Why and how to go telco cloud native: AT&T, DISH and Rakuten

The telco business is being disaggregated

Telcos are facing a situation in which the elements that have traditionally made up and produced their core business are being ‘disaggregated’: broken up into their component parts and recombined in different ways, while some of the elements of the telco business are increasingly being provided by players from other industry verticals.

By the same token, telcos face the pressure – and the opportunity – to combine connectivity with other capabilities as part of new vertical-specific offerings.

Telco disaggregation primarily affects three interrelated aspects of the telco business:

  1. Technology:
    • ‘Vertical’ disaggregation: separating out of network functions previously delivered by dedicated, physical equipment into software running on commodity computing hardware (NFV, virtualisation)
    • ‘Horizontal’ disaggregation: breaking up of network functions themselves into their component parts – at both the software and hardware levels; and re-engineering, recombining and redistributing of those component parts (geographically and architecturally) to meet the needs of new use cases. In respect of software, this typically involves cloud-native network functions (CNFs) and containerisation
    • Open RAN is an example of both types of disaggregation: vertical disaggregation through separation of baseband processing software and hardware; and horizontal disaggregation by breaking out the baseband function into centralised and distributed units (CU and DU), along with a separate, programmable controller (RAN Intelligent Controller, or RIC), where all of these can in theory be provided by different vendors, and interface with radios that can also be provided by third-party vendors.
  2. Organisational structure and operating model: Breaking up of organisational hierarchies, departmental siloes, and waterfall development processes focused on the core connectivity business. As telcos face the need to develop new vertical- and client-specific services and use cases beyond the increasingly commoditised, low-margin connectivity business, these structures are being – or need to be – replaced by more multi-disciplinary teams taking end-to-end responsibility for product development and operations (e.g. DevOps), go-to-market, profitability, and technology.

Transformation from the vertical telco to the disaggregated telco

3. Value chain and business model: Breaking up of the traditional model whereby telcos owned – or at least had end-to-end operational oversight over – . This is not to deny that telcos have always relied on third party-owned or outsourced infrastructure and services, such as wholesale networks, interconnect services or vendor outsourcing. However, these discrete elements have always been welded into an end-to-end, network-based services offering under the auspices of the telco’s BSS and OSS. These ensured that the telco took overall responsibility for end-to-end service design, delivery, assurance and billing.

    • The theory behind this traditional model is that all the customer’s connectivity needs should be met by leveraging the end-to-end telco network / service offering. In practice, the end-to-end characteristics have not always been fully controlled or owned by the service provider.
    • In the new, further disaggregated value chain, different parts of the now more software-, IT- and cloud-based technology stack are increasingly provided by other types of player, including from other industry verticals. Telcos must compete to play within these new markets, and have no automatic right to deliver even just the connectivity elements.

All of these aspects of disaggregation can be seen as manifestations of a fundamental shift where telecoms is evolving from a utility communications and connectivity business to a component of distributed computing. The core business of telecoms is becoming the processing and delivery of distributed computing workloads, and the enablement of ubiquitous computing.

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Telco disaggregation is a by-product of computerisation

Telco industry disaggregation is part of a broader evolution in the domains of technology, business, the economy, and society. This evolution comprises ‘computerisation’. Computing analyses and breaks up material processes and systems into a set of logical and functional sub-components, enabling processes and products to be re-engineered, optimised, recombined in different ways, managed, and executed more efficiently and automatically.

In essence, ‘telco disaggregation’ is a term that describes a moment in time at which telecoms technology, organisations, value chains and processes are being broken up into their component parts and re-engineered, under the impact of computerisation and its synonyms: digitisation, softwarisation, virtualisation and cloud.

This is part of a new wave of societal computerisation / digitisation, which at STL Partners we call the Coordination Age. At a high level, this can be described as ‘cross-domain computerisation’: separating out processes, services and functions from multiple areas of technology, the economy and society – and optimising, recombining and automating them (i.e. coordinating them), so that they can better deliver on social, economic and environmental needs and goals. In other words, this enables scarce resources to be used more efficiently and sustainably in pursuit of individual and social needs.

NFV has computerised the network; telco cloud native subordinates it to computing

In respect of the telecoms industry in particular, one could argue that the first wave of virtualisation (NFV and SDN), which unfolded during the 2010s, represented the computerisation and digitisation of telecoms networking. The focus of this was internal to the telecoms industry in the first instance, rather than connected to other social and technology domains and goals. It was about taking legacy, physical networking processes and functions, and redesigning and reimplementing them in software.

Then, the second wave of virtualisation (cloud-native – which is happening now) is what enables telecoms networking to play a part in the second wave of societal computerisation more broadly (the Coordination Age). This is because the different layers and elements of telecoms networks (services, network functions and infrastructure) are redefined, instantiated in software, broken up into their component parts, redistributed (logically and physically), and reassembled as a function of an increasing variety of cross-domain and cross-vertical use cases that are enabled and delivered, ultimately, by computerisation. Telecoms is disaggregated by, subordinated to, and defined and controlled by computing.

In summary, we can say that telecoms networks and operations are going through disaggregation now because this forms part of a broader societal transformation in which physical processes, functions and systems are being brought under the control of computing / IT, in pursuit of broader human, societal, economic and environmental goals.

In practice, this also means that telcos are facing increasing competition from many new types of actor, such as:

  • Computing, IT and cloud players
  • More specialist and agile networking providers
  • And vertical-market actors – delivering connectivity in support of vertical-specific, Coordination Age use cases.

 

Table of contents

  • Executive Summary
    • Three critical success factors for Coordination Age telcos
    • What capabilities will remain distinctively ‘telco’?
    • Our take on three pioneering cloud-native telcos
  • Introduction
    • The telco business is being disaggregated
    • Telco disaggregation is a by-product of computerisation
  • The disaggregated telco landscape: Where’s the value for telcos?
    • Is there anything left that is distinctively ‘telco’?
    • The ‘core’ telecoms business has evolved from delivering ubiquitous communications to enabling ubiquitous computing
    • Six telco-specific roles for telecoms remain in play
  • Radical telco disaggregation in action: AT&T, DISH and Rakuten
    • Servco, netco or infraco – or a patchwork of all three?
    • AT&T Network Cloud sell-off: Desperation or strategic acuity?
    • DISH Networks: Building the hyperscale network
    • Rakuten Mobile: Ecommerce platform turned cloud-native telco, turned telco cloud platform provider
  • Conclusion

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Airports: The roles of 5G & private networks

A deep dive into private networks for the aviation vertical

This report is intended to be both a specific examination of an important sector of opportunity for Private 5G (P5G) and an example of the complexity of major industrial sectors and campus-based environments. It also covers opportunities for MNOs.

Airports have been among the earliest sites for private cellular and remain a major focus for vendors and service providers, as solutions mature and spectrum options proliferate. They already generate huge investments into public cellular (indoor and outdoor) as well as being headline sites for Wi-Fi deployment and use. They also employ dozens of other wireless technologies, from radar to critical voice communications.

In the case of airports, the largest are so large and diverse that they actually resemble cities, with “private” networks serving an environment actually quite similar to a small national operator or regional MNO. For example, Dallas Fort-Worth airport spans 27 square miles – larger than the island of Manhattan or the principality of San Marino. They may have 100s of companies as tenants, and 10000s of employees – as well as passengers, vehicles and IoT devices. This may mean that they end up with multiple private wireless networks in different parts of the airfield – from the passenger terminal to maintenance hangars to hotels, to the car-rental facility.

They are also intensive Coordination Age ecosystems. Their effective operation involves the safe and secure management of millions of physical and digital assets across multiple parties, billions of dollars, and many lives.

Often technology product and marketing executives think of industry sectors as monolithic (“finance”, “retail”, “oil and gas” etc), typically aligning with familiar industry classification codes. The truth is that each industry has multiple sub-sectors and varied site types, numerous applications, several user-groups, arrays of legacy systems and technology vendors, and differing attitudes and affordability of wireless solutions.

STL Partners hopes that this exercise examining airports will prompt suppliers and operators to drill into other vertical sectors in similar depth. Depending on the response to this type of document, we may well write up other areas in similar fashion in future. (We are also available for private analysis projects).

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Sector trends and drivers affecting private 5G networks

This report is not the appropriate venue for a full analysis of the aviation and airport industry. However, a number of top-level trends are important to understand, as there is a fairly direct link to the deployment of cellular technologies and private 4G/5G.

Trends for airlines

Before the pandemic, there was a sustained growth in worldwide air-passenger traffic, fuelled by the growth of Chinese and Indian middle-classes, as well as inter-regional and long-haul flights in and between Europe, Asia, the Americas and the Middle East. Forecasts were continued for growth, with air-freight also increasing alongside passenger numbers.

This growth resulted in numerous impacts on aviation more broadly:

  • Construction of many entirely new airports, along with extra terminals and refurbishments at established sites. Examples have included immense new airports at Beijing, Doha and Istanbul. These developments typically include huge focus on efficiency, IoT and safety – all heavily reliant on connectivity.
  • Low-cost and “basic” airlines such as Southwest, EasyJet, AirAsia and others have grown rapidly (at least pre-pandemic). Some have built dedicated terminals. Many have a huge focus on fast “turns” of aircraft between arrival and departure. This needs enhanced coordination and communications between multiple ground-service providers to manage 50+ tasks, from baggage unloading to cleaning and refuelling.
  • Established airlines focusing on greater efficiency, novel route choices, new hub airports, better customer satisfaction via information and interactivity throughout their journeys, as well as pushing ancillary services such as contract maintenance. Again, connectivity plays a variety of roles, from hangars to in-flight wireless.
  • Major warehousing and logistics centres built at airports for companies such as Fedex and UPS, as well as eCommerce players such as Amazon starting to build fleets of planes and on- or near-airport facilities. These typically feature high levels of automation and wide use of robotics.
Long-term air passenger growth (pre-pandemic)

Long-term air passenger growth (pre-pandemic)

Airports as “hubs” for multiple businesses

Many airports now operate on-site business centres, hotels, large retail facilities – as well as growing sophistication of air-freight, contract maintenance services and aircraft refits. Each is often a business in its own right, with separate buildings – but must also coordinate with the central airport authority in terms of security, traffic, signage and vehicle movements.

As well as their own internal connectivity requirements for employees and a growing range of IoT systems, the site-owners are also responsible for wired and wireless links for stakeholders such as:

  • Transportation companies
    • Airlines, both within the terminals and at hangars / warehouses and nearby offices.
    • Shipping agents and freight forwarders
    • Logistics and package-delivery firms
  • Services providers
    • National mobile network operators
    • Retailers and other concessions
    • Vehicle rental agencies
    • Bus, rail, taxi & tour companies
    • Caterers
    • Fuel companies
    • Security firms
    • On-site hotels, warehouses and business parks
    • Insurance and finance organisations
  • Operations and public safety
    • Police and firefighters
    • Medical services
    • Air / port traffic control
    • Power and lighting providers
    • Construction contractors

Many of these groups could potentially justify their own investments in private cellular networks (as well as indoor coverage and Wi-Fi if they have dedicated buildings). An open question is whether airport authorities will try to deploy fully campus-wide networks, or whether a diverse array of separate infrastructures will emerge organically.

Industry transformation, automation and IoT-led innovation

As well as the airlines, the airport authorities have become ever-more focused on technology of the site overall. They are aware of operational efficiency, security and safety – and increasing the potential to earn extra revenues from passengers. A very broad array of existing and new use-cases are leaning on improved connectivity, such as:

  • In-building coverage (and huge capacity) for passengers and workers, all of whom expect both multi-network cellular and ubiquitous Wi-Fi availability
  • Prolific use of digital sign-boards for passengers, staff, plane/ship crews etc
  • Freight-tracking, including details about pallets and containers
  • Security cameras and sensors
  • Smart lighting for runways, loading areas and local roadways
  • Support of complex and mission-critical baggage-handling systems
  • Border and customs functions, including automated passport scanners with video analytics
  • “Smart building” technology ensuring optimal use of ventilation, heating, lighting and safety sensors
  • Robotic and remote-controlled vehicles, such as tugs or drones
  • Voice communications systems, now evolving from 2-way radios to cellular-based systems
  • Maintenance systems for aircraft in hangars – increasingly with high-definition video inspections, augmented reality for engineers, and strict requirements on documentation and record-keeping.

Security and safety concerns

Airports have always had to contend with security issues, from immigration to fire-safety, anti-terrorism, theft and smuggling operations. This has required continued evolution of screening systems, cameras, staff access control and multiple layers of analytics software.

This translates to private cellular in a number of ways:

  • Desire to update legacy critical communications systems (e.g. TETRA radios) to more-capable LTE or 5G equivalents, to enable data, video and other applications.
  • Requirement for networks with a bias towards data uplink rather than downlink, especially for HD video and other security  This may mean a preference for separate frequencies to the public networks, in order to accommodate a different mix of up/down traffic.
  • Involvement of a wide range of systems integrators and critical communications specialists with a long history of deploying reliable wireless  Many are adopting 4G and 5G skill-sets internally.
  • Requirement for 100% coverage of the airport environment, both indoors and outdoors as far as the perimeter fence. This may be outside the coverage of many public networks, especially for higher-frequency 5G

Complex wireless environment

It is important to recognise that airfields have a huge array of different technology systems, many of which depend on radio communications or other electromagnetic use-cases. Some of these – such as radars – can occupy frequency bands quite close to those used for 4G or 5G mobile. There are also assorted niche applications, for air traffic control, critical communications among ground workers and emergency services, satellite connectivity for aircraft, scientific instruments for weather forecasting and many others. Wi-Fi is used intensively, both inside the terminal and across some outdoor areas. Some airports have sections used by the military as well as civil aviation, with yet another group of radio types and frequencies employed.

This has several implications:

  • Unlike many other sites, cellular communications is not the most important use of spectrum  Mobile networks – whether public or private – need to fit alongside a huge variety of other services and functions.
  • Some frequency bands that are offered by regulators on a local basis for private 4G/5G may not be available for licensing at airports, as there may be important incumbent users.
  • Airports take increasing interest in overall spectrum management tools, as well as site surveys and the ability to intervene rapidly in case of problems.
  • The aviation industry has a large number of wireless and RF specialists, some of whom are likely to be cross-trained in cellular  This makes it more capable than many sectors to adopt private networks rather than always relying on public MNO service.

Covid-19 Pandemic

Since early 2020, the aviation and airline sector has been decimated by travel restrictions imposed because of the pandemic. Traffic and passenger levels at many airports fell to 20% of pre-pandemic levels or lower. However, as vaccination programs enable the re-opening of travel, growth is starting to occur again.

Various after-effects of the pandemic will increase the need for automation, connectivity and communications. There are new security-checks on vaccination and testing status, more cameras for fever-detection and mask-compliance, automated sanitising of surfaces and much more. Many airports have needed to reconfigure the layouts of their terminals to accommodate testing centres, facilitate social distancing, or sometimes close areas in order to reduce costs. This puts a premium on wireless connectivity that can be adapt to new circumstances rapidly.

Another impact of the last 2 years has been growth in the importance of cargo shipments, from both dedicated freight terminals and in commercial airliners. This has led to new warehouse facilities being constructed, as well as different types of asset tracking and loading vehicles being employed. Again, this has driven the need for better connectivity.

Table of content

  • Executive Summary
    • Overview
    • Recommendations for Airport Operators & Airlines
    • Recommendations for Mobile Operators
    • Recommendations for Regulators & Policymakers
    • Recommendations for Vendors
  • Introduction
    • Sector trends and drivers affecting private networks
  • Evolving airport use-cases for 4G/5G
    • Understanding airports’ layout
    • Background: Public cellular at airports
    • From public to private connectivity: growth in B2B wireless
    • Specific use-cases for private 4G / 5G at airports
  • Airports – a subset of “campus” networks
    • Characteristics of campus networks
    • Adjacent trends
    • Campus networks: who is responsible?
  • Building & operating airport private networks
    • Supply-side evolution for airport networks
    • Airport stakeholders
    • Monetisation opportunities
    • Airport private network case studies
    • Can public 5G network slicing work instead of private 5G?
    • Where does Wi-Fi & other wireless technology fit?

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Telco edge computing: What is the operator strategy?

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Edge computing can help telcos to move up the value chain

The edge computing market and the technologies enabling it are rapidly developing and attracting new players, providing new opportunities to enterprises and service providers. Telco operators are eyeing the market and looking to leverage the technology to move up the value chain and generate more revenue from their networks and services. Edge computing also represents an opportunity for telcos to extend their role beyond offering connectivity services and move into the platform and the application space.

However, operators will be faced with tough competition from other market players such as cloud providers, who are moving rapidly to define and own the biggest share of the edge market. Plus, industrial solution providers, such as Bosch and Siemens, are similarly investing in their own edge services. Telcos are also dealing with technical and business challenges as they venture into the new market and trying to position themselves and identifying their strategies accordingly.

Telcos that fail to develop a strategic approach to the edge could risk losing their share of the growing market as non-telco first movers continue to develop the technology and dictate the market dynamics. This report looks into what telcos should consider regarding their edge strategies and what roles they can play in the market.

Following this introduction, we focus on:

  1. Edge terminology and structure, explaining common terms used within the edge computing context, where the edge resides, and the role of edge computing in 5G.
  2. An overview of the edge computing market, describing different types of stakeholders, current telecoms operators’ deployments and plans, competition from hyperscale cloud providers and the current investment and consolidation trends.
  3. Telcos challenges in addressing the edge opportunity: technical, organisational and commercial challenges given the market
  4. Potential use cases and business models for operators, also exploring possible scenarios of how the market is going to develop and operators’ likely positioning.
  5. A set of recommendations for operators that are building their strategy for the edge.

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What is edge computing and where exactly is the edge?

Edge computing brings cloud services and capabilities including computing, storage and networking physically closer to the end-user by locating them on more widely distributed compute infrastructure, typically at smaller sites.

One could argue that edge computing has existed for some time – local infrastructure has been used for compute and storage, be it end-devices, gateways or on-premises data centres. However, edge computing, or edge cloud, refers to bringing the flexibility and openness of cloud-native infrastructure to that local infrastructure.

In contrast to hyperscale cloud computing where all the data is sent to central locations to be processed and stored, edge computing local processing aims to reduce time and save bandwidth needed to send and receive data between the applications and cloud, which improves the performance of the network and the applications. This does not mean that edge computing is an alternative to cloud computing. It is rather an evolutionary step that complements the current cloud computing infrastructure and offers more flexibility in executing and delivering applications.

Edge computing offers mobile operators several opportunities such as:

  • Differentiating service offerings using edge capabilities
  • Providing new applications and solutions using edge capabilities
  • Enabling customers and partners to leverage the distributed computing network in application development
  • Improving networkperformance and achieving efficiencies / cost savings

As edge computing technologies and definitions are still evolving, different terms are sometimes used interchangeably or have been associated with a certain type of stakeholder. For example, mobile edge computing is often used within the mobile network context and has evolved into multi-access edge computing (MEC) – adopted by the European Telecommunications Standards Institute (ETSI) – to include fixed and converged network edge computing scenarios. Fog computing is also often compared to edge computing; the former includes running intelligence on the end-device and is more IoT focused.

These are some of the key terms that need to be identified when discussing edge computing:

  • Network edge refers to edge compute locations that are at sites or points of presence (PoPs) owned by a telecoms operator, for example at a central office in the mobile network or at an ISP’s node.
  • Telco edge cloud is mainly defined as distributed compute managed by a telco  This includes running workloads on customer premises equipment (CPE) at customers’ sites as well as locations within the operator network such as base stations, central offices and other aggregation points on access and/or core network. One of the reasons for caching and processing data closer to the customer data centres is that it allows both the operators and their customers to enjoy the benefit of reduced backhaul traffic and costs.
  • On-premise edge computing refers to the computing resources that are residing at the customer side, e.g. in a gateway on-site, an on-premises data centre, etc. As a result, customers retain their sensitive data on-premise and enjoy other flexibility and elasticity benefits brought by edge computing.
  • Edge cloud is used to describe the virtualised infrastructure available at the edge. It creates a distributed version of the cloud with some flexibility and scalability at the edge. This flexibility allows it to have the capacity to handle sudden surges in workloads from unplanned activities, unlike static on-premise servers. Figure 1 shows the differences between these terms.

Figure 1: Edge computing types

definition of edge computing

Source: STL Partners

Network infrastructure and how the edge relates to 5G

Discussions on edge computing strategies and market are often linked to 5G. Both technologies have overlapping goals of improving performance and throughput and reducing latency for applications such as AR/VR, autonomous vehicles and IoT. 5G improves speed by increasing spectral efficacy, it offers the potential of much higher speeds than 4G. Edge computing, on the other hand, reduces latency by shortening the time required for data processing by allocating resources closer to the application. When combined, edge and 5G can help to achieve round-trip latency below 10 milliseconds.

While 5G deployment is yet to accelerate and reach ubiquitous coverage, the edge can be utilised in some places to reduce latency where needed. There are two reasons why the edge will be part of 5G:

  • First, it has been included in the 5Gstandards (3GPP Release 15) to enable ultra-low latency which will not be achieved by only improvements in the radio interface.
  • Second, operators are in general taking a slow and gradual approach to 5G deployment which means that 5G coverage alone will not provide a big incentive for developers to drive the application market. Edge can be used to fill the network gaps to stimulate the application market growth.

The network edge can be used for applications that need coverage (i.e. accessible anywhere) and can be moved across different edge locations to scale capacity up or down as required. Where an operator decides to establish an edge node depends on:

  • Application latency needs. Some applications such as streaming virtual reality or mission critical applications will require locations close enough to its users to enable sub-50 milliseconds latency.
  • Current network topology. Based on the operators’ network topology, there will be selected locations that can meet the edge latency requirements for the specific application under consideration in terms of the number of hops and the part of the network it resides in.
  • Virtualisation roadmap. The operator needs to consider virtualisation roadmap and where data centre facilities are planned to be built to support future network
  • Site and maintenance costs. The cloud computing economies of scale may diminish as the number of sites proliferate at the edge, for example there is a significant difference in maintaining 1-2 large data centres to maintaining 100s across the country
  • Site availability. Some operators’ edge compute deployment plans assume the nodes reside in the same facilities as those which host their NFV infrastructure. However, many telcos are still in the process of renovating these locations to turn them into (mini) data centres so aren’t yet ready.
  • Site ownership. Sometimes the preferred edge location is within sites that the operators have limited control over, whether that is in the customer premise or within the network. For example, in the US, the cell towers are owned by tower operators such as Crown Castle, American Tower and SBA Communications.

The potential locations for edge nodes can be mapped across the mobile network in four levels as shown in Figure 2.

Figure 2: possible locations for edge computing

edge computing locations

Source: STL Partners

Table of Contents

  • Executive Summary
    • Recommendations for telco operators at the edge
    • Four key use cases for operators
    • Edge computing players are tackling market fragmentation with strategic partnerships
    • What next?
  • Table of Figures
  • Introduction
  • Definitions of edge computing terms and key components
    • What is edge computing and where exactly is the edge?
    • Network infrastructure and how the edge relates to 5G
  • Market overview and opportunities
    • The value chain and the types of stakeholders
    • Hyperscale cloud provider activities at the edge
    • Telco initiatives, pilots and plans
    • Investment and merger and acquisition trends in edge computing
  • Use cases and business models for telcos
    • Telco edge computing use cases
    • Vertical opportunities
    • Roles and business models for telcos
  • Telcos’ challenges at the edge
  • Scenarios for network edge infrastructure development
  • Recommendation
  • Index

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TELUS Health: Innovation leader case study

Introduction

Why healthcare?

Healthcare is one of the few sectors where, in every country, there is a huge and ongoing need. This demand will only rise as populations age and grow, exacerbating significant pain points relating to costs and funding models, and unmet needs. Meanwhile, the combination of cost pressures, the sensitive nature of health data and the complexity of healthcare systems have left it as one of the least digitised sectors. Thus, many telcos have identified healthcare as a sector where there is significant opportunity to drive efficiency through new services leveraging their network infrastructure and customer reach.

In some respects, telcos are well positioned to fill the healthcare sector’s needs. For example, enabling doctors to offer virtual care to patients through secure messaging or video chats, and to share electronic health records with patients and other doctors more easily, seem like low hanging fruit. However, in practice this is much more complicated; hospitals, primary care providers (general practitioners, family doctors), specialised clinics (e.g. mental health, physiotherapy) and pharmacies all store patient records in different systems (that are not necessarily digitised), and have different views on how to securely share data between each other. Every healthcare system also has a unique funding model, ranging from predominantly privately funded through insurance providers or out of pocket payments, like the United States, to single payer models like the UK, where the National Health Service accounts for more than 80% of healthcare spending, and budgets – including IT solutions – are closely tied to electoral and economic cycles.

These synergies have prompted a number of telcos to launch consumer health services or to pursue opportunities in the health IT market. Besides TELUS, AT&T, Verizon, Vodafone, Telefónica, NTT DoCoMo, Telstra, Deutsche Telekom AG and BT have all been active in healthcare. We explore their strategies and differences in comparison with TELUS’ approach on page 33. Why TELUS? This report focuses on TELUS Health, which has one of the longest and the most committed investment into the healthcare sector by a telco that we are aware of. We see it as a leading example of how telcos can build a business in healthcare, as well as in other sectors that are not instinctively linked to telecoms.

To put the Canadian healthcare market, which TELUS entered ten years ago, into context:

  • Canada’s healthcare system is fragmented between 13 provincial/territorial systems and the federal level.
  • The payer model is split between the government (70%) for necessary hospital and physician services and private insurers (30%) for supplemental care and drug prescriptions.
  • Healthcare spending accounted for 11.1% of GDP in 2016, on par with other developed countries globally.
  • The huge geographical distances mean that the 19% of Canadians living in rural areas have very limited access to specialist care.
  • Adoption of electronic medical record (EMR) systems among family doctors and specialised clinics started from a low base of 20% in 2006, rising to 62% in 2013 and 80% by 2017.

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 the CEO, 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 (see figure 3). 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 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.

Contents:

  • Executive Summary
  • Healthcare can be a viable investment opportunity…
  • …But there are risks
  • Introduction
  • Why TELUS got into healthcare: a viable growth opportunity
  • How TELUS got into healthcare: buying a way in
  • Overview of the Canadian healthcare system
  • The payer model
  • Access to healthcare and demographics
  • TELUS’ objectives and evidence of success in healthcare
  • Build a new revenue stream
  • Synergy: supporting telecoms revenues
  • Differentiate brand among consumers
  • Drive better health outcomes
  • Understanding TELUS Health’s strategy
  • TELUS Health’s three step strategy
  • eHealth market challenges: how is TELUS responding?
  • Comparing TELUS with other telcos: a deeper dive
  • Lessons for other telcos
  • Challenges of the digital health market
  • Healthcare is a long-term play
  • Healthcare matrix: mapping the healthcare sector for telcos

Figures:

  • Figure 1: Snapshot of TELUS Health business
  • Figure 2: Public vs. private healthcare services in Canada
  • Figure 3: Rate of chronic disease rises dramatically among seniors
  • Figure 4: TELUS Health’s reach in the healthcare market
  • Figure 5: TELUS Health is outpacing TELUS in revenue growth
  • Figure 6: TELUS Health’s contribution to TELUS revenues
  • Figure 7: Healthcare investment contributes to improving customer loyalty
  • Figure 8: How do consumers feel about TELUS?
  • Figure 9: TELUS vs. other Canadian telcos’ consumer brand score and rank
  • Figure 10: BC pilot of HHM shows reduction in hospital admissions
  • Figure 11: TELUS acquisitions
  • Figure 12: Methodology for building collaborative solutions
  • Figure 13: List of collaborative solutions and end-users
  • Figure 14: Roadmap for eClaims solution
  • Figure 15: Roadmap for PharmaSpace solution
  • Figure 16: Roadmap for Mobile EMR solution
  • Figure 17: Patient engagement is central to TELUS Health’s target growth opportunities
  • Figure 18: Home health monitoring overview
  • Figure 19: Results of HHM trials across two health authorities in British Colombia
  • Figure 20: Healthcare in TELUS ad campaigns
  • Figure 21: Sample of TELUS Health investments and partnerships
  • Figure 22: Telco digital health strategies
  • Figure 23: Healthcare Matrix scoring criteria
  • Figure 24: Where are telcos’ strengths in digital health?

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