NEW YORK (
) -- With large-cap stocks expected to produce bigger results in 2010, some big-name health care companies are also looking to extend rallies.
The biggest rally won't come from the health care stocks that already showed improvement over the second half of 2009, though, but from some of the health care sector's biggest recent underperformers, a new poll by
says. It will be a combination of price-to-earnings ratio discounts, faith in new management turnaround plans and managed care underperformance turning into outperformance in 2010 that our survey-takers think will lead to the best health care stock bets.
Health care stocks started last year on investors' "do not touch" list, due to the health care reform effort. However, by the end of the year, with health care reform nearing resolution, health stocks in managed care, hospitals, information technology and medical device sub-sectors had experienced a major rally.
That health care rally posed a big question for investors who had been on the sidelines due to the reform uncertainty: Was it time to get back into the big-cap health stocks, or was it already too late?
There was a big price-to-earnings discount in health care stocks for much of 2009. Pharmacy benefit managers (PBMs) like
were a good example. At the beginning of last year, Express Scripts and its peers were trading at 10x forward earnings multiples, a far cry from their five-year historic average of 20x multiples. However, by the first week of 2010 -- when Morgan Stanley notably initiated coverage of Express Scripts at overweight -- the forward-looking p/e for the pharmacy benefit managers was back to the 20x level that had been typical of the PBM stocks.
Dallas-based hospital operator
was up more than 380% in 2009 -- among the biggest annual gains in S&P 500 Index stocks. The Tenet run was a combination of the health care reform overhang, and the fact that hospitals stocks had been pummeled by investors in 2008 more than other health stocks, opening up a wider margin for recovery.
Managed care players had huge gains in 2009 also, especially
. Cigna stock began a big rally in March, and WellPoint also moved up steadily from a 52-week low last March.
For many managed care bulls, Cigna and WellPoint are still overweights even after the big rally. For the biggest managed care bears, there is a belief that the health care reform will actually be worse than anyone expects, and in a few years' time, for-profit insurance providers won't even exist and it will be a non-profit business only.
comes in somewhere in between these extremes. Approximately 11% of survey takers though WellPoint would be the best performing among large-cap health stocks in 2010. However, WellPoint's 11% vote tally was the highest among the large-cap health stocks that already have experienced significant run-ups.
Notably, only 6% of survey takers think Tenet Healthcare, after its astronomical 380% rise, will be the best-performing large-cap health stock in 2010. Part of this negative outlook on Tenet could be linked to fears that the road to recovery for the U.S. economy will not be straight or speedy. Hospital stocks are highly sensitive to the economic conditions. For example, continued job losses -- as this past Friday's surprise non-farm payroll report showed -- can have a big impact on hospital debt levels.
Health care investors evince even less faith in Cigna to extend its rally into 2010, with only 5% of survey takers saying the managed care provider will outperform again.
It's not that all the p/e discount plays have been eradicated by the 2009 rally among health stocks, though. The survey indicates that the big pharmaceutical stocks will take advantage of historically low p/e ratios in 2010.
has 800-pound-gorilla-in-the-lab drug Lipitor going off patent in the coming year, and Lipitor represents a huge chunk of Pfizer earnings. Both Pfizer and
are in the midst of M&A integration --
in the case of Pfizer and
in the case of Merck.
While the Merck deal received higher marks from the market, survey takers like Pfizer to perform better than expected in 2010. Approximately 21% of survey takers think Pfizer will be the health sector outperformer in 2010, while 15% think Merck will stand above its peers in performance.
There is no doubt that Pfizer and Merck can offer investors stable earnings and continued cost-cutting from the corporate integrations. While some investors yawn at this kind of growth prospect, not our survey takers. The big pharmaceutical stocks, trading at big p/e discounts -- though, to be clear, they have never been big p/e premium stocks -- beat out the managed care, hospital and medical information technology health rally stocks in the survey.
In the medical information-technology sector, which was the least affected by health care reform, Cerner
has been the darling stock. Still, some analysts think that trading near a 52-week high of $91.49 that it attained last Wednesday, Cerner has little room left to grow.
A big portion of the demand from hospitals to make the move to electronic records -- Cerner's linchpin for success -- may not occur until 2011, according to analysts. What's more, the move to electronic records was never in doubt, just the pace and size of the adoption by hospitals and physician groups. And while Cerner is expected to benefit earlier than other medical IT players from the electronic-records initiative, as large hospital groups move to adopt the electronic reform quickest, TheStreet survey-takers share the analyst doubts about continued growth above the current 52-week high level.
Only 9% of survey takers think Cerner will be the health care outperformer among large caps in 2010.
It's clear so far that the underperforming big pharmaceutical stocks are favored by survey takers over the 2009 rally health care stocks by a wide margin.
Still, what might be most notable from the survey is that two of the biggest health care dogs are also expected to outperform the rally stocks in 2010. In the medical technology healthcare sub-sector, all eyes are on
, which has a new CEO who has engineered previous health care turnaround stories. Shares of Boston Scientific have trailed peers, especially
, whose last earnings included a sales level that drove investors into Medtronic shares.
Some analysts say that even if Boston Scientific improves marginally in 2010 performance, it will look impressive because the stock has performed so poorly relative to peers like Medtronic. Our survey takers go a step beyond that level of guarded, almost cynical optimism, with 19% of survey takers saying that Boston Scientific will be the healthiest health stock in 2010, right behind Pfizer.
So we've got Pfizer -- considered by many to be the weaker pharmaceutical play in comparison to Merck -- edging out Merck for top big pharma stock in this survey. And medical technology dog Boston Scientific finishing second overall.
Clearly, the health underdogs are the ones to watch in 2010, according to our survey, which leads to the last big underdog in the sector, which also performed well in the survey:
While Cigna and WellPoint got all the attention last year for the big rally and detractors say UnitedHealth is worse-positioned than these managed care players to benefit from the final shape of health reform, our survey takers place UnitedHealth alongside Pfizer and Boston Scientific as the recovery stories of 2010. Approximately 14% of investors expected managed care laggard UnitedHealth to outperform the other big large-cap health stocks in 2010.
Taking the temperature of investors after the big 2009 health stock rally, it looks like the 2010 health heat will be generated by Pfizer, Merck and UnitedHealth. The comeback kids in pharmacuetical, medical technology and managed care are headed out of the health reform operating theatre and into the recovery room.
-- Written by Eric Rosenbaum from New York