BTSG vs ACHC vs SEM vs ENSG

For growth investors, The Ensign Group, Inc.

(ENSG) is the stronger pick with 18. 7% revenue growth year-over-year, versus 5. 0% for Acadia Healthcare Company, Inc. (ACHC). Select Medical Holdings Corporation (SEM) offers the better valuation at 13. 9x trailing P/E (13. 1x forward), making it the more compelling value choice. Analysts rate BrightSpring Health Services, Inc. Common Stock (BTSG) a "Buy" — based on 9 analyst ratings — the highest consensus in this comparison. The "better buy" depends entirely on your goals: growth investors should weight revenue trajectory, value investors should weight P/E and PEG, and income investors should weight dividend yield and streak.

On trailing P/E, Select Medical Holdings Corporation (SEM) is the cheapest at 13.

9x versus BrightSpring Health Services, Inc. Common Stock at 60. 9x. On forward P/E, Select Medical Holdings Corporation is actually cheaper at 13. 1x. The PEG ratio (P/E divided by earnings growth rate) is the most growth-adjusted single valuation metric: BrightSpring Health Services, Inc. Common Stock wins at 0. 70x versus The Ensign Group, Inc. 's 1. 68x — a PEG below 1. 0 traditionally signals the market is underpricing earnings growth.

Over the past 5 years, BrightSpring Health Services, Inc.

Common Stock (BTSG) delivered a total return of +381. 3%, compared to -61. 8% for Acadia Healthcare Company, Inc. (ACHC). Over 10 years, the gap is even starker: ENSG returned +752. 0% versus ACHC's -58. 5%. Past returns do not guarantee future results, and the stock with the higher historical return may already have its best growth priced in.

By beta (market sensitivity over 5 years), The Ensign Group, Inc.

(ENSG) is the lower-risk stock at 0. 42β versus BrightSpring Health Services, Inc. Common Stock's 1. 46β — meaning BTSG is approximately 247% more volatile than ENSG relative to the S&P 500. On balance sheet safety, Acadia Healthcare Company, Inc. (ACHC) carries a lower debt/equity ratio of 124% versus 186% for The Ensign Group, Inc. — giving it more financial flexibility in a downturn.

By revenue growth (latest reported year), The Ensign Group, Inc.

(ENSG) is pulling ahead at 18. 7% versus 5. 0% for Acadia Healthcare Company, Inc. (ACHC). On earnings-per-share growth, the picture is similar: BrightSpring Health Services, Inc. Common Stock grew EPS 1029% year-over-year, compared to -537. 4% for Acadia Healthcare Company, Inc.. Over a 3-year CAGR, BTSG leads at 18. 7% annualised revenue growth. Higher growth typically commands a higher valuation multiple — check whether the premium P/E or P/S is justified by the growth rate using the PEG ratio.

The Ensign Group, Inc.

(ENSG) is the more profitable company, earning 6. 8% net margin versus -33. 3% for Acadia Healthcare Company, Inc. — meaning it keeps 6. 8% of every revenue dollar as bottom-line profit. Operating margin tells a similar story: ACHC leads at 11. 7% versus 3. 2% for BTSG. At the gross margin level — before operating expenses — ACHC leads at 17. 6%, reflecting greater pricing power or product mix advantage. Stronger margins indicate durable pricing power, lower cost of revenue, or higher mix of software/services. They are one of the clearest signs of business quality.

The PEG ratio (forward P/E divided by expected earnings growth rate) is the most precise measure of undervaluation relative to growth potential.

By this metric, BrightSpring Health Services, Inc. Common Stock (BTSG) is the more undervalued stock at a PEG of 0. 70x versus The Ensign Group, Inc. 's 1. 68x. A PEG below 1. 0 is traditionally considered the threshold for growth-adjusted undervaluation. On forward earnings alone, Select Medical Holdings Corporation (SEM) trades at 13. 1x forward P/E versus 34. 0x for BrightSpring Health Services, Inc. Common Stock — 20. 9x cheaper on a one-year earnings basis. Analyst consensus price targets imply the most upside for ENSG: 27. 6% to $222. 33.

In this comparison, SEM (1.

5% yield), ENSG (0. 1% yield) pay a dividend. BTSG, ACHC do not pay a meaningful dividend and should not be held primarily for income.

For long-horizon retirement investors, Select Medical Holdings Corporation (SEM) is the stronger choice — it scores higher on the combination of lower volatility, dividend reliability, and long-term compounding (low volatility (β 0.

46), 1. 5% yield, +158. 5% 10Y return). Both have compounded well over 10 years (SEM: +158. 5%, BTSG: +381. 3%), confirming both are viable long-term holds — but the lower-volatility option typically results in less emotional selling during corrections. Retirement portfolios generally favour predictability over maximum returns. Consult a financial advisor before making allocation decisions.

Both stocks operate in the Healthcare sector, making this a peer-level intra-sector comparison — the same macro tailwinds and headwinds will affect both.

In terms of investment character: BTSG is a mid-cap quality compounder stock; ACHC is a small-cap quality compounder stock; SEM is a small-cap deep-value stock; ENSG is a mid-cap high-growth stock. SEM pays a dividend while BTSG, ACHC, ENSG do not, making them suitable for different income and tax situations. These fundamental differences mean investors should not choose between them on a single metric — the "better stock" depends entirely on which of these characteristics aligns with your investment strategy.