Health scape final project

HealthScape Advisors
SIBC Consulting Project
Spring 2018

2
Team Introduction
Anthony Ramirez
Sophomore
Program of Liberal
Studies
Cleveland, OH
Hunter Urrea
Sophomore
International
Economics
El Paso, TX
Joseph Corcoran
Sophomore
IT Management
Chester, NJ
Christopher Prattos
Sophomore
Business Analytics
and Applied Math
Jacksonville, FL
Joseph Andrews
Freshman
Management
Consulting
Wood Dale, IL
Kathryn O’Connell
Sophomore
ACMS
Hingham, MA
Steven Lanasky
Sophomore
Economics &
Program of Liberal
Studies
Livonia, MI
Matthew Pitts
Sophomore
Finance &
Economics
East Hanover, NJ
Hannah Ueland
Freshman
History & Pre-Health
Cary, NC
Cristian Magdaleno
Junior
Program of Liberal
Studies
Bakersfield, CA

3SIBC.nd.edu
What is SIBC?
▪ Student International Business Council
▪ Largest Student-Run Organization on Campus
▪ Amidst 28th Academic Year
▪ Divisions Include: Consulting, Finance, Marketing, STEM
▪ Credo of “Peace through Commerce”

4
Executive Summary
The Director of Strategic Initiatives for a multi-state health plan in
the northeastern United States
Client
The client has engaged our team to conduct a market scan to identify, prioritize, and
recommend a major strategic investment for 2018 that can be realized in the next 3-5 years
Situation
Wearable devices present a necessary,
attractive innovation for gathering
customers and maintaining insurance
coverage
The healthcare industry can incorporate
Telehealth as a collection of means to cut
costs while strengthening the healthcare
experience for physicians and patients
Recommendation
The Director of Strategic Initiatives should
integrate Biovotion’s wearable technology
to improve healthcare treatment outcomes
and reduce health service provision costs
The Director of Strategic Initiatives should
integrate CipherHealth’s telehealth system
to increase patient satisfaction and
promote population health
Recommendation

5
Healthcare Space
Feasibility of
Investment
Implementation of Investment
Implementation Roadmap Consumer/Provider Acceptance
OBJECTIVE:
Provide the health plan with an implementation plan regarding Biovotion
and CipherHealth adoption in the plan’s commercial line of business.
Potential Risks
and Threats
Cost Saving
Component
Industry
Growth
Market Context
Suggestion: Adopt Biovotion and CipherHealth Technology
Measurement of TechnologyCompany Overview
Investment Opportunities

6Sources: IBIS World
Industry Overview: Healthcare
Major PlayersRecent Healthcare Trends
• Private, group and public health, medical
and dental insurers
• Revenue in 2017 was $784.9 billion
• Revenue growth driven by increases in
healthcare expenditure, medical costs, and
the insured rate
• Reduced employer coverage and consumer
deleveraging has led to recent slow growth
• Mature, medium concentrated,
competitive market with high entry barrier
• Have achieved success through organic growth and
acquisitions (averaging 3 to 5 companies per year)
• Revenue increase averaged 12.8% over last five years
• Primary sources of revenue are premiums and
administrative fees charged for management of
healthcare plans
• Offer full-risk health and dental plans through
Medicare
699
717
701
764 779 785 797 807 816 825 834
400
500
600
700
800
900
2012A
2013A
2014A
2015A
2016A
2017A
2018E
2019E
2020E
2021E
2022E
CAGR: 2.4%
CAGR: 1.2%
Alternative Payment Models aim to increase
affordability by connecting patients and
providers.
New technology and improved data serve to
personalize patient experience
Telemedicine educates patients and makes
healthcare remotely accessible
Industry Characteristics Revenue Projections ($bn)

Industry Overview: Telehealth Services in the US
Historical and Projected Growth ($m)Key Drivers
Industry Overview Products and Services Segmentation
Primary
Activates
Current
Performance
• Transmit and provide communication
& medical information between all
market players through multiple
mediums: videoconferencing, remote
patient monitoring, digital devices
• Annual Growth 12-17: 45.1%
• $1.9 Billion in revenue, 2017
• Industry is rapidly expanding, driven
by advances in healthcare related
technologies
20%
36%
44% Telehealth
Software
Virtual physican
visits
Medical devices and
hardware
Total: $1.9bn
Medical devices and hardware is the most valuable segment.
This is followed closely by virtual physician visits
• Demand for telehealth services will
continue to rise with an increasingly
aging population
Aging Adults
• Revenue in the industry will increase
as the industry expands with more
medical devices coming to markets.
Demand for
medical
devices
• Increased insurance acceptance of
telehealth services and number of
insured individuals will spur growth
People with
private
health
insurance
0.0
500.0
1,000.0
1,500.0
2,000.0
2,500.0
3,000.0
3,500.0
2012
2013
2014
2015
2016
2017
2018E
2019E
2020E
2021E
2022E
2023E
CAGR = 36.3%
CAGR = 7.8%
The telehealth industry is a continually growing industry that offers a potential solution to the skyrocketing cost in
Healthcare.

8
Healthcare Space
Feasibility of
Investment
OBJECTIVE:
Potential Risks
and Threats
Cost Saving
Component
Industry
Growth
Market Context

9Sources: Deloitte, IBISWorld, Nasdaq.com, ibm.com
Blockchain Technology
Healthcare organizations could reduce the significant amount of time and money spent managing traditional information
systems and data exchanges with Blockchain, though it is not feasible with the 3-5 year and $100 million parameters.
Blockchain Impact in Numbers
$20 billion
Annual Cost Savings through a
simple, decentralized platform
51 %
Blockchain technology market
CAGR, 2017-2021
$20 million
Operational Efficiency through
faster transactions
Advantages in Healthcare
Health Records Stored on Ledger
Highly Difficult to Hack
Share Data as Needed
No Data is Ever Lost
Saves Time!
Key Benefits
Cost Savings
• Distributed ledger removes the need of a
centralized ledger and third parties in the
process
• Cuts down on operational inefficiencies
Security
• Blockchain databases are shared and synced
to network in real time
• All changes and additions to the blockchain
are permanent
• All transactions are verified
Efficiency
• Compared to traditional systems, blockchain
technology is quicker to process transactions
• Immediate confirmation of transaction
success

10Source: Statista, NACHC, IBIS World
Telehealth Projections
Hospitals and Insurance Companies
Sources of Growth
• Frequent doctor visitors: treated with fewer
resources, which saves costs
• Infrequent doctor visitors: more likely to use
telehealth because of convenience, which
recaptures lost revenue
• 62 million Americans lack a primary healthcare
physician, which telehealth can offer a solution for
• 25 million Americans currently uninsured will gain
insurance through the ACA by 2023
0
5
10
15
2014 2015 2016 2017 2018 2019 2020
Telehealth User Growth (in
millions)
Diabetes Hypertension Heart Failure
0
2000
4000
6000
2014 2015 2016 2017 2018 2019 2020
Revenue Projections (in
millions)
Diabetes Hypertension Heart Failure
Telehealth’s strong growth and cost savings potential gives both healthcare providers and insurance companies a
strong incentive to adopt and promote the service.
Hospitals
•Charge consumers based on the treatment
they receive
•Cost saving measures in hospital = increased
profits
Insurance Companies
•Receive monthly insurance payments from
clients and pay for portion of client's medical
bill
•Cost savings in hospitals = less of patient's bill
the insurance company must cover =
increased profit

11Source: IBIS World, PR Newswire
Wearable Devices
Technology
• Increase in accuracy and
usability of wearable
devices meets needs of
old and young clients
Trends
• Increase in number of
health based applications
and desire for wireless
connection
Need
• Upcoming shortage of
doctors by 2025 will
require tools to monitor
increasing number of
patients
Platforms
• Telehealth platforms can
benefit greatly from the
implementation of
wearable devices
• Projected growth from 6.2
billion in 2017 to ~$14.4
billion by 2022 (CAGR: 18.3%)
Wearable Medical Devices Market and Telehealth Compatibility
Evolution of Wearables

12
Healthcare Space
Feasibility of
Investment
OBJECTIVE:
Potential Risks
and Threats
Cost Saving
Component
Industry
Growth
Market Context

13Source: American Hospital Association, Telemedicine Magazine
Telehealth & Wearables Cost Savings
Treatment
83% of lower-level health costs
can be eliminated with
telehealth services
Referrals / Transfers
Allows patient access to
healthcare remotely and
increases feasibility of
physician consultations
At Home Patient Care
Reduce costs by 32%
with telehealth
systems
Follow Ups
Reduce follow up visits
by more than 50%
Wearable Devices
Better monitor existing
conditions and focus on
preventative care for
healthy patients
Medical Procedures
Personalize patient care
and reduce need for
unnecessary procedures

14Source: Brooklyn Works, Stat News
Claim Reduction Data
Wearable devices are prevention tools to improve employee health outcomes, which translate to lower overall
compensation claims.
Wearable devices as
wellness incentives
Lowers compensation
costs and reduces
pharmacy charges
• Lessen risk factors by promoting wellness
initiatives and integrating wearable devices.
• Policyholders will establish healthier lifestyle
choices and benefit from insurance discounts
by sharing some or all data from device.
• Using the collected data, insurers can reduce
premiums and costs of its policyholders.
• Tokyo Electron (Japanese semiconductor
manufacturing company) saw annual claims
decrease from 11% to 6% over 8 years.
• Estimated they would have paid $3200 per
employee per year without wearable
implementation.
Improve
health and
financials
Streamline
recovery
Prevent
accidents
Company Discount
with Data sharing
Anthem reduced
risks and costs of
policyholders
Free FitBits
for Employees Appirio
(consulting firm)

Telehealth Growth
Sources of Growth
A Look into the Numbers
• 62 million Americans lack a primary
healthcare physician
• 25 million Americans currently
uninsured will gain insurance through
the Affordable Care Act by 2023
• Centers for Medicare and Medicaid
Innovation are developing patient-care
models using remote-based monitoring
systems
0
200
400
600
800
1,000
1,200
1,400
2013 2014 2015 2016 2017 2018 2019 2020 2021
Industry Value Added ($m)
0
500
1,000
1,500
2,000
2,500
3,000
2013 2014 2015 2016 2017 2018 2019 2020 2021
Revenue ($m)
CAGR: 30.11% IVA Growth: 28.2%
Predicted shortage
of Doctors by
2025: 130,600
Annualized
Increase in Adults
age 65+: 3.3%
Annualized
Growth in Number
of Enterprises:
37.9%
CAGR: 30.11%
Increasing IVA growth trend, the expected shortage of doctors, and an increase in retirement-age adults, cause us
to expect that the Telehealth industry will experience revenue growth in the future, attracting more enterprises.

16Sources: Investopedia, BizTimes, Crunchbase, TechCrunch, Company Websites
Attractive Companies
Telehealth Wearables
Fitbit
•Last Investment: $43 million (Aug 2013)
•Pro: Current leader in wearable fitness trackers
•Con: Most expensive to invest in
AliveCor
•Last Investment: $30 million (Mar 2017)
•Pro: KardiaBand recently proven to detect AFib
•Con: Narrow focus
Aparito
•Last Investment: £15K (Jan 2015)
•Pro: Products used in National Institutes of
Health research
•Con: Small team (six employees)
Biovotion
•Last Investment: Unknown (Jul 2017)
•Pro: Named Europe’s most innovative medical
device company
•Con: Arm band less familiar to consumers
American Well
•Last Investment: $59.2 million (Jan 2018)
•Pro: Focus on easy integration for doctors
•Con: Capital intensive (six rounds of funding)
Teladoc
•Last Investment: $50 million (Jul 2016)
•Pro: Stock has more than doubled in a year
•Con: Most expensive to invest in
X2AI
•Last Investment: $1.31 million (Apr 2016)
•Pro: Few overhead costs
•Con: Limited focus
CipherHealth
•Last Investment: Unknown (Nov 2013)
•Pro: Recognized by KLAS as having best patient
outreach
•Con: Less proven track record than competitors
CipherHealth and Biovotion’s wide focus, promising case studies, established infrastructure, and reasonable
investment price make them prime candidates for growing a multi-state health plan.

17
CipherHealth Overview
Company Overview
Technology Offerings and Application
• Founded in 2009; based out of New York, NY
• Currently in Series B funding
• FDA approved as a medical device
• Vision: Create a unified platform for all patient
communication and care coordination
• Handles follow ups, preventive health outreach,
care coordination, risk assessment, patient
triage, data feeds & integration, and more
Patient engagement through reminders, post-discharge
calls, care continuum outreach, preventive campaigns
Point-of-care application for service excellence,
rounding, and quality initiatives
Recorded messages patients & caretakers access
from home, either via voice call.
Platform that enables care teams to manage any
population, with a focus on the highest risk patients by
leveraging clinically-validated care plans.
Partnerships around the US
*Orange dot = case study on website
CipherHealth’s all-inclusive telehealth service provides a strong interface for both the doctor and the patient, giving
the company a solid platform to help lead the telehealth revolution.

18Sources: www.Biovotion.com, www.altran.com, Crunchbase
Biovotion AG and Altran Overview
Company Overviews
Everion technology Offerings and Application
• Founded in 2011; based out of Switzerland
• Currently in Series A funding
• Digital health company in the field of
sophisticated, medical-grade, wearable
health monitoring solutions
• Everion, a medically certified wearable, was
launched by Biovotion in 2017, and is
available to early stage partners
• Global leader in Engineering and R&D services
for its clients
• 45,000 employees & $3.5 billion 2017 revenues
• Helping Biovotion to develop discreet and
secure health monitoring solutions
• Overall provides great value to Biovotion on
R&D side. Not a lot of experience on Healthcare
side
Heart Rate
Blood Pulse
Blood Oxygen
Respiration Rate
Steps & Activity
Blood Perfusion
The Everion wearable device
capabilities:
• Upload information directly
to the Biovotion app
• Indicate who has access to
their information
• Restrict access when
sending information
• Ensures that only physicians
have regular access to data
The synergies between Biovotion and Altran cover R&D and device concerns, but lacks expertise in healthcare

19Sources: www.Biovotion.com, www.altran.com, cipherhaelth.com
Strategic Synergies
Ideal Strategic Fit
Strategic Alignment
Boundary
Strategic Opportunity
Strategic Avoidance
Strategic Synergy
Strategic Opportunity
Telehealth
Expertise
Meritocracy
Global Reach
Wearable Device
Expertise
Medically
Specialization
Large Domestic
Presence
A partnership between CipherHealth and Biovotion would generate a number of powerful strategic synergies.

20
Healthcare Space
Feasibility of
Investment
OBJECTIVE:
Potential Risks
and Threats
Cost Saving
Component
Industry
Growth
Market Context

21Sources: www.Biovotion.com, cipherhaelth.com
Measurement of Investment
Cost Structure/ Cash Disbursement
Feasibility of CipherHealth
Hospital HCAHPS Savings
Post-Discharge Calling
LaborCost Savings
Additional Medicare
Reimbusment
Total Estimated
3-yearreturn
Mayo Clinic- Phoenix $51,438 $235,051 $403,189 $689,678
Mayo Clinic- Jacksonville $46,646 $220,339 $168,395 $435,380
FlaglerHospital- St.Aug $108,102 $242,210 $403,186 $753,498
St. Vincents East - Birmingham $105,541 $270,491 $1,490,398 $1,866,430
Mizell Memorial - Opp $10,661 $28,019 $38,680
*Estiamtes are based on experience with comparable hospitals
• Based on
CipherHealth’s
experience with their
partners, they are able
to extrapolate on the
savings associated with
comparable hospitals.
• Demonstrates viability
to recoup cost
associated with
investing in their
platform.
• Leave $9 million for unseen expenses or emergencies
Feasibility of Biovotion
• Problem: Very little quantitate data
available for Biovotion.
• However, there is a plethora of public
experiments done that prove the
effectiveness of wearable devices.
• Given the proven concept, implementation
of Biovotion’s wearables is feasible so long
as the supply chain management operates
effectively
Our $100 million dollar investment would yield profitable returns over time given the feasibility and proven track
record of both CipherHealth and Biovotion.
(in millions of dollars)
Cost Structure 2019 2020 2021 2022 2023 2024
To CipherHealth:
6 7 8 10 12
To Biovotion
Device cost 20 1 1 1 1 1
miscellaneous 2 2 2 2 2
Internal cost
New hires 1 1 1 1 1
SG&A added cost 1 1 1.5 2 2.5
Total cost: $ 91

22Source: New York Times. Forbes. NPR. Altran. MobiHealth News.
Partnering with Biovotion
Consistency
Similar to current plans with UnitedHealthcare with Dexcom &
FitBit
Growth Provides room for growth and deviation in strategy in long-run
Risk Averse
Rather than having a large, up-front deal with a start-up with the
hope for growth, this provides direct incentives and spreads cost
Partnering with Biovotion, with Altran’s consultation, will present a consistent, growth-oriented and risk-averse
strategy for entrance into the wearables and telehealth market.
• The insurer would pay Biovotion at a reduced-cost, per-unit structure
(to be negotiated).
• Supply to insurance consumers would be decided wholly by the insurer,
providing flexibility in scope and pricing models.
• Work in unison with Altran to coordinate an effective platform in
short- and long-run.
Partnership Details

23Sources: New York Times. Forbes. NPR. Statista. CDC.
Risks & Threats: Long-Term
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
18-24 25-34 35-44 45-54 55-64 65+
Expansion in Wearables
Adoption of Wearables Uninsured
Age
Distributions
& Adoption
Lop-sided targeting across age
distributions, as witnessed in
general wearables market
Data Breeches
Growing connectivity and data
transfers open windows for
failures; breeches cost an
average $1.3 Million—each!
Free-Loader
Problem
Changing physician-patient
relations altering health
insurance coverage
Initial Troubles
with Integration
Privacy Concerns
and Liability
Targeting to
Saturated
Demographics
Changing
Relations with
Healthcare
Insurer Sponsored
Telehealth
"Phased-Out”
Several long-term risks, from implementation to continuation and expansion, present tangible risks.

24Sources: New York Times. Forbes. NPR. Statista. CDC. Signa. Scientific American. Unleash (PwC survey). Brooklyn Law Review.
Liability & Security
Dangers in Cyber Security, Legal Liability, and Public Relations present potential risks but can be mitigated through
effective communication, cohesion and commitment.
• Average $1.3M Loss each hack
• Increased connectivity opens
up vulnerability
• Opportunity: Block Chain’s
development
• HIPAA Violations and Liability
for Data Loss
• Potential issues with
increased regulation (from
currently unregulated state)
based on privacy (ex. Google)
• What appears to be a
positive marketing strategy
could be spun negatively
• 40% of employees don’t trust
their employer to use the
data for their benefit
Cyber Security Lawsuits Public Relations
Consumers frightened by privacy
concerns & insurer’s interests
(only 53% of employees in PwC
survey would be tracked for
relative benefit)
Meanwhile, data leaks and lawsuits
could simultaneously scare aware
consumers while adding higher costs of
operation and liability

25
Healthcare Space
Feasibility of
Investment
OBJECTIVE:
Potential Risks
and Threats
Cost Saving
Component
Industry
Growth
Market Context

26
Integration
Prototype Phase Large-Scale PilotsSmall-Scale Pilots
Technology
Support, training,
usability, quality
1 year
Acceptance
Financing &
Organization
Policy &
Legislation
Attitude and usability,
evidence-based
medicine, diffusion
and dissemination
Service provider and
structure, scalability
Legislation and policy,
standardization,
security,
interoperability
Within 6 months Within 2 years Within 4 years
OperationalStage
Category
Determinants
of Success
When
Creating a large scale, operational telehealth system for a medical provider to use within 5 years is possible, but
after initial app creation and integration with technologies already being used by doctors and patients, it will be
worth the effort and save ample time and money in the future.
Additional Investments
• Expanding the Biovotion app to allow for patient/doctor communication to allow
telehealth capabilities
• There would need to be additional investment throughout the prototype phase to
account for updates to the application and troubleshooting issues
• Need to account for updates and trouble shooting during the prototyping phase
• Once the product is operational, focus will move to expanding capability with
non-Environ devices
• Find method of linking Biovotion with EMR to allow physicians the best access to
data from Bluetooth-integrated devices

27
Healthcare Space
Feasibility of
Investment
OBJECTIVE:
Potential Risks
and Threats
Cost Saving
Component
Industry
Growth
Market Context

28Sources: Mayo Clinic
Patient Acceptance
Communication
Time
Personal Portal
• More secure than email
• Can create a Personal Health
Record (PHR) that can be
personally accessed whenever
necessary
• Access to all the data
gathered by the device, which
allows for personal health
monitoring in addition to
remote monitoring
• Can more readily contact
physicians / providers
• Can set reminders and
make appointments
through devices / portal
• Request refills directly
• Can reduce need for in
person visits
• Possibility of virtual
appointments for minor
health concerns
Wearable Device based Telehealth offers patients safer access to their medical information, easier access to
physicians, and time saving options

29Sources: Health Navigator, Mayo Clinic
Provider and Doctor Acceptance
Store
Capture
Use
Send
Build
• Receive more
complete patient
file
• Reduce need for
patient narrative
• Ability to monitor
patient outside of
medical facilities
• Easy access to
patient
information for
providers/ doctors
• Allows for a
centralization of
patient
information
• Wearable Devices
work in
conjunction with
storage systems
• Medical decision
making can be
made with the
most recent
information
• Decisions will be
more cost
effective
• Patient
information can
be sent to all
parties involved in
case
• Doctors and
providers can
directly
communicate with
each other
• All data can be
used to optimize
clinical workflow
• Providers can
change based on
medical trends,
which leads to
cost effectiveness

30Sources: Telehealth Resource Center
Marketing Strategy
By delivering an informative and engaging message, through the right media, to the key influencers in the Telhealth
industry, our investment will garner both provider and patient support.
Market
• Who do we want to speak to?
• Influencers of Telehealth Awareness,
Utilization, and Reputation
Message
• What do we want to tell them?
• Problems of current healthcare
• Benefits of telehealth and wearable device investment
Media • How do we want to get our message across?
• Goal is to maximize exposure
“Connect to
Better Health”
“Fast, Easy
Reliable”
“Experience
Healthcare the
right way”
“Transforming
the face of
Healthcare”
“Healthcare at
your
fingertips”

31
Conclusion: adopt CipherHealth technology and
Biovotion wearables to increase health plan profits
Market
Penetration
Developing
Technology
CipherHealth technology allows
our client to improve the patient
and physician experience while
making healthcare more
accessible
=
Telehealth
Implementation
Optimized
Treatment Protocol
Revenue
Additions
Cost Savings
=
Increased Profit
Wearable device can incorporate
a personalized user experience
to attract more subscribers and
efficiently provide physicians
with patient data

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