Digital health is all the rage. In 2019, the global digital health market was worth an estimated $175B. With an expected CAGR of almost 25 per cent from 2019 to 2025, the digital health market should reach nearly 660 billion dollars by 2025, Statista says. No surprise, then, that investors’ appetite in the industry is growing, too: In 2020, funding by investors in the digital health industry totalled $21.6B - the largest amount so far, again, according to Statista.
However, in spite of the hype, challenges unique to digital health are becoming increasingly obvious to many entrepreneurs and investors. Even in Germany, where the Digital Care Act, a new law that makes health apps eligible for reimbursement to the 73M Germans covered by public insurance, so far only 3.700 apps have been prescribed in the first three months of this new act. Not the boom that most expected.
There are various reasons for this slow adoption. One big reason is the unique circumstances that make marketing difficult in this context. Here are some examples:
- Many diseases disproportionately affect older consumer groups who are less amenable to social media
- It’s not just the patients who need to be convinced of the solution, their healthcare providers (doctors, nurses, caregivers, therapists) do, too, since they’re the ones supposed to prescribe the solution
- In most countries, advertising medical products and services are regulated.
- Value propositions are more complicated to convey if they involve medical claims, and not just emotional or operational benefits
- Many people with chronic illness diseases are more disconnected from society and harder to reach
That’s why a thoughtful approach to marketing is particularly important in digital health. Simply copy-pasting approaches from other industries are likely to fail. The effort put into the marketing strategy will be worth it, especially if you manage to reach older patients, who often benefit most from digital health and are increasingly open to digital solutions, especially since the Covid-pandemic (see visual 1). Furthermore, seniors control nearly 70% of all assets in the United States.” according to the US census.
Visual 1: Push of digital health offers for +65 years old seniors in Germany. (Source: bitkom)
But this isn’t just about age. Diseases affect different people differently. Some are more common in elderly, others more common in people with certain jobs or ethnic backgrounds, etc. The key message is that each digital health solution might need a different marketing strategy because they cater to very different people with unique needs.
This is why we as digital health entrepreneurs have adapted the guidance of a much-beloved book called “Traction” by Gabriel Weinberg and Justin Mares to the digital health context. We have tested it and operationalised it in our own digital health ventures - both outside and within FoundersLane, a Corporate Venture Builder with a focus on healthcare innovation. One of the book's key recommendations and learnings is that you shouldn’t over-rely on your intuition and instead work in a hypothesis- and data-driven manner, to find the top 2-3 traction channels that are ideal for your solution in your target market at this specific development stage.
The approach is straightforward: Out of 19 potential traction channels, you can choose the 6 that you think are most likely to be successful.Then test them systematically on a low budget until you find evidence for the top 2-3 that outperform the others. Those are the channels that you should focus on and invest your budget in.
Visual 2: 19 traction channels adapted to digital health - originally by Weinberg & Mares
Targeting blogs There are plenty of blogs out there that are focused on certain health topics. You have blogs for diabetics, blogs for better sleep, blogs for gluten-free nutrition, etc. Blogs that have a good readership can get you a lot of highly relevant eyeballs on your startup in no time. Plus, you can assume that successful blog owners really know their community and target audiences really well so they can find the right wording and angles that will earn the highest interest from your target group. Getting featured on a relevant blog has several advantages:
- you get exposed to the right people who care about your solutions
- you have someone who can help you craft the right message to them
- you benefit from the endorsement by a blogger who has already built up social capital within the target group that interests you.
Be mindful that there are different types of bloggers. You might have patient-facing bloggers, these could be your typical ‘influencers’, often lay people who have been affected by a disease themselves and speak through the lens of a patient. And then you typically have writers who target a professional audience, these are more what the pharmaceutical industry likes to call “Key Opinion Leaders”, they are (outside of their blogs) usually less present on Instagram or Facebook but more active in professional societies and visible on Twitter, YouTube or ResearchGate. So that’s where you should try to find and background-check them, before engaging with them.
Don’t think that you always need to pay them. We’ve received invaluable support for free patient and doctor influencers because they loved our mission and simply wanted to support us because we were contributing to their cause. Sometimes you can barter with reciprocal publication offers (I.e. I publish on your platform, you publish on mine). But even if they charge for a mention, that’s still worth consideration.
Publicity Especially for older populations, traditional newspapers, TV, radio, etc. are often a preferred and trusted source of information. Getting covered, either as a press-mention or by writing your own articles for the press, you can reach relevant people that would otherwise probably never hear of you. However, unlike digital media, mentions in traditional publications fade away quickly as they will rarely be broadcast or published over and over again and they often reach way more individuals than are relevant for your solution. But traditional publicity also adds a lot of credibility.
For this approach, general interest media are just as interesting as health-focused media (WebMD is a good example of a trusted online health magazine in the USA, while in Germany, Apothekenumschau, a print magazine, is by far the most widely distributed medium, especially among elderly). With each publication, you reach a different audience (forcing serendipitous encounters with interested readers) and sometimes get noticed by the same reader in different media (increasing brand trust).
Unconventional PR This one is for the true attention seekers, doing something that is unusual and unexpected to get media attention. Viral videos like the ice bucket challenge, publicity stunts like RedBull’s skydive from space can get a lot of traction but sometimes it’s also the little moments of delight one can create for their customers, e.g. by helping them find an unexpected diagnosis that they otherwise would not have found so fast. Or you can do it like Spring and Clue, who actively contribute to health research together with renowned academic partners and thereby get additional attention in the press. This traction channel can work particularly well in healthcare, where patients often have many unknown unknowns and you can surprise them with simple interventions that make their lives better and the topics are often highly emotional, which is good for headlines.
Search engine marketing (SEM) Here, the idea is obviously to get into a paid advertisement to appear on search engine results. This has always been tricky in healthcare because there are many restrictions, either because of legal constraints or because the platforms like google ban advertising drugs or medical treatments. Plus, with the recent changes, e.g. Apple’s new iOS, truly targeted advertising becomes increasingly difficult (see a Forbes piece on that). Note that in healthcare, there are often professional terms and lay terms, you need to be very conscious about which term you are advertising. For example, if you focus on “heart attack”, you are more likely to get laypeople finding your ad than for the term “myocardial infarction”.
Social and display ads With all the recent iOS updates and restrictions on re-marketing, social and display ads are becoming a difficult channel. They always were in healthcare, however, because health-related advertisements, especially when they include treatments and health claims, are subject to comprehensive scrutiny or simply get blocked entirely. But you can use it successfully to increase brand awareness and clever marketeers, working closely with legal experts can find ways of getting the right message across without infringing on social media platform requirements or laws.
Offline ads These are still well-liked, even for digital products—think billboards and newspaper ads. We’ve had great experiences with funny billboard ads that are tailored to the narratives of our TV- and social media video ads. If you can trigger an emotion with your audience (which should be possible with health-related topics), then you can increase your brand awareness. Public transport billboards can also be good or you can aim to go somewhat more niche by taking it close to where your specific audience might be present: pharmacies, public swimming facilities, or parks, for example.
Search engine optimisation (SEO) Any approach that lets you rank higher on search results for certain keywords without having to pay someone to actively put you on top will make your life much easier, from a regulatory standpoint. In digital health, the challenge is, of course, to choose the right keywords to push. Most startups start in a niche and then expand further, but don’t over-focus on your ‘long tail’ terms for the first disease (like arthrosis, hip surgery, hip joint pain), try to also get associated with some broader terms such as “patient companion”, “patient education” or even digital health. Again, it’s not just about convincing your patients but also the doctors, nurses, and therapists. Terms should be both general and specific, lay-friendly and professional-level (e.g. try to get SEO for myocardial infarction AND heart attack, not just one of the two).
Content marketing Especially in healthcare, it’s super difficult for laypeople to figure out which content is trustworthy, and which one isn’t. People love to google their health problems and double-check what they heard from their doctors. You can quickly provide a lot of value to your customers by becoming that trusted source of surprising and easy-to-understand but well-curated and fact-checked content. Think about involving influential co-authors, like doctors or prominent patients and journalists to further increase the clout of your content. By the way: even if you write primarily for patients—when doctors see you’re doing a good job at it, they’ll take note of it and are more likely to promote you. Patient education is important for their work, too. It is also incredibly difficult, so anyone who can help them on that front is a welcome ally.
Email marketing Sending out beautiful emails and analysing reader behaviour has become fairly easy thanks to the various e-mailing tools like Mailchimp or Activecampaign. But getting the content right can be quite labour intense which is why it is often combined with content marketing. To make your life easier, you can reuse your content, e.g. by emailing your website content before it goes online on your page or by creating a short listicle out of an existing piece. Some newsletters only curate existing content from other relevant news webpages—and create great value for their readers in doing so. Make sure to get very analytical about your user behaviour. We learned in one case that reducing the frequency of the newsletter actually led to higher opening rates! After months of stressing out about creating original content, we ran an experiment with wider intervals and learned that less was truly more in this scenario. If your key audience is elderly, consider sending physical mail rather than a newsletter. At least you could offer the option.
Viral marketing Virality can work wonders for health solutions. Doctors are really well connected and so are patients if they have to go to the hospital or attend group treatment sessions. So if your tool is intrinsically convincing, the word can spread fast on both the sides that are important to you: the patients and the providers. But we do recommend giving this a push, add referral programs and perhaps offer incentives for a successful referral. Just be mindful that in the case of healthcare professionals, financial incentives can quickly lead to compliance problems and might achieve the opposite (doctors becoming afraid of recommending you). So be sure to check all the details with your legal counsel first.
Engineering as marketing This sounds more sophisticated than it has to be. We fared well with creating freebies for our key consumers like offering checklists for patients that would help our prospective consumers prepare for a doctor meeting or how to make sure one can return home after a hip replacement surgery.
Business development Here you can think about teaming up with other players to cross-promote or create joint offerings that benefit both. Those could be other startups that offer services that can complement your solution. For example, if your app focuses on heart disease it might be sensible to think about partnerships with diabetes or mental health app providers. Alternatively, you can aim to work with care providers, such as hospitals and nursing homes, or perhaps medical supply stores might be suitable partners. Insurers might also be interesting traction partners, at least in theory. They typically want to differentiate themselves over their competition by having customer-centric digital solutions that attract and keep interesting insurees (i.e. those who are generally more interested in proactively managing their health). Health warning: Don’t expect fast traction through partnerships with traditional players. It’s not a good idea to get your hopes too high here, but do keep these potential partnerships in mind and invest some time exploring them.
Existing platforms Rather than building your own community from scratch, it might be worth looking at existing platforms. There are many out there, more or less focused on certain diseases or target groups. Most have super strict rules and do not allow any external researchers or companies to engage with their audience. This is mostly for very good reasons: patients need a safe space where they can interact without people constantly nagging them (with ultimately financial motives). So you generally have better chances by looking at communities that are driven by laypeople, patients or relatives (parents of children with chronic disease are often very well connected). These existing communities are frequently part of existing platforms like Facebook. Depending on what age group you’re looking for, some platforms are going to be more valuable for you than others. Facebook, as you can see in the graph below, is generally a better place for older populations. For one of our startups, we found a community of 3500 users with hip problems. The owner of the group was very supportive since he liked our mission and we could help him out by promoting his book on the topic. These types of exchanges are often more fruitful and rewarding than working with large dedicated patient communities with many gatekeepers.
Visual 3: Facebook most used social network for +65 years
Sales Direct sales is a classic approach in healthcare and it has been perfected by the pharmaceutical and medical device industries over the past decades. However, it has become increasingly regulated and most doctors now have sales rep fatigue. Some startups we work with are strong proponents of the direct sales route as the key traction channel for any solutions that needs to be sold to clinics. However, we also hear of many frustrating sales meetings with multiple stakeholders, long sales cycles, and low conversion rates.
Affiliate Marketing This is essentially the idea that other companies receive compensation for generating leads for you. Sounds charming and works well in many industries but here again, you need to check every detail with the lawyers first as you might quickly get into compliance issues and many affiliate marketing services are banning health-related solutions. However, don’t get discouraged too fast. Especially websites with an existing focus on healthcare might be more open to affiliate marketing, especially if it clearly adds value to their audience and is not merely marketing for the good of the affiliate company.
Speaking Engagements Whether free or paid, speaking engagements are a great way to gain traction because it gives a very personal impression of oneself. Whenever possible, try to get a recording or opt for podcasts and VLOGs as they will bring you a larger audience over time compared to an offline one-off speech and you can always refer people to it in the future. Be very mindful of the different audiences you need to cater to. Ideally, you will have speeches that engage patients and others that will be more interesting to doctors, nurses, or strategic business partners.
Trade shows There is an abundance of trade shows in the healthcare industry. This isn’t typically a helpful channel to reach patients but it can be good to find strategic partnerships. There are various healthcare-related conferences, e.g. for orthopaedics or cardiology, then you have events like HIMSS that are more focused on digital innovation in healthcare, and there are also trade events that focus on elderly or caregivers like The Care Show (UK) or REHACARE INTERNATIONAL (GER) - the world’s biggest international fair for rehabilitation and care. We frequently see young startups who feel strong FOMO if they do not purchase a booth at those trade shows. Frankly, these are more often than not too expensive and rarely good value for money. Even after spending thousands, startups will often end up with a not-so-impressive small booth in a corner, which might even do more harm than good in terms of persisting positively in people’s memory. It can be enough to attend the event as a guest or perhaps get a speaking engagement somewhere. Then try to pre-arrange as many meetings with companies, journalists, and influencers that you would like to know you.
Offline events Especially in healthcare, personal interaction can go a long way. There are various offline events that you can attend to meet your target group. Many hospitals, for example, have information evenings around specific diseases. These are typically free to attend and are aimed at helping patients understand their diseases better and show them the treatment options available to them. Attending those has various advantages. You can learn from what topics the speakers focus on, you can learn from what questions are being asked by the audience, and you can directly approach patients after the talk to get more insights and potentially early customers. It’s also possible to launch your own events. We’ve run information evenings for patients ourselves, led by a doctor on our startup team. And then we followed up with user testing sessions to get feedback on our App. It’s quite an effort but can go really well in the mid-term once word spreads and you get larger groups gathering at your events. Offline events can also be nice to get other stakeholders involved, for example, we did a similar information evening for general practitioners interested in getting a ‘kitchen view’ of digital health innovation.
Community building And finally, you can of course create your own community. This can happen through offline events, newsletters, creating your own online forum, etc. Or you can think about adding social components to your digital health solution, which might be a significant value driver for your customers and your solution’s valuation. If you succeed here, you might find yourself having a naturally growing passionate community of loyal supporters. As said earlier, word of mouth is strong in healthcare, especially among doctors as they are typically well connected among each other. However, it will consume a lot of your time since a community needs strong initial activity to be interesting and appear alive. It also requires a lot of moderation and oversight to make sure the content has high quality and is free from uncomfortable speech. Only when it reaches a certain size will it become relevant to users and given that there are so many communities already out there, it might be incredibly hard to make your new community take off.
Visual 4: Idea Brainstorming session with the team along the 19 traction channels
Main takeaways
- Many patient segments are dominated by elderly consumers. Seniors in the digital health area is a growing market segment that is typically considered to be difficult to reach but if done well you can seize a sizeable market with strong needs.
- Given that more and more digitally literate consumers are entering the silver surfer age and that non-digitally native citizens are also increasingly adopting digital technologies, the opportunities for gaining traction among the elderly is growing fast for digital health entrepreneurs.
- When choosing your traction channels, think like a scientist. Don’t jump on your initial preferences, they’re biased and probably don’t fit patient and elderly target groups.
- As you start, try to brainstorm as creatively as possible on how you could turn each of the listed traction channels into reality for your specific case. We hope that our examples serve as inspirations, however, they should not constrain your thinking.
- Document and structure your ideas in an actionable and measurable way. In the end, it is not about your gut feeling but about validating or falsifying hypotheses. See also visual 5 as an example of how you can document your experiments.
Visual 5: Example: How we applied the framework in practice to our ventures
- Test cheap. You shouldn’t spend more than a few hundred on each channel at first. That should be enough to gain insights on potential leads generated etc.
- Once you’ve tested the different channels systematically, you should arrive at 2-3 core traction channels that really drive your growth. Double down on those and explore where you find synergies between them. What channels fly is highly case dependent.
- Once you found them, stick to them but keep challenging yourself. As your solution matures, your target groups might change. Or your growth might stagnate in one target population because you are reaching a saturation level—if you then need to target other types of people, you might need a different traction strategy. Simply repeat the ideation and testing process.
- Health Warning: Advertising and marketing in healthcare always require close conversations with legal experts. You’ll be surprised how much more it is regulated than other industries—and how much you can do if you’re smart about the constraints.
Tim Bogdan is a digital health entrepreneur and former Venture Development Lead - Health at FoundersLane. His passion and focus are on building digital ventures in the health space — for example, alley.de. Currently, he is active as a co-founder of an elderly care startup with the mission to simplify access to care services. In his previous roles, he founded the b2b marketplace Frescue in the sustainability space and was working in digital innovation as a strategy consultant, chief of staff to the management board of a global professional services firm and project lead in an innovation lab.
Dr Sven Jungmann is a doctor-turned-entrepreneur. He is a partner at FoundersLane and an advisor to health startups and investors. Handelsblatt listed him among Germany’s smartest innovators. Sven consults various startups including Wellster Healthtech, a hugely successful D2C healthcare startup in Germany and Halitus, a breath analytics solution. He also founded an award-winning company that gamifies medical education.
