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No. of Recommendations: 1
I am also doubting this company's estimates and have lowered my expectations, I have not sold out completely yet, but have trimmed, especially since I do not think that the stock price will recover from its lows significantly given the uncertainty in their numbers/forecast. These are my internal notes that I have kept on my bearish thesis. My only bull case here is that somehow Livongo will contribute meaningfully after 2022, and they might be able to launch effectively their virtual primary care (but concerns on age cohorts below)

* From their earning call "Turning to fourth quarter results. Total revenue increased 145% to $383 million or 79% on an organic basis. U.S. access fee revenue for the quarter was $283 million, representing growth of 188% over the prior year’s quarter. Total international revenue of $34 million grew 16% versus the prior year."

My note: So the above represents, 10% international revenue, and growing YoY only 16%

Where is this international going to come from exactly? 16% YoY is nothing! Other concerns here is that most countries have national health systems, not sure why would they want to adopt Teladoc, and more specifically how Teladoc will make money from that. There are so many rules and regulations, on top of localization concerns - I don't see the International part expanding significantly.

* The margins for doctor visits, shrink, with more visits per client, cost is increasing

* Physicians don't like it because supposedly get paid "$20" per visit ? Saw that comment somewhere, not sure if its actually the case.

* Bad reviews - their app has plenty of bad reviews, some of which are actually describing the app as being buggy (video concern below), some the actual service (doctors servicing clients on the go/from their cars,etc)

* The age cohorts are not clear for their estimated potential membership - old people (ones that are sick more often) prefer to go doctor in person, only younger are more tech savvy but they are not that sick in general

Age/Wealth/Etc Cohort concerns
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The use of technology to maintain access to outpatient care raises important equity concerns. The digital divide has been well documented, with lower rates of technology and broadband adoption among older patients, racial/ethnic minority groups, and those of lower socioeconomic status
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Teladoc requires video - which is not available in rural area if patient has no access to broadband connection (or no money to pay for one).
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This report is related to different cohort and demographic concerns in telehealth:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
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