How Lukas Saari Built Severe PMF and Raised $50M
Lukas Saari on building, selling and scaling Tandem Health in regulated environments across Europe.
Some founders dream of selling into one major institution.
Imagine doing it across multiple countries, with multiple governments, under multiple layers of bureaucracy - all at the same time.
Selling into the NHS alone is a decade-long battle for most companies.
Lukas is closing deals not just in Sweden and the UK, but across Europe, navigating different laws, different procurement systems, and different political realities.
Tandem Health isn’t a “promising startup.”
It’s already one of the most dangerously effective scale stories in European healthtech.
Healthcare is not a forgiving environment.
Hospitals don’t “experiment.”
Compliance isn’t optional.
Trust, once broken, doesn’t reset.
How do you build a company rapidly, with this amount of complexity, in healthcare?
You’re about to find out →
The first real institutional deal (and what it actually takes)
What Lukas achieved
Winning Tandem’s first serious institutional rollout with Capio (the largest care provider in the Nordics) and turning a pilot into an org-wide decision to deploy.The limitations (what made this hard)
Healthcare buyers can’t “beta test” something half-baked
Trust is fragile: you need reliability in the core before scaling
Institutional decisions are slow and require proof in real workflows
Early success required a level of high-touch support that didn’t scale
How he started and how he knew it was the right time
Lukas didn’t start by trying to “close an institution.”Early on, the goal was simply to get the product used in real settings and learn how it behaved.
Once the core was working reliably and they had enough confidence in the product, they moved into larger institutional conversations.
How the mechanics worked (step by step, from first contact to close)
Entry point / first contact
The first real institutional opportunity didn’t come from a cold outreach strategy. Lukas explained that it came through existing relationships from previous work, which created a natural opening for a conversation. It wasn’t framed as a deliberate enterprise GTM play at the time, it was simply the next logical step once the product was starting to work.
The first pilot (limited scope)
They ran an initial pilot across several primary care centres for a defined period of time (roughly a couple of months). The aim wasn’t to sell a rollout. It was to see whether the product actually held up in real clinical workflows and to understand what broke.
Close, ongoing feedback
During this phase, Lukas described staying very close to clinicians and how the product was being used day to day. Feedback was frequent and direct, and Capio was clear about what they would need to see improved before considering anything beyond the pilot.Iteration, then a second pilot with broader scope
Instead of pushing for expansion after the first phase, Tandem ran a second pilot that included more complex settings, such as specialist clinics and a hospital. This wasn’t presented as a big strategic decision, it was the obvious next step to test whether the product worked beyond primary care.Very hands-on involvement
Lukas talked about how involved the team was during this period. They were physically present, spent a lot of time with clinicians, and made themselves highly available for onboarding, questions, and support. This level of involvement wasn’t scalable, and they knew that. It was done because trust and learning mattered more than efficiency at that stage.
The real signal that mattered
At the end of the second pilot, clinicians wanted to continue using the product. That pull from the people actually using Tandem was the strongest signal. It wasn’t framed as a dramatic turning point, just a clear indication that the product was doing something valuable enough to keep.
The rollout decision
Only after those phases did Capio decide to roll Tandem out more broadly across the organisation. There wasn’t a single “close” moment. It was the result of sustained usage, iteration, and internal confidence building over time.
What this clarified about selling in healthcare
Lukas didn’t present this as purely bottom-up or purely top-down. What came through was that both mattered: real usage and belief from clinicians created momentum, and formal approval higher up the organisation made it official. One without the other wouldn’t have worked.
Cross-border deals: how scaling across Europe really works
The goal
Expanding Tandem beyond Sweden into multiple European healthcare systems without losing trust, breaking the product, or slowing the company to a crawl.The limitations (what made this hard)
Europe is not one market, every country has its own healthcare system
Buying processes, decision-makers, and expectations differ widely
Language and local credibility matter far more than centralised sales decks
Trust builds slowly and breaks easily, especially in healthcare
What works in Sweden does not automatically translate elsewhere
How he knew it was the right time
Lukas didn’t describe this as a big strategic “international expansion” decision. Interest from outside Sweden started to come in once the product was working well locally. Organisations in other countries could see the value, and those conversations became the signal that it was time.The question wasn’t whether to expand, but how to do it without breaking what already worked.
How the mechanics worked
Keep the core centralised
Product development, engineering, and operations stayed central. Tandem did not try to duplicate the full company structure in every country.Move trust and sales locally
What could not be centralised was credibility. Sales into healthcare depends heavily on local context: how decisions are made, who holds influence, and how trust is established. That had to live in each market.Hire local leaders with founder-level trust
Lukas talked about placing senior people on the ground in each country, not junior sales reps or lightweight country managers, but operators he trusted deeply. These people were given real autonomy and responsibility, especially on the commercial side. They functioned much closer to mini co-founders than traditional sales roles.Let local teams run elite relationships
Those local leaders were responsible for building and owning relationships with top-tier healthcare institutions. They didn’t escalate everything back to Stockholm. They were trusted to make judgment calls and adapt to local dynamics.Accept manual, unscalable work early
Early cross-border deals involved a lot of hands-on effort. Processes weren’t optimised, and many things were done manually on purpose. The goal wasn’t speed, it was learning how each system actually worked.Adapt the approach, not the product
While the way Tandem entered each market differed, the core product did not fragment. They resisted building fundamentally different versions for different countries.Pace expansion to protect trust
They didn’t rush market entry just to claim presence. Expansion was paced so Tandem could properly support customers once they entered a new country.
What this unlocked
This approach allowed Tandem to expand across Europe without damaging credibility or overwhelming a growing organisation. Cross-border growth wasn’t treated as a growth hack. It was treated as a trust-building exercise.
Surviving bureaucracy: how Tandem kept momentum in a slow, regulated environment
The aim
Keeping the company moving forward in healthcare environments where decisions are slow, approvals are layered, and progress can disappear for weeks at a time without warning.The limitations (what made this hard)
Healthcare institutions move at institutional speed, not startup speed
Regulatory reviews, legal checks, and procurement processes are unavoidable
Feedback loops are long and often indirect
It’s easy to lose momentum, morale, and clarity while waiting
How he approached the problem
Lukas didn’t try to “hack” bureaucracy or fight it head-on.Instead, he focused on controlling what was controllable: internal pace, clarity of ownership, and how decisions were made inside Tandem.
The key wasn’t moving faster externally. It was preventing internal slowdown while waiting on external processes.
How the mechanics worked
Separate external speed from internal speed
Lukas was clear that even if customers or institutions were slow, the company couldn’t be. Tandem continued shipping, improving, and making decisions internally regardless of how long external approvals took.Hire people who can operate independently
Bureaucracy punishes founder bottlenecks. Lukas emphasised hiring senior people who didn’t need constant direction and could keep moving in ambiguous, slow-moving environments.Reduce decision friction internally
Decisions inside Tandem were kept as simple as possible. Waiting for consensus or perfect information wasn’t an option. The goal was to decide, act, and adjust rather than stall while things were reviewed externally.Accept slow timelines, but don’t pause execution
Lukas didn’t frame waiting periods as “dead time.” While institutions deliberated, Tandem continued onboarding new users, improving workflows, and preparing for the next phase so they were ready the moment approval came.Avoid over-engineering systems too early
Instead of building heavy internal processes to manage complexity, they relied more on ownership and accountability. Systems were added only when they clearly reduced friction rather than created it.Protect team morale through momentum
Even when deals dragged, the team could still see progress through product usage, clinician feedback, and internal wins. That visible progress mattered in environments where external signals are slow.
The lesson
You can’t control how fast institutions decide. You can control whether your own organisation grinds to a halt while they do.
Product market fit
Judging PMF
Knowing when Tandem had real product–market fit, not just early interest or polite feedback and feeling confident enough in that signal to scale the company around it.The limitations (why PMF was hard to read)
Healthcare buyers move slowly, so revenue lags usage
Feedback can be encouraging without being decisive
Pilots don’t automatically convert to long-term contracts
How he thought about PMF
Lukas didn’t describe PMF as a single moment or metric. It wasn’t something that showed up clearly on a dashboard. Instead, it emerged through behaviour, specifically, through how people started using and reacting to the product over time.The signals he actually trusted
Embedded, day-to-day usage
Clinicians weren’t just testing Tandem or giving feedback. They were using it as part of their daily workflow. It became something they relied on, not something they evaluated occasionally.Pull after pilots ended
Instead of usage dropping off once pilot periods were over, clinicians pushed internally to keep the product and expand its use. That shift — from Tandem pushing to customers pulling — mattered far more than positive meetings or compliments.Repeat patterns across different environments
Similar behaviour showed up in multiple clinics and settings. PMF wasn’t dependent on one unusually enthusiastic user or one ideal setup.The first user who wanted to invest
One of the clinicians using Tandem reached out and asked whether they could invest in the company. This wasn’t a professional investor, and it wasn’t prompted. It came directly from seeing the product working in practice.What mattered was the signal: if your ICP wants to invest after they first use your product, that means they know this is going to be a winner.
The lesson
In healthcare and enterprise, product–market fit doesn’t announce itself loudly. It shows up quietly, through consistent use, internal pull, and small but meaningful commitments from users.If people would struggle to go back to how things worked before, you’re probably there. If they’re comfortable pausing, you’re not there yet.
The $50M Series A: what actually had to be true
What Lukas achieved
Raising a $50M Series A to scale Tandem across Europe, without fundamentally changing how the company operated or what it prioritised.The limitations (why this round was different from Seed)
At Series A, vision alone is not enough
Investors expect evidence that the company can scale, not just exist
Weaknesses that are forgivable at Seed become deal-breakers
Institutional healthcare businesses are scrutinised more heavily
How this raise differed from earlier funding
Lukas was clear that this round wasn’t about telling a better story. It was about having specific things in place that couldn’t be hand-waved.At Seed, investors were underwriting potential.
At Series A, they were underwriting reality.What had to be true for the round to close
Clear product–market fit signals
Not just pilots or interest, but real usage, institutional rollout, and repeat demand across settings. Investors needed to see that Tandem wasn’t dependent on one customer or one market.A credible path to European scale
It wasn’t enough to say “this works in Sweden.” Lukas pointed to concrete examples of cross-border traction and a clear understanding of how expansion actually worked in practice.Operational maturity in a regulated environment
Investors needed confidence that Tandem could handle healthcare regulation, data requirements, and institutional scrutiny at scale without blowing up. This included how the product was built and how the organisation operated.A strong team with ownership at multiple levels
The company couldn’t hinge on Lukas personally. There had to be senior people who could run markets, close deals, and make decisions independently.
What would have killed the deal?
Lukas was clear that by the time they raised the Series A, certain gaps were no longer acceptable.In particular, investors needed to see:
clear signals of product–market fit beyond early interest
pilots that converted into real, ongoing usage
confidence in Tandem’s ability to operate in a regulated healthcare environment
a team that could demonstrate execution, not just impressive backgrounds
These weren’t things that could be explained away with vision anymore. They had to be visible in how the company was already operating.
Then I asked Lukas a question →
“After the 50 million raised, what multiple of your previous salary are you now paying yourself?”
and Lukas replied: “One.”
Is that normal after raising ~$50M?
It’s not the most common move, but it’s absolutely a “normal founder move” in venture-land.
Here’s the nuance:
Many founders do raise their salary after a successful round (because investors want you stable and focused).
But keeping it flat is a legit signal: “I’m not here to cash out early; I’m here to build, keep burn controlled, and extend runway.” That logic shows up a lot in founder pay guidance.
And, practically: if you’re scaling internationally, hiring hard, and selling into slow institutions, the company needs the cash more than your lifestyle does (especially if you’re already on a survivable salary).
Prioritisation and time allocation: what Lukas actually spends his time on
Hiring senior people
He spends a significant amount of time on senior hires. Not filling roles quickly, but getting the right people in place. He stays closely involved because mistakes here are costly and hard to reverse.Key institutional relationships
Lukas remains directly involved in relationships that materially affect the company. These are long-term, high-stakes relationships where trust and credibility matter, not day-to-day account work.Decisions that cut across the company
His role isn’t to execute everywhere, but to make decisions that affect multiple teams, set direction, or shape how the company operates over time.Stepping in selectively when stakes are high
He doesn’t try to be involved in everything. He steps in when a situation is sensitive, ambiguous, or high-impact, and stays out when his involvement wouldn’t meaningfully change the outcome.What he deliberately avoids
He actively avoids being pulled into work that others can do just as well, or better. His involvement is intentional, not constant.The practical lesson
As the company grows, the founder’s job isn’t to do more. It’s to decide what only they can do and let go of the rest before it becomes a constraint.
The hardest thing right now
The reality
Lukas didn’t describe this stage as calmer or more settled. The pressure hasn’t disappeared, it’s just changed.What makes this phase hard
higher expectations from customers, team, and investors
more people depending on decisions being right
less room for error in a regulated environment
the need to stay clear-headed as the surface area of the company expands
What stood out
What came through clearly is that the job doesn’t become comfortable once funding is secured or scale is reached. Responsibility increases, and the cost of mistakes gets higher.
The challenge didn’t come across as a lack of motivation or energy, but as staying disciplined and focused as complexity grows.
The practical lesson
Growth doesn’t remove difficulty, it redistributes it. Each stage solves some problems and replaces them with harder ones.