Teladoc, Inc. (NYSE:TDOC) Teladoc Acquires Advance Medical June 4, 2018 8:00 AM ET
Mark Hirschhorn - COO and CFO
Jason Gorevic - CEO
Lisa Gill - JP Morgan
Jamie Stockton - Wells Fargo
Sean Wieland - Piper Jaffray
Mohan Naidu - Oppenheimer
Donald Hooker - KeyBanc
Matthew Gillmor - Robert Baird
Sandy Draper - SunTrust
Richard Close - Canaccord Genuity
Steve Wardell - Chardan Capital Markets
Stephanie Demko - Citi
Good morning my name is Lisa, and I’ll be your conference operator today. At this time, I’d like to welcome everyone for the Teladoc Investor Conference Call. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question-and-answer-session. [Operator Instructions] Thank you.
Mark Hirschhorn, Chief Operating Officer and CFO, you may begin your conference.
Thank you, operator, and welcome everyone. With me today is Jason Gorevic, our Chief Executive Officer. This morning we issued a press release announcing our strategic acquisition of Advance Medical. The release and supplemental slides are posted on our website. We have also filed on Form 8-K a copy of the slides rather than financial information and the merger agreement.
Teladoc intends to avail itself of the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995. Certain statements made during this call will be forward-looking statements within the meaning of that law and are subject to risk, uncertainties and other factors that could cause Teladoc’s actual results to differ materially from those expressed or implied by the forward-looking statements. For additional information on the risks factors facing Teladoc, please refer to our filings with the SEC.
We will also reference certain non-GAAP financial measures which we believe are important in evaluating our performance. For more details on these measures, the most comparable GAAP measures and a reconciliation of the two, please refer to the press release I just mentioned and also posted on teladoc.com.
I will now turn the call over to Jason.
Thanks, Mark, and good morning everyone. Thank you for joining us on such short notice. It is a big day in Teladoc's history and I’m extremely excited to announce that Teladoc and Advance Medical have agreed to come together to form the only comprehensive virtual care delivery platform addressing the needs of companies and consumers on a global level.
If you watch Teladoc evolve and grow over the past few years, you have seen that we have a track record of identifying, executing and integrating acquisitions that either enhance our solutions offering like better health and the behavior of health space, and Best Doctors and expert medical opinions or that deepen our relationships in particular segments of the market, as HealthiestYou did in the small business market and Stat Doctors did in the provider market.
Today's acquisition of Advance Medical is particularly exciting because it does both, brings new solutions to our customer base and dramatically strengthens our global footprint. Advance Medical philosophy of bringing a comprehensive virtual care solution to the consumer aligns closely with Teladocs, and our combined solution will allow for our complementary suite of offerings to address the needs of a global markets.
We believe combining the leading international virtual care company with the established global leader provides an offering that is unparalleled in the market today. If you're following along with the presentation available on our website, you will see on Slide 3, the key reasons that this acquisition uniquely accelerates our mission and maximizes value creation.
We believe the combination of the leading U.S. and the leading international virtual care companies creates an offering that is unparalleled in the market today. By unlocking global markets, enhancing our clinical capabilities, expanding our existing relationships and creating operational synergies, this highly strategic acquisition is not only accretive to Teladoc's financial performance, but it also accelerates our goal of providing a comprehensive virtual care delivery platform worldwide.
Before I go into the details of the Advance Medical business and for those of you who may be newer to the Teladoc story, we thought it will be worth noting the extraordinary growth that our business has seen over the last several years. Teladoc's growth can be attributed to an extended portfolio of clinical services that meet the needs of healthcare consumers, payers and providers and delivering on our vision of transforming the way people access healthcare.
Importantly, our visit volume and consumer engagement has continued to grow at a strong pace which contributes to my certainty that virtual care has passed the point of inevitability and is rapidly becoming a critical component of the healthcare delivery system. Advance Medical represents an important addition that will help us accelerate this trend globally.
Turning to Advance Medical, on Slide 5, you will see highlights about their business which is cultivated an impressive client list of over 300 customers who benefit from the consumer-centric and global clinical services. These clients fall under two primary categories. First, the significant majority of their revenue is derived from insurers outside the U.S. who incorporated Advance Medical services into their products similarly to how U.S. health plans used Teladoc services today.
The remaining revenue comes primarily from large U.S.-based multinational employers who turn to Advance to provide care for their employees the world over. Notably with less than 5% customer overlap, we believe there is ample opportunity to cross sell the offerings to both customer bases. Additionally, this active acquisition will allow us to be more aggressive in going after Fortune 1000 companies as we'll now be able to meet the needs of their global workforces by providing the highest quality medical care on a consistent platform around the world.
With approximately $63 million in revenue in 2017 Advance posted top line growth of approximately 15% last year, similar to Teladoc, their annual or multiyear contracts provide for recurring subscription revenue. I'll go into more detail on their product portfolio and geographic footprint later in the discussion, but wanted to highlight their offices and medical staff around the world.
As a bit of background, Advance Medical has a very unique history. The Company was founded nearly 20 years ago in 1999 by Carlos Nueno and Marc Subirats as a graduate school project. The two founders are still Co-CEOs and I've been incredibly impressed by Carlos and Marc as I've gotten to know them, and I'm pleased to say that they will both be joining the Teledoc executive team to continue to lead the Advance Medical business outside of the U.S.
On Slide 6, we look at the previously untapped opportunity present in the massive global health insurance market that this deal opens up to Teledoc. Advance Medical provides us access into this market where growth is being driven by healthcare consumerism, aging populations, public finance strain and the growing need to supplement national insurance offerings. This is a multitrillion dollar market poised to double in the next 10 years and we're incredibly enthusiastic about the opportunity at hand. We are equally excited by the expansion of our addressable employer market.
Slide 7 highlights how with the addition of Advance Medical, we become the only virtual care provider who can offer truly global access to healthcare to multinational companies. One third of the U.S. employees of U.S. multinational employers reside outside the U.S. When you combine this with the proliferation of ex-pats and global travelers, the need for a global solution becomes clear. Advance Medical has a local presence in the three primary markets and Teledoc's largest market outside the U.S. is Canada, where we provide expert medical opinions, and we know that the Canadian market is anxious for a broader array of clinical services.
Slide 8 provides a deeper look at the Advance Medical product offering. Advance is the leading provider of virtual healthcare solutions outside the U.S. and we tried to array their products against the healthcare pyramid that we described before. Most of you will be familiar with general medical and expert medical opinions which are similar to Teladoc's, but Advance Medical's other offerings represent an expansion of our portfolio. Advance is taken a unique approach to chronic care management by creating a virtual medical home and pairing the chronically ill patients with a physician who acts as an always available resource to answer questions, curate medical records and coordinate the care for that member.
Medication management is a service in which Advance Medical assist members on certain medication regimens to answer questions, support adherence and ensure compliance. This service is scalable across the combined global footprint. The clinical risk assessment service provides virtual encounters that help insurance companies better understand the medical risk of their perspective and existing members.
We believe that this capability will help us meet the demand in the U.S. for clinical risk assessment services associated with the government program. Of course, with respect to the solutions they're common to the two companies, we see an opportunity to determine best practices and when appropriate leverage that knowledge across our U.S. operations.
I think Slide 9 really tells the story of this combination. We've been saying for some time that the comprehensive virtual care solution is the winning consumer experience and the best way to optimize engagement. The acquisition of Advance Medical fully realizes our vision on a global level. Looking at our new solution portfolio across the spectrum of care, we can now address the needs of our members from important critical-care cases all the way through high-frequency episodic care needs around the world.
Our core set of solutions is highly complementary, providing numerous opportunities where we can learn from one another and rollout best practices across the platform. Further we will be able to leverage our solutions to enhance Advance Medical's offering. For example, we can integrate our behavioral health capabilities and oncology insight with Watson into Advance Medical's current offering.
Slide 10 goes into greater detail regarding the combined service offerings on a global basis. A critical factor in delivering a global solution is having local capabilities. This slide demonstrates the global product suite, but even more importantly, our local market knowledge and presence. Clearly, scale is a key competitive advantage for Teladoc, and this transaction solidifies us as a global leader in the virtual health market. Not only do we now have the ability to provide virtual care on nearly every continent, but our services in each geography complement each other almost to a T, and for those regions in which there is overlap, we will look to find any and all opportunities for synergies.
Turning to Slide 11, the combination of our newly achieved global reach, and the breadth of our solution has further strengthened our leadership position in virtual health. In a landscape cluttered by single market point solutions, Teledoc stands alone as the only global comprehensive virtual care platform.
Finally before I turn the call over to Mark, I want to take a moment to address Slide 12, which may look familiar to those of you who joined us at our Investor Day last fall. We proposed a growth strategy at the time of our IPO road show nearly three years ago and continue to check back to demonstrate our execution of that strategic plan. The acquisition of Advance Medical brings us just a few steps closer to completing our strategic goals from the IPO, and I believe shows how truly versatile and beneficial virtual health can be to consumers.
Next, I'll turn the call over to Mark to review the operational and financial aspects of this transaction. Mark.
Thanks Jason. As Jason mentioned in his remarks, we see great opportunity in terms of synergies from this acquisition of Advance Medical. And if you turn to slide 13, I'll go a bit deeper into those details. We touched on the growth opportunities stemming from expanded global reach, the ability to cross sell our broad suite of virtual health solutions around the world and leveraging our newly combined clinical resources into new geographic markets.
Additionally, we can apply our best-in-class approach to marketing to Advance Medical's customers to identify future growth opportunities. Teledoc has developed world-class engagement programs that we can now leverage across the Advance Medical membership base to drive access and utilization improvements. We've also invested heavily into our IT infrastructure and technology platform and have the additional capacity to drive efficiencies throughout the combined organization.
In terms of executing on the synergies we'll start with the low hanging fruit immediately, but we will have to wait until our Investor Day in late September to provide you with an aggregate total and timeline to realize all of the synergy opportunities at hand. Longer-term, you will see evidence of the true value of this transaction in our financials specifically increasing our revenue per client, continued utilization improvements, cross-selling and launching new and innovative products to yield new clients. Again, we'll dig into all of that to a much deeper degree later this year.
Finally, I want to review the terms of the transaction before opening the call to questions. As noted in the press release and on Slide 14 of the presentation, the total purchase price of $352 million, consisting of $292 million of cash on hand and approximately 60 million dollars or 1.3 million shares of our common stock. The transaction closed on May 31st, so you should anticipate seven months of contribution from Advance Medical in our 2018 financial statements.
While we will be updating the financial outlook for the entire company in conjunction with our second quarter earnings release in August, we anticipate Advance Medical to contribute approximately $40 million in revenues for the seven months of activity and approximately 2 million in adjusted EBITDA for 2018. We feel this is a really impressive combination of complementary businesses, like-minded cultures and a perfectly aligned mission to bring a comprehensive suite of virtual solutions directly to the consumer anywhere in the world.
I'll now turn it back to Jason to close out our remarks.
Thanks Mark. We believe this is the right acquisition at the right time for Teledoc and Advance Medical's clients as well as for our shareholders and employees, combined with an opportunity for significant value creation.
And with that, operator, I think we can open the call to questions.
Thank you. [Operator Instructions] And our first question comes from the line of Lisa Gill from JP Morgan. Your line is open.
Let me just start on a couple of things. One, I believe, Jason, you've made the remark that less than 5% overlap between the two companies. Should we think about Advance Medical any of that overlap is it between Best Doctors and Advance Medical? And how much of their business today is in the U.S. versus outside the U.S.?
Yes, Lisa. Thanks for the question. So let me start with the second one first because it's easier. About 80% of the revenue is outside the U.S. today and about 20% in the U.S., where we have some overlap, it's where we have Teledoc general medical services in a U.S. multinational employer alongside their expert medical opinion services that's in the same multinational on a global level. It's -- we really don't have much in the way of overlap relative to Best Doctors and Advance Medical.
And then just secondly, when Mark -- when you talked about low hanging synergies that first you'll be able to capture, I understand you'll give us a bigger picture at the end of September. But can you give us an idea of what some of those low hanging synergies that you'll be able to initially capture?
Yes, certainly, we have some overlapping operations and a footprint in the U.S. and in Europe. Additionally, we were looking to expand our services in Canada, the UK, Australia for the traditional Teledoc services into existing what were previously Best Doctors geographic locations. Now that we have Advance Medical's suite of solutions, we'll be able to accelerate that Advance into those respective countries and of course there will be operating synergies in both the U.S. and in Spain where we, where both companies have significant presence.
Our next question comes from the line of Jamie Stockton from Wells Fargo. Your line is open.
I guess maybe the first one, if you could give us some sense on an up maybe Slide 9 is the best way to think about it as far as critical care, complex care, episodic care, the Advance Medical business. How does it breakdown between those three buckets, if you give us some color on that? That'd be great.
Yes, Advance Medical's business is sold in a very similar way that our visits included business is sold here in the U.S. So once you contract under the subscription access the model, again about 90, I'd say about 98% of Advance Medical's revenues are under contract either one year or multiyear contracts that afford you the opportunity to access both acute care the traditional general medical visits that will serve north of probably 2 million this year.
But in addition to that, you also get the opportunity for expert medical opinion and a number of other services all under the same contract. So it's a -- what we would typically referred to as a comprehensive visits included model that gives you the full spectrum of services under the single contract. And again probably 98% of this is recurring revenue on a single or multiyear basis.
Mark, is there a ballpark that we should think about for number of members? Or what the typical PMPM looks like for their contracts?
Yes, we will get into further detail about that at the first week of August. But as Jason noted about 20% to 25% of their revenue is outside or as in the U.S. So that's international, and similar to the reporting that we do today. We don't include members as defined for any clients or entities outside the U.S. We will add most likely a million plus members for that 20% to 25% of domestic revenue that they generate. Their clients include some of the largest high-tech clients out in the West Coast, a number of the top airlines in the United States companies that have hundreds of thousands of employees. So when you think about the approximately perhaps $20 million being generated in the U.S., you can do the math and understand that there are per member per month or per employee per month is going to be very similar to what Best Doctors had evidenced in the market for the last several years.
And then maybe just one more question, the employee number, it looks like they do directly employ some docs on a part-time basis. The location of those doctors, I think that maybe presentation said 125 countries. I assume it's not that diverse.
Majority of those doctors are located in Spain and then there are a number of doctors located in country in China, in Brazil, Portugal, Chile, Hungary and the number of physicians and other European countries and then clearly the U.S. as well. But the vast majority is in Europe.
Our next question comes from the line of Sean Wieland from Piper Jaffray. Your line is now open.
So on Page 8 maybe just a follow-up on Jamie's question. I'm just trying to get my head wrapped around. What's the long poll in this? Is there one of these five products that is representing the core of the business? How should we think about that?
So, let me give you a little history on the Company Sean. They started as an expert medical opinion company similar to how Best Doctors did. As they saw the need for greater consumer engagement and a demand from their clients for a broader array of services, they expanded into these other areas with general medical being the first additions to their portfolio and now represents the majority of their transactional volume, BUT similar to what Teladoc sees you may have a lot more transactional volume with the high-frequency general medical services, but greater financial impact for the more critical-care things around expert medical opinion or chronic care management programs.
When I think about the clinical risk assessment, they use that as a mechanism to get a foot in the door at a lot of international insurance companies, where they help them assess their risk with the virtual encounter between a patient and physician and that then opens the door to some of these other products, but the ultimate goal is to have a comprehensive solution in the client and that continues to both get additional populations as well as greater revenue potential because they're serving a bigger population with a broader array of services. Does that make sense?
Yes, it does. And so similar to other transactions, are you going to be basically moving the backend infrastructure of this company onto your own? And if so what kind of cost savings do you think you can pull out of the model?
Sean, we will be integrating the service delivery and of course the infrastructure for the app and platform for physicians as well as members will be integrated in time onto the existing Teladoc infrastructure. We're not going to provide savings synergies at this point. We will do that most likely either in August to some degree and then to a fuller extent at our Investor Day in September. But you should think about the fact that the number of interactions that Advance Medical has annually is nearly equal to what Teladoc does solely in the United States.
So you should think of Advance Medical as the international Teladoc with obviously a very, very significant influence in Europe. But their utilization and their interactions with members hit an extremely high number principally as a result of their various services that they provide on an integrated basis. So that's something that we will look to join in many countries over the next couple of years. We will obviously be investing heavily into bringing those services into those countries with the greatest need the largest populations.
So maybe just slide one last one in. I think you said it was 15% revenue growth. Do you think you will be able to accelerate that up to Teladoc levels of revenue growth?
Yes, we absolutely do. Marc and Carlos the founders of Advance have bootstrapped their company for nearly 20 years. The first time they took any capital was in January of this year and they were just at the point of beginning to deploy some of that capital. They have been running profitably for many years. And now with the obviously the technological experience to marketing knowhow some of the other I think key characteristics that Teladoc can bring as well as available balance sheet will enable them to accelerate their revenue growth. And we would expect to bring their revenue growth in 2019 up to the 20% to 30% Teladoc revenue growth.
Our next question comes from the line of Mohan Naidu from Oppenheimer. Your line is open.
Mark on the last answer. Should we think about any changes to your EBITDA targets or profitability as you make more investments here?
Again, we'll provide that greater level of detail into August, but as far as 2018 is concerned because we'll be reflecting seven months of the Company's results in our consolidated statements for the year you'll see a contribution of about $40 million of revenue and a couple million dollars of EBITDA. This combination extends our financial strength into not only the U.S. but will make us even more profitable in Europe.
I think we'll end up again having the opportunity to invest a bit more rapidly as we had planned throughout 2017 following the acquisition of Best Doctors, but we're now going to benefit from the goodwill and the operating experience in multiple large markets like China, like Brazil and of course with this combination in Europe we can accelerate some of our internal goals.
Thanks Mark and one more, quick one around seasonality, anything specific at Advance Medical that we should know of?
Also, much less seasonality than what we experienced we're selling Advance Medical selling traditionally ex-U.S. to private insurers. These sales take place throughout the year. They're not as prone to the seasonal benefits periods of the first quarter of every calendar year. So, we'll tend to see greater midyear sales. And again, we're less reliant on anything having to do with the first or fourth quarters like we see in conjunction with the flu and other recurring quarterly incidents.
And one more on the physician -- I guess employed physicians under Advance Medical. Does that change the cost structure for you guys? I mean historically you guys have relied on more non-employed physicians versus employed. How does that cost structure impact you guys?
You know it's a great question we had been telling people in the past that we're getting to a bit of a critical mass in certain areas and we were looking to bring on some employed physicians against certain full-time employed physicians and others that we would also classify as employees, but many of them would still be working on a part-time basis.
I think the demand and the economic, the profitability that's been proven out under Advance Medical's model, is one that we can clearly replicate in several other countries. The profitability again the results of their operations suggested that they can scale and they could scale profitably. We're going to be able to I think continue with their model in certain countries. And in fact, our model by using a flexible workforce will continue at this point in the U.S. and a couple of other countries.
Our next question comes from the line of Donald Hooker from KeyBanc. Your line is open.
Great, curious how Advance Medical compares to you guys on terms of utilization? I know you guys had put a lot of work into an engagement around using different forms of social media and things like that. Where do they kind of stand versus you? And is that one area where potentially they could be sharing of knowledge?
Hi, Don, it's Mark. I think you should look at it from two perspectives. One is utilization in the U.S. which is consistent with what I would suggest was Best Doctors utilization in the past because in the U.S. they're really only offering expert medical opinions and clearly that level of engagement while it's consistent with the pure Best Doctors side for anything that's been cross sold and clearly for the traditional Teladoc business utilization is much stronger.
You get the reverse of that in Europe where traditionally Teladoc has only offered expert medical and Advance Medical has offered everything from general medical triage and the expert medical. So their level of utilization would suggest that they have multiples on what we have experienced it is a mirror-image of the U.S. So bringing the two together is a wonderful combination.
And I guess I would just add to it, where they have done a consumer engagement that marketing, it's more traditional in terms of direct mail and relying on their partners to do the communications so, as Mark mentioned in his prepared remarks, there is a significant opportunity to bring our surround sound engagement strategy to bear for Advance Medical's customer base, especially as we roll out the broader solution together.
In greater I know you’re going to provide more detail and synergies at the Investor Day. But do you guys work with a lot of what -- how many multinational players do you guys work with? I am just through thinking about potential immediate cross sell.
Sure, so, you should think of Teladoc having hundreds and hundreds of multinational employers. In addition to that Advance Medical has probably somewhere in the range of about 50 multinational employers and I would also suggest about 90% of those 50 clients would be recognizable to everybody on the phone call. They have a pedigree of clients that they master in the U.S. that clearly second to none for a company of their size. The fact that we have the opportunity now to offer to our clients those clients represents millions of lives in Europe and Asia.
We've not been able to service those members in the past because of our lack of available services and geographic presence in many countries that Advance Medical brings us today. So it will be immediately accretive to the number of members and the hopefully the expansion opportunities with an existing Teladoc domestic clients. I would say our recent employer clients' summit and about 40% of the clients in the room indicated that they had employees overseas. So when you consider that population plus the ex-pat population, plus the global traveling workforce there is a very significant opportunity here.
Thank you. Our next question comes from the line of Matthew Gillmor from Robert Baird. Your line is now open.
I want to asked about the international regulatory dynamics, I guess in U.S. were starting to see some of the government payers embrace telehealth and I was curious how that's the internationally? Is a similar trend?
There is a significant trend toward the international insurers embracing virtual care and you know as I said in my prepared remarks, there are a bunch of single market point solutions, but outside the U.S. Advance Medical really represents the only multimarket, a comprehensive virtual care platform. And with respect to the regulatory environment, there are far fewer constraining regulations in most countries outside the U.S. and I think importantly in the U.S. where we look at individual state-by-state regulation.
Outside the U.S., it tends to national regulation that looks an entire country with the single regulatory landscape instead of the patchwork quilt that we see here in the U.S. In fact, Advance Medical would have been more aggressive with the comprehensive virtual care platform here or solutions year in the U.S., if it weren't for our complicated regulatory environment which made it slower for them to expand that offering. So it makes it very, very complementary for us to put the two companies together.
And one follow-up on I guess the international geographic exposure and then specifically asking about foreign exchange exposure. Is it safe to assume that most of the revenue coming in is in euros, and if there is other currencies that to mention that will be helpful in terms of understanding that dynamic?
Yes, that’s correct. So thinking 20% to 25% of revenues being generated in U.S. dollars and about 70% international -- the remaining so 70% that international coming in euros and about 5% coming from Asia and Latin America.
Our next question comes from the line of Sandy Draper from SunTrust. Your line is open.
Most of my questions have been asked and answered, but maybe Jason, going on a theme I know I have asked a while on [indiscernible] of getting enough doctors and adding capacity. As you think about this acquisition in really simple terms, is that putting more pressure on capacity in terms of having enough doctors to service? Or does it actually ease up some of the capacity because it brings additional doctors through additional relationships? Just thinking of that, as you expand globally are you adding more capacity to service that? Or is it going to [indiscernible] work harder and run faster to bring on more capacity?
Yes, Sandy, so, you are breaking up a little bit but with respect to capacity of our provider network on a combined basis this provides us with additional capacity. Their model of sort of a combination of employed and contracted physicians, many of whom are on a part-time basis, provides us with an additional incremental pool of physicians to tap into.
And there's the opportunity for us to combine the international expert networks of the traditional Best Doctors organization and the Advance Medical team and put in additional volumes through those combined networks. So this certainly increases our overall capacity and we feel really good about sort of the step function opportunity for growth those in driving the demand side but also as you indicate the supply side.
Our next question comes from the line of Richard Close from Canaccord Genuity. Your line is open.
Just had a follow-up maybe to one of Jamie's question. Mark you said something about 2 million visits this year, I was wondering if you could clarify that a little bit? And then as we think about the 40 million in revenue that you're targeting for the transaction here in the seven months, can you sort of break that down, maybe a little bit in terms of where we should be putting that in terms of the buckets of revenue that you have on your income statement?
Sure, let me take that last one first, that 40 million will almost entirely be reflected in subscription access fees again the structure of those contracts are aligned at nearly perfectly with our contracts here in the U.S., which provide for that per member per month or per employee per month fee to cover all of the lives that either these private insurance companies or employers avail the members or employees of the use of Advance Medical services.
We will also see a split clearly when you think of that seven months $40 million of revenue. Think about approximately 75% of that coming from international where of course we break that out today. Also, you should think you should think about this year we'll have business in international business of over $100 million again in '18 and clearly much higher over that in '19 as we reflect the full 12 months of activity.
The first part of your question, the two million in visits right so we spoke about interactions and the fact that there multiple hundreds of physicians are interacting with members or employees every single day, when we count our interactions it's often only expert medical opinions and visits for some of the general medical, dermatology as well as behavioral health. So they measure it very similarly but their interactions in Europe, in Asia and elsewhere will likely exceed two million this year.
Okay so the 2 million isn't necessarily from the completion of the deal to be under 2018?
No, that's going to be full year 2018.
Our next question comes from the line of Steve Wardell from Chardan Capital Markets. Your line is open.
So I was intrigued by the employed physicians at Advance Medical. Can you just give us some color on why that was appropriate to the Advance Medical model and will you be keeping that going? And I think I saw the figure of 450 physicians on staff and does that mean full time or part time?
Steve, we completely appreciate and respect the model that Advance Medical has built. We intend to keep that in place going forward. They have proven to us through both existing operations in Spain for nearly 20 years and newer operations in China and Brazil that that model can generate profitably throughout their organization both in scale and at relative early startup phase. The fact that their physicians have the flexibility to deliver up or decrease the number of hours that they provide its clearly of one of characterization of whether somebody is truly an independent contractor or viewed as an employee under the different jurisdictions in which we operate.
Our focus has been here in the U.S. with the regulatory environment is far stricter and much more challenging than almost anywhere else in the world, and the way we launched over 15 years ago was by classifying and contracting with our physician on an independent contractor model. What they had done is, while it's different, it is appropriate and it is financially obviously rewarding and it's 00 and we think its leverageable not only for further growth in the countries where they operate today, but in those new jurisdictions as we mentioned Canada and other countries where we think will be that -- we think will be expanding relatively quickly.
We think the model replicable and something again more of a hybrid internationally was will reflect some traditional Teladoc staffing models, but will also continue to use in Advance Medical employee model.
Our next question comes from the line of Stephanie Demko from Citi. Your line is open.
Could you talk to Advance's chronic care management solution and maybe how you can lever you to grow your, your U.S. business in that solution domestically? And as a result, could we see a potential for a more hiring of physicians or a different physician model in the U.S.?
Stephanie, it’s a great question. We do see this is an opportunity to leverage their chronic care approach to accelerate our development in that area. They've been very pragmatic about an approach and really view it as I said sort of virtual medical home where you take a membership base that has a certain chronic conditions, pair them with experts in that field and provide them on an ongoing basis as a resource to coach them through their management of that condition that can be getting them ready for an in person visit. It can be helping them to titrate their medications. It can be answering questions about comorbidities or drug interactions and we found that this is that when we look at their business. It has provided significant value to both their clients as well as the consumers who were availing themselves.
So, we do think that it's an opportunity for us to learn from their model and leverage that both in the U.S. as well as outside the U.S. And then with respect to the employee versus our contracted physicians, we think that there is probably an ongoing hybrid approach here. As Mark said, we've been working at our overall supply dynamics as we get to larger scale and we have been looking at a hybrid model anyway. So I think this will just accelerate that model. And we think that it can bring sort of best practices to executing on that. So I would say continue to look for us to have a hybrid model that optimizes the physician network on a going forward basis.
And one quick follow-up just on the cross sales opportunity. Have you looked at how many of your global clients or rough percentage today that utilizes a separate vendor for international telehealth?
We think very few because we've been hearing from our clients the interest in us developing that solution in their local markets. So, we think we can very rapidly bring the Advance Medical general medical telehealth solutions to those clients to really complete the picture of a comprehensive virtual care platform.
And we have no further questions in queue. I’ll turn the call back to the presenters for closing remarks.
So thanks again for everybody for jumping on the call on short notice. As I hope you can tell we are extremely excited about the opportunity ahead of us. We will do our best to continue to provide information and transparency. And as Mark said, we will be able to talk more about the financial impact at our call reflecting the second quarter that we have in August and then even more again at our Investor Day in September.
So, thank you again. And with that, I think operator we will close the call.
This concludes today's conference call. You may now disconnect.