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North America Equity Research May 2020
US Healthcare What Consumers Are Saying About Resuming Elective Procedures
Medical Supplies & Devices Robbie Marcus, CFA AC
+1 212 622 6657 Robert.j.marcus@jpmorgan.com
HC Technology & Distribution Lisa Gill AC
+1 212 622 6466 Lisa.c.gill@jpmorgan.com
HC Facilities & Managed Care Gary Taylor AC
+1 212 622 6600 Gary.taylor@jpmorgan.com
Life Science Tools & Diagnostics Tycho Peterson AC
+1 212 622 6568 Tycho.peterson@jpmorgan.com
European MedTech & Services David Adlington AC
207 134 5828 David.adlington@jpmorgan.com| See the end pages of this presentation for analyst certification and important disclosures, including non-US analyst disclosures. J.P. Morgan 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.
2
“ “Goldilocks Prevails” - 72% of those with a deferred medical procedure stated they were willing to undergo the procedure either “now” or “within a few months as crisis eases”. Hospitals & Providers: This seems fairly bullish for hospitals off the down 50% April lows; particularly given the responses were collected over 5/5-5/11/20 as states were just beginning to re-open social movement and elective procedures. Managed Care: The data is still plenty benign for managed care medical loss ratios (MLR); 38% of previously- scheduled cases are not willing to come back until there is treatment or vaccine development. Two modest surprises from this same subset of patients: 1) no material skew of outpatient vs inpatient (more positive for hospitals vs ASCs than we would have guessed), and 2) a slight skew of government vs commercial insurance (slightly worse returning payor mix for hospitals than we would have guessed given frailty of senior population vs younger commercial population). Managed
Care
&
Healthcare
Facilities
With more than a third of respondents planning to wait until a treatment or vaccine becomes available, this reaffirms our view that COVID-19 will have lasting impacts well-beyond 2Q20 Disruptions to the pipeline of patients could also stifle the recovery, with only 36% of patients currently seeing a physician either in-person or virtually. MedTech
Elective procedure pushouts and hospital capex spending continue to look bleak amidst the pandemic (for more color on the latter, see our hospital capex survey)
We continue to recommend select exposure. In particular, we would avoid some dental names in light of a slower recovery in elective procedures (i.e. XRAY), as well as radiation oncology (i.e., VAR, ARAY), which remains prone to a more lasting hospital capex budget freeze and changing reimbursement, while we note that ISRG plans to use the balance sheet aggressively to place capital under an operating lease model, which should offer some cushion. Lastly, we remain constructive on HOLX, in light of the COVID-19 diagnostic tailwinds, among other things.
Outside of med tech and dental, we remain positive (and Overweight) on several diversified life science tools names (AVTR, DHR), smid cap growth companies (ADPT, GH, NTRA, TXG) and CRO/CDMOs (CRL, CTLT, IQV, PPD). We remain Underweight on LMNX, MYGN, QDEL, VAR and WAT. Life
Science
Tools
&
Diagnostics
Healthcare
Services
Telehealth:
We
believe
the
results
are
broadly
bullish
as
it
relates
to
continued
adoption
of
telehealth.
While
32%
of total
respondents
have
had
a
telehealth
consult
in
the
past,
69%
of
total
respondents
indicated
they
would
be
willing to
have
a
telehealth
consult
in
the
future.
Satisfaction
appears
high,
with
79%
of
respondents
that
have
had
a telehealth
consult
in
the
past
indicating
that
they
would
be
willing
to
do
it
again
in
the
future.
We
believe
these
results reinforce
our
positive
views
on
Teladoc
Health
(TDOC/OW)
and
One
Medical
(ONEM/OW),
as
new
users
and
positive experiences
should
lead
to
increasing
comfort
around
future
use
of
telehealth
across
a
range
of
conditions. Clinical
Labs:
61%
of
respondents
were
not
willing
to
wait
more
than
3
months
to
have
a
test
performed,
which
we view
as
a
positive
take
for
the
labs,
which
saw
a
50-60%
decline
in
volumes
from
healthcare
utilization
deferrals. Digging
further
into
the
question,
84%
of
respondents
would
not
be
willing
to
wait
more
than
6
months
from
the
time of
the
survey
to
defer
testing.
This
is
consistent
with
commentary
they
have
started
to
see
volumes
return
faster
and to
a
greater
extent
than
they
had
anticipated,
and
would
represent
upside
to
our
models. Healthcare
IT:
Within
Healthcare
IT,
Change
Healthcare,
Progyny,
and
Phreesia
have
the
largest
utilization
exposure at
40-50%,
55%
and
100%
respectively.
Looking
at
the
survey
results,
55%
of
respondents
who
did
not
have
a procedure
deferred
would
be
willing
to
undergo
a
medical
procedure
within
a
few
months,
while
72%
of
those
that had
deferred
procedures
would
be
willing
to
return.
This
echoes
commentary
from
1Q
calls
around
pent-up
demand, which
we
view
as
favorable
to
our
models.
European
MedTech
Orthopedics
–
Smith
&
Nephew,
Medacta
S&N
has
been
relatively
cautious
on
pace
of
near
term
rebound
–
confirmed
by
this
survey.
Also
wary
of increased
pricing
pressure
in
near
to
mid-term.
Medacta
–
has
indicated
it
expects
to
see
earlier
demand
come back
into
ASCs,
with
hospitals
coming
back
later
(not
confirmed
by
the
survey) Dental – Straumann
The key data point on dental implants was that procedures have been deferred rather than cancelled, and are almost all being rescheduled for next 3-6 months. What this survey doesn’t capture is how any economic impact might influence future decisions Cardiovascular – Philips, Getinge
While a relatively small part of Philips, the CV business is profitable (particularly the consumables) and high growth and was hit hard on late Q1/early Q2. An early rebound is probably factored into expectations and this looks to be confirmed by the survey Surgical Urology – Coloplast
Coloplast cut guidance for this year, almost exclusively citing weakness in their surgical urology business - backed up by the survey, with no respondents who had had an endoscopy or urology procedure deferred saying they would get a procedure done immediately if possible, with 54% indicating that they would defer it by 6 months or longer. Hopes of early rebound seem unlikely Hospital capex – Philips, Siemens Healthineers, Elekta, Getinge
While not directly assessed as part of this survey, a slower patient rebound likely has implications for Hospital capex budgets, something we have addressed directly with our hospital capex survey
Demographic
Selection
Criteria
We conducted a survey of 544 patients through Survey Monkey with the following criteria: Data was collected between May 5-11, 2020 Respondents were selected so that ~2/3 were over the age of 65 and ~1/3 under the age of 65 We expected higher healthcare system utilization among an older demographic Respondents were selected so that ~1/2 of patients had a procedure deferred due to disruptions from COVID-19, and ~1/2 who had not had a procedure deferred. Patients didn’t have to answer every question, that’s the reason for minor discrepancies in sample sizes. We did not edit or exclude and responses.
(n=247) 9%
14%
62%
15%
have? (n=
65 6%
9%
28%
52%
2%
3%
217)
ot looking 1%
3%
15%
81%
Patient
Demographics
of
Those
With
a
Deferred
Procedure
The survey criteria was set so as to select for older patients who are more likely to undergo regular medical procedures
Respondents were selected so that ~2/3 were over the age of 65 52% of respondents are retired 81% of respondents are covered by either Medicare or Medicaid
Q: What is your age? (n=257) Q: What is your employment status? What type of healthcare insurance do you
Under 30
Part-time Self-employed I do not have health insurance Private/employer sponsored healthcare Not sure, but have health insurance
30-45
Older than 65
46-
Full-time Retired
Public/Medicare/M edicaid
Furloughed Not employed, n
6
(n=250) 8%
13%
60%
19%
have? (n=255) 5% 8%
19%
68%
Private
Not sure, but 30-45 have health insurance
I 5%
2%
11%
58%
19%
1%
5%
Patient
Demographics
of
Those
Without
a
Deferred
Procedure
The survey criteria was set so as to select for older patients who are more likely to undergo regular medical procedures
60% of respondents were over the age of 65 58% of respondents were retired 68% of respondents are covered by either Medicare or Medicaid
Q: What is your age? (n=279) Q: What is your employment status? What type of healthcare insurance do you
Under 30
Part-time Self-employed /employer sponsored healthcare
Older than 65
46-65 Other
Full-time
Retired
do not have health insurance
Public/Medicare/Medicaid
Furloughed
Not employed, not looking
7
(N=544 Total Respondents; 100% of Total)
Deferral
of
Medical
Procedures
Q: Did you have a medical procedure that was delayed or cancelled due to COVID-19?
Type
of
Health
Insurance
TAKEAWAY :
The
payor
mix
breakdown
between
sample
cohorts
is
approximately
similar.
Q: Of those who did not have a procedure deferred, what insurance do you have? (N=280 Total Respondents; 51% of Total) Q: Of those who did have a procedure deferred, what insurance do you have? (N=264 Total Respondents; 49% of Total)
Earliest
Timeframe
Willing
to
Undergo
a
Medical
Procedure
TAKEAWAY :
Patients
who
did
have
a
procedure
deferred
are
more
willing
to
have
a
procedure
“now” (32%
vs
20%).
...