Women’s Health A BSC Healthcare Services Sector Report

The women’s healthcare market is poised to expand rapidly in the years to come. This report chronicles all of the major developments within the sector to include changes in , physician practice management, women’s telehealth and FemTech.

| March 2021 Contents

Introduction…………………………………………………………………………………………………………………………………3 The Women’s Healthcare Market…………………………………………………………...... 3 The She Economy…..…………………………………………………………………………………………….4 Fertility……………………………………………………………………………………………………………………….5 COVID-19…………………………………………………………………………………………………………………..6 Overview……………………………………………………………………………………………………………………………………….7 Assisted Reproductive Technologies ……………………………………………………………………9 ART Overview………….………………………………………………………………………………………………9 In Vitro Fertilization……………………………………………………………………………………………10 Other Fertility Treatments………………………………………………………………………………12 ART – Industry Participants…………………………………………………………………………………………..14 ART Transactions………………………………………………………………………………………………………………….15 Physician Practice Management………………………………………………………………………………16 PPM – Industry Participants………………………………………………………………………………………….19 PPM Transactions…………………………………………………………………………………………………………………20 Women’s Telehealth …………………………………………………………………………………………………………21 Telehealth – Industry Participants………………………………………………………………………….23 Telehealth Transactions…………………………………………………………………………………………………24 Bailey Southwell & Co………………………………………………………………………………………………………25

2 | March 2021 Introduction

The Women’s Healthcare Market

Females account for 50.52% of the U.S. population; nearly 175 million people. Now, more than ever before, the country-wide healthcare system cannot meet the demand for quality, all- encompassing medical care for women. In 2019, the global women’s health market size was valued at $32 billion. It is projected to increase at a CAGR of 4.9% over the next six years, to $47.8 billion.

Several factors contribute to this growth, such as there is a growing incidence of chronic health conditions among women and an increase in the number of couples and individuals seeking fertility treatments. Globally, the fertility industry saw total revenue increase to $2.4 billion in 2020.

Some of the aforementioned chronic conditions women are at a higher risk to develop include osteoporosis, osteoarthritis, anemia, menstrual health-related disorders, depression, and obesity. Furthermore, favorable government polices to improve women’s health, and health in general, have raised significant awareness that is expected to contribute to this 4.9% CAGR.

Furthermore, as demand and funds continue to flow into the women’s health industry it is expected to see increased success rates as it relates to fertility treatments, OB/GYN services, and behavioral health outcomes.

A major driving factor in the sector’s growth has been the increase in covered services from U.S. insurance carriers and their acceptance of fertility treatments that had previously not been covered. This category accounts for nearly all of increased spending within the sector.

In the United States, coverage plans now provide preventative services for women without any copayment charges. Such plans apply to anemia screening on a regular basis, folic acid supplements for women who may become pregnant, hepatitis B screening, screening, and contraception. Many women, including those with Medicaid coverage, consider their OB/GYN to be their primary care physician. This offers a bigger play around referrals to other specialties within women’s health.

3 | March 2021 Introduction Cont.

The She Economy

It is important to note that our country has a very long way to go before it accomplishes complete gender equality across the U.S. Most notably, inequality can be seen in the extreme disparity in the gender wage gap or lack of equal opportunity employment opportunities. But strides of progress have been made over the last century.

It is clear that gender equality has started to gain traction. Often coined “A Gender Revolution,” women have finally started to shatter some glass ceilings and achieve long- awaited milestones. All of these facts play a crucial role in the study, focus, and growth of the women’s health space. Social scientists have begun to document the dramatic change in gender inequality over the last half century. An increase in female employment, even among women with children became the norm. ’s widespread acceptance and availability has allowed women to stay engaged in the workforce for longer.

The number of women enrolled in higher education now dwarfs that of men. 58% of college students in 1969 were men, today more than 56% are women. As such, the proportion of women receiving baccalaureate or doctoral degrees have increased greatly. In 2017, among adults ages 25 to 64, 38% were women with a bachelor’s degree, compared to 33% for men. As for postgraduate education, 14% of women had an advanced degree, while 12% of men maintained the same status.

Furthermore, women rose as a proportion of those getting degrees in areas of study that were typically dominated by men, such as management, accounting, science, technology, engineering, and mathematics. Today, women make up 47% of the U.S. labor force, up from just 30% in 1950.

All of this information applies to the women’s health space. While problems still exist, women are now more educated than most men and their health is of paramount concern. This can be seen in the widespread government emphasis within the United States, the numerous organizations now advocating for further development in the sector, and health plans adopting more female friendly health options. These are all major drivers in the growth that is expected to occur over the next several years.

4 | March 2021 Introduction Cont.

Fertility

Arguably the most in-demand service within women’s health is fertility and all that it involves. As mentioned, fertility benefits are becoming a covered benefit more often in commercial health insurance plans. One such example is Progyny. The Company can be added to most employer’s health benefit plans and allows individuals to have health insurance coverage for their fertility needs. Some covered areas include IVF, egg freezing, , and adoption. All of this is intended to meet the ever-growing stream of demand that has evolved over recent years. Our society now widely accepts expressive women-hood. Fertility is openly talked about and access to clinics is easier than before. Gay marriage laws further demand of couples looking to fertility clinics to find alternative methods of conception.

Perhaps the most influential contributor to this high level of demand is that women are waiting longer in life to have children. This is influenced by many different things. The urge to delay has increased the use of contraception in the United States, as well.

The average age of first-time mothers is now 26. In 1972, it was 21. In New York and San Francisco, the average age is 31 and 32, respectively. Success rates in conception and births fall dramatically with age. The CDC reports that about 10% (6.1 million) of all women between 15 and 44 years of age have trouble conceiving. While the U.S. Department of Health and Human Services says that 12 to 13% of all American couples struggle with .

Not surprisingly, the majority of fertility treatments are conducted on women aged 40 to 49. This group accounts for 47.1% of treatments. Women 30 to 39 make up 37.6% and women between 15 and 29 make up 15.3%.

The main reason for this delay in child-rearing appears to be due to financial reasons. The millennial generation is the most educated generation in American history and is largely burdened with student loans. Furthermore, they spent much of their early twenties climbing out of the “Great Recession.” In 2020, SoFi and Modern Fertility conducted a survey of thousands of women on the matter. 61% of participants reported they are choosing to wait to have children because they are restricted financially. 51% said they are waiting to have a higher yearly income first. Not surprisingly, the study found that 3 out of 5 participants were willing to delay family life until they achieved a certain job title or level within their career.

5 | March 2021 Introduction Cont.

This reasoning may have some validity. A Princeton study found that the gender wage gap is primarily due to . After having children, a woman’s earning potential can fall as much as 20% over the course of their careers when compared to a mans. Additionally, for each child a mother has, this earning power drops 4%. As a result, women want to have children later in life because they expect to be able to support a dip in compensation.

All of these facts point to the rise of a new sub-sector within the healthcare industry. Millions of people have turned to fertility clinics to help them accomplish the goal of reproducing a child. The demand is only expected in increase in the years to come as all of the above become more prominent within the United States. COVID-19

It appears that this industry has remained, by enlarge, unaffected by the COVID-19 pandemic. This fact points to the extreme resiliency of women’s health. Women, who got pregnant before March 2020, still had to give birth. Women still must undergo regular mammograms and cancer treatments. Moreover, most states ruled fertility clinics to be essential, so most clinics remained open across the country.

In fact, the pandemic has accelerated parts of the sector. On one hand, demand for contraception has increased dramatically over the last year in developed countries like the United States. This is largely due to instability and the potential dangers of hospital visits. In June 2020, the Digital Health Clinic reported that it had a 50% increase in birth control requests and a 40% increase in emergency contraception orders. On the other hand, some experts are predicting a boom in birth rates in the coming months. They expect that all the restrictions, limitations, and time at home has left many couples eager to start a family. Adding to a potential growth in population is the growth in savings deposits during the pandemic lockdown. Saving rates are directly tied to women’s health. This is largely due to many of the services offered in the industry being on a cash pay basis only. While much of the country has suffered over the last year, there are large pockets of the population who have seen an increase in their financial holdings. A fact that stems from multiple stimulus checks and a lack of spending on vacations and restaurants. Based on historical data, a higher level of disposable income will almost certainly lead to increased demand for women’s health services. Another major area that has seen growth is women’s behavioral health and telehealth. The last twelve months have been hard on many. Women are seeking help via applications from Clementine, Hims & Hers, and many others.

In each of the cases above, the women’s healthcare market has an answer. As a result, the pandemic has left the sector unaffected and, arguably, better off. This adds to the lofty expectation of women’s wellness being a $50 billion-dollar industry in just six years.

6 | March 2021 Overview

Women in Higher Education

There are more women than men enrolled in higher education (right). Not surprisingly, there are far more women than men receiving baccalaureate degrees (left).

Revenue Segmentation within the Fertility Industry

Fertility

Consultation and

Other Services

Assisted Reporductive Technologies

0% 5% 10% 15% 20% 25% 30% 35% 40%

7 | March 2021 Overview Cont.

Fertility Industry at a Glance

Total U.S. Market Total profit Total profit is Revenue is margin is $2.4B $261.8mm 10.8%

There are Total Total wages were 526 clinics employment is $876mm in the U.S. 17,655 in 2019

OB/GYN Industry at a Glance

Total U.S. Market Total profit Total profit is Revenue is margin is $23B $2.8B 12.2%

There are Total Total wages were 15,700 employment is $9.8B practices in U.S. 111,000 in 2019

8 | March 2021 Assisted Reproductive Technologies

ART OVERVIEW

The fertility market is comprised of more than 500 fertility clinics, more than 100 sperm donor banks, the market, fertility , and 1,700 reproductive endocrinologists. IVF procedures represent a large portion of total yearly revenue within the space. While the U.S. market for fertility drugs is worth roughly $750 million.

The market is vast but has expansive room to grow. 75% of potential clients are not using infertility services. Specifically, only 15% of American women have used fertility drugs, 5.5% have tried , and only 1% have used In Vitro Fertilization. However, the number of IVF cycles preformed has grown from 70,000 in 1997 to 331,000 in 2019.

Assisted (“ART”) now produces more than 50,000 babies a year in the United States. Most of these births are subsequent to multiple IVF cycles. Demand for ART and IVF is expected to balloon as the number of infertile women in the U.S. continues to grow. Currently, this is about 7 million women.

The market is largely fragmented as most clinics are operated by small M.D. practices or as a part of a hospital or university. These programs mainly operate regionally. .

The amount of fertility clinics in

the United States has seen

continual and constant growth

over the decade. U.S. Market Size Market Clinic Fertility U.S.

9 | March 2021 Assisted Reproductive Technologies Cont.

Demand for these clinics has experienced modest growth over the last five years with total industry revenue increasing at an annualized rate of 2.9%. This growth includes an annual increase of 1.0% in 2020, alone.

This demand is directly correlated with the growth in overall population and internal population subtleties. Specifically, the formation of households, increased marriage rates, and the ability to afford treatments have driven this demand and expansion. Furthermore, the widespread prevalence of private health coverage and healthcare spending play a role in the rise of fertility clinics, although most of the industry remains cash pay.

The demand for these procedures and services is expected to sustain growth through 2025. This is largely due to the expectation of increased population growth, establishment of households, and further payer acceptance. Over the 2017-2025 period, it is projected that the assisted reproductive technology market will rise at a CAGR of 6.3%.

2020 Fertility Clinic Data in the United States $2.4B Market Size

1.0% Market Size Growth in 2020

2.9% Annualized Market Size Growth (2015-2020)

526 Number of Clinics

17,655 Industry Employment IN VITRO FERTILIZATION

Since the beginning of mankind, there was only one way to conceive a child. For six million years, this was widely accepted. Forty years ago, this fact changed due to the invention, implementation, and now extensive use of Assisted Reproductive Technologies.

Now, doctors can fertilize a women’s egg to create an embryo that can then be inserted into the uterus, or mechanically bring selected sperm and eggs together in the fallopian tubes for fertilization. These eggs can also be frozen for safe keeping and later use.

The desire to reproduce children of biological relation is arguably one of the strongest intrinsic aspiration's humans maintain. These adaptions target the ever-growing issue of infertility, which plagues millions of people worldwide. Infertility can happen to any couple if there is a problem in any part of the incredibly complicated traditional conception process.

10 | March 2021 Assisted Reproductive Technologies Cont.

For example, a couple can be infertile if ovulation doesn’t happen, egg or sperm quality is low, a blockage within the fallopian tubes, abnormal embryos or implantation, and countless other potential disturbances.

This is where ART can play a role. The most common of such technologies is In Vitro Fertilization (“IVF”). In Vitro, meaning “in glass,” is the process of uniting sperm and egg in a laboratory dish, instead of the female’s body. The goal is to produce healthy, normal embryos that can be transferred and developed to term.

The IVF process is technically complex, but can be summarized in five main steps:

1. Ovarian stimulation (superovulation) – The patient consumes ovulation (fertility drugs) to promote the release of several eggs at once. 2. Egg retrieval – These eggs are then extracted in a 30-minute outpatient surgery. 3. Insemination/fertilization – The eggs are then sorted based on their quality and mixed with sperm cells which results in fertilization within a few hours. The success rate of this process can be greatly increased with the use of intracytoplasmic sperm injection (“ICSI”). This is the procedure where clinicians manually inject an egg with a single sperm cell. 4. Embryo culture – Next these embryos are left to grow in a culture medium where, after three days, fertility experts can determine if the embryos contain any genetic disease using implantation genetic diagnosis (“PGD”). 5. - Up to six days after the egg retrieval, embryos can be transferred to the women in a painless procedure.

▪ In 2011 to 2013, about 11% of the 61 million women of reproductive age had received fertility services at some point in their lifetime. ▪ In the same time period, about 6% of married women of reproductive age were infertile. ▪ In 2012, the average percentage of fresh nondonor IVF cycles that led to a live birth was 40% in women younger than 35 years; 31% in women 35 to 37 years old; 12% in women 41 or older. ▪ In 2013, of the 93,787 fresh donor IVF cycles started, 33,425 (36%) led to a pregnancy and 27,406 (29%) resulted in a live birth. ▪ There were 190,773 IVF cycles preformed at 467 reporting clinics in 2013, resulting in 54,323 births. ▪ About 1.5% of all infants born in the United States are conceived using IVF. Fertility Milestones Fertility ▪ A 2017 CDC report estimated 284,384 ART cycles were preformed that year. This data does not take into account the non-reporting clinics. Only 448 practices participated in the polling. This amounts to an average of 600 annual cycles per clinic.

Various other methods can be utilized, although these five steps remain relatively unchanged. Other methods include gamete intrafallopian transfer (“GIFT”) and zygote intrafallopian transfer (“ZIFT”). GIFT and ZIFT make up less than 2% of all completed IVF cycles. The main difference between these and the traditional procedure is where the fertilization takes place.

11 | March 2021 Assisted Reproductive Technologies Cont.

The number of desperate couples and individuals longing to be become parents to a biologically related child is large and growing. There are over 2 million infertile couples in the United States alone. Since 1981, IVF has been meeting demand and helping couples give birth to hundreds of thousands of babies.

Traditional IVF Other Fertility Treatments

▪ $13,000 - $17,000 per cycle. Donor eggs in IVF treatments range from $25,000 - $30,000 ▪ Fertility drugs add $1,500 - $3,000 per cycle. (excluding fertility drugs). ▪ Per cycle average = $19,234. ICSI treatment is an additional $1,000 - $2,500. ▪ Each additional cycle averages $6,955. Genetic testing is an additional $1,800 - $7,500. ▪ The National Institute of Health and Medicine Egg freezing is $1,000, storage fees range $200 - $800 per year. Pricing ("NICE") recommends at least three cycles. Frozen embryo transfer is an additional $3,000 - $5,000. ▪ Three IVF cycles = $33,661. An embryo donor cycle ranges from $5,000 - $7,000. ▪ Much of this is cash pay. Insurance may cover Using a gestational carrier ranges from $50,000 - $100,000. monitoring or some expenses. Using a surrogate will cost nearly $100,000. OTHER FERTILITY TREATMENTS

FERTILITY DRUGS are not only used in the IVF process. These are used to stimulate ovulation in order to produce one or more eggs within a given time period. Ovulation disorders account for about 25% of all female factor infertility diagnosis and is the most common reason for the use of fertility drug treatment.

They are also utilized in IUI cycles and are, as mentioned, always used during IVF treatments. These drugs can stimulate ovulation 80% of the time. A few commonly used fertility medications are Clomid, Femara, and .

The most common of these three is Clomid. It is usually the first drug used in any fertility treatment. It is mainly used in ; however, it can be used in male factor infertility, as well. About 40 to 45% of couples using Clomid will conceive within six cycles of use.

INTRAUTERINE INSEMINATION (“IUI”), also referred to as artificial insemination, is an operation where washed sperm is placed directly into the uterus. This is used often in cases of unexplained infertility and can also be utilized for donor sperm.

As with IVF, the success rate is not high. Only 4% of women conceive while using IUI without fertility drugs and 8 to 17% while using IUI cycles in conjunction with fertility drugs. Where it differs from In Vitro is in the cost. IUI is far cheaper than IVF.

12 | March 2021 Assisted Reproductive Technologies Cont.

IUI is only one form of artificial insemination. There are four methods in total, but IUI is the most common. This method is used by a wide variety of people, including lesbian couples who wish to have a baby with donor sperm.

SURGERY is another alternative option. In nearly 35% of infertility cases, issues are discovered relating to the fallopian tubes or the lining of the pelvis and abdomen. These problems are typically diagnosed with a test called a hysterosalpingogram (“HSG”).

If the HSG reveals a possible blockage, the clinician can perform laparoscopic surgery to evaluate and potentially clear the obstruction. If an is also discovered via the HSG, surgery and may also be required. However, sometimes blockages and scarring are nonrepairable or non-operable. This is where IVF can be used to yield pregnancy.

Laparoscopy can also be used to treat women with endometriosis by removing endometrial deposits. This is often done for patients with severe menstrual cramps or pelvic pain and is less likely to be used in the case of infertility alone. It can also be recommended if uterine fibroids are interfering with fertility.

Another surgical intervention is surgical hysteroscopy. This procedure is often used in the case of adhesions within the uterine cavity itself. Lastly, is ovarian drilling. This is not routinely used due to the risks and low success rates. It may be used in the case of hormone imbalance infertility.

SURROGACY AND DONORS are also used to combat infertility. Donors are often used in IVF if issues arise relating to the quality of eggs or sperm. Egg donors are used mainly in the case of low ovarian reserves, insufficiency, or continued IVF failure. They are also used for male gay couples in conjunction with a surrogate. While a sperm donor can be used when there is severe or if a single woman or lesbian couple wish to conceive a child. Furthermore, sperm donors can also be used in IVF and IUI procedures.

Embryo donation is used for the same reasons as above, but also in IVF because it is less expensive than using an egg donor or going through the complete IVF process.

Fertility clinics offer donor finding services. This is an attempt to screen potential donors and surrogates. In the past, many women have searched the internet for such people. Not surprisingly, this is not an efficient method of donor discovery.

Surrogacy is when a woman carries a pregnancy for another couple or individual. It is utilized if the women has had a hysterectomy, has other uterine problems, or after repeated IVF cycle failures.

13 | March 2021 ART - Industry Participants

Company Ownership # of States Year Invested

29 2010

23 2020

10 2018

9 2015

8 2019

7 2020

4 2019

14 | March 2021 ART Transactions

Date Deal Type Target Investor(s)

8/26/20 Acquisition

12/16/19 Acquisition

10/1/19 Acquisition

6/17/19 Acquisition

4/3/19 Acquisition

3/29/19 Acquisition

3/22/19 Acquisition

9/20/18 Acquisition

15 | March 2021 Physician Practice Management

The growth of the women’s health sector expands beyond fertility and the many services offered by fertility clinics. Another important piece of the industry is OB/GYN services.

This space is separated into two parts: Gynecology and . Gynecologists are medical professionals who focus on diseases of the female reproductive system. Typically, these physicians analyze, diagnose, and preform surgeries on the uterus, fallopian tubes, and cervix. Obstetricians specialize in and childbirth.

The OB/GYN market is as equally fragmented as the fertility market. Physician practices typically have two options. They will partner with a hospital or hospital system or, more commonly, they will partner with a Physician Practice Management Organization (“PPM”).

PPMs are also referred to as Management Support Organizations (“MSO”) and are defined as a company that provides non-clinical practice management services to medical practices. The demand for such services is high as many physicians feel that non-medical burdens of private practice increase over time. This allows the clinicians to spend more time with patients and, in turn, increase revenue.

In these arrangements, the PPM will typically handle all business and non-clinical functions, while the doctors remain in control of the patient experience, medical decision making, and health outcomes.

1 Financial management 2 Billing, claims and collections 3 Technological and information support systems 4 Bookkeeping and accounting 5 Management of administrative personnel (i.e., clerical staff)

6 Assistance with managed care contracting PPM PPM Services 7 Human resources management

The National Center for Health Statistics reports that the number physicians choosing to practice in larger, PPM managed, practices has grown over the last 20 years. In fact, this has become the norm and is recommended. Doctors who recently finished medical school are often burdened with student loans and tend to be risk adverse. This makes the prospects of practicing in a small, stand-alone group uninviting.

Another appealing aspect of working with a PPM is the value-add component. Often, PPMs have extensive experience within the women’s health industry and, as such, can connect doctors to a deep network of patients and fellow clinicians. These organizations also have access to vast amounts of capital that allow for nearly endless possibilities as it relates to expansion and improved patient care.

16 | March 2021 Physician Practice Management Cont.

An example of such a business is Women’s Health USA, which is backed by Sverica Capital Management. This PPM works with over 350 OB/GYNs across 5 different states. Their CEO, Goran Dragolovic, recently noted what a tie to a financial sponsor can bring to the table, “We’re equity-backed, which means that we have access to capital that typically has better terms and conditions than what physicians would get on their own. This enables them to access capital they couldn’t get otherwise or would be too risk-prohibitive. This resonates with groups that have a strong commitment to preserving their autonomy and independence, and who want to continue to expand upon the legacy they’ve constructed

over the years.” OB/GYN Practices by State by Practices OB/GYN

The OB/GYN industry is extremely diluted. No single operator or practice accounts for over 5% of revenue and over 90% of all U.S practices are not affiliated with a PPM.

Furthermore, there is widespread and increasing demand for the services offered by women's health specialists. A major driver of this is the fact that, as mentioned, women are pushing off pregnancy until later life. Another driver is the large population growth the country has experienced in recent years, which is also expected to continue.

Over the last ten years, patient demand grew by 6%. This is expected to continue, as well. The number of women with private health insurance has largely contributed to this demand. As such, industry revenue reached $23 billion in 2020. Additionally, industry EBIT is expected to reach 12.2% of revenue. All these facts point to a revenue projection of $24.5 billion by 2025 (an annualized increase of 1.3%).

17 | March 2021 Physician Practice Management Cont.

Preventative Care

New Problems

Chronic Problems

Pre or Post Surgery or Injury Revenue SegmentationRevenue 0% 10% 20% 30% 40% 50% 60% 70%

OB/GYN services also include contraception consultation and prescription. This is the reason that much of the sector’s revenue derives from preventative care. This is also the reason that demand for services remain high. Women are using contraception more than ever before.

Ages 45 - 64

Ages 15 - 24

Ages 25 - 44 Demographics Ages 65+

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

The demographics present a clear picture of the revenue mix. Women over the age of 45 use gynecological services more often than younger females. This likely originates from surgical and oncology treatments. While the younger group (ages 15 – 44) calls on contraceptive and birthing services.

18 | March 2021 PPM – Industry Participants

Company Ownership # of States Year Invested

34 2017

29 2010

23 2020

13 2013

7 2020

5 2020

5 2017

5 2017

3 2020

19 | March 2021 PPM Transactions

Date Deal Type Company Investor(s)

12/31/20 Acquisition

12/1/20 Acquisition

10/1/20 Acquisition

3/12/20 Acquisition

11/4/19 Acquisition

12/1/18 Acquisition

2/1/18 Acquisition

9/29/17 Acquisition

7/1/17 Acquisition

20 | March 2021 Women’s Telehealth

There is a burgeoning sector within the women’s healthcare market. Femtech, also called Female Technology, is defined as software, diagnostics, products, and services that use technology to improve women’s health. The demand for Femtech products is primarily driven by the fact that 66% of females who use the internet look online for healthcare information. Furthermore, women are 75% more likely to use digital tools for healthcare than men.

The landscape can be corralled into five main segments: fertility, pregnancy/motherhood, sexual wellness, chronic illness, and lifestyle. In recent years and months, Femtech has been extremely active in the areas of menstrual health, pregnancy, and fertility. Around 65% of all Femtech funding has poured into these market segments.

Such services include period-tracking smartphone applications (like Clue and Glow), period care services (Flex and Cora), fertility wearables (Ava), and networking apps for expecting mothers (Peanut). It is worth mentioning that there is a huge area of potential expansion into women who may be in the later stages of life. As of now, there is an abundance of healthcare services for women in their teens through their 30s. It is clear that Femtech’s next frontier will be centered on the post-menopausal market.

One company operating in the sparse space is CurieMD. They offer remote consolations for women of menopausal age. They were the first to market with their mail- order prescription service of menopause hormone-replacement therapies.

Kindbody offers a full-service experience. Their platform provides a full range of fertility, gynecology, and wellness services via modern, tech-enabled in-person clinics, as well as telehealth consultations. The Company also has a yearly membership program and accepts many health insurance providers.

Over the last ten years, nearly 400 venture capital firms have invested into women’s health technology. Most of these investments have occurred recently; 2013 only saw five deals in the space. Specifically, investments into these companies increased by 812% from 2014 to 2018. Proving how novice this industry is, only 30% of VC deals within the space were at least Series B in 2018. In total, Femtech made up nearly 5% of total digital health funding in the same year. It is predicted that the market will reach over $50 billion by 2025.

21 | March 2021 Women’s Telehealth Cont.

Femtech has also expanded into widespread use within lower income communities. Often times, contraceptive apps or delivery services are utilized to fill gaps left by lack of or low- quality medical insurance.

The pandemic has also attributed to the rise of Femtech. For example, more women than ever are looking to digitized healthcare. Modern Fertility, a provider of a direct-to-consumer fertility test, conducted a survey that found that 46% of women have a greater of fear around having access to prenatal care. As such, many women have flocked to online remedies and telehealth.

Regulations have also loosened in response to the health crisis. This fact has ruled in favor of women’s telehealth. The Centers for Medicare and Medicaid Services (“CMS”) released guidance in March 2020 that encouraged states to limit telehealth restrictions. Furthermore, the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act built on CMS’ actions. The Act expanded Medicare flexibilities for telemedicine service delivery and allocated funding to this expansion. The Food and Drug Administration (“FDA”) also relaxed its regulatory process for telehealth products and digital therapeutics. It is now easier for makers of such products to reach those in need.

While many things about the pandemic remain uncertain, one certainty is that it will end eventually. It is because of this fact that there is a widespread consensus that the gains made by telehealth will be here to stay. People will forever access healthcare in a different way.

The Femtech industry is primarily made up of 3,000 app-based solutions. The industry sees over 151 million global downloads every year and it appears to maintain a sticky customer base as it sees consistent use by millions of users. It is because of this that women’s health is the largest consumer-oriented digital healthcare market.

BSC Case Study:

Wildflower Health has developed an engagement platform to connect women to health resources via a smartphone app. This platform offers many health solutions, including a maternity program that uses self-reported data to identify high-risk and drive interventions.

Digital Engagement Clinician Enablement Value Alignment ▪ RPM devices ▪ Workflow integration ▪ Payer/provider networking ▪ Health risk assessments ▪ EHR integration ▪ Value-based contracting ▪ Personalized connections ▪ Biometric monitoring ▪ Program design ▪ Tools & trackers ▪ Clinical escalation pathways ▪ Performance reconciliation ▪ Educational content ▪ Population dashboards ▪ Outcomes measurement ▪ Resource calls to action ▪ Patient specific dashboards ▪ Risk stratification ▪ Care plans ▪ Health advocates

22 | March 2021 Telehealth – Industry Participants

Company Ownership Year Founded Description Fertility, gynecology, and wellness services in modern, tech-enabled clinics. Offers quality care, accessible pricing, and a seamless patient experience. VC Backed 2018

Developer of fertility diagnostic technology designed to make personalized reproductive health information accessible to all women. VC Backed 2017

Provider of reproductive healthcare services intended to offer women and couples comprehensive fertility testing and support. VC Backed 2016

Provider of a medication prescription and delivery platform intended to put women in control of their own health. VC Backed 2015

Engaged in the specialization of fertility and family building benefits solutions. Its clients include employers across various industries. NAS: PGNY 2008

23 | March 2021 Telehealth Transactions

Date Deal Type Company Investor(s)

Later Stage VC 10/1/20 ($5.14mm)

Seed Round Unshackled Ventures, Dorm Room 9/2/20 ($3.22mm) Fund, Bantam Group

Early-Stage VC 8/31/20 ($4.41mm)

Seed Round 8/25/20 ($2.5mm)

Early-Stage VC 8/24/20 Undisclosed ($7.58mm)

Later Stage VC 8/1/20 ($20mm)

Perceptive Advisors, GV, NFP Ventures, Freemark Partners, Early-Stage VC 7/9/20 Goodgrower, Claritas Capital, RRE ($32mm) Ventures, Saltwater Capital and Rock Springs Capital

Threshold Ventures, Homebrew, Early-Stage VC Compound, Human Ventures, 5/28/20 ($24.28mm) Torch Capital, Define Ventures, ACME Capital

Early-Stage VC 5/19/20 TMRW Life Scien ($36.50mm)

24 | March 2021 Bailey Southwell & Co.

Bailey Southwell & Co. was founded in 2005 and is currently headquartered in Nashville, TN. BSC is a boutique investment bank providing customized mergers & acquisitions and capital raising services to leading healthcare and tech-enabled services businesses. More information can be found at www.baileysouthwell.com. Jeff Bailey Stephen Scott Co-Founder & Managing Director Partner & Managing Director (615) 800-6206 (615) 800-6233 [email protected] [email protected]

Russell Bryan Steven Harris Managing Director Managing Director (704) 705-3652 (615) 800-6212 [email protected] [email protected]

Richard Jacques 211 Franklin Rd. Senior Vice President Suite 225 (615) 800-6108 Brentwood, TN 37027 [email protected] (615) 800-6200 25 | March 2021 Sources

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26 | March 2021