TradingKey - The healthcare system was one of the first industries to go through a major transformation; now, investors are watching closely.
Every day, we see new technology being created for diagnosing and treating diseases. The method of delivery in allowing patients access to care has changed almost as rapidly.
One of the most significant changes has been with telemedicine/telehealth; these terms are often used interchangeably because they both represent the same type of remote patient care delivered by way of telecommunications.
They do have some small definitional differences, though: telemedicine deals only with clinical services being provided remotely, while telehealth refers to both clinical and non-clinical services delivered remotely.
The COVID-19 pandemic has caused an explosion in the use of telemedicine, and this rapid growth has led many investors to look for opportunities within the telehealth space.
Hundreds of companies operate across telemedicine and telehealth, and many remain private or relatively small.
Investors with publicly traded shares continue to have enough options, as there are a small number of popular telemedicine companies, such as Teladoc (TDOC), Doximity (DOCS), CVS Health (CVS), GoodRx (GDRX), and Amwell (AMWL), offering different ways for investors to participate in the shift to remote healthcare, including traditional virtual visits to provider platforms as well as multiple combined insurance and healthcare service companies.
Teladoc Health has become a global leader in virtual healthcare by providing an extensive array of services and products, such as virtual primary care and behavioral health, and also chronic disease management.
They currently have an expansive scale with greater than 93 million members in the United States who can utilize their services, and over 40,000 clinicians in their network utilizing their services via telehealth.
Teladoc has been able to facilitate over 75 million virtual visits since 2020, indicating just how much mainstream use of remote care has grown.
The two main segments of their business model are Integrated Care and BetterHelp.
Integrated Care includes telemedicine and digital chronic care solutions and provides more than half of the total revenue. BetterHelp is a virtual platform for mental health services.
Growth opportunities are anticipated to derive from additional products/services, as well as long-term sustaining positive trends, including the increasing number of individuals with chronic conditions, and ongoing supply shortages of health service providers, giving virtual care a significant need.
Doximity is described as a LinkedIn for Doctors since it connects over 80% of US physicians via its website.
About 95% of its revenue comes from subscriptions sold to drug manufacturers and health care provider organizations that use Doximity’s services to market to clinicians, which includes both pharmaceuticals and health plans.
In addition, Doximity has built upon its early success in telehealth (e.g., it had an early adopter audience of about 500K physicians) with its voice and video product “Dialer” which KLAS Research has rated as “the best telehealth video conferencing platform” for the past four years giving increased credibility to hospitals and practices using Doximity now and in the future through their use of Dialer.
While the majority of their growth continues to be derived from drug manufacturer and healthcare system investments in Doximity’s marketing solution(s), Doximity sees an opportunity to penetrate the $4.3B telehealth market, enabling both a physician’s network and a telehealth enabling platform for healthcare providers.
While CVS Health is primarily known for its pharmacy chain, its significant pharmacy benefits business, and its Aetna insurance division, it is also a player in the telehealth market as well. CVS began partnering with Amwell, Doctor on Demand, and Teladoc in 2015 to create and incorporate virtual telemedicine into its MinuteClinics.
Doctor on Demand and Teladoc offer patients the opportunity to connect with licensed providers 24/7 at MinuteClinic locations in their communities for non-emergency (routine) medical issues, common illnesses, or refilling prescriptions. For telehealth services provided through video chat with providers, there are regular business hours of operation for appointments, specifically for patients with chronic conditions or mental health issues.
Teladoc has also partnered with Aetna to give its members access to virtual healthcare 24/7 for their convenience and comfort. In 2021, Aetna launched virtual primary care via Teladoc’s Primary360 platform, which is indicative of the insurer’s commitment to providing a digital-first approach to care and servicing patients.
For CVS investors, telemedicine on its own is not the primary factor for considering CVS stock; however, the potential for growth in CVS Health’s telemedicine business will support Aetna’s insurance offerings as well as the retail pharmacy model.
GoodRx created a name for itself when it helped people save money on prescription medications, as well as providing tools to allow them access to all areas of healthcare via the web.
Their vision includes telehealth services, and so they acquired HeyDoctor in 2019, rebranding it to GoodRx Care the next year. Consumer pricing continues to be reasonable, with typical telehealth services costing between $40-$90 to use and costing GoodRx Gold members only being $19 per visit.
GoodRx does not just send patients to their own staff for treatment; in addition, GoodRx's Telehealth Marketplace is made up of outside telehealth providers as well, creating a one-stop shop for virtual visits.
They are confident that telehealth will contribute to a significant amount of growth from this segment alone, as well as act as a catalyst for increasing the number of prescription transactions and provide many opportunities for cross-selling additional products and services.
Enterprise software delivered through Amwell provides hospitals, health systems, and payers with the ability to deliver virtual health services. Their technology integrates into patient portal systems and claims systems to help manage virtual care.
Amwell Medical Group provides a nationwide network of clinicians who are available 24/7/365 to help clients supplement their existing clinician resources when there is an increased need for physician resources.
Approximately 50 health insurance companies utilize Amwell's platform to serve their customers, which collectively cover more than 80 million members. More than 2,000 hospitals currently utilize Amwell's technology to provide virtual care as well.
The company anticipates growth through product innovations and by entering new countries. Amwell's acquisition of SilverCloud Health in 2021 will position Amwell to accelerate its scaling of behavioral telehealth services internationally, as SilverCloud Health currently partners with a number of health programs in Europe.
The forces that drove telemedicine’s surge remain in place. Compared to pre-pandemic times, there are now fewer governmental regulations that restrict telemedicine and increased reimbursement for telemedicine services, both of which create the foundation for continued long-term growth of the telemedicine sector.
The aging population will continue to create a demand for easier access to ongoing health management services that can be met with telemedicine.
There are distinct benefits associated with the theme. Lighter regulatory friction and broader reimbursement facilitate growth, as do favorable demographics surrounding virtual care use. Investors have multiple entry points, including category leaders, diversified incumbents, and enterprise platforms.
However, competition remains fierce, and in some niche markets, the barriers to entry can be quite low. Regulatory uncertainty remains as policies continue to evolve, and there are additional restrictions preventing certain types of services from being safely and effectively delivered via telemedicine, which directly impacts the total available market in some specialty areas.
Evaluating telemedicine stocks is similar to evaluating stocks of other companies, with a few exceptions due to the nature of the telemedicine sector that require specific evaluations.
A profile that is considered solid would have developed a track record of consistent revenue and earnings growth paired with a sufficient amount of free cash flow, and where the level of valuation reflects the growth outlook and does not excessively inflate a telemedicine company's valuation.
Competitive advantages, including company scale, network effects, payer integration, and superior workflow efficiencies, are very much a part of what needs to be evaluated in telemedicine.
Does the management team have enough experience? Has it demonstrated the ability to implement its vision and have they delivered results? Can the telemedicine company provide evidence of in-house innovation and a pipeline for further innovation?
And is there a high level of customer satisfaction in using the telemedicine platform, and are there different rules regarding reimbursement and regulations in each of the respective television markets where the company operates?