Private Equity Health Care Acquisitions – May 2024

In light of continued investor interest in healthcare and the risks associated with private equity ownership of healthcare companies, the Private Equity Stakeholder Project is tracking private equity-backed healthcare acquisitions. Below is a list of private equity healthcare buyouts, growth investments, and add-on acquisitions completed or announced during May 2024. We will continue to track acquisitions on a monthly basis.

See April 2024 acquisitions here.

In May 2024, we tracked five buyouts, 33 add-on acquisitions, and 24 growth/expansion investments.

Dental care

At seven deals, dental care saw the highest number of deals of the categories PESP tracks. Three of these deals were add-on acquisitions made by private equity firm Quad-C Management to its platform company Specialized Dental Partners, a Dental Services Organization (DSO). Quad-C Management has been voraciously adding dental practices to Specialized Dental Partners – in 2023 alone, it made 31 add-on acquisitions.[1]

Specialized Dental has over 200 affiliated dental practices in over 35 states.[2] Its May acquisitions include locations in Arizona, Massachusetts, and Illinois.[3]

Private equity firms have increasingly been investing in the US dental industry through DSOs. DSOs handle the business side of dental practices, such as administrative, marketing, bookkeeping, and financial services. As of 2021, private equity firms dominated the DSO market; 9 of the top 10 DSOs in the US were owned by private equity firms. Private equity firms owned 27 of the top 30 DSOs, accounting for 84% of practice locations affiliated with the top 30 firms.[4]

Private equity-owned DSOs have been found to employ cost cutting tactics that can hurt patient care, including pushing medically unnecessary or expensive procedures and understaffing while attempting to maximize patient volume. These companies also provide an avenue for private equity firms to skirt around regulations. Both the DSO and physician practice management industries appear to have been created, largely by private equity firms, to bypass regulations that prohibit investor ownership of clinical practices.[5]

Despite challenges in exiting their dental care investments,[6] private equity firms are continuing to make new investments in this space. In PESP’s analysis of private equity deals in healthcare for 2023, dental care accounted for the second highest number of deals (146 deals) of the categories PESP tracks.[7]

These deals are primarily add-on acquisitions, which is when a private equity uses a platform company to “roll-up” smaller companies. Such acquisitions allow firms to engage in “stealth consolidation.” That’s because most add-on acquisitions do not meet the Hart-Scott-Rodino threshold that triggers antitrust review by the Federal Trade Commission (the 2024 threshold is $119.5 million.)[8]

The FTC and Justice Department’s (DOJ) Antitrust Division recently launched a public inquiry to identify serial acquisitions and roll-up strategies throughout the economy, such as what is seen in the dental care space, that have led to consolidation that has harmed competition. The inquiry includes a focus on private equity’s specific strategies.[9]

Youth behavioral services

The area of youth behavioral services, which includes services for youth with intellectual and developmental disabilities, services for youth in foster care, troubled teen programs, youth residential treatment centers, and autism services,[10] saw two new private equity investments in May 2024.

Autism services
Private equity firm Optimal Investment Group acquired autism services provider, Spectrum Behavioral Therapies, in a leveraged buyout.[11] Spectrum Behavioral Therapies offers various autism-related services, included Applied Behavioral Analysis (ABA) therapy to children and young adults.[12] Facilities that offer ABA therapy have become particularly attractive targets for investors due to the growing number of autism diagnoses and the fact that the “ABA industry charges tens of thousands of dollars per client per year for services insurers are legally obligated to cover,” according to STAT.^[13]

Because of private equity’s typical playbook that aims to make outsized profits over short time horizons, private equity investment in autism services has recently come under scrutiny. Some families and clinicians believe that investors’ focus on profits has degraded the quality of care at private equity-owned ABA providers.^[14]

Youth residential treatment
Lago Innovation Fund, a division of Lago Asset Management, made a growth investment in Youth Opportunity for an undisclosed amount.[15] Youth Opportunity provides residential behavioral health care for adolescents, as well as operates juvenile detention centers. It has 20 locations across Florida, Michigan, Tennessee and Texas.[16]

Youth Opportunity’s juvenile detention centers have been criticized for dangerous conditions and policy failures, including a “a culture of fear and humiliation,” failing to provide necessary therapeutic and medical care, and “unclean” conditions.[17]

Youth residential treatment centers, as well as private equity involvement in this space, have come under scrutiny from advocacy groups and policymakers in recent years.[18] In response to growing allegations of abuse and neglect at these types of facilities, the Senate Committee on Finance held a hearing on June 12, 2024 to investigate the issue[19] and released a 136 page investigatory report on youth residential treatment facilities operated by four providers: Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare.[20] Vivant has the same CEO as a company called Sequel Youth and Family Services,  which was acquired by private equity firm Altamont Capital Partners in 2017. According to the Senate Finance Committee report, “In 2021, after being plagued by reporting on abuse and neglect allegations, Sequel sold 13 facilities to a newly-incorporated company, Vivant Behavioral Health (Vivant).”[21] The report highlights a disturbing incident in which a 16-year old boy died in the hospital after a violent incident in which seven staff members had restrained him at a Sequel facility in Michigan in 2020. The medical examiner ruled his death a homicide by asphyxiation.[22]

One youth detention facility in Florida that was formerly operated by Sequel[23] is now operated by Youth Innovation.[24]

A report from PESP in 2022 identified cost-cutting tactics at private equity-owned youth behavioral health companies, such as cutting staff, relying on unlicensed staff, and failing to maintain facilities, which can lead to abuse, neglect, and unsafe living conditions for youth under the care of those companies.^[25]

Table 1: Buyouts

Table 2: Add-on acquisitions

Table 3: Growth/Expansion Investments

Resources

[1] Bugbee, Mary, Eileen O’Grady, and Michael Fenne. “Private Equity in U.S. Healthcare: Trends in 2023 Deal Activity.” Private Equity Stakeholder Project, March 6, 2024. https://pestakeholder.org/private-equity-healthcare-2023-trends/.

[2] Specialized Dental Partners website. Accessed June 14, 2024. https://specializeddental.com/partnership/

[3] Pitchbook, Specialized Dental Partners investments. https://my.pitchbook.com/profile/435555-28/company/profile#investments ;  Gargiulo Periodontics (IL), Mesa Implants & Periodontics (AZ), Life Dental Specialties (MA).

[4] O’Grady, Eileen. “Deceptive Marketing, Medicaid Fraud, and Unnecessary Root Canals on Babies: Private Equity Drills into the Dental Care Industry.” Private Equity Stakeholder Project, July 2021. https://pestakeholder.org/wp-content/uploads/2021/08/PESP_DSO_July2021.pdf.

[5] O’Grady, Eileen. “Deceptive Marketing, Medicaid Fraud, and Unnecessary Root Canals on Babies: Private Equity Drills into the Dental Care Industry.” Private Equity Stakeholder Project, July 2021. https://pestakeholder.org/wp-content/uploads/2021/08/PESP_DSO_July2021.pdf.

[6] Bradley, Janelle. “Pulling Teeth: Why Dental Sector Exits Have Been Tough for PE.” PitchBook (blog), May 30, 2024. https://pitchbook.com/news/articles/private-equity-dental-exits.

[7] Bugbee, Mary, Eileen O’Grady, and Michael Fenne. “Private Equity in U.S. Healthcare: Trends in 2023 Deal Activity.” Private Equity Stakeholder Project, March 6, 2024. https://pestakeholder.org/private-equity-healthcare-2023-trends/.

[8]Federal Trade Commission. “New HSR Thresholds and Filing Fees for 2024,” February 1, 2024. https://www.ftc.gov/enforcement/competition-matters/2024/02/new-hsr-thresholds-filing-fees-2024.

[9] Federal Trade Commission. “FTC and DOJ Seek Info on Serial Acquisitions, Roll-Up Strategies Across U.S. Economy,” May 23, 2024. https://www.ftc.gov/news-events/news/press-releases/2024/05/ftc-doj-seek-info-serial-acquisitions-roll-strategies-across-us-economy.

[10] O’Grady, Eileen. “The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth.” Private Equity Stakeholder Project, February 2022. https://pestakeholder.org/wp-content/uploads/2022/02/PESP_Youth_BH_Report_2022.pdf.

[11] Larson, Chris. “Optimal Investment Group Acquires Autism Provider Spectrum Behavioral Therapies.” Behavioral Health Business, May 13, 2024. https://bhbusiness.com/2024/05/13/optimal-investment-group-acquires-autism-provider-spectrum-behavioral-therapies/; “PitchBook Profile – Spectrum Behavioral Therapies.” Accessed June 25, 2024. https://my.pitchbook.com/profile/597564-46/company/profile#deal-history.

[12] “Discover Breakthrough With Autism Intervention Strategies,” March 13, 2024. https://sbtaba.com/autism-intervention-strategies/.

[13] Bannow, Tara. “The Private Equity Firms, like Blackstone and KKR, behind 8 of the Biggest Names in Autism Therapy.” STAT, August 15, 2022. https://www.statnews.com/2022/08/15/private-equity-autism-therapy-major-names/.

[14] Bannow, Tara. “Parents and Clinicians Say Private Equity’s Profit Fixation Is Short-Changing Kids with Autism.” STAT, August 15, 2022. https://www.statnews.com/2022/08/15/private-equity-autism-aba-therapy/.

[15] “PitchBook Profile – Youth Opportunity.” Accessed June 10, 2024. https://my.pitchbook.com/profile/494241-85/company/profile#general-info; Lago Innovation Fund. “PORTFOLIO.” Accessed June 10, 2024. https://www.lagoinnovation.com/portfolio.

[16] “Locations – Youth Opportunity.” Accessed June 7, 2024. https://youthopportunity.com/locations/.

[17] Mariah Timms, “Nashville juvenile detention center operator withdraws, prompting emergency contract,” The Tennessean, Jule 29, 2022. https://www.tennessean.com/story/news/crime/2022/07/29/embattled-youth-opportunity-pulls-out-juvenile-detention-center/10175316002/ ; Tori Gessner, “‘Culture of fear and humiliation’: Scathing report raises safety, ethical, sanitary concerns over Gallatin facility for at-risk youth,” WKRN, August 9, 2023. https://www.wkrn.com/news/local-news/report-raises-safety-ethical-concerns-over-tn-at-risk-youth-facility/

[18] Reedy, Caitlin. “Murray, Wyden Demand Answers on Mistreatment at Youth Residential Treatment Facilities.” Senator Patty Murray (blog), July 22, 2022. https://www.murray.senate.gov/murray-wyden-demand-answers-on-mistreatment-at-youth-residential-treatment-facilities/; Pg. 3 of Eileen O’Grady. “The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth.” Private Equity Stakeholder Project PESP, February 17, 2022. https://pestakeholder.org/news/the-kids-are-not-alright-how-private-equity-profits-off-of-behavioral-health-services-for-vulnerable-and-at-risk-youth/.

[19] “Youth Residential Treatment Facilities: Examining Failures and Evaluating Solutions | The United States Senate Committee on Finance.” Accessed June 11, 2024. https://www.finance.senate.gov/hearings/youth-residential-treatment-facilities-examining-failures-and-evaluating-solutions.

[20] “Warehouses of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities.” Senate Committee on Finance, June 2024. https://www.finance.senate.gov/imo/media/doc/rtf_report_warehouses_of_neglect1.pdf.

[21] Pg. 6 of “Warehouses of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities.” Senate Committee on Finance, June 2024. https://www.finance.senate.gov/imo/media/doc/rtf_report_warehouses_of_neglect1.pdf.

[22] Pg. 10 of “Warehouses of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities.” Senate Committee on Finance, June 2024. https://www.finance.senate.gov/imo/media/doc/rtf_report_warehouses_of_neglect1.pdf.

[23] The Florida Department of Juvenile Justice, “Comprehensive Accountability Report: Residential Services,” 2016-17. Accessed June 14, 2024. https://www.djj.state.fl.us/content/download/21299/file/%282016-17-car%29-residential-%28final%29.pdf pg. 10.

[24] Florida Department of Juvenile Justice, Kissimmee Youth Academy. Accessed June 14, 2024. https://www.djj.state.fl.us/programs-facilities/residential-facilities/kissimmee-youth-academy

[25] Eileen O’Grady. “The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth.” Private Equity Stakeholder Project PESP, February 17, 2022. https://pestakeholder.org/news/the-kids-are-not-alright-how-private-equity-profits-off-of-behavioral-health-services-for-vulnerable-and-at-risk-youth/.