Bellevue Medtech & Services (CH)

The Bellevue Medtech & Services Fund CH lost ground in December (-5.5%) and closed the month behind its benchmark (-5.0%) and the broad healthcare sector index (-4.2%). Global equities (-7.2%) were much weaker in comparison. Healthcare services had a negative effect of -3.6% on the fund’s performance, medtech stocks -1.9%.

The digital health companies Doximity (-4.3%) and Veeva Systems (-17.9%) detracted from absolute and relative performance. After a strong performance in November (+22.0%), Doximity traded lower on profit-taking. Veeva, a US provider of cloud software solutions, beat sales and earnings expectations for the third quarter, but its weak guidance for the fourth quarter disappointed investors. Veeva management also announced that it would migrate customers from the cloud-based CRM software provided by Salesforce to its own platform called Vault, which caused some uncertainty.

US health insurers Humana (-9.6%), Centene (-8.7%), Elevance (-6.5%), UnitedHealth (-5.9%), Molina (-5.0%) and Cigna (-2.0%) were performance detractors. We attribute their correction to a variety of factors – a severe flu season, the expected normalization of elective procedures in 2023, and the previously strong performance of health insurance stocks going back to mid-June 2022. Their fundamentals, meanwhile, are just as solid as before.

Medtech names Outset Medical (+18.7%), Align Technology (+3.9%), Tandem Diabetes (+3.6%), Zimmer Biomet (+3.1%), Stryker (+1.6%) and Inspire Medical (+1.0%) made positive contributions to absolute performance. Outset Medical, a specialist for digital dialysis management, convinced investors at a conference on its intuitive and convenient hemodialysis system called Tablo, which it claims is the first such system that has a real chance to tap the huge potential that at-home dialysis offers. Tandem Diabetes announced the takeover of AMF Medical. AMF is the developer of Sigi, an insulin patch pump with no tubing, which complements Tandem’s intelligent t:slim X2 insulin pump, which delivers insulin through a tube.

Shockwave (-21.4%), Edwards Lifesciences (-6.4%), Dexcom (-5.6%) and Intuitive Surgical
(-4.9%) hurt the fund's absolute and relative performance. We attribute the lower prices primarily to profit-taking, for example after the FDA approved Dexcom’s new G7 CGM system.

Life science tools companies Danaher (-5.8%) and Thermo Fisher (-4.7%) also had a negative impact on portfolio performance.

All data in CHF unless otherwise stated.

In the healthcare services segment, we believe the US health insurance offer the most upside potential. Premium volumes are expected to show a very good trend in 2023. On the one hand we expect solid enrollment growth in Medicare Advantage and Commercial health plans and above-average premium growth rates on the other. We think the conservative earnings projections of US health insurers offer more than enough cushion to offset a full recovery in elective procedures. What’s more, their minimal forex exposure and the high short to mid-term bond yields can give their earnings an additional boost. On the political front, risks are very low because the US Congress is now divided.
 
For medtech companies, we expect treatment volumes will be back to normal levels by the end of 2023, given the high levels of immunity and improving staffing conditions at hospitals. Additional upside is certainly possible considering the current treatment backlogs. We assume pricing power will improve, i.e. prices are unlikely to change, whereas during the previous 10 years medtech companies experienced a price erosion of 1-2% p.a. Better cost management and strong sales growth are therefore likely to lead to better margins. Attractive catalysts ranging from new product launches (e.g. TriClip, Dexcom G7, Omnipod 5) and groundbreaking clinical trial results (e.g. TRILUMINATE) to first-time reimbursements (e.g. for CardioMEMS, CGM sensors for type 2 diabetes patients requiring basal insulin therapy) will provide additional upswing.

We think a recession is possible in 2023. Medtech & services stocks tend to outperform in a recessionary environment.