Show Notes

The COVID-19 pandemic has helped to shine a light on the need for telehealth platforms. One startup that is striving to fill the void in the market is MediQuo, which is based in Spain. MediQuo is aiming to increase doctor efficiency and patient access with asynchronous healthcare consultations via both a 24/7 instant service and a SaaS platform.

MediQuo co-founder and CEO Bruno Cuevas joined startup coach Roland Siebelink this week on the Midstage Startup Momentum Podcast to discuss the state of telehealth and the services that MediQuo brings to the table. They also discussed the process of getting MediQuo off the ground and Bruno’s key learnings along the way.

• How MediQuo has attempted to solve a two-sided marketplace with different experiences for both patients and health professionals.
• The value of earning trust in the marketplace.
• Why Bruno regrets not trying to monetize MediQuo sooner.
• Why it can be a good idea to extract value once you’ve started to deliver it.
• Useful fundraising methods outside of the venture capital route.
• Why your customers are sometimes the best source of financing.

Transcript

Roland Siebelink:Hello, and welcome to the Midstage Startup Momentum Podcast, my name is Roland Siebelink joining you from San Francisco, California today. And with us is Bruno Cuevas, the CEO of MediQuo, joining us from Bilbao in Spain. Hello, Bruno.

Bruno Cuevas:Hello, Roland. Nice to meet you. Thanks for having me here.

Roland Siebelink:It's such an honor to have you on the podcast. MediQuo, quite a compelling company already. Tell us what you do, for whom, and what difference does MediQuo make in the world?

Bruno Cuevas:Mediquo is at its core a healthcare communication platform. MediQuo is based on two main pillars. The first one is that three out of our medical consultations don't need to be taken face to face. When we say face to face, this means neither physically nor video meetings. And the other main pillar is that in the geographies that we are operating in - that is mainly, as of today, Spain and Latam - most health professionals are already using instant messaging platforms, such as WhatsApp, to communicate with patients or other health professionals. In countries like Spain, around 60% of the professionals who are doing so. In countries like Brazil, the percentage elevates to 90% of the health professionals using WhatsApp for health purposes. And with MediQuo, what we try to offer is a data-compliant platform. But at the same time, allowing privacy for health professionals, plus all of the telehealth platform specials that you need. It's patient management. More efficient communication through automatic follow-ups. Of course, prescriptions and payment gateways et cetera, et cetera. But the two main differences that we have from most of the telehealth competitors is that we are chat-based. Our approach is to start with chat. And it's going to be the health professional, the one who decides later on whether it's needed to go to a video or audio.

Roland Siebelink:Interesting. Okay. Let's talk about that a little bit. The typical paradigm in telehealth, I think, is to start with the video call. What makes you look at this from a different angle? What value is that providing?

Bruno Cuevas:If you look at the value that the video call is providing, there is some value, of course. You're taking out the commute of the patient to the health practitioner. But if you look at it closely, this is only based on a pure legacy. We're doing so because we used to see each other face-to-face. If you put yourself in the skin of the health professional, you're actually getting the worst of both worlds because you still are dependent on an agenda-based system, and it's actually the patient who is deciding on that agenda and on your time. And at the same time, you're not getting the ability to explore that patient. For the health professional, it's actually the worst of both worlds. But then when you look into instant messaging as a base - it's asynchronous communication. The sender and the receiver don't need to be at the same time. When you translate that kind of communication into health care, it means continuity of care. In a natural face-to-face consultation or by video, once that consultation is over, the patient is lost and you need to reactivate somehow inorganically, whether that's a follow-up call, the patient has to activate themselves through a booking or whatever it is. Whereas in an asynchronous system, such as this one, your patients are always there latent, waiting for you. When you look at it from a cost perspective on the financial perspective, you can attend six times more patients in the same amount of time.

Roland Siebelink:Right. Because of the many conversations going on at the same time.

Bruno Cuevas:Yeah. You can go in parallel. And what this allows - other than the filtering of those that actually need to be present or on video - it also allows the professional to have a bigger portfolio of potential clients. Therefore, a higher monetization potential.

Roland Siebelink:How does that break down in how many patients, how many doctors do you have on your platform already?

Bruno Cuevas:We have more or less 40,000 monthly active people on our platform. When it comes to the professionals, we have over 1,500 professionals with our platform. But here I should explain what our main two business lines are. The first one is what we call 24/7 instant service. And the second business line is the SaaS platform. 24/7 instant service means that we are providing value to the patient that downloads the MediQuo app with instant response from health professionals. And please note, it's not only doctors but psychologists and nutritionists, even pharmacists are part of the potential spectrum of professionals using the platform. In that business line, it's the patient or an entity on behalf of the patient who is paying for this premium service. If it's the patient out-of-pocket money, it's a B2C approach. If it's your employer, then it's a corporate benefit, it's a B2B2C approach. That's the first line. And basically, the patient has a Spotify kind of model. They can use it as much as they want. And we are paying for the digital consultation in the back. The second business line is our MediQuo Pro SaaS platform. And here, we are reaching out either to health corporations - and we're talking about private hospital groups, insurance groups, pharma companies, or even public health administration - that want to give out this platform to their health professionals. Or we can also go directly into the individual health professional that has their own practice and they want to use something else. It's a B2B2C option. In the end, we are giving out a differential experience to the end user. The patient has their own end-user experience. The professional has their end-user experience. But all of the agents in the ecosystem - the ones we mentioned: insurance, pharma, private hospital groups, public health administration - all of these have a place to be within MediQuo. It's all about who's paying for the party in the end.

Roland Siebelink:Very good. It's a platform business model where you bring providers of different kinds with patients of different kinds. What many founders have asked us in the past, how do I get that ball rolling? When you have a platform, you have a two-sided marketplace, if you will. What's been your experience there? How has MediQuo solved part of that challenge?

Bruno Cuevas:What we did is - if we look at two times two matrix in terms of the 24/7 service, the telehealth SaaS platform, and then if you go straight to the final end user, the B2C, either patient or professional, or the B2B - what we did is we started with a 24/7 service to the end user to the patient. What happens here, you can achieve through marketing and performance marketing, you can achieve high volumes of downloads. Of course, if the service is good, you get good ratings, you get the consultations going. And you basically kickstart with higher volumes. There's an investment over there. But then what you achieve is trust from the market. You achieve the trust that downloads the ratings, but you're not really achieving the margins. It's a bit difficult in that particular space to make a huge profitable business. I don't know any single player who has actually achieved this properly. When you have that and you have the trust, then you can move and go and start selling B2B. That's been our play. And this 24/7 service, once you move into a B2B approach, then you can go volume based. You're separating the buyer from the user. Therefore, the usage decreases and you get better conversions, better returns.

Roland Siebelink:What have been some of those things that you thought would have come easier or where you had to learn something to take a different approach. It's a common thing in startups, right, so that's why I always ask for it.

Bruno Cuevas:I think we should have started to monetize earlier. We've had some quite big freemium options, maybe more than we should have. Here the learning for us is once you're delivering value, you can also extract. Don't be too afraid to extract the value. That's something that I think is relevant.

Roland Siebelink:Can you expand on that a little bit, if you will ,Bruno? What was the fear?

Bruno Cuevas:Well, not really the fear. When we started, we started with this 24/7 to the end patient. And we were really looking hard to find what's the best way to make this as profitable as possible. We understand that this is going to be most likely a zero-profit segment. Let's also move into the B2B faster so that we can obtain the maximum value out of both worlds. Because the value in that segment was not that much the margins, but it was the great trust that was brought. And then also it's about understanding what is the best approach regarding your product portfolio - you want to call it - to your users. We started mobile only for the patients. That was we believe the right approach. When it comes to professionals, we also started mobile first - not only, but mobile first. And I guess looking back, this is something that, depending on who your audience is, you need to challenge. We are mobile and web based for professionals. But in the countries we're operating in, it seems like web-based is mostly used.

Roland Siebelink:I see. Because people consider it part of their professional work, right off the job, the desk work.

Bruno Cuevas:Exactly. It's their workstation, if you want to call it. Having mobile is very nice to have, and you can become a mobile health professional. Fantastic. But don't neglect that the reality of their world is probably the workstations. We have both, but in hindsight, maybe we should have started web.

Roland Siebelink:I wondered since you just raised Series A, you did say one of the concerns of launching the 24/7 platform was that it wasn't going to be a profitable operation. I believe you got your financing from European investors mostly. Do you feel that this might've been a different calculation if you would have been a Silicon valley company?

Bruno Cuevas:It's difficult to say. When you go into Silicon Valley, normally the investments - the little experience I've had - is that they want to see that you have proven that you are able to raise in your own country first. That's one thing. Some will say that you need to look for the money where the money is. Of course, it's over there. It's two views that are opposing each other. This last investment round - and I can give a bit of my own personal thought because it's not that easy many times, if you want to go the venture capital way. What we achieved in this last one was a mix of crowdfunding plus venture capital plus individuals joining to come in. When you're looking at this - most of my experience is in Europe. What we do see is that in venture capital, there's many pieces of the puzzle that need to sync. You need to have the size and maturity of the company that needs to match this venture capital that wants to join in with a sweet spot in terms of ticket size, plus what is the vertical investing in, geography, et cetera. Then you need to also prove the traction in terms not only of KPIs but of monetization. Many like to say that monetization is not important. Well, I guess it's not important if your KPIs are astonishing. If you're growing but not in unicorn mode, then monetization KPIs come into place normally. That's something that you need to be aware of. Of course, you need to have an understanding that you are in the right market with the right opportunity size. Then you need to have the right team in place. That's very, very relevant. And then on top of this, the cap table of the company needs to solve certain requirements. To go into venture capital fundraising, you need to be pretty sure that you are matching the criteria. And if you're not matching, there's something that really exceeds and eliminates the red flags in the others. In our case, we just managed to close a round. But it was tough. Everybody from the outside here, it's tough. Not until you actually live it do you really understand how tough it is.

Roland Siebelink:Absolutely. Some markets are so much easier than what it actually feels like. That's been most people's experience. Has the pandemic had a negative or positive effect on your business model and your fundraising efforts?

Bruno Cuevas:I would say it has had a mixed effect. Definitely COVID has put e-health in the radar for everybody. This is good and bad. It's good in many ways, especially commercially speaking, when you're trying to sell your product and services, you find that what was important before becomes urgent now. When COVID struck really badly and everything actually collapsed, everything collapsed. Nobody had time for even considering new telehealth providers. People were, as they should, taking care of the situation. When things calmed down a bit, then it's when you start having nice and fruitful conversations. What COVID has also brought is many players coming into the business. Or existing players who were doing adjacent stuff are now adding e-health possibilities. This has increased competition. Then also, at the same time, having higher visibility and understanding, then down the road, there will be some consolidation happening. Well, you get higher exposure to this potential consolidation. Overall, of course, for telehealth, it's been very, very positive. But it is also true that the competitive landscape is now more complex.

Roland Siebelink:Exactly. What would you say in the last few minutes, what have been your key lessons learned that you would like to impart on other entrepreneurs coming behind you?

Bruno Cuevas:We've already talked about extracting value. It's not only good for the business, it's good also for the occasion of your users. That's something that I would encourage quite a lot. When it comes to financing your business, the best finance comes from your own clients. I guess we are obsessed with investment rounds. I guess there's a huge hype when it comes to venture capital. It's great. It's one of the options. But there's many others. There's not only venture capital, there's venture debt. There's crowdfunding. There's ways to go with institutional investors. There's many ways that you can - revenue-based financing. If you are a founder, if you have not done this before, Inform yourself first. What is the best option for your particular situation?

Roland Siebelink:I like that you link that to the growth prospects as well. Depending on your attraction KPIs, some options may open up or close down for you.

Bruno Cuevas:Yeah. There's huge companies that have gone really far with very, very low investment levels because they found a way that really worked for them. And you see then unicorns where the founders are in possession of more than 50% of the company. This looks impossible on a venture capital approach.

Roland Siebelink:Or indeed like the other side where a company did okay but not that great and had to raise six, seven, eight rounds of capital, and then it's an IPO and the founder is left with less than 1% at that stage. You also have to then look at how interesting this is in the end.

Bruno Cuevas:Exactly. The best financing comes from the money of your own clients.

Roland Siebelink:What, if anything, is there a lesson learned about the person of the CEO and the person of the startup founder? Did you get some personal lessons to impart to others?

Bruno Cuevas:It's an emotional roller coaster. Be prepared for that. I guess it's not meant for everybody. You need to be aware that there's days that you think you're going to conquer the world and there's days that you are actually thinking, "How can I pull this off?" And this is a constant. It will happen several times during the week. Be prepared for that.

Roland Siebelink:What do you do in that case, Bruno? What's your coping mechanism when you feel down or you feel like, "Oh, it's not a good moment." What's the way to get out of that?

Bruno Cuevas:Normally, you need to be in business with people you can talk these things through. And that's quite relevant. You need to be surrounded with people who actually understand these things. If you have friends or partners who are not in this world, they will not be able to really understand. Get either business partners or close friends that are doing similar stuff and who can relate and that will help quite a lot.

Roland Siebelink:Okay. Very good. Coming back to a positive note, where do you see MediQuo in five to 10 years from now? How big could this become? And what kind of investors would you like to see join the company at some point in time?

Bruno Cuevas:Where I see Medico in five years time, things are changing very, very much. And the potential is huge. Things that could happen is that MediQuo, we do things right and we grow big time, and that would be a great scenario. There's also chances that down the line there's going to be interesting consolidation opportunities. And that's something that would have to be explored if it happens. When it comes to investors coming in, I would say that this model, when the traction, the monetization is completely proven if taken by a big industrial player who can actually distribute it properly amongst the different countries or segments, that could take this project to a whole new level. I guess we are open to where we can be. I think that's the right approach. The geographies we have, we have decided to go first, which is Spain and Latam. There's a reason for it because it's still up for grabs to telehealth. But we do believe we're doing something differential and it has a valid market fit in most of the countries. Let's see where it takes us and we'll be pushing.

Roland Siebelink:Excellent. Well, this was an amazing conversation, Bruno Cuevas. I'm so happy that you joined us, the CEO of MediQuo. Bruno, if people want to find out more about MediQuo, where should they go and what should they download?

Bruno Cuevas:If they want to visit our website, it's mediquo.com. If they want to use us, then you have to go to the Apple Store or Google Play and download the patient app MediQuo. If you're a health professional and you want to use MediQuo Pro, go to the app store or to our website and you can actually do it also from the website. That would be it.

Roland Siebelink:Very cool. And if investors, of course, are interested in hearing more about MediQuo, then I'm happy to provide an introduction to Bruno as well. Thanks once again, Bruno Cuevas, the CEO of MediQuo, for joining us in the Midstage Startup Momentum Podcast. This was a true honor.

Bruno Cuevas:Thank you, Roland. Pleasure to be here.

Roland Siebelink:Thank you so much.

Roland Siebelink talks all things tech startup and bring you interviews with tech cofounders across the world.