Quick: Somebody call a virtual doctor! The stock market just pushed America's leading telehealth business down a flight of stairs.
Shares of Teladoc Health (TDOC -0.07%) fell hard after U.S. stock markets closed on Wednesday in response to a dismal first-quarter earnings call. The company was able to report total revenue that soared 25% year over year, but the market is responding to signs of trouble that aren't apparent until you look past the headline numbers.
Here's why investment bank analysts quickly lined up to downgrade the already embattled telehealth stock.
A chronic disaster
Using smartphones to connect patients with doctors is a minor challenge that at least a dozen of Teladoc's competitors can handle. With this fear of commoditization in mind, Teladoc Health boldly acquired a chronic-care management business called Livongo Health for $18.5 billion in 2020.
Just before the acquisition, Livongo was growing by leaps and bounds. On Sept. 30, 2020, Livongo for Diabetes had 442,000 members, which was 113% more than it had a year earlier.
Data source: Teladoc Health. Chart by author.
Livongo had already begun expanding from its flagship diabetes service to blood pressure management and weight loss at the time of the acquisition. Despite having a lot more resources to work with than Livongo did, Teladoc hasn't been able to repeat Livongo's success. In fact, chronic-care membership has slowed down so much that the company had to record a whopping $6.6 billion impairment charge related to the Livongo acquisition.
BetterHelp needs help
Teladoc Health's chronic-care numbers have been disappointing for over a year. But BetterHelp, its mental health segment, was until recently making big gains. Unfortunately, the company is losing ground to well-funded competitors that keep entering the market.
For example, Talkspace (TALK -2.23%) went public in a $1.4 billion deal with a special purpose acquisition company (SPAC) last year.
When reporting first-quarter results, Teladoc Health walked back the forward-looking guidance it provided three months earlier. Instead of revenue rising to a range between $2.55 billion and $2.65 billion, the company told investors to expect between $2.4 billion and $2.5 billion in top-line sales. According to management, investing in heavy advertising for BetterHelp has been delivering lower returns than it used to. Specifically, the company complained about increasing competition for keywords associated with online therapy.
More trouble ahead
Teladoc Health is the largest independent telehealth business in America, but it's competing with some deep-pocketed giants of the healthcare-benefits management industry that want their members to see the physicians they employ.
For example, CVS Health (CVS -1.07%) acquired Aetna a few years ago, and it also operates MinuteClinics in many of its pharmacies that also offer virtual visits. CVS Health would never say so in so many words, but it has a lot to gain when Aetna members visit physicians employed by a CVS MinuteClinic versus Teladoc Health.
Cash flow generated by CVS Health's highly integrated operations reached a whopping $18.3 billion last year, and the company expects between $12.5 billion and $13 billion this year. In stark contrast, cash from Teladoc Health's operations came in below $200 million last year and slid back into negative territory in the first quarter of 2022.
Teladoc Health may be the largest pure-play business in the telehealth industry, but we still don't know if it can compete with giant healthcare benefits managers and a slew of smaller upstarts at the same time. It's probably a good idea to watch the company's story play out from a safe distance until we see signs it can compete in a rapidly shifting market for telehealth services.
