ESG issues alive in healthcare

Katherine Collins, CFA, MTS

Katherine Collins, CFA, MTS
Head of Sustainable Investing, 05/12/20


  • High U.S. healthcare costs make many individuals and families less financially secure.
  • Our team analyzes medical costs and access as ESG issues affecting human well-being and sustainable economic development.
  • We believe treatment innovations can help improve patient outcomes and financial impact for millions in the United States.
The world is learning a difficult lesson about the links between healthcare and financial security. An incredibly infectious virus is taking a huge human toll, causing terrible health consequences, creating personal financial insecurity for tens of millions of people, and costing trillions of dollars in economic impact for world economies.

In our work as sustainable investment researchers, we have a long-term focus on analyzing the connection between healthcare and financial security. We integrate relevant ESG issues in our investment process, and look for companies that are improving current systems and shaping the systems of the future.

We want to share highlights from our recently published 2020 Sustainability and impact report about the potential impact of innovation.

Costs burden household budgets

According to the Centers for Medicare & Medicaid Services, healthcare spending in the United States grew to $3.6 trillion in 2018, or almost 18% of GDP (Source: healthaffairs.org). In 2019, an average American family of four with an employer-sponsored healthcare plan incurred annual medical costs of over $28,000 (Source: milliman.com). These costs can be even higher for self-employed individuals or those employed by small businesses.

Chronic diseases increase costs

Over 30 million Americans currently have diabetes and another 84 million are believed to have pre-diabetes (Source: cdc.gov). Costs of chronic diseases are stunning: The American Diabetes Association estimates that Americans with diabetes have 2.3x greater healthcare costs than others, which results in an estimated $237 billion in annual direct medical cost.

Innovation can have positive impact

While the U.S. healthcare system is effective at treating acute conditions like broken bones and cardiac surgeries, successful management of chronic conditions such as diabetes, obesity, and hypertension often benefits from a more hands-on, continuous approach to care. Several healthcare innovations may better support this approach.

Digitally enabled healthcare platforms are helping to improve patient outcomes and lower total costs of care through improved patient adherence and fewer surprise trips to the emergency room. Livongo Health is an example. The company works to help people better manage their chronic conditions by providing live coaching and digital “nudges,” which encourage choices like daily activity and healthier eating. Peer-reviewed studies have found that these services have achieved meaningful improvements for people in terms of blood glucose levels, coronary heart disease, stroke, and weight loss.

Other solutions focus on improving access to care. Teladoc Health is a leading telemedicine platform that enables patients and clinicians to connect virtually in a secure and HIPPA-compliant manner. Through the end of 2019, Teladoc Health increased the utilization rate of members using telemedicine services to over 9% (Source: Teladoc). If the U.S. population were to mirror this same adoption rate of telemedicine over time, nearly 30 million visits could be offered virtually, saving both time and resources.

There is also room for improvement in how people interact with primary care providers. One Medical (1Life Healthcare) aims to transform access to care by offering a membership plan that allows for same-day primary care appointments and quick turnaround on testing services. The company has been able to demonstrate a 41% reduction in emergency room visits for its client populations.

Travel time to hospital can affect access to healthcare

Building clinic capacity in more user-friendly locations is another way that some companies are helping to improve access to care. Walmart has begun to introduce clinics attached to existing retail stores that offer a range of primary care, dental, vision, and psychiatric services. Ninety percent of the U.S. population lives within 10 miles of a Walmart store, and about 140 million customers visit U.S. Walmart stores every week (Sources: walmart.com and sec.gov).

We see a variety of ways that healthcare innovation can improve both health outcomes and financial security for millions of people.



As of March 31, 2020, Livongo Health, Teladoc Health, One Medical (1LifeHealthcare), and Walmart accounted for 0.64%, 2.61%, 0.21%, and 0.00%, respectively, of Putnam Sustainable Future Strategy, and 0.00%, 0.00%, 0.00%, and 2.34% of Putnam Sustainable Leaders Strategy. The companies presented as investment examples represent the positions deemed most relevant to the applicable ESG investment themes being discussed. Investment themes selected are determined by the sustainable investing team based on certain environmental, social, and governance factors. Current investment themes were selected without regard to whether such themes, or relevant securities, were profitable and are intended to help illustrate the investment process. A security may be selected for a portfolio based on factors other than the ESG themes highlighted herein, and the analysis should not be considered a recommendation to purchase or sell any security. It should not be assumed that an investment in the securities mentioned was or will be profitable. Holdings are for a representative account and are shown for illustrative purposes only. Each account is managed individually. Accordingly, account characteristics may vary.

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