The document discusses a webcast on key growth sectors in the health care M&A market. It provides an agenda that will discuss trends in hospital, physician groups, managed care, and financing. It then introduces several speakers who will provide perspectives on health care services M&A trends.
PYA Senior Consultant Kathryn Culver presented "Fundamentals of Healthcare Valuation" before the Tennessee Society of Certified Public Accountants (TSCPA). The presentation:
Provided a healthcare valuation overview.
Discussed healthcare valuation approaches.
Covered healthcare valuation considerations and trends.
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
Marpai is an AI tech company revolutionizing the self-funded health plan
market representing over $1 trillion in health claims, $20 billion in
administrative fees, and 95 million Americans. Just as Netflix, Amazon,
Uber, and Tesla use artificial intelligence to transform and lead industry
sectors, Marpai (pronounced Mar-pay) is using deep learning, the most
advanced artificial intelligence, to transform health plan administration
for companies who self-fund their health plans. As a next-generation
TPA (Third Party Administrator) using SMART technology (deeplearning powered), Marpai’s mission is to save lives, improve lives, and
radically reduce the costs of healthcare for employers and plan
members.
PYA Principal Jim Lloyd was among the faculty who spoke at the 2013 Mid-South Commercial Law Institute during a panel discussion on “Healthcare Facilities in Bankruptcy.” The presentation provided an overview of healthcare facilities and key issues, healthcare regulatory environment, valuation of healthcare facilities, and red flags for healthcare businesses in bankruptcy or distress.
PYA Presents Intro to Healthcare Valuation PYA, P.C.
PYA Principal Jim Lloyd, along with other presenters, provided a “Healthcare Valuation 101” during a pre-conference workshop at the 2013 AICPA Healthcare Industry Conference.
As public and private insurers move away from traditional fee-for-service payments, healthcare organizations are struggling to make the leap. Market share, regional characteristics, financial health and an organization’s mission and culture are shaping the path as the flow of money shifts and the skills to manage and measure risk are being redirected in largely untested ways.
PYA Senior Consultant Kathryn Culver presented "Fundamentals of Healthcare Valuation" before the Tennessee Society of Certified Public Accountants (TSCPA). The presentation:
Provided a healthcare valuation overview.
Discussed healthcare valuation approaches.
Covered healthcare valuation considerations and trends.
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
Marpai is an AI tech company revolutionizing the self-funded health plan
market representing over $1 trillion in health claims, $20 billion in
administrative fees, and 95 million Americans. Just as Netflix, Amazon,
Uber, and Tesla use artificial intelligence to transform and lead industry
sectors, Marpai (pronounced Mar-pay) is using deep learning, the most
advanced artificial intelligence, to transform health plan administration
for companies who self-fund their health plans. As a next-generation
TPA (Third Party Administrator) using SMART technology (deeplearning powered), Marpai’s mission is to save lives, improve lives, and
radically reduce the costs of healthcare for employers and plan
members.
PYA Principal Jim Lloyd was among the faculty who spoke at the 2013 Mid-South Commercial Law Institute during a panel discussion on “Healthcare Facilities in Bankruptcy.” The presentation provided an overview of healthcare facilities and key issues, healthcare regulatory environment, valuation of healthcare facilities, and red flags for healthcare businesses in bankruptcy or distress.
PYA Presents Intro to Healthcare Valuation PYA, P.C.
PYA Principal Jim Lloyd, along with other presenters, provided a “Healthcare Valuation 101” during a pre-conference workshop at the 2013 AICPA Healthcare Industry Conference.
As public and private insurers move away from traditional fee-for-service payments, healthcare organizations are struggling to make the leap. Market share, regional characteristics, financial health and an organization’s mission and culture are shaping the path as the flow of money shifts and the skills to manage and measure risk are being redirected in largely untested ways.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
Don’t Stumble Coming Out of the Gate –Top Ten Issues to Address When Acquirin...PYA, P.C.
PYA Consulting Principal Carol Carden co-presented with Charlene McGinty of McKenna Long. They examined the top issues to address when acquiring a physician practice and some of the common and more complex issues hospitals face during the acquisition.
Health Services Tax Conference May 18-19, 2015, Presentations included: Mega Trends and the Impact on Healthcare, The Healthcare Industry: A View from Washington and The New Health Economy.
Mercer Capital's Value Focus: Medtech & Device Industry | Q4 2018 Mercer Capital
Mercer Capital provides valuation services to start ups, larger public and private companies, and private equity and venture capital funds. Mercer Capital’s expertise in the medtech and device industry spans the following segments: Biotechnology and life sciences, medical devices, and healthcare technology.
Presentation Covers Physician Practice CompliancePYA, P.C.
PYA Consulting Manager Valerie Rock presented “Compliance in the Physician Practice.” She discussed the importance of having a compliance plan, coding and billing monitoring, audit schedules, and provider expectations.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
Presentation Uncovers Trends in the Unpredictable Healthcare IndustryPYA, P.C.
With the healthcare industry in a state of flux, not much is known about what lies ahead; but trends across the industry have become apparent and are likely to stick. These trends were the subject of a presentation given by PYA Principal David McMillan at the PKF North America Healthcare Fly-In.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
The Next Revolution in Healthcare: Why the New MSSP Revisions Matter Now More...Health Catalyst
Now more than ever, we are entering a period of rapid change catalyzed by the power of data. On December 21, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program (MSSP), strengthening the financial incentives for ACOs to drive improved outcomes. The health systems that embrace data to achieve financial success will grow while the rest will struggle to compete. View this webinar for a discussion on how to prepare.
The US healthcare system didn’t develop overnight, rather, it is the culmination of a series of revolutions within wealthy parts of the world. In this webinar, we explore the high points of history that have led us to our current challenges. While care has steadily improved over time, the cost of that care has risen at a much more dramatic rate. CMS created the MSSP to help mitigate the growth of these costs while providing better care for individuals and populations. On a larger scale, the program serves to shift the healthcare industry towards fee-for-value.
Despite general frustration related to legislative involvement, history has proven that regulatory changes precede attitudinal changes and the MSSP (combined with accurate, timely data) may be just the piece of legislation to help make value-based care a reality. By viewing this webinar you will learn:
- How the US healthcare industry reached its current state.
- Why financial imperatives drive cultural change in our economic model.
- Ways that the MSSP can help your organization achieve financial success.
- Ideas for how to utilize data to develop better healthcare delivery systems.
Dr. Will Caldwell is a strong proponent of the use of data analytics to promote good health and save lives. His area of expertise rests in technology-enabled health care delivery models and value-based care platforms. We hope that you will view this webinar and learn from his 17-years of work as a data-informed clinician.
How to Have a Successful Engagement and a Happily Ever After: “New Age” Nuanc...PYA, P.C.
PYA’s Tynan Olechny and Valerie Rock presented “How to Have a Successful Engagement and a Happily Ever After: ‘New Age’ Nuances to Physician Hospital Arrangements” with R. Ross Burris III of Polsinelli at the Health Care Compliance Association’s (HCCA) Regional Annual Conference.
The FDA and industry: A recipe for collaborating in the New Health EconomyPwC
Pharmaceutical and life science companies and their chief regulator – the FDA – must find new ways to collaborate to meet 21st century demands.
Web Page: http://www.pwc.com/us/en/health-industries/health-research-institute/hri-pharma-life-sciences-fda.jhtml
Payer Analytics In A Shifting Healthcare Landscape - June Presentation To Chi...Dan Wellisch
This is the June 2018 presentation to the Chicago Technology For Value-Based Healthcare https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
Employers are always looking for ways to reduce one of their biggest expenditures–the cost of providing health insurance to employees. Many employers have explored solutions such as adding wellness plans, reducing usage, and providing different provider access mechanisms, all with modest success.
Stemming the rising costs of health insurance requires management to understand and improve healthcare outcomes for their employee and dependent populations. Changing the future of employer health insurance will require a multi-faceted approach:
Driving additional value by reducing utilization of healthcare services within these employer populations.
Utilizing a wider lens through which to view performance of various providers, then making decisions based on those who are consistently providing low cost, high quality care.
Employer will need to combine their data with other companies across a geographic region to get a better picture of the provider landscape than has ever been possible before.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
In “Valuing Healthcare Management Services Agreements,” PYA Principal Tynan Olechny discussed the types of management services found in the healthcare marketplace. Her NACVA webinar presentation addressed the valuation of these services with a focus on how the appraiser can analyze the key economics of management services agreements. She also examined how the commercial reasonableness of these arrangements can be evaluated and assessed as part of the valuation process.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
Don’t Stumble Coming Out of the Gate –Top Ten Issues to Address When Acquirin...PYA, P.C.
PYA Consulting Principal Carol Carden co-presented with Charlene McGinty of McKenna Long. They examined the top issues to address when acquiring a physician practice and some of the common and more complex issues hospitals face during the acquisition.
Health Services Tax Conference May 18-19, 2015, Presentations included: Mega Trends and the Impact on Healthcare, The Healthcare Industry: A View from Washington and The New Health Economy.
Mercer Capital's Value Focus: Medtech & Device Industry | Q4 2018 Mercer Capital
Mercer Capital provides valuation services to start ups, larger public and private companies, and private equity and venture capital funds. Mercer Capital’s expertise in the medtech and device industry spans the following segments: Biotechnology and life sciences, medical devices, and healthcare technology.
Presentation Covers Physician Practice CompliancePYA, P.C.
PYA Consulting Manager Valerie Rock presented “Compliance in the Physician Practice.” She discussed the importance of having a compliance plan, coding and billing monitoring, audit schedules, and provider expectations.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
Presentation Uncovers Trends in the Unpredictable Healthcare IndustryPYA, P.C.
With the healthcare industry in a state of flux, not much is known about what lies ahead; but trends across the industry have become apparent and are likely to stick. These trends were the subject of a presentation given by PYA Principal David McMillan at the PKF North America Healthcare Fly-In.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
The Next Revolution in Healthcare: Why the New MSSP Revisions Matter Now More...Health Catalyst
Now more than ever, we are entering a period of rapid change catalyzed by the power of data. On December 21, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program (MSSP), strengthening the financial incentives for ACOs to drive improved outcomes. The health systems that embrace data to achieve financial success will grow while the rest will struggle to compete. View this webinar for a discussion on how to prepare.
The US healthcare system didn’t develop overnight, rather, it is the culmination of a series of revolutions within wealthy parts of the world. In this webinar, we explore the high points of history that have led us to our current challenges. While care has steadily improved over time, the cost of that care has risen at a much more dramatic rate. CMS created the MSSP to help mitigate the growth of these costs while providing better care for individuals and populations. On a larger scale, the program serves to shift the healthcare industry towards fee-for-value.
Despite general frustration related to legislative involvement, history has proven that regulatory changes precede attitudinal changes and the MSSP (combined with accurate, timely data) may be just the piece of legislation to help make value-based care a reality. By viewing this webinar you will learn:
- How the US healthcare industry reached its current state.
- Why financial imperatives drive cultural change in our economic model.
- Ways that the MSSP can help your organization achieve financial success.
- Ideas for how to utilize data to develop better healthcare delivery systems.
Dr. Will Caldwell is a strong proponent of the use of data analytics to promote good health and save lives. His area of expertise rests in technology-enabled health care delivery models and value-based care platforms. We hope that you will view this webinar and learn from his 17-years of work as a data-informed clinician.
How to Have a Successful Engagement and a Happily Ever After: “New Age” Nuanc...PYA, P.C.
PYA’s Tynan Olechny and Valerie Rock presented “How to Have a Successful Engagement and a Happily Ever After: ‘New Age’ Nuances to Physician Hospital Arrangements” with R. Ross Burris III of Polsinelli at the Health Care Compliance Association’s (HCCA) Regional Annual Conference.
The FDA and industry: A recipe for collaborating in the New Health EconomyPwC
Pharmaceutical and life science companies and their chief regulator – the FDA – must find new ways to collaborate to meet 21st century demands.
Web Page: http://www.pwc.com/us/en/health-industries/health-research-institute/hri-pharma-life-sciences-fda.jhtml
Payer Analytics In A Shifting Healthcare Landscape - June Presentation To Chi...Dan Wellisch
This is the June 2018 presentation to the Chicago Technology For Value-Based Healthcare https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
Employers are always looking for ways to reduce one of their biggest expenditures–the cost of providing health insurance to employees. Many employers have explored solutions such as adding wellness plans, reducing usage, and providing different provider access mechanisms, all with modest success.
Stemming the rising costs of health insurance requires management to understand and improve healthcare outcomes for their employee and dependent populations. Changing the future of employer health insurance will require a multi-faceted approach:
Driving additional value by reducing utilization of healthcare services within these employer populations.
Utilizing a wider lens through which to view performance of various providers, then making decisions based on those who are consistently providing low cost, high quality care.
Employer will need to combine their data with other companies across a geographic region to get a better picture of the provider landscape than has ever been possible before.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
In “Valuing Healthcare Management Services Agreements,” PYA Principal Tynan Olechny discussed the types of management services found in the healthcare marketplace. Her NACVA webinar presentation addressed the valuation of these services with a focus on how the appraiser can analyze the key economics of management services agreements. She also examined how the commercial reasonableness of these arrangements can be evaluated and assessed as part of the valuation process.
From “Big Data” to Digital Medicine--PYA Explores Innovations in HealthcarePYA, P.C.
With reform in healthcare and advancements in technology, the future of medicine is in a state of flux. What it all means can be heard in discussions from coast-to-coast, in the halls of hospitals, at conferences, and in board rooms.
Among the thought leaders who have broached this timely subject is PYA Principal Kent Bottles, MD, who is also PYA Analytics’ Chief Medical Officer. He recently spoke at The North American Menopause Society Annual Meeting on the topic: “The Perils and Prospects of Practicing Medicine in a Digital Era.”
We specialize in the successful placement of all physician specialties and sub-specialties in small rural facilities, large medical centers, healthcare systems, and academics. We ensure that your new physician will integrate well into your community as both a true leader and a valuable asset for your facility.
students wonder exactly what health economics is. is it about money in health, more health for the same money ? about health in hospitals or health of the country.
discussion on Health Economics and Health Care in our country and abroad, and what resources are given by the private sectors and with the very scarce help from the DOH, national and local government, and from the support given by WHO.
2016 Survey of US Physicians: Physician awareness, perspectives, and readines...Deloitte United States
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a Medicare payment law intended to drive health care payment and delivery system reform for clinicians, health systems, Medicare, and other government and commercial payers. Deloitte’s 2016 Survey of US Physicians sought to shed light on physicians’ awareness of MACRA, their perspectives on its implications, and their attitudes and readiness for change. The survey found that many physicians are unaware of MACRA. Regardless of their awareness level, most physicians surveyed would have to change aspects of their practice to meet the law’s requirements and to do well under its incentives. Many physicians surveyed recognize they will need to bear increased financial risk (under MACRA and in general) and need support and resources to develop the capabilities do so. http://www.deloitte.com/us/macra?id=us:2sm:3ss:macra:eng:lshc:071216
TD Mergers & Acquisitions Competition 2015
We created a presentation on the potential bid structure and analysis of the transaction based on HBS case 9-210-040 "Roche's Acquisition of Genentech".
Team members:
Catherine Qian
Jenny Li
Terence Leung
Yu Cao
FLAACOs 2014 Conference - Shift in the Payer Movement in the Provider Space t...MARCYINC
Shift in the Payer Movement in the Provider Space to Augment the Movement of Value Based Integrated Payments - The Evolution to Health Solutions presented by Jon Gavras, MD at the FLAACOs Fall 2014 Conference
In October 2014, INTEGRATED's Bill Jessee presented "Where Is Healthcare Going? And How Will We Get There?" at Iowa Hospital Association's annual meeting. The presentation focuses on the forces shaping healthcare today, the delivery system changing in response to the environment, and what this all means for hospitals and physicians.
Chris Carnahan, President of Carnahan Group, presented at the National Association of Certified Valuators and Analysts' (NACVA) Advanced Valuation: Applications and Models Workshop on December 6, 2016. The presentation covers valuing physician practices; specifically,fair market valuations (FMVs) in healthcare, the government regulations surrounding FMVs, the current trends and marketplace, as well as valuing physician compensation.
Healthcare Financial Transformation: Five Leading StrategiesHealth Catalyst
Healthcare financial transformation—improving care delivery while lowering costs—has been an ongoing challenge for health systems in the era of value-based care and an even more prominent concern amid COVID-19. While better care and reduced expense to organizations and consumers might seem like opposing goals, by understanding the true cost of services and other drivers of expense, organizations can successfully manage costs while maintaining, and even improving, care delivery. To that end, health systems can use data- and analytics-driven tools and strategies to addresses financial challenges, including uncompensated care, prolonged accounts receivable days, discharged not final billed cases, inefficient resource use, and more.
Ahead of the marcus evans National Healthcare CXO Summit 2023, Joy Figarsky discusses the link between mental health costs and medical costs, and why hospitals should adopt a whole-person care approach.
Centric Health Corporation - Investor Presentation - May 2020SharePitch
Updated investor presentation for Centric Health Corporation (TSX: CHH). Updates include the competion of the Remedy'sRx acquisition and first quarter financial results.
Health Services Tax Conference May 18-19, 2015, Presentations included: Mega Trends and the Impact on Healthcare, The Healthcare Industry: A View from Washington and The New Health Economy.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Key Growth Sectors in the Health Care Services M&A Market
1. Key Growth Sectors in the
Health-Care Services M&A Market
Sponsored by Regions Bank
May 1, 2014
The Merger & Acquisition Webcast Series 1
2. Webcast Information:
The webcast can be accessed online and/or by phone.
A copy of the slide presentation is sent to each registered
participant; it is also available by logging in to your online
account at www.levinassociates.com/user.
If you have any trouble with the webcast, please call (800)248-
1668 for assistance.
You can ask questions at any time; use the online question box
or fax them to THE MERGER AND ACQUISITION WEBCAST at
(203)846-8300.
The Merger & Acquisition Webcast Series 2
3. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
May 1, 2014
Agenda:
Introduction: Today’s market
When to buy, when to sell
M&A activity: Hospitals and physicians group sectors
M&A activity: Managed care sector, financing
PLEASE NOTE: You will be given the opportunity to ask questions live during the call. You may also fax
your questions to (203)846-8300 at any time.
The Merger & Acquisition Webcast Series 3
4. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Christopher Carnahan
President
Carnahan Group
chris.carnahan@carnahangroup.com
www.carnahangroup.com
Christopher Carnahan has more than 21
years of experience in health care and
finance. He has held executive-level
positions in health care, technology, and
manufacturing. Chris is the founder of
Carnahan Group, Inc. and is responsible for
the leadership, strategic direction, and
financial matters of the firm. Chris has been
involved with more than 150 medical staff
demand analyses for not-for-profit and for-profit
entities, including modeling demand
and supply analysis for health-care services
within diverse communities.
The Merger & Acquisition Webcast Series 4
5. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Robert James Cimasi
Chief Executive Officer
Health Capital Consultants
rcimasi@healthcapital.com
www.healthcapital.com
Robert James Cimasi, MHA, ASA, FRICS,
MCBA, CVA, CM&AA, serves as Chief Executive
Officer of Health Capital Consultants (HCC), a
nationally recognized healthcare financial and
economic consulting firm headquartered in St.
Louis, MO, serving clients in 49 states since
1993. Bob has over thirty years of experience in
serving clients, with a professional focus on the
financial and economic aspects of healthcare
service sector entities including: valuation
consulting and capital formation services;
healthcare industry transactions including joint
ventures, mergers, acquisitions, and
divestitures; litigation support & expert
testimony; and, certificate-of-need and other
regulatory and policy planning consulting.
The Merger & Acquisition Webcast Series 5
6. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Court Houseworth
Managing Director
Cain Brothers
chouseworth@cainbrothers.comw
ww.cainbrothers.com
Court Houseworth, Managing Director,
joined Cain Brothers in 2004 in San Francisco
and serves as the co-head of the firm’s
Managed Care and Behavioral Health
investment banking practices. Prior to
joining the firm, Court had been a managing
director at Lehman Brothers and Bear
Stearns. Over the past 25 years, Court has
been involved in mergers and acquisitions,
debt and equity financings, restructurings,
valuations, and not-for-profit conversions.
Cain Brothers has more experience with
mid-market health-care transactions than
any advisory firm.
The Merger & Acquisition Webcast Series 6
7. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Scott Li
Vice President
Hammond Hanlon Camp LLC
sli@h2cllc.com
www.h2cllc.com
Scott Li is a vice president in the New York
office of Hammond Hanlon Camp LLC. With
more than 10 years of experience across roles
in investment banking and the health-care
industry, Scott provides strategic and financial
advisory services to a variety of health-care
clients. He has recently completed or is
actively working on engagements for clients in
the hospital, senior living, and health IT
sectors. Prior to joining Hammond Hanlon
Camp LLC, Scott was Chief Financial Officer of
pingmd, a provider of an online
communication platform for primary care
physicians. .
The Merger & Acquisition Webcast Series 7
19. Overview of Hammond Hanlon Camp
Hammond Hanlon Camp (“H2C”) LLC is a healthcare-focused strategic advisory and investment banking firm with
a particular emphasis on the not-for-profit sector
H2C traces its heritage back almost 30 years through its predecessor organizations, including Shattuck Hammond
Partners
H2C has assembled a team of professionals that have worked with leading health systems across the country and
executed many of the most creative transactions in the not-for-profit healthcare industry
– Senior professionals average over 20 years of experience serving not-for-profit health systems
Offices in Atlanta, Chicago, New York and San Diego
Lead advisor on hundreds of transactions in the healthcare industry representing billions of dollars in value
Strategic Advisory
Services designed to assist
organizations in evaluation of
options prior to transaction
Capital Markets & Derivatives
Financial advisor and/or
placement
agent on all types of debt and
derivative transactions
Mergers & Acquisitions
Advisor on all types of
affiliations, joint ventures,
acquisitions and divestiture
transactions
Restructuring
Financial advisor to restructure
distressed credits / sell assets
Real Estate
Advisor on monetization and
project financing of real estate
assets
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 19
20. Healthcare Provider Strategic Context
Tailwinds
Demographics: aging
population, increasing
life expectancy, etc.
Push to lower cost of
care settings (for certain
sectors)
Newly insured
population growing
Headwinds
Reimbursement
uncertainty due to ACA
Shift from volume to
value
Intensifying focus on
cost and choice for
consumers and insurers
Econom
y
Post-Reform
Environment
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 20
21. The New Normal
The realities of shifting from volume to value are causing financial forecasts to evolve
Illustrative Hospital Operating Income Projections
Challenging
reimbursement
environment
Inpatient
admissions
under pressure
Shift from
commercial to
exchanges
Increasing
consumerism
2012 2013 2014 2015 2016
Projected Operating Income
Prior Forecast Post-Reform Revised Post-Reform Downside
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 21
22. Not THAT Kind of Sustainability: the New Model for Survival
Across the continuum of care, providers will need to possess or develop many
attributes to achieve sustainability or permanence in serving their community or
customers
Essential
market
position and
critical mass
Capital
Integrated
physicians
High quality
leadership
and staff
Measurable
quality and
cost
effectiveness
Alignment
with other
providers /
payors
IT and care
managemen
t
infrastructur
es
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 22
23. 2, 4, 6, 8…Who Do We Integrate?
There are many ways for providers to access or offer these skills and attributes
With the ACA sparking new payment systems – bundled payments, capitation,
narrow networks – the delivery of and payment for service is becoming
significantly more challenging
Hospitals have been and will continue to be the core of the health care system
but the system will be different
A blurring of traditional lines between healthcare service sectors has continued
with upstream or downstream diversification increasingly common
– Revenue diversification via cross-sector activity
– Payer-provider convergence
– Post-acute or behavioral health capabilities via ownership or partnership
The critical questions are:
– Which of these components will hospitals integrate into their systems?
– How will providers in other parts of the continuum respond?
Overall, providers will be joining together in vertically stacked organizations
or networks to provide and bill for service
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 23
24. New Kinds of Dance Partners
Once upon time, consolidation meant organizations in the same business joined
forces
No longer as simple as saying bigger is better, even though that is often true
The new paradigm dictates that providers will need to align, partner, or merge
with others in the continuum of care for a variety of skills and competencies
– Population health management capabilities
– Marketing capabilities to respond to increasing consumerism
– IT impacting strategic decisions
– Acquiring or refining activities in other parts of the continuum
Access to capital is critical and whether the debt and equity markets are
supportive will be an especially important consideration
Comfort with for-profit operators is growing
– For-profit management style for not-for-profit organizations – “No Margin, No
Mission” has never been more applicable
Private equity will continue to be a growing force across the continuum of care
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 24
25. Reassessing the Toolkit
Monetization to
Improve Balance
Sheet
Sharpen Focus on
Core Businesses
Harvesting
Non-Core Assets
Enhance Service
Quality and/or
Reduce Cost
Increase Managerial
Bandwidth
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 25
26. Will the M&A Activity Work?
“Only time will tell whether this merger makes sense or not”
Healthcare M&A Trends HAMMOND HANLON CAMP LLC h2cllc.com 26
27. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
The Four Pillars
27
28. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
28
Physician Primacy
Integration & Coordination Driving Consolidation
“Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services,” Robert
James Cimasi, John Wiley & Sons, 2014, p. 980.
29. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Supply of Physicians, 1975 – 2011
29
450,000
400,000
350,000
300,000
250,000
200,000
150,000
100,000
50,000
-
1975 1980 1985 1990 1995 2000 2011
Primary Care
Specialty Care
Surgeons
“Physician Characteristics and Distribution in the U.S.: 2013 Edition,” Derek R. Smart, American
Medical Association, 2013, p. 288, 441.
30. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Physician Supply and Demand
1,000,000
900,000
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
0
2008 2010 2015 2020 2025
Supply Demand
-The difference
between supply and
demand represents
the anticipated
physician shortage.
“Physician Shortages to Worsen Without Increases in Residency Training” Association of American Medical College,
https://www.aamc.org/download/153160/data/physician_shortages_to_worsen_without_increases_in_residency_tr.pdf
(Accessed 4/30/14) 30
31. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Physician Shortage
70000
60000
50000
40000
30000
20000
10000
0
2008 2010 2015 2020 2025
Specialist Shortage PC Shortage
Total Physician Shortage
7,400 13,700 62,900 91,500 130,600
“Physician Shortages to Worsen Without Increases in Residency Training” Association of American Medical College,
https://www.aamc.org/download/153160/data/physician_shortages_to_worsen_without_increases_in_residency_tr.pdf
(Accessed 4/30/14)
31
32. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Percent Change in Physician Practice Setting
Since 2000
“Physician Characteristics and Distribution in the US” American Medical Association, 2002-2003 edition, p. 329; 2003-2004
edition, p. 320; 2004 edition, p. 322; 2005 edition, p. 311; 2006 edition, p. 311; 2007 edition, p. 311; 2008 edition, p. 403; 2009
edition, p. 406; 2010 edition, p. 438; 2011 edition, p. 436. 2011 edition, p. 436; 2012 edition, p. 440; 2013 edition, p. 440.
125%
120%
115%
110%
105%
100%
95%
1998 2000 2002 2004 2006 2008 2010 2012
Physicians in
Office-Based Practices
Physicians in
Hospital-Based Practices
Total Patient
Care Physicians
32
33. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Organizational Models of Alignment
Emerging Models in an Era of Reform
Degree of
Hospital
Control
MOST LEAST
"A Guide to Consulting Services for Emerging Healthcare Organization," By Robert James Cimasi, John Wiley & Sons, New
York, NY, 1999, p. 51-56, 163. “Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services,” Robert
James Cimasi, John Wiley & Sons, 2014, p. 646. “Hospital/Physician Integration: Three Key Models” by Michael A. Cassidy et
al., American Health Lawyers Association, October 2011, p. 9.
33
Model Description
Solo/Group Medical Practice Physicians practice independently
Independent Practice Association (IPA)
Legal entities of independent physicians that contract with health insurance companies to
provide medical services
Co-Management Arrangement
Typically formed through a contractual agreement between a group of physicians and a
hospital, for the purpose of the physicians providing management services to a specified
hospital service line related to the specialty of the contracted physicians
Management Services Agreement
(MSA)/Organization (MSO)
A legal entity that provides administrative and practice management services to a
physician entity that is owned by participating physicians and that contracts with the MSO
for services
Accountable Care Organization (ACO)
Participant
A legal entity recognized and authorized under applicable State, Federal, or Tribal Law
that is identified by a Taxpayer Identification Number (TIN) and is formed by one or more
ACO participant(s)
Physician Practice Management
Company (PPMC)
Company specializing in physician practice management with the goal of earning a profit;
often purchase or affiliate with physicians, offering capital, management experience,
economies of scale, and economic security
Physician Hospital Organization (PHO)
(“Clinically Integrated Network”)
Unites Hospital with Physician through a contractual relationship. Usually owned by
Physicians and Hospitals, and in many cases non-profit
Professional Service Agreement (PSA)
An agreement in which an entity contracts with a physician practice, requiring the
physician practice to provide professional medical services on behalf of the contracting
entity
Physician Hospital Organization (PHO)
(“Clinically Integrated Network”)
Unites Hospital with Physician through a contractual relationship. Usually owned by
Physicians and Hospitals, and in many cases non-profit
Physician Employment Agreement (PEA)
Hospital purchases some or all of a medical practice’s assets and begin employing the
former medical group’s physicians directly
34. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Provider Consolidation
Accountable Care Organizations (ACOs)
• Healthcare organizations with a coordinated set of
providers
• Provider mix dependent on whether it is a federal or
commercial ACO structure
• Share responsibility and accountability for the
continuum of care
• Clinical accountability – Quality of care
• Financial responsibility – Cost of care
“Perspectives on Accountable Care Organizations-ACO Overview” by Robert James Cimasi, 2011 International Expo, Health
Industry Group Purchasing Association & healthcare Industry Supply Chain Institute, Washington, D.C.: Oct. 12-14, 2011, p. 2.
34
34
35. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Different Approaches to Managing the
Entire Continuum of Care for the Patient
Historical Forces:
• Practice of medicine has historically been viewed as a learned profession,
with physicians perceived as professionals who applied their training and
knowledge to provide quality patient care within their independent
practices.
• Shift from physician-owned, independent private practices to captive
practices with multiple affiliations within larger integrated health systems;
another step towards the “corporatization” of professional practices, in
contrast to the “cottage industry” healthcare delivery system of the past.
• Healthcare costs continue to rise faster than inflation, driven by advances in
technology and treatment, as well the increased demand for services from
the growing baby-boomer population
Result: A new healthcare delivery paradigm that promotes a
managed “continuum of care,” in contrast to the current system of
segmented independent provider “silos.”
35
36. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Different Approaches to Managing the
Entire Continuum of Care for the Patient
• Provider affiliations are likely to increase due to:
• Disproportionate number of physicians retiring
• An inadequate supply medical graduates
• Expected continuing growth in patient demand
• The diversification, specialization, and collaboration of
physician and non-physician practitioners will continue
to grow to meet the compounding demand, including:
• Allied health professionals
• Mid-level providers
• Technicians and paraprofessionals
• Complementary and alternative medical practitioners
36
37. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
What Has Changed This Time Around?
• Alignment is being seen as an offensive strategy,
not merely as a defensive one
• Large single and multi-specialty groups are
becoming more common and are often considered
necessary to achieve optimal results
• The loss of autonomy is seen as a fair trade-off for
the benefits of being an employee
• Much more experimentation
• Direct employment is no longer the only option
37
38. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Direct Employment
A Fresh Look at an Old Concept
• Hospitals like the ability to require employees to use their
facilities (except when patient needs dictate otherwise)
• Employment supports the use of clinical guidelines and
emerging concepts such as the medical home
• Provider-based reimbursement is sometimes available
• Easier to invest in EMR technology
• Avoids some of the more difficult aspects of Stark, e.g.,
the severe limits placed on under arrangement deals
38
39. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
39
40. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Merger & Acquisition Volume, 2011-2013
As derived and calculated from reported transactional data from The Healthcare M&A Report by
Irving Levin Associates, INC. Quarterly Reports from 2011 to 2013; Note that of the MD
purchasers, approximately 2/3 were reported as being the original group. As to the remaining 1/3
of reported transactions, that fact may have been true, but was not reported.
40
A B C D E
Year
Total
Deals
Physician
Medical Group
Acquisition
Non-Physician
Medical Group
Acquisition
Reported Dollars
Spent on
Physician Medical
Groups M&A
1 2011 107 6 101 $464 Million
2 2012 68 8 60 $4.4 Billion
3 2013 65 3 62 $583 Million
4 Total 240 17 223 $5.447 Billion
41. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Marcus Welby is Dead
Increasing Complexity of Integration Transactions
41
42. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Types of Tangible and Intangible
Property/Assets in Healthcare
“Valuation of Healthcare Entities and Assets: The Impact of 2010 Legislation” By Robert James Cimasi,
CPA Leadership Institute (11/6/2012) p. 55.
42
43. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
43
“Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services,” Robert
James Cimasi, John Wiley & Sons, 2014, p. 979.
44. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
44
“Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services,” Robert
James Cimasi, John Wiley & Sons, 2014, p. 980.
45. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
Managed Care
Agreements and
Provider Service
Agreements
HMO Enrollment
Lists
Assets
Human Capital-
Related Intangible
Assets
Employee and
Provider
Employee
Agreements
Trained and
Assembled
Workforce In-
Place
Non-Copyrighted
Policies and
Procedures
Depth of
Management
Intellectual
Property-Related
Intangible Assets
Clinical
Practice
Protocols and
Treatment Plans
Copyrights
Trademarks and
Trade names
Patents
Trade Secrets or
Other Know
How
Payor or Client
Related
Operations and
Location Related
Intangible Assets
Historical
Information and
Documentation
Supplier
Contracts
Asset
Assemblage
Factors and
Going Concern
Value
Governance or
Legal Structure
Related Intangible
Assets
Organizational
Documents
Income
Distribution
Plans
Right of First
Refusal
Covenants-Not-
To-Compete
Marketing and
Business
Development
Related Intangible
Assets
Advertising
Franchise/
Licensing
Agreements
Joint Venture
Alliances
Regulatory or
Legal-Related
Intangible Assets
Provider or
Medical Licenses
Certificates of
Need
Medicare
Certification
Other
Certifications and
Accreditations
Financial or
Revenue Stream-
Related Intangible
Assets
Office Share
Arrangements
Management
Service
Agreements
Financing
Agreements
Financial
Derivatives
Technology-
Related Intangible
Assets
Computerized
Management
Information
Systems
Electronic
Medical Records
Maintenance and
Support
Relationships
Patient-Related
Intangible Assets
Custodial
Rights to the
Patient Medical
Charts and
Records
Patient Recall
Lists
Goodwill
Professional
/Personal
Goodwill
Practice/
Commercial
Goodwill
Easements
Permits
Leasehold
Interests
In-Place
Leases
Zoning
Waivers/
Variances
Use Rights
Tangible
Real
Property
Tangible
Personal
Property
Cash and
Investments
Accounts
Receivable
Supplies &
Drugs –
Consumables
and Inventory
Held for Sale
Furniture,
Fixtures, and
Equipment
Leasehold
Improvements
Litigation
Awards and
Liquidated
Damages
Buildings
Land and
Land
Improvements
Subject Property Interest
Tangible Assets Intangible Assets
Intangible
Real
Property
Intangible Personal Property
45
“Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services,” Robert
James Cimasi, John Wiley & Sons, 2014, p. 981.
46. Key Growth Sectors in the Health-Care M&A Market
Sponsored by Regions Bank
46
“Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services,” Robert
James Cimasi, John Wiley & Sons, 2014, p. 982.
47. Webcast: "Key Growth Sectors in the Health-Care
Services M&A Market."
Managed Care Industry M&A Perspectives
May 1, 2014
48. 48
Managed Care Industry M&A Perspectives
Introduction
The Affordable Care Act has caused companies and their executives to turn their attention from
execution to evaluating and implementing strategic initiatives
With the implementation of Health Care Reform, companies are evaluating transactions which
provide both greater scale and diversification
Connolly, an insurance payments auditing company, agreed to acquire iHealth Technologies, a medical claims company
Guardian entered an agreement to acquire Premier Access Insurance, a diversified dental benefits company
Walgreens and Water Street announced an agreement to merge Take Care Employer Solutions with CHS to form a new
worksite health company
Rite Aid signed agreements to acquire Health Dialog and RediClinic to expand its overall health and wellness strategy
Highmark agreed to merge with Blue Cross of Northeastern Pennsylvania
DaVita, the leader in kidney dialysis, acquired HealthCare Partners to enter the physician practice management sector
Private equity firms have remained interested in acquiring payer related companies
Starr Investment Holdings LLC, led by former AIG CEO Hank Greenberg, acquired health insurance claims processor
MultiPlan Inc for $4.4 billion from private equity firms BC Partners Ltd and Silver Lake
KKR acquired two leading Workers’ Comp businesses -- Sedgwick Claims Management Services for $2.4 billion and
Mitchell International for $1.1 billion
Apax Partners acquired One Call Care Management and Align Networks for approximately $3 billion
Goldman Sachs acquired MagnaCare
49. 49
Managed Care M&A Industry Perspectives
Changing Industry Landscape
The Affordable Care Act is dynamically changing the health care landscape by creating both
opportunities and challenges that will require managed care organizations to adapt their traditional
core businesses
Sector Outlooks
Medicaid outlook very favorable due to PPACA expansion
Dual eligibles present significant opportunity for those that can effectively manage the population
Medicare outlook in the long-term is compelling, but near term reimbursement pressures will challenge plans
Individual and small group markets expected to face significant headwinds due to implementation of
Changing
Model
Renewed focus on controlling costs and improving outcomes through enhanced care management
Managing care will require new levels of coordination amongst providers and payers
Will require significant information technology investments
Increased interest in integrated delivery models between providers and payers
Scale and
Diversification
Scale will matter, which will lead to further increases in M&A activity
Consolidators will be looking to diversify product offerings
Increased focus on expansion of care management solutions
Other Concerns
Access to capital will be a critical factor for not-for-profit and provider owned health plans
Overhang with respect to the economic recovery, unemployment rate trends and the impact of sequestration
Ability to pass along annual insurance fee to mitigate any meaningful impact on health plans
50. 50
Managed Care M&A Activity
____________________
Source: Irving Levin Associates, PWC October 2013 White Paper, Barclays research.
Note: Excludes workers’ compensation transactions.
(1) Total combined deal value includes Irving Levin and Barclays research. Deal volume per Irving Levin research.
(2) Only includes data for first quarter 2014.
Deal Value (in millions)
Deal Volume
40
35
30
25
20
15
10
5
$25,000
$20,000
$15,000
$10,000
$5,000
With increased visibility in the post reform era, health plans are expected to continue to use M&A as an
avenue to increase scale, capabilities and diversification
(1)
Managed Care M&A Industry Perspectives
While 2012 was the most robust year for managed care M&A activity since 2005, 2013 and the first
three months of 2014 were relatively quiet
(2)
0
$0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Deal Value Deal Volume
51. 51
Managed Care M&A Industry Perspectives
Recent Acquisition Trends for Managed Care Plans
Medicaid expansion and the need for cost-containing care management solutions have been driving
the vast majority of recent M&A activity
M&A Activity
____________________
Source: Wall Street research.
Government Programs
Commercial plans looking to diversify
away from individual and small group
to minimize expected headwinds from
the exchanges
Medicaid plans looking to capitalize on
Medicaid expansion from PPACA by
entering new states or expanding
footprint in existing geographies via
acquisitions
Medicare Advantage plans looking to
expand their scale in an effort to help
offset expected MA reimbursement
cuts and capitalize on long-term
growth potential
Providers
Health Care Information
Technology
Increased coordination with providers
viewed as an effective tool to more
effectively manage populations
Interest areas include participation in
integrated provider systems and low-cost
alternate site clinics
Particular interest in acquiring services
that enable better management of high
cost populations (chronically ill, elderly,
etc.)
Renewed acquisition appetite of
physician groups by payers
Post reform health care model
requires an expansion of HCIT
capabilities for many plans
Focus on increasing analytic
capabilities for enhanced population
health management
Heath Information Exchange platforms
and solutions will become a necessity
post reform
Payer organizations are vacillating
between vendor relationships and
ownership of core technology
Since 2012, the large managed care companies have invested over $17 billion via acquisitions to improve
positioning and capabilities to serve seniors, low-income individuals, and the dual eligible population
52. 52
Managed Care M&A Industry Perspectives
Recent M&A Activity
Select Medicare
Operations
Pension Plans in
Turkey
PCCM Network Medicaid Contract
(1)
____________________
(1) Acquired non-controlling interest.
53. 53
Managed Care M&A Industry Perspectives
Recent M&A Activity (cont’d)
Select Medicaid
Operations
Arcadian Medicare
Operations in Arizona
CareNex LLC
____________________
(1) Announced sale of 1-800 Contacts to Thomas H. Lee Partners on January 8, 2014.
(2) Acquired minority interest.
(1)
Plus One Health
Management
Other Selected M&A Activity
Target Acquirer Target Acquirer Target Acquirer
Citrus
Universal
Healthcare
Amerigroup
Virginia
Michigan
Ohio
(2)
54. 54
Provider and payer consolidation trends have accelerated over the past several years, and these
trends are expected to continue
Neither provider / payer integration nor provider risk-bearing entities are new
concepts. Provider-owned health plans and other risk bearing provider organizations
(i.e. capitation) have been around since the 1980s
However, few provider-owned plans are truly integrated with the provider owner, and
risk-bearing entities have long histories only in limited geographies
There are approximately 100 provider-owned health plans that manage on average
around 100,000 lives per plan
Strengthen primary care network directly or indirectly
Foster coordination among all participating providers
Remove fee-for-service payment incentives so as to appropriately manage volume
and quality
Foster accountability for total per-capita costs
Provide tools to providers to bear risk and benefit from lower cost / higher quality
Develop limited networks in order to coordinate care and lower cost
Provider and payer
organization
concept
Objectives for
providers and / or
payer
organizations
Managed Care M&A Industry Perspectives
Provider and Payer Integration – An Accelerating Trend
55. 55
Recent consolidation activity has included payer acquisitions of providers
Acquirer /
Target
Highmark formed a
holding company that is
the parent of Highmark
and of new Provider
subsidiary (WPAHS)
WPAHS includes five
acute care hospitals,
1,600 beds, and over
1,700 MDs on staff
Purchase Price = Not
disclosed
Acquisition of more than
75 physicians, 90,000
active patients, including
approximately 27,000
Medicare beneficiaries
Purchase Price = $800
million
NAMM is part of the Aveta’s
family of companies – one of
the largest providers of
managed health care
services
Acquisition of NAMM’s 600
primary care providers and
1,200 specialists
Purchase Price = Not
disclosed
Minority equity
investment by BCBSNC
in FastMed. FastMed is
the largest urgent care
company in North
Carolina and the second
largest urgent care
company in Arizona
Over 320,000 patient
visits in 2012
WPAHS was a
distressed system.
Financial commitments
by Highmark will
maintain provider choice
in the region
WPAHS part of a
broader integrated
delivery network strategy
by Highmark
Driven by local market
dynamics – competitor is
an integrated
provider/payer (UPMC)
Will bolster Florida Blue's
value-based care
presence in Tampa/St.
Petersburg area
Acquisition will continue
to promote
implementation of
additional aligned
incentive models to meet
Diagnostic Clinic Medical
Group’s overall value-based
goals of improving
quality and enhancing
member experiences
while lowering overall
cost
Allows continued expansion
of a successful medical
management model
Extends opportunities for
UnitedHealth Group to build
out further physician
partnerships throughout the
country
NAMM deal adds to strong
Optum footprint in southern
California, which includes
Monarch, AppleCare Medical
Group and Memorial
HealthCare
Strategic collaboration
will allow FastMed Urgent
Care to expand its
network of physician-owned
urgent care clinics
across North Carolina,
while helping to launch
innovative programs and
services for BCBSNC
customers
BCBSNC’s member
population will receive
increased access to
convenient, high quality
urgent care and lower
medical costs
____________________
Source: Company press releases and CapitalIQ.
Transactio
n Summary
Transactio
n Benefits
and
Nuances
Managed Care M&A Industry Perspectives
Recent Provider-Payer Integration Activity
56. Confidential
Cain Brothers’ Disclaimer
This document is for discussion purposes only and does not constitute advice of any kind, including tax, accounting, legal or regulatory advice, and Cain
Brothers & Company, LLC (“Cain Brothers”) is not and does not hold itself out to be an advisor as to tax, accounting, legal or regulatory matters. We
recommend that you seek independent third party legal, regulatory, accounting and tax advice regarding the contents of this document. The matters
discussed herein are subject to our review and assessment from a legal, compliance, accounting policy and risk perspective, as appropriate, following our
discussion with you.
This document was prepared on a confidential basis solely for discussion between you and Cain Brothers and not with a view toward public disclosure. This
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Editor's Notes
Source: U.S. Census Bureau, International Data Base.
2. SOURCE: CDC/NCHS, National Vital Statistics System. Expectation of life, by age, sex, race, and Hispanic origin: United States, 2009