UK healthtech Cera has pushed back plans to expand to the US as the company looks to become profitable in 2024.
It’s part of a shift in strategy that’s seen Cera focus on the UK and Germany, says founder and CEO Ben Maruthappu, resulting in losses dropping “significantly” this year from highs of £35m in 2022.
Annualised revenue at the company has grown from £178m in 2022 to £275m in 2023, says Maruthappu.
While moving into the black is the key milestone for Cera over the next six months, it’s also planning on investing in other healthtech startups for equity, as it looks to expand its elderly at-home care offering.
Dialling back international expansion
Cera helps elderly patients and their carers manage at-home healthcare via an app where users can log symptoms and schedule appointments, as well as a recruiting platform for care providers. The company also employs more than 10k carers directly.
It’s one of the fastest-growing digital health startups in Europe by headcount and has raised over $200m in equity since launching in 2016 — including a £260m round of roughly half debt and equity in August 2022.
Back then, Maruthappu told Sifted Cera would expand into the US and other countries in Europe across the next two years.
But tricky macroeconomic headwinds have delayed plans for global domination. Digital health startups have picked up just $831m so far this year — dropping from $2.5bn across the whole of 2022, according to Dealroom.
“In 2022 our growth plans shifted. At the beginning of the year, tech companies started to drop in valuation, then there was the war in Ukraine, followed by rising inflation and interest rates,” says Maruthappu. “All of that led to a greater market focus on profitability.”
While Cera is still considering expanding to the US towards the end of 2024 or 2025, at the moment it’s focusing on operations in the UK and Germany — where it has single digit market shares. Its earnings before interest, taxes, depreciation and amortisation (EBITDA) was positive in 2023, says Maruthappu.
Cera isn’t alone in dialling back on international expansion plans.
Across a “major readjustment” in 2022, Swedish telehealth provider Kry pulled out of two markets and laid off hundreds of employees as it pushed for profitability. UK-based employee healthcare benefits platform Peppy also made redundancies after struggling to crack the market.
If Cera does launch in the US, the startup will look to licence its platform — as opposed to employing carers directly.
Tech for profitability
Cera has digitised much of the recruitment process — like interviews, parts of training and background checks (although potential carers will still need to visit a physical location once during the interview stage) — leading to a 6x reduction in costs compared to 18 months ago.
That’s mostly down to the speed at which applications are assessed. “Typically in the care sector when someone applies for a job it takes two weeks to receive an offer. At Cera the average is 1.7 days.”
Cera is also using generative AI to simplify care plan preparation — which are based on conversations between medical professionals and patients and can take as long as 12 hours to put together, according to Maruthappu. The startup uses OpenAI’s GPT-4 to convert a conversation recorded on a care assessor’s phone into a care plan automatically, reducing the process to a couple of hours.
“Results [from Cera’s investment in its tech across 2021 and 2022] have really started to transpire in the past 18 months, and our profit per patient visit has increased 10-fold.”
Looking ahead
Cera doesn’t need to raise more capital from investors for growth as it’ll hit profitability next year, says Maruthappu. The startup had £55m cash in the bank at the end of 2022 (some of the £260m round came in early this year) and a similar amount 11 months on.
But it may look to fundraise from existing investors for an acquisition or investing in other healthtechs, he adds.
“Earlier in the year, we mentioned to health startups that we would be open to investing in them [for equity],” says Maruthappu. “We see it as a way to expand our portfolio [of products] and we’re having conversations with a number of healthtech companies.”
Cera will look to increase headcount 50% over the next 12 months — not including carers — from its current 1000 employees, as it pushes for profitability in 2024.
Over the next 12 months, the startup plans to grow its offering for people with learning disabilities and upskill carers to become nurses. It will also build out more products using AI — like patient monitoring, predicting if patients will have falls and whether they are flight risks.
