The S&P Healthcare Services Index decreased 6.1% over the past month, underperforming the S&P 500, which remained relatively flat over the same period. The best performing sectors were Diagnostic Imaging (up 12.2%), Specialty Managed Care (up 6.1%) and HCIT (up 3.6%) as certain companies in these sectors reported strong financial performance during the month.

1. Duff & Phelps
he S&P Healthcare Services Index has decreased 6.9% over the last month, performing worse than the S&P 500, which decreased 5.1% over the same period.
ver the past month:
The best performing sectors were Dialysis Services (up 1.4%) and Specialty Managed Care (up 0.2%)
The worst performing sectors were Pharmacy Management (down 17.5%), Consumer Directed Health & Wellness (down 16.8%) and Distribution / Supply (down 12.4%)
The current average LTM revenue and LTM EBITDA multiples for the Healthcare Services industry overall are 1.93x and 11.7x, respectively.
The sectors with the highest valuation multiples include:
Healthcare REITs (12.11x LTM Revenue, 17.1x LTM EBITDA)
HCIT (3.35x LTM Revenue, 17.7x LTM EBITDA)
Contract Research Orgs (2.44x LTM Revenue, 13.1x LTM EBITDA)
Other Services (2.08x LTM Revenue, 16.9x LTM EBITDA)
Healthcare Services
Sector Update
August 2016
BY THE NUMBERS
The S&P Healthcare Services Index has decreased 6.1% over the last month,
underperforming the S&P 500, which decreased 0.1% over the same period.
Over the past month:
•• The best performing sectors were Diagnostic Imaging (up 12.2%), Specialty
Managed Care (up 6.1%) and HCIT (up 3.6%)
•• The poorest performing sectors were Healthcare Staffing (down 14.9%),
Psychiatric Hospitals (down 11.3%) and Home Care / Hospice (down 7.9%)
The current average LTM revenue and LTM EBITDA multiples for the Healthcare
Services industry overall are 2.22x and 13.5x, respectively.
The sectors with the highest valuation multiples include:
•• Other Services (1.91x LTM Revenue, 33.5x LTM EBITDA)
•• HCIT (4.55x LTM Revenue, 23.4x LTM EBITDA)
•• Consumer Directed Health and Wellness (3.80x LTM Revenue, 21.9x LTM
EBITDA)
•• Healthcare REITs (12.72x LTM Revenue, 19.0x LTM EBITDA)

2. Healthcare Services Sector Update
MARKET SECTOR
No. of
Cos.
Ag. Eqty
Mkt.
Value
Average % Change LTM Multiples Earnings Ratio PEG
Ratio
2016E1 mo 12 mo Rev EBITDA LTM 2016E
Acute Care Hospitals 5 $46,278 (4.8%) (17.1%) 1.17x 8.2x 16.4x 13.2x 1.4x
Assisted/Independent Living 3 3,820 (7.6%) (34.6%) 1.81x 10.7x NM NM NM
Care Management/TPA 5 5,439 (2.1%) 14.0% 1.18x 10.2x 25.1x 33.1x 1.5x
Clinical Laboratories 5 33,073 (2.5%) 18.5% 4.51x 14.9x 25.2x 17.6x 2.1x
Consumer Directed Health
and Wellness
9 19,934 3.4% (1.5%) 3.80x 21.9x 32.2x 26.0x 1.3x
Contract Research Orgs 7 27,020 0.0% 8.6% 2.57x 14.2x 26.2x 17.9x 1.3x
Diagnostic Imaging 3 397 12.2% (0.2%) 1.75x 6.6x 23.9x 48.3x 3.9x
Dialysis Services 3 41,032 (7.9%) 5.4% 1.84x 9.1x 31.0x 20.6x 1.5x
Distribution/Supply 8 111,737 (4.1%) (4.0%) 0.89x 11.8x 19.2x 16.8x 1.6x
Emergency Services 2 2,036 2.2% (23.6%) 2.12x 13.6x 9.2x 13.7x 0.4x
HCIT 20 49,685 3.6% 3.8% 4.55x 23.4x 33.1x 32.5x 1.9x
Healthcare REITs 18 111,695 (1.5%) 24.3% 12.72x 19.0x 28.3x 35.9x 7.6x
Healthcare Staffing 4 8,628 (14.9%) (33.6%) 1.04x 11.5x 26.3x 15.7x 1.0x
Home Care/Hospice 7 6,458 (7.9%) 1.5% 0.98x 12.1x 26.4x 20.4x 1.7x
Skilled Nursing 6 3,195 (5.5%) (22.2%) 1.76x 8.0x 18.6x 12.9x 1.2x
Managed Care – Commercial 6 263,589 (2.5%) 6.2% 0.67x 10.5x 19.4x 19.8x 1.4x
Managed Care – Government 3 19,705 (1.3%) 8.1% 0.30x 7.3x 25.9x 19.3x 1.1x
Other Services 4 10,280 (2.3%) (22.1%) 1.91x 33.5x 38.3x 47.4x 2.6x
Pharmacy Management 4 48,247 (4.4%) (12.4%) 1.12x 16.5x 22.0x 15.9x 1.2x
Physician Practice Mgmt 2 6,083 (4.5%) (18.1%) 1.56x 12.3x 18.4x 15.9x 1.3x
Psychiatric Hospitals 3 6,343 (11.3%) (21.9%) 0.35x 16.1x 33.1x 21.1x 1.1x
Specialty Managed Care 2 5,924 6.1% 19.0% 0.37x 7.2x 17.2x 18.3x 2.3x
Surgicenters/Rehabilitation 7 12,127 (7.0%) (3.4%) 2.19x 11.2x 18.7x 22.0x 1.3x
Total/Average ($MM) 136 $842,726 (2.8%) (4.6%) 2.22x 13.5x 24.3x 22.9x 1.8x
Source: Capital IQ
CAPITALIZATION
PROFILE
No. of
Cos.
Ag. Eqty
Mkt.
Value
% Total
No. of
Cos.
% Ag.
Eqty Mkt.
Value
Average Stock Performance
1 mo YTD 12 mo 36 mo
> $5 billion 29 $678,417 21.3% 80.5% (2.3%) 4.8% 3.6% 48.6%
$1 billion – $5 billion 52 140,731 38.2% 16.7% (2.3%) 3.4% 1.7% 38.2%
$250 million – $1 billion 38 22,554 27.9% 2.7% (2.7%) 4.0% 0.2% 28.1%
$100 million – $250 million 4 598 2.9% 0.1% 3.1% 2.8% (9.5%) 0.2%
< $100 million 13 425 9.6% 0.1% 0.4% (12.8%) (36.7%) (28.2%)
Total/Average ($MM) 136 $842,726 100.0% 100.0% (0.8%) 0.4% (8.2%) 17.4%
Source: Capital IQ
MARKET INDICES
Value at
8/31/16
% Change
1 mo YTD 12 mo 36 mo
Dow Jones Industrial Average 18,401 (0.2%) 5.6% 11.3% 24.2%
S&P 500 Index 2,170.9 (0.1%) 6.2% 10.1% 32.9%
NASDAQ Composite Index 5,213.2 1.0% 4.1% 9.1% 45.2%
Russell 2000 Index 1,239.9 1.6% 9.2% 6.9% 22.7%
AMEX Sector Index – Healthcare 80.6 (4.6%) (15.8%) (11.5%) (14.8%)
S&P Healthcare Facilities (Sub Ind) Index 301.9 (9.5%) (13.4%) (32.4%) 13.1%
S&P Healthcare Providers & Services (Industry) Index 578.7 (5.6%) (5.7%) (15.5%) 42.9%
S&P Managed Healthcare (Sub Ind) Index 463.6 1.9% 7.3% 5.6% 102.4%
S&P Healthcare Services 497.8 (6.1%) 3.1% 4.3% 50.5%
Source: Capital IQ as of August 31, 2016, and includes the most actively traded healthcare companies for respective covered sectors,
excluding most microcap companies.
Duff & Phelps 2
INTEREST RATES Value at 8/31/16 1 mo ago 3 mo ago 12 mo ago
LIBOR – USD – 6 months 1.24% 1.11% 0.99% 0.53%
U.S. Treasury – 2 years 0.80% 0.67% 0.87% 0.74%
U.S. Treasury – 5 years 1.18% 1.03% 1.36% 1.54%
U.S. Treasury – 10 years 1.57% 1.46% 1.84% 2.20%
U.S. Treasury – 30 years 2.23% 2.19% 2.63% 2.63%
U.S. Prime Rate 3.50% 3.50% 3.50% 3.50%
Source: Capital IQ

3. S&P 500 Index NASDAQ Composite Index Russell 2000 Index S&P Healthcare ServicesDow Jones Industrial Average
180
160
140
120
100
80
8/31/13 11/30/13 2/28/14 5/31/14 8/31/14 11/30/14 2/28/15 5/31/15 8/31/15 11/30/15 2/29/16 5/31/16 8/31/16
Source: Capital IQ Healthcare Staffing
Psychiatric Hospitals
Dialysis Services
Home Care/Hospice
Assisted/Independent Living
Surgicenters/Rehabilitation
Skilled Nursing
Acute Care Hospitals
Physician Practice Mgmt
Pharmacy Management
Distribution/Supply
Clinical Laboratories
Managed Care – Commercial
Other Services
Care Management/TPA
Healthcare REITs
Managed Care – Government
S&P 500 Index
Contract Research Orgs
Emergency Services
Consumer Directed Health and Wellness
HCIT
Specialty Managed Care
Diagnostic Imaging
0% 5%(5%)(10%)(15%) 10% 15%
Average % Change — 1 Month
Healthcare Services Sector Update
0.0x
5.0x
10.0x
15.0x
20.0x
25.0x
35.0x
30.0x
23.4x
21.9x
19.0x
16.5x 16.1x
14.9x 14.2x 13.6x
12.3x 12.1x 11.8x 11.5x 11.2x 10.7x 10.5x 10.2x
9.1x
8.2x 8.0x 7.3x 6.6x7.2x
33.5x
D
iagnostic
Im
aging
Specialty
M
anaged
C
are
M
anaged
C
are
–
G
overnm
ent
S
killed
N
ursing
Acute
C
are
H
ospitals
D
ialysis
Services
C
are
M
anagem
ent/TPA
M
anaged
C
are
–
C
om
m
ercial
Assisted/IndependentLiving
Surgicenters/Rehabilitation
H
ealthcare
Staffing
D
istribution/Supply
H
om
e
C
are/H
ospice
Physician
Practice
M
gm
t
Em
ergency
Services
C
ontractResearch
O
rgs
C
linicalLaboratories
Psychiatric
H
ospitals
Pharm
acy
M
anagem
ent
H
ealthcare
R
EITs
C
onsum
erD
irected
H
ealth
&
W
ellness
H
C
IT
O
therServices
23
33.5x
.4x
21
23
.9x
19
21
.0x
16
19
.5x 1616 .1x
14
16
.9x 1414 .2x 1314 .6x
12
13
.3x 1212 .1x 1112 .8x 1111 .5x 1111 .2x 1011 .7x 1010 .5x 1010 .2x
9
10
1x
8
9.
2x 8 08. 0x 7 38.0 3x 77.3 62x7. 6x6.
Overview of Subsector EV / LTM EBITDA
Performance of Market Indices for Latest 36 Months
Source: Capital IQ as of August 31, 2016, and includes the most actively traded healthcare companies for respective covered sectors, excluding most microcap companies.
Duff & Phelps 3
Source: Capital IQ as of August 31, 2016, and includes the most actively traded healthcare companies for respective covered sectors,
excluding most microcap companies.

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Head of Healthcare M&A
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+1 424 249 1646
brooks.dexter@duffandphelps.com
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Director
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Managing Director
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For the detailed August trading multiples for individual healthcare services companies,
please contact one of our professionals below.