医疗颠覆性技术与创新

1、Equity Research Americas | United StatesHealthcare TechnologyHealthcare TechnologyHealthcare Disruptive Technologies & Innovations(HCDT&I)SanFranciscoDayRecapHealthcareTechnology&Distribution|ManagementMeetingWerecentlyhostedour2nd HealthcareDisruptiveTechnologies&Innovations(HCDT&I) day in San Fran

2、cisco. Presenters included executives from Advanced ICU Care, Anthem, Glooko, Grand Rounds, Heal, HeyDoctor, Kura MD, Omada Health, Uber Health, and Vida Health.APayersIncreasedFocusonDigitalHealthInitiatives.Ourkeynotespeaker,Rajeev Ronanki, SVP & Chief Digital Officer at Anthem, highlighted the co

3、mpanys increased focus on leveraging Artificial Intelligence, 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 CareSpre

4、e, etc.) are the result of the companys investment in its digital offerings, capabilities, and platform based solutions. For the capabilities which are critical to its businessandpatientexperience,Anthemgenerallywantstobuildthemin-house.However, forcapabilitiesthathelpthecompanytofurtherimproveitsme

5、mbersexperience,Anthem assesses partnership opportunities. With respect to Telemedicine, Anthem is seeing some oftheself-insuredemployersevaluatingwaystoalignincentivestodrivetelehealth(likelyto be reflected in 2021 benefit designs). Additionally, Anthem has included telehealth (via partnership with

6、 American Well) as part of its benefit design 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 ofdifferentvendors.Thecompanybelievesthattheoveralltrendofth

7、eindustryistowards moving more PI activities in-house.Addressing the Chronic Care Conditions Problem Targeted vs Broader Approach.Severalpresentershighlightedtheireffortsaroundemployingacombinationof dataanalysis,behaviorinterventions,andconnecteddevicestodrivehealthierhabitsamong patientswithchroni

8、cconditions.Whilesomecompaniesspecializeononeparticularchronic 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 presentersalsohighlightedtheimportanceofcoachesandcarecoordinators

9、,whichprovide 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 utilizationandconsumerenga

10、gement,andimprovedclinicaloutcomes.However,ourbelief 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 hasbecome increasingly important for all healthcare industry stake

11、holders. Payers and providers are now increasingly evaluated through rating systems that incorporate customer satisfaction andengagement.Whileearlytrendshavebeenencouraging,severalpresentersnotedthat the industry needs a sustained consumer engagement to achieve meaningful health outcomes.Research An

12、alystsJailendra Singh212 325 8121 HYPERLINK mailto:jailendra.singh jailendra.singhDISCLOSURE 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 busines

13、s with companies covered in its research reports. As a result, investors should be aware that the Firm may have a conflict of interest that couldTable of Contents HYPERLINK l _TOC_250035 Keynote Speaker (Anthems ChiefDigitalOfficer)4 HYPERLINK l _TOC_250034 Anthems Focus on Digital Health Initiative

14、s4 HYPERLINK l _TOC_250033 Anthem Digital Platforms Building Blocks4 HYPERLINK l _TOC_250032 Sydney - Anthems new Mobile App4 HYPERLINK l _TOC_250031 Project CareSpree5 HYPERLINK l _TOC_250030 To Build or Buy or Partner?5 HYPERLINK l _TOC_250029 Views on Telemedicine5 HYPERLINK l _TOC_250028 Address

15、ing Social Determinants of Health6 HYPERLINK l _TOC_250027 Payment Integrity and Risk Adjustment6 HYPERLINK l _TOC_250026 AdvancedICUCare7 HYPERLINK l _TOC_250025 Overview and Company Background7 HYPERLINK l _TOC_250024 Total Addressable Market Opportunity and Competitive Landscape7 HYPERLINK l _TOC

16、_250023 Value Proposition for Clients8 HYPERLINK l _TOC_250022 Client Contracts8 HYPERLINK l _TOC_250021 Comparison with the other Telemedicine Approaches8 HYPERLINK l _TOC_250020 Glooko10 HYPERLINK l _TOC_250019 Company Overview and Business Model10 HYPERLINK l _TOC_250018 Diabetes A Huge and Growi

17、ng Global Challenge & Glookos Solutions10 HYPERLINK l _TOC_250017 Revenue Model11 HYPERLINK l _TOC_250016 Benefits to the Health System11 HYPERLINK l _TOC_250015 Future Opportunities11 HYPERLINK l _TOC_250014 GrandRounds13 HYPERLINK l _TOC_250013 Overview and Business Model13 HYPERLINK l _TOC_250012

18、 Employer Market Focus13 HYPERLINK l _TOC_250011 Physician Relationship and Contracting13 HYPERLINK l _TOC_250010 Care Coordinators14 HYPERLINK l _TOC_250009 Competitive Landscape and Sales Cycle14 HYPERLINK l _TOC_250008 Utilization & Consumer Engagement15 HYPERLINK l _TOC_250007 Data and Customer

19、Experience15 HYPERLINK l _TOC_250006 Partnership with Uber Health15 HYPERLINK l _TOC_250005 Heal16 HYPERLINK l _TOC_250004 Company Background and Business Model16 HYPERLINK l _TOC_250003 Margin Profile16 HYPERLINK l _TOC_250002 Physicians and Other Company Staff16 HYPERLINK l _TOC_250001 Comparison

20、with Optum17 HYPERLINK l _TOC_250000 HeyDoctor18Overview and Company Background18GoodRxs Acquisition of HeyDoctor18Customer Outreach18DTC vs B2B/B2B2C Telemedicine18Physicians19KuraMD20Overview and Business Model20Kura MD Platform21Revenue and Claims Management22OmadaHealth24Overview and Company Bac

21、kground24Industry Focus and Company Evolvement24Client Focus and Contracts24The Omada Experience25Competitive Landscape25UberHealth27Uber Healths Background and Business Focus27HIPAA Compliance and Privacy/Safety Issues27Supplemental Benefits in MA Providing an Opportunity28Reimbursement and Pricing

22、 Model28Future Opportunities28Competing with Telemedicine29Grand Rounds Partnership29VidaHealth30Company Background and Business Model30Member Enrollment and Engagement31Revenue Model31Teladoc Partnership31KeynoteSpeaker(AnthemsChiefDigital Officer)Presenter: Rajeev Ronanki SVP & Chief Digital Offic

23、er at AnthemAnthems Focus on Digital Health InitiativesMr.Ronanki,whopreviouslyworkedattheconsultingfirmDeloitteonhealthinnovation-related projects,notesthatAnthemiscommittedtodeliveringthebestcombinationofhealth,careand valueintheindustry,andtofindingnewandimprovedwaystoprovidereal-worldsolutionsth

24、at simplify health care processes and improve health care quality. The companys goal is to essentially ensure that healthcare is affordable, accessible, customized and most importantly simple. By simplifying the process, the company believes that a lot of waste in the healthcare ecosystem can be eli

25、minated. The company is looking to leverage Artificial Intelligence (AI), robotics, augmented reality, virtual reality, blockchain, and other innovative solutions and integrate them into a platform based approach (“Anthem Digital Platform”). The intent of this platformistoserveasamechanismforconnect

26、ingemployers,providers,communityofpartners, third party developers etc. with consumers and make that experience seamless and easily accessible. Mr. Ronanki notes that Anthems CEO, Gail Boudreaux, has emphasized the companys continued investment in its digital offerings, including putting budget behi

27、nd its consumer tech and artificial intelligence teams. The company believes that, to compete in healthcare, it also needs to be a technology player and thus need to make big investments in capabilities and platform based solutions.Anthem Digital Platforms Building BlocksTo launch its Anthem Digital

28、 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 million lives, and clinical and lab data for over 10 mln lives. The company put all this data together and harmonizedthatintoacommonoperatingsystem.Thecom

29、panythennormalizedallthedistinct data sources and put all the information into a system, which the company refers as health operating system. Anthem then makes all of that data available to its internal stakeholders as well as the companys select third party partners as appropriate, through its conn

30、ection layer (called as CQ). Further, the company layers AI, machine learning algorithm etc. run on top of this data to determine insights. Finally, the company serves up these insights to consumers, providers, employers/brokers, internal stakeholders, communities, etc. The key is that the consumers

31、olutions,theprovidersolutions,theemployersolutions,andthebrokersolutionsare operatingoffasinglecommondataplatform,whichfragmentationofthehealthcareecosystem much less, and it moves to be a more integrated ecosystem as opposed to separate silo systems.Sydney - Anthems new Mobile AppAnthem recently la

32、unched its new mobile app, Sydney, which gives Anthem members a smart and more human experience. Management notes that Sydney is a personal health ally powered by AI that feels as if its a real person. Sydneys interactive chat feature gives members answers rightaway.Additionally,withSydney,membersca

33、nseetheirbenefitsandgetaccesstomedical, dental and vision claims all in one place. Sydney also gives members a quick view of their care 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 Sydne

34、y. Anthem believes that consumers need to own their own data and based of their permissions, Anthem can make that data available to different stakeholders (family, community, doctors, etc.). Anthem plans to open source Sydney in 2020 for communities to use for a variety of purposes. From the employe

35、rs perspective, employers can look at an aggregated view of trends and the effectiveness of benefit design. Providers have the population health view of the same information. PCPs have attributed membership that they are responsible for caring for.Project CareSpreeAnthem recently launched Project Ca

36、reSpree, which the company defines as digital first insurance product. CareSpree is currently available in Indiana 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 purc

37、hase insurance on top of it. The app will make use of AI technology, at the back of its partnership with K Health, 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

38、 prompted by an AI system, and allowing users to make an accurate self-diagnosis. Management notes that this data is accumulated 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 languag

39、e processing to prepare diagnosis reports based on the symptoms in question. The app is going to entail a number of other 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

40、of the capabilities which are critical to its business and patient experience. Anthem notes that the key for the company is to create the platform, for which the company has released the initial version. This platform is packaged as adevelopment toolkit which the company is making available to the d

41、eveloper community. The company also partners with variety of third party developer communities to create certain capabilities for the company. The company is leveraging its existing partners to build some of the key capabilities suchasabilitytotriagesymptoms,telemedicine,etc.Infact,severalofotherBl

42、uesarepartners and co-partners on Anthems development platform.However, Anthem notes that there are various capabilities that help the company to further improve its member experience and make it more complete and seamless. In such cases, the companyassessespartnershipopportunities.Typically,inpartn

43、eringwiththestartupecosystem, Anthem has made equity investments to ensure the startup company being invested is financiallystable.Additionally,suchanapproachallowsANTMtoinfluencetheproductroadmap more closely.Views on TelemedicineAnthem has had a joint venture with American Well for more than seven

44、 years, which has allowedthecompanytohaveanationwidenetworkforthetelemedicineproviders.Thecompany 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 ge

45、t network depth. The rules from states around telemedicine are still all over the place. For example, 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

46、 there are only 3 or 4 doctors that are certified in all 50 states to practice medicine. So by partnering 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 d

47、igital tools and capabilities (including telemedicine) in the commercial market, primarily driven by large self-insured national accounts. These large employersbelieveintheconnectionbetweenproductivityandhealth.Localgroup,Smallgroup, individual commercial as well as Medicaid segments are also users

48、of Anthems digital tools. The use has been more sporadic with respect for administrative questions (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, tre

49、nds are changing within Medicare population as well.Management believes that it is the responsibility of health insurers to push for more telehealth utilization. With respect to the employers, they can evaluate options related to puttingincentives/penaltiesinplacetodrivemoreadoption.Thecompanynotest

50、hatthehealthbenefit design people at the self-insured employer group are evaluating on ways to align incentives to drivetelehealthutilization.Anthemexpectssomeoftheseemployerstoincludebenefitdesigns in 2021 cycle pushing for more digital versus physical. Additionally, Anthem is partnering with these

51、 employers on trends, creating risk sharing agreements 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). Whereemployerspromotetelemedicine,80%peopletendtouseit.Thet

52、elehealthutilizationof the Anthems 40 million membership base, but not all of Anthems members have access to telemedicine. Finally, Anthem notes that the company has included telehealth (via partnership with American Well) as part of its benefit design in Medicare Advantage.Addressing Social Determi

53、nants of HealthHealthcare payers and providers are starting to incorporate Social Determinants of Health (SDOH) factors to predict the impact on an individuals health. Anthems data sources have number of those factors, such as access to care, factors inhibiting access to care, nutrition issues, and

54、all other kind of community and social drivers, etc. Anthem wants to connect more people into the entire ecosystem to make it easier for them to get access to these things. This includes providing access to transportation, partnering with grocery store chains, launching community health marketplace,

55、 etc.Payment Integrity and Risk AdjustmentAround 85% of the payment integrity (PI) related activities are handled in house using the companys own AI and machine learning platform. However, for remainder of 15%, the company has partnerships with dozens of different vendors. Management believes that t

56、he overalltrendoftheindustryisto movingmorePIinhouse,andthecompanydoesntseeaneed for a third-party vendor to manage PI.With respect to the risk adjustment, Anthem outsources the chart acquisition, collection and acquisition of data, etc. However, for the identification of which charts the company ne

57、eds, it relies on its in-house analytics.Advanced ICU CarePresenter: Lou Silverman, Chairman/CEOOverview and Company BackgroundAdvanced ICU Care is the countrys largest and most experienced provider of 24 x 7 x 365 technology-enabled remote inpatient monitoring services. The company currently serves

58、 ICUs andtelemetryunitswithover1,500beds.AICUcurrentlyservesaround100hospitalsandmore than 80K patients on an annual basis. The bulk of AICUs business is in Tele-ICU; a year and half ago, the company expanded a second service line of business in telemetry monitoring for patients who are in hospitals

59、 but not in ICU. A Tele-ICU is a care model that uses sophisticated telemedicine technology and care specialists to allow a remote care team to continuously monitor patients in a hospitals ICU. At the most basic level, off-site clinicians interact with bedside staff to consult on patient care. Howev

60、er, the true potential of Tele-ICU is realized through a highly engaged approach.Advanced ICU Care also has licensed staff in 37 states which management notes is a huge competitiveadvantageforthecompany.AdvancedICUCareusesa“continuous”modelofTele- ICU, which means that its intensivist-led care teams