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HPHW: Providing Solutions For Corporate Wellness

By Anita Dushyanth, PhD


 Hooper Holmes (OTC:HPHW), headquartered in Olathe, KS, is an independent wellness company that provides on-site health screenings, laboratory testing, risk assessment and sample collection services.  Roughly  45% of Hooper Holmes’ revenue is generated by their channel partners (i.e. indirect, third-party administrators), which service various health plans and other providers.  Some of the clients include a large insurance company, American Healthways Services, Inc., IncentiSoft Solutions, LLC and New England Health Plan.  About 45% of Hooper Holmes’ revenue stems from direct sales.  Some of the major direct customers include an international beverage company, Federation of Statewide Municipalities, two hospital chains, a Big 4 accounting firm   and a large family-owned food store.  The rest of their clients (~10% of revenue stream) are those in government and clinical research organizations.  

In April 2015, Hooper Holmes acquired Accountable Health Systems (AHS), a provider of telephonic health coaching, wellness portals and data analytics.  The acquisition was accretive to earnings in 2015.  In May 2017, Hooper Holmes merged with Provant Health, a Rhode Island-based wellness organization.  The increased size, upselling capabilities, diverse offerings and larger footprint created by the merger positions HPHW to capitalize on a high-growth wellness market segment.  Pro forma for the combined companies, 2016 revenue was approximately $67 million.  

We believe the combination of Hooper Holmes and Provant’s infrastructure, screening capabilities, nationwide network of experienced health professionals, scalable technology and engagement platform, health coaches and analytical tools positions the company to become a leader in the growing health and wellness market.  Management is of the opinion that the transaction with Provant is a game changer in the wellness industry since this is a merger involving two companies, which provide very similar services and offers up-selling opportunities.  The key business strengths of the merger include the following:

➢ A stronger presence in the corporate wellness market
➢ Hooper’s screening platform, which is tailored to suit client’s needs, is scalable.
➢ Provant’s portal and coaching services could help improve the merged entity’s financial performance as they are scalable, high-margin products.
➢ The merged company is expected to have business equally distributed among direct customers, channel partners, clinical research organizations and insurance providers. 
➢ The merger expands national network of health professionals, enables the delivery of more complex blood panels and vaccinations and strengthens on-site health coaching services for the channel partners.  
➢ The merger offers enhanced technology, coaching capabilities, engagement expertise and advanced data management services for the direct customers.  
➢ Both companies have strong recurring revenue streams from the online portal and coaching segments.

Screenings comprise more than 70% of Hooper Holmes’ services.  HRA or a health risk questionnaire (HRQ) is a questionnaire that involves personal health information such as physical characteristics, smoking history, alcohol consumption, cholesterol levels, height, weight, blood pressure, family history, cancer screening, flu and other vaccinations, and more.  Based on the individual’s input, the program has tools that connect them with clinical services, health management programs as well as coaching/counselling.  

The data gathered from biometric screenings is objective, quantifiable and can help track progression of a wellness program when repeated annually.  Further, it also helps classify employees into well-defined health programs.  Currently, biometric screenings have become one of the primary screening services in corporate wellness programs to help improve health awareness among employees.  Screenings are performed either on site, in primary care clinics or in partnership with health plans through the employees’ regular physicians.  Clinical screenings usually measure height, weight, waist circumference, BMI, resting heart rate, blood pressure and pulse.  A fingerstick screening for immediate results or a comprehensive venipuncture screening are also offered by Hooper.  The company also offers additional tests based on clinical guidelines such as Hemoglobin A1C, prostate specific antigen (PSA) and cotinine.  Hooper Holmes also uses its wellness portals and data analytics to track an individual’s progress and their incentive and reward opportunities in the program. 

Hooper Holmes’ ScreeningPro™ tablet technology is a mobile platform used to securely replace paper data collection during screening events.  The online portal is able to help with; 
➢ scheduling 
➢ sending out reminders 
➢ allowing for online reporting 
➢ conducting a confidential Personal Health Assessment 
➢ delivering biometric test results within 48 hours of screening 
➢ providing educational tools such as online videos, articles and webinars 
➢ tracking program participation 
➢ tracking and administering incentives and rewards and providing other health-promoting tools

Further, the program generates (electronic) Personal Wellness and Corporate Wellness reports and can provide data to third-party vendors.  It also helps with data storage and serves as an easy access for Preferred Health Professionals (PHPs) to discuss results and direct members to the right programs and/or activities.  Additionally, Wellness Support Now(SM) provides onsite health consultation services, which includes year-round education and activities, as well as individual and team challenges.  This resource can be integrated into any business’ benefits website and can be linked with other resources to seamlessly provide individualized referrals.  In addition, telephonic health coaching for lifestyle and health risk improvement, data analytics and reporting services, communication and engagement services, and wellness program advisory services are also provided. 

In addition to working with companies onsite, Hooper Holmes also offers remote screening options for organizations including
➢ Individual screenings at home or work
➢ EZLink (physician fax record retrieval service)
➢ Walk-in local retail clinics for blood tests and biometrics
➢ At-home sample collection kits
Hooper Holmes’ data center is secured via an entry door employing biometrics, camera monitoring and centralized uninterrupted power supply (UPS) with generator backing.  The firm also uses robust security measures including firewalls that extend into all layers of the IT environment as well as a cloud operating environment.  

The corporate wellness landscape is diverse, competitive, crowded and highly fragmented.  Many players like Virgin Pulse, Sonic Boom, Ceridian LifeWorks, Corporate Fitness Works, Limeade, Keas, The Vitality Group and several smaller startups are crowding the field.  Hooper Holmes is not trying to diversify their product mix, but rather provide a complete end-to-end service within their existing business line, thereby capturing more market share via a larger client base.  

As many firms expand the scope of their wellness programs, industry revenue is forecast to expand at a CAGR of 7.8% ($11.3 billion) through 2021.  The RAND employer survey indicated that only 49% of organizations that offer wellness programs have biometric screenings – indicating that the biometric screening segment remains fairly untapped and offers significant potential for growth.  The U.S. demand for wellness programs is forecasted to grow more than 9% over the next several years driven by rising healthcare costs, increasing incidence of chronic conditions and greater investment in corporate wellness.  Favorable regulatory changes and market dynamics are also fueling the growth in this segment. Despite having competitors in the market, we believe Hooper Holmes can expand in this segment based on their end-to-end experience and flexible program offerings for members that have achieved over 99% satisfaction from participants.

The HRA segment alone equates to a $1.5 billion (17.7% of $7.8B) market opportunity.  Further, this market segment is in a high-growth phase as more organizations come on board with wellness programs.  With more than 70% of Hooper Holmes’ services focused on the HRA segment, the company is well positioned to take advantage of the growth in this space.  Despite the fact that there are many players in this segment and a low barrier to entry, Hooper Holmes has successfully competed by consolidating its position, increasing size and scale, and broadening its footprint and service offerings (via mergers/ acquisitions).  Hooper Holmes differentiates itself from other cookie-cutter wellness offerings in the following ways:  

➢ Being a pure-play wellness company managing the end-to-end logistics of screening
➢ Offering flexibility in tailoring wellness programs and tracking individual progress
➢ Offering their services using “internet-of-things” (IoT) technology.

Financial Condition
The bulk of Hooper’s revenue is generated from screenings and wellness services.  In addition, Hooper Holmes generates ancillary revenue through the assembly of medical kits for sale to third parties.  Hooper Holmes experiences a significant uptick in revenue in the third and fourth quarters every year.  The increase in demand for screenings from mid-August through November is during the period when corporate annual health benefits are renewed.  Therefore, the screening services are subject to some variability in sales due to this seasonality.  Consequently, gross profit is higher during this time period.  The health and wellness service operations also experience variability due to the timing of the health coaching programs, which are billed per-participant and typically start shortly after the conclusion of onsite screening events.  
In a September press release, Hooper indicated that they signed contracts worth nearly $14 million.  They expect to realize a portion of those contracts as revenue in 2017 and the remainder in 2018.

Management has identified over $7 million in (annualized) expected cost savings through operational efficiencies.  Of this amount, they expect to achieve about $3 million in savings for 2017.

Debt: Balance of a credit agreement with SWK Funding LLC, as of September 30, 2017, was $8.5 million.  The loan has a term of four years and expires on May 11, 2021.  It accrues interest at an adjustable annual rate of LIBOR+12.5%.  Principal repayments will be made from February 2019.  Additionally, in order to meet higher seasonal cash needs, SWK has also provided the firm with up to $4 million in 2017 and $2 million in 2018 that  can be used between the months of June and November.  As the company experiences seasonality in revenue, such an arrangement helps the firm fund working capital.    

Additionally, as of September 30, 2017 the firm owed $2.1 million to Century Focused Fund III, LP.  The firm had $12.1 million of outstanding borrowings and $1.7 million of unused borrowing capacity with SCM Specialty Finance Opportunities Fund, L.P. as of November 10, 2017. 

Cash: The company used net cash of $11.5 million in operating activities for the first nine months in 2017.  The firm had cash and cash equivalents of $1.6 million as of September 30, 2017.  

Additional liquidity is available through a $10 million stock purchase agreement, which Hooper entered into in September with Lincoln Park Capital Fund LLC (LPC), a Chicago-based institutional investor.  Hooper has the flexibility to access this source of funding anytime at its discretion, which has put the company in a stronger financial position. 
Currently, Hooper Holmes services clients throughout the U.S.  They have two main sources of revenue. 
1. Recurring monthly revenue from their online wellness portal and employee coaching.  This is billed on a per-employee basis. 
2. Seasonal revenue from health screening that typically occurs in the 3rd quarter of each year. In 2016, the firm had more than 500,000 screenings.

We think that the merger with Provant, could help create a hockey stick like growth curve for Hooper Holmes in the near term.  Provant and AHS expanded Hooper’s offerings as they were servicing a different pool of clients and as a result, this merger expanded Hooper’s reach within this segment.  The merger created a strong value proposition for both consumers and wellness companies, positioning Hooper as a better solution as compared to its competitors in this 2-sided marketplace.  The company expects the integration to be completed by year-end.  

Hooper Holmes’ annual net revenue is weighted more heavily toward the second half of the fiscal year, reflecting the historical strength in sales during annual benefit renewal cycles.  The firm experiences a higher percentage of third quarter revenues from their channel partners and clinical customers.  Provant’s revenues are heavily concentrated in the fourth quarter.  Pro forma revenue for the combined companies for the year 2016 was $67 million.  With a solid customer base, robust revenue growth, increased operating capabilities, leverageable cost structure and recent growth trends, we model revenue of approximately $59 million in 2017 and $75 million in 2018.  We model an initial relatively high rate of revenue growth and for this to drop to a stable rate of 9%, commensurate with the growth in the wellness market.  
Hooper’s biggest strength comes from their extensive national network of healthcare professionals, affording nationwide coverage and allowing them to offer screening services even for small sites.  The cost of sales has an undisclosed percentage of fixed costs related to customer servicing, which is required even during periods of relatively low screening volume.  As the firm continues to expand their client base and exploit economies of scale from their recent merger, we expect widening of gross margins (from the 23% in 2016) to 30% from upselling opportunities and high-margin services.  This should also help offset certain fixed costs which are also captured in cost of sales.   

Thus far, the firm’s financial reserves have been primarily used for business development.  Management has been successful in controlling expenditures in the past.  Since Hooper and Provant have complementary strengths in services, operations and technology, this merger is expected to create significant near-term value through meaningful and substantial cost synergies, especially from infrastructure consolidation (combining platforms and eliminating redundant tools).  Although mergers seem to offer strategic as well as financial benefit, we think the firm will continue to incur transition costs associated with the merger until integration is complete, probably, through to year-end.
Operating loss through 1H 2017 was $7.4 million (includes contribution from Provant beginning May 11th).  The variable cost component in the SG&A spend includes expenses related to seasonal staffing and laboratory supplies (diabetic and biometric screening supplies).  Variable operating expenses are also correlated to the number of enrolled participants.  However, there is also a fixed-cost component in SG&A, which (by definition) remains more constant even during seasonally-slow times or when revenue-generating activity may otherwise decline such as due to the unexpected loss of a major contract.  Management expects about $3 million in savings during 2017 from the consolidation of IT operating systems around a single platform and the elimination of underused office space.  We expect to see a decrease in SG&A spend as a percentage of revenues from 2018 onwards when integration will be complete.  Management expects to turn cash flow positive and enter a period of higher growth in the near term.  As per guidance, we think this inflection point could occur when revenues are closer to $100 million and when SG&A as a percent of revenues drops below 30%.  Given the merger/integration risk associated with Hooper Holmes, we use a discount rate of 12.5% in our DCF model and assume a terminal growth rate of 2%.  We are initiating coverage of Hooper Holmes with a price target of $2.25/share. 


Merger/Integration Risk: Hooper may face integration challenges including those associated with 
➢ blending both companies’ cultures 
➢ elimination/decreasing redundancies
➢ integration of technology infrastructure
➢ retention of clients

If this were to happen, Hooper may not be able to realize anticipated growth in revenues and OpEx savings from synergies.  

Crowded marketplace:
The firm is operating in a crowded marketplace.  If they fail to differentiate themselves by offering complementary/additional services, differentiated approach to wellness or expand their business into potential new markets, there is a possibility of being out run by competitors.

Regulatory risks: The federal and state governments have varied requirements for corporate wellness programs.  The requirements can vary from specificity to the practice such as having mandated personnel on site, Health Insurance Portability and Accountability Act (HIPAA) patient privacy rules and lack of/limited reimbursements for such services.

Security Risks: Corporate wellness programs often have online patient portals that make it imperative to have data protection.  HIPAA regulations do not allow retail establishments to have access to personal health information.  There is always a threat of security breach when Electronic Health Records (EHRs) are accessed online.  Further, integrating these online portals with payors as well as companies increases the propensity for security threats. 

Model-based assumptions are prone to large variations: Our projected revenue growth from the current year and beyond is largely based on best-guesses related to expected growth of the overall corporate wellness market.  Revenue could underperform relative to our model if there are wide variations in screening volume, if the customer base does not grow at our assumed forecast or is less correlated to revenue growth than what we are assuming. Achieving our price objective includes competitive and financial risks.


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