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瑞信-美股-医疗科技行业-第三届医疗保健颠覆性技术与创新(HCDT&I)虚拟日回顾-322-37页.pdf
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瑞信-美股-医疗科技行业-第三届医疗保健颠覆性技术与创新(HCDT&I)虚拟日回顾-322-37页.pdf
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Healthcare Technology
3
rd
Healthcare Disruptive Technologies &
Innovations (HCDT&I) Virtual Day Recap
Healthcare Technology & Distribution | Management Meeting
Last week, we hosted our 3
rd
Healthcare Disruptive Technologies & Innovations (HCDT&I) day
virtually. Presenters included executives from Altruista Health, Buoy Health, Livongo, Quartet
Health, Somatus, Welltok, Iora Health, and Heal. We also hosted sessions with Will Brady, the
Chief of Staff to HHS Deputy Secretary, and Dr. Sylvia Romm, Atlantic Health System’s CIO.
Technology Playing a Critical Role in Dealing with the COVID-19 Pandemic.
Dealing with the COVID-19 pandemic was a key discussion topic at our HCDT&I day.
Artificial Intelligence (AI) focused companies, such as Buoy Health, released a COVID-19
screening tool that took the CDC guidelines and layered them on top of the AI. Companies
such as Livongo and Somatus serve chronic care populations, which are most vulnerable to
the coronavirus. Their role and solutions in these circumstances vary from helping members
manage stress/anxiety to sharing a detailed picture of member’s underlying conditions with
the appropriate provider to best inform the treatment (if needed). Livongo has not seen any
disruption to date in sales activity. Quartet Health, which serves individuals with mental
health conditions, is focused on the rapid acceleration of digital care options to help its
members deal with fear and anxiety related to the pandemic. The COVID-19 pandemic has
pushed Iora Health and Heal (both companies have historically relied on in-person
interactions with members) to make changes to their clinical protocols, increase their focus
on virtual care, etc. Finally, companies such as Welltok, are leveraging its consumer data
and multi-channel communication platform to increase communication, education and
support to its members and partners. Finally, Altruista Health noted that its RFP backlog
has not been impacted by COVID-19. However, the company notes that the new sales
may be impacted given that it’ll be difficult for people to come together to make decisions.
Both Keynote Speakers Highlighted the Importance of Telehealth in the Current
Circumstances. Dr. Romm noted that telehealth utilization has increased recently, driven
by its usage to triage patients, patients avoiding crowded places, and physicians wanting to
protect their staff/self. Dr. Romm also emphasized that, though an extremely valuable
resource in the current environment, telehealth has been burdened by regulations which
have hampered its adoption curve in recent years. Mr. Brady, in his session, noted that the
Administration’s decision to waive several telehealth restrictions & expand the access to
telehealth services will provide the incentives for physicians to provide virtual care & for
patients to adopt telemedicine as a first line of defense. Mr. Brady also noted that the
effectiveness of the role telehealth plays in these unusual circumstances will influence how
the telehealth industry needs to be regulated going forward.
Consumer Engagement Remains Critical. Several of the presenting companies
highlighted the increasing importance of consumer engagement. Payers and providers are
now increasingly evaluated through rating systems that incorporate customer satisfaction
and engagement. The focus remains to deliver care in better, cheaper, and more efficient
ways in locations that are easier to access and convenient for consumers.
22 March 2020
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 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
Jermaine Brown
212 325 8125
Adam Heussner
212 325 4727
22 March 2020
Healthcare Technology
2
Table of Contents
Keynote Speakers 4
Will Brady (Chief of Staff to U.S. Department of Health and Human Services Deputy
Secretary) ..................................................................................................................... 4
Dr. Sylvia Romm, Atlantic Health System’s CIO ............................................................... 6
Altruista Health 10
Business Model ........................................................................................................... 10
Market Opportunity ...................................................................................................... 10
Value Proposition ......................................................................................................... 11
Defined Initiatives to Drive Continued Growth ................................................................. 12
COVID-19 Impact to Business ...................................................................................... 12
Buoy Health 13
Creating A Front Door to Healthcare ............................................................................. 13
Role as a Health Navigator ........................................................................................... 13
Revenue Model ............................................................................................................ 14
Selling to Health Systems ............................................................................................. 15
Responding to COVID-19 Pandemic ............................................................................. 15
Heal 17
Business Model ........................................................................................................... 17
Physicians and Other Company Staff ............................................................................ 17
Financials .................................................................................................................... 18
Responding to COVID-19 Pandemic ............................................................................. 18
Iora Health 19
Business Model ........................................................................................................... 19
Focus on Medicare Advantage ...................................................................................... 19
Sourcing Patients......................................................................................................... 20
Target Markets & Hiring Physicians ............................................................................... 20
Responding to COVID-19 Pandemic ............................................................................. 21
Livongo Health 22
Business Model ........................................................................................................... 22
Roadmap to Growth ..................................................................................................... 23
Telehealth or Virtual Health? ......................................................................................... 24
Responding to COVID-19 Pandemic ............................................................................. 24
Financials .................................................................................................................... 24
Quartet Health 26
Two-Sided Business Model Treats Patients Holistically ................................................... 26
22 March 2020
Healthcare Technology
3
$5-10 Billion TAM with Few Competitors....................................................................... 27
Value Creation Opportunities ........................................................................................ 27
On Shortage of Mental Health Specialists ...................................................................... 27
Competing with Tele-Behavioral Services....................................................................... 28
Quartet’s Response to COVID-19 Pandemic ................................................................. 28
Thoughts on Regulations .............................................................................................. 28
Somatus 29
Business Profile and Market Opportunity ....................................................................... 29
Tech Platform Improves Network engagement and Proactive Outreach ........................... 30
Government Regulation ................................................................................................ 30
Update on Somatus’ Response to COVID-19 ................................................................ 30
Welltok 31
Well-Diversified Client base .......................................................................................... 31
5-15x ROI Across Market Segments ............................................................................. 31
Competitive Landscape ................................................................................................ 32
Integrated Partnerships ................................................................................................ 32
Responding to COVID-19 Pandemic ............................................................................. 32
Financials .................................................................................................................... 32
22 March 2020
Healthcare Technology
4
Keynote Speakers
Will Brady (Chief of Staff to U.S. Department of Health
and Human Services Deputy Secretary)
See our note: Healthcare Disruptive Technologies & Innovations Series: HHS Shares Views on
COVID-19 Efforts & Role of Innovation; Virtual Meeting Takeaways
With over 80 thousand employees and an annual budget of over $1 trillion, the U.S.
Department of Health and Human Services is one of the largest government organizations in
the world. It regulates over 20% of the US economy, pays for over 30% of healthcare in the
US, and provides medical response for natural disasters and billions in education grants. The
HHS is the largest R&D facility in the world. This department purchases over $25 billion in
goods and services and grants over $100 billion per year.
Update on HHS’s Response to COVID-19 Pandemic
Mr. Brady notes that the U.S. is entering a new phase where testing will be much more readily
and easily accessible as a result of the transition from public health laboratories to private sector
automated high-throughput testing. Individuals are tested at the recommendation of their
providers using evidence based guidance and CDC guidelines, which have always allowed for
clinical discretion. With the administration unleashing the private sector in particular, the capacity
is expected to increase to a level potentially sufficient to meet demand. This week more than
one million high-automated throughput tests will become available and the U.S Food and Drug
Administration (FDA) is working around the clock to authorize new testing options and
monitoring to address supply chain challenges. The national public/private partnership that HHS
launched last week will help complement state and local efforts and fill gaps. The HHS is also
working to make testing easily accessible to those that need it most, namely the healthcare
workers, first responders and those with preexisting health conditions.
In addition to the lab testing efforts and increasing availability, HHS is gathering information
from health centers to gain on-the-ground perspectives on responses to the coronavirus. HHS’s
Biomedical Advanced Research and Development Authority (BARDA) highlighted the “technical
expertise” of Mesa Biotech, a San Diego-based molecular diagnostic company, and announced
funding to develop its coronavirus diagnostic test, which the company says would provide results
in about 30 minutes. The effort is to support the company to complete developmental work
needed to obtain Emergency Use Authorization from the FDA. The FDA’s emergency
authorizations fast-track unapproved medical products for use during a public health emergency.
Mr. Brady notes that, with the community spread in a number of countries, temporary travel
restrictions and screening help the administration buy some time for further preparation to
combat the virus spread.
HHS is engaged in combating this outbreak from multiple fronts. The department will continue
to operationalize a multilayered, cross-agency public health response (e.g. enhanced screening,
educating the public etc). The Administration also secured funding from congress to help cover
therapeutics, vaccines, PPE, state/local support and surveillance. A Phase 1 clinical trial
evaluating an investigational vaccine designed to protect against COVID-19 recently began at
Kaiser Permanente Washington Health Research Institute in Seattle, funded by National
Institutes of Health (NIH). The study is evaluating different doses of the experimental vaccine
for safety and its ability to induce an immune response in participants.
HHS is also proactively reaching out to manufactures of FDA regulated products to gather
supply chain information to mitigate shortages. These steps will help determine what stresses
the healthcare facilities are experiencing and how to remove these pressure points since these
facilities play a vital role in response efforts. HHS recently announced that the administration is
purchasing 500 million N95 respirators over the next 18 months for the Strategic National
Stockpile (SNS). Through guaranteed orders, this acquisition encourages manufacturers to
immediately increase production of N95s for use by health care professionals. These
22 March 2020
Healthcare Technology
5
guaranteed orders offer reassurance to manufacturers that they will not be left with excess
supply if private sector orders are cancelled once the COVID-19 response subsides.
Manufacturers typically avoid ramping up production without such a guarantee. Finally, the FDA
is working to authorize new testing options to monitor and address any supply challenges in
addition to these efforts.
A number of state and local government and private providers have already opened up drive-
through testing as they know how best to meet their communities’ needs. The CDC also
enacted guidelines that has made it possible to test more people with the same number of tests.
As a result of these measures, state and local partners can make testing more accessible.
The HHS has also taken unprecedented steps to expand Americans’ access to telehealth
services during the outbreak including expanding Medicare coverage for telehealth visits across
the country and allowing telehealth to be provided directly to the home which was not permitted
under prior federal law. The administration also waived potential HIPAA penalties to allow
telehealth visits to occur through everyday technologies like FaceTime, Skype and other video
and audio communication tools. The HHS has also provided flexibility for healthcare providers to
reduce or waive beneficiary cost sharing for telehealth visits paid for by the federal healthcare
program. These three actions in particular will provide the incentives for physicians to provide
virtual care and for patients to adopt telemedicine as a first line of defense. This will not only
help hospitals save supplies but also reduce exposure for patients. In response to a question if
these telehealth restrictions could be waived permanently (not just in case of the public
emergency), Mr. Brady notes that the current environment is unique in so many ways. However,
Mr. Brady notes that the effectiveness and role that telehealth plays in these unusual
circumstances will influence how the telehealth industry will be regulated going forward.
Driving Innovation via Four Key Buckets
Best Practices for Approval and Reimbursement to Limit Uncertainty
One of the key drivers of innovation that the HHS is employing is making sure that people who
are innovating understand what needs to be done to get from an idea to commercialization.
Some steps that the HHS is taking to meet these goals are to decrease regulatory
reimbursement and cycle times and burden, particularly the time gap between SBA approval
and CMS coverage of innovation. The HHS is also increasing new technology add-on payments
(NTAP) from 50% to 65%. By way of background, NTAP is a mechanism in which Medicare
pays for innovative devices and is used for a limited time to reimburse manufacturers delivering
and providing innovative technologies that fit the criteria. The HHS plans to improve clarity by
removing the regulatory hurdle of substantial clinical improvement for breakthrough devices and
provide clarity on NTAP eligibility.
Mr. Brady notes that ambiguity and uncertainty are factors that stifle innovation. There’s a
framework in the FDA called “breakthrough devices” that allows for an accelerated review
process if there’s no equal alternative and the therapy provides an outcome that is unmatched.
HHS took the action to align those two standards, i.e. if the breakthrough standard is met, you
don’t have to go through another process to explain why you have a substantial clinical
improvement in CMS.
Looking forward, the department is looking to further improve coverage of innovative
technologies, reforming parallel review so devices are approved by both the FDA and CMS
simultaneously and clarifying terminology such as “reasonable and necessary” so people can
understand the standards necessary to be a part of the Medicare program.
Transitioning to Value-Based Care
The second bucket is transitioning to value-based care to ensure that the highest quality care
can be delivered at the best cost. The department wants people to be incentivized to deliver
outcomes and empower patients. Some actions that the HHS are taking to achieve these goals
are Primary Care First and Direct Contracting CMMI Models, which allow for providers to take
on risk for patient outcomes in total cost of care vs process metrics and more burdensome
tracking and management.
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