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远程医学的未来是谷歌和苹果吗?Teladoc(远医) 和 Amwell(美好)  

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远程医学的未来是谷歌和苹果吗?Teladoc(远医) 和 Amwell(美好)

Move Over, Teladoc: Are Google and Apple the Future of Telehealth?

Telehealth companies have been in the headlines because of recent deals, but the future of healthcare is shaping up to be a familiar brawl between Silicon Valley titans.

Jason Hawthorne
Oct 4, 2020 at 6:45AM

In international relations, a proxy war is an armed conflict between two smaller groups each representing the interests of larger nations. Two recent examples saw the U.S. and Iran supporting opposing factions in Iraq in the mid-2010s and the U.S and Russia doing the same in Afghanistan during the early 1990s.

Although the stakes are not comparable, there may be similarities in how the telehealth industry takes shape over the next decade.

Fast growers Teladoc (NYSE:TDOC) and American Well (NYSE:AMWL) (recently rebranded as Amwell) are getting a lot of attention due to their recent transactions: an acquisition and an IPO, respectively. But technology giants Apple (NASDAQ:AAPL) and Google parent Alphabet (NASDAQ:GOOG) (NASDAQ:GOOGL) are taking up positions that may make telehealth players pawns in a larger battle.

an electronic medical record on a tablet held by two hands



The right place at the right time 

The telehealth market is estimated to grow to $23 billion in 2025 from only $8.3 billion in 2019. Office closures and social distancing guidelines have only accelerated this trend, as patients are unable (or unwilling) to sit in a waiting room until the doctor can see them. Consulting firm Frost & Sullivan estimates the demand for telehealth will grow more than 60% in 2020.

As insurance companies and Medicare further establish the relationship between care outside the hospital and health outcomes, financial incentives will force clinicians to engage easily and often with patients beyond traditional visits. Periodic check-ins, health monitoring, and regular digital communication are likely to become the norm. 

Follow the money

Connecting patients and doctors is an important part of the healthcare system, but it is not the most profitable. Telehealth companies charge $49, $79, or $99 per visit for a few million patients per year, but electronic health records (EHR) systems are massive software platforms that sometimes cost billions of dollars just to purchase, not to mention additional costs for frequent upgrades and maintenance. It's not the Teladocs of the world who will make today's healthcare investors rich, but EHR system companies.

Duke University Health System recently paid $700 million for its Epic EHR. Kaiser Permanente paid $4 billion. Additionally, users of Epic systems reportedly spent another 40% to 49% of initial implementation costs in upgrades. Epic has the highest market share in the hospital market with 29%, while Cerner holds 26%. The opportunity of the EHR market is evident once we compare the revenues and gross margins of a few publicly traded players.

TDOC Revenue (Annual) Chart


TDOC Gross Profit Margin Chart


Once implemented, EHR systems are incredibly difficult to replace. Fortune and Kaiser Health News investigated a $38 billion government subsidy program aimed at improving efficiency and data sharing, and found that many vendors whose certificates were fraudulent continued to operate because their technology was deemed too costly to replace.

The healthcare sector is an intriguing target for giant technology companies that need to find tens of billions of dollars of new growth per year, and EHRs are especially attractive. As care moves further away from the hospital, consumer tech companies are further along in penetrating this market than it might appear. These companies can integrate records systems, provide video platforms, and deploy health monitoring tools through wearables that could create a seamless remote patient experience.

Google's initial attempt at an EHR was shut down in 2012, but the company recently filed patents for EHR tools powered by artificial intelligence (AI). Google invested $100 million as part of telehealth provider Amwell's recent IPO. This is noteworthy because Amwell's product is embedded in both Epic's and Cerner's EHR platforms. Furthermore, Google's pending acquisition of Fitbit would provide a trove of health-monitoring capabilities. The recently released Fitbit Sense monitors stress, sleep, heart rate, blood-oxygen levels, and other physical processes. The combination would offer a useful end-to-end option for both patients and clinicians.

Similarly, Apple has its own EHR pilot under way to help patients and providers share information. Early reports indicate Apple has taken a complex, disjointed experience and made it easier and more intuitive for users. Like Fitbit, Apple has its own wearable -- the Apple Watch -- that monitors various data to quantify health and wellbeing. Apple also boasts a Health app for aggregating data on the ubiquitous iPhone, making it even easier for patients to own their data and keep it locked away in their pockets. Finally, let's not forget FaceTime, Apple's native video-call app.

The healthcare industry is shaping up very much like the smartphone market did a decade ago. Similar to its Android operating system, Google is making small investments in an effort to create a tool that its existing customers can utilize. Meanwhile, Apple is constructing a closed system that offers a more integrated experience, allowing users to control their data and manage their lives through the iOS operating system on their devices. Who would want to get into that fight? 

Not quite going at it alone

Teladoc isn't ceding the telehealth market to Apple and Google just yet. The company has a partnership with Microsoft for cloud services, which could evolve in the future. Teladoc is also integrated with Epic, although Cerner is considered far more popular with settings where care delivery is actively moving, like clinical or ambulatory care. Importantly, Amwell is the sole provider to offer embedded solutions in Cerner's EHR platform.

The healthcare landscape has been changing quickly. Despite saying it would never happen, Epic's 77-year-old CEO could decide to sell the company to Apple, Google, or Microsoft when she retires, transforming the industry overnight. Even if that doesn't happen, the tech behemoths will continue trying to gain traction in the $2.5 trillion U.S. healthcare industry. It may be years before the strategies become obvious to investors, but the healthcare industry is setting up to be the next battleground between giant tech companies. Investors should pay close attention to how the health monitoring capabilities of wearables are integrating with EHRs for clues.

Microsoft and Google may just be getting started using Teladoc and Amwell to battle for the healthcare market. Telehealth will certainly play an important role in the future of care delivery, but cautious investors should bet on the large technology incumbents rather than risk owning a company caught in a proxy war between some of the most successful companies in the world.

Illustrious Member Admin
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杰森·霍桑(Jason Hawthorne)
远医Teladoc(NYSE:TDOC)和American Well(NYSE:AMWL)(最近更名为Amwell)由于它们最近的交易而受到了广泛的关注:分别是收购和IPO。但是,科技巨头苹果公司(Apple)(NASDAQ:AAPL)和谷歌母公司Alphabet(NASDAQ:GOOG)(NASDAQ:GOOGL)的卡位可能使远程医疗参与者成为更大战斗中的走卒。
杜克大学医疗系统最近为其Epic EHR支付了7亿美元。 Kaiser Permanente支付了40亿美元。此外,据报道,Epic系统的用户还花费了最初实施成本的40%至49%进行升级。 Epic在医院市场上的市场份额最高,为29%,而Cerner则为26%。一旦我们比较了一些公开交易参与者的收入和毛利率,EHR市场的机会就显而易见。
一旦实施,EHR系统将很难更换。 《财富》和《凯撒健康新闻》调查了一项旨在提高效率和数据共享的380亿美元政府补贴计划,发现许多证书被欺诈的供应商继续营业,因为他们的技术被认为太昂贵了,无法更换。
Google最初尝试进行EHR的尝试在2012年被关闭,但是该公司最近为由人工智能(AI)驱动的EHR工具申请了专利。谷歌投资了1亿美元作为远程医疗提供商Amwell最近的IPO的一部分。值得注意的是,Amwell的产品已嵌入Epic和Cerner的EHR平台中。此外,谷歌即将收购的Fitbit将提供大量的健康监测功能。最近发布的Fitbit Sense可以监测压力,睡眠,心律,血氧水平和其他身体过程。该组合将为患者和临床医生提供有用的端到端选择。
同样,苹果公司正在实施自己的电子病历试验,以帮助患者和医护人员共享信息。早期的报告表明,Apple采取了复杂而脱节的体验,并使用户更轻松,更直观。与Fitbit一样,Apple也有自己的可穿戴设备(Apple Watch),可监视各种数据以量化健康状况。苹果还拥有一个Health应用程序,用于在无处不在的iPhone上汇总数据,使患者更容易拥有自己的数据并将其锁定在口袋中。最后,别忘了Apple的本地视频通话应用FaceTime。
Teladoc尚未将远程医疗市场割让给Apple和Google。该公司与Microsoft在云服务方面建立了合作伙伴关系,这种关系可能会在未来发展。 Teladoc也与Epic集成在一起,尽管Cerner被认为在诸如临床或非卧床护理之类的提供护理服务活跃的环境中更受欢迎。重要的是,Amwell是在Cerner的EHR平台中提供嵌入式解决方案的唯一提供商。


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