Ankura is pleased to present an overview of healthcare transactions announced or closed during Q1 2024 in the United States. Total transactions decreased by 7.6% in the first quarter of 2024 after remaining relatively flat in the fourth quarter of 2023. Excluding the Life Sciences and Medical Office Buildings sectors, the total number of transactions in the United States decreased by 12.1%.
Notable Transactions Announced or Closed in Q11
- UCI Health entered into a definitive agreement to acquire four hospitals from Tenet Healthcare Corporation (NYSE: THC) on February 1, 2024, for $975.0 million, implying a 1.0x trailing revenue multiple and 13.7x trailing adjusted Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) multiple.
- Nuvance Health entered into a definitive agreement to join Northwell Health on February 28, 2024. After closing, the newly combined health system will consist of over 14,000 providers and over 1,000 sites of care, including 28 hospitals.
- National Cancer Care Alliance entered into a definitive merger agreement to merge with Quality Cancer Care Alliance on February 29, 2024. The newly formed company, ONCare Alliance, will represent 33 independent practices providing oncology care.
- Waud Capital Partners acquired Senior Helpers from Advocate Health on March 21, 2024, marking Waud Capital's continued investment in the post-acute and home care space. Senior Helpers provides home care and wellness offerings for seniors, operating more than 380 locations across the United States, Canada, and Australia.
- Boston Scientific (NYSE: BSX) entered into a definitive agreement to acquire Axonics, Inc (NASDAQ: AXNX) on January 8, 2024, for $3.6 billion, implying a 9.2x trailing revenue multiple and 8.0x forward revenue multiple. Axonics is a medical technology company developing and commercializing products with a focus in the urology space.
Key Observations
The notable decrease in acquisition activity in the first quarter of 2024 marks the lowest number of announced transactions for the healthcare industry since Q4 2020. Despite previous optimism that healthcare transaction activity would rebound from the declines seen in 2023, the industry faced a slower start to the year as a result of ongoing downward pressure, including continued high interest rates and intensified regulatory scrutiny. The increased cost of borrowing associated with elevated interest rates continues to pose significant financial obstacles for market participants and likely discourages some potential investors. Simultaneously, increased regulatory scrutiny has created a more cautious environment. In particular, private equity involvement in healthcare acquisitions has received heightened attention from the government and media alike.
As shown in the figures below, recent healthcare acquisitions continued to be dominated by three sectors: Physician Medical Groups, Other Services 2, and eHealth. Despite declines in transaction activity in Q1, the Physician Medical Group sector remained the most active sector in terms of total transactions as a result of continued interest from health system and private equity buyers alike, accounting for 25.2% of total deal volume. However, private equity involvement in healthcare transactions overall declined significantly, participating in only 136 announced transactions after averaging nearly 200 transactions each quarter over the past three years.
Despite broader declines in activity, certain sectors remained relatively active, including the hospital sector. In addition to the merger between Nuvance Health and Northwell Health, Tenet Healthcare closed the divestiture of ten hospitals through three separate transactions. The oncology space also remained active with seven announced transactions. In addition to the National Cancer Care Alliance's merger with Quality Cancer Care Alliance, American Shared Hospital Services acquired three radiation centers in Rhode Island and a number of independent practices were acquired by larger operators such as American Oncology Network and OneOncology.
Future Outlook
Moving forward in 2024, there are continued headwinds facing transaction activity in the healthcare industry. Sustained high inflation figures have signaled to investors that any cuts to interest rates could be delayed. Additionally, increased scrutiny from regulatory agencies could continue to dampen transaction activity, particularly with private equity investments.
Footnotes
1. Sources: LevinPro HC Database, published by Irving Levin Associates LLC; Capital IQ
2.The category "Other Services" includes real estate, surgery center, urgent care, staffing and occupational health sub-sections.
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