2014 | 2015 | ||||||
Price: | 2.79 | EPS | -$0.21 | $0.20 | |||
Shares Out. (in M): | 98 | P/E | n/a | 13.9x | |||
Market Cap (in $M): | 272 | P/FCF | 24.8x | 13.5x | |||
Net Debt (in $M): | 216 | EBIT | 15 | 36 | |||
TEV (in $M): | 488 | TEV/EBIT | 33.4x | 13.5x |
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This idea is a company that is a levered roll-up with a history reckless capital allocation, is on the brink of technical default, with free-falling revenue, deteriorating margins, terrible disclosures and confusing segment data, and a history of pervasive related party transactions.
In what is likely an apocryphal story, J.L. Austin, Brithish philosopher of English was giving a lecture at Oxford with another noted philosopher, Sidney Morgenbesser in the audience. Austin said "we know that in many instances in language two negatives make a positive." So for example if I say Tesla is never not rising, it means Tesla is always rising. Austin continued, "But, there is no language where two positives make a negative." Morgenbesser immediately disproves him with a quip from the back of the room,"Yeahhh, riggghht." In the case of investing we know that multiple negatives make for some of the most positive situations. The laundry list of negatives I mentioned very accurately describes my idea, Merge Healthcare, but I think it's a long with 65% upside in a conservative status quo scenario.
Core Thesis
Additionally, we believe these tough times have forced the company to make the hard choices necessary to improve long term profitability. Newly implemented and re-instated CEO, Justin Dearborn, with a successful track record, has already shown signs of improving profitability by abandoning profitless segments, and is working towards improved segment transparency.
In a bear case where stabilization doesn’t occur, the company still has a hidden gem of an asset in their Merge eClinical OS product that, if sold, could act as a deleveraging escape pod and alleviate concerns over a default. We think that they will begin reporting this product as a separate line item later this year, an action that should help shed light on the value as investors can then easily compare eClinical OS to its pure play public comp, Medidata Solutions (MDSO).
Company Overview
Background & Analysis
The company is a levered roll-up with a history of poor capital allocation (evidence: current EV is about ½ of cumulative capital spent on M&A the last few years), has many moving pieces/new products, segment data and reporting disclosures that are confusing, and results that have been abysmal (doesn't screen well; it has only been marginally net income positive in one year out of eight). Software sales in the most recent periods have been in free-fall (down ~40% year-over-year, if stripping out hardware from “software & other” income statement line item) and gross margins hit an all-time low in Q3 due to a sales mix-shift to lower margin hardware.
Software sales: There has been a what may prove to be a temporary lull in revenue due to the upcoming October 1st deadline for hospitals to shift to ICD-10 implementation. ICD-10 sets coding for medical diagnoses and patient procedures for CMS reimbursement. This nearly singular regulatory focus within the healthcare industry has caused Merge to badly miss estimates the last few quarters and the shares came down hard (a ~40% decline after Q2 2013 earnings) as they came dangerously close to breaching a Net Debt/TTM EBITDA covenant on their term loan. The primary IT beneficiaries of the ICD-10 implementation are Revenue Cycle Management providers, an area where Merge is admittedly relatively weak.
Reason for Optimism: We believe when this deadline for ICD-10 passes, and hospitals and physician groups turn their IT investment focus to yet another government mandated shift-- “Meaningful Use Stage 2” metrics, Merge is very well positioned to capture an outsized proportion of healthcare IT spending. As part of Obama’s Health Information Technology for Economic and Clinical Health (HITECH) Act, within the American Recovery & Reinvestment Act of 2009, healthcare providers were forced to invest in electronic medical record keeping, with increasingly tough standards over time, and they must show “meaningful use” in incremental stages. In 2014, Stage 2 is kicking in, which requires physicians to give access to electronic records including any related images, directly with patients. Merge is a leader in this area. The standards for Meaningful Use Stage 2 attestation have become increasingly difficult and only ~8% of healthcare IT vendors have received certification, down from >98% for Stage 1 (source: Citigroup initiation on ATHN/Medical Group Management Association).
Merge’s SaaS solutions allow imaging centers to effectively and securely share images and attach them to a patient’s EMR. The coming forced shift to Meaningful Use Stage 2 will accelerate the adoption towards Merge’s products in 2H 2014 (there will be 1%/year overall reimbursement rate cuts for up to five years for hospitals not passing pre-set MU Stage 2 metrics by the end of 2014). Hospitals are shifting away from departmental divides to enterprise wide software solutions for imaging that works seamlessly across departments, another theme that should benefit growth in Merge’s iConnect.
By looking across the Healthcare IT space, we corroborated the fact that software sales have been weak/negative across many of the major providers, so it is unlikely that Merge is losing market share.
Q-2 | Q-1 | Q0 | |
MRGE Software | 3.6% | -29.2% | -8.8% |
Cerner Total | 6.1% | 11.0% | 7.6% |
Cerner System (software) | -11.9% | 2.7% | -11.9% |
Allscripts Software | -11.4% | -12.5% | -2.4% |
McKesson Software | 4.2% | -9.2% | -26.2% |
Quality Systems | 8.9% | 7.7% | -5.1% |
Many of the other larger healthcare IT companies have been focused on EMR as opposed to the imaging interoperability aspect, so in many cases they partner with Merge and Merge's imaging products work in conjunction with their EMR platform (e.g. recent partnership announced with Athena Health).
If the company were losing market share we would be even more concerned about the revenue declines. As shown in the table above, though, we believe the market in general has been terrible.
Transition to SaaS: Another major contributor to the recent revenue misses is Merge’s business model shift from selling software licenses, with the bulk of revenue recognized in the period of the sale, to a SaaS model based on monthly subscriptions. This hurts revenue in the near term, but ultimately creates a more stable cash flow stream and increases the value of each customer over a lifetime. A recent example is a $5 million contract signed with the Mount Sinai Hospital system. This was their largest contract in quite sometime, and the revenue will be recognized ratably over a sixty month period as opposed to ~80% of it being recognized in the quarter it was signed. Unfortunately it is very tough to quantify this shift overall because management does not offer clear guidepost and metrics, such as pricing differentials and estimated number of clients changing over. We do know however that their main growth driver, iConnect, will be sold purely on a SaaS basis and we can monitor backlog as evidence of the success of the transition. The shift to the SaaS model should ultimately be successful as there is less upfront investment required from a customer while MRGE also wins as the lifetime value of the customer is higher.
Reason for Optimism: Wall Street should love the SaaS shift story, but management doesn’t do a good job of explaining this, in our opinion. To cherry pick the quintessential example, Adobe went through a similar business model shift—although one executed flawlessly. Their 2015 EPS estimates in the last 18 months have collapsed by 41.9%, but the stock is up >100% (run EEG function for 2015 EPS estimates on Bloomberg). The stock declined immediately after the SaaS transition announcement. However, communication on SaaS benchmarks and hitting those benchmarks has allowed their 2015 Earnings multiple to expand from 8.5x to 34x—partly based on the frothy tech market, but also based on optimism that the subscription transition will be successful and the market correctly ascribing a higher multiple on the steadier cash flow stream.
Debt Covenant
This is probably the most important reason for MRGE’s collapse. MRGE currently has ~$216.4 million in net debt and a 5.3x Debt/Adjusted EBITDA. Their max leverage covenant currently sits at 5.5x and will drop to 5.0x by the end of Q3 2014, ratcheting down a further quarter turn every quarter until bottoming at 4.0x by 12/31/2015. We believe the covenant overhang has been the biggest drag on the company as many investors in healthcare IT would obviously prefer a high growth, no debt name to a low growth, high debt name.
Reasons for Optimism:
An important piece of the thesis is that we believe EBITDA margins have troughed, driven by a decrease in mix to low margin hardware (exiting the kiosk business), effective cost management, and our projected trough in software sales. A pickup in the industry and even just a leveling off of revenue could drive EBITDA margins materially higher, in our view. For a point of reference, the comp group’s three year average is 23.6%, which Merge should be able to match or exceed within a few years.
Q1 | Q2 | Q3 | Q4 | |
2013 | 2013 | 2013 | 2013 | |
Adj. EBITDA Margin | 19.65% | 14.77% | 12.53% | 16.80% |
Rolling LTM Adj. EBITDA Margin | 15.69% | 13.97% | 11.95% | 16.03% |
Management has also guided for SG&A to come down to 10% of sales over time, from the current 14.9% (we only give them credit for this in our Bull Case DCF).
Growth Drivers
Stepping back and thinking strategically about Merge:
Valuation
Despite the whole industry suffering in the software space, Merge's shares have been disproportionately de-rated most likely due to the leverage. This chart directly above shows a basket of Healthcare IT stocks on a forward EV/EBITDA basis and Merge's growing discount. On a variety of other metrics the discount is equally or more pronounced. Throughout most of their history Merge traded on par with their peers, so as margins expand and they return to revenue growth and quickly de-lever, the valuation gap could lessen.
When comparing MRGE to negative/flat growth healthcare software peers on an EV/Recurring Maintenance Revenue basis, MRGE commands less than half the going multiple (3.0x versus 6.3x for Quality Systems and 7.3x for Allscripts), so even without a return to growth, the extreme discount could shrink as leverage comes down and margins expand.
Comps below are a group of companies with high maintenance, low/negative growth, and are Enterprise exposed | ||
Company | EV/Maintenance | Growth Y/Y (last Q) |
CA | 5.2x | -1.6% |
Synopsys | 5.3x | -5.2% |
Progress Software | 5.3x | 0.4% |
Quality Systems | 6.3x | -1.0% |
Allscripts | 7.3x | -0.8% |
Merge | 3.0x | 1.6% |
Software Median | 8.7x |
The best way to value Merge may be a on a sum of the parts basis. We ascribe a 3.5x sales multiple to their steady recurring maintenance piece, which is still several turns below negative-growth trading comps and appears to be a valuation floor for comparable transactions. We ascribe a 5.0x trailing multiple on the eClinical OS subscription business, the rationale being pure-play public comp Medidata Solutions is at a 9.5x forward multiple. We think MDSO is overvalued, and Merge’s eClinical has significantly higher EBITDA margins and is growing nearly as fast, but we still just put half the multiple on for conservatism. We put 2.5x on other core software revenue (on a trailing basis, so assume zero growth), where there is likely pent-up demand to replace antiquated PACS systems. Lastly we ascribe minimal to no value for their non-software sales. For each of these as shown we are assuming zero growth, despite guidance for eClinical growing at 20%+ this year and their main growth driver iConnect and Honeycomb just now ramping up. We simply assume that once it becomes clear what eClinical’s sales are that it commands a higher valuation, and once it is clear that they will de-lever quickly and EBITDA margins will continue to expand even with no revenue growth, the only other assumption is the maintenance revenue multiple expands half a turn (still well below no-growth comps).
Revenue Groups | LTM | Base Case Multiple | Implied Value |
Healthcare Maintenance & EDI | $107,223.0 | 3.5x | $375,281 |
DNA Subscription Business | $30,046.0 | 5.0x | $150,230 |
Other Non-Hardware Revenue | $52,697.9 | 2.5x | $131,745 |
Hardware Revenue | $41,700.1 | 0.3x | $10,425 |
Total | $231,667.0 | ||
Implied EV Value | $ 667,680 | ||
Net Cash | $ (226,000) | ||
Implied Market Cap Value | $441,680 | ||
Current Market Cap Value | $272,025 | ||
Blended EV/Sales Multiple | 2.9x | ||
Implied Upside | 62.4% |
In sum Merge is a levered software company that's missed estimates due to temporary industry headwinds, but a regulatory deadline will act as a catalyst for re-acceleration of growth in the back half of 2014, and provide secular growth potential. It's a structurally attractive, asset-light business model that is highly scalable with high FCF conversion, and has an increasing majority of its revenue from recurring subscriptions. The stock is at an extreme relative discount and could see major multiple expansion upon removal of default worry and a return to revenue growth. They've re-fi'd their debt which alone will provide $16 million in annual interest expense savings this year. The cost structure overall will be down over $20 million in 2014 year-over-year.
The margin of uncertainty built in is the numerous levers the company can pull and the lack of growth and conservatism baked in throughout our assumptions. We believe the stock’s narrative will morph in a positive way throughout 2014 as growth initiatives and SaaS potential come back into focus and there is 60%+ upside in a conservative, status quo scenario.
Other Important Points
Risks
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