1、 Healthcare Technology Healthcare Disruptive Technologies&Innovations(HCDT&I)San Francisco Day Recap Healthcare Technology&Distribution|Management Meeting We recently hosted our 2nd Healthcare Disruptive Technologies&Innovations(HCDT&I)day in San Francisco.Presenters included executives from Advance
2、d ICU Care,Anthem,Glooko,Grand Rounds,Heal,HeyDoctor,Kura MD,Omada Health,Uber Health,and Vida Health.A Payers Increased Focus on Digital Health Initiatives.Our keynote speaker,Rajeev Ronanki,SVP&Chief Digital Officer at Anthem,highlighted the companys increased focus on leveraging Artificial Intell
3、igence,robotics,augmented reality,virtual reality,blockchain,and other innovative solutions and integrating them into a platform based approach(“Anthem Digital Platform”).Several of the companys recent initiatives(Sydney,Project CareSpree,etc.)are the result of the companys investment in its digital
4、 offerings,capabilities,and platform based solutions.For the capabilities which are critical to its business and patient experience,Anthem generally wants to build them in-house.However,for capabilities that help the company to further improve its members experience,Anthem assesses partnership oppor
5、tunities.With respect to Telemedicine,Anthem is seeing some of the self-insured employers evaluating ways to align incentives to drive telehealth(likely to be reflected in 2021 benefit designs).Additionally,Anthem has included telehealth(via partnership with American Well)as part of its benefit desi
6、gn in Medicare Advantage for 2020.With respect to Payment Integrity(PI),Anthem handles around 85%of such activities in-house.For the remainder of 15%,the company has partnerships with dozens of different vendors.The company believes that the overall trend of the industry is towards moving more PI ac
7、tivities in-house.Addressing the Chronic Care Conditions Problem Targeted vs Broader Approach.Several presenters highlighted their efforts around employing a combination of data analysis,behavior interventions,and connected devices to drive healthier habits among patients with chronic conditions.Whi
8、le some companies specialize on one particular chronic condition,others are taking a broader approach.Companies like Omada and Livongo have used the approach of a gradual expansion from one disease to others.Several of our presenters also highlighted the importance of coaches and care coordinators,w
9、hich provide guidance,support,and accountability to the members.While having a broader approach carries some operational and quality risks,presenters note that having a platform to address multiple chronic conditions helps them to better manage patients health,higher utilization and consumer engagem
10、ent,and improved clinical outcomes.However,our belief is that consolidating the number of benefit vendors is still not one of the top priorities or focus for the employers.Consumer Engagement is the Key to Success.Consumer engagement has become increasingly important for all healthcare industry stak
11、eholders.Payers and providers are now increasingly evaluated through rating systems that incorporate customer satisfaction and engagement.While early trends have been encouraging,several presenters noted that the industry needs a sustained consumer engagement to achieve meaningful health outcomes.29
12、 November 2019 Equity Research Americas|United States DISCLOSURE APPENDIX AT THE BACK OF THIS REPORT CONTAINS IMPORTANT DISCLOSURES,ANALYST CERTIFICATIONS,LEGAL ENTITY DISCLOSURE AND THE STATUS OF NON-US ANALYSTS.US Disclosure:Credit Suisse does and seeks to do business with companies covered in its
13、 research reports.As a result,investors should be aware that the Firm may have a conflict of interest that could affect the objectivity of this report.Investors should consider this report as only a single factor in making their investment decision.Research Analysts Jailendra Singh 212 325 8121 jail
14、endra.singhcredit- 29 November 2019 Healthcare Technology 2 Table of Contents Keynote Speaker(Anthems Chief Digital Officer)4 Anthems Focus on Digital Health Initiatives.4 Anthem Digital Platforms Building Blocks.4 Sydney-Anthems new Mobile App.4 Project CareSpree.5 To Build or Buy or Partner?.5 Vie
15、ws on Telemedicine.5 Addressing Social Determinants of Health.6 Payment Integrity and Risk Adjustment.6 Advanced ICU Care 7 Overview and Company Background.7 Total Addressable Market Opportunity and Competitive Landscape.7 Value Proposition for Clients.8 Client Contracts.8 Comparison with the other
16、Telemedicine Approaches.8 Glooko 10 Company Overview and Business Model.10 Diabetes A Huge and Growing Global Challenge&Glookos Solutions.10 Revenue Model.11 Benefits to the Health System.11 Future Opportunities.11 Grand Rounds 13 Overview and Business Model.13 Employer Market Focus.13 Physician Rel
17、ationship and Contracting.13 Care Coordinators.14 Competitive Landscape and Sales Cycle.14 Utilization&Consumer Engagement.15 Data and Customer Experience.15 Partnership with Uber Health.15 Heal 16 Company Background and Business Model.16 Margin Profile.16 Physicians and Other Company Staff.16 Compa
18、rison with Optum.17 HeyDoctor 18 29 November 2019 Healthcare Technology 3 Overview and Company Background.18 GoodRxs Acquisition of HeyDoctor.18 Customer Outreach.18 DTC vs B2B/B2B2C Telemedicine.18 Physicians.19 Kura MD 20 Overview and Business Model.20 Kura MD Platform.21 Revenue and Claims Manage
19、ment.22 Omada Health 24 Overview and Company Background.24 Industry Focus and Company Evolvement.24 Client Focus and Contracts.24 The Omada Experience.25 Competitive Landscape.25 Uber Health 27 Uber Healths Background and Business Focus.27 HIPAA Compliance and Privacy/Safety Issues.27 Supplemental B
20、enefits in MA Providing an Opportunity.28 Reimbursement and Pricing Model.28 Future Opportunities.28 Competing with Telemedicine.29 Grand Rounds Partnership.29 Vida Health 30 Company Background and Business Model.30 Member Enrollment and Engagement.31 Revenue Model.31 Teladoc Partnership.31 29 Novem
21、ber 2019 Healthcare Technology 4 Keynote Speaker(Anthems Chief Digital Officer)Presenter:Rajeev Ronanki SVP&Chief Digital Officer at Anthem Anthems Focus on Digital Health Initiatives Mr.Ronanki,who previously worked at the consulting firm Deloitte on health innovation-related projects,notes that An
22、them is committed to delivering the best combination of health,care and value in the industry,and to finding new and improved ways to provide real-world solutions that simplify health care processes and improve health care quality.The companys goal is to essentially ensure that healthcare is afforda
23、ble,accessible,customized and most importantly simple.By simplifying the process,the company believes that a lot of waste in the healthcare ecosystem can be eliminated.The company is looking to leverage Artificial Intelligence(AI),robotics,augmented reality,virtual reality,blockchain,and other innov
24、ative solutions and integrate them into a platform based approach(“Anthem Digital Platform”).The intent of this platform is to serve as a mechanism for connecting employers,providers,community of partners,third party developers etc.with consumers and make that experience seamless and easily accessib
25、le.Mr.Ronanki notes that Anthems CEO,Gail Boudreaux,has emphasized the companys continued investment in its digital offerings,including putting budget behind its consumer tech and artificial intelligence teams.The company believes that,to compete in healthcare,it also needs to be a technology player
26、 and thus need to make big investments in capabilities and platform based solutions.Anthem Digital Platforms Building Blocks To launch its Anthem Digital Platform,Anthem relies on its access to huge data(which the company refers as Data Quotient-DQ).The companys DQ has claims data for over 70 millio
27、n lives,and clinical and lab data for over 10 mln lives.The company put all this data together and harmonized that into a common operating system.The company then normalized all the distinct data sources and put all the information into a system,which the company refers as health operating system.An
28、them then makes all of that data available to its internal stakeholders as well as the companys select third party partners as appropriate,through its connection layer(called as CQ).Further,the company layers AI,machine learning algorithm etc.run on top of this data to determine insights.Finally,the
29、 company serves up these insights to consumers,providers,employers/brokers,internal stakeholders,communities,etc.The key is that the consumer solutions,the provider solutions,the employer solutions,and the broker solutions are operating off a single common data platform,which fragmentation of the he
30、althcare ecosystem much less,and it moves to be a more integrated ecosystem as opposed to separate silo systems.Sydney-Anthems new Mobile App Anthem recently launched its new mobile app,Sydney,which gives Anthem members a smart and more human experience.Management notes that Sydney is a personal hea
31、lth ally powered by AI that feels as if its a real person.Sydneys interactive chat feature gives members answers right away.Additionally,with Sydney,members can see their benefits and get access to medical,dental and vision claims all in one place.Sydney also gives members a quick view of their care
32、 team(contact information etc.).Anthem enables its members access to all of the data integrated into My Family Health Record(myFHR),and thats available via Sydney.Anthem believes that consumers need to own their own data and based of their permissions,Anthem can make that data available to different
33、 stakeholders(family,community,doctors,etc.).Anthem plans to open source Sydney in 2020 for communities to use for a variety of purposes.From the employers perspective,employers can look at an aggregated view of trends and the effectiveness of benefit design.Providers have the population health view
34、 of the same information.PCPs have attributed membership that they are responsible for caring for.29 November 2019 Healthcare Technology 5 Project CareSpree Anthem recently launched Project CareSpree,which the company defines as digital first insurance product.CareSpree is currently available in Ind
35、iana and the company expects to fully roll out across the nation starting in 2020.CareSpree provides an ability for any consumer to download and start using it using as an app and also purchase insurance on top of it.The app will make use of AI technology,at the back of its partnership with K Health
36、,an Israeli start-up,which would work around 2 million anonymized healthcare records of patients.K Health is a mobile app which allows users to enter symptoms by answering 22 questions prompted by an AI system,and allowing users to make an accurate self-diagnosis.Management notes that this data is a
37、ccumulated from the past 20 years of Healthcare records and around 400 million doctor visit notes.Anthem is using the AI technology to process this data and then use natural language processing to prepare diagnosis reports based on the symptoms in question.The app is going to entail a number of othe
38、r new features as well like video doctor visits,in-person doctor visits,magnetic-resonance-image scans,X-rays,etc.To Build or Buy or Partner?Anthem wants to own and build some of the capabilities which are critical to its business and patient experience.Anthem notes that the key for the company is t
39、o create the platform,for which the company has released the initial version.This platform is packaged as a development toolkit which the company is making available to the developer community.The company also partners with variety of third party developer communities to create certain capabilities
40、for the company.The company is leveraging its existing partners to build some of the key capabilities such as ability to triage symptoms,telemedicine,etc.In fact,several of other Blues are partners and co-partners on Anthems development platform.However,Anthem notes that there are various capabiliti
41、es that help the company to further improve its member experience and make it more complete and seamless.In such cases,the company assesses partnership opportunities.Typically,in partnering with the startup ecosystem,Anthem has made equity investments to ensure the startup company being invested is
42、financially stable.Additionally,such an approach allows ANTM to influence the product roadmap more closely.Views on Telemedicine Anthem has had a joint venture with American Well for more than seven years,which has allowed the company to have a nationwide network for the telemedicine providers.The c
43、ompany plans to leverage that telemedicine network and capabilities for its CareSpree project as well.The company believes that some of its peers likely want to work with the multiple telehealth vendors to get network depth.The rules from states around telemedicine are still all over the place.For e
44、xample,to be a telemedicine provider in a state,the doctors have to be board certified by the state to practice medicine,which the company believes does not make any sense.In fact,management noted that there are only 3 or 4 doctors that are certified in all 50 states to practice medicine.So by partn
45、ering with multiple vendors,health insurers get that network reach.However,Anthem has already invested in that and got the nationwide network of telemedicine providers.Anthem sees adoption of its digital tools and capabilities(including telemedicine)in the commercial market,primarily driven by large
46、 self-insured national accounts.These large employers believe in the connection between productivity and health.Local group,Small group,individual commercial as well as Medicaid segments are also users of Anthems digital tools.The use has been more sporadic with respect for administrative questions(
47、claim status,coverage,etc.)among Medicare enrollees.However,when it comes to using digital tools,Anthem notes that Medicare enrollees are least digitally savvy.With baby boomers turning 65,trends are changing within Medicare population as well.Management believes that it is the responsibility of hea
48、lth insurers to push for more telehealth utilization.With respect to the employers,they can evaluate options related to putting 29 November 2019 Healthcare Technology 6 incentives/penalties in place to drive more adoption.The company notes that the health benefit design people at the self-insured em
49、ployer group are evaluating on ways to align incentives to drive telehealth utilization.Anthem expects some of these employers to include benefit designs in 2021 cycle pushing for more digital versus physical.Additionally,Anthem is partnering with these employers on trends,creating risk sharing agre
50、ements on trends,etc.,which in some ways is moving the ASO business to almost being fully-insured.Across the board,Anthem has about 30-35%utilization for telemedicine(if it is available).Where employers promote telemedicine,80%people tend to use it.The telehealth utilization of the Anthems 40 millio
