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Augmedix Inc. (NASDAQ: AUGX)

Augmedix Inc. (NASDAQ: AUGX), a leading provider of virtual medical documentation and live clinical support based in San Francisco, California, is on a mission to "rehumanize healthcare." The company has set out to tackle the largest pain point in the U.S. healthcare system – the burden of documentation and administrative tasks on physicians.

Augmedix enables physicians to have natural interactions with patients without being distracted by taking notes during patient visits. When physicians are free to focus on just being physicians, they have been found to save up to 3 hours per day, improve productivity by as much as 20%, and increase satisfaction with work-life balance by over 40%. The time spent by physicians on documentation is estimated by management to cost the US healthcare industry as much as $100 billion annually and adversely impacts both physician and patient satisfaction.

By increasing physician satisfaction, Augmedix is also addressing a significant and growing problem in the U.S. healthcare industry – physician burnout – which costs the industry an estimated $4.8 billion every year. The cost to replace one physician can be as high as $1 million for a healthcare system.

Augmedix's Platform and Technology

A physician's exclusive focus on the patient is made possible by virtual medical documentation and live clinical support. Physicians are provided dedicated Google Glass units or smartphones with which they access the Augmedix service. As the physician and the patient interact naturally, the physician's device enables the interaction to be observed remotely by trained medical documentation specialists who enter key inputs for the medical note. The company's proprietary Ambient Automation Platform, incorporating structured data models, automatic speech recognition (ASR) and machine learning models, then takes those inputs and converts them into a medical note. This medical documentation is then uploaded into the patient's electronic health record (EHR) for sign off by the physician.

Augmedix pioneered the concept of remote, real-time medical note documentation. Its approach to clinical documentation enables not only natural physician-patient conversations, which are very important for patients and physicians, but also physician mobility, given the mobile devices through which the service is accessed and the virtual nature of the company's offering.

Augmedix's Two Levels of Service

The company's service is designed for ease of use by physicians. Entering a unique authentication code, physicians open a secure communication channel to the service platform through a dedicated smartphone or Google Glass unit supplied by Augmedix. Physicians have a choice of real-time service or non-real time service.

Augmedix LIVE – Real-Time Service

Under its real-time service offering, called "Live," Augmedix's highly-trained specialists observe the interaction between the physician and the patient, both visually and audibly, and make the appropriate contextual selections within the proprietary note creation application, "Notebuilder". This then drives the company's auto sentence generation models within the Notebuilder tool. The completed medical note is then supplied back to the physician for review and sign-off at the conclusion of the patient encounter.

Augmedix NOTES – Non-Real Time Service

Through its non-real time service, which the company calls "Notes," the conversation between the physician and patient is recorded. It then passes through the Augmedix ASR software model. The text output is edited by specialists and further processed by Notebuilder into a comprehensive and accurate medical note. Medical notes in the non-real time service are supplied back to the physician prior to the next shift, typically the next day.

Utilizing either service, the administrative burden is lifted from physicians, who no longer need to type notes into their EHR system, allowing them to focus their energy on what they are trained to do – taking care of patients.

Specialties and Health Systems

Augmedix is compatible with more than 35 specialties and trusted by four of the top 10 and six of the top 20 enterprises, as measured by patient revenue, and many physician group practices supporting medical offices, clinics, hospitals, and telemedicine across the U.S.

Augmedix and Telemedicine

In recognition of the challenges imposed by the COVID-19 pandemic on in-person patient visits, Augmedix services are compatible with telemedicine, which will likely remain a meaningful healthcare delivery platform well after the pandemic has passed. Importantly, Augmedix is application-agnostic, meaning that it can accommodate any application used by physicians for remote patient encounters.

Market Outlook

Augmedix's service is provided under a monthly subscription revenue model. As such, the company maintains high visibility into its future business outlook. Augmedix's Net Promoter Score of 56 is more than twice that of the healthcare industry average of 27 and is yet another testament to its value proposition.

Over time, the company aims to increase the automation of clinical documentation, which represents a multi-billion-dollar market opportunity. As more data is collected and harvested through machine learning, Augmedix's models will be able to automatically process an increasing portion of the medical note across an increasing number of patient visit types. Automation benefits the company's business by reducing the time to create the note, as well as providing more uniform note quality, among other operational benefits.

Augmedix estimates its total addressable market to be about 300,000 physicians in the U.S., representing a potential annual revenue opportunity of about $6 billion. The company has a direct expansion path to about $1 billion among the healthcare enterprises already under contract. But Augmedix won't stop there. It is continuing to sign up new major accounts through its "land and expand" sales and marketing strategy.

Management Team

Emmanuel "Manny" Krakaris is the President, Chief Executive Officer and Secretary of Augmedix. Mr. Krakaris has been a member of the Augmedix board of directors since October 2018. Prior to Augmedix, Mr. Krakaris served as the Chief Executive Officer of Streetline Inc., from August 2014 to February 2018, and as Chief Financial Officer and Chief Operating Officer, from 2011 to August 2014. Mr. Krakaris also served as Chief Financial Officer of Command Audio Corporation from 1996 to 2011. Mr. Krakaris received a Bachelor of Commerce in Marketing and International Business from McGill University and an M.B.A. from the University of California, Berkeley, Haas School of Business.

Paul Ginocchio joined Augmedix in July 2020 as Chief Financial Officer. Prior to joining Augmedix, Mr. Ginocchio served as an independent strategic advisor to multiple technology companies. Mr. Ginocchio previously served as Chief Financial Officer of Brightfield Strategies LLC, a workplace data and analytics company, from January 2017 to September 2019. From November 1998 to May 2016, Mr. Ginocchio was Lead Analyst, then Managing Director of Information & Business Services Equity Research at Deutsche Bank AG. Mr. Ginocchio holds a B.A. in Economics & Business Management from North Carolina State University, and an M.B.A. in Finance from Indiana University Kelley School of Business.

Sandra Breber has served as Chief Operating Officer of Augmedix since March 2019 and, prior to that, served as an advisor to the company from November 2018 to March 2019. Ms. Breber also served as President and Co-founder of Ziploop Inc. from April 2013 to November 2018. Prior to that, she was a management partner at Andersen, a global professional services firm. Ms. Breber holds a Bachelor of Commerce in Accounting and Finance from McGill University.

Saurav Chatterjee joined Augmedix in November of 2020 as Chief Technology Officer. Prior to joining Augmedix, Mr. Chatterjee served as Vice President of Engineering at Lumiata Inc. Mr. Chatterjee also served as the Senior Director and Head Conversational AI at Asurion Inc., from May 2014 to October 2019. Mr. Chatterjee holds a B.A in Electrical Engineering and Computer Science from the University of California, Berkeley, and a PhD in Computer Engineering from Carnegie Mellon University.

Jonathan Hawkins joined Augmedix in April 2019 as its Chief Revenue Officer. Prior to joining Augmedix, Mr. Hawkins served as Senior Vice President of Business Development, Sales and Marketing for Spry Health Inc., a healthcare data analytics provider that identifies early signs of clinical deterioration in chronically ill patients. Mr. Hawkins was also a Founding Investor and Advisor to The Batchery, a startup incubator and accelerator. Prior to that, Mr. Hawkins was Vice President of Business Development and Sales for MedeAnalytics Inc. Mr. Hawkins holds a B.A. in International Relations from Stanford University and an M.B.A. from Harvard Business School.

Ian Shakil is the founder of Augmedix and has served as Chief Strategy Officer since October 2018. Mr. Shakil has been a member of the Augmedix board since April 2013. From April 2013 to October 2018, Mr. Shakil served as the Chief Executive Officer of Augmedix. Mr. Shakil has also served as Advisor to Edwards Lifesciences Corporation since May 2019, and as Advisor to since January 2018. Mr. Shakil has a B.S.E. in Biomedical Engineering from Duke University and an M.B.A. from Stanford University Graduate School of Business.

Investment Considerations

  • Large Market Opportunity with Growing Need for Real-Time Remote Documentation Services: Augmedix boosts physician productivity by as much as 20% and significantly improves physician job satisfaction. We help health enterprises add capacity and retain physicians, which is critical right now due to increasing retirements and physicians leaving the practice post COVID. We have a $6bn revenue opportunity (TAM – Total Addressable Market) and existing health enterprises represent a $1bn revenue opportunity.
  • Differentiated Platform with Industry-Leading Solutions: We point our technology internally so that physicians can have unfettered conversations with patients without the need to learn new systems or platforms. Proprietary automation, including ASR and natural language processing modules, create timely, accurate, and structured EHR notes from natural physician-patient conversations.
  • Attractive Scaling Subscription-Based Model: Our subscription business model has allowed us to consistently grow quarter over quarter for 31 out of 32 quarters since revenue began in 4Q13, with the only QoQ decline in 2Q20 due to COVID. We grew 39% YoY in 2Q21 and 33% YoY in 3Q21 and have a multi-year YoY growth rate target of 30% to 45%. Our gross margin has risen from 8% in 2018 to 45% in 3Q21 and we have a goal to get to mid-50% gross margins at scale.
  • Significant Barriers to Entry: Our scale of 40K notes per week helps to train and continuously improve our AI. We have substantial operational HIPAA-compliant infrastructure across four countries; depth of team, deep domain expertise; stickiness of an embedded service within physician workflow
  • Highly Experienced Management Team Backed by Blue-Chip Investors: Our senior team and Board of Directors have deep healthcare, technology and finance experience. We are backed by leading technology-focused investors including Redmile Group, McKesson Ventures, DCM, and LifeSci Venture Partners


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