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　North America Equity Research May 2020

　US Healthcare What Consumers Are Saying About Resuming Elective Procedures

　 Medical Supplies & Devices Robbie Marcus, CFA AC

　+1 212 622 6657 Robert.j.marcus@jpmorgan.com

　HC Technology & Distribution Lisa Gill AC

　+1 212 622 6466 Lisa.c.gill@jpmorgan.com

　HC Facilities & Managed Care Gary Taylor AC

　+1 212 622 6600 Gary.taylor@jpmorgan.com

　 Life Science Tools & Diagnostics Tycho Peterson AC

　+1 212 622 6568 Tycho.peterson@jpmorgan.com

　European MedTech & Services David Adlington AC

　207 134 5828 David.adlington@jpmorgan.com| See the end pages of this presentation for analyst certification and important disclosures, including non-US analyst disclosures. J.P. Morgan does and seeks to do business with companies covered in its research reports. As a result, investors should be aware that the firm may have a conflict of interest that could affect the objectivity of this report. Investors should consider this report as only a single factor in making their investment decision.

　2

　  “ “Goldilocks Prevails” - 72% of those with a deferred medical procedure stated they were willing to undergo the procedure either “now” or “within a few months as crisis eases”.  Hospitals & Providers: This seems fairly bullish for hospitals off the down 50% April lows; particularly given the responses were collected over 5/5-5/11/20 as states were just beginning to re-open social movement and elective procedures.  Managed Care: The data is still plenty benign for managed care medical loss ratios (MLR); 38% of previously- scheduled cases are not willing to come back until there is treatment or vaccine development.  Two modest surprises from this same subset of patients: 1) no material skew of outpatient vs inpatient (more positive for hospitals vs ASCs than we would have guessed), and 2) a slight skew of government vs commercial insurance (slightly worse returning payor mix for hospitals than we would have guessed given frailty of senior population vs younger commercial population). Managed

　Care

　&

　Healthcare

　Facilities

　 With more than a third of respondents planning to wait until a treatment or vaccine becomes available, this reaffirms our view that COVID-19 will have lasting impacts well-beyond 2Q20  Disruptions to the pipeline of patients could also stifle the recovery, with only 36% of patients currently seeing a physician either in-person or virtually. MedTech

　

　Elective procedure pushouts and hospital capex spending continue to look bleak amidst the pandemic (for more color on the latter, see our hospital capex survey) 

　We continue to recommend select exposure. In particular, we would avoid some dental names in light of a slower recovery in elective procedures (i.e. XRAY), as well as radiation oncology (i.e., VAR, ARAY), which remains prone to a more lasting hospital capex budget freeze and changing reimbursement, while we note that ISRG plans to use the balance sheet aggressively to place capital under an operating lease model, which should offer some cushion. Lastly, we remain constructive on HOLX, in light of the COVID-19 diagnostic tailwinds, among other things. 

　Outside of med tech and dental, we remain positive (and Overweight) on several diversified life science tools names (AVTR, DHR), smid cap growth companies (ADPT, GH, NTRA, TXG) and CRO/CDMOs (CRL, CTLT, IQV, PPD). We remain Underweight on LMNX, MYGN, QDEL, VAR and WAT. Life

　Science

　Tools

　&

　Diagnostics

　 Healthcare

　Services

　  Telehealth:

　 We

　believe

　the

　results

　are

　broadly

　bullish

　as

　it

　relates

　to

　continued

　adoption

　of

　telehealth.

　 While

　32%

　of total

　respondents

　have

　had

　a

　telehealth

　consult

　in

　the

　past,

　69%

　of

　total

　respondents

　indicated

　they

　would

　be

　willing to

　have

　a

　telehealth

　consult

　in

　the

　future.

　 Satisfaction

　appears

　high,

　with

　79%

　of

　respondents

　that

　have

　had

　a telehealth

　consult

　in

　the

　past

　indicating

　that

　they

　would

　be

　willing

　to

　do

　it

　again

　in

　the

　future.

　We

　believe

　these

　results reinforce

　our

　positive

　views

　on

　Teladoc

　Health

　(TDOC/OW)

　and

　One

　Medical

　(ONEM/OW),

　as

　new

　users

　and

　positive experiences

　should

　lead

　to

　increasing

　comfort

　around

　future

　use

　of

　telehealth

　across

　a

　range

　of

　conditions.  Clinical

　Labs:

　61%

　of

　respondents

　were

　not

　willing

　to

　wait

　more

　than

　3

　months

　to

　have

　a

　test

　performed,

　which

　we view

　as

　a

　positive

　take

　for

　the

　labs,

　which

　saw

　a

　50-60%

　decline

　in

　volumes

　from

　healthcare

　utilization

　deferrals. Digging

　further

　into

　the

　question,

　84%

　of

　respondents

　would

　not

　be

　willing

　to

　wait

　more

　than

　6

　months

　from

　the

　time of

　the

　survey

　to

　defer

　testing.

　 This

　is

　consistent

　with

　commentary

　they

　have

　started

　to

　see

　volumes

　return

　faster

　and to

　a

　greater

　extent

　than

　they

　had

　anticipated,

　and

　would

　represent

　upside

　to

　our

　models.  Healthcare

　IT:

　Within

　Healthcare

　IT,

　Change

　Healthcare,

　Progyny,

　and

　Phreesia

　have

　the

　largest

　utilization

　exposure at

　40-50%,

　55%

　and

　100%

　respectively.

　 Looking

　at

　the

　survey

　results,

　55%

　of

　respondents

　who

　did

　not

　have

　a procedure

　deferred

　would

　be

　willing

　to

　undergo

　a

　medical

　procedure

　within

　a

　few

　months,

　while

　72%

　of

　those

　that had

　deferred

　procedures

　would

　be

　willing

　to

　return.

　 This

　echoes

　commentary

　from

　1Q

　calls

　around

　pent-up

　demand, which

　we

　view

　as

　favorable

　to

　our

　models. 

　 European

　MedTech

　  Orthopedics

　–

　Smith

　&

　Nephew,

　Medacta 

　S&N

　has

　been

　relatively

　cautious

　on

　pace

　of

　near

　term

　rebound

　–

　confirmed

　by

　this

　survey.

　Also

　wary

　of increased

　pricing

　pressure

　in

　near

　to

　mid-term.

　Medacta

　–

　has

　indicated

　it

　expects

　to

　see

　earlier

　demand

　come back

　into

　ASCs,

　with

　hospitals

　coming

　back

　later

　(not

　confirmed

　by

　the

　survey)  Dental – Straumann 

　The key data point on dental implants was that procedures have been deferred rather than cancelled, and are almost all being rescheduled for next 3-6 months. What this survey doesn’t capture is how any economic impact might influence future decisions  Cardiovascular – Philips, Getinge 

　While a relatively small part of Philips, the CV business is profitable (particularly the consumables) and high growth and was hit hard on late Q1/early Q2. An early rebound is probably factored into expectations and this looks to be confirmed by the survey  Surgical Urology – Coloplast 

　Coloplast cut guidance for this year, almost exclusively citing weakness in their surgical urology business - backed up by the survey, with no respondents who had had an endoscopy or urology procedure deferred saying they would get a procedure done immediately if possible, with 54% indicating that they would defer it by 6 months or longer. Hopes of early rebound seem unlikely  Hospital capex – Philips, Siemens Healthineers, Elekta, Getinge 

　While not directly assessed as part of this survey, a slower patient rebound likely has implications for Hospital capex budgets, something we have addressed directly with our hospital capex survey 

　 Demographic

　Selection

　Criteria

　 We conducted a survey of 544 patients through Survey Monkey with the following criteria:  Data was collected between May 5-11, 2020  Respondents were selected so that ~2/3 were over the age of 65 and ~1/3 under the age of 65  We expected higher healthcare system utilization among an older demographic  Respondents were selected so that ~1/2 of patients had a procedure deferred due to disruptions from COVID-19, and ~1/2 who had not had a procedure deferred.  Patients didn’t have to answer every question, that’s the reason for minor discrepancies in sample sizes. We did not edit or exclude and responses. 

　(n=247) 9%

　14%

　 62%

　15%

　have? (n=

　65 6%

　9%

　28%

　52%

　2%

　 3%

　217)

　 ot looking 1%

　3%

　 15%

　81%

　 Patient

　Demographics

　of

　Those

　With

　a

　Deferred

　Procedure

　 The survey criteria was set so as to select for older patients who are more likely to undergo regular medical procedures

　 Respondents were selected so that ~2/3 were over the age of 65   52% of respondents are retired   81% of respondents are covered by either Medicare or Medicaid 

　Q: What is your age? (n=257) Q: What is your employment status? What type of healthcare insurance do you

　Under 30

　 Part-time Self-employed I do not have health insurance Private/employer sponsored healthcare Not sure, but have health insurance

　30-45

　Older than 65

　 46-

　Full-time Retired

　 Public/Medicare/M edicaid

　 Furloughed Not employed, n

　 6

　(n=250) 8%

　13%

　60%

　19%

　have? (n=255) 5% 8%

　19%

　 68%

　Private

　Not sure, but 30-45 have health insurance

　I 5%

　2%

　11%

　58%

　19%

　 1%

　5%

　 Patient

　Demographics

　of

　Those

　Without

　a

　Deferred

　Procedure

　 The survey criteria was set so as to select for older patients who are more likely to undergo regular medical procedures

　 60% of respondents were over the age of 65   58% of respondents were retired   68% of respondents are covered by either Medicare or Medicaid 

　Q: What is your age? (n=279) Q: What is your employment status? What type of healthcare insurance do you

　Under 30

　Part-time Self-employed /employer sponsored healthcare

　 Older than 65

　 46-65 Other

　 Full-time

　Retired

　do not have health insurance

　Public/Medicare/Medicaid

　Furloughed

　Not employed, not looking

　 7

　(N=544 Total Respondents; 100% of Total)

　Deferral

　of

　Medical

　Procedures

　 Q: Did you have a medical procedure that was delayed or cancelled due to COVID-19?

　 Type

　of

　Health

　Insurance

　  TAKEAWAY :

　The

　payor

　mix

　breakdown

　between

　sample

　cohorts

　is

　approximately

　similar.

　Q: Of those who did not have a procedure deferred, what insurance do you have? (N=280 Total Respondents; 51% of Total) Q: Of those who did have a procedure deferred, what insurance do you have? (N=264 Total Respondents; 49% of Total)

　 Earliest

　Timeframe

　Willing

　to

　Undergo

　a

　Medical

　Procedure

　 TAKEAWAY :

　Patients

　who

　did

　have

　a

　procedure

　deferred

　are

　more

　willing

　to

　have

　a

　procedure

　“now” (32%

　vs

　20%).

　...

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