Telcos in health – Part 2: How to crack the healthcare opportunity

This report is a follow-up from our first report Telcos in health – Part 1: Where is the opportunity? which looked at overarching trends in digital health and how telcos, global internet players, and health focused software and hardware vendors are positioning themselves to address the needs of resource-strained healthcare providers.

It also build on in depth case studies we did on TELUS Health and Telstra Health.

Telcos should invest in health if…

  • They want to build new revenue further up the IT value chain
  • They are prepared to make a long term commitment
  • They can clearly identify a barrier to healthcare access and/or delivery in their market

…Then healthcare is a good adjacent opportunity with strong long term potential that ties closely with core telco assets beyond connectivity:

  • Relationships with local regulators
  • Capabilities in data exchange, transactions processing, authentication, etc.

Telcos can help healthcare systems address escalating resourcing and service delivery challenges

Pressures on healthcare - ageing populations and lack of resources
Chart showing the dynamics driving challenges in healthcare systems

Telcos can help overcome the key barriers to more efficient, patient-friendly healthcare:

  • Permissions and security for sharing data between providers and patients
  • Surfacing actionable insights from patient data (e.g. using AI) while protecting their privacy

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Why telcos’ local presence makes them good candidates to coordinate the digital and physical elements of healthcare

  • As locally regulated organisations, telcos can position themselves as more trustworthy than global players for exchange and management of health data
  • Given their universal reach, telcos make good partners for governments seeking to improve access and monitor quality of healthcare, e.g.:
    • Telco-agnostic, national SMS shortcodes could be created to enable patients to access health information and services, or standard billing codes linked to health IT systems for physicians to send SMS reminders
    • Partner with health delivery organisations to ensure available mobile health apps meet best practice guidelines
    • Authentication and digital signatures for high-risk drugs like opioids
  • Healthcare applications need more careful development than most consumer sectors, playing to telcos’ strengths – service developers should not take a “fail fast” approach with people’s health

Telcos have further reach across the diverse  healthcare ecosystem than most companies

The complexity of healthcare systems - what needs to be linked
To coordinate healthcare, you need to make these things work together

However, based on the nine telco health case studies in this report, to successfully help healthcare customers adopt IoT, data-driven processes and AI, telcos must offer at least some systems integration, and probably develop much more health-specific IT solutions.

Case study overview: Depth of healthcare focus

Nine telcos shown on a spectrum of the kind of healthcare services they provide
Where Vodafone, AT&T, BT, Verizon, O2, Swisscom, Telstra, Telenor Tonic and TELUS Health fit on a spectrum of services to healthcare,

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Telcos in health – Part 1: Where is the opportunity?

Why is healthcare an attractive sector?

  • Healthcare systems – particularly in developed markets – must find ways to treat ageing populations with chronic illnesses in a more cost effective way.
  • Resource strained health providers have very limited internal IT expertise. This means healthcare is among the least digitised sectors, with high demand for end-to-end solutions.
  • The sensitive nature of health data means locally-regulated telcos may be able to build on positions of trust in their markets.
  • In emerging markets, there are huge populations with limited access to health insurance, information and treatment. Telcos may be able to leverage their brands and distribution networks to address these needs.
  • This report outlines how the digital health landscape is addressing these challenges, and how telcos can help

Four tech trends are supporting healthcare transformation – all underpinned by connectivity and integration for data sharing

These four trends are not separate – they all interrelate. The true value lies in enabling secure data transfer across the four areas, and presenting data and insights in a useful way for end-users, e.g. GPs don’t have the time to look at ten pages of a patient’s wearable data, in part because they may be liable to act on additional information.

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Digital health solutions break down into three layers

Digital health solutions in 3 layers

This report explores how telcos can address opportunities across these three layers, as well as how they can partner or compete with other players seeking to support healthcare providers in their digital transformation.

Our follow up report looks at nine case studies of telcos’ healthcare propositions: Telcos in health – Part 2: How to crack the healthcare opportunity

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Creating a healthy culture

Introduction

Creating a healthy culture is a key component of success in any organisation. It is particularly important – and challenging – where a company is building a new business operating in a new industry that combines people steeped in an existing cultures. This was the case for TELUS Health in Canada, so we spoke to its then CEO to understand the approach it took.

Three components of ‘Culture’

Whenever we ask our clients what the biggest problem they face is, there’s an excellent chance they will say ‘changing the culture’.

Yet it’s a bit of a coverall statement: what exactly do they mean?

It’s often a bit of a mish-mash of processes, organisation, behaviours and incentives: ‘the way we do things around here’.

Some of this is formalised, through organisation, line-management, how projects are managed and so on. Other aspects are softer – how companies expect people to behave when they are at work: how much autonomy do they have, can they work from home, etc.

To put some structure to this catch-all idea, it can be useful to think about three fundamental components of culture:

  • Shared purpose: what are we all trying to achieve?
  • Common values: what do we believe we need to be like to get there?
  • Processes and behaviours: how do we do things round here?

Looking at these definitions makes it clear why change needs to be led from the top, and why culture change is so challenging.

It needs to be led from the top because you cannot have a credible common purpose that conflicts with what the leadership says it wants, what it values, or how the organisation acts.

Even if you have clear direction from the top, it’s still hard to change because:

  • Most of your organisation will start from a position of ‘this is how we previously learned to be – and now you’re asking us to be different from that?’
  • Culture essentially means a set of behaviours or characteristics that have been socialised, and thereby enmeshed in a complex human web of habits and expectations.

According to Paul Lepage, President of TELUS Health, “culture eats why for breakfast”, paraphrasing the quote “culture eats strategy for breakfast” in a fascinating conversation we had recently.

What Paul meant was that one of the key drivers to creating a great culture is to ensure that your team is truly engaged with your organisation’s meaning or purpose, or ‘why are we doing this?’ beyond making money.

In the case of TELUS Health, this is ‘delivering better healthcare outcomes’, and in Paul’s case at least, this idea comes over very strongly in every interaction I have had with him.

Author’s note: I was talking to Paul because I am fascinated by the role that culture plays in business success. I have known some of the team at TELUS Health for several years, and I am always struck by the quality and consistency of their culture across all the people I have met at TELUS. Andrew Collinson, Partner and Research Director, STL Partners.

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TELUS and TELUS Health: consistent internal and external KPIs

There is a notable consistency between TELUS’ results on internal measures of employee engagement, customer opinion, and commercial performance.

  • Employee engagement: TELUS’ overall employee engagement score consistently ranks within the top quartile and has risen steadily in recent years.  TELUS was also named as one of Canada’s Top 100 Employers and Achiever’s 50 Most Engaged Workplaces in 2017.
  • Customer recommendation: TELUS’ customers have given it improving ‘Likelihood to recommend’ scores since 2011.
  • Market valuation: TELUS’ share price has also grown steadily from 2011.

Figure: TELUS’ share price has also steadily grown

TELUS Annual share price chart
TELUS Annual share price, as at end August 2011-2018

Source: Google Finance, STL Partners

Is this a coincidence, or is there a link between these results? And if it is not a coincidence, how has it achieved this, and what can others learn?

TELUS and TELUS Health

Background

STL Partners has worked closely with TELUS and TELUS Health over the last few years, analysing the healthcare division’s progress in TELUS Health: Innovation leader case study. We’ve participated in its Healthcare Summits in Toronto and come to know several of its executives over the years. The following is a brief introduction to TELUS Health from our 2017 report.

Why TELUS got into healthcare: a viable growth opportunity

Starting in 2005, led by the CEO Darren Entwistle, TELUS executives came to a consensus that just focusing on connectivity would not be enough to sustain long term revenue growth for telecoms companies in Canada, so the telco began a search into adjacent areas where it felt there were strong synergies with its core assets and capabilities. TELUS initially considered options in many sectors with similar business environments to telecoms – i.e. high fixed costs, capex intensive, highly regulated – including financial services, healthcare and energy (mining, oil).

In contrast with other telcos in Canada and globally, TELUS made a conscious decision not to focus on entertainment, anticipating that regulatory moves to democratise access to content would gradually erode the differentiating value of exclusive rights.

By 2007, health had emerged as TELUS’ preferred option for a ‘content play’, supported by four key factors which remain crucial to TELUS’ ongoing commitment to the healthcare sector, nearly a decade later. These are:

  1. Strong correlation with TELUS’ socially responsible brand. TELUS has always prioritised social responsibility as a core company value, consistently being recognised by Canadian, North American and global organisations for its commitment to sustainability and philanthropy. For example, in 2010, the Association for Fundraising Professionals’ named it the most outstanding philanthropic corporation in the world. Thus, investing into the healthcare, with the aim of improving efficiency and health outcomes through digitisation of the sector, closely aligns with TELUS’ core values.
  2. Healthcare’s low digital base. Healthcare was and remains one of the least digitised sectors both in Canada and globally. This is due to a number of factors, including the complexity and fragmented nature of healthcare systems, the difficulty of identifying the right payer model for digital solutions, and cultural resistance among healthcare workers who are already stretched for time and resources.
  3. Personal commitment from Darren Entwistle, TELUS’ CEO since he joined the company in 2000. Based on personal experiences with the flaws in the Canadian healthcare system, Darren Entwistle forged his conviction that there was a business case for TELUS to drive adoption of digital health records and other ehealth solutions that could help minimise such errors, which was crucial in winning and maintaining shareholders’ support for investment into health IT.
  4. Healthcare is a growing sector. An ageing population means that the burden on Canada’s healthcare system has and will continue to grow for the foreseeable future. As people live longer, the demands on the healthcare system are also shifting from acute care to chronic care. For example, data from the OECD and the Canadian Institute for Health Information show that the rate of chronic disease among patients over 65 years old is double that of those aged 45-64. Meanwhile, funding is not increasing at the same rate as demand, convincing TELUS of the need for the type of digital disruption that has occurred in many other sectors.

That all four of TELUS’ reasons for investing in healthcare remain equally relevant in 2017/18 as in 2007 is key to its unwavering commitment to the sector. Darren Entwistle refers to healthcare as a ‘generational investment’, saying that over the long term, TELUS may shift into a healthcare company that offers telecoms services, rather than the other way around.

TELUS Health: On leadership and culture

To get insight for this report, I spoke at length with Paul Lepage, President-TELUS Health and Payment Solutions at TELUS, on the recommendation of his colleagues, who’d told me that ‘culture’ was of deep importance to Paul. He has been instrumental in setting up TELUS Health, and holds joint responsibility for TELUS Health on the international markets with Dave Sharma, President, TELUS Partner Solutions and Senior Vice-president, Business Solutions Sales. Paul runs the operation on the ground in Canada, while Dave spearheads partnerships and international activity.

I also requested additional support material from TELUS Health, which is included in the Appendix of this report.

This report would not have been possible without their kind collaboration and openness. Nonetheless, its contents represent the opinion of STL Partners, and were not sponsored or commissioned by TELUS.

Contents

  • Executive Summary: For telcos and others wanting to change culture
  • Introduction
  • Three components of ‘Culture’
  • Culture eats ‘why’ for breakfast
  • TELUS and TELUS Health: consistent internal and external KPIs
  • Background
  • Why TELUS got into healthcare: a viable growth opportunity
  • TELUS Health: On leadership and culture
  • Culture = Purpose and process
  • Culture creates a yardstick for performance
  • The importance of a compelling ‘why?’
  • Fair Process
  • Diversity and talent
  • Measuring culture and results
  • Communicating, listening and reflecting is at least 50% of the job
  • Recruitment, partnerships and culture
  • The ‘why?’ must be genuine
  • Conclusions: TELUS Health – A consistent and compelling culture
  • Appendix: Prepared by TELUS Health External Communications

Figures

  • TELUS’ share price has increased steadily
  • Why is ‘why?’ important?
  • TELUS’ ‘Fair process’

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The IoT money problem: 3 options

Introduction

IoT has been a hot topic since 2010, but despite countless IoT initiatives being launched questions remain about how to monetise the opportunity.

This report presents:

  • A top-level summary of our thinking on IoT so far
  • Examples of 12 IoT verticals and over 40 use-cases
  • Case-studies of four telcos’ experimentation in IoT
  • Three potential roles that could help telcos monetise IoT

Overview

In the early days of the IoT (about five years ago) cellular connectivity was expected to play a major role – Ericsson predicted 50 billion connected devices by 2020, 20 billion of which would be cellular.

However, many IoT products have evolved without cellular connectivity, and lower cost connectivity solutions – such as SIGFOX – have had a considerable impact on the market.

Ericsson now forecasts that, although the headline number of around 50 billion connected devices by 2020 will remain the same, just over 1 billion will use cellular.

Despite these changes IoT is still a significant opportunity for telcos, but they need to change their IoT strategy to become more than connectivity providers as the value of this role in the ecosystem is likely to be modest.

Mapping the IoT ecosystem

The term IoT describes a diverse ecosystem covering a wide range of different connectivity types and use-cases. Therefore, to understand IoT better it is necessary to break it down into horizontal layers and vertical segments (see Figure 1).

Figure 1: A simplified map of the IoT ecosystem

Source: STL Partners

We are seeking input from our clients to shape our IoT research and have put together a short survey asking for your thoughts on:

  • What role telcos can play in the IoT ecosystem
  • Which verticals telcos can be successful in
  • What challenges telcos facing in IoT
  • How can STL support telcos developing their IoT strategy

To thank you for your time we will send you a summary of the survey results at the end of June 2017.

…to access the other 28 pages of this 31 page Telco 2.0 Report, including…

  • Introduction
  • Mapping the IoT ecosystem
  • Overview
  • Mapping the IoT ecosystem
  • IoT: A complicated and evolving market
  • Telcos are moving beyond connectivity
  • And use cases are increasing in complexity
  • IoT verticals – different end-customers with different needs
  • 12 examples of IoT verticals
  • What connectivity should telcos provide?
  • Four examples of IoT experimentation
  • Case study 1: AT&T: Vertically-integrated ecosystem architect
  • Case study 2: Vodafone: a ‘connectivity plus’ approach
  • Case study 3: SK Telecom: ecnouraging innovation through interoperability
  • Case study 4: Deutsche Telekom AG: the open platform integrator
  • Three potential monetisation strategies
  • Ecosystem orchestrator
  • Vertical champion
  • Trust broker
  • Conclusions

…and the following figures…   

  • Figure 1: A simplified map of the IoT ecosystem
  • Figure 2: Telcos moving beyond connectivity
  • Figure 3: IoT use cases are increasing in complexity
  • Figure 4: Use cases in manufacturing
  • Figure 5: Use cases in transportation
  • Figure 6: Use cases in utilities
  • Figure 7: Use cases in surveillance
  • Figure 8: Use cases in smart cities
  • Figure 9: Use cases in health & care
  • Figure 10: Use cases in agriculture
  • Figure 11: Use cases in extractive industries
  • Figure 12: Use cases in retail
  • Figure 13: Use cases in finance
  • Figure 14: Use cases in logistics
  • Figure 15: Use cases in smart home / building
  • Figure 16: Connectivity complexity profile for pay-as-you-drive insurance and rental services
  • Figure 17: Telco opportunity for deep learning pay-as-you-drive insurance and rental services

Vertical Innovation Leaders: How Telstra’s Healthcare Jigsaw is Coming Together

Introduction

Over the course of 2013-2015, Australian operator Telstra has invested heavily in acquisitions, tapping into the A$11.2bn (US$8.52bn) it received from the Australian government for access to its legacy copper network required to connect the country’s National Broadband Network. Telstra spent $1.2bn on acquiring digital businesses during 2015  alone.

Telstra’s stated aims were: geographic expansion of its core telecoms offerings, as illustrated by its acquisition of Asian carrier and managed services provider Pacnet for US$697Mn, completed in April 2015; and growing its digital service offerings, as illustrated by its multiple acquisitions in the digital platforms and applications space.

The telco has taken a particularly innovative approach to building its offerings in the healthcare vertical, where its ‘new digital’ investments have focused.

Telstra’s approach to establishing its digital (and non-digital) healthcare business is a good indicator of its future overall digital strategy, at the core of which is a highly customer-centric approach and a commitment to bringing agile and lean business practices to all parts of its own business.

Telstra, is, of course, not an established healthcare brand, either in Australia or elsewhere. As we discuss below, this has created a number of challenges, both in engendering relevance with healthcare customers and in achieving Telstra’s particular aims in the health space. The operator has sought to collaborate with or acquire health service providers in order to overcome these challenges.

Telstra’s overall strategy in regard to its digital health care investments and partnerships has been aggressive and unusual, both in terms of the telco’s rapidity in developing such relationships, and in terms of the relatively large number of eHealth companies which it has invested in or partnered with. Perhaps unsurprisingly, many industry observers have questioned the approach.  Indeed, one could argue that the diversity of the acquisitions and partnerships points to a lack of clear direction, and that the sheer number of these may be difficult for the operator to manage effectively, let alone consolidate into a healthy and growing digital revenue stream.

This report addresses the following:

  • Telstra’s approach to eHealth, and the key drivers for this
  • How the Telstra Health acquisition strategy fits with Telstra’s larger digital strategy
  • Impact and evidence of success thus far
  • Key challenges and lessons learned

The Telstra approach to digital healthcare

The Telstra Health proposition

Telstra has targeted healthcare as the most important focus area for its move into broader digital economy activities, based on the ongoing societal and demographic shifts driving demand for healthcare services and spend on these, and on the high potential for digital technology to be transformative in the sector.

At high level, the primary objective of Telstra’s Health business is to address the central challenges or pain points facing the healthcare industry, and to combine the best features of the services and applications it acquires with the telco’s own core capabilities, to provide relevant digital healthcare solutions. Telstra has identified six healthcare challenge areas its offerings aim to address, shown in Figure 2:

Figure 2: Six Healthcare Pain Points Telstra Health Aims to Address

Source: Telstra Health

Telstra’s business model, its overall strategy in health and its objectives are all centred around using digital technologies to tackle these health pain points. In practical terms, its goal is to bring the advantages of the digital revolution to bear on the specific challenges facing the health industry – and to develop a profitable new revenue stream in the process.

 

  • Executive Summary
  • Introduction
  • The Telstra approach to digital healthcare
  • The Telstra Health proposition
  • The Telstra Health offering: ecosystem and target customer segments
  • Understanding Telstra’s healthcare acquisition strategy
  • Telstra’s eHealth acquisitions and partnerships
  • Other Telcos Have Been Far Less Acquisitive in eHealth
  • How Telstra Health Fits Into Telstra’s Larger Digital Strategy
  • Impact and Evidence of Success
  • Revenue impact – A$1 billion by 2020 for Telstra Health?
  • Impact on share price – a ‘digital bump’?
  • Other measures of success
  • Evaluating Telstra’s Objectives and Challenges for the Health Business
  • Telstra’s external market objectives
  • Telstra’s organisational objectives
  • General eHealth market challenges

 

  • Figure 1: Telstra Health’s key objectives and challenges
  • Figure 2: Six Healthcare Pain Points Telstra Health Aims to Address
  • Figure 3: The Telstra Health ecosystem
  • Figure 4: Telstra Health: Provider Apps Offerings and Target Market Segments
  • Figure 5: Telstra Health: Connected Care and Telehealth Offerings and Target Market Segments
  • Figure 6: Telstra Health: Intelligence (Analytics) Offerings and Target Market Segments
  • Figure 7: Telstra Health’s Spine Health Intelligence Ecosystem
  • Figure 8: Telstra’s digital health acquisitions, 2013-2016
  • Figure 9: Telstra’s digital health direct investments and key partnerships, 2009-2016
  • Figure 10: Selected digital health acquisitions and investments – Telefonica
  • Figure 11: Telstra Group Key Product Revenues: FY 2013-2015 (AUD billion)
  • Figure 12: Telstra Revenue by Business Segment, FY2013-2015 (A$ billions)
  • Figure 13: Telstra Share Price Performance – 2000-2016 (A$)
  • Figure 14: Telstra Health’s key objectives and challenges