to sign in less than an hour. When the offer is concentrated and dominated by a local giant (often an Economic Interest Grouping), Ambler gathers all the small medical transporters which are not part of the EIG, those who struggle to get enough rides and stay profitable, and altogether they become the largest local player, and often win a public tender with Ambler. Each situation is structurally different and requires adapting sales techniques.

Secondly, Ambler is not a standalone platform: it is integrated in both the transporter’s rides systems (it connects with their planning) and in the healthcare systems (it has access to patient files). And both systems are manifold and old-school. To successfully integrate with them, it’s about change management and patience: you need to understand all their constraints and turn the IT system director into your best friend.

The medical transportation market is not a market you can win from your office in Paris. You often need to be in the field to understand local needs and be able to adapt fast to local constraints.

Learning #4: Demonstrating long term value creation is key

Structurally a marketplace is an intermediary that captures value in exchange for facilitating access to a product or a service. In most cases, the demand or the supply sides of the marketplace agrees to share a part of that value. But in the healthcare sector, which is under strong budget pressure, it doesn’t work this way. You often have to demonstrate your capacity to bring value to every stakeholder (clinics and hospitals, medical transporters and patients) to get accepted.

In order to convince potentially reluctant stakeholders, Ambler has chosen to first focus on how they could create value in an under-optimized and under-financed system before capturing it. They developed a platform that would create value for everyone.

For hospitals and clinics, the platform enables to book the right vehicle for their patient in just a few clicks (it does not require tons of calls to find a transporter anymore), better manage patient flows (medical staff knows exactly when a patient arrives) and have a clear view on their budget to better control it.

For medical transporters, Ambler brings them more rides, optimizes routes and avoids empty rides (vs. only 45% capacity utilization today), and manages invoice payments to make sure they are paid on time.

Finally, for patients, Ambler enables them to easily book their vehicle and have real-time information on their ride in order to have more serenity before and after, and to have high-level services during the trip.

Now that Ambler has started to prove it is creating value, it is defining the most sustainable and fair repartition of that value among stakeholders. Creating and sharing the value is vital for a solution to last and become the reference platform in this market.

Supporting Ambler over this past year helped me to better understand some of the specificities of the healthcare market. It also showed that sometimes you have to overcome your preconceptions and forget about the “classic” recipes in order to succeed.

For Ambler, there is still a long way to go but the company is moving fast to conquer the non-urgent medical transportation market and become the reference in France. And at the end of the day, what a great challenge for young entrepreneurs to contribute to bring efficiency and better service quality to the healthcare market which has too often been left behind by fast-growing startups. I’m looking forward to continuing sharing the path together and seeing Ambler grow.