Rayan Salam on the GCC’s investor-backed shift to outcomes-driven healthcare

Driven by sovereign and private equity investments, the GCC’s healthcare sector is undergoing a notable shift in care models from volume to more measurable outcomes. Rayan Salam, CEO of Cedro Strategy and formerly the Deputy CEO of Emirates Hospitals Group, discusses the shift and what it means for the sector and investors.

To start with, what specifically is changing because of investments? What main delivery-model shifts are you seeing?

What has shifted fundamentally over the past several years is the definition of success in healthcare. For a long time, a credible healthcare business in this region could be built on the right name above the door, the right location, and respected physicians on the roster. Volume followed brand. That was the model.

What investment capital is now forcing, and this is arguable overdue, is a much harder question: can outcomes actually be proven, repeated at scale, and made economically sustainable?

The most significant shift is from personality-driven medicine to institutionalized systems. This plays out acutely in fertility. A clinic can have a brilliant embryologist and a strong reputation, but if results live in that person’s hands rather than in standardized protocols and auditable lab processes, there is no scalable business – there is a dependency. Capital doesn’t scale individuals. It scales repeatable systems.

This is exactly the kind of strategy-to-implementation shift that can be seen at Umniya Fertility, a hub for personalized fertility solutions. Umniya Fertility focuses on shifting fertility care from isolated procedures to a coordinated, outcome-driven system of care. This is delivered through the Umniya Method, a measurable four-phase approach that blends data precision, human connection, technology, and holistic wellness to support the shortest responsible time to healthy delivery.

The second shift is accountability for the full patient journey, not just procedural completion. In fertility, the only number that genuinely matters are healthy delivery rate relative to cycles initiated. Everything else is noise if it doesn’t connect to that outcome. That reframes how clinical pathways are designed, how follow-up is structured, and what technology gets prioritized.

The third is operating discipline becoming non-negotiable. Service-line economics need to be transparent, costs properly allocated, and incentives aligned with performance rather than activity. Too many platforms look strong on revenue but have no real visibility into what is driving margin - or where it is quietly leaking.

You consider Abu Dhabi as the testbed for such innovative healthcare delivery models. What does Abu Dhabi have that makes it better positioned than other places?

Abu Dhabi combines regulatory clarity, payer coordination, and governance alignment in a way that creates a uniquely coherent platform. Having worked across several regional markets, Abu Dhabi stands apart structurally – not aspirationally, but in practice.

The Department of Health in Abu Dhabi has built reporting frameworks that make outcome transparency a regulatory requirement. That matters because it removes the option of sheltering behind activity metrics. When structured reporting is mandated, providers are compelled to invest in the infrastructure to support it: interoperable EMRs (Electronic Medical Records), real-time dashboards, analytics capabilities.

In Abu Dhabi, the typical compliance burden has shifted to an accelerant for modernization.

The payer environment is more coordinated than elsewhere in the region, and that has real consequences for how providers behave. In fertility particularly, paying for a completed procedure and paying for a successful outcome are fundamentally different reimbursement philosophies. When the framework starts to reflect that distinction, clinical and operational priorities have to follow.

What makes Abu Dhabi a genuine proving ground is the degree of alignment between regulators, sovereign capital, insurers, and operators. In most markets those groups pull in different directions, creating friction that slows reform. There is enough synchronization that new care models can be piloted and stress-tested faster.

In your view, value-based healthcare has reached an inflection point. How will this shift change provider behaviour in practice?

Value-based incentives fundamentally change behaviour by tying financial performance directly to clinical outcomes. Under fee-for-service models, throughput can mask inefficiencies. Under pay-for-quality frameworks, weak documentation, inconsistent protocols, and outdated infrastructure translate directly into margin pressure.

When reimbursement is tied to measurable results, that insulation disappears. Under the Pay-for-Quality scheme by Abu Dhabi’s Department of Health, reimbursement is explicitly outcome-focused, linking incentives to measurable improvements in clinical care, patient experience, patient safety, and population outcomes. The investment case for advanced laboratory systems, AI-supported diagnostics, and integrated data infrastructure stops being a quality argument alone and becomes tied to medical outcomes, patient journeys, and financial health.

In fertility, this is particularly concrete. The difference between a clinic running modern embryo grading tools, continuous incubator monitoring, and structured hormonal tracking versus one relying on subjective assessment shows up directly in delivery rates. Under value-based models, it shows up in revenue. Those are no longer separate conversations.

What will separate serious platforms from the rest is not scale or brand recognition alone – it is system integrity. Providers who embed outcome monitoring into daily clinical operations, align team incentives with quality metrics, and treat technology investment as an ongoing discipline rather than a periodic capital event will compound their advantage.

The feedback loop is self-reinforcing: better outcomes earn better reimbursement, which funds better infrastructure, which drives further improvement. The gap between those who build this loop early and those who defer it will widen quickly.

Data is a key driver of new healthcare delivery models. What do you see as the minimum capability around data and system integration?

The most useful framing is straightforward: data only shifts outcomes when it supports a clinical decision in real time. Everything else is reporting infrastructure – valuable, but not transformative.

In fertility, the stakes around data integration are very tangible. Embryo development is sensitive to small environmental variations such as temperature, gas concentrations, assessment timing. When incubator monitoring, embryo grading, hormonal tracking, and physician documentation all feed into a connected system, deviations can be caught and corrected while intervention is still possible.

When those systems sit in silos, outcomes are reviewed after the fact rather than managed in the moment. That distinction is the difference between reactive and predictive clinical management.

The minimum viable capability for any provider serious about competing in a performance-linked environment is not a wish list – it is the operational baseline: structured data capture at source, interoperable systems across lab and clinical functions, modern diagnostic and laboratory infrastructure, real-time dashboards that clinicians actually act on, and governance mechanisms that audit protocol adherence continuously.

Providers who treat this as aspirational rather than operational are already behind.

Finally, as investors up their stakes in the healthcare sector and drive consolidation; what are the most common execution failures you see?

Having seen consolidation done well and seen it destroy value, the difference almost always comes down to one question: does operational reform happen alongside acquisition, or get deferred until after?

The pattern that erodes value most reliably is platforms that move quickly on transactions, underestimate the complexity of harmonizing clinical protocols across sites, and treat technology integration and equipment modernization as problems for the next planning cycle. That deferral compounds. The result is a larger organization that is structurally harder to manage than the individual parts ever were.

The non-negotiables are consistent regardless of market: transparent unit economics, standardized clinical pathways, interoperable digital infrastructure, and incentive structures that connect team behaviour to quality outcomes rather than volume. These are not best practices - they are the conditions under which consolidation actually creates value rather than just scale.

The cultural dimension is consistently underestimated. Moving from a model where clinicians operate with high individual autonomy to one built around accountability, protocol adherence, and standardized measurement is a genuine organizational challenge. Systems can be implemented, but if the cultural shift doesn’t happen in parallel, data quality degrades and dashboards become unreliable.

Lastly, unreliable data in a performance-linked reimbursement environment is not a minor operational issue – it is a strategic liability.

In summary, end-to-end transformation means transactions and operating reform move together, not sequentially.