Investing

Buy-and-build in healthcare technology: ecosystem vs. roll-up

Why PCD chooses an ecosystem approach over a traditional roll-up. The advantages of interoperability over consolidation.

By Niels Roest 7 min read
Strategy

Two models for growth in healthcare technology

In the world of healthcare technology, investors face a fundamental strategic choice. The market for digital healthcare is growing exponentially – driven by an aging population, workforce shortages, and increasing regulation around digitalization. But how you build scale as an investor makes the difference between sustainable success and costly failures.

The first model is the traditional roll-up: acquiring companies, merging them into a single platform, and consolidating into one entity. The goal is economies of scale through centralization. Overhead is reduced, systems are integrated, and a single brand with a single offering emerges.

The second model is the ecosystem approach: connecting companies while they retain their unique strengths. Each participant operates autonomously, but is linked to the greater whole through open standards and shared infrastructure. The goal is economies of scale through collaboration.

Both models pursue growth and market position. But the underlying philosophy differs fundamentally – and in healthcare, where specialization and trust are crucial, that philosophy has far-reaching consequences.

25

Companies in the ecosystem

Source: PCD ecosysteem-strategie

1

Connected ecosystem

Source: PCD ecosysteem-strategie

€50M+

Investment strategy

Source: PCD investeringsstrategie

The limitations of the traditional roll-up

The traditional roll-up strategy has proven its value in sectors such as telecom and retail. However, in healthcare technology, these trajectories often stall due to sector-specific challenges that fundamentally undermine the business case.

1. Cultural integration challenges

Healthcare technology companies are often founded by professionals with deep domain expertise – physicians, nurses, mental health specialists. A forced merger leads to loss of culture and departure of key figures. Research by McKinsey & Harvard Business Review shows that 60-70% of mergers in the technology sector fail to realize the expected synergy value, partly due to cultural friction.

2. Loss of specialized knowledge

An EHR vendor for mental healthcare has different domain expertise than a scheduling tool for long-term care. During consolidation, this specialization is lost. The result: a generic platform that is not the best solution for any target group. In a market where healthcare organizations increasingly choose best-of-breed, that is a risky position.

3. Forced platform migration

In a roll-up, clients are often forced to migrate to a single central platform. In healthcare – where systems are deeply intertwined with daily workflows – this leads to months of disruption, frustration among end users, and in the worst case, client attrition. Healthcare organizations that have just invested in an implementation are not eager to make a mandatory switch.

4. Interoperability is lost

Paradoxically, consolidation often reduces interoperability. Where individual companies communicated with the broader healthcare landscape via open APIs and standards such as FHIR and HL7, a closed mono-platform actually creates new data silos. This contradicts the direction prescribed by the Wegiz and the IZA.

The consequence: high integration costs, loss of client trust, and a product that no longer optimally serves the market. In a sector where trust and continuity are essential, that is a high price to pay.

Our approach

The ecosystem approach: stronger together

PCD CareHub has deliberately chosen a fundamentally different strategy. With the CareHub ecosystem, we are building a network of 25 complementary healthcare technology companies that together form a complete digital care hub – without losing their identity.

How does the CareHub ecosystem work?

01

Autonomy with connectivity

Each company in the CareHub ecosystem retains its own brand, culture, client relationships, and product vision. A mental health specialist remains a mental health specialist. A long-term care scheduling expert remains exactly that. But behind the scenes, they are connected via standardized APIs and open standards such as FHIR and HL7, enabling data to flow seamlessly between systems.

02

Shared services and governance

Where individual healthtech companies struggle with compliance (GDPR, NEN7510, Wegiz), the ecosystem offers shared services for governance, legal affairs, information security, and quality management. This lowers costs and raises the compliance level for all participants.

03

Complementary value creation

Instead of competition within the portfolio, PCD deliberately selects complementary companies. An EHR vendor, a teleconsultation platform, a scheduling solution, and a client portal strengthen each other’s value proposition. Together, they offer healthcare organizations an integrated suite that no single company can deliver alone.

This approach directly aligns with PCD’s investment strategy: buy-and-build with respect for entrepreneurship, strengthened by the power of the collective.

25 companies, 1 ecosystem

Together they form the digital backbone of the Dutch healthcare chain.

Benefits for all stakeholders

The ecosystem approach creates value for every party involved. Unlike a roll-up – where value creation is primarily focused on the investor – in an ecosystem, everyone benefits.

For healthtech companies

  • Access to a broader ecosystem and client base
  • Shared infrastructure for compliance and governance
  • Preservation of own identity, culture, and product vision

For investors

  • Diversified portfolio with lower concentration risks
  • Lower integration costs and risks compared to consolidation
  • Network effects that increase the value of each participant

For healthcare organizations

  • Best-of-breed solutions that work together seamlessly
  • Freedom of choice without interoperability issues
  • A single point of contact for a complete digital care landscape

For patients and clients

  • Better integrated care through data exchange between systems
  • Greater control over their own care journey via client portals
  • Faster access to care through more efficient processes

The result is a positive spiral: the more companies join the ecosystem, the more valuable it becomes for all participants – a classic network effect that is absent in a traditional roll-up.

The future: from consolidation to collaboration

Wegiz and IZA as catalysts

The Dutch Electronic Data Exchange in Healthcare Act (Wegiz) and the Integrated Care Agreement (IZA) make interoperability no longer optional, but mandatory. Healthcare systems must be able to exchange data via open standards. This makes the ecosystem approach not only strategically attractive, but also future-proof – it is the direction the government prescribes.

Market trends confirm the ecosystem thesis

Internationally, we see a shift from closed platforms to open ecosystems. In the fintech sector, open banking has demonstrated how interoperability accelerates innovation. In healthcare, the same movement is unfolding: healthcare organizations no longer want vendor lock-in, but flexibility and freedom of choice. Platforms that fail to deliver this are losing ground.

PCD’s vision toward 2033

PCD CareHub aims to have built an ecosystem of 25 complementary healthcare technology companies by 2033. Not as an integrated mono-platform, but as a network of specialized solutions that together form the digital backbone of the Dutch – and ultimately European – healthcare sector.

Why the ecosystem approach wins:

  • Regulation: Wegiz and IZA mandate interoperability – ecosystems are inherently designed for this
  • Market preference: healthcare organizations increasingly choose best-of-breed over monolithic suites
  • Innovation speed: autonomous companies innovate faster than divisions within a centralized organization
  • Talent retention: entrepreneurs and specialists remain engaged longer when they retain their autonomy

The future of healthcare technology is connected, not consolidated

PCD CareHub is building the ecosystem that digitally connects Dutch healthcare – company by company, standard by standard.

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