As more signs point to a return to normal by summer, investors need to think about how industries that have been warped by the pandemic over the past year will be affected. Just as vaccinations will lead to more travel, dining out, and live events, they will also mean more people ready to get treatment for other health issues they've been putting off.
A recent study estimated that 1 in 5 Americans delayed seeking healthcare during the pandemic. When those patients return, the influx will require caregivers -- and that's where the country's largest healthcare staffing company, AMN Healthcare Services (AMN 0.04%), shines. The company is a leader in talent solutions for the healthcare industry, and is in the perfect position to staff clinics, operating rooms, and hospital units to meet the demand. And that's not all -- recent technology-centered acquisitions have set it up for growth as the healthcare landscape changes.
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Healthcare staffing and beyond
AMN Healthcare is made up of three business segments. The nurse and allied solutions segment offers geographically flexible nurses to fill positions on a non-permanent basis, as well as staff such as occupational and physical therapists; this business unit brings in more than two-thirds of revenue. The second segment is physician and leadership solutions, which places both permanent and short-term doctors and healthcare executives. The third is technology and workforce solutions, which offers software for tasks like scheduling and labor management, vendor management, and physician credentialing.
| Business Unit | 2020 Revenue | Percentage of Revenue |
|---|---|---|
| Nurse and allied solutions | $1.699 billion | 70.9% |
| Physician and leadership solutions | $467 million | 19.5% |
| Technology and workforce solutions | $228 million | 9.5% |
Data source: AMN Healthcare.
Management has added services through acquisition, including a couple of well-timed purchases in virtual health. In 2019, AMN bought Advanced Medical Personnel Services, which provides, among other services, a platform for both on-site and telehealth therapists. In January 2020, AMN purchased Stratus Video, the leading provider of language interpretation services via remote video. Both deals enabled the company to better serve customers during the pandemic.
The effects of the coronavirus in 2020
Nearly all elective procedures were canceled in the spring of 2020, and their frequency slowly returned by the fall and winter. The effects were felt very differently across AMN's three business segments.
| Business Unit | 2020 Revenue Growth (YOY) | Q4 2020 Revenue Growth (YOY) |
|---|---|---|
| Nurse and allied solutions | 9% | 6% |
| Physician and leadership solutions | (17%) | (20%) |
| Technology and workforce solutions | 135% | 192% |
Looking at the fourth-quarter and full-year numbers doesn't tell the story of volatility through the year. The nursing and allied staffing segment whipsawed from 21% growth in the second quarter, led by demand for travel nurses, to a 4% drop in the third quarter. Physician and leadership staffing ran consistently lower throughout the year, as health systems worked to reduce positions not directly related to caring for patients. Thanks to acquisitions, the technology and workforce management unit posted greater than 100% growth throughout the year. Overall, 2020 revenue and earnings grew about 8%. And as patients return, the demand for caregivers is growing.
How management sees 2021 unfolding
In the latest earnings release, the company guided to first-quarter revenue of $800 million to $820 million. That reflects growth of 33% to 36% year over year, driven by a 40% rise in the nursing and allied solutions segment. Demand for nursing hit record levels in the fourth quarter, only to be topped in January, and then again in February.
On top of volume growth, the CFO noted that bill rates for nurses are expected to increase 20% from just the fourth quarter. The positive guidance applied to the other segments, as well. Although the physician and leadership solutions division was hit hard last year, revenue there is expected to stabilize in the first quarter, down only 5% year over year. The contribution from acquisitions is expected to keep the growth rate in the technology unit inflated, at 100%.
After the wave of pent-up demand in the first quarter, business is expected to normalize to a 15% to 20% growth rate for the remainder of the year. That growth will be supported by a continued labor shortage: The pandemic forced many out of the workforce due to early retirement, or to care for children or loved ones. Further exacerbating the shortage, AMN's recent survey shows that 75% of nurses describe themselves as "burned out," and fully one-third plan to make changes to how much they work in the next year.
AMN Healthcare was able to make it through the pandemic, and is becoming a more technology-centered company to adapt to the changing healthcare landscape. As health systems come under more pressure from payers to lower costs, its technology enabling virtual care and its optimization of functions like workforce planning and vendor management should all position AMN Healthcare for growth in the coming years.
The price is nearing its pre-pandemic high, but investors needn't worry -- the market should begin valuing the company's technology-related recurring revenue much higher than the less-predictable staffing segment. When this happens, shareholders should be handsomely rewarded.
