When I started researching ResMed (RMD), I thought I was analysing a medical device company. The debate seemed simple: Philips lost share after the recall, Fisher & Paykel is a capable competitor, and GLP 1 drugs may reduce future sleep apnea demand. After working through more than twenty questions design to analyse RMD’s competitive advantage, I reached a very different conclusion. The CPAP device is probably one of the weakest parts of ResMed's moat. ResMed generates roughly 87.5% of revenue from Sleep & Breathing Health and 12.5% from Residential Care Software. In sleep therapy, RMD currently holds about 62% market share compared with Philips at 20% and F&P at 13%. Before the Philips recall, ResMed and Philips each held roughly 42.5% share. Most investors focus on the recall, but I increasingly believe the more important event was ResMed's decision to build a healthcare software ecosystem through acquisitions such as Brightree, HEALTHCAREfirst, MatrixCare, and MEDIFOX DAN.
At first glance, the software business looks insignificant because it contributes only 12.5% of revenue. However, under my base case assumptions, the Residential Care Software ecosystem may represent a patient opportunity pool equivalent to roughly 55% of ResMed's connected device ecosystem. This does not mean 55% of revenue comes from software customers. It means the software network may give ResMed access to a much larger population than investors realise. These software platforms serve home health agencies, HME providers, senior living operators, skilled nursing facilities, hospice providers, and other post acute care organisations. These populations are generally older, medically complex, and more likely to suffer from respiratory and sleep disorders. They are also less exposed to the GLP 1 thesis because much of their sleep apnea risk comes from aging and chronic disease rather than obesity alone.
The biggest insight from my research is that the moat is the software. Philips can build a CPAP. Fisher & Paykel can build a CPAP. What appears much harder to replicate is an ecosystem that sits inside provider operations and touches billing, reimbursement, claims, referrals, patient intake, inventory management, compliance, resupply programs, and patient monitoring. ResMed increasingly sits inside the information flow between providers and patients. That creates meaningful switching costs. A provider moving away from platforms like Brightree or MatrixCare may need to migrate data, rebuild integrations, redesign workflows, retrain staff, and potentially disrupt reimbursement processes. Importantly, ResMed built this moat over roughly a decade through acquisitions, which is why I believe even a well executed Philips strategy would likely require 5-10 years to build something comparable.
This changes how I think about competition and valuation. My base case assumes Philips eventually recovers 8.2 percentage points of share, leaving ResMed with roughly 54% market share long term. Even after accounting for both Philips recovery and GLP 1 headwinds, **I still arrive at approximately 12% long run owner earnings growth,** down from a historical range of roughly 15%-18%. That's a slowdown, not a collapse. ResMed also appears to convert innovation spending into economic value efficiently, generating approximately $15.5 of revenue and $4.2 of profit for every $1 spent on R&D, compared with roughly $9.8 of revenue and $2.0 of profit for Fisher & Paykel. My biggest takeaway is simple: ResMed should not be analyzed primarily as a CPAP company. It should be analyzed as a healthcare ecosystem company. Philips and Fisher & Paykel can compete on devices and masks, but what appears far harder to replicate is the combination of software, provider workflows, connected patients, recurring revenue streams, and information flow that ResMed has spent years assembling. The machine is what the patient sees. The ecosystem is what protects the business. **The next question I'm researching is: has the market become so focused on GLP 1 fears and Philips recovery that it has pushed ResMed below intrinsic value? That will be the focus of the next stage of my research.**