Dutch telehealth company Quin recently sold seven of its 11 physical GP practices and plans to sell the remaining four. CEO Bart Malenstein tells HBI that the company will instead focus on a licensing model to make its digital platform available to operators. This includes plans to expand into more specialist care and into other countries. 

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Quin started as a project at ambulatory group Bergman Clinics to provide specialist care via a digital platform. At the beginning of 2019, it was spun off as a separate company and spent the rest of the year in the development phase. After consulting with GPs, primary care became the focus and at the beginning of 2020, it acquired 11 physical GP clinics through which it trialled a digital app. The app allows patients to check, track and monitor symptoms and to receive teleconsultations.

Malenstein says: “It has been a nice journey so far, with some hiccups. The pathway is never smooth when you are trying to disrupt the healthcare sector.”

After experiencing what he describes as significant capacity issues, Quin decided to sell all of its physical practices earlier this year and instead operate as a purely digital platform.

Local media reported that The Amsterdamse Huisartsen alliantie (Amsterdam Alliance of General Practitioners) had to step in in July after the group had one GP for 13,500 patients.

Malenstein says the issues it faced are present throughout Dutch primary care and not specific to Quin: “There is a large shortage of GPs in the Netherlands. When you buy an existing clinic, invariably it will be a less good practice, since they are up for sale.

“I still believe the entry strategy was good but we underestimated the structural problems in these practices. If you don’t have enough capacity, everyone on the team has to be diverted to managing patient flows and all the time and effort gets spent on that. Also, we’re essentially a tech company; managing healthcare operations is a totally different ball game. But the clinics have been a good ‘testing platform’.”

The focus going forward is to license it out to any GPs, clinics and primary care groups that wish to use it. All of the 11 practices also continue to use the digital platform. 

Quin now has one major operator partner that has 10 clinics. Conversations are being held with five to ten additional groups that have multiple clinics each. There are also a handful of independent GPs who use the platform. 

Although the company’s reach is small compared to major international telehealth groups, the Quin platform has been integrated very successfully in the primary care clinics in which it is used, Malenstein claims. “80-85% of the consultations done by our partner practices are done virtually, through our platform,” says Malenstein.

Whilst the company is currently focused on primary care, it is now gradually turning the focus back to specialist care. This will be done in phases: gastroenterology is being trialled and other disease specifications will soon follow. 

“We want a platform covering the entire patient pathway; from prevention, complaint, diagnosis to follow-up.”

But Malenstein says primary care will always make up the majority of the care that Quin delivers and that this is a unique selling point: “Unlike other digital health platforms, we want to keep our patients within primary care as far as possible and only refer them to a specialist if objectively indicated with our platform. GPs act as extended gatekeepers on our platform and they collaborate with medical specialists in a standardized patient pathway. This helps keep costs down.”

The platform is currently only used in the Netherlands, where it is funded via statutory insurers, sometimes directly and sometimes via the GP practice. For primary care, payment is done based on a capitation rate and for specialist care, fee-per-service is used. 

Being funded entirely via the Dutch statutory insurance system means that the company has to work within budget ceilings imposed on insurers. Malenstein says Quin has had conversations with insurance companies about new forms of payment for its platform.

With a 150-strong team working on the product, the aim is to have a more international focus in the future, with plans to expand into Germany and the US: “Now we are really ready to scale.”