Saturday, September 4, 2021

Teladoc (TDOC): Only a video call with a provider? Think again!

Today I am taking a deep dive into Teladoc Health to see whats under the hood. We will look at the company and its subsidiaries to see how they are connected. We will assess if there are synergies between the various business divisions and see if there are clues to further opportunities.

First, background: We will be working with a semantic network model of Teladoc ecosystem. Each node is a tangible concept or entity. Lines connecting the nodes are relationships between any two entities. Thus, if 2 entities are related, there is a line connecting 2 nodes. This type graph is called a network and is an excellent tool to represent relationships between 'things'. Moreover,  this is an unsupervised graph, meaning, the placement of the nodes is by mathematical modeling as opposed to human bias. The information in the relationships decides which node is placed where.

A big reason to do this is to understand the underlying business and to get a sense of scale, interconnections and inter-dependencies. Connections can make a company strong or can drag it down to oblivion if it does not have positive synergies. That being said lets begin - 


Click on image to Zoom

Lets orient ourselves to the model.

  1. Teladoc: Provider of virtual care to patient, shown in dark green nodes
  2. Betterhelp: Provider of online counseling and therapy, cyan nodes
  3. Mystrength: Employer based digital program for behavioral health, red nodes/shape
  4. Livongo: Connected devices for preventative care, light blue nodes
  5. HealthierYou: App platform for all-in-one healthcare needs, purple nodes
  6. Intouch Health: Integrated virtual care experience devices for providers and hospitals, light green nodes.
  7. MedecinDirect: Teladoc clone for France, yellow node (did not replicate the subnodes for sake of clarity)
  8. Hospital to home: My speculation. Post discharge care, potential opportunity, area of need (grey nodes)

Impressions from the network model:

1. Teladoc has built a healthy ecosystem since going public in 2015. The various domains (represented in the shaded colors) are either core businesses which Teladoc acquired (e.g. Betterhelp, Livongo or InTouch) or which it has developed.

2. Teladoc's mental health arm overlapping with Livongos connected care has lead to development of MyStrength Complete. As seen in figure, this was a brilliant move to utilize a preexisting resource of mental health professionals including counseling professionals with connected care components of Livongo. I envision, a similar foray into connected devices for weight management, diabetes with their wellness care, primary360 and medical care. This would be a huge increase for TDOC in terms of total addressable market (TAM). Their recent agreements with several insurers may tap into this market but no formal product (such as mystrength complete for mental wellness) has been announced for diabetes, hypertension. I think this will be a matter of time before they come up with a unified digital program for these other diseases.

3. Few interesting observations for Teladoc core (green) segment. Wellness care is huge and these topics like nutrition, smoking/tobacco cessation are going to be key connecting pieces with other Livongo modules. Also Telederm (virtual dermatology) is a big opportunity. A high resolution photo of a skin condition can offer a dermatologist a preliminary idea about whether the patient needs to come in or can be managed virtually. This would be a billable visit with subsequent revenue downstream is exam or biopsy is needed.

4. The HealthierYou app ties in with core Teladoc by finding a provider 24/7 or a general medical service. It also allows for low cost prescriptions by connecting to pharmacy and connection to insurance. Thus this takes care of the 'peripherals' associated with a medical visit.

5. Intouch is a whole another ball game which has the potential to change critical ways in which outpatient and inpatient medicine is practiced. Intouch Solo is a platform for providers (registration, scheduling, visit, etc) which can tie in with Electronic medical records (EMR). Telehealth devices are solutions for hospitals where virtual care can be brought to the location. Many of these devices can be outfitted with sensors which can assist an remote physician specialist to get vital information to make judgement calls. for example, the cardiology module can have a digital stethoscope and an Electrocardiogram (ECG) machine attached to the device providing telemetry data. 

6. It is my speculation that the next area that Teladoc will focus are patients who are post hospital care and discharged to home. The hospitals are penalized if a patient is readmitted to the hospital after discharge for specific conditions. Also longer admission are financial drag to hospital and burden to patients, plus risk of hospital acquired infections for longer inpatient admissions is real. With these factors, optimal timing of discharge to home and keeping patient from coming back to the hospital is a critical unmet need. With Teladoc's, access to specialists, Intouch's virtual care telehealth devices, it is possible. My suspicion is kindled by hiring by Teladoc of Claus Jensen(Chief Innovation Office) in April this year (2021). This is what Jason Gorevic CEO said "“We are excited to welcome Claus to the Teladoc Health team to lead our innovation efforts,” said Jason Gorevic, Teladoc Health chief executive officer. 

“With deep experience transforming hospital systems and health plans, Claus is the right leader at the right time to accelerate Teladoc Health’s vision of connecting the healthcare experience from hospital to home."
So do you still think Teladoc (TDOC) is only a video call with a provider?

I own shares of Teladoc (TDOC). The data were collected from publicly available sources online and from company websites.

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