The iPhone Is A High-Priced Commodity The iPhone is little more than a high-priced commodity at this juncture. There is little differentiation between it and lower cost alternatives (OnePlus for example) both from a design and feature functionality standpoint. However, with 2 billion-plus devices in circulation, Apple’s future does not rest exclusively with new device…
A New Heavyweight Healthcare Entrant
The recently announced non-profit joint venture between Amazon, J.P Morgan and Berkshire Hathaway was notably scarce on detail. We previously wrote about how Apple is well-positioned to “consumerize” healthcare. The good news is that there is room for others to add value to the healthcare ecosystem.
Trust, Payments & Price Discovery
If we were to fast forward 5-10 years its easy to imagine that Amazon’s contribution to the “NewCo” healthcare joint-venture will borrow heavily from the company’s experience in online retail where three key elements may come into play: trust, price discovery and payments.
1.) Trust: Since its founding Amazon has developed a deep trust with consumers. Consumers trust Amazon to securely store payment-related information, to offer competitive pricing, to provide a wide variety of goods and services and to deliver goods and services in a secure and timely manner.
2.) Price Discovery: Transparent pricing is a key value-added element of Amazon’s platform as it enables consumers to quickly assess value. Further, Amazon has extended the visibility and reach of independent third-party sellers (3rd party sellers generated $32 billion on Amazon in 2017, a 39% increase over 2016), by allowing them to list their businesses.
It is the “Price Discovery” category where we believe the NewCo venture can create the most value. It could on-board independent healthcare providers such as neighborhood urgent care centers – forcing them to disclose pricing as a pre-requisite for listing. This would be a “win-win” for providers and consumers. Healthcare providers would benefit from listing their businesses and consumers win by having greater choice and pricing transparency.
3.) Payments: consumers and businesses have widely adopted and trust Amazon’s payment platform. This technology could easily be leveraged within NewCo’s platform to facilitate payment transactions between interested parties.
AmazonGo for Healthcare?
How far back in the healthcare stack will Amazon/ NewCo participate? The more information Amazon/ NewCo collects about consumers, the more friction can be removed from the process. One example is patient check-in. It is easy to imagine how Amazon/ NewCo could quickly become the industry standard for Electronic Medical Records (“EMRs”) enabling patient check-in to consist of a phone swipe on an electric reader. AmazonGo for healthcare?
Welcome to Apple Health
Apple recently announced that this spring it will release an update to its iOS for iPhones and iPads that will include a new “Health Records” feature that will provide access to personal medical records covering allergies, conditions, immunizations, lab results, medications, procedures and vitals. Given the ubiquity of the iPhone we believe that Apple is well-positioned to succeed where others – most notably Microsoft and Google – have failed. Listen to our recent podcast on the subject:
Tower of Babel
The Healthcare IT industry suffers from data fragmentation. Some healthcare providers store medical records using difficult to account for paper-based filing systems. Forward-thinking healthcare providers leverage Electronic Medical Records (“EMR”) which are an improvement over paper-based records yet are far from perfect. EMR products from different vendors don’t talk to one another and it’s common for different software versions from the same vendor to experience less than perfect communication. A lack of standards typically creates friction in any technology process and healthcare IT is no different.
EMR software is used by healthcare professionals at small, mid-sized and large medical practices/ healthcare providers to replace inefficient paper-based medical records. EMRs are required to store patient/consumer data in compliance with HIPAA.
How to Achieve EMR Nirvana
Step 1.) Universal Adoption of Secure EMRs: All electronic medical records are required to be stored in a secure-HIPAA-compliant format. This includes text-based, image-based and video-based health records. I considered breaking out “security” as its own “step” given that many CEOs and Boards are slow to address CyberSecurity (see our many CEORater Podcasts and TEK2day.com writings that cover CyberSecurity). No industry is more at risk of CyberBreaches than healthcare given the vast stores of sensitive Personally Identifiable Information (“PII”). We’ve frequently communicated about CyberSecurity and have been a vocal critic of Equifax and “sleepy” CEOs and Boards in the aftermath of Equifax’s 2017 CyberBreach (discovered in July 2017, disclosed in September 2017). I ultimately decided against breaking out CyberSecurity as a separate step given that it must become a way of life, embedded in every workflow, implicit in every operational process. That said, the EMR should become the single version of the truth replacing paper-based medical records.
Step 2.) EMRs On-Demand: EMR data elements must be searchable and readily accessible by any authorized person any time, anywhere in a HIPAA-compliant manner across platforms (zero friction goal). This is true both at the point of care and outside the point of care. One such example outside the point of care would be the application of advanced analytics across millions (if not billions) of anonymous personal medical records – only of course when patients/consumers elect to share their anonymous information. For example, if everyone who owns an iPhone volunteered certain anonymous health record elements to Apple it is not unreasonable to expect that Apple could move society steps closer to personalized healthcare by way of machine learning analytics at massive scale. For our money the world’s most valuable company over the next 100 years will be the company that cracks the code to personalized healthcare/medicine. But I digress..
Step 3.) Portability: EMRs must be portable. For example, if I take a job with a new employer that moves me from Dallas TX to Seattle WA a great deal of friction is eliminated from my move process if my complete EMR is readily accessible from one location that I control (iPhone).
M&A as a Catalyst
Apple could accelerate its Health initiative with one of several Healthcare IT acquisitions. We would focus on the EMR segment. Acquiring an EMR vendor would enable Apple to tightly integrate its Health App with EMRs to a greater degree than would be possible through EMR partnerships. Cerner and Epic are the leading EMR software vendors – each with a long history and vast domain expertise. Cerner recently recruited a new CEO – Brent Shafer – after the untimely passing of its former founder and CEO Neal Patterson. Epic continues to be led by its founder and CEO Judith Faulkner. Were we to advise Apple from an M&A perspective we would focus on Cerner (tkr: CERN) and Epic (private) with athenahealth (tkr: ATHN) as the alternate.
- athenahealth: Boston-based athenahealth is led by its founder and CEO – Jonathan Bush – cousin to former President George W. Bush. Jon Bush is an entrepreneurial dynamo and in the event of an acquisition would be unlikely to stay beyond the negotiated earn-out period. In addition, ATHN has recently experienced senior-level turnover. Therefore, it would be essential that Apple gain comfort with the key senior leadership team members before executing an acquisition of athenahealth.
- Epic: Judith Faulkner founded Epic in 1979 and doesn’t have to deal with the turnover that is typical in San Francisco, New York and Boston. The firm is culturally stable.
- Cerner: enjoys similar cultural stability. New CEO Brent Shafer comes from Philips North America where he was CEO since February 2014. Co-founder and former interim CEO Cliff Illig remains a significant CERN shareholder.
“Consumerization” of Healthcare
We believe that if the iPhone becomes the preferred EMR access point the patient/consumer will be empowered at the expense of:
- Healthcare Providers: will have less customer lock-in as a result of portability/ reduced friction associated with changing providers. Many healthcare providers will gravitate toward transparency (i.e. publish pricing if they feel they are price competitive) in an effort to capture business. Major hospital systems are already losing share to neighborhood providers and urgent care centers. We expect this pressure on the large hospital systems to continue (see our earlier post on the healthcare industry).
- Health Insurers: will continue to face economic pressure. The perverse government subsidization of various components of the healthcare system makes it impossible to have true price discovery and to establish a real healthcare market.
More Fodder for Apple Pay
- Apple Pay and Apple Insurance? Should Apple Health effectively execute its strategy of becoming the preferred medical record access point it will be the connective tissue between consumers and healthcare providers. This will afford Apple the opportunity to monetize this symbiotic relationship by way of facilitating payments and/or offering its own brand of healthcare insurance – perhaps offering pay-as-you-go and peer-to-peer insurance models. Time will tell.
Healthcare IT Vendors
Partial List of Healthcare IT vendors sorted by Run Rate revenue. The “Run Rate” figure for each company was derived by multiplying the “Most Recent Reported Q” or “MRRQ” revenue figure for each company by “4” unless otherwise noted. For example, GE’s MRRQ revenue figure of $5,402 x 4 = Run Rate revenue of $21,608. Note that rounding may impact certain of the Run Rate revenue figures.