2022-12-01-PitchBook-2022年三季度医疗保健服务报告（英）_51页_6mb

Vertical Overview Insights

Healthcare services is the largest PE vertical, comprising roughly 10% of all US PE buyout and growth deals in 2022. This segment attracts investors due to demographic trends, consolidation opportunities, and favorable reimbursement dynamics. US healthcare services expenditures reached $2.9 trillion in 2020 and are projected to exceed $4 trillion by 2027. PE firms have $62 billion in dry powder available to deploy in this space, which translates to roughly $150 billion in cumulative company enterprise value. Providers focus on preventative care, cost control, and improving patient outcomes under value-based payment models. The industry faces headwinds from staffing shortages, particularly in lower-margin service lines, and reimbursement pressures from CMS policies.

PE Activity Trends

In 2022, despite economic pressures, PE deal activity in healthcare services showed resilience, with deal counts exceeding 2020’s full-year total. However, staffing shortages are squeezing nearly all segments, increasing costs and inhibiting growth. High-quality assets continue to attract buyers, with multiples slightly easing from 2021 highs. The syndicated loan market has tightened, making financing more challenging for larger transactions. Exit activity slowed in Q3 2022, particularly in high-margin segments like dermatology and infusion services, while MA-focused platforms gained traction as payers increasingly prioritize risk-based contracts.

Trending Investment Drivers

• Value-Based Care (VBC): Providers are adapting to scrutiny of quality metrics and payer contracts under value-based payment models like MA and HHVBP. PE-backed platforms are investing in data and analytics capabilities to track outcomes and improve care coordination.

• Consumerization: Home-based care is gaining traction as patient and payer preferences shift away from skilled nursing facilities. Low-margin agencies are particularly vulnerable to staffing shortages and wage inflation, while larger multistate platforms are best-positioned to capitalize on this trend.

• Fertility & Specialized Services: Demand for reproductive medicine and specialized care (dermatology, infusion, ABA therapy) remains strong. EBITDA multiples in high-growth areas like infusion services remain robust due to cost savings compared to hospital settings.

Market Map Analysis

• Generalist Providers: Primary care leads deal activity, driven by consolidation post-pandemic. Urgent care investments focus on tiered/suburban markets to complement hospital systems and MA requirements.

• Multispecialty Providers: Ambulatory surgical centers (ASCs) and clinical staffing groups face labor shortages but offer staffing efficiencies and convenience drivers. Oncology is an emerging VBC focus area with expanded CMS models.

• PPMs: Dental, dermatology, and vision roll-ups remain highly active, with increasing focus on mobile cafes and tech-enabled services. Deals are consolidating from mid-sized platforms into strategic buyers, with fewer high-dollar platform trades than in 2021.

• Skilled Care: Behavioral health and home care are experiencing significant consolidation due to demand from aging populations and behavioral health crises exacerbated by COVID. MA-focused acquisitions and post-pandemic service shifts create ongoing consolidation opportunities.

Regulatory & Reimbursement Updates

• No Surprises Act: CMS extends surprise billing protections through arbitration, limiting revenue potential for out-of-network providers and shifting care away from emergency settings to lower-cost alternatives.

• Reimbursement Shifts: CMS’s 2023 PDGM cuts and HHVBP expansion reduce Medicare reimbursement while increasing performance pressure. MA plans have grown market share, incentivizing consolidation in home care and hospice segments.

• Provider Shortages: Regulatory relief via expanded telehealth under the PHE is temporary, impacting access to specialist behavioral care. Growing autism rates have increased demand for ABA therapies, improving opportunities for PE-backed ABA expansion.

Antitrust & Strategic Developments

• Consolidation Review: Antitrust enforcement in hospital acquisitions has increased under the Biden administration, with several proposed deals delayed. PE-backed hospital investors face exit challenges and must navigate increasing regulatory scrutiny.

• Strategic Shifts: Competitors — both payers and retailers — are expanding primary care and behavioral health platforms to address provider shortages and value-based care requirements. Optum’s major purchases of mental health assets highlight the strategic focus on value-based service expansion.

Appendix Data

• PE-backed healthcare services transactions are highly concentrated among firms like Shore Capital Partners (16 platform deals) and Vistria Group (33 growth investments).
• Key exit targets include large behavioral health platforms and specialized practices, reflecting investor focus on value-based performance and diversification outside traditional senior care.

This summary highlights key trends, investment targets, and risk factors shaping healthcare services PE activity, concluding that despite near-term challenges, long-term demand drivers like demographic shifts and behavioral healthcare expansion continue to attract significant PE capital.