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Global Healthcare Private Equity and M&A Report 2023 | First Look Summary

Core Content

The Global Healthcare Private Equity and M&A Report 2023 | First Look by Bain & Company provides an overview of the healthcare private equity (HCPE) market in 2022 and outlines the outlook for 2023 and beyond. The report emphasizes the resilience of HCPE despite macroeconomic challenges such as inflation, interest rate hikes, and geopolitical tensions.

Main Points

2022 Market Performance

• Deal Volume and Value: 2022 is expected to be the second-highest year on record for HCPE in terms of deal value and count, with a projected 400 deals compared to 515 in 2021.
• Activity Trends:
  • Deal volume fell in Q3 due to geopolitical uncertainty and inflationary pressures.
  • The top 10 deals accounted for ~40% of total deal value year-to-date.
  • Life sciences and HCIT saw increased interest from PE funds.
• Geographical Focus:
  • Asia-Pacific experienced notable large deals, with three over $1 billion.
  • North America and Europe saw a tightening credit market, limiting large-check financing and forcing funds to be more creative.

Credit Market Challenges

• Tight Credit: Central banks raised interest rates to combat inflation, leading to higher financing costs and limited availability of large-check financing.
• Alternative Financing Approaches:
  • All-equity deals became more attractive.
  • Club deals (joint investments) were used to overcome funding challenges.
  • Private credit emerged as a key alternative, with firms like Owl Rock Capital, Ares Management, and BlackRock offering large-debt financing.

Outlook for 2023 and Beyond

• Ample Dry Powder: Despite macroeconomic headwinds, HCPE remains a priority for top firms due to strong returns and continued fundraising.
• Resilient Sectors: HCIT, biopharma, and life science tools are expected to perform well during downturns due to their fundamental value propositions.
• Opportunities in Public-to-Private Deals: Depressed public valuations may present opportunistic investment opportunities for PE funds.
• Regional Challenges:
  • North America: Fed rate hikes may limit large-check financing, with a potential shift toward recession-resilient plays.
  • Europe: Similar credit constraints and inflationary pressures are expected to persist.
  • Asia-Pacific: Long-term healthcare tailwinds, mature market, and diversification from China to other regions are expected to continue.

Key Sectors and Subsectors

Payer/Provider

• Nondiscretionary specialties: Sectors like veterinary, dental, radiology, oral surgery, and vision are less affected during downturns due to higher private pay exposure and stable demand.
• Next-gen office-based specialties: Cardiology and orthopedics are expected to remain attractive due to site-of-care shift and value-based care trends.
• Medicaid Services: With rising unemployment, Medicaid enrollment tends to increase. Outsourced service providers are well-positioned to help state agencies manage costs. Examples include Carlyle's acquisition of Kepro and CNSI.

HCIT

• Operational Efficiency: HCIT firms that help optimize operations and reduce labor costs are in demand. Examples include LeanTaaS and Intelligent Medical Objects.
• Sticky Revenue Models: Companies with recurring revenue models (SaaS-based) are more resilient during downturns.

Biopharma and Life Science Tools

• Contract Services: Assets focused on research and early development (CROs/CDMOs), commercial-scale manufacturing, and late-stage drug development are more resilient.
• Investment Risks: Assets serving late-stage biopharma may face greater financial risk due to reduced capital availability and increased costs.

Conclusion

The report highlights that while 2022 was a challenging year for the broader PE market, HCPE maintained strong performance due to its resilient sectors and strategic focus. As the market moves into 2023, PE funds are expected to adapt to new macroeconomic conditions, prioritize recession-resilient themes, and innovate in financing strategies to secure deals. The long-term outlook remains positive, with increased interest in HCPE and continued investment in key subsectors.