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A three-horizon strategy to defend the core, accelerate adjacencies, and seed two new ventures over the next 36 months.
Mid-market and SMB segments grew 22% CAGR over the last three years vs 6% in our enterprise core. We hold 3% share against a $4B addressable market.
Two prioritized investments — a self-serve SMB motion and a vertical solution for healthcare — model to $200M ARR by 2029 at a 24% incremental margin.
Two well-funded competitors will reach scale in our adjacencies by 2027. Re-entering then will cost 3× more in customer acquisition.
A diagnostic of where we are today, why the status quo is no longer tenable, and what the data tells us must change.
Over the last five years, we built a $1.2B enterprise software business with 18% EBITDA margins and 35% share of our segment. The core is healthy.
Enterprise spend is consolidating, our top-10 customers are flat, and competitive renewal pressure has compressed pricing by 7 points over 18 months.
Two adjacencies — self-serve SMB and a vertical healthcare solution — can replace the lost growth and exceed it by 2028 with disciplined investment.
Two well-funded entrants are capturing the share we are not pursuing. By 2028, the gap reaches 24 points — at that point, re-entry CAC triples and the window closes.
What we will do, what we will deliberately not do, and how the choices fit together as a single coherent move.
Retain 95%+ of top-50 accounts. Compress costs by 8% to fund the bets.
$60M investment over 36 months. Target $120M ARR by 2029.
$20M investment. Target $80M ARR with HIPAA + compliance moat.
Migrate 90% of customers to cloud by 2027. Stop new on-prem sales now.
A single product platform, a unified data model, and a re-segmented go-to-market organized by buyer type — not by legacy P&L.
22% CAGR in adjacencies vs 6% in core. Two entrants gaining 8 share points/year against us.
SMB self-serve LTV/CAC of 4.2× vs 2.1× in enterprise. Vertical pricing premium of 30%.
70% of our platform is reusable across segments. Healthcare hires already in flight.
Sales, marketing, and product report into separate business units organized by historical product. Buyers see three overlapping pitches. Engineering is asked to build different versions of the same feature.
Result: 40% of engineering hours spent on rebuilds, 22-month sales cycles, customer NPS of 31.
Engineering reports into a single platform team. Three GTM units — Enterprise, SMB, Healthcare — own buyer relationships end-to-end. Pricing and packaging are segment-specific; product is shared.
Target: 15% rebuild ratio, 14-month sales cycles, NPS of 50+.
Procurement maturity in SMB hit an inflection in late 2025; 67% of mid-market firms now run formal software procurement cycles, up from 41% in 2022.
Vendor A and Vendor B compete with each other in our adjacencies; neither has reached the scale required to defend share aggressively. The next 18 months are open.
The platform unification project — a two-year prerequisite — ships in 90 days. Without it, an SMB self-serve motion was not technically feasible.
A 36-month roadmap with explicit gate decisions, risk register, and the options we evaluated before recommending this path.
$80M committed over 36 months, gated.
Platform ships, hires complete, GTM segmented.
50% of MRR plan or stop SMB investment.
LTV/CAC > 3.0× or de-scope scale plan.
Board-level review of full plan vs targets.
| Enterprise core | SMB self-serve | Healthcare vertical | Legacy on-prem | |
|---|---|---|---|---|
| Mandate | Defend & harvest | Aggressive growth | Build new category | Sunset |
| Capex 2026–29 | $20M | $60M | $20M | $0 |
| Primary metric | Logo retention | ARR & LTV/CAC | Design-partner conversion | Migration rate |
| Target 2029 | 95% retention, flat ARR | $120M ARR | $80M ARR | < 5% of customer base |
| Margin target | 40% gross | 70% gross | 65% gross | N/A |
| Option | EBITDA 2029 | Capital required | Execution risk | Strategic fit | Reversibility |
|---|---|---|---|---|---|
| A · Hold steady, optimize core only | low | $10M | low | poor | high |
| B · Concentrate on two adjacencies (recommended) | $480M | $80M | moderate | strong | gated |
| C · Pursue all four adjacencies | $420M | $180M | high | weak focus | low |
| D · Acquire a vertical player | $400M | $400M+ | moderate | conditional | low |
Four views of the plan: the trajectory we are on, the segments at stake, the mix we are moving to, and the bridge from today's EBITDA to 2029.
Where this analysis is most likely to be wrong — and where we should look harder before we commit.
| Vendor | Feature parity | Integration depth | Pricing fit | Reference customers | Roadmap alignment |
|---|---|---|---|---|---|
| Vendor A | |||||
| Vendor B (recommended) | |||||
| Vendor C | |||||
| Vendor D |
| Name | Role | Team / BU | Tenure | Stance today | Engagement |
|---|---|---|---|---|---|
| Sara Chen | VP Engineering | R&D | 3 yrs | Supportive | Week 1 |
| Marcus Ortiz | VP Sales · NA | Commercial | 5 yrs | Skeptical | Week 1 |
| Priya Raman | CFO | Finance | 2 yrs | Neutral | Week 1 |
| James Whitfield | Head of Product | R&D | 4 yrs | Supportive | Week 2 |
| Anna Lindqvist | VP Customer Success | Commercial | 3 yrs | Neutral | Week 2 |
| David Park | CTO | R&D | 1 yr | Supportive | Week 2 |
| Rachel Tanner | VP Marketing | Commercial | 2 yrs | Unknown | Month 1 |
| Hiroshi Kamada | VP Sales · APAC | Commercial | 6 yrs | Supportive | Month 1 |
The mid-market segment grows 4× faster than our core, and is captured today by Vendors A and B. Without an SMB motion, we cede that growth permanently.
$120M ARR run-rate by 2029 at LTV/CAC of 4.2×, with no incremental enterprise sales overhead.
Standalone product team, self-serve onboarding, $40/mo entry pricing, gated launch over 18 months.
$4.1B vertical TAM, growing 18% per year, with regulatory complexity that creates a defensible moat.
$80M ARR by 2029 at 30% pricing premium; first defensible vertical position in our portfolio.
Hire HIPAA + clinical operations leaders, ship compliance pack in Q3, 5 design partners in 2027.
Legacy on-prem consumes 28% of engineering hours for 4% of revenue, and the costs are accelerating.
$15M annual support cost out; engineering refocused on cloud platform; cleaner story for buyers.
Stop new on-prem sales now, migrate 90% of customers to cloud by 2027 with white-glove support.
| # | Risk | Impact (1–5) |
Likelihood (1–5) |
Score | Mitigation | Cost if happens | Mitigation cost | Mitigation ROI |
|---|---|---|---|---|---|---|---|---|
| R1 | Platform unification slips past Q3 | 5 | 4 | 20 | Add 3 engineers; weekly gate review with CTO | $1,200K | $180K | 5.7× |
| R2 | SMB CAC drifts above $1.8K | 4 | 3 | 12 | Pricing experiments; PLG growth-loops; pause if breached | $650K | $80K | 7.1× |
| R3 | Healthcare regulatory delay | 4 | 2 | 8 | External counsel retained; pre-clearance with regulators | $420K | $95K | 3.4× |
| R4 | Vendor B enters mid-market before 2027 | 3 | 3 | 9 | Accelerate GA by 60 days; lock 10 design partners in Q3 | $380K | $60K | 5.3× |
| R5 | Key hires miss target (4 of 12 open) | 3 | 3 | 9 | Two retained search firms; raise bands by 8% | $220K | $50K | 3.8× |
| R6 | FX exposure on EU revenue | 2 | 2 | 4 | Treasury hedges 60% of EUR exposure quarterly | $80K | $15K | 3.0× |
| Task | Owner | Start | End | Days | Status |
|---|---|---|---|---|---|
| Step 1 · Confirm business opportunity | K. Vardrup | Jul 10 | Jul 31 | 21 | Complete |
| Kickoff with leadership team | K. Vardrup | Jul 10 | Jul 12 | 2 | Complete |
| Specify high-level business need | M. Stigzelius | Jul 21 | Jul 31 | 10 | Complete |
| Step 2 · Identify and evaluate options | M. Stigzelius | Aug 1 | Sep 8 | 35 | In progress |
| Identify solution options | M. Stigzelius | Aug 1 | Aug 5 | 4 | Complete |
| Select 2–3 options for deep analysis | M. Stigzelius | Aug 7 | Aug 8 | 1 | Overdue |
| Run financial models for each option | P. Raman | Aug 11 | Aug 22 | 11 | In progress |
| Compare and rank options | K. Vardrup | Aug 25 | Sep 8 | 14 | Not started |
| Step 3 · Build the case for recommended option | K. Vardrup | Sep 9 | Sep 30 | 21 | Not started |
| Detail solution and benefits | J. Whitfield | Sep 9 | Sep 18 | 9 | Not started |
| Build implementation roadmap | D. Park | Sep 19 | Sep 26 | 7 | Overdue |
| Draft governance and risk plan | K. Vardrup | Sep 27 | Sep 30 | 3 | Not started |
| Yr 1 | Yr 2 | Yr 3 | Yr 4 | Yr 5 | 5-yr total | |
|---|---|---|---|---|---|---|
| Costs ($M) | ||||||
| Platform licence | (1.2) | (0.8) | (0.8) | (0.8) | (0.8) | (4.4) |
| Implementation & integration | (2.8) | — | — | — | — | (2.8) |
| Infrastructure (HW & network) | (0.6) | (0.2) | (0.2) | (0.2) | (0.2) | (1.4) |
| Ongoing support & training | (0.3) | (0.2) | (0.2) | (0.2) | (0.2) | (1.1) |
| Total cost | (4.9) | (1.2) | (1.2) | (1.2) | (1.2) | (9.7) |
| Benefits ($M) | ||||||
| Incident cost avoidance | 0.8 | 2.4 | 2.8 | 3.1 | 3.4 | 12.5 |
| Labour efficiency gains | 0.4 | 1.2 | 1.4 | 1.5 | 1.6 | 6.1 |
| Operations optimisation | 0.2 | 0.6 | 0.7 | 0.8 | 0.9 | 3.2 |
| Total benefit | 1.4 | 4.2 | 4.9 | 5.4 | 5.9 | 21.8 |
| Net annual | (3.5) | 3.0 | 3.7 | 4.2 | 4.7 | 12.1 |
| Cumulative | (3.5) | (0.5) | 3.2 | 7.4 | 12.1 | — |
Local use-case pilots. Push for digital agenda. No cross-functional coordination.
Ensuring value-chain alignment. Joint digital transformation agenda. First shared platforms deployed.
| Dimension | Pfizer | AZ | Roche | Novartis | Sanofi | J&J | Merck | Novo Nordisk | Bayer | Eli Lilly |
|---|---|---|---|---|---|---|---|---|---|---|
| A. Strategy | ||||||||||
| Formulated digital strategy | 5 | 4 | 4 | 5 | 3 | 4 | 3 | 3 | 3 | 2 |
| Digital targets / KPIs | 4 | 4 | 4 | 3 | 3 | 3 | 4 | 2 | 3 | 3 |
| Investment in digital talent | 4 | 3 | 4 | 4 | 3 | 3 | 3 | 2 | 2 | 3 |
| CDO presence and mandate | 4 | 5 | 4 | 4 | 4 | 2 | 3 | 3 | 2 | 3 |
| B. Eco-system | ||||||||||
| Innovation hubs | 3 | 4 | 4 | 5 | 3 | 4 | 2 | 2 | 3 | 3 |
| M&A and venture investments | 5 | 3 | 5 | 4 | 3 | 5 | 4 | 2 | 3 | 4 |
| Healthtech partnerships | 4 | 5 | 5 | 4 | 3 | 4 | 3 | 1 | 2 | 2 |
| C. Value chain innovation | ||||||||||
| Discovery | 4 | 4 | 3 | 4 | 3 | 4 | 5 | 3 | 2 | 3 |
| Development | 4 | 4 | 4 | 3 | 4 | 3 | 3 | 3 | 3 | 3 |
| Manufacturing and supply | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 3 | 4 | 3 |
| Commercial | 4 | 3 | 3 | 3 | 4 | 3 | 3 | 2 | 3 | 3 |
| Total score | 3.9 | 3.8 | 3.7 | 3.7 | 3.4 | 3.4 | 3.3 | 3.0 | 3.0 | 3.0 |
Digital is a standalone function with a separate reporting line. Sanofi, Eli Lilly.
IT and digital are embedded in the BU or function. AstraZeneca, Roche.
Digital is in the BU but a digital sub-unit coordinates across. Novo Nordisk, Pfizer.
Pfizer, Roche — strong central coordination of digital priorities.
Eli Lilly, AstraZeneca — coordination through a centre of excellence.
Novo Nordisk — BUs set and own the digital agenda with limited central input.
Sanofi — one central budget pool for all digital activities.
Most peers — BU budgets earmarked for digital with a central cross-BU pool.
Novo Nordisk — BUs allocate their own budgets to digital; very limited central overlay.
Pfizer, Novartis — digital talent managed and deployed centrally.
AZ, Roche, Eli Lilly — hybrid between central expertise and embedded specialists.
Novo Nordisk — digital talent recruited and managed within each function.
| Year | Partner / Target | Amount | Category | Strategic rationale | |
|---|---|---|---|---|---|
| 2023 | 🇺🇸 | Seagen | $43B | Treatment | Acquired antibody-drug conjugate oncology platform to expand cancer treatment pipeline. |
| 2022 | 🇺🇸 | Tempus AI | $150M | Data & AI | Strategic investment in AI diagnostics platform for precision oncology and genomics. |
| 2022 | 🇺🇸 | BioAtla | $1.2B | Research | Licensed conditionally active biologics technology for tumour microenvironment targeting. |
| 2022 | 🇬🇧 | Arena Pharma | $6.7B | Treatment | Acquired to gain etrasimod and four additional clinical-stage inflammation assets. |
| 2021 | 🇺🇸 | Trilliant Health | $125M | Platform | Investment in healthcare predictive analytics platform tracking 300M+ patient journeys. |
| 2021 | 🇨🇳 | GenScript | $340M | Research | Stake in Asia's largest biologics contract research and manufacturing organisation. |
| 2020 | 🇺🇸 | Cerevel Therapeutics | $350M | Research | Partnership and stake in neuroscience pipeline for Parkinson's and schizophrenia. |
| 2020 | 🇺🇸 | Beam Therapeutics | $300M | Research | Collaboration on base editing therapies for genetic diseases across three therapeutic areas. |
Pfizer leveraged AI to optimise the manufacturing of PAXLOVID by analysing supply chain data to monitor, identify, and address issues in production.
In their first step of the pilot, they were able to reduce cycle time by 67% and produce 20,000 extra doses per batch — applying identical techniques across all manufacturing lines.
| Patient journey stage | Opportunities for PharmaCos | Potential barriers | Relative activity | Expected global market 2026 |
|---|---|---|---|---|
Wellness & Prevention |
Create population strategies to identify at-risk patients. Expand partnerships with consumer health platforms and insurers. | Limited monetisation pathway given current reimbursement frameworks. Weak evidence base for preventive digital interventions. | ~$150bmarket size 2026 | |
Screening & Diagnosis |
Detect disease earlier via AI diagnostics. Improve research outcomes; support HCPs with AI-assisted diagnostic workflows. | No guarantee of link between better diagnosis and incremental therapy revenues. Requires deep HCP workflow integration. | ~$120bmarket size 2026 | |
Care Delivery & Treatment |
Increase patient recruitment and treatment adherence. Improve healthcare outcomes with smart connected devices and dose optimisation. | Requires greater regulatory oversight and clinical validation. Growing competition from tech platforms (Apple, Google) entering care delivery. | ~$280bmarket size 2026 | |
Disease Management |
Create new patient touchpoints beyond the clinic. Digitalise disease management to generate real-world evidence and improve outcomes. | Regulatory uncertainty around digital therapeutics reimbursement. Significant patient privacy concerns and data governance complexity. | ~$450bmarket size 2026 |
| Year | Partner | Focus | Description | |
|---|---|---|---|---|
| 2023 | 🇬🇧 | HUMA | Adherence | Digital companion app for chronic disease adherence; embedded in AZ patient support programmes. |
| 2022 | 🇺🇸 | Tempus | Diagnostics | Collaboration on AI diagnostic tools to match patients with oncology clinical trials at scale. |
| 2022 | 🇨🇳 | Alibaba Health | Platform | Digital health platform for Chinese patients — prescription delivery and disease management. |
| 2021 | 🇬🇧 | Benevolent AI | Research | Multi-year AI drug discovery collaboration; first molecule from programme entered IND in 2022. |
| 2021 | 🇺🇸 | Aetion | Data & AI | Real-world evidence analytics platform; supports regulatory submissions and outcomes research. |
| 2020 | 🇺🇸 | Glinthawk | Diagnostics | AI imaging analysis for early lung cancer detection — integrated into AZ oncology portfolio. |
AZ's digital strategy is driven top-down from the CEO, with a clear belief that digital capabilities will define competitive advantage in oncology and rare disease.
All 35 partnerships since 2020 have a focused objective — AZ does not partner broadly for optionality. Each deal has a clear use-case owner in a BU.
Partnership focus on US (10), UK (8), China (4), France (5) — notably the highest China engagement of any peer, leveraging JV relationships predating digital.