Position Healthcare for this Trend
As a healthcare focused investor, I think it is very important to have a sense of the broad industry trends. One thing I have tried to focus on is firms that promote productivity and wellness improvements, whereas volume of service plays are a bit less interesting. This is in part due to the ACA (Obamacare) and its efforts to try to shift the focus to wellness from churn of services.
Helping to feed my confirmation bias on this opinion was a piece today from Planet Money (and NPR podcast).
Overall, the piece is about hospitals addressing cost consideration as part of the ACA legislation (Obamacare). This one is focused on cardiac care, bundled payments, and the efforts in the legislation to move the focus from 'pay for procedure' to 'pay for results'. I encourage a listen to the entire piece. At ~ 9:45, they report on an effort to provide home health care services to one patient being released, an effort that wasn't incentivized so much in the past when a readmission would have meant more money to the hospital rather than less, due to the one time bundled payment.
One reason why I continue to think Almost Family and perhaps other home care organizations are a long term worthwhile investment, though I do own less now after the long awaited recent gains.
On the flip side, I booked my profits on BioReference Laboratories. They recently guided to lower growth and hinted at tighter margins for their diagnostic services. While diagnostics should provide better care and help doctors promote wellness, they do benefit from service 'churn' as well. The piece notes that the doctors were reevaluating the amount and cost of tests they requested. I think firms like BRLI will do well long term, but the next couple of years may see them setting to a new normal.
In other moves, I added to my Athenahealth position, and took an initial stake in development stage pharmaceutical firm Mirati Therapeutics. The former should continue to benefit from the mandate for health records, and hopefully sign more and larger groups onto their system. The latter is another jockey-like speculative investment following Uber-investors Julian and Felix Baker.