Finding Value in Healthcare

Interest in these services is likely to remain elevated as aging populations in the U.S. turn to remote solutions for routine visits that don’t necessarily require in-person consultations.

Additionally, large hospital systems and provider groups continue to modernize operations. They’re increasingly seeking technology solutions that can support not just electronic health records but more comprehensive administrative services, including practice management.

Value-Based Care

The first quarter of 2022 saw a handful of deals in value-based care, a healthcare reimbursement model that pays based on patient outcomes instead of volume of claims. In February, New York-based Kinderhook Industries made a $500 million investment in Physician Partners, a value-based primary care physician group and managed service organization headquartered in Florida. Physician Partners has a patient member network of 137,000 and a network of over 545 physicians throughout the state.

In March, three provider groups—Fresenius Health Partners, Cricket Health and InterWell Health—combined to form a new value-based care company focused on services for early-stage kidney disease. The new combined entity is valued at $2.4 billion.

For Dustin Thompson, a director at Provident Healthcare Partners, an investment bank focused on healthcare, these deals reflect one of the bigger trends in value-based care right now: a focus on platform deals.

“Last year, we saw several large deals and companies going public. I don’t think you’re going to see that happen as much this year. It’s harder to take companies public right now, and sponsors are focusing on growth, which favors platform deals,” he explains. “We currently have about
50 platforms in value-based care, and they all have plenty of cash to put to work. There are also a number of large independent groups that are looking to expand through acquisitions.”

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Thompson notes that by creating platforms with networks of providers, value-based care companies can achieve the efficiencies necessary for their model to work. Just over a decade ago, Medicare Advantage Plans—the most common insurance option among older people—switched to a value-based care model to cut costs and improve patient outcomes. Medicare now requires providers to take on many of the costs of patient care as part of their operating expenses, a practice known as risk sharing. Medicare will only reimburse claims that lead to improvements in patient care.

Value-based care requires providers (and their private equity sponsors) to focus on efficiency and only order tests or procedures that are necessary. If Medicare thinks providers are submitting too many claims, it may decline to reimburse them. Within provider groups, that reality is driving consolidation as larger platforms seek to benefit from economies of scale. Larger platforms manage more patients, so they can take advantage of having a higher number of “necessary” claims. Platforms can also cut costs through technological improvements and by streamlining administrative work.

“Platforms are really valuable,” Thompson says. “There are some natural barriers to entry as well. If you’re an investor looking to get into the space and you don’t have a primary care platform, you can get priced out easily. There is a lot of competition for these companies.”

John McDonald, senior managing director at investment bank Hyde Park Capital, agrees. “We’re working on a debt capital raise for a large primary care company in Florida to support them as they acquire other practices. The market is still very healthy for deals, especially if you have a quality company, and we expect that to continue as the push for consolidation grows.”

If you’re an investor looking to get into the space and you don’t have a primary care platform, you can get priced out easily. There is a lot of competition for these companies.

Dustin Thompson

Provident Healthcare Partners

Healthcare IT

Healthcare information technology is another area where platforms are driving deal flow. In March, Morgan Stanley Capital Partners, the middle-market focused private equity team at Morgan Stanley Investment Management, acquired a controlling interest in SpendMend from Sheridan Capital Partners. Investment bank Harris Williams worked with Morgan Stanley Capital on the deal.

Based in Grand Rapids, Michigan, SpendMend provides technology solutions for cost cycle management in healthcare. The company serves more than a third of the top 100 health systems. Its technology identifies instances of payment errors and tracks payment compliance within hospitals’ operating expenses. SpendMend has grown into one of the largest platforms in the industry through organic growth as well as strategic M&A, having completed four acquisitions since 2017.

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Dan Linsalata, a managing director in the Harris Williams Technology Group who focuses on healthcare IT, says that he expects this kind of consolidation to continue. “It can be tempting to think of healthcare IT as just the big incumbent electronic medical records providers or the telemedicine providers, but IT is a really diverse part of the healthcare market. There are companies from the venture stage through the buyout stage that are in the market making acquisitions or getting new investments from sponsors,” he explains. “As providers continue to modernize, the need for technology solutions will continue to grow.”

Healthcare IT as a sector can include anything from companies like SpendMend to patient platforms that support texting with doctors or even specialist care. Linsalata says many patients expect a tech-enabled experience, and that’s driving adoption of these solutions. “On one hand, providers need administrative systems that can support exponentially larger numbers of patients because we have an aging population,” Linsalata says. “On the other hand, there is a growing interest in specialized care, tech-enabled health services and care coordination, all of which require support. So there are organic growth opportunities and there are opportunities to put platforms together that can support that demand.”

Linsalata, Thompson and McDonald all say they expect elevated M&A activity in healthcare IT over the medium term. Private equity and venture funds, strategic buyers and other investors have unprecedented levels of cash that needs to be put to work. That money, coupled with the push toward greater consolidation through platforms, is creating conditions for an M&A cycle that will likely last several years.

“I think you’re going to see activity at all levels, all types of deal sizes. What we’re hearing from market participants is that there is ongoing demand for quality companies, add-on opportunities, platform opportunities,” says Linsalata. “It’s important to remember that the majority of deals in healthcare are sponsor-to-sponsor or sponsor-to-strategic [sales]. As companies mature, you’ll see them move on to sponsors that can support them through the next phase of growth. There is a very robust ecosystem within healthcare.”