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2020年美国医疗科技展望:前景取决于消费者

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2020年美国医疗科技展望:前景取决于消费者

 

 North America Equity Research December 2019

 Healthcare Technology & Distribution 2020 Outlook: 2020 Vision Remains on the Consumer

  Conference Call Details Thursday, December 19 @ 10:00am ET/ 15:00 UK Dial-in Info: Please contact us or your JPM salesperson for details Replay through 1/17

 Healthcare Technology & Distribution Lisa C. Gill AC

 (212) 622-6466 lisa.c.gill@jpmorgan.com Bloomberg JPMA GILL<GO> J.P. Morgan Securities LLC

 Michael R. Minchak, CFA AC

 (212) 622-6506 michael.minchak@jpmorgan.com Bloomberg JPMA MINCHAK<GO> J.P. Morgan Securities LLC

 Anne E. Samuel AC

 (212) 622-4163 anne.e.samuel@jpmorgan.com Bloomberg JPMA SAMUEL<GO> J.P. Morgan Securities LLC

  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.

  Looking Back at 2019 – Performance Generally Lagged the Index

 The S&P 500 is up +27.4% in 2019 YTD and the S&P 500 Health Care Sector Index is up +17.4%. Four stocks in our coverage universe outperformed the S&P 500 YTD, with the group up +2.3% on average.  The Labs are the best performing group within our coverage universe, up 30.4% YTD, on average, in 2019, with LH up +32.6% and DGX up +28.2%.

  Drug Distributors are up +17.4% in 2019 on a YTD basis, on average, with MCK outperforming both ABC and CAH (note that ABC and CAH had outperformed MCK in 2018).  Dental Distributors are up +9.1% YTD in 2019, with HSIC up +10.7% YTD, and PDCO up 7.5% YTD.  Drug Retail is the second worst performing group, down -2.2% YTD, on average in 2019. CVS is up +12% YTD, outperforming WBA, which is down -16.4% YTD (recall that WBA had outperformed in 2018).  Healthcare IT is down -1.7% YTD, on average, in 2019 led by CERN (up 36.6% YTD and the second best performing stock in our coverage universe), and offset by EVH (down -64.3% YTD and the second worst performing stock in our coverage universe). This excludes recent IPOs.  Two small cap stocks, TDOC (a Telehealth provider) and DPLO (a Specialty Pharmacy), are up +59.9% and down -70.8%, respectively. TDOC is the top performing stock in our coverage universe, while DPLO is the worst performing stock in our coverage universe.  OMI (a Medical Supply Distributor) is down -17.4% in 2019 on a YTD basis, following a -66% decline in 2018 and a -47% decline in 2017.

  PINC, -0.1% MDRX, -2.5% NXGN, -2.7% WBA, -16.4% OMI, -17.4% RAD, -45.9% EVH, -64.3% DPLO, -70.8%

 TDOC, 59.9% CERN, 36.6% LH, 32.6% DGX, 28.2% SPX, 27.4% MCK, 24.8% HQY, 24.7% CAH, 15.6% CVS, 12.0% ABC, 11.8% HSIC, 10.7% PDCO, 7.5% Key Theme Top Pick Other OWs Other Themes Looking Back 2019 Events Sector Reviews

  2019 YTD Performance by Stock

 Healthcare Technology & Distribution 2020 Outlook

  Looking Back at 2019 – Performance Generally Lagged the S&P 500

  40%

 30%

 20%

 10%

 0%

 -10%

 -20%

 -30% 31-Dec 31-Jan 28-Feb 31-Mar 30-Apr 31-May 30-Jun 31-Jul 31-Aug 30-Sep 31-Oct 30-Nov

 Pricing data as of 12/17/19. Drug Distributor Drug Retail Labs Dental Dist Healthcare IT S&P 500 Note: Drug Distributor includes ABC, CAH, MCK; Drug Retail includes CVS, WBA; Labs include DGX, LH; Dental Dist includes HSIC, PDCO; Healthcare IT includes MDRX, CERN, EVH, HQY, NXGN.

  2019 YTD Stock Performance by Subsector

 Key Theme Top Pick Other OWs Other Themes Looking Back 2019 Events Sector Reviews Healthcare Technology & Distribution 2020 Outlook

  Capturing the Consumer in 2020

  We Continue to Expect the Consumer to be the Single Largest Disruptor in Healthcare Rationale: Patients are becoming educated consumers as they are increasingly paying for their own healthcare Best Positioned to Capitalize on this Theme:

 • CVS Health (CVS/OW) - top pick

 Others that are Well-Positioned around the Consumer:

 • LabCorp (LH/OW)

 • Teladoc (TDOC/OW) Key Differentiators

 Cost

  • Phreesia (PHR/OW) Quality Convenience

  4

 Key Theme Consumer

 Top Pick Other OWs Other Themes Looking Back Sector Reviews Healthcare Technology & Distribution 2020 Outlook

  Top Pick for 2020: CVS

 Implied Upside

 CVS Health Ticker: CVS Rating: Overweight Dec-20 Price Target: $97

  Rationale: Plays on Key Theme, with an Identifiable Catalyst and Attractive Valuation

 • Integrated model and broad suite of services position CVS well in an evolving marketplace characterized by the ongoing “retailization” of healthcare and shift to new reimbursement models (value-based care) • Aetna deal brings a new integrated model to marketplace. Combined entity to drive lower overall health costs through data/analytics, more effective patient engagement and shifting care to lower cost sites • Company has provided favorable outlook for next several years, with a return to double digit EPS growth in 2022 driven by integration synergies, enterprise modernization and transformation initiatives. • CVS has beat estimates/raised guidance in the past three quarters

 5

 Source: Bloomberg (prices based on 12/17/19 close), J.P. Morgan estimates.

 32% Key Theme Top Pick CVS Other OWs Other Themes Looking Back Sector Reviews Top Pick Healthcare Technology & Distribution 2020 Outlook

  Top Pick for 2020: CVS

 We believe CVS is very well positioned based on evolving market dynamics

 6

 

 New reimbursement models 

 We expect ongoing interest from all stakeholders in value-based models that tie reimbursement to health outcomes 

 CVS has a broad suite of assets across the care continuum – Access to high-quality lower-cost sites of care – Enhanced clinical care programs 

 We expect the company to be a partner of choice for payors and providers over the longer term 

 The “retailization” of healthcare 

 We continue to believe the consumer will be the single largest disrupter in healthcare 

 Patients (consumers) are getting more involved in their healthcare and making decisions on how to allocate healthcare dollars 

 CVS owns the patient touchpoint – pharmacy is the most frequently used health benefit 

 The company’s strong reputation and trusted brand will be key assets Key Theme Top Pick CVS Other OWs Other Themes Looking Back Sector Reviews Healthcare Technology & Distribution 2020 Outlook

 `

 Top Pick for 2020: CVS

 CVS is the first company to combine each of the five following capabilities in-house:

 Source: J.P. Morgan. Note: WBA exiting wholly-owned clinic business, although health system partners to continue to operate clinics in Walgreens stores; WBA

 also has clinic 7 relationships with United (urgent care) as well as Humana and VillageMD (primary care). CVS/ AET

 UNH CI/ ESRX

 WBA

 ANTM

 HUM Retail Pharmacy Pharmacy Benefit Management Health Insurance Specialty Pharmacy Retail-Based Clinics Key Theme Top Pick CVS Other OWs Other Themes Looking Back Sector Reviews Healthcare Technology & Distribution 2020 Outlook

  Top Pick for 2020: CVS

 We continue to believe in the strategic rationale for the Aetna deal

 Improved quality of care Better patient outcomes Lower overall healthcare costs Leverage medical, pharmacy and lab data in real time 

 Use analytics to identify members with opportunity for targeted interventions 

 Close gaps in care, improve medication adherence and better coordinate care Improve member engagement to drive behavior change 

 CVS owns the patient touchpoint through its broad retail footprint 

 Pharmacy is typically the most frequently used part of a patient’s healthcare benefit Drive patient care to lower cost settings using existing assets 

 Utilize retail-based clinics to reduce ER visits 

 Move infusion services out of the hospital setting 

 Capitalize on emerging telehealth opportunity This Can Ultimately Drive: We believe all this should ultimately help drive profitability for the combined entity Key Theme Top Pick CVS Other OWs Other Themes Looking Back Sector Reviews Healthcare Technology & Distribution 2020 Outlook

  Top Pick for 2020: CVS

 CVS provided favorable commentary on the long term outlook at the Investor Day in June

 

 The company expects accelerating earnings growth over the next few years 

 Y/y adjusted EPS growth projected to be in the low single digits in 2020, mid single digits in 2021 and low double digits in 2022  2019 2020 2021 2022+

 

 CVS also highlighted key factors underlying anticipated earnings growth, including: integration synergies, enterprise modernization and transformation initiatives 

 Integration Synergies: 2019: $300-$350M, 2020: ~$800M 2021+ run rate: ~$900M business integration general & administrative medical cost savings

  $900

  $3.5B in Operating Income in 2022

  $850 Transformation Initiatives: 2022: ~$850M, Longer term: $2.5B medical cost savings, membership growth, expanded use of CVS assets, increased customer satisfaction/retention, open platform/new business

  $1,750

 Enterprise Modernization: 2020: $400-$600M, 2021: ~$900M-$1.1B, 2022 run rate: ~$1.5-$2.0B technology modernization, productivity improvements Source: Company data, J.P. Morgan. LDD MSD LSD Key Theme Top Pick CVS Other OWs Other Themes Looking Back Sector Reviews Healthcare Technology & Distribution 2020 Outlook

  Top Pick for 2020: CVS

 CVS expects to grow adjusted operating income in FY20 

 Retail/LTC – adjusted operating profit up LSD % in FY20E 

 Continued Rx growth 

 Synergies / enterprise modernization 

 LTC Pharmacy (Omnicare) expected to improve in 2020 

 Benefit from generics: “we see 2020 improving from where we were in 2019” 

 Reimbursement pressure to remain an ongoing headwind 

 Uncertainty: will expected tailwinds be enough to mitigate reimbursement pressure  

 Pharmacy Services (PBM) – adjusted operating profit down MSD % in FY20E 

 Anthem (onboarding investments in FY19 won’t recur / benefit from contract ramp) 

 Synergies / enterprise modernization 

 Rebate guarantee headwind peaks in 2019 and rolls off at end of 2020 

 Specialty...

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