Globally, private equity (PE) buyouts in healthcare reached a three year high at $29.6 billion in 2014, with deal volume relatively steady, research by Bain & Company finds. Total M&A activity in healthcare has however almost doubled, with strategic investors involved in $380 billion worth of deals. IPOs became an increasingly strong exist strategy for PE funds, while the value of firms sold to strategic investors increased in value from $22 billion in 2013 to $34 billion in 2014.
Healthcare systems are coming under increasing funding pressures globally, as governments and private providers look to contain reducing costs. According to a recent Bain & Company report, titled ‘Global Healthcare Private Equity Report 2015’, the effect of cost reductions has been a corresponding increase in M&A activity – with healthcare firms looking to pick up high growth assets, ditching low growth assets and make use of profitable taxation rules.
The largest segment of the total healthcare M&A activity in 2014 came from the activity of strategic players – with a total of $380 billion in deals. While deal volume only increased 5% and is still below levels in 2012, the total value almost doubled to record levels.
The reasons for the record activity come from several fronts, with a flood of cheap capital, resulting from continued low interest rates, and the need to find new growth engines in the wake of expiring patents and slowing healthcare expenditures, driving activity.
PE fund buyouts
For PE funds looking to expand their portfolios into healthcare, 2014 showed mixed results. The value of healthcare related buyouts reached a three-year high of $29.6 billion, which is nearly a doubling of the levels in 2013. Deal volume however dropped slightly (10%) from those of 2013, to 188. The value of deals came particularly from an increase in midsized deals – between $500 million and $1 billion.
The strategic reasoning behind the deals has not greatly changed over the past years, according to the consulting firm. Some investors were seeking ‘gem’ assets – and paying a premium for them; some funds were seeking to deploy their turnaround capabilities, therefore buying up carve-outs; with a lack of super-deals, large institutional investors moved down-market; while ‘buy-and-build’ investments too were part of the mix, with many firms building out previously acquired platform assets and a few firms buying new platforms.
The number of buyout-backed exits increased very slightly on 2013, with 1 more transaction than the year before. Of exists, IPOs increased in popularity – up from 31 in 2013 to 38 in 2014. While sale to strategic investors dropped slightly, from 70 to 63.
While the deal volume to strategic buys decreased slightly, the value of those deals increased significantly, up from $22 billion in 2013 to $34 billion in 2014. With Bain’s expectation that “PE firms to keep taking advantage of attractive exit opportunities and to continue investing in portfolio value-creation activities to best position their assets for eventual exit.”
PE activity regionally and in target market
The location and volume of deals has not change greatly over the past years, with 188 deals in 2014 compared to 209 deals in 2013 and 195 deals in 2012. Both Europe and North America had high numbers of deals, yet the Bain analysis notes that investors could not find a great deal of good quality high price assets to buyout.
While the kinds of healthcare companies drawing investors too has remained relatively stable, with ‘provider and related services’ remaining almost unchanged in terms of investor interest, the ‘medtech and related services’ grew significantly for investor interest between 2013 and 2014. Europe particularly increased its appetite for companies even as interest in ‘biopharma and related services’ waned in the region.
Commenting on the increased number of PE healthcare buyouts, Nirad Jain, a Bain partner and author of the report, says: "It used to be that prominent healthcare PE deals occurred only here and there, but momentum has steadily ticked up. In 2014, they made up 11% of PE buyout deals overall. This progression is a result of disruptive changes in healthcare that are enabling access to more efficient and affordable care, while also creating opportunities for PE to aid and accelerate those changes.”