Unlocking Neko’s growth through ephemeral architecture
After years of research and development, Neko Health has opened its first clinics in Stockholm and London. Thousands of patients have already done their tests, with tens of thousands more on the waitlist. However, following the current path, getting the company to continental and global scale is going to take decades.
In my view, you have made many correct decisions so far: the annual visit sets the right cadence, the focus on doctors’ augmentation rather than substitution, and managing scarcity through waiting lists. Although I could get into further detail on each one of these issues, in this essay I focus on growth. Specifically, how the company can use ephemeral architecture to accelerate growth and win in the marketplace.
First, I share some information on the origins and characteristics of ephemeral architecture and its potential impact on the company’s growth. Secondly, I provide a high-level analysis on unit economics. Lastly, I explore its potential to have broader impact on Neko’s brand and how it can provide flexibility on the clinical side.
This is one idea I have been working on. My hope is that this essay embodies deep care, ambition and creativity, with the ultimate objective being to work at Neko – on this, or any other priorities of the company.
After years of research and development, Neko Health has opened its first clinics in Stockholm and London. Thousands of patients have already done their tests, with tens of thousands more on the waitlist. However, following the current path, getting the company to continental and global scale is going to take decades.
In my view, you have made many correct decisions so far: the annual visit sets the right cadence, the focus on doctors’ augmentation rather than substitution, and managing scarcity through waiting lists. Although I could get into further detail on each one of these issues, in this essay I focus on growth. Specifically, how the company can use ephemeral architecture to accelerate growth and win in the marketplace.
First, I share some information on the origins and characteristics of ephemeral architecture and its potential impact on the company’s growth. Secondly, I provide a high-level analysis on unit economics. Lastly, I explore its potential to have broader impact on Neko’s brand and how it can provide flexibility on the clinical side.
This is one idea I have been working on. My hope is that this essay embodies deep care, ambition and creativity, with the ultimate objective being to work at Neko – on this, or any other priorities of the company.
Ephemeral architecture, a tool for growth
Ephemeral architecture, a tool for growth
From its use during the Baroque period in their search for exuberance, to pushing the boundaries of design and engineering at the 20th century world’s expos, ephemeral architecture has shaped art, technology and culture. Currently, ephemeral installations are used by luxury brands for fashion shows, by museums for art installations (Serpentine Gallery Pavilions are truly works of art), and at stadiums for concerts or festivals¹.
From its use during the Baroque period in their search for exuberance, to pushing the boundaries of design and engineering at the 20th century world’s expos, ephemeral architecture has shaped art, technology and culture. Currently, ephemeral installations are used by luxury brands for fashion shows, by museums for art installations (Serpentine Gallery Pavilions are truly works of art), and at stadiums for concerts or festivals¹.
Crystal Palace, built for the 1851 Great Exhibition, Hyde Park.
Crystal Palace, built for the 1851 Great Exhibition, Hyde Park.
Ephemeral architecture is temporary in its nature, with structures that are conceived from its origin to be demolished. Therefore, using them could be considered a rather fragile and unambitious way to grow. My suggestion is that the opposite is true – it would amplify the company’s reach while remaining agile. And it allows the company to be bold and creative. The reality is that not every city is ready for a permanent Neko clinic. Demand needs to be high enough in order to make the initial investment worth it. Renovation, installation and high operating expenses lead to long payback periods. These investments need to be financed by the company, which makes growth capital intensive. At the same time, every new patient is an opportunity to consolidate the company’s leadership in the preventative health care space, and to improve both the company’s services and AI models.
Ephemeral clinics can unlock Neko’s growth, and the company is currently at an inflection point. With tens of thousands in the waitlist, there are too many potential customers that the company at this moment is not able to serve. In this sense, waitlists are positive but dangerous. As a leading indicator of growth, they validate the presence of latent demand and feel good. But they have to serve the business through free cash flow generation. Ephemeral clinics could be a new channel that allows the company to grow in a flexible, capital efficient way.
Ephemeral architecture is temporary in its nature, with structures that are conceived from its origin to be demolished. Therefore, using them could be considered a rather fragile and unambitious way to grow. My suggestion is that the opposite is true – it would amplify the company’s reach while remaining agile. And it allows the company to be bold and creative. The reality is that not every city is ready for a permanent Neko clinic. Demand needs to be high enough in order to make the initial investment worth it. Renovation, installation and high operating expenses lead to long payback periods. These investments need to be financed by the company, which makes growth capital intensive. At the same time, every new patient is an opportunity to consolidate the company’s leadership in the preventative health care space, and to improve both the company’s services and AI models.
Ephemeral clinics can unlock Neko’s growth, and the company is currently at an inflection point. With tens of thousands in the waitlist, there are too many potential customers that the company at this moment is not able to serve. In this sense, waitlists are positive but dangerous. As a leading indicator of growth, they validate the presence of latent demand and feel good. But they have to serve the business through free cash flow generation. Ephemeral clinics could be a new channel that allows the company to grow in a flexible, capital efficient way.
Unit economics: ephemeral vs. permanent clinics
Unit economics: ephemeral vs. permanent clinics
Barriers to entry are coming down in health care. Superpower – a horizontal health company – launched its beta program in 6 months and has over 150,000 people on their waitlist. However, barriers to scale profitably are only going up. Superpower now has to scale a service that relies on nurses to do in-home testing, with a wide range of test providers². This will be an incredible challenge. Scaling vertically integrated, clinic-based businesses is not less challenging. Forward Health, before its CarePods expansion in its last year of existence, was available in only 19 locations. Carbon Health has been reliant on acquisitions and partnerships (such as the one with CVS) in order to grow its clinic footprint, and even had to close some clinics in its 2023 cost-cutting adjustment. One Medical and Oak Street Health have been able to scale to more than 200 clinics each³. However, in both cases, they could not maintain those investment levels as independent entities.
Ephemeral clinics should be a source of profitable growth from the get go. Profitable growth that would also allow more permanent clinics to be built, faster. In addition, it helps as a real test of demand and therefore de-risk permanent clinics investments. In order to guarantee profitability, demand should always precede installation. The exact number of patients and their schedules – everything should be organised before the ephemeral clinic is even built. Payments should be collected beforehand, therefore reducing upfront investment needs from Neko.
In order to avoid low utilisation rates on the hardware, the company should manage metropolitan areas and regions – not small, disperse cities. In the long term, the objective is for these clinics to amplify the company’s reach. They would provide flexibility to operate both in cities with populations of 20 million or 300 thousand. In cities with permanent clinics, ephemeral structures can cover demand spikes and reach new neighbourhoods. In smaller cities which do not have enough demand for permanent clinics, they can guarantee access for customers while providing a source of revenue for the company.
Their build-out can be fast. Some ephemeral projects such as the Studio East Dining in London have been built up in as little as 10 weeks, from first sketch to opening⁴. Through modularity and partnerships with architecture studios, real estate and hospitality operators, these clinics could be located both in empty public space or existing infrastructure.
Barriers to entry are coming down in health care. Superpower – a horizontal health company – launched its beta program in 6 months and has over 150,000 people on their waitlist. However, barriers to scale profitably are only going up. Superpower now has to scale a service that relies on nurses to do in-home testing, with a wide range of test providers². This will be an incredible challenge. Scaling vertically integrated, clinic-based businesses is not less challenging. Forward Health, before its CarePods expansion in its last year of existence, was available in only 19 locations. Carbon Health has been reliant on acquisitions and partnerships (such as the one with CVS) in order to grow its clinic footprint, and even had to close some clinics in its 2023 cost-cutting adjustment. One Medical and Oak Street Health have been able to scale to more than 200 clinics each³. However, in both cases, they could not maintain those investment levels as independent entities.
Ephemeral clinics should be a source of profitable growth from the get go. Profitable growth that would also allow more permanent clinics to be built, faster. In addition, it helps as a real test of demand and therefore de-risk permanent clinics investments. In order to guarantee profitability, demand should always precede installation. The exact number of patients and their schedules – everything should be organised before the ephemeral clinic is even built. Payments should be collected beforehand, therefore reducing upfront investment needs from Neko.
In order to avoid low utilisation rates on the hardware, the company should manage metropolitan areas and regions – not small, disperse cities. In the long term, the objective is for these clinics to amplify the company’s reach. They would provide flexibility to operate both in cities with populations of 20 million or 300 thousand. In cities with permanent clinics, ephemeral structures can cover demand spikes and reach new neighbourhoods. In smaller cities which do not have enough demand for permanent clinics, they can guarantee access for customers while providing a source of revenue for the company.
Their build-out can be fast. Some ephemeral projects such as the Studio East Dining in London have been built up in as little as 10 weeks, from first sketch to opening⁴. Through modularity and partnerships with architecture studios, real estate and hospitality operators, these clinics could be located both in empty public space or existing infrastructure.
Studio East Dining, London.
Studio East Dining, London.
Brand and cultural impact
Brand and cultural impact
“We believe that the thing that will truly transform health care and bring it into the 21st century, is not politicians. It’s not even technology. It is consumers.”
– Hjalmar Nilsonne
“We believe that the thing that will truly transform health care and bring it into the 21st century, is not politicians. It’s not even technology. It is consumers.”
– Hjalmar Nilsonne
The shift towards the power of the consumer in health care is one of the main insights of Neko’s founders. And consumers are gravitating towards brands that embrace creativity, authenticity, and connection. Brands that create culturally-rich experiences that feel intimate and tailored to their needs. Experiences that positively shape who they are.
As one of the main exceptions in Europe’s slow path towards irrelevance, luxury companies continue to lead through strong identities, vision and creativity, and need to be studied by any ambitious company innovating in the consumer space. Companies such as Dior, Prada, or Jacquemus are able to connect with consumers in a way that shapes culture.
Health care is not fashion and Neko should not just follow any luxury playbook – but boldness, connection to artists and broader culture, and a continuous push to projecting new realities will be needed in order to make Neko a multibillion euro company. And for luxury companies, the creation of unique images through ephemeral installations has been a key part of sharing their vision with the world⁵.
The fashion show has been indeed an important part, but brands have extended way beyond. They are diversifying where they show up, and are creating world-building initiatives that help them engage with consumers. Dior’s Seongsu-dong store is a perfect example. It opened on May 1st, 2022. Originally planned to stay until November 30th of that year, it will ultimately remain open for 3 years. Located in a formerly industrial district, its 1,500-square-meter space immerses the consumer in the world of Dior⁶.
The shift towards the power of the consumer in health care is one of the main insights of Neko’s founders. And consumers are gravitating towards brands that embrace creativity, authenticity, and connection. Brands that create culturally-rich experiences that feel intimate and tailored to their needs. Experiences that positively shape who they are.
As one of the main exceptions in Europe’s slow path towards irrelevance, luxury companies continue to lead through strong identities, vision and creativity, and need to be studied by any ambitious company innovating in the consumer space. Companies such as Dior, Prada, or Jacquemus are able to connect with consumers in a way that shapes culture.
Health care is not fashion and Neko should not just follow any luxury playbook – but boldness, connection to artists and broader culture, and a continuous push to projecting new realities will be needed in order to make Neko a multibillion euro company. And for luxury companies, the creation of unique images through ephemeral installations has been a key part of sharing their vision with the world⁵.
The fashion show has been indeed an important part, but brands have extended way beyond. They are diversifying where they show up, and are creating world-building initiatives that help them engage with consumers. Dior’s Seongsu-dong store is a perfect example. It opened on May 1st, 2022. Originally planned to stay until November 30th of that year, it will ultimately remain open for 3 years. Located in a formerly industrial district, its 1,500-square-meter space immerses the consumer in the world of Dior⁶.
Dior’s Seongsu-dong Ephemeral store, Seoul.
Dior’s Seongsu-dong Ephemeral store, Seoul.
So far, pop up clinics in health care have not represented a path towards the future. Mainly deployed during crises, they are built in a rush in order to provide emergency assistance to existing medical infrastructure. When it has been used for more commercial purposes, execution has led to experiences that are far from inspirational. We can do better than this.
So far, pop up clinics in health care have not represented a path towards the future. Mainly deployed during crises, they are built in a rush in order to provide emergency assistance to existing medical infrastructure. When it has been used for more commercial purposes, execution has led to experiences that are far from inspirational. We can do better than this.
Lilly Eli “The Weight of the Invisible” Tour in Spain, 2024.
Lilly Eli “The Weight of the Invisible” Tour in Spain, 2024.
A flexible model for future needs
A flexible model for future needs
In order to transform health care and create a new experience for consumers we will need to work really hard. Neko will need to reach hundreds of millions of consumers. It might need spaces for more recurrent evaluation. It might need larger or differentiated spaces in order to tackle the needs of specific populations, from patients with chronic diseases to high-performance athletes. To expand to new diagnostics areas or target diverse populations or age groups.
In order to become ubiquitous, Neko has to be comfortable outside its own clinics. It has to be nimble, flexible, creative. It must continue to be bold.
This is my presentation to you. I would love to join the company and help you build the future of health care. I hope we can have that conversation soon.
In order to transform health care and create a new experience for consumers we will need to work really hard. Neko will need to reach hundreds of millions of consumers. It might need spaces for more recurrent evaluation. It might need larger or differentiated spaces in order to tackle the needs of specific populations, from patients with chronic diseases to high-performance athletes. To expand to new diagnostics areas or target diverse populations or age groups.
In order to become ubiquitous, Neko has to be comfortable outside its own clinics. It has to be nimble, flexible, creative. It must continue to be bold.
This is my presentation to you. I would love to join the company and help you build the future of health care. I hope we can have that conversation soon.
References
References
In the case you want to check some unique projects: in fashion, I would recommend Bureau Betak – they have done more than 1,500 runway shows, and came about with very creative ideas to convince cities to have their installations, such as Dior's mirror pavilion on the Red Square in Moscow. Serpentine Gallery has been able to partner with the most innovative architecture studios for their pavilions. Lastly, on concerts, an interesting discovery for me has been the ephemeral architecture of Burning Man.
In the case you want to check some unique projects: in fashion, I would recommend Bureau Betak – they have done more than 1,500 runway shows, and came about with very creative ideas to convince cities to have their installations, such as Dior's mirror pavilion on the Red Square in Moscow. Serpentine Gallery has been able to partner with the most innovative architecture studios for their pavilions. Lastly, on concerts, an interesting discovery for me has been the ephemeral architecture of Burning Man.
The 150k number came from this tweet of Jacob Peters, one of the cofounders of the company. The details on their model come from an interview with Max Marchione, another cofounder.
The 150k number came from this tweet of Jacob Peters, one of the cofounders of the company. The details on their model come from an interview with Max Marchione, another cofounder.
References of the number of clinics can be found in the following articles on Forward, One Medical, and Oak Street Health. Information on Carbon Health's growth model comes from this article.
References of the number of clinics can be found in the following articles on Forward, One Medical, and Oak Street Health. Information on Carbon Health's growth model comes from this article.
Article that shares the details of the construction of Studio East Dining, designed by Carmody Groarke.
Article that shares the details of the construction of Studio East Dining, designed by Carmody Groarke.
In this whitepaper by The Independents they highlight the nuances on the ephemeral retail experiences of luxury brands. Besides that, the report is just great.
In this whitepaper by The Independents they highlight the nuances on the ephemeral retail experiences of luxury brands. Besides that, the report is just great.
Yarō Studio's case study on the Seangsu Concept Store shares some details on the construction, images I used in this article, as well as an in-depth video of the interior.
Yarō Studio's case study on the Seangsu Concept Store shares some details on the construction, images I used in this article, as well as an in-depth video of the interior.
