Growing Diversity Amongst Outdoor Enthusiasts

If you’ve spent much time in the outdoors over the past twenty-plus years, you’ve certainly seen trends emerge and fade, fads take hold and then dissipate. One of the changes that has taken hold (and is here to stay) is the increase in diversity seen amongst participants in outdoor activities. There are a host of reasons as to why outdoor enthusiasts have tended to be predominantly white over the past several decades, but the most pronounced is simply demographics, and those are rapidly shifting. In 2010, 64% of the population was white, 17% Latino, 13% black, and 5% Asian. In 1970, those numbers were 84% white, 4% Latino, 11% black, and less than 1% Asian, according to analysis of U.S. Census data. Those trends are projected to continue, such that by 2060, the U.S.’s population will be 42% white, 31% Latino, 13% black, and 8% Asian.

While the increase in ethnic diversity in outdoor participation reflects greater population trends, that doesn’t tell the whole story. There certainly are greater numbers when it comes to people of color as a percentage of the population, but the demand hasn’t simply appeared organically. People exposed to the outdoors at a young age tend to spend time there as they grow older and expose their kids to more of the same. Given roughly 82% of the U.S. is living in urban areas, up from approximately 74% in 1970, a growing number of people don’t have ready access to the outdoors, which is disproportionately felt in minority communities as they tend to have higher concentrations in cities. What then, has been the catalyst to drive increased engagement between minorities and the outdoor industry? Happily, a number of trailblazers from minority communities have gained prominence across a slew of outdoor activities from climbing to skiing, surfing to hunting. Many of these early adopters have found ways to pass their enthusiasm on to their communities through organizations such as Outdoor Afro, whose tag line is ‘Where Black People & Nature Meet.’ Clubs such as Latino Outdoors and Asian Outdoors have similar missions for their respective communities. According to the L.A. Times, a 2016 survey found that among the 1 million people who began camping for the first time in the prior year, almost 20% were black and 11% were Latino, nearly twice the rate for those groups in 2014.

Outdoor and enthusiast companies have taken notice. Another minority group, female hunters grew a remarkable 83% over the last ten years. As a frequent and recent attendee of the Outdoor Retailer (OR) and SHOT shows, one can’t help but notice the abundance of booth signage consistent with this movement. Not only do minorities offer an attractive avenue of growth into under-penetrated markets, but the outdoor industry in general embraces the idea that the folks you see in the wild should mirror the population at large.

Marketing efforts often highlight minority influencers as brand ambassadors and emphasize inclusiveness. The stakes are high and attractive: black consumers controlled over $1.2 trillion in buying power in 2015, almost tripling from $320 billion 1990; Latinos garnered a further $1.3 trillion in buying power in 2015, according to MarketWatch. Outdoor apparel and gear companies can do well while doing good by better serving these growing markets.

Source: U.S. Census data

The Future of Higher Education

The ongoing increase in tuition prices compared to stagnating wages for college graduates poses challenges for the prospective collegiate, particularly one requiring student loans. The added cost of room and board, transportation and other incidentals are an added burden to the gross price of higher education. For students and families on a budget, finding ways to cut costs is an important consideration. The obvious alternative to a four-year degree without paying a premium is online higher education. But is online education really the same?

Fully online institutions spend approximately $5,000 per student, approximately one-sixth the amount spent by private, non-profit schools with fewer than 5% online enrollment.  Traditional schools tend to spend more on instruction and faculty, which are expensive resources. Fully online schools devote proportionally more resources to academic support and student services, most likely due to the self-paced nature of these programs. One of the obvious benefits to online education beyond the reduced cost is student accessibility regardless of geography or proximity to the school. Students have greater flexibility when it comes to attendance and completing course work.  This model is especially useful for students who live at home and need to balance work or family obligations with their academic requirements.

Despite the benefits, online education has suffered from the image of a cheap knockoff to traditional higher education.  Many employers still prefer job candidates from traditional, physical universities, where budget dollars are dedicated to attracting the top professors and best instruction. Furthermore, students with online degrees are considered to have had fewer in-person interactions with professors and people of different backgrounds, cultures and ideas, which they will inevitably encounter in the workplace.  Online courses also may limit opportunities to develop presentation and communication skills, which are vital in the professional world.

No doubt, the cost and experiences of online and physical higher education are different, but are results the same? Naturally, quality is more challenging to measure. Fully online and traditional schools offer the same degrees and have the same accreditation. That said, graduation rates for fully online institutions tend to be one-third lower than those of traditional schools. Whether this variance stems from a less traditional student body or lower quality learning of online programs remains to be seen.

So, what does the future hold? While online higher education is likely to put stress on traditional residential colleges in terms of enrollment and tuition prices, it is unlikely to replace them altogether.  The physical location of a university campus is more likely to become a place where online and classroom learning is blended.  Examples of creative blends of in-person and online learning already exist, even among some elite private colleges in the U.S.  These schools attempt to leverage the best of faculty and technology in order to produce the optimal combination of quality and cost reduction.  That said, as pricing pressure affects all degree-granting institutions, they will likely continue to offer the best in-person experiences at their physical campuses and transition the rest to online, which may result in a consolidation of higher education institutions and an interesting dynamic for the M&A markets.

If you would like to learn more about MHT Partners, a leading education investment bank, please e-mail Shawn D. Terry (sterry@mhtpartners.com), Alex Hicks (ahicks@mhtpartners.com) or Rebecca Bell (rbell@mhtpartners.com).

Source:  Eduventures and IPEDS data

 

The Potential of Care Coordination and Patient Communication to Improve U.S. Healthcare

The challenges facing the U.S. healthcare system are complex but boil down to two fundamental objectives: to lower the aggregate cost of care and to deliver improved outcomes. These dual objectives are oftentimes at odds under the existing industry construct. For many reasons, such as restricted access to care, legacy fee-for-service models, high drug prices, and imperfect implementation of public health initiatives, the incumbent regime is deeply rooted. To boot, many powerful participants within the industry are positioned to benefit from the status quo.

Achieving improvements in cost and outcomes, and an increasingly common thesis for healthcare investors, revolves around implementing technology-enabled systems to enhance communication within the clinical environment. Deficient care coordination, patient flow models, and information sharing among providers is arguably the largest impediment to efficient healthcare operations. Triage, diagnosis, treatment, follow-up, and disease management are heavily dependent upon provider-provider and provider-patient communication channels. Nevertheless, existing network structures, despite rapid advancement of technology capacity and the decade-long focus on widespread electronic health record (“EHR”) implementation, haven’t sufficiently improved the flow of patient information.

One reason that communication has been stifled is due to the legacy of independence and entrepreneurship that underlies U.S. healthcare, whether that be among providers, facilities, or payors. On one hand the U.S. is positively differentiated in that regard; the incumbent-free enterprise system incentivizes innovation, differentiation, and a work ethic that is unique globally. Nevertheless, independence can disincentivize cooperation and coordination, as certain providers compete for the same increasingly elusive healthcare dollar. As new solutions are implemented, creative destruction will yield its fair share of losers as well as winners.

For that reason, incremental technology and structural solutions that incentivize coordination and enhance communication are the forces that will improve the U.S. healthcare model in the coming years. The companies that engineer those solutions, revolving around transparency, patient empowerment, technology as a means to improve communication, and comprehensive care coordination, are poised to emerge in the next decade as the latest commercial success stories within healthcare services.

Healthcare services and healthcare technology (“HCIT”) observers, including private equity investors, operating companies (a.k.a. “strategics”), nonprofit organizations, and governmental agencies, are all closely watching for differentiated innovation in care coordination and communication. All have a significant incentive to invest early in promising solutions, giving owners and founders of companies trafficking in the space broad and attractive strategic options.

At MHT Partners, a leading healthcare services investment bank, we believe that care coordination and patient communication are two of the most promising areas for investment in the healthcare industry. If you would like to learn more about MHT’s healthcare services advisory practice, please e-mail Taylor Curtis (tcurtis@mhtpartners.com) or Alex Sauter (asauter@mhtpartners.com).

Where There’s Smoke There’s Fire – a CBD update

I recently attended Global Pet Expo, and over the prior two and half months we also attended ICR, Fancy Food, OR and Expo West.  To say CBD has dominated the conversation would be an understatement.  In general, here’s a few seeds to chew on – I promise I’m not just blowing smoke:

  • While CBD is a non-psychoactive compound found in hemp and cannabis, truths, falsehoods, dreams and fears abound about its present and future states given the science around it is still evolving, and the space, in general, is in its infancy.
  • While the market is moving faster than a coffee stain (coffee is also a cannabinoid!) and is projected to reach $20B + by 2022 (up from an estimated and approximate $1B today), there’s a school of thought that it’s better to be “selling pick axes to the gold rushers” (services, co-packing, packaging, etc.).
  • Stroke-of-the-pen risk, while perhaps diminishing from a perception perspective, is still very real. The knowledge of its efficacy (good and bad) continues to evolve.
  • CBD in and of itself does not make a great product or company. Similar to commentary surrounding the internet 20 years ago (“is it a standalone business model?”), CBD product companies need to have more than just CBD in their value proposition – CBD is a differentiator, but not a model in its own right.
  • CBD products (consumable and beauty) are viewed as real opportunities, though products largely remain outside mainstream retailers and limited to the independent, all-natural channels.
  • No one has really “cracked the code” on a complete CBD product: user friendly forms (tinctures, pills, drops are lacking), product (different dosage and different products for different needs – energy, pain management, epilepsy, insomnia, anxiety/relaxation), messaging, packaging etc.  Ultimately what will determine the winners are points of sustainable differentiation from a consumer perspective.
  • Hemp CBD, because it results in THC levels < .3% holds an advantage over cannabis CBD (with higher THC levels) and because of this, enjoys a much larger potential retailer market at this point.

MHT Partners, a leading consumer investment bank, is actively exploring the CBD deal space and welcome speaking with interested parties operating or investing in this growing market.

 

What’s on the Menu? Maximizing the Potential of Hospital Pricing Transparency Regulations

Beginning January 1st of this year, by order of the Trump administration, all hospitals in the U.S. are now required to publish master price lists – known as “chargemasters” – detailing all products and services offered to patients. According to the mandate, chargemasters must be readily available on the internet in a machine-readable format. While greater price transparency is a righteous goal, in practice, the pricing information is prohibitively difficult to find and utilize. The industry must take great strides in pricing data presentation and availability before the information can begin to positively impact affordability and patient care.

Pricing information currently available has been buried, disorganized, and widely variable among organizations, rendering it unusable for the vast majority of patients. The chargemasters are often hidden in fine print, deep within hospitals’ websites. Once located, the data can be overwhelming and incoherent. As evidenced by chargemasters from the Cleveland Clinic, Cedars-Sinai Medical Center, and Memorial Healthcare System linked below, pricing lists consist of thousands of lines of arcane, often duplicative procedure descriptions and corresponding dollar values. Additionally, data formats vary widely among organizations, restricting the potential for price comparability. Together, these factors make it nearly impossible for patients to navigate and understand the information.

Extracting actionable information from the pricing data will require significant progress by hospital organizations and third parties such as research institutions and healthcare services firms. For certain procedures, in order for patients to make sense out of what is listed in chargemasters, providers must clearly outline necessary procedures, allowing patients to calculate total projected costs before consenting to care. Further, implementing the ability to search and assemble the required procedures and total costs by CPT code can give patients the ability to shop in advance of a visit to the doctor. Next, industry adoption of a standardized data format can permit third parties to aggregate chargemasters into a combined database, empowering patients to compare hospitals’ prices against each other. Over time, consumers will gain the ability to compare prices among hospitals and make an informed decision on providers based on both cost and quality of care. This new demand elasticity can lead to increased price competition among hospitals and a reduction in listed prices in order to retain and grow patient bases. Finally, adding the ability to compare Medicare reimbursement rates to hospital prices can increase transparency and empower uninsured patients to negotiate outrageous bills.

In some cases, the uninsured patient population stands to benefit the most from increased pricing transparency. Without an insurance provider to negotiate rates to reasonable levels, uninsured patients are charged exorbitant list prices with no context. A 2015 study in Health Affairs found 50 U.S. hospitals charging over ten times the cost of care and a national average of 3.4 times the cost of care. Even after “uninsured discounts,” commonly around 20-40% of the total bill, patients can be left with unmanageable bills that are ultimately sent to collections agencies.

The new hospital pricing mandate is a step in the right direction for patients, but we have a long way to go. Ultimately, increasing transparency of hospital billing practices and fostering competition can make healthcare more affordable and can improve the overall health of the population by expanding access to care.

MHT Partners, a leading healthcare services investment bank, believes that innovative, niche solutions that decrease the cost of care while improving outcomes will shape the future state of healthcare. If you would like to learn more about MHT’s healthcare services advisory practice, please e-mail Taylor Curtis (tcurtis@mhtpartners.com) or Alex Sauter (asauter@mhtpartners.com).

Example Chargemasters:
Cleveland Clinic
Cedars-Sinai Medical Center
Memorial Healthcare System

Sources:
“50 Hospitals Charge Uninsured More than 10 Times Cost of Care, Study Finds,” The Washington Post
“As Hospitals Post Sticker Prices Online, Most Patients Will Remain Befuddled,” Kaiser Health News
“Extreme Markup: The Fifty US Hospitals with the Highest Charge-To-Cost Ratios,” Health Affairs
“Hospitals Must Now Post Prices. But It May Take a Brain Surgeon to Decipher Them,” The New York Times
“Opinion | Donald Trump Did Something Right,” The New York Times
“US Hospitals Are Now Required by Law to Post Prices Online. Good Luck Finding Them,” Quartz