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Thursday, April 18, 2019

Medical Office Could Be The Safest Asset Class During A Recession

The potential of a looming economic downturn has investors looking for safe places to put their money, and one top investment manager says medical office could be the best bet.
LaSalle Investment Management Head of U.S. Healthcare Real Estate Steve Bolen, speaking at Bisnow’s National Healthcare Mid-Atlantic event last week at the Washington Marriott Georgetown, said the two safest asset classes in commercial real estate are multifamily and medical office.  Apartment owners are able to maintain occupancy during a downturn by lowering rents, and they have the flexibility to bring them back up with the economy improves, Bolen said. Medical office space has the benefit of being occupied by an industry, healthcare, that typically does not suffer the same job loss as other sectors during a downturn.
During the Great Recession, Bolen said the overall U.S. employment base was shrinking by more than 6%, but the healthcare employment base was still able to grow by more than 2%.
“There is no better sector of our U.S. economy in terms of job growth during downturns in the economy than healthcare,” Bolen said. “Astute institutional investors have come over to medical office and view medical office as a key component of a well-diversified commercial real estate portfolio.”
Another benefit of medical office, Bolen said, is tenant retention. LaSalle has made about $2.5B of medical office investments, he said, and the overall retention rate for its medical office tenants is in the mid-80% range. In standard commercial office space, he said, retention is in the 60% to 70% range.
“So you’ve got excellent employment growth during downturns in the economy and very sticky tenants,” Bolen said. “Medical office has a lot of attributes investors view very favorably when investing for defense.”
The main challenge in investing in medical office today, Bolen said, is that so many investors are looking to put money into the asset class that there is not enough supply to satisfy the demand. The solution for this, he said, is to look in secondary and tertiary markets that investors might overlook.
Medical office investors do not need to stick to the top 25 largest metropolitan areas as investors of commercial office do, he said, and they can instead find quality hospitals that create demand for medical office space in smaller markets.
“There’s just not enough to buy that’s good quality for the amount of capital that is seeking a home in this space,” Bolen said. “So you have to go where the deals are. You have to align yourselves with hospital systems in secondary and tertiary markets.”
Demand for medical office space is booming in part because health systems are moving many services away from traditional hospital campuses and into outpatient facilities. Over the last two years, the revenues that leading hospital systems make outside of the hospital have begun to equal the money they’re making inside the hospital, said Dr. Sunil Budhrani, CEO of Innovation Health, a partnership between Inova and Aetna.
“The world outside the walls of the hospital has become very important to us,” Budhrani said. “In some markets, you’ll see a reshaping toward ambulatory, outpatient [facilities] … We’re going to reshape how we’re delivering healthcare and how the hospital plays into that space.”

Telehealth device puts power of medical exam into consumers’ hands

Tyto Care digital kit is available through Best Buy and participating health systems.


KEY TAKEAWAYS

Digital device enables patients to conduct remote physical exams from home.
Kits sold through Best Buy will direct most consumers to physicians at LiveHealth Online.
Participating health systems include Ochsner Health System and Sanford Health.
Kit helps bridge the gap between video and in-person care
The physical divide between telehealth providers and consumers has now been compressed thanks to TytoHome, a handheld device that enables patients to conduct remote exams from their home and transmit the data through a smartphone.
Manufactured by Tyto Care, the digital kit is now available through BestBuy.com, as well as from participating health systems, including Ochsner Health System, based in New Orleans, and Sanford Health, headquartered in Sioux Falls, South Dakota. Most kits purchased directly through Best Buy will connect consumers to physicians at LiveHealth Online, setting up a national caller base for the telehealth provider.
The TytoHome portable examination device features a touch screen that guides patients through the exam process and has attachments that capture digital heart and lung sounds; body temperature; and images of the skin, ears, and throat. The data can be used during live video encounters with physicians or stored on a mobile app and forwarded for review by a clinician at a later time. An online videodemonstrates how the product can be used.
The platform also allows for simple integration with electronic health records, third party exam tools, and other telehealth platforms.
“Our patients want to do virtual care, and they just want to make sure that the providers can do everything that they need to do over video [as well as they can] in person,” says Jennifer Humbert MSN, MHA, RN, director of telemedicine, development and solutions at Ochsner Health System. “This device really helps bridge that gap.”

OCHSNER TELEHEALTH PATIENTS PURCHASE NEARLY 400 KITS IN SIX WEEKS

Last November the health system launched Ochsner Anywhere Care, an urgent care telehealth program, which has signed up 10,000 individuals. The kit was made available to Ochsner employees six weeks ago. Ochsner kicked off a digital and radio advertising campaign April 1 to promote the kits to consumers. Humbert says 350 to 400 kits have been sold at $299 apiece.
The early sales trends are promising, says Humbert. “It was enlightening to us that people want to do this type of care in their home.” Parents and families are the primary targets, she says.
The kits give patients another way to access care at the health system, she adds. Because the telehealth program uses American Well‘s platform, there are no geographic boundaries; Ochsner Anywhere Care serves patients in all 50 states.
Individuals are not required to purchase the kits to use Ochsner’s telehealth service. The device is designed to further enhance the experience between the patient and the provider “to create the best connections,” Humbert says.

MOST BEST BUY DEVICE PURCHASES WILL DIRECT CONSUMERS TO LIVEHEALTH ONLINE

While TytoHome also is available through Best Buy, patients cannot use it to connect with just any physician. Kits sold through the retailer connect consumers in most states to LiveHealth Onlinewhich also uses the American Well platform. Residents of Minnesota, Iowa, North Dakota, and South Dakota who purchase the kit through the retailer will receive services through Sanford Health.
According to a news release issued by Tyto Care, each TytoHome telehealth visit made through a device purchased through Best Buy will cost no more than $59—and potentially less—depending on the type of visit and/or the user’s health insurance plan.
“We’re excited to partner with Best Buy, LiveHealth Online, American Well, and regional health systems to extend our on-demand telehealth platform across the U.S., enhancing primary care delivery,” said Dedi Gilad, CEO and co-founder of Tyto Care in the release. “Tyto Care is combining increased convenience and accessibility with the power of a trusted retailer, health care providers, insurers, and employers to deliver consumers the best that telehealth has to offer.”
As more non-traditional players enter the healthcare arena, it appears that Best Buy is making its own interesting moves. According to the news release, “The partnership is the latest example of Best Buy’s growing commitment to the health space and its dedication to improving the lives of its customers through technology. Last year, the company also acquired GreatCall, a leading provider of connected health and personal emergency response services to the aging population.”

Congress to Consider Raising Tobacco-Buying Age to 21

Senate Majority Leader Mitch McConnell plans to introduce legislation raising the minimum age to purchase tobacco products to 21 from 18, a move that public-health advocates and tobacco companies hope would curb the use of e-cigarettes among youths.
More than a dozen states have passed or enacted laws raising the minimum age to 21 and others are considering doing so. Sen. McConnell’s announcement Thursday follows the introduction earlier this month of similar bills in the House.
Altria Group Inc. and British American Tobacco PLC, the two biggest U.S. cigarette manufacturers, both support an increase of the minimum age to 21, as does Juul Labs Inc., a startup whose e-cigarettes are blamed by health officials for a surge in underage smoking.
Laws raising the age to 21 “fight one of the largest contributors to this problem: sharing by legal-age peers,” Juul Chief Executive Kevin Burns said.
Youth use of e-cigarettes jumped 78% between 2017 and 2018 — to one out of every five high-school students — thanks largely to the popularity of USB-shaped vaporizers made by Juul.
The increase has prompted a regulatory crackdown on the e-cigarette industry. The Food and Drug Administration in March issued new sales restrictions that will effectively ban convenience stores and gasoline stations from selling most flavored e-cigarettes. The passage of a bill raising the legal age nationwide to 21 could alleviate that regulatory pressure, analysts say.
“For some time, I’ve been hearing from the parents who are seeing an unprecedented spike in vaping among their teenage children,” Sen. McConnell said, adding that his bill would exempt military-service members. The Kentucky Republican said he would introduce his bill in May.
Altria, which makes Marlboro, has been lobbying for the move at the state and federal levels, last week taking out ads in The Wall Street Journal, the Washington Post and other news outlets. The tobacco giant has much at stake: In December, it invested $12.8 billion for a minority stake in Juul.
“This is the most effective action to reverse rising underage” use of e-cigarettes, Altria CEO Howard Willard said in a news release Thursday. According to the Food and Drug Administration, the most common way children and teens obtain e-cigarettes is from someone they know. Mr. Willard and other proponents of the policy change say a minimum age of 21 would ensure that high-school students wouldn’t have classmates who could purchase e-cigarettes for them.
Over the long term, a move to 21 could hasten the decline of cigarette sales. Among people who smoke cigarettes daily, 87% first used a cigarette by age 18, according to a 2014 Surgeon General report.
About 5% of adult tobacco consumers are between 18 and 20 years old, Ms. Kaufman said. She added that a nationwide increase of the minimum age to 21 could cause tobacco sales to drop about 4% in the short term.

Best Buy, Target jump into at-home medical device market

At a time when the story of Theranos — the unicorn startup that developed finger-prick blood testing that was rolled out to Walgreens stores before the company was criticized for fraudulent practices and shut down — is captivating the nation, home health device makers are turning to retailers to get their own machines into the hands of consumers.
Best Buy today announced the expansion of its reach into healthcare with sales of a new device, TytoHome. It allows users to measure certain information like body temperature readings, upper respiratory recordings and throat scans, among others, and send them to a telehealth clinician or their own physician or nurse.
The handheld device, which also employs a smartphone app, is available for $299.99 on BestBuy.com for all customers and in select Minnesota Best Buy stores, with sales coming soon to stores in North Dakota, South Dakota, California and Ohio, according to a press release Tyto Care emailed to Retail Dive. Best Buy’s Geek Squad will eventually be employed to support users, Tyto Care CEO and co-founder Dedi Gilad told Retail Dive in an interview.
Target, meanwhile, began selling at-home test kits this month from startup EverlyWell for medical diagnoses including Lyme disease, fertility, menopause and certain sexually transmitted diseases, according to an EverlyWell press release emailed to Retail Dive. The retailer is offering nine EverlyWell products in over 1,600 stores.
Tyto Care and EverlyWell both seem geared toward simplifying healthcare by providing products that patients can use at home in order to facilitate diagnoses more easily and cheaply. The Theranos story doesn’t seem to be casting much of a cloud over those efforts, either.
For Tyto, that’s because these devices have grown through the regulatory due diligence that Theranos never did, according to Gilad. “Ours is completely different and a different use case,” he said when asked about the Theranos debacle. “Our core promise to the consumer is that we allow you to get the best medical service by a licensed professional. We are a full medical device — highly regulated by the FDA, and cleared by the FDA and other regulators to market in the U.S., Canada and Europe. Tyto is not recommending any treatment. We always give the data to a clinician.”
EverlyWell CEO and founder Julia Cheek also said the company isn’t trying to upend basic medical testing. “The EverlyWell platform connects consumers to physicians and lab tests that are already-validated and available through 3rd-party certified lab partners but with price and results transparency,” she told Retail Dive in an email. “EverlyWell is not creating new or novel medical devices or lab tests.”
The devices may bring relief to patients facing ever-escalating healthcare costs and higher-deductible insurance plans that often don’t cover expensive tests. A TytoHome telehealth visit is $59, possibly less if health insurance covers medical phone consultations, the company said. Tyto Care works with LiveHealth Online, which is an offer for those who buy the devices at BestBuy.com and live outside of current coverage areas. Otherwise, the company is partnering with regional healthcare systems to provide medical care to consumers throughout the country, according to the release. That includes not-for-profit healthcare system Sanford Health for users in Minnesota, North Dakota, and South Dakota.
The TytoHome partnership is Best Buy’s latest step into the health space. Last year, the company acquired GreatCall, which provides tech-enabled emergency response services to the aging population. These moves are a natural fit for the consumer electronics retailer, which has differentiated itself with tech expertise and support, according to Stephen Baker, vice president and technology industry analyst at The NPD Group.
“The future of many segments of [consumer electronics] is going to be to add your services on top of hardware, or enable someone else’s services through your sale of their hardware,” he told Retail Dive in an email. “Medical is clearly a huge opportunity to implement this strategy and Best Buy is well positioned to sell these types of devices as they are one of the few CE hardware sellers with the service capabilities and the hardware reach to implement this.”
The partnership with Best Buy is Tyto’s first with a retailer, and the move is key, Gilad said, in large part thanks to Best Buy’s service-oriented approach to tech, along with its access to consumers. “We are sitting in between mass consumers and service providers like health systems,” he told Retail Dive. “Before Best Buy we sold only to B2B partners like health organizations. Best Buy has the ability with their Geek Squad to do on-boarding and explain complex technology, and it helps us on the logistics and fulfillment side.”
EverlyWell’s Cheek similarly said that its Target partnership helps get kits into consumer hands. “EverlyWell’s mission is to provide access to affordable, insightful and life-changing lab tests,” she said. “Being able to partner with a national retail brand and offer lab tests where people already shop is a huge benefit for consumers and a big leap forward for our mission.”
The tie-up also helps Best Buy “get a very good 360 degree view of the consumer,” according to Rajeev Kapoor, M&A partner at Ernst & Young. “Best Buy is indeed up on consumer tech and does have a huge amount of customer data around it,” he told Retail Dive in an email. “The beauty of the solution is their retail footprint … We will continue to see more retailers getting into spot checks for health.”

Private equity deals set record in healthcare sector

  • Private equity interest in healthcare hit a record again in 2018, according to Boston-based consulting firm Bain & Company. Bain’s report on global healthcare private equity and M&A tallied 316 deals globally in 2018, a jump from 265 the year prior.
  • Deal value also spiked to record levels, reaching a total disclosed value of $63.1 billion, the highest on record since 2006. The most activity was in North America, which also captured the highest values. The deal roundup includes the pharmaceutical and device sectors.
  • One of the largest deals in 2018 was private equity firm KKR’s buyout of physician services provider Envision Healthcare for nearly $10 billion. Another deal to make Bain’s top-10 list included a European deal in which Recordati, a drugmaker, was purchased for $7.4 billion.

Fueling the 50% increase in total deal value from 2017 was the sheer size of the buyouts. Eight deals in 2018 were valued at more than $2 billion each, according to the report. The four largest deals of 2017 were public to private transactions.
Private equity in healthcare is not expected to slow down in 2019, according to Bain and other experts with a pulse on the sector.
“We expect competition for assets will not likely decline in the near future. For all of these reasons, 2019 should be another banner year for healthcare private equity,” Bain reported.
Credit: Bain & Company
Despite flashes of a potential recession and other sociopolitical uncertainty, demand for these deals will remain strong, according to the report.
“Returns in healthcare PE markets have proven resilient through such storms in the past, however, and Bain & Company is confident that investor demand for these fundamentally strong, recession-resistant assets will endure,” the report said.
Private equity investors are looking for deals in areas that are highly fragmented, areas that still operate in silos and are undercapitalized, Healthcare Dive previously reported. Fragmentation provides a means for private equity to come in and align practices on the same platform, in an effort to increase size and scale.
PE firms may be taking a closer look at orthopedic practices and mental health services for deals, along with other areas of the healthcare sector.
Bain noted that investors are seizing a few trends in healthcare as they look at future dealmaking, including the aging population and potential outside disruptors like Amazon. Funds are also looking to lower-acuity and retail care settings.
Areas of interest in the IT sector include revenue cycle management platforms for hospitals. Clinical decision support is also a space to watch, though no major deals in that area were completed last year, Bain said.

Pfizer, Lilly Top-Line Results From Phase 3 Study of Tanezumab in Osteoarthritis

Pfizer Inc. (NYSE: PFE) and Eli Lilly and Company (NYSE: LLY) today announced top-line results from a Phase 3 study evaluating tanezumab 2.5 mg and 5 mg. The objective of the study was to compare the long-term joint safety and 16-week efficacy of tanezumab relative to nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with moderate-to-severe osteoarthritis (OA) of the hip or knee. The tanezumab 5 mg treatment arm met two of the three co-primary efficacy endpoints, demonstrating a statistically significant improvement in pain and physical function compared to NSAIDs at the 16-week analysis, while patients’ overall assessment of their OA was not statistically different than NSAIDs. Patients who received tanezumab 2.5 mg did not experience a statistically significant improvement in pain, physical function or patients’ overall assessment of their OA at 16 weeks compared to NSAIDs. In the safety analysis, there was a higher rate of joint safety events in the tanezumab arms compared to NSAIDs at 80 weeks; the difference was statistically significant. Joint safety was a composite measure consisting of adjudicated outcomes of rapidly progressive osteoarthritis (RPOA) type 1 or type 2, subchondral insufficiency fracture, osteonecrosis or pathological fracture. Tanezumab is a monoclonal antibody that is part of an investigational class of non-opioid chronic pain medications known as nerve growth factor (NGF) inhibitors.
“We are analyzing these findings in the context of the recent Phase 3 results as we assess potential next steps for tanezumab,” said Ken Verburg, tanezumab development team leader, Pfizer Global Product Development. “We plan to review the totality of data from our clinical development program for tanezumab with regulatory authorities.”

US IPO Week Ahead: No IPOs but these 12 deals can hop back in after Easter

The IPO calendar is empty thanks to Easter and Passover, but not for long. Six companies become free to launch their roadshows in the week ahead. Six others appear poised to move forward as well.
Those should kick off a very active May, which we expect to surpass the prior year period’s 21 offerings, becoming the most active May since 2013 (30).
Launch Schedule
Several deals can launch next Monday and price the week of April 29, including social gaming spinoff SciPlay (SCPL), fast growing device maker TransMedics (TMDX), and neurological biotech Trevi Therapeutics (TMDX).
Chinese plastic surgery marketplace So-Young International (SY) can set terms for its $150 million IPO on Tuesday; the company grew 138% in 2018 ($92 million) with positive EBITDA ($12 million). Small-cap Louisiana bank Red River Bancshares (RRBI) can go on Thursday.
Uber (UBER) becomes free to launch its roadshow this Friday. IPOs more commonly set terms on Monday, but Friday launches allow a company to market the deal in Asia on Monday.
Plant-based burger maker Beyond Meat (BYND)) and postal REIT Postal Realty Trust (PSTL) also look ready to launch roadshows, along with a four potential billion-dollar IPOs, Chinese e-commerce site Yunji (YJ), radio station giant iHeartMedia (IHRT.RC), revenue cycle software provider Change Healthcare (CHNG), and laboratory supplies company Avantor (AVTR).
12 IPOS LOOK READY TO LAUNCH THE WEEK OF APRIL 22ND, 2019
ISSUER
BUSINESS
EST. DEAL
SIZE
SECTORLEAD
UNDERWRITER
Uber (UBER)$10,000MTechnologyMorgan Stanley
Operates the world’s largest on-demand ridesharing network.
Change Healthcare (CHNG)$2,000MTechnologyBarclays
Provides healthcare revenue cycle management software and services.
iHeartMedia (IHRT.RC)$1,500MComm. ServicesGoldman
Restructured radio station operator with the US’s largest footprint.
Avantor (AVTR)$1,500MMaterialsDeutsche Bank
LBO’d provider of laboratory supplies and services.
Yunji (YJ)$1,000MTechnologyMorgan Stanley
Chinese e-commerce site that uses a social platform to promote its products.
SciPlay (SCPL)$200MTechnologyBofA ML
Scientific Games’ social gaming unit offering casino-style mobile games.
So-Young International (SY)$150MTechnologyDeutsche Bank
China-based online marketplace for plastic surgery services.
Postal Realty Trust (PSTL)$115MReal EstateStifel
Recently-formed REIT that manages and leases properties to the USPS.
Beyond Meat (BYND)$100MConsumer Stap.Goldman
Makes plant-based meat products for groceries.
Trevi Therapeutics (TRVI)$86MHealth CareSVB Leerink
Clinical stage biotech developing therapies for neurological disorders.
TransMedics (TMDX)$86MHealth CareMorgan Stanley
Medical device company that provides a system for organ transplants.
Red River Bancshares (RRBI)$30MFinancialsFIG Partners
Louisiana commercial bank with 24 locations across the state.