Healthtech M&A Trends: Fall 2022

Healthtech Market Insights: What We’re Watching

Big Tech’s Continued Interest in Healthcare; is Buying Power Limited?

• Big tech invested $3.6Bn in healthcare in 2021 alone and has shown no sign of diminished interest in 2022, though there are increasing signs that their buying power may be limited
• Since Amazon’s 2018 acquisition of PillPack, it is clear that healthcare is of great interest to the company, though their 2022 decision to shut down the internal Amazon Care platform underscores that its mastery of healthcare is not yet complete
• Amazon recently agreed to acquire One Medical, the leading subscription-based, technology-enabled primary care provider, for $3.9Bn, highlighting increasing consumer adoption and maturation of healthtech
• The FTC is investigating this acquisition and antitrust concerns surround Amazon and healthcare. Similarly, antitrust concerns over UnitedHealth’s Optum purchasing Change Healthcare for $13Bn, as announced in January 2021, took until September 2022 for a federal judge to allow to go forward
• Conversely, Alphabet’s healthtech arm, Verily, has shown it is adept at building solutions, having received FDA approval this summer for the Zio Watch, a continuous monitoring solution for atrial fibrillation, and just this September, Verily raised $1Bn in capital to further its focus on precision medicine, now under the direction of a newly appointed CEO 
• Building rather than buying is one way to avoid antitrust scrutiny, as is focusing on acquisitions under the HSR threshold, which is likely to make middle market companies increasingly attractive acquisition targets

Healthcare is not Immune to Economic Pressures

• Healthtech’s meteoric rise was certainly helped by COVID-19, however, as economic pressures due to the pandemic and long-term effects of it continue, healthtech and healthcare overall have been shown to not be fully insulated 
• Innovaccer, a digital healthcare Unicorn, has recently laid off about 8% of its workforce, citing economic conditions and a focus on maintaining profitability during its rapid growth
• Furthermore, healthcare at large is facing severe economic conditions, with Lisa Goldstein, SVP at Kaufman Hall, stating that “hospitals stand to lose billions of dollars in 2022…it will be the worst year since the start of the pandemic”
• This can be traced to a tight labor economy, specifically within the healthcare Industry
  • Mike Slubowski, president and CEO of Trinity Health stated that there are currently nearly 4,000 vacant positions for nurses within his organization and a 14% clinical support staff vacancy rate
  • Hospitals are unable to use 25% of the beds they have, and nearly half of operating rooms and diagnostic services are inoperable due to staffing shortages

Is Healthtech the Answer? A Real-Life Case Study

• Administrative applications are where AI-based healthtech solutions have seen the greatest traction and produced the greatest savings over manual efforts in claims processing, revenue cycle management, and medical records management, among others
• Home healthcare has also been shown to offer savings over traditional hospital care, as in a Johns Hopkins trial that found the cost of the former to be 32% less than the latter
• Advances in medical equipment and devices are what often makes home care possible, as one of us experienced with the February 2021 birth of her daughter, who had nearly severe jaundice as a newborn; without the modern innovation of mobile phototherapy units, readmission to the hospital would have been required

Source: McKinsey Company, Deloitte, E&Y, CBInsights, PitchBook Data, Mergermarket, Company Press Releases, Meridian Research 

Healthtech M&A Activity and Trends

Recent Middle Market Transaction Activity

Public Market Valuations (EV/EBITDA)

Healthtech M&A Commentary

• Year-to-date, middle market healthtech M&A has come down from the pandemic-fueled high of 2021, lagging the same time period by ~20%, but showing growth to 2020 on a run-rate basis
• Within this market, Private Equity investments have fared better than the whole, showing deal activity down only ~10% from the same period last year and already above 2020’s entire deal count
• Across the board, known transaction values are also decreasing from 2021 as M&A focuses on smaller companies within the middle market as healthtech innovation expands
• Enterprise Systems lead in terms of total healthtech investments, given the lack of FDA approval and insurance coverage required as well as growing consumer comfort with, if not preference for, interacting both directly and indirectly with technology in all areas of life
• Mental health investments were the darling of 2021 and interest here has carried over into 2022, as well as the strong interest in AI in healthcare, which currently is focused on administrative tasks and the associated cost savings and efficiencies, especially beneficial now in this time of increasing cost pressures and macroeconomic headwinds

2022: As of October 7, 2022
Source: PitchBook Data, Mergermarket, Company Press Releases, Meridian Research 

Office Ally Has Been Acquired by Francisco Partners

Deal Represents How Service Software Solutions are Transforming Healthtech

Meridian Capital LLC (“Meridian”), a leading West Coast middle market investment bank and M&A advisory firm, is pleased to announce the successful acquisition of one of its clients, Office Alley (the “Company”) by Francisco Partners (“Francisco”). Meridian served alongside Lazard as a financial advisor to Office Ally on the transaction.

Office Ally is a leading provider of electronic clearinghouse services, revenue cycle management, and healthcare software solutions to payers and office-based physicians in the U.S. Since 2000, Office Ally’s comprehensive product portfolio of mission-critical solutions has enabled its customers to drive better operational results and streamline administrative workflows. Today, Office Ally processes approximately 25 million claims monthly for more than 720,000 providers and 4,000 payers nationwide. 

The investment by Francisco Partners will provide Office Ally with a new partner to help capitalize on its current momentum and continue to drive product innovation and growth, with a strong continued focus on supporting its customers.

Gloria Chung, Office Ally COO, stated, “For many of us, this was our first experience in a sale process and the Meridian Capital team’s hands-on approach helped get the deal to the finish line successfully. They worked tirelessly alongside us, providing guidance and support every step of the way. I am excited for our next chapter of growth with Francisco Partners and the opportunity this acquisition provides for our customers and our team.”

Patrick Ringland, Managing Director and Head of the Technology Practice at Meridian stated, “Working with the Office Ally team has been an absolute pleasure. This transaction is a testament to the strength of the platform the Company has built over the past 21 years. We are excited about the Company’s next phase of growth offered through this investment by Francisco.”

Office Ally is a healthcare technology company that offers cloud-based solutions to healthcare providers, independent physician associations (IPAs) and health plans. Office Ally’s platform supports both the management of care and facilitates payments between providers, health plans and patients. 

Office Ally’s platform is paired with a clearinghouse that enables the secure exchange of healthcare information including claims, remits, and eligibility information between covered entities and across the healthcare market.  

Health Perspectives Group Receives Majority Investment From 424 Capital

Deal Represents How Healthcare Technology is Transforming the Tech Industry

Meridian Capital LLC (“Meridian”), a leading West Coast middle market investment bank and M&A advisory firm, is pleased to announce that one of its clients, Health Perspectives Group (“HPG” or the “Company”) has sold a majority stake to 424 Capital (“424”). Meridian Capital served as the exclusive financial advisor to HPG on the transaction.

Headquartered in Seattle, Washington, Health Perspectives Group provides patient engagement services and technology solutions to biopharmaceutical companies, transforming the ways in which healthcare companies think and interact with patients. Core solutions include technology-enabled platforms to capture and promote the healthcare consumer perspective – making compliant, patient-centered action possible.

Health Perspectives Group was founded by Robin Shapiro and is headed by CEO Cheryl Lubbert. The Company is led by a seasoned management team with deep biopharmaceutical industry experience and a unique vision for shaping healthcare around client and patient needs. 

Through its two key technological platforms, Advocate Resource Center™ (ARC 2.0) and CareConcierge™, HPG paves the way for pharmaceutical companies to manage patient engagement programs effectively and efficiently. The Company has engaged patients across more than 450 disease areas for 22 of the largest 30 biopharmaceutical companies in the world.

Cheryl Lubbert, CEO of Health Perspectives Group shared, “Meridian provided their expertise and advice from our initial valuation all the way through a successful investment over many years. Their guidance helped ensure a successful outcome.”

Patrick Ringland, Managing Director and Head of the Technology Practice at Meridian stated, “We’re very happy with the outcome for Cheryl, Robin, and the HPG team. The investment represents an exciting opportunity for all parties and provides HPG with additional capabilities and resources that will accelerate the execution of its growth objectives and continued expansion of its platform.”

These transactions represent continued momentum for Meridian’s Technology practice. 

Healthtech Selected M&A Activity

Highlighted Tech-enabled Healthcare Services M&A Transaction

Under FTC Review

Amazon Acquires One Medical

July 2022

EV
$3,900M

EV/Revenue
4.0x

Target Description: One Medical is a  membership-based and technology-powered primary care platform with seamless digital health and inviting in-office care, convenient to where people work, shop, live, and click.

Investment Rationale: The acquisition will enable Amazon to expand its telehealth and primary care services reach, allowing for the integration of Amazon’s other healthcare and adjacent offerings, including grocery and pharmacy.

Highlighted Medical Equipment & Devices M&A Transaction

Senzime Acquires Respiratory Motion

April 2022

EV
$44M

EV/Revenue
NA

Target Description: Respiratory Motion is a developer of respiratory monitoring systems designed to monitor patients’ breathing volume and real-time breathing frequency. Its system has been  validated on over 6,000 patients in more than 30 scientific publications.

Investment Rationale: The acquisition will enable Senzime to expand its product portfolio and accelerate the market penetration of its TetraGraph system with evident sales and margin synergies. The transaction supports Senzime’s mission of becoming a global market leader in vital sign monitoring.

Highlighted Patient / Provider Software M&A Transaction

Telemedicine EV/Rev multiples of 10-12x seen in 2020

Patient Square Capital Acquires SOC Telemed

April 2022

EV
$302.5M

EV/Revenue
2.8x

Target Description: SOC Telemed is one of largest national providers of acute care telemedicine services and technology to U.S. hospitals and healthcare systems based on number of clients.

Investment Rationale: The public-to-private LBO will enable SOC Telemed to have more flexibility and resources to continue investing in its clinical capabilities, innovating its offering, and expanding its footprint.

Source: PitchBook Data, Mergermarket, Company Press Releases, Meridian Research 

Public Company Valuations

Select Healthtech M&A Transactions

As of October 7, 2022

Source: PitchBook Data, Mergermarket, Company Press Releases, Meridian Research