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covered under the new CMS billing code 99490 for Chronic Care
innovative remote patient monitoring, c are c ollaboration and
telemedic ine solutions (c alled iUGO Care) for c ommunity- based
Management, which further incentives for healthcare providers. healthc are, whic h refers to patients outside of the hospital setting.
Beacon Securities Ltd.| 66 Wellington Street West, Suite 4050, Toronto, Ontario, M5K 1H1 |416.643.3830|www.beaconsecurities.ca
Who They Are and What Do They Do?
• Hamilton-based Reliq Health Technologies (“Reliq”) has developed innovative remote patient
monitoring, care collaboration and telemedicine solutions (called iUGO Care) for community-based
healthcare, which refers to patients outside of the hospital setting.
• iUGO Care is a powerful platform for care coordination and home healthcare that integrates wearables,
sensors, voice technology and intuitive mobile apps and desktop user interfaces for patients, families,
clinicians and healthcare administrators. Key advantages to deploying iUGO Care include improving
health outcomes, enhancing quality of life for patients and families, reducing the cost of care delivery,
and preventing costly hospital readmissions and ER visits.
• Reliq has generated good early traction having signed four contracts representing over 50,000 patient
deployments or over US$30M in potential annual recurring revenues once fully deployed. Reliq’s
addressable market is represented by ~38M Americans (Medicare/Medicaid recipients) who have two
or more chronic conditions, which represents ~$23B in annual recurring revues. Reliq’s pipeline of
opportunities is currently in the hundreds of thousands of at-home patients.
• Reliq went public via the RTO between Golden Virtue and MobSafety in April 2015 at which time it
changed the name of its company to Moseda Technologies. Reliq acquired the core iUGO Care
platform through the acquisition of CareKit Health in February 2016 and changed its name to Reliq
Health Technologies in May 2016 to reflect its Community Care focus. Reliq spent the following year on
R&D, leading to several pilot projects and ultimately commercial launch in September 2017.
• Reliq is addressing the challenges within the global Community Care market. Community Care is an
umbrella term that refers to the healthcare services patients receive outside of the hospital setting. With
inpatient costs continuing to escalate, one trend to help mitigate this has been to move care into the
Community, which is burdened by its own challenges.
– Poor access to specialized care in remote, rural and inner city areas
– The revelation that chronic diseases account for ~80% of all healthcare spending. However, chronic conditions are
typically poorly managed by patients at home leading to complications (e.g. 50% of patients do not take
medication as prescribed) and the need for hospitalizations, ER visits and other costly and disruptive interventions
• To elaborate on the last point, the Centers for Disease and Control and Prevention reports that about
half of adults in the US or ~117M individuals had one or more chronic health conditions. One in four
adults had two or more chronic health conditions.
• As it relates to hospital readmission costs, we’d note that Kaiser Health News expects Medicare/Medicaid
to fine US hospitals ~$564M in FY 2018 for “preventable readmissions”. Preventable hospital
readmissions are estimated to account for more than $17B in Medicare expenditures annually.
• Furthermore, as Medicaid/Medicare reimbursements continue to shift towards more value-based
structures (versus fee-for service), we believe there is a greater incentive for healthcare organizations to
look for ways to reduce costs and provide better healthcare outcomes.
• While moving chronic care patients to the home setting has helped to relieve inpatient cost
burdens, it has created its own cost challenges.
• Based on a recent report “Strengthening Chronic Care” by West Corporation, it is clear that
chronic patients desire more support with 70% of patients with a chronic condition wanting
more resources or clarity to help manage their disease and 91% say they need help managing
their disease.
• Furthermore, the report found that only 6% of patients surveyed believed that a two-way, at-
home device that collects data, reports data, and communicates information back to patients
would not be useful.
• The current model for home care is very “high touch” and relies on increasingly scare human
resources such as nurses, personal support workers with monthly costs running in the $2,000 –
$10,000 per patient range (scaling higher with age).
• As such, we believe there is an opportunity for a technology provider to offer a two-way home
monitoring solution that will improve collaboration between chronic care providers and patients
and engage them to improve chronic disease management, while also helping to lower the
overall costs of delivering healthcare to at home chronic care patients.
• In our opinion, the successful adoption of any software platform is predicated on potential ROI
and ease of use.
• In our opinion, Reliq’s iUGO Care platform checks a lot of the boxes including:
- Ease of use for patients given that functions are voice-based and largely automated in nature. Note that
Reliq’s initial healthcare customers have employed a hybrid model, which utilizes monitoring tools, care
workers (at a patient’s home) and mobile applications (with data all flowing into Reliq’s cloud platform) to
help ease the patient to a more automated model.
- Ease of deployment for providers given that the software platform is cloud-based and most of the
associated hardware are off the shelf.
- Given the monthly cost of ~US$50 per patient, we believe there is huge potential reduction in healthcare
costs vis-à-vis sending a nurse or personal support worker to the home (this monthly cost is also
reimbursed by CMS).
- iUGO should also help improve medication adherence, which is one of the key catalysts for properly
managing chronic conditions. This should help to enhance a patient’s quality of life and improve health
outcomes thereby reducing hospital readmissions, ER visits (and therefore healthcare costs and
readmission penalties). The reduction in costs are important for providers, particularly those which are
being compensated via fee for value (versus fee for service).
• iUGO Care is offered as a subscription service with monthly costs at US$50 per patient.
• Reliq is focused exclusively on providing the back-end software infrastructure, while the healthcare
provider is responsible for procuring all the associated hardware and deploying the platform to their
at-home patients. Reliq provides initial training to the provider’s deployment team.
• As noted above, hardware costs, including sensors, voice recognition device, docking station, patient
monitoring tools are borne by chronic care providers (and are typically reimbursed by CMS).
• The company estimates that ~38M Americans who are covered by Medicare or Medicaid have two or
more chronic conditions and also qualify for virtual care in the home under the new CMS billing code
99490 for Chronic Care Management.
• Under this billing code, iUGO Care’s entire $50 monthly fee should be reimbursed, which we believe
provides significant financial incentive for a provider to consider adopting iUGO Care.
• Based on the aforementioned ~38M target individuals, we believe the annual recurring revenue
market opportunity in the US for Reliq is in the ~US$23B range. The company is in early stages of
exploring opportunities outside of the US (notably in Canada and the UK), which could increase the
near-term market opportunity.
• In our opinion, Reliq has achieved several key milestones including those associated with new
customer signups, deployments and financials.
– On February 16, 2017, the company announced that it had signed an agreement with Paz Home Health
LLC in Texas to provide iUGO to over 10k at-home patients
– On April 6, 2017, the company announced it had signed an agreement with Rio Grande Valley Health
Alliance, LLC in McAllen, Texas to pilot iUGO with its primary care patients. Rio Grande has over 30k
registered at-home patients.
– On December 20, 2017, the company announced that signed an agreement with B Golden Care
Services in McAllen, Texas to implement iUGO Care for its 1,000 complex continuing care patients.
Onboarding of patients is expected to begin in late Q1 2018.
– On January 11, 2018, the company announced it had deployed over 6,000 patients representing
monthly recurring revenues of US$300k and that it was profitable for the month of December.
– On January 25, 2018, the company announced it had signed True Life Home Health LLC in Texas to
provide iUGO Care to over 2,000 home care clients.
• In our opinion, near-term milestones will continue to revolve around deployment milestones and
new customer wins. In recent discussions, management suggests that it is dealing with a very
strong pipeline, which have been largely referral-based or have been in-bound, which have
minimized sales and marketing spend.
• To date, Reliq’s financial results have been relatively anemic with revenues coming from milestone
payments. However, we would remind investors that iUGO Care only went live in early Q4 2017.
• However, based on the company’s mid-December update, we believe it exited CY17 with ~$4.5M in
annualized recurring revenues (~6,000 patients deployed) and EBITDA positive operations.
• With deployments currently running in the ~2,000 per month range, we estimate that the company
should be comfortably hit its target of 30,000 patient deployments (of the over 50,000 in its backlog) by
the end of CY18. In our opinion, any new provider win could increase the 2018 deployment target.
• Furthermore, given the company’s focus on providing only the software aspect of the platform (with
hardware to be procured and deployed by customers), we believe there could be very strong EBITDA
flow through (the company has hinted at ~85% EBITDA flow-through).
• The company currently has ~20 employees, and it expects to exit CY18 with a higher figure (up to ~30).
• From a balance sheet perspective, we estimate the company has ~$13M in cash. There are ~25M
warrants outstanding with exercise prices between $0.18 – 1.75 and 7.65M options with an average
exercise price of $0.14. The company also has ~$13.5M in tax loss carry-forwards to help mitigate
potential cash taxes over the near-term.
• The company most recent financings were in June 2017 where it raised $763k at $0.11/sh (1/2 warrant at
$0.165), in November 2017 where it raised $5M at $0.40/sh (1/2 warrant at $0.60) and in January 2018
where it raised $10M at $1.12/sh (1/2 warrant at $1.75).
• We are forecasting the company to hit its target of ~30,000 patients deployed by the end of
CY18, which should come from its existing backlog of ~50,000 patients (note that the company
has a June fiscal year). We further model the company to announce additional wins that could
add another ~12,000 patients deployed in CY18.
• The net impact is that we think the company could exit CY18 with ~US$25M in annualized
recurring revenues.
• For FY19 (ending June 2019) and FY20 (ending June 2020), we model the company to exit with
62,000 and 100,000 patients deployed respectively representing a revenue exit run-rate of
US$37M and US$60M respectively.
• From a margin perspective, we are modeling EBITDA margins of negative 3% for FY18, 38% for
FY19 and 47% for FY20 with increases in operating expenses coming primarily from advertising
and promotion and R&D. While we acknowledge that there could be greater operating leverage
than what we have modeled (the company has alluded to this), we also acknowledge that we are
in the early stages of growth and that operating expenses will likely need to increase as the
company rolls out its solution nationally across the US.
- As highlighted by the table in the following page, comparable SaaS-based companies are
trading at forward EV/Sales multiple of ~6x and EV/EBITDA of ~20x (excluding outliers).
- By comparison, based on our FY20 forecasts (ending June 2020), Reliq is trading at ~4.6x and
10x.
- In our opinion, given its earlier stage, we believe Reliq could experience much higher growth
rates relative to the group justifying a higher valuation multiple.
- The market’s willingness to reward the company with a multiple expansion will be predicated on
financial and new customer milestones over the coming quarters. We are however, buoyed by
the company’s progress to date, along with its large pipeline of opportunities, which we
understand to be in the hundreds of thousands of potential at-home patients.
- Applying a 15x EV/EBITDA multiple to our FY20e estimates results in a target price of C$3.00
- This represents a 50%+ potential return leading us to initiative coverage with a Spec. Buy rating.
We will reconsider the Speculative aspect of our rating as additional data points are released
(most notably in the from of additional new wins and additional financial disclosures).
Comps
Descartes DSGX.O 1,984.59 9.8 x 8.5 x 7.4 x 15% 28.6 x 24.9 x 21.1 x 16% 83.0 x 71.1 x 52.5 x
Solium Capital SUM.TO 593.30 6.8 x 6.1 x 5.2 x 14% 39.1 x 49.8 x 39.4 x 0% 135.3 x 145.3 x 102.1 x
Open Text OTEX.O 9,143.84 5.0 x 4.1 x 3.9 x 13% 14.4 x 11.1 x 10.4 x 18% 8.6 x 13.1 x 12.1 x
Constellation Software CSU.TO 16,755.72 7.8 x 6.8 x 5.8 x 16% 30.0 x 25.9 x 21.8 x 17% 81.0 x 36.8 x 30.2 x
Mediagrif MDF.TO 170.61 2.5 x 2.4 x 2.3 x 4% 6.8 x 8.0 x 7.1 x -2% 10.9 x 18.4 x 13.5 x
Shopify SHOP.N 12,611.55 29.9 x 17.6 x 12.2 x 57% 6391.4 x 621.6 x 235.5 x 421% nmf 2441.2 x 485.0 x
Tecsys TCS.TO 228.94 3.2 x 2.9 x 2.6 x 10% 23.4 x 28.2 x 20.0 x 8% 35.9 x 52.0 x 33.0 x
Kinaxis KXS.TO 2,127.87 17.0 x 14.8 x 12.2 x 18% 69.3 x 51.9 x 41.8 x 29% 201.7 x 77.7 x 69.2 x
Cortex CBX.V 35.93 2.7 x 2.2 x 1.8 x 21% 70.9 x 13.1 x 7.9 x 200% -85.5 x 26.8 x 12.3 x
Global Average 9.4 x 7.3 x 5.9 x 18.8% 741.5 x 92.7 x 45.0 x 78.6% 58.9 x 320.3 x 90.0 x
Global Median 6.8 x 6.1 x 5.2 x 15.1% 30.0 x 25.9 x 21.1 x 17.3% 58.5 x 52.0 x 33.0 x
Reliq Health RHT.V 249.86 52.2 x 9.4 x 4.6 x 236% nmf 25.1 x 9.9 x nmf nmf 39.8 x 15.3 x
Source: Thomson, Company filings, Beacon Securities
Note: For Reliq Health FY-1 = June 2018, FY = June 2019, FY = June 2020
Giancarlo De Lio, Chief Visionary Officer is a serial entrepreneur who previously founded and/or led successful business in digital,
mobility, healthcare and IT.
Stephen Samson, CTO is an internationally recognized cybersecurity expert with extensive experience in healthcare. He was previously
Director of Cybersecurity at PwC, Senior Security Architect for Adobe, Best Buy, Accenture, and CenterPoint Energy.
Aman Thindal, CFO was formerly CFO of a mid-tier real estate development firm with expertise in financial reporting, corporate
structuring and tax management.
Richard Sztramko, Chief Medical Officer, is a practicing geriatric and general internal medicine physician in Hamilton, ON. He is a serial
entrepreneur who previously founded Virtual Ward Inc. and created the online iGeriCare tool for dementia patients.
Board of Directors:
Eugene Beukman, Corporate Counsel of Pender Street Corporate Consulting. Mr. Beukman was previously employed as legal advisor to
the predecessor of BHP Billiton. He has over 20 years experience in the acquisition of assets and joint ventures.
Brian Storseth, businessman and was a Member of Parliament with the Conservative Party of Canada from 2006 – 2015. During his
tenure as an MP, he served on committees for Aboriginal affairs, agriculture and agri-food
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Beacon Securities Ltd.| 66 Wellington Street West, Suite 4050, Toronto, Ontario, M5K 1H1 |416.643.3830|www.beaconsecurities.ca