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Telehealth Research Analysts COMMENT Jailendra Singh 212 325 8121 [email protected] Review of 2019 Employer Benefit Guides A.J

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Telehealth Research Analysts COMMENT Jailendra Singh 212 325 8121 Jailendra.Singh@Credit-Suisse.Com Review of 2019 Employer Benefit Guides A.J 17 January 2019 Americas/United States Equity Research Managed Care & Healthcare Facilities Telehealth Research Analysts COMMENT Jailendra Singh 212 325 8121 [email protected] Review of 2019 Employer Benefit Guides A.J. Rice 212 325 8134 ■ We have conducted a review of 2019 Employer Benefit Guides in an [email protected] effort to better understand the competitive environment for Eduardo Ron Telehealth. We analyzed 145 open enrollment benefit guides (including 212 325 7491 many from the Fortune 100). This note summarizes the key themes [email protected] emerging for 2019, and we have developed a spreadsheet that tracks the Caleb Harris, CPA changes we have seen for Teladoc Health, the lone public company in the 212 325 7458 [email protected] space currently. Please e-mail us if you want access to the detailed spreadsheet summarizing our findings from the employer guides (not just those relevant to TDOC) we have reviewed. ■ Telehealth Offerings Steady in Large Employer Market. The large group employer market is highly penetrated, underscoring our view that any benefit of incremental telehealth adoption remains limited. Additionally, large employers seem to be maintaining the status quo on telehealth offerings, underscoring the sticky nature of these contracts. We have come across a few instances where large employers have narrowed the number of telehealth vendors (if contracted directly). For example, Home Depot offered Teladoc Health and Doctor on Demand to its employees in 2018 but is offering only Teladoc Health in 2019. Additionally, in the majority of cases, large employers continue to rely on their medical plans for telehealth offerings (instead of contracting directly). For example, AET is offering Teladoc Health, Cigna is offering American Well and MDLive, Anthem is offering LiveHealth Online (American Well’s white-labeled product for ANTM), and UNH is offering Teladoc, American Well, and Doctor on Demand. Interestingly, there have been some instances where Teladoc Health offerings were expanded to cover UNH enrollees for 2019. In the cases where large employers switched telehealth vendors for 2019, it was generally driven by a change in the contracted medical plan vendors. ■ Opportunities for Telehealth Adoption Still Remains Among Small Group Employers. Unlike the large group market, where we believe more than 80% of employers are now offering telehealth benefits to their employees, small group employers are still not heavily penetrated with respect to telehealth offerings. In fact, several small group employers we tracked introduced telehealth offerings to their employees in 1H18/2019, with Teladoc Health capturing its fair share in that market. By way of background, according to our small group broker respondents, the percentage of employers offering telehealth benefits in 2019 is around 46%, while the percentage of employers offering second opinion/expert opinion benefits in 2019 is around 12%. ■ Cross-Selling Opportunities Between Teladoc Health and Best Doctors Remain. Our analysis also indicates several instances where employers are using Teladoc Health as one of their telehealth vendors but are not offering any second opinion/expert opinion offerings. Additionally, we tracked some clients offering Best Doctors (TDOC) to employees that have a contract with some other telehealth vendor. For 2019, we did not come across many instances of TDOC’s cross-selling success, especially in the large group market. However, the company has been extremely 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. 17 January 2019 positive on this opportunity, and noted to us recently that some of the client wins highlighted at the investor conference were essentially cross-sell wins. Based on our analysis, TDOC’s second opinion/expert opinion faces significant competition from Grand Rounds, which contracts with several large and middle market employers. ■ Up-Selling Success with Dermatology and Behavioral Services. Teladoc Health has consistently highlighted potential opportunities to cross- sell its offerings to its existing clients, noting that only 13% of its U.S. membership has three or more products and only 1% has four or more products. Based on our research of employers’ telehealth offerings, we saw increased interest in covering dermatological services (beyond just low acuity medical care services) under telehealth, with several instances of success for TDOC. The coverage of behavioral health services was another area of interest among employers offering expansion for 2019. ■ Implications for Our Organic Revenue Growth Estimates for TDOC. Most of the trends reflected by our analysis are in-line with our expectations (large group employer market largely penetrated for telehealth offerings, opportunities in the small group market, cross-selling and up-selling opportunities, etc.). Our 2019 revenue growth estimate for TDOC of $550.3 mln, up 32.7% Y/Y, already incorporates 25% organic revenue growth and 7-8% incremental contribution from the deals closed in 2018 (primarily Advance Medical). The new membership wins (including cross-selling wins) and up-selling success provides support for two-thirds of our organic growth revenue estimate (increased utilization is the remaining one-third). As such, we see Teladoc Health guiding largely in-line with current expectations, with the company’s assumptions around the utilization rate pick-up in 2019 being a swing factor. ■ Thoughts on Potential Revenue Opportunity from CVS Health MinuteClinic Contract and MA Telehealth Offerings. Based on our recent conversation with management, CVS Health plans to advertise Teladoc Health’s telehealth offering in MinuteClinics after it is fully rolled out across the country in 2019. As such, this contract is unlikely to meaningfully contribute to revenues in 2019. Additionally, expectations related to some meaningful incremental contract win announcements with respect to the MA rollout of telehealth offerings seem premature. Our view is that due to the uncertainty related to the telehealth adoption among seniors and the way CMS plans to reimburse for these offerings, MA plans are likely to contract with telehealth vendors on a more white-labeled approach and a visit-fee model, which means less significant and uncertain potential revenue stream for the telehealth vendors. ■ Recent Sell-off in TDOC Shares Has Trimmed Valuations. TDOC shares currently trade at 6.5x our 2020 revenues estimates. This represents a significant decline from its 52-week high of 9.0x revenue multiple, primarily driven by a decline in share price. However, even at 6.5x 2020 revenue, TDOC shares are trading at a valuation essentially in-line with those of the similar growth HCIT & SaaS companies. We remain on the sideline given our concerns around TDOC’s underrepresentation in the provider hub-and-spoke market (where we see the potential growth opportunities in the telehealth market), growth approaching saturation in the large payer (employers and health plans) market, management uncertainty, and margins. (We believe the push for a higher utilization rate could pressure margins and could offset the scale benefit resulting from growth in revenues.) Telehealth2 Telehealth 3 Figure 1: Summary of Telehealth and Expert Opinion Offerings Findings Related to TDOC Type of Employer / Coverage Telemedicine Related Changes Effective New Coverage Estimated Impact on Employees / CS Remarks Organization Effective Year TDOC Members Client/Membership Wins/Losses Partners N/A 1-Jan-19 The health system is working in conjunction with Teladoc Membership: No Impact New contract for TDOC; TDOC HealthCare Health on the new solution, which is called Partners HealthCare Visits: Positive Impact disclosed this partnership at its On Demand and will provide urgent care services from Partners Revenue: Positive Impact investor day in September. HealthCare clinicians for minor illnesses and injuries. Partners HealthCare On Demand will first be exclusively offered to commercial members of the system's health plan, Neighborhood Health Plan (NHP), which will become AllWays Health Partners on January 1, 2019. Centene / Health Enrolled 1-Jan-19 Based on the disclosures at some of the employers where Membership: Positive New contract for TDOC; TDOC Net Members Health Net is one of the medical plan, Teladoc is being Impact disclosed this partnership at its introduced by Health Net for the next coverage year. Some Visits: Positive Impact investor day in September. disclosures also indicate that Health Net is switching from Revenue: Positive Impact MDLive ExxonMobil Current Staff 1-Jan-19 Introduced telemedicine services for the full-time regular Membership: Positive New contract for TDOC; TDOC employees (effective Sept 2018) and retirees (effective Jan Impact disclosed this partnership at its 2019): Teladoc for AET enrollees and Amwell and MDLive for Visits: Positive Impact investor day in September. Cigna enrollees. Revenue: Positive Impact Ensign Group Current Staff 1-Jan-19 Switches to Teladoc effective 1/1/2019 from
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