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Private Equity Healthcare Acquisitions – November 2021

In light of the growing investor interest in health care and the risks associated with private equity ownership of health care companies, the Private Equity Stakeholder Project will be tracking private equity-backed health care acquisitions. Below is a list of private equity health care buyouts and add-on acquisitions completed or announced during November 2021. We will continue to track acquisitions on a monthly basis.

See October 2021 acquisitions here.

Athenahealth – Hellman & Friedman and Bain Capital

In a $17 billion deal, private equity firms Hellman & Friedman (H&F) and Bain Capital announced they will acquire healthcare software company Athenahealth. It is one of the largest healthcare buyouts of the year.[1]

Athenahealth is owned by private equity firm Veritas Capital and hedge fund Elliott Investment, which took the company private for $5.7 billion in 2018.[2]

This is the second major healthcare buyout for H&F this year, which also participated in the $34 billion buyout of Medline Industries this summer. The Medline buyout is largest deal of its kind since the 2008 financial crisis and includes almost $15 billion in debt.[3]

Athenahealth’s software includes tools for electronic health records (EHR) and medical billing and collections, also known as revenue cycle management (RCM).  RCM companies specialize in the collection of medical debt, a service that cash-strapped hospitals pay to outsource.[4] Athenahealth currently partners with more than 140,000 hospitals and ambulatory care providers in every US state.[5]

Private equity firms are increasingly investing in RCM companies; in 2021, there were at least 43 private equity acquisitions of companies that do revenue cycle management valued at $21.4 billion. This compares to 2011, when there were 20 deals valued at $7.4 billion.[6]

Source: Pitchbook, Inc.

While abuses pervade the medical debt collection industry, private equity firms’ ownership of RCM companies raises particular concern. Earlier this year, an analysis by PESP of Consumer Financial Protection Bureau (CFPB) data found that private equity-owned RCM companies face high numbers of debt-related consumer complaints, particularly related to attempts to collect a debt that is not owed, either because it had already been paid, was the wrong amount, or targeted the wrong individual.

See: How Private Equity Profits from Aggressive Medical Debt Collection

Innovacare – Bain Capital

Bain Capital will acquire Innovacare, a physician practice management group with 30 medical clinics across Florida.[7]

Bain’s acquisition of the company is part of a wave of private equity investment in management service organizations (MSO), where private-equity-owned MSOs take over the business functions of physicians’ practices. This often includes management, billing, staffing, credentialing, accounting, and other services. Private equity firms typically acquire or create a platform company, which then makes add-on acquisitions of smaller providers with the goal of expanding regionally and beyond. Physician specialty groups, such as dermatology, orthopedics, and anesthesia, in particular have seen substantial private equity investment.[8]

Bain Capital has a checkered history of healthcare company ownership. For example, Bain used to own pediatric home health company Aveanna Healthcare with private equity firm J. H. Whitney. A 2019 investigation by Bloomberg News found that Avenna was cited for numerous safety violations while under Bain and Whitney’s ownership, with at least seven children dying under its care in just one year. Aveanna employees interviewed by Bloomberg said that company pressure to make a profit jeopardized the quality of care. Employee bonuses at Aveanna were overwhelmingly (90%) tied to earnings growth, patient care hours provided and cash collection, while patient satisfaction and clinical outcomes together counted for just 10%.[9]

Bain also owned CRC Group, a behavioral healthcare company that ran addiction treatment and “troubled teen” programs across the US. Under Bain’s ownership CRC and its subsidiary, Aspen Education Group, faced allegations of widespread abuse and neglect at its facilities.

Private Equity Buyouts

CompanyTypePE Firm
Inovalon HoldingsHealth tech22C Capital, Insight Partners, Nordic Capital
Ro HealthStaffingAchieve Partners
Iodine SoftwareHealth techAdvent International
Leinco TechnologiesBiopharmaceuticalsAmpersand Capital Partners
Avera eCareTelehealthAquiline Capital Partners
Cube BiotechBiopharmaceuticalsArchiMed
M2 OrthopedicsPractice managementArchimedes Health Investors, Heritage Medical Systems, The Firmament Group
Alvogen GroupPharmaceuticalsAztiq Pharma Partners, Innobic
InnovaCare HealthPractice managementBain Capital
AthenahealthRevenue cycle managementBain Capital, Government of Singapore Investment Corporation (GIC), Hellman & Friedman
VorroHealthHealth techBasis Vectors
MJH Life SciencesHealthcare consultingBDT Capital Partners
CIVCO RadiotherapyMedical devicesBlue Wolf Capital Partners
Nevada Behavioral Health SystemsBehavioral healthBPEA Private Equity
VorroHealthVitamin supplementsButterfly Equity
EMS Management and ConsultantsRevenue cycle managementBV Investment Partners
Infusion for HealthInfusion therapyCimarron Healthcare Capital, Oak HC/FT
BioAgilytix LabsMedical suppliesCinven
Perkins Biomedical ServicesMedical devicesCopley Equity Partners
Leiters HealthMedical suppliesFrazier Healthcare Partners, H.I.G. Capital, Intermountain Ventures, Kaiser Permanente Ventures, Mayo Clinic, Novant Health, Rex Health Ventures, Spectrum Health Ventures, SV Health Investors, University of North Carolina Health Care System, Welsh, Carson, Anderson & Stowe
Pacific Fertility CentersFertility servicesGelman Brothers
Genesis ResearchPharma consultingGHO Capital
Rectangle HealthRevenue cycle managementGI Partners
U.S. Medical ManagementHome health and hospiceHLM Venture Partners, Oak HC/FT, Rubicon Founders, Valtruis
American Health StaffingStaffingLittlejohn & Co.
KaleoPharmaceuticalsMarathon Asset Management
ImagineSoftwareRevenue cycle managementMarlin Equity Partners
Lighthouse Lab ServicesPractice managementMartis Capital, NaviMed Capital
CalciumHealthcae marketingNexPhase Capital
U.S. Oral Surgery ManagementOral surgeryOak Hill Capital
Summit Behavioral HealthcareBehavioral healthPatient Square Capital
US Health PartnersPractice managementSilversmith Capital Partners
Executive Home Care FranchisingHome careThe Riverside Company
BioCareSDBiopharmaceuticalsVistria Group
Stateserv MedicalMedical devicesWindRose Health Investors

Private Equity Add-On Acquisitions

CompanyTypePE FirmAdd-on Platform
North Suburban Vision ConsultantsEye careACE & Company, Golub Capital BDC, J.P. Morgan), Riata Capital Group, Unusual VenturesAEG Vision
Guidemark HealthHealthcare consultingArsenal Capital PartnersPharma Value Demonstration
ArcherhealthcareHealthcare marketingAudax Group, Odyssey Investment PartnersTrialCard
Basic LaboratoryLaboratory servicesAurora Capital Group, The Cambria GroupPace Analytical Services
MedbioHealthcare suppliesBerwindCaplugs
Abingdon Hearing CareHearing careBeverly Capital, Northstar Capital, Thompson Street Capital PartnersAlpaca Audiology
Hughes Family Hearing Aid CenterHearing careBeverly Capital, Northstar Capital, Thompson Street Capital PartnersAlpaca Audiology
iMedRISHealth techBratenahl Capital Partners, Primus Capital, Quad PartnersCayuse
Jmi LaboratoriesPharmaceuticalsBridgepoint Advisers, Temasek HoldingsElement Materials Technology
Worcester Physical Therapy ServicesPhysical therapyCalera CapitalBay State Physical Therapy
Suburban OtolaryngologyHearing careCandescent Partners, Harvey & CompanyENT Partners
Digital ArtefactsHealth techCGI Partners, McKesson Ventures, NovaQuest Capital ManagementClinical Ink
Omni IPA Medical GroupManaged careChicago Pacific Founders, Leavitt Equity PartnersP3 Health Partners
Albany Physical Therapy (United States)Physical therapyChurchill Asset Management, Gryphon InvestorsPhysical Rehabilitation Network
HealthCare SupportStaffingCornell Capital, Trilantic North AmericaIngenovis Health
PreventimedPractice managementCrestline InvestorsGenuine Health Group
SuitXMedical devicesEQTOttobock
Schedule360Health techFrancisco Partners, ICONIQ CapitalQGenda
Health FidelityHealth techFrancisco Partners, TA Associates ManagementEdifecs
Frontida BiopharmBiopharmaceuticalsFrazier Healthcare Partners, Thomas H. Lee PartnersAdare Pharma Solutions
ProComp SoftwareHealth techGPB CapitalCantata Health
Advanced Physical Therapy And Sports MedicinePhysical therapyGreat Point PartnersSpine & Sport Physical Therapy (San Diego)
USOC MedicalHealthcare devicesInsight EquityCSAT Solutions
Colorado Springs Urological AssociatesUrologyLee Equity PartnersSolaris Health
Michigan Institute of UrologyUrologyLee Equity PartnersSolaris Health
Healthcare Real Estate CapitalHealthcare consultingMadison Dearborn PartnersKaufman, Hall and Associates
Dr. Profet Health & Wellness CenterPimary careMBF Healthcare PartnersPalm Medical Centers
Fields Healthcare ResearchPatient data collectionMubadala Investment Company, Thoma BravoMedallia
Cincinnati Eye InstituteEye carePartners GroupEyecare Partners
The Eye Institute of West FloridaEye carePartners Group 
Silver Linings Hospice CareHospicePharos Capital GroupCharter Health Care Group
CareSignalHealthcare devicesPrimus CapitalLightbeam Health Solutions
Change & Innovation AgencyHealth techRealization Capital PartnersGetInsured
Envigorate Healthcare SolutionsHealthcare cost managementRenovus Capital PartnersFutura Mobility
Arcadia Hospice of SEPAHospiceRevelstoke Capital PartnersThe Care Team
Rural SolutionsPractice managementRevelstoke Capital Partners, WP Global PartnersFast Pace Health Urgent Care
Adelson Eye & Laser CenterEye careRidgemont Equity PartnersSunvera Group
Endoscopy Development CompanyMedical devicesRoundTable Healthcare PartnersAmerican Optics
Mountain Empire Eye PhysiciansEye careSheridan Capital PartnersAtlantic Vision Partners
Center for Allergy & Asthma CareENT serrvicesShore Capital PartnersSouthern Ear, Nose, Throat and Allergy Partners
Scott & Christie Eyecare AssociatesEye careShore Capital PartnersEyeSouth Partners
LacrimedicsMedical devicesShore Capital PartnersInnovia Medical
Appco PharmaPharmaceuticalsThe Carlyle GroupViyash Pharmaceuticals
Medical Machining SpecialstsMedical devicesThe Jordan CompanyArch Global Precision
MUSE MicroscopyMedical devicesVisionary Private Equity GroupPredictive Health Diagnostics
Retina Associates of UtahEye careWebster Equity PartnersRetina Consultants of America
Interim HealthCare (Treasure Coast Franchise)Home health and hospiceWellspring Capital ManagementInterim HealthCare
The Columbus OrganizationLaboratory servicesWelsh, Carson, Anderson & StoweCareSource Management Services

[1]https://www.nytimes.com/2021/11/22/business/athenahealth-hellman-friedman-bain-capital.html

[2]https://www.cnbc.com/2021/11/20/bain-capital-hellman-are-reportedly-near-an-athenahealth-buyout-deal.html

[3]https://www.ft.com/content/5c1e4817-0a42-4de5-a281-baad2149a40f

[4]https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3593887 pg. 78.

[5]https://www.healthcareitnews.com/news/athenahealth-bought-private-equity-firms-hellman-friedman-bain-capital

[6] Pitchbook, accessed December 2, 2021.

[7]https://innovacarehealth.com/about/

[8]https://www.modernhealthcare.com/physicians/specialty-physician-groups-attracting-private-equity-investment

[9]https://www.bloomberg.com/news/features/2019-10-22/death-and-deals-sick-children-suffer-private-equity-profits

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