Former VP at Teladoc Health Inc
- Telehealth landscape and impact from the novel coronavirus pandemic
- Handling a surge in patient volume – abilities across telehealth segments
- Competitive landscape and relative differentiation across key players
- Impact of the coronavirus on insurers and potential breaking point
- Outlook for 2020, including best- and worst-case scenarios
What key trends and themes are you following in the telehealth sector?
What are your thoughts on Teladoc’s IT network capabilities, given the drastic uptick in usage over the last few weeks? Is Teladoc well-prepared to handle that peak volume? AmWell has had some issues with crashes.
Some of Teladoc’s smaller competitors allude to a shortage of physicians to handle the influx virtually. What are your thoughts on physician network capacity? How might Teladoc mitigate that shortage of doctors and efficiently reach the maximum number of patients?
Is the surge in telehealth demand temporary, or do you think it will be a new normal? Could we expect higher utilisation in future?
What are your thoughts on the longer-term supply-demand dynamics for ancillary services from companies like Livongo and Hims? Is there stickiness here? Do you think this will be more of a pandemic response and won’t develop into a business segment? Livongo yesterday announced it was adding telebehavioural capabilities with Kaiser, and Hims & Hers is using its DTC platform to do virtual COVID screening.
What is a reasonable expectation for the percentage of visits during this time that will be paid? Do you think 50% is a reasonable baseline estimation for visits paid?
In March, some 50% of Teladoc visits were first-time users and cost-sharing fees were waived. You mentioned you expect some stickiness from this customer base long term. What are your thoughts on fee waivers post-coronavirus? Would you expect most payers to revert to pre-coronavirus fee dynamics? How might negotiations evolve?
Some of Teladoc’s competitors have chosen to work with large payers directly. Do you expect more negotiation from Teladoc on that front? Would working directly with payers be more fruitful as employer dynamics shift?
What industry regulatory changes would you expect post-coronavirus, if any? Do you think the response of CMS [Centres for Medicare and Medicaid Services], the public payer channel, might be a commercial payer catalyst?
How is Teladoc’s international business set up for potential global increases in utilisation and volume? Do you think it is penetrated to the point where that would materially impact the company?
Is Teladoc marketed to international providers? Is provider adoption strong? Are they broadly aware of the Teladoc?
How scalable and replicable are telehealth businesses from one country to another? What are the hurdles to consider as Teladoc and others seek to expand internationally?
Do you think building the businesses overseas mirrors the US market strategy in building out the primary care channel first, then considering behavioural health, remote patient monitoring and rehabilitation? Do you think it’ll be all services at once or gradually building up business service line by service line?
With Teladoc entering Europe and other international markets, is there any potential for European players to enter the US? Or is the US relatively saturated? Do you expect most international build-out to come from US-based companies?
Would you expect a lot of Teladoc’s growth to still be catalysed from M&A, or is there enough critical mass internationally that organic growth should suffice?
Would you expect any material contribution to revenue in the near or mid-term from the international business, or will it be relatively marginal? The coronavirus will probably lead to slowdown in infrastructure build-out. When can we expect a more meaningful revenue contribution from the international business?
How would you outline the competitive landscape between Teladoc and competitors such as American Well, Doctor On Demand and others, in the coronavirus situation and more broadly?
Is there any risk of new entrants into the market, given the attractiveness and media spotlight on telehealth? Is there any risk of encroachment?
How concerned are you about more established healthcare software providers seeking to enter telehealth? Would incumbents, given their penetration with hospital systems or payers, pose any competitive threat? Or is it primarily Amazon and then everybody else?
Do you have any visibility on Babylon Health? It’s a European operator which recently entered the US market.
What is the level of variability between Teladoc’s commercial health plan contracts in the scope of visits that are reimbursable, and the actual pricing for each visit type? Is it similar to the structure you laid out where it’s USD 49 per visit? Is that consistent or does it vary across contracts?
Could new regulation on the public payer side force more commercial standardisation longer term? Do you think there’s a read-through we can get from public to private?
Given Teladoc has relatively high exposure to commercial payers, is there any concern that higher unemployment could negatively impact volumes? Could the CMS waivers potentially mitigate some of that downside?
What do you think of Teladoc’s ability to perform in a recessionary environment? Will its work in Medicaid over the next few months be a determinant of success or failure?
Would you expect Teladoc to still have high acquisition appetite? Would you expect it to expand or add service lines? Or is it focused on building the book of business it has now?
Is there anything we haven’t spoken about that you think might be important to highlight?
What is your outlook for Teladoc over the next 12-18 months? What will you be monitoring over that time frame?
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