J.P. 摩根-美股-医疗保健行业-美国医疗行业：消费者对恢复选择程序的看法-2020.5-55页.pdf

1US HealthcareWhat Consumers Are Saying About Resuming Elective ProceduresSee 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.North America Equity ResearchMay 2020Medical Supplies&DevicesRobbie Marcus,CFA AC+1 212 622 6657RHC Technology&DistributionLisa Gill AC+1 212 622 6466LHC Facilities&Managed CareGary TaylorAC+1 212 622 6600GLife Science Tools&DiagnosticsTycho PetersonAC+1 212 622 6568TEuropean MedTech&ServicesDavid Adlington AC207 134 5828D|2Life Science Tools&DiagnosticsElective 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.MedTechManaged Care&Healthcare Facilities“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).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 2Q20Disruptions to the pipeline of patients could also stifle the recovery,with only 36%of patients currently seeing a physician either in-person or virtually.Sector Takeaways3Healthcare ServicesTelehealth: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.Sector Takeaways(cont.)4European MedTechOrthopedics Smith&Nephew,MedactaS&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 StraumannThe 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 doesnt capture is how any economic impact might influence future decisionsCardiovascular Philips,GetingeWhile 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 surveySurgical Urology ColoplastColoplast 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 unlikelyHospital capex Philips,Siemens Healthineers,Elekta,GetingeWhile 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 surveySector Takeaways(cont.)5Demographic Selection CriteriaWe conducted a survey of 544 patients through Survey Monkey with the following criteria:Data was collected between May 5-11,2020Respondents were selected so that 2/3 were over the age of 65 and 1/3 under the age of 65We expected higher healthcare system utilization among an older demographicRespondents 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 didnt have to answer every question,thats the reason for minor discrepancies in sample sizes.We did not edit or exclude and responses.Survey Methodology6Patient Demographics of Those With a Deferred ProcedureThe survey criteria was set so as to select for older patients who are more likely to undergo regular medical proceduresRespondents were selected so that 2/3 were over the age of 6552%of respondents are retired81%of respondents are covered by either Medicare or MedicaidDeferred Procedure Patient DemographicsSource:JP Morgan ResearchQ:What is your age?(n=257)Q:What is your employment status?(n=247)What type of healthcare insurance do you have?(n=217)9%14%15%62%Older than 65Under 3046-6530-4552%3%2%28%9%6%RetiredSelf-employedPart-timeFull-timeFurloughedNot employed,not looking81%15%1%3%Public/Medicare/MedicaidPrivate/employersponsored healthcareI do not have health insuranceNot sure,but have health insurance7Patient Demographics of Those Without a Deferred ProcedureThe survey criteria was set so as to select for older patients who are more likely to undergo regular medical procedures60%of respondents were over the age of 6558%of respondents were retired68%of respondents are covered by either Medicare or MedicaidNon-Deferred Procedure Patient DemographicsSource:JP Morgan ResearchQ:What is your age?(n=279)Q:What is your employment status?(n=250)What type of healthcare insurance do you have?(n=255)8%13%19%60%46-65Under 30Older than 6530-4568%19%5%8%Public/Medicare/MedicaidNot sure,but have health insurancePrivate/employer sponsored healthcareI do not have health insurance58%5%1%19%2%11%5%RetiredFull-timePart-timeNot employed,not lookingOtherSelf-employedFurloughed8Deferral of Medical ProceduresSurvey CharacteristicsSource:JP Morgan ResearchQ:Did you have a medical procedure that was delayed or cancelled due to COVID-19?(N=544 Total Respondents;100%of Total)9Type of Health InsuranceSource of InsuranceSource:JP Morgan ResearchQ:Of those who did not have a procedure deferred,what insurance do you have?(N=280 Total Respondents;51%of Total)TAKEAWAY:The payor mix breakdown between sample cohorts is approximately similar.Q:Of those who did have a procedure deferred,what insurance do you have?(N=264 Total Respondents;49%of Total)10Earliest Timeframe Willing to Undergo a Medical ProcedureAttitudes Towards ReschedulingSource:JP Morgan ResearchQ:Of those who did not have a procedure deferred,when is the earliest timeframe youd be willing to undergo a medical procedure?(N=254 Total Respondents;47%of Total)TAKEAWAY:Patients who did have a procedure deferred are more willing to have a procedure“now”(32%vs 20%).The majority of both cohorts(55%&72%)are willing to have a procedure before treatment or vaccine is developed.Q:Of those who did have a procedure deferred,when is the earliest timeframe youd be willing to undergo a medical procedure?(N=249 Total Respondents;46%of Total)11Type of Health InsuranceAttitudes Towards ReschedulingSource:JP Morgan ResearchQ:Of those who did not have a procedure deferred and are willing to have a procedure now,what insurance do you have?(N=50 Total Respondents;9%of Total)Q:Of those who did have a procedure deferred and are willing to have a procedure now,what insurance do you have?(N=80 Total Respondents;15%of Total)TAKEAWAY:Slightly higher govn(64%vs 62%)&higher commercial insurance(34%vs 26%)vs total cohort distribution.TAKEAWAY:Slightly higher govn(70%vs 67%)&slightly lower commercial(25%vs 28%)vs total cohort distribution implies some mix deterioration initially.12Type of Health InsuranceAttitudes Towards ReschedulingSource:JP Morgan ResearchQ:Of those who did not have a procedure deferred and are either willing to have a procedure now and/or within a few months,what insurance do you have?(N=138 Total Respondents;25%of Total)Q:Of those who did have a procedure deferred and are either willing to have a procedure now and/or within a few months,what insurance do you have?(N=180 Total Respondents;33%of Total)TAKEAWAY:Slightly higher govn(64%vs 62%)&higher commercial insurance(30%vs 26%)vs total cohort distribution.TAKEAWAY:Similar govn(68%vs 67%)&only slightly higher commercial(30%vs 28%)vs total cohort distribution implies similar mix.13Type of Health InsuranceAttitudes Towards ReschedulingSource:JP Morgan ResearchQ:Of those who did not have a procedure deferred and would only have a procedure after a treatment is developed(but before vaccine)and/or a vaccine is developed,what insurance do you have?(N=116 Total Respondents;21%of Total)Q:Of those who did not have a procedure deferred and would only have a procedure after a treatment is developed(but before vaccine)and/or a vaccine is developed,what insurance do you have?(N=69 Total Respondents;13%of Total)TAKEAWAY:Higher govn(70%vs 62%)&similar commercial insurance(26%vs 26%)vs total cohort distribution.TAKEAWAY:Higher govn(72%vs 67%)&lower commercial(24%vs 28%)vs total cohort distribution implies slight mix deterioration.14Inpatient or OutpatientSite of CareSource:JP Morgan ResearchQ:Of those who did have a procedure deferred,was the procedure inpatient/outpatient?(N=264 Total Respondents;49%of Total)Q:Of those who did have a procedure deferred,what facility was this procedure to be performed in?(N=264 Total Respondents;49%of Total)TAKEAWAY:Intuitively,outpatient would be less acute and more deferrable.TAKEAWAY:The chart illustrates the broad spectrum of the healthcare delivery system impacted by deferrals.Facility Type15Facility TypeSite of CareSource:JP Morgan ResearchQ:Of those who did have a procedure deferred and are willing to have a procedure now,what facility was this procedure to be performed in?(N=80 Total Respondents;15%of Total)Q:Of those who did have a procedure deferred and are either willing to have a procedure now or within a few months,what facility was this procedure to be performed in?(N=180 Total Respondents;33%of Total)TAKEAWAY:Surprisingly,this mix is barely different from the mix of all deferred procedures,indicating little of the preference for outpatient over inpatient settings that we expected.16May Hospital Survey:Healthcare Facilities/Managed CareSource:JP Morgan Hospital Survey TAKEAWAY:If JNJ set the bar for recovery,hospitals are already reporting a sizable revenue rebound off early-April lows that may put 2Q20E closer to JNJs 3Q20E recovery storyJPM Hospital Survey(YTY%Revenue)(N=316 Hospitals/30 States)JNJ-Anticipated YTY%Utilization 2Q20E3Q20E4Q20ELowHighMidpointLowHighMidpointLowHighMidpointCRITICAL(20%)(30%)(25%)(10%)(20%)(15%)+0%+0%+0%NON-CRITICAL(65%)(85%)(75%)(20%)(60%)(40%)+0%+15%+8%BLENDED(50%)(65%)(58%)(16%)(47%)(32%)+0%+10%+5%17Current Patient Access to PhysiciansThe pipeline of patients is likely to be disrupted with many patients who have had procedures deferred not currently seeing a physician59%of respondents are not currently seeing a physician either in-person or virtuallyLooking at the 41%of respondents that indicated they are currently seeing a physician,45%of those are doing physical visits,while 35%are doing telemedicine visits and 20%are doing a combination of both physical visits and telemedicine visitsDeferred Procedure Patient Access to PhysiciansSource:JP Morgan ResearchQ:Given todays environment with COVID-19,are you still seeing doctors in-office for regular visits?(n=211)Among those that are still seeing a physician,how are patients accessing care(n=105)15%19%8%40%19%No,and I dont plan toNo,but I plan to as soon as I can physically visit an officeYes,both physical and telemedicine visitsYes,physicalvisitsYes,telemedicinevisits18Experience and Views Around TelehealthWe point to a high willingness to use telehealth,with satisfaction among users high given plans to use it again42%of total respondents have had a telehealth consultant in the past,and among those,over 80%indicated they would be willing to do it again in the future76%of total respondents in total indicated they are willing to use telehealth consultations in the future,which includes those that have had a