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Campbell: You know what's really fascinating about this, and the reason I brought up flu season, think about the benefit that there could be for patients who are interested in a better mousetrap when they have, say, a cold or a flu. Rather than calling up and hoping to be able to fit themselves into a primary care doctor visit, going over there, waiting in the lobby, waiting an hour or more while you're there, and then walking out of there and having to go to Rite Aid or whatever your pharmacy happens to be. There has to be a better solution, right, Shannon?

Jones: Absolutely. You know this as a parent, Todd, there's nothing worse than having a child with the flu who you then have to take into the doctor's office, sit in a lobby with other sick kids, [laughs] and wait through the agony of that. You know how that is.

Campbell: It's the worst! On today's show, we decided it'd be fun to talk about telemedicine. Just a quick, dirty definition of what that is, it's the remote diagnosis and treatment of patients using video or audio. On your smartphone, on your computer, via Skype, whatever it happens to be, that would be telemedicine. The opportunity that exists for telemedicine to disrupt is huge, and I think every healthcare investor needs to be considering how this space may evolve over the course of the next 20 years.

Jones: Absolutely. Speaking of, going to what Dr. Levy wrote in, he said, "Thanks for your great podcast. As a non-sophisticated investor who uses Stock Advisor and Rule Breakers as primary investing tools -- " I would say that you are sophisticated because you use those tools. He says, "You guys add a lot of value and knowledge. Can we discuss some interesting trends? I think you guys discussed Teladoc at some point. I believe I'm at a 71% return since I bought it immediately after the show. But there are other interesting telemedicine companies, specifically RadNet, which I have followed for a while, but I usually buy stocks only after I hear good vibes from Fool analysts." Again, Dr. Levy, thanks so much for writing in.

Let's dive even further into this huge opportunity, Todd. We've laid the groundwork. Telemedicine is here. It's actually not that new to begin with, but it's here. There are a few factors that have really been driving the rise of telemedicine. Let's just start with the most obvious one, and that's technology itself. You mentioned a smartphone. We're talking smartphones, computers, the whole gamut of technology. Now that we are so much more connected with wireless connectivity, you're really starting to see the adoption of telemedicine start to take off.

Campbell: Right, because we have these devices that allow us to make that "personal" connection with the person on the other side of the device. I think a lot of people before either didn't have a smartphone in their pocket, or were leery of technology. I think technology has become so commonplace that even people who were late adopters now can actually use these things and gain value out of them. I think that evolving technology is going to continue to be a big driver of adoption of telemedicine. I'm sure we'll talk about some of the struggles or obstacles in the way of it.

One of the other really big trends that people need to be thinking about here when it comes to telemedicine's opportunity is a larger, increasingly longer-living population. Aging baby boomers are turning 65 at a rate of 10,000 people a day. By 2035, the population of people who are over 65 in the U.S. will outnumber the population of children for the first time. We have got this huge population of people who are getting older. Those are the biggest consumers of healthcare services, the elderly.

Jones: It's interesting. The obvious driver of technology, you don't immediately then think, "The elderly are going to be a huge diver," because of the technology. But you're exactly right, Todd. Even more so when you think about nursing facilities and skilled nursing facilities. That's actually one of the fastest-growing segments, in terms of using telemedicine, but it makes so much sense. Studies show that approximately 60-70% of all nursing home transfers to the hospital are flat-out unnecessary. One particular study that was done in 2015 found that an off-hours telemedicine service prevented over 90 hospital admissions or readmissions over the course of a year. This was for a 360-bed facility based out of New York. The savings were over a million dollars in Medicare cost alone, and improving the clinical outcomes for these patients, as well. So, I'd say even more so than the technology is the fact that we've got this aging baby boomer population driving it, too.

Campbell: One thing that we don't have to worry about when it comes to the healthcare industry is demand. The demand side of the equation is not going to be a problem. The real problem is going to be supply. And part of that supply problem is going to be being able to deliver it cheaper and more conveniently. That's to your point. The ability to reduce unnecessary visits that can tamp down on spending, that's huge, especially when you're talking about a patient population that has such a big need for healthcare. I saw a statistic, it said that of Americans who are over age 50 today -- there's roughly 70 million of us out there -- four out of five of us have at least one chronic condition. But anyone who's above 65, nearly nine out of ten has a chronic condition. Aging Americans are truly a big driver of healthcare spending in the country today. We spend 4X more on caring for the elderly who have chronic disease than those that don't have a chronic disease. And part of that is because of things like unnecessary visits to the ER.

Jones: Absolutely. That also brings up a good point, in terms of the physician shortage. This has been an ongoing issue, Todd, for quite some time. As you think about the astronomical numbers of people with chronic conditions, especially as we age, what becomes even more concerning is that we may not have enough physicians to meet the actual demands. Let's actually dive into that, because there are some really fascinating stats with that, too.

Campbell: They call them medical deserts. Think about it this way. All of us are getting older, including the doctors. About one-third of the doctors who are out there are baby boomers, who are going to be coming up on retirement themselves. As I was going through and prepping for the show today, I discovered that there are over one billion visits to either primary care offices or hospital outpatient visits every year. 991 million to primary care offices alone. If you think about the fact that we have this tremendous amount of demand coming through the pipeline, and this potential for so many doctors to retire, yeah, you could have a massive shortage. As a matter of fact, the Association of American Medical Colleges' estimate right now is that by 2030, we're going to have a shortage of about 49,000 primary care physicians. That equates to having 62 million people in the United States that are inadequately served because of these physician shortages. It's a huge problem. We've got to find new ways to boost healthcare supply, especially if we want to move the needle on cost.

Jones: Absolutely. That brings us to the point of where the limitations are with telemedicine. The opportunity, the need, is tremendous, but it doesn't necessarily mean that telemedicine has it all right now, Todd. In particular, there are a couple of barriers that telemedicine still needs to overcome. One of the biggest hurdles, and what has really, I think, been one of the things that have slowed it down the most, has been on the reimbursement and regulatory end of things. For example, even defining what telemedicine is still a work in progress when it comes to reimbursement. Payers want to be able to narrowly define, what is telemedicine, how do we code for it, how do we pay for it? That term is still broad. Until we get more traction on what it is, I think that's the first thing. There's obviously also some legal concerns. Of course, if you're treating someone via telemedicine and something were to happen to that patient, and because you weren't actually physically examining them in the office, obviously, insurance companies weren't too keen on that.

But, in 2019, we are starting to see a shift. There were some big moves on the regulatory and legislative front to remove some of those barriers, both on the payer and the health plan policy side. What's interesting for me on that front is, you are starting to see a shift. Granted, it's slow. But telemedicine is shifting away from this stand-alone service that's separate from and apart from your typical insurance and healthcare. Now, it's actually being integrated into the existing healthcare system. I think that is certainly a positive on that front. We're getting there. Still a long way to go on that front, though.

Campbell: The "how to pay for it" issue is a big one. I think that's been a big obstacle to adoption. The last thing you want to do is tell a patient now, "Guess what? We have something else that you're going to have to buy." One of the ways that they're overcoming that objection is, they're coming up with business models where the telemedicine company will actually sign a contract with the employer or the health insurance plan and receive a fee based upon the number of members they want to cover with telemedicine. The payer is actually footing the bill for providing access to telemedicine. That's really been a big driver of some of the growth that we've seen in the industry in the last few years. I was reading somewhere that of large companies, largest employers in the country, we're up to about 74% of them offering telemedicine services to their employees. Listeners, if you don't think you have telemedicine and you work for a big employer, you may actually have access to telemedicine. It's definitely worth looking into, especially if you're interested in the convenience and potentially a lower cost, depending on what your copay happens to be.

You mentioned the regulatory side of things. Yes, that's been a problem. You have to have states actually agree to what the definitions are. They need to figure out, "Are we going to allow a doctor in, say, Massachusetts to be able to treat a patient in New Hampshire? Will they have to get licensed in New Hampshire, as well?" How are you going to handle that or address that kind of an issue? Obviously, the best way would be to have a national registry or something like that. That way, you have a slow doctor's office in, say, Utah, they have the extra capacity in their workday to be able to see more patients, maybe then they could see people in an area where there's a tremendous amount of demand, an area that's underserved. Those are some of the other considerations that we're trying to figure out, the growing pains in getting telemedicine to become something that's much more commonly used by people.

Jones: Exactly. And even on a logistical front, Todd, you're recognizing that for these types of visits, these are non-emergency visits. These are for things like a cold, the flu, things that don't require immediate care and are non-life-threatening. Of course, that's certainly a limitation. I don't think that will ever change.

All in all, I think that telemedicine represents a huge opportunity. We're just seeing the beginnings of what telemedicine will look like. We'll get into some of the stocks and what they're doing, to go after some of the opportunities there. That's just to say, the future of telemedicine does look quite bright, Todd.

Campbell: Absolutely. I wouldn't shortchange it. One of the companies we're going to talk about later on has moved much more into specialty care over the course of the last couple years. As technology gets better and we're able to do a lot more in the way of remote monitoring -- and, who knows. Maybe someday, we'll have holographic images where our doctor is actually standing in front of us to evaluate us in our living rooms. I wouldn't count technology out, as far as being able to break through some of those technology barriers and get us to a point where telemedicine is helping more complex cases. But, to your point, we're still a long ways away from that.

Jones: I don't know about a hologram. I think about my mother, who actually still refuses to use the banking app on her phone, for security concerns. Could you imagine having a hologram in your living room? I don't know how open people would be. But, I do think that's where we're headed. Eventually, we'll get there.

Let's turn the tables a little bit. Let's talk about the first stock that was brought up. This company is at the forefront of revolutionizing the healthcare delivery model with their drive for telemedicine. That company is Teladoc Health, ticker TDOC. The stock is up about 67% this year versus the S&P up only about 2% on the year. At one point, this stock was up almost 150%, but it's had some turbulence over the past month or so. We'll dive into that. Right now, the company is trading at about $58 a share, down from $86 a share. Todd, it sounds like this might actually be a good buying opportunity for a company that is really on the leading edge.

Campbell: Full disclosure here, I wrote an article for The Fool about two weeks ago, where I said, three growth stocks I want to buy the next time we get a sell-off. And one of those was Teladoc. And sure enough, we got a sell-off. And I'm beyond our restrictions, so I can talk about it. I did indeed go out and buy Teladoc on that recent weakness.

It's a small position. I always say on the show, you've got to diversify. It's only a 2% position for me. But I did feel that the opportunity long-term here warrants it being in my growth portfolio so I went out and I took a little bit on that weakness. It's a fast-growing company. It's about a $4 billion market cap company. In the third quarter, its sales grew about 62% year over year to $111 million.

Jones: Fascinating, the growth story here. When you look at how the company has been growing, they've been doing it through smart acquisitions, which I think is a very smart strategy for them. If you look at their revenue over the past five years, it's been growing at a compound annual growth rate of 75%. Granted, the company is still not profitable. I think they'll get there over time. But this is a company who is really defining what telemedicine, telehealth, will look like. They use a subscription-based model that's certainly helping them to get over that finish line into profitability.

Campbell: You highlighted the growth. There's a couple different numbers I want to hammer home for our listeners here. In 2016, Teladoc did about 952,000 telehealth visits, a little less than a million. In 2017, they did almost 1.5 million telehealth visits. If you look at last quarter, they did 641,000 visits. If you analyze that out, that gets you a run rate of around 2.4 million visits. Think about that statistic I shared with you earlier today about the total number of primary care and outpatient hospital visits per year. Over a billion.

Am I worried that this company is losing money right now? Obviously, you have to watch and see how that progresses, but no. I'm totally fine, as a growth investor, with them going out and investing back out into their business, with the assumption that there's still a tremendously long runway for this company.

Jones: Absolutely. Talking about the revenue growth, that 62% that you mentioned does include growth from its recent acquisition of Best Doctors. But even on the organic front, organically, revenue grew 29% in the third quarter. Another thing that really stands out for me with Teladoc is the fact that they've got a global footprint now. They've got operations in North America, South America, Europe, Asia, Australia, and more than 12,000 clients in over 125 countries. It's astounding to me how quickly they've been growing. I know this stock in particular has been a favorite among many Fools here. I believe even David Gardner is very bullish about this stock.

Campbell: Of the three biggest players in telemedicine, it's the only pure-play that we as investors can buy right now. I think that's one of the other reasons that it catches a lot of attention of investors. You mentioned the global growth opportunity. We shouldn't forget, they just went out this past summer, they bought Advance Medical for $352 million. That gives them another $63 million in recurring revenues. Advance Medical is global. Most of their business comes from outside the U.S. This isn't an opportunity that's limited to simply the U.S. market.

Then, going back and looking at that broader market opportunity again, by Teledoc's calculation, they think that roughly 417 million of the over 1 billion visits per year could be handled through telehealth. 417 million. Again, from my perspective, pretty much just scratching the surface. They did update their guidance when they put out their most recent quarterly numbers. That reflects this recent acquisition. They're now expecting between $414-416 million in revenue for the full year. They're going to lose between $1.48-1.50 per share.

Jones: Another growth opportunity that I'll point out is the fact that Medicare's Advantage plan could actually now include telehealth visits as a part of their coverage for their 2020 plan year. This is a huge opportunity for the industry itself but specifically for Teledoc, with their size and scale. That would mean they could offer their full suite of services to all 21 million Medicare Advantage enrollees. A huge opportunity, and really a great way to increase their U.S. paid membership base.

We mentioned at the beginning that there was a sell-off. The markets have been quite volatile over the past two months. Teladoc in particular fell about 12% in early November for a couple of different reasons. One was investors reading through because of insider selling, basically. The COO and CFO had a personal sale of about $700,000 worth of stock. I think investors got scared by this, especially with it being so close to earnings. They thought there was a readthrough to earnings. But if you actually dig a little bit deeper, these were shares that he had already planned to sell, and he'd planned to do this five months prior. So, really a non-event there. And then, of course, as is the case with most growth stocks, there's always the short seller on the prowl. Actually, we've got a great article. If our listeners want to check it out, Keith, one of our writers, on November 5th, wrote an article entitled Why Teladoc Health Tanked Today. He really went through and piece by piece deconstructed that entire thesis, and why Teladoc is still a strong performer.

Campbell: The short sellers were calling into question some of the marketing that they do through affiliates. Yes, you're always going to have these moments in time where people will take shots at them. I think that you ignore that as an investor. Stay focused on the long-haul opportunity. That's one of the reasons that I was willing to step in and pick some up for my own portfolio.

One of the things I want to go back to is that Medicare thing is pretty huge. To put 21 million people in perspective, right now, the way the company makes its money is selling subscriptions to payers, like employers and insurance companies, to cover a certain number of people per month. They cover about 23 million people right now. So, that represents a really, really significant potential to boost its addressable market.

Jones: All around, certainly a great stock, and now could be one of the best times to get in or add to a current position.

Next up, let's talk about another company in the space, RadNet, ticker RDNT. In comparison to Teladoc, relatively small in scale. Also, telemedicine makes up a very small percentage of their actual business. Todd, what can you tell us about this company?

Campbell: It's interesting, I hadn't spent any time learning about this company up until prepping for this show. So, I wasn't very familiar with the story. Digging into it, it's quite interesting.

What they do is, they operate freestanding diagnostic imaging centers in the United States. Historically, getting radiology or imaging done, that occurred in a hospital environment, which, of course is expensive. What they're doing is partnering up with health centers and hospitals to create freestanding units where they're majority owners, and maybe these health centers own a small minority interest in them, with the goal of being able to deliver the same service faster, better, at a lower cost. And so far, it seems to be working. They've got 341 different outpatient imaging centers that they're running right now. About 86 of those are held in joint ventures with health system partners, but they're looking to try and boost that to 50% over time.

The company does a pretty good business. The most recent quarter, $242 million in revenue. Over an $800 million run rate for the company, in terms of sales. But Shannon, the sales really aren't growing very quickly.

Jones: No. When you look at the company itself in the past, it has quadrupled in size since 2006. This has been through acquisitions, but also, it's got some organic growth. But the company is guiding for about 1-3% organic growth over the long-term. This is not going to be your high-growth stock if you are looking for one.

To your point, Todd, it's got some really interesting strategic components about it. You mentioned that it's building out the network of freestanding alternatives, which I love, especially as you have more price-conscious consumers. Think about the millennials, who are looking at prices. And now, more than ever, you have consumers who before they go into a physician, are looking at, "What kind of diagnostic test will I need, and how much will it cost? Can I compare costs from place to place?" I think this is a company that's at least starting to fill that gap, and allowing for this free-standing, lower-cost, ambulatory setting environment will help to mitigate some of that.

It's a big behavioral shift, it's a huge shift to turn, if you think about it. We're used to, when we need diagnostic imaging, MRIs, CT scans, we're typically going to go to the hospital to get that done. Going to these freestanding clinics that aren't associated with the hospital, I think there's some of that behavioral adjustment that's needed. And of course, as you know, in healthcare, any sort of behavioral change takes time. So, I think the story is compelling with RadNet, but it'll be a much slower compelling story to watch.

Campbell: Yeah. And they don't have a lot of pricing pressure, because so much of their business comes from the Medicare crowds, so they're at the whims of whatever the Medicare reimbursement rates are going to be for that next year. As far as turning that freighter, again, that's why they want to boost a lot of these joint ventures with these little hospital systems. You mentioned integration earlier, and how a lot of these different companies are trying to integrate across the whole spectrum. You've got hospital systems buying up private practices. If they're buying up those private practices, who do you think that the doctors are going to end up referring imaging to? They're going to refer to the hospital system. As a stand-alone operator, that could be a competitive disadvantage.

Now, an advantage from RadNet's perspective could be that, "We're relatively big fish in this independent, free-standing marketplace. There are a lot of small, fragmented companies that could be struggling much more than we are. We can go in, acquire these that at a relatively good price, then figure out new ways to work with these different health services providers in that area to drive sales growth."

But, again, guiding for 1-3% growth. 6% growth last quarter year over a year. Most of that's coming from acquisitions. If you look at procedure volume, on the aggregate, their procedure volumes were up 3.5%. But, again, because of acquisitions. If you look at same-center procedure volumes, it rose less than 1%. I think this is one of those steady-eddy things. Demand will increase over time because, again, aging baby boomers are going to demand many more healthcare services, including imaging. But I wouldn't expect this to be able to deliver the same breakneck growth that, say, a Teladoc might.

Now, as far as telemedicine goes, they have two products or solutions that they offer that fall within that telemedicine camp. The first is their eRAD product solution. It creates web-based cloud solutions that helps hospital systems manage their medical imaging workflow and their communications with their patients. Basically, taking that hardware and all that data out of the hospital, putting it up in the cloud so that people can more easily share and review images between different facilities or locations. Then, they also have Imaging On Call. Imaging On Call is teleradiology. They work in a couple different ways. For example, let's say that you have a hospital system that usually does its own stuff in-house, but it's got some staffing concerns it needs to fill or it gets really heavy volume in a certain period of time and they need to ramp up their ability to read through these images that they're taking. Then, they can reach out and remotely have RadNet's radiologist analyze the imagery and provide feedback. And they can do it relatively quickly. The average turnaround time is about 17 minutes, which is pretty rapid. Again, that can help hospital systems overall reduce costs by outsourcing some of that image-reading.

Jones: Absolutely. That's why you see some of the private payers becoming more aggressive in sending patients to these freestanding sites, particularly Anthem and UnitedHealth. One interesting thing that you probably won't see in the near-term, but something interesting to watch here, is that this company is actually investing heavily in artificial intelligence. For healthcare investors, you probably already know, radiology is one of the areas where AI is being invested in the most heavily. I read one stat, over 50% of the funds being invested in AI in the healthcare space are just in radiology alone. The company plans to talk more about this, and you'll probably see some acquisitions happening into 2019 and beyond. But I think this will be a really interesting space. Think about it, Todd. If I can go get a diagnostic tool like an MRI, CT scan, AI then analyzes that scan, then sends a detailed report over to my physician -- that not only saves time, but it also saves money.

Campbell: Absolutely. That's potentially pretty disruptive. We could be a little bit ways away on that, but it's one of these advances that you may actually end up seeing. And if that were to happen, if they were to launch something like that, it would certainly make me want to take another look at this company from a growth perspective, and see whether or not it becomes more intriguing to me. If you look at what they're expecting for sales this year, they came into the year expecting sales of $950-975 million for the year. They're actually now, because of a weak first quarter, because of sicknesses and weather and all sorts of things in the first quarter, they now expect $945-970 million. That's up from $922 million the prior year. Again, not gangbusters growth, but really intriguing. A company to keep your eye on.

Jones: Absolutely. Todd, with the time we have left, let's switch gears just a bit and talk about two privately held companies, the first of which is a company called MDLIVE. It started back in 2006. It sounds very similar, to me, to Teladoc. But, it's attracted the likes of some big-name healthcare backers and partners.

Campbell: What's interesting for investors to keep an eye on, I mentioned early on when we were talking about Teladoc that of the big three, Teladoc is the only one that's publicly traded. Two more, these other two that you should be keeping your eye on. MDLIVE is one of them. They have about 30 million consumers that are enrolled as members because of relationships that they have with different healthcare payers. They expect to do about 500,000 virtual visits, that's the run rate right now, per year. Smaller. That's less than what Teladoc did last quarter. Still, a big player.

And, as you mentioned, big investors in the healthcare area, especially as of this year, through a new capital raise that they did, include Cigna, which is a major insurer, and Novo Holdings, which is the venture capital arm of Novo Nordisk, a major biopharma company.

Jones: The other company is actually the company that's been behind Apple's health study, a company called American Well. For those of our listeners who aren't familiar with the Apple heart study, Apple has been using an app using the Apple Watch -- wearable devices -- to identify irregular heart rhythms, including those from potentially serious heart conditions like atrial fibrillation. The Apple heart study is basically utilizing this video consultation to connect participants in the study to physicians 24 hours a day, seven days a week. Let's talk a little bit more about American Well, one that I didn't even realize was a part of this study. It's gotten so much press. I didn't realize just how connected they were to Apple.

Campbell: This another company that you can't buy yourself, necessarily, unless you're one of the lucky few. It's a private equity, private venture. But they're raising a truckload of money -- just shows how much interest there is out there in telemedicine companies. They just raised $366 million this summer alone. Participating in that capital raise was Philips, which is one of the global leaders in telemedicine technology. They're actually going to be joining American Well's board. Anthem Health is also an investor in this company. One of the things that's interesting when you look at MDLIVE and American Well is to see that these insurance companies are taking these equity stakes within these telemedicine providers. I think that's incredibly encouraging for what their view is of telemedicine in the future, and how it could change how people get low-cost care.

Jones: Absolutely. Definitely a positive there. In closing, Todd, it sounds like telemedicine, intriguing opportunity for investors if you're not already in the space. An even more intriguing value proposition for patients. Everyone can agree that healthcare costs here in the U.S. are out of control and need to be reined in. Sounds like telemedicine could be just what the doctor ordered to help with that, Todd.

Campbell: Absolutely. And like most things, don't go crazy with it in your portfolio. But keep an eye on it. I think it's really exciting. In ten years from now, these companies are going to be a lot bigger than they are today.

Jones: Totally agree. That's it for this week's Industry Focus: Healthcare show. Thanks so much for tuning in. As always, people on the program may have interest in the stocks they talk about, and The Motley Fool may have formal recommendations for or against, so don't buy or sell stocks based solely on what you hear. This show is produced by Austin Morgan. For Todd Campbell, I'm Shannon Jones, thanks for listening and Fool on!

Shannon Jones owns shares of Apple. Todd Campbell owns shares of Apple and Teladoc Health. The Motley Fool owns shares of and recommends Apple. The Motley Fool has the following options: long January 2020 $150 calls on Apple and short January 2020 $155 calls on Apple. The Motley Fool recommends Novo Nordisk, Teladoc Health, and UnitedHealth Group. The Motley Fool has a disclosure policy.