Joe Kaeser, President and CEO, Siemens AG
Dr. Ralf P. Thomas, CFO, Siemens AG
Dr. Bernd Montag, CEO, Siemens Healthineers
Dr. Jochen Schmitz, CFO, Siemens Healthineers
Michael Reitermann, COO, Siemens Healthineers
Barbara Humpton, CEO, Siemens USA
Heribert Stumpf, CFO, Siemens USA
David Pacitti, President, Siemens Medical Solutions USA, Head of Siemens Healthineers North America
NO. OF EMPLOYEES: 48,000 (372,000 total)
GLOBAL HEADQUARTERS: Munich, Germany
Valued somewhere in the neighborhood of $38 billion, it could be the largest initial public offering (IPO) that Europe has seen in a long time.
German conglomerate company Siemens AG has not been secretive about its plans to spin off its Healthineers business. As far back as November 2016’s earnings call, Siemens CEO Joe Kaeser was teasing investors about faster growth ahead, voicing plans for the healthcare business to be separately listed on the stock market and give Healthineers “even more focus and flexibility in pursuing its growth strategy.” The titillating announcement, however, was somewhat shrouded in mystery as Kaeser offered no other clarifying details about the IPO.
The intent to spin off Healthineers is the latest in Siemens’ “Vision 2020” entrepreneurial plan, which has manifested in a pruning of its core business focus over recent years. Part of the scheme leans on the company’s success from a strong presence in, as Siemens refers to it, the “electrification, automation, and digitalization” value chains it so eagerly pursues.
Though the eager upstart healthcare company is ambitious, Healthineers has needed to exercise some patience before setting out on its own. Siemens declared there would be a delay in Healthineers’ IPO in 2017, predicting it to take place during the first half of 2018. (Editor’s Note: No news in that vein has come to light so far.) This postponement was due, in part, to a controversy about four Siemens gas turbines being illegally moved to Crimea, according to Reuters.
“Everything is not perfect at Siemens,” Kaeser told reporters on an August 2017 conference call. “The Crimea affair has cost us much time and effort. We have to ask ourselves what this means for our future business processes and relationships.”
ANALYST INSIGHTS: Now that Siemens has formally spun-off its medical business as “Siemens Healthineers,” it should give the Siemens leadership team the ability to have more flexibility to be more aggressive and opportunistic relative to strategic acquisitions. It will be interesting to observe as Siemens decides “what they are” and “what they are not.”
—Dave Sheppard, Co-Founder and Principal, MedWorld Advisors
As the global healthcare market continues to shift from Siemens’ core imaging business to molecular diagnosis (a Healthineers business focus) and self-management, Siemens believes it prudent for Healthineers to have its own currency for acquisitions and investments. There was no list of M&A targets as such, however, according to Siemens board member Michael Sen.
“The equity story begins with a highly attractive portfolio, which we already have,” he told Reuters.
That attractive portfolio may find a home in the U.S., according to Sen. Siemens has thus far not disclosed where it intends to list Healthineers, but the company already has a strong presence in the market with Siemens USA and Healthineers North America.
“Most peer group companies...are listed in the U.S.A.,” he told reporters. “One has to ask where will one get the best research and coverage...and sufficient market-making capacity and liquidity.”
Healthineers’ trading debut transpired in Frankfurt, Germany, this past March. The company ended up raising $5.2 billion in its 15 percent stake IPO, according to Bloomberg Business. The minority stake offering represented Germany’s second-largest IPO in almost two decades, trailing RWE AG’s green energy business Innogy SE in 2016. Investors ended up shelling out 28 euros for each of 150 million shares—a price firmly situated in the bottom half of the 26 euro to 31 euro range previously marketed by banks.
The 28 euro price values Healthineers at an estimated 28 billion euros ($35 billion), well down on analysts’ initial expectations of 35-40 billion euros. Investors cited dubious prospects for Healthineers’ diagnostics business (machines for high-throughput blood and urine testing) and increasingly volatile markets as factors responsible for the lower-than-expected valuation.
Despite those ominous portends, the global diagnostic imaging, laboratory diagnostics, software solutions, and clinical consulting services provider achieved fiscal year 2017—ended Sept. 30—sales of $16.3 billion, a moderate 7.2 percent increase over the preceding year. In fiscal 2017, the Healthineers business was organized into six franchises: diagnostic imaging, laboratory diagnostics, advanced therapies, ultrasound, point-of-care diagnostics, and services. The firm’s growth was largely driven by the Latin America and Asia, Australia, and China markets—in fact, China accounted for over half the revenue boost year-over-year on a geographic basis. In contrast, market volume in Europe and the United States remained close to prior year levels.
Healthineers’ diagnostic imaging business led the charge of the company’s profit growth. The diagnostic imaging segment continued to account for the largest share of Healthineers’ overall profit—demand for imaging procedures continued to grow, though the gains were somewhat offset by price pressures on new purchases and increased utilization rates for installed systems.
Apart from increased sales, Healthineers’ diagnostic imaging portfolio was fortified by new offerings in computed tomography (CT), positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), and corresponding accessories and enhancements to these machines.
December 2016 saw FDA 510(k) clearance for the SOMATOM Confidence RT Pro CT scanner with features dedicated to radiation therapy (RT) planning. The CT scanner delivers radiation therapy images that facilitate precise contouring as well as personalized dose calculation. SOMATOM Confidence RT Pro’s DirectDensity algorithm can reconstruct images where values can be interpreted as showing relative electron density at any kV setting. The CT scanner is complemented by the syngo.via RT Image suite, which integrates image assessment, contouring, and patient marking features.
Healthineers won two FDA nods for MRI technologies in February 2017. The MAGNETOM Sempra MRI system arrived first, a 1.5 Tesla, 60 cm MRI system distinguished by low operating costs and a full-coverage service contract to help healthcare institutions operate profitably despite rising cost pressures. MAGNETOM Sempra can be automated to streamline workflow for brain, spine, and large joint procedures, with exams performed in 10 minutes. About a week later, the FDA cleared Healthineers’ Compressed Sensing technology, which uses iterative reconstruction to produce high-quality MR images at a rapid rate (it reduces cardiac cine imaging from the traditional four minutes to 16 seconds) with no diagnostic information loss.
Compressed Sensing technology is able to slash long MRI acquisition times in this way thanks to fewer data points, enabling cardiac patients to access cardiac MRI for the first time.
April 2017 produced two more FDA nods. The unveiling of High Definition Breast Tomosynthesis built on Healthineers’ established DBT platform, then boasting the industry’s widest tomo sweep of 50 degrees and the first technology approved for 3D-only mammograms. It incorporates EMPIRE (Enhanced Multiple Parameter Iterative REconstruction), a combination of iterative and machine learning algorithms that produce a clear, concise 3D reconstruction. It also includes Insight 2D and 3D, the industry’s first synthetic software-generated visualization of tomosynthesis volumes in both 2D and 3D. Five days later, Healthineers won FDA clearance for the SOMATOM go. CT platform, which includes the 32-slice SOMATOM go.Now and the up to 64-slice SOMATOM go.Up CT scanners. Each can be controlled via tablet and remotely to increase patient interaction, and the platform’s single-room concept enables lower installation cost and a smaller, more efficient footprint.
Healthineers ramped it up a bit in June with three new FDA clearances for diagnostic imaging products and accessories. First came the release of syngo.via VB20 for Molecular Imaging (MI), the latest in the company’s intelligent visualization software for multi-modality imaging. syngo.via VB20 for MI touts multi-foci segmentation for PET and single-photon emission computed tomography (SPECT), allowing automatic calculation of the patient’s whole-body tumor burden. A few days later, the Biograph Horizon Flow edition PET/CT system with continuous bed motion scanning capability was cleared. This feature permits personalized exam protocols based on patient anatomy, which can be configured based on the radiology department’s most commonly scanned indications. A few days after that, the MAGNETOM Vida 3T MRI system achieved an FDA nod. MAGNETOM Vida comes equipped with BioMatrix sensing technology, which automatically tracks breathing patterns to formulate an optimal exam strategy and boosts whole spine diffusion imaging by way of individual slice adjustments that mitigate image distortion.
In September, Healthineers launched TrueFusion, a cardiovascular application that integrates advanced ultrasound and angiographic imaging to improve navigation and guidance during structural heart disease interventions. The tool was made available for the ACUSON SC2000 cardiovascular ultrasound system and works to facilitate better communication between echocardiographers and interventionists as well as reduce contrast usage and procedure time as well as patient and clinician X-ray exposure.
Healthineers’ laboratory and point of care (POC) diagnostics businesses were also buttressed by several product debuts throughout the fiscal year, but the POC segment was the forum for most of the company’s merger and acquisition activity.
The company closed its acquisition of Conworx Technology GmBH in late October 2016. The Berlin-based POC device interfaces and data management solutions firm’s claim to fame—its suite of UniPOC and POCcelerator solutions—was deemed an excellent fit to complement Healthineers’ RAPIDComm Data Management System. The Combined Siemens-Conworx suite opened connectivity to over 100 different POC instruments from all major manufacturers. Conworx’s team of 75 employees merged with Healthineers to become Siemens Healthineers Point of Care Informatics, a team of interface development, application development, and data management specialists led by Conworx CEO Roman Rosenkranz.
Last July, the company also entered an agreement to acquire Epocal, a subsidiary of Alere (now owned by Abbott Laboratories). The developer of POC blood diagnostic systems for healthcare enterprises most intriguing product, the handheld, wireless epoc Blood Analysis System, endowed Healthineers with a complete set of blood gas diagnostics offerings ranging from a low-volume, single-use device to a high-volume, multi-use benchtop solution. And although the transaction was subject to the completion of Abbott’s tumultuous Alere acquisition, it closed without any ado last Halloween.
Healthineers’ POC diagnostics business achieved its first 2017 fiscal year FDA clearance in October 2016 with the introduction of the Xprecia Stride portable, handheld coagulation analyzer. Xprecia Stride provides fast and reliable Prothrombin Time International Normalize Ratio (PT/INR) testing at the point of care for management of oral anticoagulation therapy with warfarin. It touts features including an integrated bar-code scanner, hands-free strip disposal, and intuitive navigation, and was the first POC PT/INR device cleared based on new rules for regulation of such technologies developed in March of that year.
A month later, the company launched its Atellica PM 1.0 software to simplify laboratory operations with a customizable process management solution that enables labs to oversee process data for automation systems, IT, and connected instruments. The software’s customizable alerts and exception management procedures allows labs to receive instantaneous alerts for at-risk samples, and assesses key metrics like turnaround times and testing volumes in real time. Atellica won CE mark clearance last September, opening it to global commercial availability.
With an estimated 150 million people chronically infected worldwide, HCV infection is a serious public health issue. To aid in the growing threat, last March, the company’s VERSANT HCV Genotype 2.0 Assay (LiPA) was awarded FDA premarket approval. The assay permits accurate HCV genotype and subtype identification, guiding selection of optimal treatments for Hepatitis C patients. VERSANT HCV’s single-step RT-PCR kit can be used on commonly available thermocyclers to increase lab efficiency as well.
Healthineers’ only advanced therapies product unveiling came with last March’s clearance of ARTIS pheno, a robotic C-arm angiography system for minimally invasive interventional procedures. ARTIS pheno was designed with infection prevention in mind—it comes equipped with an antimicrobial coating on the C-arm surface, the stand, and patient table. ARTIS pheno is mounted on the floor instead of the ceiling, rendering simpler OR installation as well as uninterrupted sterile air flow from the ceiling. The system supports a variety of interventional procedures including stent positioning and transcatheter aortic valve replacement (TAVR).
Healthineers also made a few moves last year to expand its Population Health Management (PHM) portfolio and capabilities. Last April, the company entered negotiations to acquire Medicalis Corporation, a provider of clinical decision support solutions at the point of order entry, imaging workflow management, and referral management. In gaining Medicalis, Healthineers will be able to address the immediate need for consolidating providers to orchestrate and standardize their imaging workflow and to achieve compliance with the Protecting Access to Medicare Act of 2014, which became effective on Jan. 1 of this year. The regulation mandates consultation of appropriate clinical decision support at the point of order for certain advanced imaging tests. Healthineers closed the Medicalis acquisition at the start of last June.
In October 2016, Healthineers began a five year, global strategic alliance with IBM Watson Health that aims to assist healthcare facilities deliver value-based care to patients with complex, chronic, and costly conditions. Healthineers will be able to offer PHM solutions and services from IBM Watson Health, including IBM Watson Care Manager, which integrates disparate clinical and individual data and applies cognitive analysis to elicit insights for nurses and care managers for closer chronic condition monitoring and counseling.
“The adoption of PHM solutions that demonstrate meaningful use of IT applications is expected to accelerate rapidly. Patient care is moving into a broader but coordinated environment where routine, manual tasks are automated by PHM solutions that unify siloed systems, stratify comorbidities, empower patients through engagement, and benchmark outcomes at network, practice, and patient level,” Koustav Chatterjee, Frost & Sullivan Transformational Health Industry Analyst, said at the time of the announcement. “I expect the shift from volume to value-based healthcare delivery will accelerate adoption of PHM technology and service solutions helping providers effectively manage chronic conditions and prevent unnecessary system utilization.”