Pricing model for SRT

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Nuance - 2017 Analyst Reports

After extensive searches in the Investext/Thomson Banker report database and in various related sites, there were no reports that were published directly by the identified analysts in 2017. Given this, we then looked for articles and reports that contain some information about Nuance, as stated by the client-identified analysts. There were only a few articles about speech recognition technology so we included those that discuss Nuance’s healthcare topics as requested. The 20 articles and reports found below contain various topics ranging from the analysts’ statements, the company’s stock information, its speech recognition technology, and Nuance’s healthcare news. All the reports and articles found are summarized in the linked spreadsheet as well.

Nuance — 2017 Reports and Articles

The following articles and reports that cover the requested topics were found: Note that the exact titles of the reports or articles are indicated below for faster reference.

1) Barclays Believes Nuance Communications (NASDAQ: NUAN) Won’t Stop Here
2) Nuance growth engine in healthcare not affected by hack, says Craig-Hallum
3) Nuance calls active as shares jump on earnings
4) In-line guidance likely good news for Nuance, says Morgan Stanley
5) The Nuance Communications Turnaround Story Is Growing More Convincing, Says Morgan Stanley
6) Nuance sentiment seems 'washed out,' says Deutsche Bank
7) Oppenheimer: Nuance Communications Rebounding From Recent Cyberattack
8) Nuance and NVIDIA to Advance AI for Radiology
9) Pete Najarian Sees Unusual Options Activity In Nuance Communication
10) Nuance Ranked #1 in Healthcare Industry Reports from Black Book
11) Nuance Wins Two 2017 Speech Industry Awards
12) Nuance's Dragon Medical One Accelerates Adoption among Clinicians for Clinical Documentation
13) Global Malware Attacks Hit Nuance's Results
14) BRIEF-Nuance Communications provides update on restoration process
15) Analyst Favorites With Strong Buyback Activity: Nuance Communications Ranks As a Top Pick
16) Najarian Brothers See Unusual Options Activity In Nuance Communications And Nabors Industries
17) EHR Study Finds Healthcare Leaders Plan to Adopt Enhancing Technologies to Improve Clinician Satisfaction
18) Nuance Named #1 Category Leader for Quality Management and Speech Recognition- Front End Imaging in 2017 Best in KLAS Report
19) NUAN — Nuance Communications Inc. at Deutsche Bank Technology Conference
20) Nuance Communications (NUAN): Subscription Should Provide Stability — Deutsche Bank
These are also summarized in the linked spreadsheet.


Given the non-existence of reports that were directly published by the identified analysts, we found 20 articles and reports on Nuance that were released in 2017. Some of these articles have statements about Nuance from requested analysts that includes Saket Khalia, Jeff Van Rhee, Sanjit Singh and Nandan Amladi. Articles about speech recognition technology are also very few, so other requested topics such as healthcare, stocks, and some information about Nuance were included as well.
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M*Modal - 2017 Analyst reports

After an extensive search, we were unable to find any publicly available 2017 analyst's reports for M*Modal as related to speech recognition. The best analyst report we found is from Klas Research, but the report is behind a paywall. We have also compiled a short list of helpful reports/reviews we found you may find useful. Below you will find more details.


To compile a list of all 2017 analyst reports for M*Modal as related to speech recognition technology (SRT), we started by looking for reports from Glen Santangelo and Raphael Taubenfeld, as requested, but our search didn't turn up any result. This is most likely because Glen Santangelo and Raphael Taubenfeld are yet to analyze M*Modal's SRT.
Next, we searched industry research platforms and research aggregators such as Thomson Banker, Markets and Markets, Global Newswire, Elsevier, PR Newswire and Qualtrics and conducted general searches for any M*Modal SRT reports. Our search didn't turn up any detailed SRT reports, but we were able to find a couple of reports/reviews, which we have compiled in the "Helpful Findings" section below.
In general, the reason there is limited analysis or SRT reports for M*Modal is probably because such reports are either behind a paywall or non-existent. Analysts typically provide such analysis and reports to the public for only publicly-listed companies. When such analysis is done for private companies such as M*Modal, access generally requires payment as the research is proprietary.
Please note that due to the limited resource available on this, we expanded our search to find useful reports or reviews published between 2015 and 2018, not just 2017. Also, in addition to searching for SRT reports, we also searched for healthcare and finance-related analyst reports.

helpful FINDINGS

1) Klas Research has a premium 2018 report on M*Modal's SRT. It ranks M*Modal's speech recognition as best in class in 2018, as it did in 2017. However, a full analysis of the technology is behind a paywall. A CIO that participated in Klas Research is reported to have said: "with M*Modal, we were really impressed with how fast and easy the product was to use and get up to speed on. We achieved a 75% uptake; our uptake on Dragon had been only 2%... We have a whole queue of physicians waiting to start using Fluency Direct."
2) Nuance published a study in 2016 based on a 2015 survey it conducted about "End-to-End Coding, Speech
Technology and Medical Records" technology providers. The research is based on a survey of over 1,500 health practitioners, hospitals, and clinics. The research ranked seven such technology providers on 18 criteria such as innovation, support, vendor overall preference/vertical industry recommendations, customization, Integration, and interfaces. M*Modal was ranked sixth overall. Please note that Nuance provides a similar solution and its solution is ranked number one overall in their study, so there may be doubt on how objective the study is.
3) has a review of M*Modal's medical transcription technology. It notes that M*Modal's medical transcription technology incorporates the latest technology into medical transcription and uses varied modes of dictation capture. The review also states that they offer "speech recognition for practices that prefer front-end speech recognition to go along with their EMRs and other software."

4) M*Modal also has a product brochure detailing the capability and specification of its technology you may find helpful.
4) Consumer Reviews: Capterra has consumer reviews of M*Modal, and it's rated 3 out of 5 stars on its platform. In addition, although Wonder doesn't generally use sources or reviews from a forum, we came across a comparison between M*Modal's Fluency Direct and similar service providers that is fairly detailed and knowledgeable in KnowBrainer's forum that you may find helpful. For instance, the forum poster notes that M*Modal's technology is quite user-friendly but doesn't respond to advanced scripting as well as that of other competitors such as Dragon. The poster also notes that M*Modal uses deep learning, but there doesn't seem to be much difference between its technology and that of competitors that don't. However, the poster backs M*Modal to triumph in the long-term as it continues to improve its technology.


To wrap up, after an extensive search, we were only able to find an analyst report for M*Modal's SRT by Klas Research, but the report is behind a paywall. However, we have provided a few reports/reviews you may find helpful.
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Nuance Analysis


Nuance Communications, Inc. (Nuance) is engaged in providing digital imaging software as well as speech and keypad solutions across the world. The company's software and solutions are useful in interaction; and help users to create, share and use documents. Nuance offers a wide range of solutions in its four core markets, namely, Healthcare, Mobile and Consumer, Enterprise and Imaging, which include healthcare solutions, enterprise solutions, mobile solutions, desktop dictation and imaging solutions.

Due to the scarcity of credible resources that provide a clear feedback of the company's pricing trends and competition specific to SRT, the research below analyzes the company's three main areas (Pricing Trends, Competition and Technology) in an overall sense and not just pertaining to SRT products.

The cost of the company's products is going down due to lower shipping prices and lower costs of transportation. Compared with its peers in the industry, changes in the company’s annual earnings are better than the changes in its revenue, implying better than median cost control and/or some economies of scale.

Due to the opening up of new markets because of government agreements, the adoption of new technology standard and government free trade agreement has provided Nuance Communications an opportunity to enter a new emerging market.

Nuance's Pricing Trends:

The cost of Nuance Communication products is generally brought down due to the decrease in the cost of transportation because of lower shipping prices. Thus providing an opportunity to the company, either to boost its profitability or pass on the benefits to the customers to gain market share.

Nuance's Peer Competition:

Stable profitability has increased the number of players in the industry over last two years which has put downward pressure on not only profitability but also on overall sales. The following points cover some major insights in comparing Nuance to its peers:

- Compared to peers, relative under performance over the last year(2017) is in contrast with the more recent out performance.
- Compared with its peers, changes in the company’s annual earnings are better than the changes in its revenue, implying better than median cost control and/or some economies of scale.
- The company’s median gross margin and relatively low pretax margin suggest high operating costs versus peers.
-The profitability ratio and Net Contribution % of Nuance Communications are below the industry average.
- Nuance's return on assets currently and over the past five years has trailed the peer median and suggests the company might be operationally challenged relative to its peers.

Nuance's Current and Emerging technologies:

Opening up of new markets because of government agreement — the adoption of new technology standard and government free trade agreement has provided Nuance Communications an opportunity to enter a new emerging market. The following points cover the most recent technology achievements of the company spanning the last two years:
- Feb 20,2017: Electronic Health Records (EHR) study finds (Healthcare Leaders Plan) provided by the company to adopt enhancing technologies to improve clinician satisfaction.
- Nov 10,2016: Carrus hospital selects Nuance software to manage healthcare documentation.
- Oct 17,2016: Nuance Announces new version of (Dragon Medical Advisor) to help physicians capture clinical documentation easily and accurately.
- June 27,2016: Nuance Improves the Clinician Experience and drives more complete and accurate patient records through a natural approach to documentation.
- Jun 08,2016: Nuance delivers breakthrough Ambulatory Clinical Documentation with introduction of Nuance velocity.


Nuance offers a wide range of solutions in its four core markets, namely, Healthcare, Mobile and Consumer, Enterprise and Imaging, which include healthcare solutions, enterprise solutions, mobile solutions, desktop dictation and imaging solutions.

Due to the scarcity of credible resources that provide a clear feedback of the company's pricing trends and competition specific to SRT, the research below analyzes the company's three main areas (Pricing Trends, Competition and Technology) in an overall sense and not just pertaining to SRT products. The cost of the company's products is going down due to lower shipping prices and lower costs of transportation. Compared with its peers in the industry, changes in the company’s annual earnings are better than the changes in its revenue, implying better than median cost control and/or some economies of scale. The adoption of new technology standard and government free trade agreement has provided Nuance Communications an opportunity to enter a new emerging market, as a result of opening up of new markets because of government agreement.
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M*Modal Analysis

By cross-referencing information from several industry reports and specialized news sources, we have determined that M*Modal is the second largest company in the medical SRT sector in terms of physician users and offers services that are both higher rated and lower priced than those offered by its nearest competitor. In addition, over the past year, M*Modal has embarked on an ambitious plan to integrate with a variety of other software platforms in the medical sector, while also enhancing the AI capabilities of its SRT service.

Competitive Landscape

M*Modal's main competitors in the medical SRT sector are Nuance Communications, Accusis, and nThrive. The market share for each firm is not publicly available, but we were able to use data on the number of physicians using each platform to estimate the market share. M*Modal has 250,000 physicians on its platform, which makes it the second largest after Nuance, with 500,000. Bringing up the rear is Acusis, with 120,000 physician-users. Numbers for nThrive were not available, even after an extensive search. Companies like nThrive may desire to keep their numbers private due to ranking factors and wanting to control their brand's image.

M*Modal has also recently won several awards, including 2017 Innovator of the Year in Health IT, and Best in KLAS for speech recognition. This indicates that M*Modal is a strong player in the sector.

new technology

Over the past year, M*Modal's technological focus has been on integrating with a variety of popular platforms in the medical sector. Its platform now supports Epic's Notereader Clinical Documentation Improvement (CDI) tool, allowing Notereader to harness the power of M*Modal's Computer Assisted Physician Documentation (CAPD) technology.

In addition, M*Modal's Speech Understanding technology has been integrated within the PACS desktop, facilitating smoother workflows. M*Modal also launched its Scribing Services using its Virtual Provider Assistant, with the goal of making clinical documentation easier and faster. As part of the integration with these platforms, M*Modal as also made substantial improvements to its AI capabilities.


Although M*Modal does not openly list prices, we were able to use third-party review services to obtain enough information to estimate the prices of M*Modal's services, and how they compare to other companies' offerings. M*Modal offers its Fluency Direct for Practices for $1,599. The closest competing products are Nuance's Dragon Medical Practice Edition and Dragon Medical One, which cost $3,000 and $5,377, respectively. In addition to being cheaper, M*Modal's offering is also rated higher than both other services.


M*Modal competes with three other major players in the medical SRT sector and, of these, it is the second largest and highly rated. Over the past year it has embarked on major integrations with other popular medical software platforms, and currently offers the lowest priced and highest rated product in the sector.
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Nuance Revenue Breakout

Nuance Communications provides speech recognition technology for the health care industry, as well as for business and mobile technologies. Approximately 46% of its 2017 revenue came from software for electronic medical records (EMR), transcription services for physicians, and cloud-based personal assistants for the healthcare industry. Revenues include speech recognition software Dragon Medical and Dragon Solutions. Overall Nuance revenue was $1,939.4 million in 2017.

revenue breakout

Total revenue for Nuance was $1.939 billion in 2017.

The healthcare segment's overall revenue was $892.12 million. Healthcare revenue includes sales of software electronic medical records (EMR), transcription services for physicians, clinical document improvement, and cloud-based personal assistants for the industry. More than 500,000 clinicians and 10,000 healthcare facilities worldwide use Nuance products. Despite deep dive research, there is no publicly available information that gives revenue breakouts specific to Nuance's speech recognition technology for healthcare.

Nanalyze estimates that 19% of Nuance's 2015 revenue came from the mobile market, which includes SRT for the automotive industry. Another 18% came from enterprise, which includes conversational systems, across voice, mobile, web and messaging channels. Imaging created 12% of Nuance's revenue in 2015.


The healthcare industry is the primary source of revenue for Nuance Communications. Approximately 46% of revenue comes from the healthcare sector, through SRT such as Dragon Medical and Dragon solutions, along with transcription services and software for medical records.

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SRT Market Size

While there were no precompiled statistics or industry reports available in the public domain pertaining to the requested information about healthcare industry speech recognition technology (SRT) market size in the United States, estimation was provided and presented using reliable statistics from different industry reports.

The U.S. market size for speech recognition in the healthcare industry based on adoption rate is $878.45 million. Currently, 28.8% of healthcare providers/physicians have adopted SRT, that's about 325,352 in numbers. In the clinical documentation, EHR speech recognition has alone generated an estimated revenue of $172.18 million with an adoption rate of 24.5%. Below you will find detailed calculations, estimations, and assumptions of how the above figures were derived.


According to News Medical, BCC Research reveals that the global SRT market for all industry was valued at $104.4 billion in 2016 and will reach $184.9 billion in 2021. Healthcare industry was said to have "deep roots" and is "aggressively expanding" at a growth rate of 20% annually. According to this report, 50% of physicians resist adopting SR technology, however, 9 out of 10 hospitals in the U.S. plan to adopt or expand their SRT use.

An industry report reveals that in 2015, the speech recognition adoption rate for all healthcare departments (most notably for radiology, cardiology, pathology, and core EHR) was at 20%, or an average 20% of all departments have already adopted SRT in their system. Radiology has the highest record of adoption rate at 80%, while pathology and cardiology measured at 25% and 8% respectively. During this year, Nuance market share for speech recognition in the healthcare industry is 88% while M*Modal is about 8%.

While 30% have considered using this technology and another 27% said they would adopt it within the next 1 to 2 years, there's no assurance or official record that they have "actually" adopted it over the past years (2016 to 2017). Hence, we will use the 20% adoption rate and multiply it with the yearly growth rate at 20% to determine estimated current adoption rate.

2017 adoption rate = 20% * 1.20 * 1.20 = 28.8%


From ACEP calculation, the average SRT cost per provider is around $2,700 annually. See breakdown below.

Costs of Speech Recognition:

• Software: $1600/provider
• Microphone: $250/device (don’t need one per provider)
• Training (1:1): $300/provider (group training cost)
• Go-live Support: $150/provider
• Maintenance/Support: $320/year
• Total Cost/provider: $2700 (for its first year)


According to Statista, the total active physicians (healthcare providers) in the U.S. as at 2017 is 479,346. However, this number was from certain categories only, i.e. psychiatry, surgery, anesthesiologists, radiology, cardiology, among others. From the Federation of State Medical Boards (FSMB) report, the total active licensed doctors/physicians of all specialties are currently at 953,695. Nurse practitioners registered as healthcare providers have about 176,000 in numbers. From here, we will assume that total licensed healthcare providers in the United States are totaled 1,129,695.

953,695 + 176,000 = 1,129,695


Using our calculations above, market size of speech recognition in the healthcare industry is calculated as below;

Adoption rate = 28.8%
Number of healthcare providers = 1,129,695
Number of healthcare providers that have adopted SRT = 1,129,695*28.8% = 325,352
Average cost of speech recognition per year = $2,700

Market size
= Number of healthcare providers that have adopted SRT *
Average cost of speech recognition per year
= 325,352 * $2,700
= $878.45 million


According to a study released by HFMA, the average adoption rate of clinical documentation for EHR's speech recognition is at 24.5% in 2016. This average was calculated from 24% adoption in the acute settings and 25% from ambulatory settings. In the United States, 96% of all physicians and doctors have adopted EHR.

1,129,695 * 96% = 1,084,507 (estimated number of providers who use EHR for their clinical documentations)

If the average adoption rate of speech recognition for EHR is 24.5%;

1,084,507 * 24.5% = 265,704 (estimated number of providers who adopt SRT in their EHR documents)

If the average EHR SRT subscription cost per year based on Dragon (Nuance) pricing is $648;

265,704 * $648 = $172.18 million (estimated market size share of SRT for EHR applications)


Speech recognition technology adoption rate in the healthcare industry was estimated to be 28.8% currently. The United States market generated an estimated value of $878.45 million in 2017 with EHR speech recognition accounts for $172.18 million market size at an average adoption rate of 24.5%. In 2015, Nuance has a share of about 88% of the market while M*Modal accounts for 8%.
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SRT Pricing Models


Face to face interaction is valued in almost every aspect of life, but especially when dealing with health professionals; however, these are the very people that are pressed for time. Speech Recognition Technology (SRT) companies are a viable solution for this problem as they offer real-time dictation devices that streamline work for health professionals. There are a variety of SRT companies, each with varying prices and contracts. However, the vast majority of these companies only provide pricing details upon request. With this being the case, the below SRT companies were chosen based on their positive ratings. Pricing information is outlined below where possible.


Nuance's most popular product is Dragon, an SRT. Nuance offers a variety of Dragon SRT products for different professions including professional, legal, law enforcement, and medical. The pricing for this software ranges from $99.99 to $500. They offer a few different subscription options, which are: one month, three months, or 12 months. Nuance Dragon has the widest range of products offering seven products in English, French, and Spanish. This product boasts 99% accuracy that continues to improve as it adapts to the user's voice. It also integrates with Dragon Anywhere, a solution that works on Android and iOS. Nuance Dragon has decent reviews on with their NaturallySpeaking software pulling in a 3.5-star rating.


EMR-Bear is an SRT company "developed by and for behavioral healthcare providers". EMR-Bear comes very highly rated on with a perfect 5-star rating. The SRT this company offers is unique as it has no hardware requirements, no licensing fees, and no hidden costs. Their product allows users to customize their system based on their specific services. They boast "true cost" pricing, which means the subscription fee paid the first time will be the same as long as the product is in use. They also understand that the medical world is under constant development and, with that in mind, do not charge for any software upgrades. EMR-Bear does not offer their pricing on their website and has not disclosed it to Capterra. Information on contract time is similarly unavailable.


ZyDoc has a more targeted audience than the other companies as they serve B2B primary and B2B secondary markets. Primary markets include hospitals, physicians, and EHRs. Secondary markets include insurers, transcription, pharmaceutical companies, and more. ZyDoc was one of the first companies to bridge into electronic media records (EMR) in 1993. This has made them a leading provider of "disruptive cloud-based medical informatics technologies." Their prototype "was purchased by the Department of Defense and helped serve as a paradigm for the industry". Although the company is not transparent with pricing, they are worth mentioning due to their rating, which is a solid 4.5 stars. Pricing information and contract length are not provided on their website and an inquiry must be made to obtain the information.

Clinic to cloud:

Similar to the previous companies, Clinic to Cloud only offers pricing and contract information through inquiry. However, they have more specific information on how pricing is decided. This company has a one-time setup fee the price of which depends on if the buyer is purchasing per clinician or per admin staff user. The pricing of the software depends on the clinic size and Clinic to Cloud serves specialists, multidisciplinary clinics, allied health, and GP's (coming soon). The product is scalable and is offered with no installation fees. Clinic to Cloud has also partnered with market leaders like Medicare and MIMS as well as the Australian Government. This company has a 4.8-star rating on their Facebook page.


Clicktate is another highly rated company. While they only have a 3-star rating overall, their scores for ease of use and customer service are both 5-stars. Clicktate offers users over 2,000 templates for various patient issues for easy data entry. This product also seamlessly transfers and organizes health records. They offer their buyers a 14-day trial before purchasing their product. This company is one of the most straightforward with their pricing. They offer two different packages that are paid for monthly. The first is their Standard package, which is $139 per month and does not include "practice management solution, patient flow tracking, billing, and claims clearing house". The Papyrus package is $395 per month and includes what the Standard does not. Along with the monthly subscription fee is a one-time activation of $99.


There are a variety of SRT companies out there, each with variable pricing and services. Many of the companies offer similar, if not the same, services. Choosing and SRT company depends on your clinic size, what services you need, and the budget you have. Some SRT companies are more transparent than others with their pricing, which may make them more appealing as you know what you are getting right away.

From Part 01