Digital therapeutics arrived promising to change how healthcare is delivered. Kai Eberhardt, who co-founded Oviva twelve years ago and built it into Europe's largest provider treating weight-related conditions, took a more patient route: work within the system, earn its trust, and use that credibility to change it from the inside. He reflects on choosing compliance over disruption, staying in Europe while the category's capital gathered in the US, and what it actually takes to get a digital product written into national treatment guidelines.

1. For someone who has never come across Oviva, what is it, and how did you come to build it?

Oviva provides care for people with weight-related conditions: obesity, type 2 diabetes, and hypertension - improving the lives of more than one million patients across Europe to date. We take the care that would normally be delivered in person by doctors, nurses, dietitians, and psychotherapists, and deliver it remotely through our app, which makes it far more accessible. Just as importantly, it is reimbursed. Most digital care, once you take it out of the traditional setting, can no longer be paid for by the system; we could get it reimbursed (healthcare speak for paid for by health insurance), and that is what lets it reach patients at scale.

My own route into this was not a straight line. I studied physics, and during my studies I had cancer, which fortunately was treated well. That gave me a much stronger sense of purpose around healthcare. I worked on MR imaging, spent a few years in consulting, and then started Oviva with my co-founder twelve years ago.

2. Healthcare innovators face a central choice: work within the existing system or try to change it. How did you approach that at Oviva?

We worked within the system; I don't think we ever really had the option to change it outright. Healthcare is built and run by people who have spent decades making it work, and it is not waiting for you. If you are thirty and starting a company, the system doesn't trust you simply because you believe you've built something better. That trust is earned in sequence: a strong solution, evidence around it, proof it works in the real world, that it can scale, and that it holds up across different patient populations.

So the early years are less about changing the system than about learning to work within it, delivering care in ways that hadn't existed before while staying fully compliant with the regulation. Going in convinced that healthcare has been waiting for you, and that everyone who has dedicated their life to it simply got it wrong, tends to not land well. The companies that end up with the most influence are usually the ones that first proved they could work within the rules, and earned the credibility to change them later.

3. Does working within the healthcare system inevitably narrow what a company can build?

Being reimbursed was part of our mission from the start; accessibility and reimbursement were always the same goal, not two separate ones. That does impose constraints, since you work inside rules you didn't write, but every company in this industry is constrained by something, and what makes it worth accepting is the scale behind it: healthcare is a wonderful mission, and an enormous market with a great deal of untapped technological potential still inside it.

You could design a product with more freedom outside reimbursement. But one that can do more on paper yet cannot be reimbursed, adopted or accessed at scale is worth less than one built around the constraints that decide whether patients can actually use it. Understanding what the system requires lets you design for adoption from the beginning rather than treating market access as a problem to solve afterward. The aim is not to maximize product freedom; it is to maximize real-world impact.

4. The US is often treated as the North Star: bolder, better funded, faster. You chose to stay and scale in Europe, at a time when the digital therapeutics unicorns were all American and there were no proven companies in your space here. Why?

There is truth to the narrative. In digital health, there might be fifty-plus unicorns in the US and only a handful in Europe, so the American opportunity is roughly ten times the size. But market size and competitive position are two different things, and the second tends to decide outcomes. The US market was not only larger; it was already crowded with players in our space who had started around the same time as us, or earlier, and raised far more than we could. It is also more permissive: the employer channel there lets you sell a genuinely new solution to someone willing to pay for it, whereas the universal, regulated systems we operate in across Europe are much less open to that.

Europe's opportunity is smaller and less well-financed, but also less competitive, and a smaller, less crowded market can be the better choice if it gives you a realistic path to leadership. Geography is a strategic decision, not a proxy for ambition: the best market is not automatically the biggest, but the one where opportunity, competition, and your own capabilities give you the clearest path to winning. I wouldn't argue against the US, but I have no regrets about how it has turned out. If we do enter one day, I expect it would be by acquiring a player there rather than building organically.

5. You stayed in Europe, but Europe is not one single healthcare market. How did you find product-market fit across systems that work so differently?

The patient problem was fairly consistent across markets. We help people change how they eat and live, and the tools to drive that behavior change are similar everywhere, even if the details and the language differ. The real variable was how you get paid. Germany, for its DiGA pathway, asks for a randomized controlled trial proving the product is effective; the UK leans more on real-world performance, monitoring what enters the system rather than demanding a fixed trial upfront. So the challenge was never a universal product, but the right reimbursement and commercial model for each market.

We started in Switzerland, small enough that it immediately forced us further, so we expanded early to the UK and Germany, and for a time France; we were international almost from the outset. That is why our growth came as a series of S-curves: each model and reimbursement route could carry us only so far before reaching its ceiling, and we had to find the next one. Product-market fit is better treated as evolutionary than as a destination you arrive at once, and the companies that keep scaling are the ones that recognize when a model is topping out and move in time.

6. Germany's DiGA framework was a turning point for digital therapeutics. What changed for Oviva when reimbursement became part of the regulatory pathway?

Before DiGA, we built a presence in Germany through individual contracts with insurers, enough to establish ourselves and gain traction and investment, but never scalable: each payer wanted a slightly different program and reimbursement model, so even signing several left the market fragmented. DiGA changed that because it was uniform across the system and, crucially, connected regulatory approval with reimbursement. That distinction matters. In the US, the FDA already regulated digital therapeutics and gave you market access, but reimbursement didn't follow; you were left marketing to the system as a self-pay solution. Germany joined the two, turning a product you could bring to market into one that could actually scale within the system, a genuinely commendable and rare step in healthcare.

What makes the model powerful is what it enables at scale: a DiGA gives a patient an experience broadly comparable to months of care with an allied health professional, but at lower cost, with greater accessibility, and a marginal cost of delivery that keeps falling as you treat more patients. The difficulty is that the framework can become overbearing. There are already some two thousand pages of DiGA regulation, and successive additions like security certifications, outcomes-based measurements, and volume rebates keep raising the cost of participation, which established players absorb far more easily than smaller entrants. For a market only around €200 million last year, that feels disproportionate to its maturity. Regulation has to balance protection with accessibility: past a point, the same framework that created the market begins to limit the competition, scale and access it was meant to enable.

7. Has anything like the DiGA framework taken hold elsewhere in Europe?

It is picking up, though slowly and on each country's own terms. France built its own version and now has its first reimbursed products; Austria, Switzerland and Italy have announced or are working on theirs. Frameworks like DiGA provide a model, but systems adapt it to their own realities rather than lifting it wholesale. It only ever moves in one direction, more digital, but it takes a long time: getting something all the way through to the last patient is often a decade or two, down not only to regulation but to the learning cycles of clinicians and the slow accumulation of evidence.

Proving that something works is necessary but never sufficient. We have done over one hundred publications on our outcomes and are running four randomized controlled trials, and digital care can still feel speculative; you will never quite satisfy the last person with the evidence base. Part of it is genuine caution; part is that digital care is threatening to those delivering care the current way, and interests are built around the status quo. The potential is enormous, but the pace depends less on proving the case than on how quickly the wider system is willing and able to adapt.

8. Your obesity DiGA is already included in clinical guidelines. Does that mean digital therapeutics have become the standard of care?

In certain indications, yes. Our obesity DiGA in Germany is written into the guidelines as a first-line treatment, and we are in the NICE guidelines in the UK as well. That is extraordinary validation: the evidence has reached the point where the medical system recognizes the intervention as legitimate, a real testament to the clinical work behind it.

But there is an important difference between being written into a guideline and becoming routine clinical practice. It is one thing for the guideline to say a treatment belongs; it is another for every doctor to know about it, understand it, prescribe it, and fit it into their workflow, and then for patients to use it well. That is the harder step, and it requires education, implementation, time, and resources. The real measure is not the guideline entry, but whether that recognition actually changes everyday clinical behavior, and that will take longer.

9. You've been one of the most successful digital therapeutics founders in Europe. What do others in the space need to hear from you?

A great deal of our success came down to relentless innovation: continually trying new things, finding better ways of doing them, and sustaining that over a very long period. Success is not about finding one approach that works and simply scaling it; it is about recognizing when an approach is no longer sufficient and being willing to change it, again and again. The hard part is keeping that up for years, and that persistence itself becomes a genuine competitive advantage.

The larger opportunity, and my real hope for the field, lies in how digital care is paid for. Because its marginal cost of delivery is so low, it lends itself to new pricing models, paying for engaged patients or measurable outcomes rather than simply for access. Value-based pricing of that kind would make digital care less speculative for the system and align incentives with the value actually delivered, and I think it has the power to move the whole system faster.