Lots of Value and Good FundamentalsLots of Value and Good Fundamentals

Industry Rating: Industry Rating: OverweightOverweight

Steven P. Halper Steven P. Halper

Partner, Equity ResearchPartner, Equity Research

Phone: 212-271-3807Phone: 212-271-3807

E-Mail: shalper@tweisel.comE-Mail: shalper@tweisel.com

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Healthcare IT & Services

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Healthcare IT and Healthcare IT and ServicesServices

Industry OverviewIndustry Overview– Macro OrientationMacro Orientation– Healthcare (products and services) is a growth Healthcare (products and services) is a growth

industryindustry Demand Trends by SectorDemand Trends by Sector

– Pharmaceutical Services Pharmaceutical Services – Provider and Payer Software ServicesProvider and Payer Software Services

Stock SelectionStock Selection– Outperform: ABC, ADVP, AGP, CERN, CNTE, IDXC, Outperform: ABC, ADVP, AGP, CERN, CNTE, IDXC,

IMPC, MCK, NDC, OCR, PHCC, PILL and PPDIIMPC, MCK, NDC, OCR, PHCC, PILL and PPDI– Peer Perform: ACDO, AHS, CAH, CVD, ESRX, HLTH, Peer Perform: ACDO, AHS, CAH, CVD, ESRX, HLTH,

MEDQ, PRXL, PSTI, RX and TZIXMEDQ, PRXL, PSTI, RX and TZIX

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Pharmaceutical ServicesPharmaceutical Services Utilization beginning to pick up again and net price Utilization beginning to pick up again and net price

increases remain solidincreases remain solid Forward buying opportunities still exist despite Forward buying opportunities still exist despite

increasing use of inventory management agreementsincreasing use of inventory management agreements Number of new product launches lowest in 19 yearsNumber of new product launches lowest in 19 years Prefer drug distribution stocks over PBMs and CROsPrefer drug distribution stocks over PBMs and CROs

Hospital industry enjoying solid performance. Hospital industry enjoying solid performance. IT expenditures still growing IT expenditures still growing Expect another good year for reimbursement trendsExpect another good year for reimbursement trends

Medicare inpatient rates increase in line with Medicare inpatient rates increase in line with expectations; Higher utilization of healthcare expectations; Higher utilization of healthcare resourcesresources

Patient Safety and efforts to reduce medical errors Patient Safety and efforts to reduce medical errors represent additional long-term growth driversrepresent additional long-term growth drivers

U.K. NHS upside for 2004 and beyondU.K. NHS upside for 2004 and beyond

Industry Overview

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Relative Price Performance: HCIT & Services Index vs. S&P 500

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HCIT & Services Index

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Healthcare IT & ServicesInvestment Framework

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Current Environment: Current Environment: Why are Big Pharma co’s cast as the villains? Why are Big Pharma co’s cast as the villains? Prescriptions filled growing in the 2-3% range Y/YPrescriptions filled growing in the 2-3% range Y/Y Price increases averaging 5-6%, net of genericsPrice increases averaging 5-6%, net of generics

Long Term Growth Drivers: Long Term Growth Drivers: New product development is more important than ever New product development is more important than ever Use technology and outsourcing solutions to bring products to Use technology and outsourcing solutions to bring products to

market faster and create efficienciesmarket faster and create efficiencies Fewer buy side margin opportunities may lead to better sell side Fewer buy side margin opportunities may lead to better sell side

marginsmargins Political Environment: Political Environment:

Medicare drug benefit limping alongMedicare drug benefit limping along Continue to expect headline risk on drug pricing, rebates and Continue to expect headline risk on drug pricing, rebates and

AWPAWP

Pharmaceutical Services

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2001-2003 Percent Change in Weekly Prescription Volume

-5%

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Ja

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Total Rx New Rx

2001-2003 Weekly Prescriptions Filled

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Total Rx New Rx

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1999-2003 Average Retail Pharmacy Same Store Sales Growth

Average of CVS, Walgreen, Eckerd, Longs, Rite Aid, and Duane Reade pharmacy comps

0

5

10

15

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25

Aug-99

Dec-9

9

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U.S. drug distribution industry now dominated by U.S. drug distribution industry now dominated by three large participants (ABC, CAH and MCK).three large participants (ABC, CAH and MCK).

Industry characterized by large revenues, low Industry characterized by large revenues, low margins and very high barriers to entry.margins and very high barriers to entry.

Retail prescription sales beginning to improve Retail prescription sales beginning to improve again. Independent drug stores showing a re-birth.again. Independent drug stores showing a re-birth.

Generic margin opportunity over-rated as many Generic margin opportunity over-rated as many large chains buy generics directly.large chains buy generics directly.

Fewer buyside margin opportunities available but Fewer buyside margin opportunities available but impact varies by distributorimpact varies by distributor

Specialty distribution still experiencing good Specialty distribution still experiencing good growthgrowth

Stocks are very inexpensive. Investor perception is Stocks are very inexpensive. Investor perception is still negative. ABC is our favorite stock.still negative. ABC is our favorite stock.

Pharmaceutical Services: Distribution

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Pharmaceutical Services: Market Intelligence

IMS Health is the dominant provider of information IMS Health is the dominant provider of information and data services to the pharmaceutical industry. and data services to the pharmaceutical industry. NDCHealth has about 10% market share in U.S.NDCHealth has about 10% market share in U.S.

Industry characterized by high margins for efficient Industry characterized by high margins for efficient providers. Securing access to data and ability to providers. Securing access to data and ability to aggregate into meaningful information is not an aggregate into meaningful information is not an easy task. easy task.

Virtually all U.S. drug manufacturers rely on IMS Virtually all U.S. drug manufacturers rely on IMS data to track sales effectiveness. Outside of U.S., data to track sales effectiveness. Outside of U.S., there exists more local competitors.there exists more local competitors.

Despite dominant participant, new competitors Despite dominant participant, new competitors always try to enter the U.S. market.always try to enter the U.S. market.

An industry with good long-term fundamentals but An industry with good long-term fundamentals but the near term remains tough due to big pharma’s the near term remains tough due to big pharma’s unwillingness to invest in new products and unwillingness to invest in new products and services. services.

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Pharmaceutical Services: PBMs As third-party payers look to reduce overall drug As third-party payers look to reduce overall drug

costs, pharmacy benefit managers are the primary costs, pharmacy benefit managers are the primary vehicle.vehicle.

Market participants include Caremark (merging Market participants include Caremark (merging with ADVP), Express Scripts and Merck-Medco. with ADVP), Express Scripts and Merck-Medco.

While most commercially-insured individuals are While most commercially-insured individuals are already covered, the potential to gain/lose market already covered, the potential to gain/lose market share always exists. Medicare drug benefit share always exists. Medicare drug benefit represents new growth potential depending on represents new growth potential depending on vehicle to administer benefit.vehicle to administer benefit.

Significant headline risk (subpoenas and DOJ Significant headline risk (subpoenas and DOJ investigations) remains but valuations over time, investigations) remains but valuations over time, will ultimately reflect good growth prospects. will ultimately reflect good growth prospects.

PBMs exploring other growth initiatives including PBMs exploring other growth initiatives including specialty distribution, mail order and market specialty distribution, mail order and market intelligence.intelligence.

Negative psychology toward CaremarkNegative psychology toward Caremark

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Current CRO market is about $5 billion; expect Current CRO market is about $5 billion; expect revenue growth of about 10% near termrevenue growth of about 10% near term

Fundamentals improving but no longer a 30% Fundamentals improving but no longer a 30% growth industrygrowth industry

““CROs” do more than just run clinical trialsCROs” do more than just run clinical trials Information technology to play an important role in Information technology to play an important role in

the drug discovery and clinical development the drug discovery and clinical development processesprocesses

Those CROs taking advantage of IT are likely to Those CROs taking advantage of IT are likely to gain market share while maintaining or improving gain market share while maintaining or improving marginsmargins

Long-term growth drivers in place given bulge in Long-term growth drivers in place given bulge in new molecules; This scenario is several years awaynew molecules; This scenario is several years away

New bookings growth and cancellation rates can be New bookings growth and cancellation rates can be unpredictable, which limits valuation over the long unpredictable, which limits valuation over the long term.term.

Pharmaceutical Services: CROs

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Current Environment: Current Environment: Hospital utilization of IT continues to expandHospital utilization of IT continues to expand Consolidation among vendors has subsided Consolidation among vendors has subsided Physician and Internet opportunities are more limitedPhysician and Internet opportunities are more limited

Long Term Growth Drivers:Long Term Growth Drivers: Continuous focus on cost controlContinuous focus on cost control Patient SafetyPatient Safety Eventually hospital capacity will increaseEventually hospital capacity will increase U.K. NHS contract awards likely in Q4/Q1U.K. NHS contract awards likely in Q4/Q1

Political Environment: Political Environment: Hospital profitability determined by Medicare Hospital profitability determined by Medicare

reimbursement, which changes every yearreimbursement, which changes every year Federal and state mandates to use information technology Federal and state mandates to use information technology

to reduce medical errors and increase patient safetyto reduce medical errors and increase patient safety

Provider and Payer Software Services

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HIMSS Survey Data HIMSS Survey Data ResultsResults

(2003 and prior Survey Data (2003 and prior Survey Data available at www.himss.org)available at www.himss.org)

Source for all survey results include previous years Annual HIMSS Leadership Survey Source for all survey results include previous years Annual HIMSS Leadership Survey Sponsored by IBM and Dell Computer Corporation and the 13Sponsored by IBM and Dell Computer Corporation and the 13thth Annual HIMSS Leadership Annual HIMSS Leadership Survey Sponsored by Superior Consultant Company, Inc. Survey Sponsored by Superior Consultant Company, Inc.

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Top 5 IT Priorities 2003 vs. Top 5 IT Priorities 2003 vs. 20022002

Survey FindingSurvey Finding Reduce Medical Errors/ Reduce Medical Errors/

Promote Patient Safety Promote Patient Safety (52% vs. 46%)(52% vs. 46%)

Upgrade security on IT Upgrade security on IT Systems to meet HIPAA Systems to meet HIPAA regulations (47% vs. regulations (47% vs. 60%)60%)

Implement privacy Implement privacy modifications for HIPAA modifications for HIPAA (46% vs. NM)(46% vs. NM)

Upgrade Inpatient Upgrade Inpatient Clinical Systems (38% Clinical Systems (38% vs. 42%)vs. 42%)

Upgrade network Upgrade network infrastructure (34% vs. infrastructure (34% vs. 37%)37%)

TWP OpinionTWP Opinion Continued recognition Continued recognition

that CPOE has potential that CPOE has potential to improve patient to improve patient safetysafety

Much HIPAA work has Much HIPAA work has already been completed already been completed on security issues but on security issues but numerous privacy numerous privacy issues still remainissues still remain

Hospitals may be Hospitals may be focused on other issues focused on other issues rather than clinical rather than clinical systems improvementssystems improvements

Infrastructure getting Infrastructure getting betterbetter

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Significant Barriers for IT (2003 Significant Barriers for IT (2003 vs 2002)vs 2002)

Survey FindingSurvey Finding Lack of adequate Lack of adequate

financial support (23% financial support (23% vs. 27%)vs. 27%)

Vendors’ inability to Vendors’ inability to effectively deliver (19% effectively deliver (19% vs. 18%) vs. 18%)

Difficulty in proving IT Difficulty in proving IT quantifiable benefits/ quantifiable benefits/ ROI (13% vs. 13%)ROI (13% vs. 13%)

Lack of staffing Lack of staffing resources (12% vs. 4%)resources (12% vs. 4%)

Difficulty achieving end-Difficulty achieving end-user acceptance (10% user acceptance (10% vs. 15%) vs. 15%)

TWP OpinionTWP Opinion Hospital execs are Hospital execs are

finally figuring it outfinally figuring it out A common complaint A common complaint

for large complex for large complex software installationssoftware installations

Hospitals are more Hospitals are more sophisticated about sophisticated about under-standing under-standing workflowsworkflows

Surprising result Surprising result especially given the especially given the overall tech meltdownoverall tech meltdown

A very positive trendA very positive trend

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Growth Driver: Growth Driver: Use of a Computer-based Patient Use of a Computer-based Patient RecordRecordWe have a fully operational CPR system in place:We have a fully operational CPR system in place:

1998 : 1998 : 2%of respondents2%of respondents

1999 : 1999 : 11%11%

2000 : 2000 : 12%12%

2001 : 2001 : 13%13%

2002 : 2002 : 13%13%

2003: 2003: 19% 19% -- installations in progress increased in -- installations in progress increased in

2003 (37% vs. 32% in 2002)2003 (37% vs. 32% in 2002)

TWP Opinion:

After all these years, CPR is making progress, yet still very under penetrated

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Anticipated Changes in IT Anticipated Changes in IT BudgetsBudgets

1998 & 1999: 1998 & 1999: 71-73% of respondents 71-73% of respondents indicated budgets were definitely or probably indicated budgets were definitely or probably increasingincreasing

2000:2000: weighted average was 67% - weighted average was 67% - representing a tough trendrepresenting a tough trend

2001: 68% of respondents indicated budgets were 68% of respondents indicated budgets were definitely or probably increasingdefinitely or probably increasing

2002:2002: 67% of respondents indicated 67% of respondents indicated budgets were definitely or probably budgets were definitely or probably increasingincreasing

2003:2003: 68% of respondents indicated 68% of respondents indicated budgets were definitely or probably budgets were definitely or probably increasingincreasing

TWP Opinion: Steady budgets confirm our belief that this is still a growth industry

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Current Environment: Current Environment: Medicaid HMOs are still not considered mainstream by Medicaid HMOs are still not considered mainstream by investors. Too many investors associate Medicaid with investors. Too many investors associate Medicaid with Medicare; Growth predicated on membership growth, not rate Medicare; Growth predicated on membership growth, not rate increases.increases.

Long Term Growth Drivers: Long Term Growth Drivers: More states will look to managed care as a solution to More states will look to managed care as a solution to expanding Medicaid population and expenditures; Studies expanding Medicaid population and expenditures; Studies indicate that managed care plans help states save money.indicate that managed care plans help states save money.

Political Environment:Political Environment:Must be monitored on a state by state basis; Recent Federal tax Must be monitored on a state by state basis; Recent Federal tax package includes $20 billion for the states over the next 2 package includes $20 billion for the states over the next 2 years, with $10 billion targeted directly at Medicaid programs.years, with $10 billion targeted directly at Medicaid programs.

Medicaid Managed Care

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Which Stocks Should We Own?Which Stocks Should We Own?(Outperform rated stocks)(Outperform rated stocks)

Pharmaceutical Services:AmerisourceBergen (ABC)AdvancePCS (ADVP)McKesson Corp. (MCK)Pharmaceutical Product and Development (PPDI)Omnicare (OCR)Priority Healthcare (PHCC)

Provider and Payer Software and Services: Cerner Corp. (CERN)IDX Systems (IDXC)IMPAC Medical (IMPC)NDCHealth (NDC)ProxyMed (PILL)

Other: Amerigroup (AGP)Centene Corporation (CNTE)

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Pharmaceutical Services:Pharmaceutical Services:AmerisourceBergen (ABC)AmerisourceBergen (ABC)Rated: OutperformRated: Outperform

– Our favorite drug distribution stock Our favorite drug distribution stock – Fears of guidance reduction are overblown; ABC Fears of guidance reduction are overblown; ABC

still has synergy capture from Bergen still has synergy capture from Bergen consolidation; not as dependent on buyside consolidation; not as dependent on buyside margins as CAH margins as CAH

– ABC focuses primarily on independent drug stores ABC focuses primarily on independent drug stores and regional chains; largest provider to mail order and regional chains; largest provider to mail order segment; We are not overly concerned with the segment; We are not overly concerned with the potential loss of ADVP business with Caremark potential loss of ADVP business with Caremark merger. Dominant provider in hospital pharmacy merger. Dominant provider in hospital pharmacy segment as well.segment as well.

– Similar to other distributors, ABC focused on Similar to other distributors, ABC focused on building ancillary businesses. Focus includes: building ancillary businesses. Focus includes: Automation, specialty pharmacy and packaging Automation, specialty pharmacy and packaging

>> Expectations are low enough which creates an Expectations are low enough which creates an interesting investment opportunity; Our favorite interesting investment opportunity; Our favorite stock among the big three distributorsstock among the big three distributors

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Pharmaceutical Services:Pharmaceutical Services: McKesson (MCK)McKesson (MCK)Rated: OutperformRated: Outperform

– Distribution operating margins still posting Distribution operating margins still posting positive trends; Revenue growth surprisingly positive trends; Revenue growth surprisingly strong; strong;

– Expectations are still achievable even with slowing Expectations are still achievable even with slowing pharmacy retail trends. Top customers include pharmacy retail trends. Top customers include RiteAid, WalMart and Omnicare.RiteAid, WalMart and Omnicare.

– Recent channel checks indicate good acceptance Recent channel checks indicate good acceptance of Horizon Expert Orders within existing customer of Horizon Expert Orders within existing customer base. MCK is uniquely positioned within hospital base. MCK is uniquely positioned within hospital business given its automation, IT and outsourcing business given its automation, IT and outsourcing focus.focus.

– Specialty pharmacy operations under appreciated Specialty pharmacy operations under appreciated by investors.by investors.

>> Much like ABC, expectations are low enough which Much like ABC, expectations are low enough which creates an interesting investment opportunity; creates an interesting investment opportunity;

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Pharmaceutical Services:Pharmaceutical Services: Priority Healthcare (PHCC)Priority Healthcare (PHCC)Rated: OutperformRated: Outperform

– Broad-based, all product specialty distributor; Broad-based, all product specialty distributor; Organic growth slowing to about 20% given Organic growth slowing to about 20% given weakness in Hep C and Fertility markets. New weakness in Hep C and Fertility markets. New product flow has been strong. Under product flow has been strong. Under appreciated alternate-site healthcare appreciated alternate-site healthcare distribution operations. distribution operations.

– All product strategy may encounter increased All product strategy may encounter increased competition from PBMs and main-line competition from PBMs and main-line distributors. distributors.

– Potentially a great acquisition target. Potentially a great acquisition target. – Wal-Mart outsourcing contract represents new Wal-Mart outsourcing contract represents new

growth opportunity which cannot be growth opportunity which cannot be duplicated by another industry participant.duplicated by another industry participant.

>>As growth continues and Wal-Mart begins to As growth continues and Wal-Mart begins to contribute, multiple expansion is likely contribute, multiple expansion is likely

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Provider Software: Provider Software: Cerner Corp. (CERN)Cerner Corp. (CERN)Rated: OutperformRated: Outperform

– Premier provider of clinical apps to hospital Premier provider of clinical apps to hospital industry; diversifying revenue streamindustry; diversifying revenue stream

– Q1 bookings disappointment represents first Q1 bookings disappointment represents first glitch in almost four years; Strong recovery glitch in almost four years; Strong recovery in Q2 in Q2

– Recovery like to be quicker this time around Recovery like to be quicker this time around as around as the company does not require as around as the company does not require major investments in sales force, client major investments in sales force, client service and R&D areasservice and R&D areas

– Industry trends remain positive. Big Industry trends remain positive. Big potential from UK NHS project. potential from UK NHS project.

> Shares are no longer that in expensive > Shares are no longer that in expensive based on 2004 EPS estimate; Still worth based on 2004 EPS estimate; Still worth owning as next EPS revision is upward.owning as next EPS revision is upward.

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Provider Software: Provider Software: IDX Systems (IDXC)IDX Systems (IDXC)Rated: OutperformRated: Outperform

– Premier provider of practice management Premier provider of practice management systems to large physician groups and systems to large physician groups and inpatient clinical applications.inpatient clinical applications.

– Much more diversified by customer focus Much more diversified by customer focus and product offering than most investors and product offering than most investors believe.believe.

– Has added new products (radiology and Has added new products (radiology and PACS) and more realistic about growth in PACS) and more realistic about growth in CareCast. CareCast.

– Recently divested struggling medical Recently divested struggling medical transcription operations; transcription operations;

– Participating in UK NHS procurement projectParticipating in UK NHS procurement project> Shares trade at 21X 2004 EPS estimates, > Shares trade at 21X 2004 EPS estimates,

but next EPS revision is probably upward.but next EPS revision is probably upward.

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Medicaid Managed Care: Medicaid Managed Care: Centene Corp. (CNTE)Centene Corp. (CNTE)rated Outperformrated Outperform

– Operates Medicaid managed care plans in WI, IN Operates Medicaid managed care plans in WI, IN and TX; Acquired NJ plan; Wisconsin and TX; Acquired NJ plan; Wisconsin characterized as stable growth and Indiana characterized as stable growth and Indiana viewed as strong growth; Texas beginning to viewed as strong growth; Texas beginning to live up to expectationslive up to expectations

– Beginning rate negotiations in WI and IN.Beginning rate negotiations in WI and IN.– Should continue to grow by acquisitions; uses Should continue to grow by acquisitions; uses

decentralized branding strategy while back decentralized branding strategy while back office operations are centralized.office operations are centralized.

> Shares are now more reasonably valued relative > Shares are now more reasonably valued relative to other managed care stocks. Strong chance of to other managed care stocks. Strong chance of upside surprise to estimates; Overtime, upside surprise to estimates; Overtime, Medicaid should be viewed as a growth industry Medicaid should be viewed as a growth industry and shares should trade at premium to and shares should trade at premium to managed care groupmanaged care group

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Stocks Not That Stocks Not That Compelling Compelling – Covance (CVD; rated PP): Well balanced development Covance (CVD; rated PP): Well balanced development

company. Repositioning itself as a lab-focused company. Repositioning itself as a lab-focused organization. Must jump start central lab bookings or organization. Must jump start central lab bookings or 2004 estimates are in jeopardy.2004 estimates are in jeopardy.

– WebMD (HLTH; rated PP): Envoy has yet to post WebMD (HLTH; rated PP): Envoy has yet to post meaningful revenue growth. Shares are very expensive meaningful revenue growth. Shares are very expensive on an Enterprise value to EBITDA basis. We need to see on an Enterprise value to EBITDA basis. We need to see better top line growth. Recent search warrants do not better top line growth. Recent search warrants do not help the cause.help the cause.

– Parexel (PRXL; rated PP): Very dependent on clinical Parexel (PRXL; rated PP): Very dependent on clinical development business but valuation remains too high. development business but valuation remains too high. Suspect use of non-recurring charges.Suspect use of non-recurring charges.

– Per Se Technologies (PSTI; rated PP): Core physician Per Se Technologies (PSTI; rated PP): Core physician services business still growing in low single digit range. services business still growing in low single digit range. Using cash to pursue Lloyd’s litigation. Balance sheet is Using cash to pursue Lloyd’s litigation. Balance sheet is leveraged.leveraged.

– TriZetto (TZIX; rated PP): New sales are lumpy; shares TriZetto (TZIX; rated PP): New sales are lumpy; shares appear expensive on PE basis.appear expensive on PE basis.

Steven P. Halper Steven P. Halper

Partner, Equity ResearchPartner, Equity Research

Phone: 212-271-3807Phone: 212-271-3807

E-Mail: shalper@tweisel.comE-Mail: shalper@tweisel.com

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Healthcare IT & Services

Lots of Value and Good FundamentalsLots of Value and Good Fundamentals

Industry Rating: Industry Rating: OverweightOverweight