00:00:00
Voice-over: "Cent Jours pour Réussir" is the podcast from G_NIUS, the Guichet National de l'Innovation et des Usages en e-Santé. Around Lionel Reichardt, meet e-health innovators and key experts to help you succeed in your projects.

00:00:20
Lionel Reichardt: Hello everyone and welcome to the "Cent Jours pour Réussir" podcast, aimed at innovators and entrepreneurs in digital healthcare, but also at anyone curious about this field. The podcast is produced by G_NIUS, the Guichet National de l'Innovation et des Usages en e-Santé. In this episode devoted to international development, we talk to Eric Carreel, Chairman and Founder of Withings, a company specializing in the remote measurement and collection of physiological data using connected health devices. We also welcome Lorena Cabrera, head of the health and cosmetics department at Business France, a structure that notably helps companies' international development and exports. Eric Carreel, hello and thank you for accepting our invitation. Could you tell us a little about your background and training?

00:01:10
Eric Carreel: Hello, I'm the son of a Picardy farmer who loved agricultural machinery more than farming, so naturally I became an engineer. That's where I met Jacques Lewiner, who fascinated me with electromagnetism and radiocommunications. I did a thesis in this field at the Laboratoire d'Electricité Générale de l'ESPCI. I did research in this laboratory for quite a few years and then, with Jacques, I co-created a first company called Inventel which was in this field of radiocommunications and little by little, but that's something I'll perhaps tell you about later, we moved on from radiocommunications to healthcare.

00:01:46
Lionel Reichardt: Effectively, you're a serial entrepreneur. You founded Withings in France in 2008. Can you tell us about it?

00:01:53
Eric Carreel: Withings was originally a company that wanted to make connected objects, and today has a new line of conduct, which is to become the provider, the supplier of clinical quality data that comes from the daily lives of patients to put them at the service of the medical profession, i.e. to take note of the fact that to monitor a chronic patient or to do prevention, you have to join the patient in his daily life, so that the doctor can accompany him daily and not only when he sees him once every month or every three months. To do this, he needs data. He needs objective data, and of course subjective data too, but it's Withings' job to provide this objective data. To provide it through devices that will be easy to use, that will join the market of what we call the consumer, i.e. anything that creates desire and ease of use. We're going to pay attention to design. We'll pay attention to battery life. We're going to pay attention to ease of use so that it generates a great deal of clinical-quality data for a very long time, and so that we can accompany the patient.

00:03:04
Lionel Reichardt: Today, Withings generates eighty percent of its sales internationally. When and why do you decide to expand internationally?

00:03:12
Eric Carreel: I think that in the case of Withings, it was done right from the start. We probably understood from our previous experience in the telecommunications field that we were in a sector that was, at the time, narrow, and we needed to reach all the people interested in these connected objects, and particularly in the bathroom scale, which was our first product, all over the world. That's why we quickly opened a sales office in the U.S.

00:03:40
Lionel Reichardt: Withings' scope has changed since its creation. Is the internationalization you initially implemented for B2C activities the same as it is today for B2B activities?

00:03:51
Eric Carreel: No, it's quite profoundly different and that's what also created a stir in the Withings story. As I was saying earlier, Withings started out in the consumer sector, in B2C through sites like Amazon, Walmart, etc. At a certain point, we wanted to move into the consumer market. At a certain point, we wanted to delve deeper into the health sector, because even if this wasn't the company's focus at the outset, we quickly realized that our users felt that we were bringing them something new in the field of health. We said to ourselves: "We need to incorporate this ability to reach the user in his daily life and this ability to do data science on this data to create biomarkers that will be useful for these people, we need to incorporate the medical profession into this loop" and so we tried to do this in France from 2015 onwards. We came up against the fact that the market wasn't ready here, which panicked our investors a little, so the company was bought out by Nokia. It stayed in Nokia's hands for two years. Then Nokia put it up for sale again. I was lucky enough to be able to buy it back. I came back because I was absolutely convinced by the energy and enthusiasm of the team, but also because I felt that the market was much more mature and it was the right time to try and incorporate this medical body into our experience, but the right time was mainly in the United States. It's this new difficulty in our international journey. It's how, far from home, in a market that's difficult to understand, we're learning to go and find these markets, and that's what we're doing now, knowing that if I go back a little in this international experience we had first and again in the consumer, we had quite a few difficulties. We set up a team in Boston, and this team in Boston, quotation marks, wore out a certain number of sales managers because we didn't know how to create a strong enough cohesion, a strong enough affection between the Boston team and the Paris team, and so very quickly, So very quickly, we were in a bit of a "there are Americans who know what they need for the American market" mode, explaining to the French team - which the Americans sometimes regarded as a team that didn't understand American marketing - what they needed to do, and from that point on, we were in a dialogue of the deaf and there was no longer any constructive working together. It took us a long time to be able to work together. Today, we're extremely sensitive to it. We're extremely sensitive to this difficulty that there is, six or eight thousand kilometers away, in creating a link strong enough for information to circulate and for neither of us to be in the mode: "I'm telling you what to do".

00:06:55
Lionel Reichardt: The cultural dimension comes into play. Is it better to recruit locals who know the market, or is it better to rely on French employees who know the parent company well? Is there a formula for successful internationalization? What feedback do you have?

00:07:08
Eric Carreel: I don't think we've found the magic formula yet. What seems to me is that it's important to have people who appreciate the company's country of origin and who appreciate France or who potentially have links with France. We've tried a bit of everything. We tried Americans who were attached to France. We tried French people who went there. I don't know what the best formula is. What I do know is that it's important that the country of origin is considered and that there's a bit of affection, but what's also important is to understand that in a team in Boston today, which isn't a design team, but which is really a marketing, support and sales team, it's necessary for this team to be able to work together, support and sales team, this team has to be sensitive to all the efforts that are made on the other side of the Atlantic to design, because in fact, it's first and foremost the company's job to design, because otherwise, the difficulty of designing is not heard. At the same time, here in Paris, the team has to understand the difficulty of responding to a market that is different from ours, that is organized differently. The healthcare system is profoundly different in the United States and France, and the mentality of explanation and marketing is also very different. There are efforts to be made. I think that as soon as you realize that it's difficult, you've already come a long way. Where it's catastrophic is when you tell yourself it's got to work, there's no reason why it should be difficult, etc. That's when you don't know what to do.

00:08:52
Lionel Reichardt: How do we become aware of these differences? How do you learn about the specifics of the markets you're targeting, the regulations, the culture? Should we call on consultants, Business France experts?

00:09:04
Eric Carreel: So, we did a bit of all that, both actually working with consultants, working with Business France. The highlight for us was taking part in the Consumer Electronics Show. This year, it's the first year we're not there because of Covid, but it's something that played a huge part in our getting to know the American market, meeting people who know the brand in the United States, meeting journalists and what everyone says and I think is important, but which we did very late, is that one of the managers or one of the founders has to be in the United States. That's what we did. Cédric, who co-founded the company with me, went in 2014, 2015, shortly before we were bought out, but it was already late. Today, neither Mathieu nor I are there. Mathieu will be going there about half of the time when it becomes possible in a few months' time, but I think it's important to make sure that we really get to grips with this culture and that we really hear about all the difficulties that are out there and that we don't necessarily see by doing a video-call from time to time.

00:10:22
Lionel Reichardt: You talk a lot about the United States. It's said to be an open market for connected healthcare. How is the European market for connected health?

00:10:30
Eric Carreel: It's a market that took a little longer to develop in Europe, but which is now quite active, although not yet very much from our experience in Spain and Italy, but already quite strong in Germany, England, the Nordic countries and Switzerland. It's happened in much the same way as in France, with the English peculiarity that the English read a lot about what's going on in the United States, so communication in the United States is also part of what's going on in England. Germany is a very specific market. Specific, from several points of view. The distribution systems are different. There are far fewer traditional stores, and there are either wholesalers or a lot of online sales. Consumers are very demanding and expect to be reached in their own language and with sufficient quality, which was one of our major shortcomings for a long time. It took us a long time to understand this, and now that we're more involved in deep healthcare, we're also reaching healthcare professionals. We're in a new market that's specific to each country, meaning that each country has a different organization of its healthcare and insurance systems. In Germany, for example, the [00:11:53] have their own insurance systems, whereas in France, there is a single public insurance scheme covering the whole country. In the United States, private insurers are chosen by companies. All this means that market dynamics are different in each case. In Germany, for example, some very interesting things are happening at the moment, since the Germans have decided that it's important to support patients in their day-to-day lives, and they've put a positive stamp on all these experiments. Where, for example, in a country like France, we would first launch a few programs to a very limited number of users. We'll let it run for a year or two. Then we'll take stock and make a decision. Cycles are much longer before mass deployment. There are differences in approach that are linked to the culture and history of the country and its insurance system, particularly when it comes to occupational health.

00:12:56
Eric Carreel: As we were saying earlier, you have two businesses, B2B, B2C. You've worked with distribution platforms. Is it international business to go through these platforms? Do you really understand a foreign market when you go through a third-party sales platform?

00:13:09
Lorena Cabrera: Yes, because these big platforms, in fact, you address them country by country. There's the United States, and even within Europe, it's managed on a country-by-country basis, so the communication and cultural aspects come into play, and you understand what's going on in each country. What's also important is that, from the moment we make connected objects, we have very precise monitoring of what's happening in each country, how they're being used, how long the product remains in stock with the supplier, and so on. We're able to monitor and understand what's going on, and we're also able to support user feedback on the use of these products. It's possible to learn and personalize the experience across countries and also across technological platforms, since when we make a connected object, for example, we are obliged to join the iOS and Android platforms. We can see that there are quite important specificities, which also need to be worked on.

00:14:19
Lionel Reichardt: In B2B, is partnership with local players possible?

00:14:22
Eric Carreel: Today, we don't have enough hindsight on B2B, which is B2B 2C. What's important in our story is that, in the end, we always reach a user in his daily life, but there may be an intermediary today who is a medical body, what the Americans call a physician extender, i.e. an extension of the GP's service. In the end, it seems to me that we're getting back to a more traditional B2B market, with large players who have very specific requirements, which are both linked to their needs vis-à-vis the end-user, but which are also manufactured in-house. That's something we learned from our telecom experience in a previous life. When you're addressing the B2B market, the difficulty is that there are always a huge number of requests made by the B2B partner that aren't necessarily justified for the final experience, and so there's always a difficulty in deciding what to do or not to do among all the requests. Doing it is easy, you feel you're pleasing the customer, but at the same time, you get bogged down in endless development. If you don't, you run the risk of being rejected. There's always an intermediary and a negotiation to be found, hence the need to have a very strong link between the account manager and the development teams, the support teams so that we can gauge at every moment in the negotiation and in the signing of this new customer, what it's necessary to do, what will be useful, what may not be useful, but which is indispensable because in any case, it's not negotiable and what we can try not to do.

00:16:14
Lionel Reichardt: To conclude Eric Carreel, what advice would you give to project leaders who would like to expand internationally in the world of digital healthcare?

00:16:22
Eric Carreel: I think it's important to reach out to the users who are most willing to experiment. You have to enter from the top, from those who aren't looking at the price of the product for x euros, for those who will be able to understand that a first product isn't necessarily perfect. We need to reach these first customers. At Withings, we've managed to do this, but a little by chance. It took us a while to understand that our first target was not women aged twenty-five to forty-five who were looking to go on a diet, but the technophiles of Silicon Valley. That's the first point, getting in from the top, which goes back a little to the same point: it's always about getting the blade of the knife in where it accepts to go in. There's no point in forcing the market into a place that isn't ready for it. In other words, the Americans have the ability to pre-target a first generation of users or customers and then, from this target, from this base, to expand, whereas we Europeans sometimes have a tendency to want to see very broadly, to fit in where we've decided we should fit in. There's a moment when you have to look where it fits, and afterwards, discard and build on this first base.

00:17:59
Lionel Reichardt: Eric Carreel, thank you for these tips. Are you wondering how to expand internationally? Here are some answers from Lorena Cabrera, head of the health and cosmetics department at Business France, an organization that assists companies in their international development and exports. Hello, Lorena Cabrera. You work for Business France. Could you remind us of its main missions?

00:18:24
Lorena CABRERA: Yes, Business France is the agency for the internationalization of the French economy, with two main missions: firstly, exporting and supporting French companies on foreign markets, and secondly, attracting foreign companies to France and helping them set up in the country.

00:18:51
Lionel Reichardt: You're in charge of the health and cosmetics department. Why is this sector important? What motivates players in this sector to expand internationally?

00:19:00
Lorena Cabrera: Our organization at Business France is vertical, in fact, to respond to sectoral issues and it's this organization into sectoral channels, it is also declined within our offices abroad, since we have an international network of eighty offices in sixty countries, We also have a network of international business managers and international advisors in France, who can be housed in CCIs or BPI France, to ensure close contact with French companies, thus ensuring a sectoral continuum from France to the target country or countries.

00:19:54
Lionel Reichardt: In this drive to internalize, and in your experience, what are the key success factors for a company wishing to expand abroad?

00:20:01
Lorena Cabrera: To develop internationally, the first piece of advice I'd like to give entrepreneurs is to get in touch with the international advisor or business manager of Team France Export, and as you know, each advisor is based in a CCI, so there's a local contact who can help you, or at least advise you on export markets, help you diagnose your preparedness for certain markets, and find out your ability to enter these international markets. The second lever I see as interesting is to get closer to local health ecosystems, which can be competitiveness clusters, local associations or even national associations with a real desire or at least motivation to help companies develop. I think that international expansion is a real opportunity, and can really be a growth lever for French companies. However, this requires a strategy to be put in place by the entrepreneur, i.e. a business plan dedicated to international expansion. It also requires the human resources needed to develop international business and identify the market access and regulatory prerequisites that are essential in developing healthcare business.

00:21:49
Lionel Reichardt: What are the reasons when there is a failure?

00:21:51
Lorena Cabrera: The opposite of what I've just said is in fact not being prepared, going in too opportunistically. Opportunism can be very profitable, but you need to be well prepared for international markets, be familiar with intercultural aspects and, above all, I'd like to say, follow up your international business properly, because there's nothing worse than initiating contacts with international partners without being able to follow them up properly and continue the planned partnership.

00:22:24
Lionel Reichardt: Is it expensive to expand internationally? How can we finance these development initiatives?

00:22:30
Lorena Cabrera: International business does indeed come at a cost, either in terms of services provided on international markets, but it's also a cost in terms of human resources to ensure this development. In this case, for any type of international financing, I would encourage all entrepreneurs to contact BPI, which offers a wide range of financial tools to help companies expand internationally, and which is also developing an export prospecting insurance scheme to finance all prospecting activities in foreign markets. All this can also be complemented by regional aid, some of which offer financial assistance to help companies expand. In the current context... you should know that there is a stimulus plan that has been in place since October 1, 2020, which will last until the end of December 2021 and which implements, or at least makes available financial tools, notably the export stimulus voucher that will enable you to finance part of your international development services.

00:23:52
Lionel Reichardt: Our episode comes to an end. Thank you for listening. We thank our two guests for their availability. Don't hesitate to subscribe to the podcast on your listening platforms. We look forward to seeing you soon for a new episode of "Cent jours pour Réussir".

00:24:11
Voice-over: Those who are making e-health today and tomorrow are on the G_NIUS podcast and all the solutions to succeed are on gnius.esante.gouv.fr.