What does the next 5 years look like for independent O&P providers?

The strategies below for the four giants of O&P (Hanger, Embla Medical, Otto Bock and Eqwal) have a clear pattern: vertical integration + geographic consolidation + digital leverage. For independent clinics, the landscape will change in at least five important ways.

1. More consolidation pressure – but also more potential buyers

What to expect

• The “big four” and other regional groups will continue to approach independents with acquisition offers, especially:

  • Owners nearing retirement

  • Groups with strong regional contracts or hospital ties

  • Clinics with specialized reputations (e.g., pediatrics, sports, complex rehab).

Implication

• Valuations for high-quality independents may remain attractive over the next 3–5 years as these giants compete for footprint and talent.

• But clinics that don’t invest in quality systems, outcomes data, and workforce may become less attractive and feel squeezed on reimbursement and cost.

2. Stronger bargaining power of the giants with payers and suppliers

What to expect

• Large networks like Hanger, Ottobock Care, and Eqwal can negotiate:

  • Better component pricing (volume discounts, exclusivity deals)

  • Preferred payer contracts with target clinical and cost outcomes

  • Access to digital tools and data analytics funded at scale.

Implication

• Independents will struggle to match raw purchasing power and may see narrower margins on components and consumables.

• The counter-strategy is to:

  • Join buying groups / cooperatives

  • Use multi-vendor relationships creatively

  • Leverage suppliers like Qaadir/Streifeneder/Embla that explicitly court independent customers as part of their growth thesis.

3. Clinical and digital expectations will rise

What to expect

• The big platforms are investing heavily in:

  • Outcome tracking (PROMs, gait metrics, re-fit rates)

  • Standardized care pathways

  • Digital workflows (scan-to-print, central fabrication, remote check-ins).

Implication

• Referral sources and payers may start asking:

  “Do you have outcome data like X?”

• Independents that don’t adopt at least basic digital tools and simple outcome reporting risk being seen as “craft only” rather than data-literate healthcare providers.

Practical moves for independents

• Start small: standard PROMs for key device categories, simple Excel/low-cost software, and a basic scan-to-CAD setup.

• Partner with digital fabrication hubs (including those owned by OEMs or groups) while keeping clinical decision-making local.

4. Differentiation will matter more than ever

In a world of consolidators, “generalist clinic on a corner” is the most vulnerable business model.

Areas where independents can win:

1. Hyper-specialization

   • Becoming the reference centre for:

     • Pediatric O&P

     • Diabetic foot & high-risk limb preservation

     • Sports performance and high-activity amputees

     • Neuro-orthotics, stroke, and CP management.

2. Community and cultural proximity

   • Deep roots in local hospitals, rehab units, NGOs, and community organizations.

   • Language, cultural competence, and trust that large corporates often struggle to replicate quickly.

3. Speed + flexibility

   • Independents can often prototype, tweak, and iterate faster, without layers of approval.

   • Ability to integrate local manufacturing, low-cost innovations, and 3D printing in ways that respond quickly to local realities.

5. New partnership models, not just “sell or stay small”

Over the next five years, expect more hybrid models:

• Clinical affiliation without full sale

  • Branding or network membership deals where clinics keep ownership but adopt shared outcomes tools, training, or co-branding with larger entities.

• Joint ventures with hospitals or insurers

  • Independents co-own new centres with hospitals or payers, anchoring long-term referral flows.

• Supplier-driven ecosystems

  • Qaadir/Embla/Streifeneder-style platforms may develop preferred independent networks, offering:

    • Better pricing

    • Training

    • Marketing support

    • Digital tools

  • in exchange for some level of product loyalty.

For strong independents, the choice won’t just be “sell vs. suffer” — it will be “sell, partner, or deliberately remain niche and premium.”

Strategic takeaways for independent O&P providers

If you’re an independent clinic owner or planner, the next 5 years will reward those who:

1. Get your house in order

   • Robust documentation, ISO-style processes, clean financials, and outcome data — whether you plan to stay independent or consider a sale.

2. Decide your strategic identity

   • Are you a local community clinic, a super-specialist centre, or a mini-network in your region?

   • All three can work, but “we do a bit of everything” is getting harder to defend.

3. Invest in people and culture

   • The giants need talent. Retaining and developing your clinicians is both:

     • a defensive move (keep your best people) and

     • an offensive asset (your culture is part of your value, whether staying independent or negotiating with a buyer).

4. Think in ecosystems, not isolation

   • Connect to universities, NGOs, digital providers, suppliers, sports and rehab networks.

   • The giants are building ecosystems; independents should, too — just on a different scale.

The Big 4's Strategies:

Hanger: Mature U.S. consolidator under private equity

Profile & strategy

• Hanger is the dominant U.S. O&P patient-care chain, taken private by Patient Square Capital in 2022 in an all-cash deal.

• Its history is built on rolling up independent practices across the U.S., adding dozens of clinics over the last two decades to build national payer coverage and scale.

Acquisition logic

1. Defensive scale in a mature market

   • U.S. reimbursement is tight and increasingly data-driven. Scale allows Hanger to negotiate with payers, standardize processes, and run centralized RCM, procurement, and data analytics.

2. Platform for adjacent services

   • With private-equity backing, expect more deals that add outcomes measurement, PT/OT integration, tele-rehab, and digital tools layered onto their clinic footprint.

3. Selective clinic M&A rather than land grab

   • The U.S. market is relatively consolidated vs. Europe/Global South, so Hanger’s next wave is likely geographic infill, succession buyouts, and high-quality niche groups, rather than hyper-aggressive roll-up.

2. Ottobock: OEM becoming global care network + listed company

Profile & strategy

• Ottobock is still primarily known as a global prosthetics & orthotics manufacturer, but over the last decade it has been quietly building a large patient-care network (“Ottobock Care”).

• It has expanded by acquiring care networks such as Livit B.V. in the Netherlands and Sahva A/S in Denmark, explicitly framed as strengthening its Western European care presence.

• The company has shown strong revenue growth (around €1.3–1.6 bn in recent years) and, in 2025, completed a major IPO in Frankfurt, valuing it around €4.2 bn and raising capital partly to support further growth and pay down acquisition-related debt.

Acquisition logic

1. Vertical integration (components → care)

   • Ottobock historically sold components to independent clinics; now it also owns clinics that use those components. The goal is to capture more of the value chain, secure product pull-through, and collect real-world outcome data at scale.

2. European network build-out

   • By acquiring established care networks (Livit, Sahva, etc.), Ottobock is constructing a pan-European O&P platform that benefits from shared clinical protocols, inventory, and digital infrastructure.

3. IPO capital = more M&A firepower

   • With IPO proceeds and equity currency, Ottobock is now structurally positioned to continue buying regionally strong care groups, especially in Europe and possibly in emerging markets where brand and technology leadership translate quickly into market share.

3. Embla Medical: Financial + strategic investor building a components & solutions platform

Profile & strategy

• Embla Medical hf, listed on Nasdaq Copenhagen, positions itself as a provider of mobility and O&P solutions and has been active on the capital markets (share buybacks) and in sector M&A.

• In 2025, Embla signed an agreement to acquire a majority stake in Streifeneder ortho.production, a long-standing German developer and supplier of O&P components, materials and equipment, with ~70% of revenue from prosthetics and orthopaedic materials.

Acquisition logic

1. Building a “behind-the-scenes” powerhouse

   • Rather than buying clinics (for now), Embla is consolidating the supply side: components, materials, tools, and potentially digital solutions that OEMs and clinics depend on.

2. Scale and breadth for independents

   • With Streifeneder’s global footprint and materials portfolio, Embla can become a one-stop manufacturing and supply platform for both large chains and independents, especially across Europe.

3. Financial discipline + bolt-ons

   • As a listed company doing buybacks and targeted acquisitions, Embla looks like a financially disciplined consolidator that will keep adding complementary niche manufacturers, software tools, or distributors to enlarge its solution “ecosystem.”

4. Eqwal: The hyper-active global roll-up in patient care + digital + products

Profile & strategy

• Eqwal, headquartered in France, describes itself as a global player in custom orthopaedic prosthetics, with three key divisions: Patient Care, Digital, and Products & Components.

• Over the last few years it has pursued very active M&A, acquiring at least five companies across orthopedics/assistive tech in several countries, with a spike in deals since 2023.

Recent examples include:

• Optech Orthotics & Prosthetics (USA), serving Chicago’s southwest suburbs.

• Steeper Group (UK) — a major UK patient-care and technology provider.

• Orthopartners BV (Netherlands), a supplier of O&P products and materials, integrated into Eqwal’s Products & Components division.

• Schindler Orthopädie (Germany), acquired via its German subsidiary Ortho Dev Deutschland.

• United Prosthetics (USA), a historic family-run provider in Boston and Quincy.

Acquisition logic

1. Tri-layer integration: care, products, digital

   • Eqwal is building joined-up infrastructure:

     • Clinics → guaranteed demand and data

     • Products & components → margin and standardization

     • Digital tools → efficiency, remote collaboration, and benchmarking.

2. Aggressive international expansion

   • Deals in the US, UK, Netherlands, Germany and more suggest a truly global footprint, with the ability to move protocols, technologies, and purchasing power across borders.

3. Buying “heritage” independents

   • Targeting respected, often family-run practices (e.g., United Prosthetics, Steeper) gives Eqwal instant credibility, local relationships, and staff retention, while injecting capital and corporate infrastructure.