Healthcare Industry: Emerging Trends & Economic Insights

Cain Brothers, a division of KeyBanc Capital Markets, served as the exclusive financial advisor to Clario in connection with the sale of its Software Solutions business to Sitero.

Cain Brothers was engaged to serve as Clario’s financial advisor based on its deep experience across the pharma services continuum, ability to navigate complex transactions and carveouts, and long-standing relationships with the relevant strategic buyers in the space.

Clario is a healthcare research technology company that delivers leading endpoint technology solutions for clinical trials. Clario’s technology platform combines its eCOA, Cardiac Safety, Respiratory and Medical Imaging business lines. Clario’s global team of science, technology and operational experts have helped deliver more than 27,000 trials and contributed to over 500 FDA and EMEA new drug approvals involving more than seven million participants in over 100 countries.

Software Solutions, a Clario business, provides an end-to-end solution to support the clinical trial lifecycle. Software’s eClinical product suite offerings include Clinical Trial Management Systems, Electronic Data Capture, Randomization and Trial Supply Management / Interactive Response Technology, Patient and Site Payments, and eConsent.

Sitero is a next-generation, site-focused CRO that helps the life science industry get treatments to market safer and faster through tech-forward services that streamline research. Sitero’s clinical, drug safety, biosafety, and ethical review services drive compliance and innovation for more than 100 customers worldwide. Sitero partners with clinical trial sponsors across therapeutic areas and from early-phase studies through late-phase and post-market research. Sitero combines the expertise of a tenured team with a nimble, innovative approach to clinical research. Sitero has offices in the U.S., U.K., and India.

Cain Brothers, a division of KeyBanc Capital Markets, served as the exclusive financial advisor to Cordant Health Solutions in connection with the divestiture of its laboratory business. Cordant divested its direct client bill business consisting of laboratories in Arizona and Indiana to DCA Partners, and its 3rd party reimbursed business consisting of laboratories in Massachusetts, New York, and Washington to Navis Clinical Laboratories.

About the Transaction
Cain Brothers was engaged to serve as Cordant’s exclusive financial advisor based on its deep experience in the Laboratory sector, ability to navigate complex transactions and carveouts and its long-standing relationships with buyers in the space.

About Cordant Health Solutions
Cordant Health Solutions provides innovative solutions for clinicians, organizations and payers involved with substance use disorder, pain management and criminal justice cases. Cordant's unique pharmacy and drug testing programs provide accurate, actionable results to protect prescribers, hold patients accountable, and optimize quality of life. Cordant is one of the only healthcare companies that offers monitoring and risk assessment tools through its innovative drug testing options and full-service, high-touch pharmacies.

About DCA Partners
DCA provides growth and buyout capital to promising, growth-oriented, middle-market businesses in under-served markets across the Western United States. DCA partners with top-quality owners and management teams, providing the capital and expertise needed to successfully expand their businesses.

About Navis Clinical Laboratories
Navis Clinical Laboratories is committed to providing cutting-edge toxicological, molecular and clinical laboratory testing solutions. Navis serves healthcare providers in the behavioral health, mental health, chronic pain management and addiction treatment spaces, as well as hospitals and health systems, with the goal of increasing patient access to whole-person healthcare and improving overall health and well-being.

Methodist Healthcare, the joint-venture between HCA Healthcare and Methodist Healthcare Ministries of South Texas, has completed the acquisition of Hill Country Memorial making Hill Country Memorial a part of Methodist Healthcare. An affiliation transaction was completed on April 1, 2023.

Cain Brothers was engaged by Hill Country Memorial as its exclusive sell-side advisor to assist HCM through the sale process and negotiations with Methodist. Cain Brothers brought deep domain expertise in the hospital and health system sector and a strong understanding of the health care market in Texas. This affiliation will help achieve HCM and Methodist’s shared goal of increasing access to care and providing quality healthcare services to patients in the Texas Hill Country region.

Hill Country Memorial is a not-for-profit, non-tax-supported health care network supporting the Hill Country region of Texas since 1971. Located in Fredericksburg, HCM includes an 84-licensed bed general Acute Care Community Hospital, 8 Medical Clinics, one Immediate Care Clinic, and a joint venture Ambulatory Surgery Center.

Methodist Healthcare, a 50-50 co-ownership between Methodist Healthcare Ministries of South Texas, Inc., and HCA Healthcare, is recognized as a leading healthcare provider in South Texas, offering an outstanding selection of doctors, healthcare professionals, equipment and health services. Methodist operates a network of hospitals in the greater San Antonio area, including nine acute care facilities: Methodist Hospital, Methodist Children's Hospital, Methodist Hospital Metropolitan, Methodist Hospital Northeast, Methodist Hospital Atascosa, Methodist Hospital Specialty and Transplant, Methodist Hospital Stone Oak and Methodist Hospital Texsan.

Nashville-based HCA Healthcare is one of the nation’s leading providers of healthcare services comprising 182 hospitals and approximately 2,300 ambulatory sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics, in 20 states and the United Kingdom. With its founding in 1968, HCA Healthcare created a new model for hospital care in the United States, using combined resources to strengthen hospitals, deliver patient-focused care and improve the practice of medicine. 

Cain Brothers, a division of KeyBanc Capital Markets, served as the exclusive financial advisor to Starling Physicians, a leading primary care and multispecialty group in Connecticut, in its sale to VillageMD.

Cain Brothers was engaged to serve as Starling’s exclusive financial advisor based on its deep expertise and experience in the multispecialty physician group space. The transaction builds on VillageMD’s expansion into both the Northeast region and multi-specialty care services.

Starling Physicians is Connecticut’s physician-led multispecialty group, delivering the highest quality medical care to people of all ages. Starling works as a unified team to deliver personalized treatment with compassion and skill, resulting in better outcomes and a more enjoyable healthcare experience. Starling Physicians practice healthcare the way it should be – where patients and doctors form enduring relationships. With Starling Physicians all members of a family can receive outstanding care for a lifetime.

VillageMD provides high-quality, accessible healthcare services for individuals and communities across the United States, with primary, multispecialty, and urgent care providers serving patients in traditional clinic settings, in patients’ homes and online appointments. Committed to serving all patients and working with all payers, VillageMD consistently innovates value-based care, bringing integrated applications, population insights and staffing expertise to its owned and affiliate practices, ensuring high-quality care, better patient outcomes and a reduction in the total cost of care. Through Village Medical, Village Medical at Home, Summit Health, CityMD and other practices, VillageMD serves millions of patients throughout their lives, wherever and whenever they need care. Its dedicated workforce of more than 20,000 operates from 680 practice locations in 26 markets.

Lone View Capital, a growth-oriented private equity firm investing across the technology ecosystem, announced its investment in Trend Health Partners, a leader in credit balance management and payment accuracy solutions for healthcare payers and providers.

Lone View Capital has made a platform investment in Trend Health Partners. Lone View plans to support Trend’s continued rapid growth by enhancing and expanding the solutions it provides to clients while accelerating innovation in the industry. Trend’s management and employees remain significant shareholders.

Cain Brothers was engaged to serve as Trend’s exclusive financial advisor based on its deep HealthTech and Payment Integrity sector knowledge as well as its strong, longstanding relationships with buyers in the space.

Founded in 2018 and Maryland-based, Trend Health Partners is a leader in credit balance management and payment accuracy solutions for healthcare payers and providers. The Company leverages proprietary, state-of-the-art applications and provider relationships to mitigate the complexity of healthcare billing and payments for their payer customers. 

Today, Trend serves more than 50 health plans and 750 hospitals, leveraging its advanced analytics and workflow platform, TRENDConnect, to identify and resolve inaccurate payments while reducing administrative costs for all parties.

Lone View is a growth-oriented private equity firm investing across the technology ecosystem. Lone View’s team comprises both investors and operators who leverage their deep domain and operational expertise to build market-leading businesses. Lone View is based in Los Angeles, CA. 

Cain Brothers, a division of KeyBanc Capital Markets, served as the exclusive financial advisor to Cordant Health Solutions in connection with the divestiture of its laboratory business. Cordant divested its direct client bill business consisting of laboratories in Arizona and Indiana to DCA Partners, and its 3rd party reimbursed business consisting of laboratories in Massachusetts, New York, and Washington to Navis Clinical Laboratories.

About the Transaction
Cain Brothers was engaged to serve as Cordant’s exclusive financial advisor based on its deep experience in the Laboratory sector, ability to navigate complex transactions and carveouts and its long-standing relationships with buyers in the space.

About Cordant Health Solutions
Cordant Health Solutions provides innovative solutions for clinicians, organizations and payers involved with substance use disorder, pain management and criminal justice cases. Cordant's unique pharmacy and drug testing programs provide accurate, actionable results to protect prescribers, hold patients accountable, and optimize quality of life. Cordant is one of the only healthcare companies that offers monitoring and risk assessment tools through its innovative drug testing options and full-service, high-touch pharmacies.

About DCA Partners
DCA provides growth and buyout capital to promising, growth-oriented, middle-market businesses in under-served markets across the Western United States. DCA partners with top-quality owners and management teams, providing the capital and expertise needed to successfully expand their businesses.

About Navis Clinical Laboratories
Navis Clinical Laboratories is committed to providing cutting-edge toxicological, molecular and clinical laboratory testing solutions. Navis serves healthcare providers in the behavioral health, mental health, chronic pain management and addiction treatment spaces, as well as hospitals and health systems, with the goal of increasing patient access to whole-person healthcare and improving overall health and well-being.

Cain Brothers, a division of KeyBanc Capital Markets, served as financial advisor to TPG Growth on its partnership with Novant Health Enterprises, a division of Novant Health, to expand MedQuest Associates.

MedQuest has more than 20 years of experience partnering with hospitals and health systems to develop and execute outpatient radiology strategies, including owning and managing freestanding outpatient and mobile imaging centers, both stand-alone and through joint ventures. As part of this new venture, the initial owned and managed imaging centers span Virginia, North Carolina, Maryland, Mississippi, and South Carolina, and MedQuest intends to quickly expand its services through new joint ventures with healthcare providers across the country. 

Novant Health, a nationally recognized not-for-profit health system, and TPG, a leading global alternative asset management firm, have announced an innovative new partnership to expand MedQuest across the country. TPG’s investment in the partnership is being made through TPG Growth, the firm’s middle market and growth equity platform.

Cain Brothers was engaged to serve as financial advisor to TPG based on its deep industry expertise in outpatient imaging, managed service organizations, and knowledge of the health system landscape, as well as its long-standing relationship with TPG.

Novant Health is an integrated network of physician clinics, outpatient facilities and hospitals that delivers a seamless and convenient healthcare experience to communities in Virginia, North and South Carolina, and Georgia. The Novant Health network consists of more than 2,400 physicians and over 37,000 employees who provide care at more than 800 locations, including 18 hospitals and hundreds of outpatient facilities and physician clinics. In 2021, Novant Health was the highest-ranking healthcare system in North Carolina to be included on Forbes’ Best Employers for Diversity list. Diversity MBA Magazine has also included Novant Health on its 2020 list of “Best Places for Women & Diverse Managers to Work.” In 2020, Novant Health provided more than $1.02 billion in community benefit, including financial assistance and services. 

TPG is a leading global alternative asset management firm, founded in San Francisco in 1992, with $135 billion of assets under management and investment and operational teams in 12 offices globally. TPG invests across five multi-product platforms: Capital, Growth, Impact, Real Estate, and Market Solutions and our unique strategy is driven by collaboration, innovation, and inclusion. TPG’s combined teams combine deep product and sector experience with broad capabilities and expertise to develop differentiated insights and add value for our fund investors, portfolio companies, management teams, and communities. 

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to AvMed Inc., a not-for-profit health plan in Florida, on its acquisition by Sentara Healthcare, one of the largest not-for-profit integrated health care delivery systems in the U.S. Mid-Atlantic region. Previously owned by SantaFe Healthcare, the transaction for AvMed was closed on December 31, 2022. 

Cain Brothers was engaged to serve as exclusive financial advisor to AvMed and SantaFe Healthcare based on its deep expertise and experience in the managed care sector, especially within the not-for-profit space, as well as its long-standing relationship with SantaFe Healthcare and AvMed. The Cain Brothers team executed a targeted and highly competitive process to identify the optimal partner for AvMed.

AvMed is a Florida-based health plan headquartered in Miami. More than 200,000 members count on AvMed for commercial group, individual and Medicare Advantage coverage. Members have the support of nearly 500 employees and a network of more than 35,000 providers.

Sentara Healthcare celebrates more than 130 years in pursuit of its mission – “we improve health every day.” Sentara is a not-for-profit integrated health care delivery system with approximately 30,000 employees (including 1,375 physicians and advanced practice providers), 12 hospitals in Virginia and Northeastern North Carolina and the Sentara Health Plans division which serves over 1.2 million members. Sentara is recognized nationally for clinical quality and safety, and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health’s “Top 15 Health Systems” in 2021 and 2018, and was recognized by Forbes as a “Best Employer for New Grads” and “Best Employer for Veterans” in 2022, “Best Employer for Women” in 2020, and one of “America’s Best Employers” in 2018.

Cain Brothers, a division of KeyBanc Capital Markets, served as financial advisor to Arlington Capital Partners on its acquisition of AVS Bio from Charles River Laboratories International, Inc. (NYSE:CRL). To support the acquisition, on December 20, 2022, KeyBanc Capital Markets Inc. successfully closed the syndication of Senior Secured Credit Facilities, consisting of a Senior Secured Revolving Credit Facility and a Senior Secured Term Loan. KBCM acted as Left Lead Arranger, Joint Bookrunner, and Administrative Agent on the Credit Facilities.

Cain Brothers was engaged to serve as financial advisor to ACP based on its deep domain expertise and experience in the Life Sciences sector, as well as its long-standing relationship with ACP.

Arlington Capital Partners is a Washington, DC-based private equity firm that has managed approximately $7 billion in capital commitments. Arlington is focused on middle market investment opportunities in growth industries including healthcare, government services and technology, aerospace and defense, and business services and software. The firm’s professionals and network have a unique combination of operating and private equity experience that enables Arlington to be a value-added investor. Arlington invests in companies in partnership with high quality management teams that are motivated to establish and/or advance their company’s position as leading competitors in their field.

Headquartered in Norwich, CT, AVS Bio is a global provider of specific pathogen-free eggs and adjacent laboratory products and services that support the development and manufacturing of vaccines, therapeutics, and other biologics used for human and animal health. Prior to its acquisition by Arlington, the Company operated as a subsidiary of Charles River. The Company currently employs ~250 employees across 20+ facilities in Connecticut, New York, Illinois, Missouri, and Europe.

Founded in 1947 and based in Wilmington, MA, Charles River is an early-stage contract research organization offering services and solutions focused on the discovery, development, and manufacturing of pharmaceuticals. Charles River covers a broad portion of the early-stage research process from discovery through pre-clinical development and offers its services and solutions to a diversified, global customer base consisting of pharmaceutical companies, biotechnology companies, government agencies, hospitals, and academic institutions.

On December 14, 2022, Cain Brothers successfully closed the Massachusetts Development Finance Agency Revenue Bond, D’Youville Senior Care Issue Series 2022 on behalf of D’Youville Senior Care and its sponsor, The Carmelite System.

Proceeds from the Series 2022 Bonds were used to refinance and streamline two existing bank loans, fund capital improvements on D’Youville’s campus and pay costs of issuance. The refinancing served to mitigate future interest rate risks in a rising interest rate environment, avoid future expensive call premiums on the prior loans and provide near-term cash flow relief to D’Youville. The variable rate Series 2022 Bonds are priced off of the index of 1-Month Term SOFR. In order to hedge against the interest rate risk of the variable rate Series 2022 Bonds, Cain Brothers served as Swap Advisor to D’Youville on a long-dated fixed-pay interest rate swap. The swap was structured with a 10-year cancellation option to mirror the put feature on the Series 2022 Bonds. Cain Brothers also assisted in the creation of a Master Trust Indenture to standardize the lender’s security package and streamline future debt obligations. 

Cain Brothers acted as Loan Arranger and Swap Structuring Agent.

D’Youville is a Massachusetts based not-for-profit corporation that operates multiple senior care facilities. D’Youville consists of a 208-bed nursing home, 33-bed short term rehab facility and a 60-unit assisted living facility. The sole corporate member of D’Youville is The Carmelite System. The Carmelite System is a New York not-for-profit corporation and the sole corporate member of several not-for-profit corporate affiliates that serve communities in Florida, Illinois, Iowa, Kentucky, Massachusetts, New York, Ohio and Ireland. The Carmelite System was formed in 1999 as a Catholic not-for-profit health system sponsored by the Carmelite Sisters for the Aged and Infirm and has been a long-standing client of Cain Brothers. 

Cain Brothers, a division of KeyBanc Capital Markets, served as financial advisor to GCX Mounting Solutions and Audax Private Equity on the acquisition of Jaco, Inc.

Cain Brothers was engaged to serve as financial advisor to GCX Corporation based on its deep expertise and experience in the medical technologies sector, as well as its long-standing relationship with Audax.

GCX, based in Petaluma, CA, has been providing medical device and IT mounting solutions for the healthcare industry since 1971, through direct sales and working with original equipment manufacturers. Major product lines include wall mounts, roll stands, countertop mounts, pole mounts, and a variety of mounting accessories. GCX mounting solutions feature space-saving, ergonomic designs to improve both equipment and patient access. The company has offices in North America, Europe, Japan and Taiwan. It also operates warehouse and production facilities in Petaluma, California; El Paso, Texas; and New Taipei City, Taiwan.

Audax Group is a leading alternative investment manager with offices in Boston, New York, San Francisco and London. Since its founding in 1999, the firm has raised over $32 billion in capital across its Private Equity and Private Debt businesses. Audax Private Equity has invested over $9 billion in more than 150 platforms and over 1,100 add-on companies and is currently investing in add-ons out of its $3.5 billion, sixth private equity fund. Through its disciplined Buy & Build approach, Audax seeks to help platform companies execute add-on acquisitions that fuel revenue growth, optimize operations, and significantly increase equity value. With more than 360 employees and over 150 investment professionals, the firm is a leading capital partner for North American middle market companies.

Jaco, Inc., located in Franklin, Massachusetts, is a leading manufacturer and integrator of computer carts and wall-arm workstations for point-of-care Electronic Health Records. Proudly manufacturing in the United States of America for over 50 years, Jaco has set the healthcare industry standard for superior infection control, ergonomic design and safety, sustainable quality and unmatched capital equipment investment value. Jaco is an ISO 9001-2008 Registered Company.

MultiCare Health System and Yakima Valley Memorial have announced plans for Memorial to become a wholly owned subsidiary of MultiCare. An Affiliation Agreement was signed in October 2022. This transaction is subject to routine regulatory approval as well as customary closing conditions and is expected to close in early 2023.

Cain Brothers, a division of KeyBanc Capital Markets, was retained by MultiCare as its exclusive buy-side advisor to assist MultiCare through the acquisition process and negotiations with Memorial. Cain Brothers brought deep domain expertise in the hospital and health system sector and a strong understanding of the Washington health care market. This affiliation will help achieve MultiCare and Memorial’s shared goal of retaining and expanding local access to health care and improving the quality and cost of care for Yakima Valley communities. Under the terms of the agreement, MultiCare will invest in new programs, implement an integrated electronic health record system, strengthen the hospital’s role as the leading health care hub in Central Washington, and help provide a sustainable future for Yakima’s only hospital. The Central Washington health system will become a part of MultiCare in early 2023 and its name will change to MultiCare Yakima Memorial Hospital at that time.

MultiCare is a not-for-profit health care organization that has been caring for communities in Washington state since the founding of Tacoma’s first hospital in 1882. MultiCare has grown from a Tacoma-centric, hospital-based organization into the largest, not-for-profit, community-based, locally owned health system in the State of Washington. With more than 20,000 team members, its network of care includes 11 hospitals and 240+ clinics in both the Puget Sound and Inland Northwest regions.

Yakima Valley Memorial is a not-for-profit health system with nearly 3,000 team members and is the largest employer in Yakima County. Memorial has been providing quality patient care to the Yakima Valley for 72 years. Memorial comprises a 226-bed hospital, primary care practices and specialty care services including cardiac care, cancer care through North Star Lodge, breast health at Ohana Mammography Center, acute hospice and respite care at Cottage in the Meadow, pain management at Water’s Edge, the only level-3 NICU in Central Washington, and advanced services for children with special health care needs at Children’s Village.

Orlando Health, a leading not-for-profit integrated health system providing care across the full spectrum of healthcare services to patients throughout central Florida, has completed the acquisition of Sabanera Health Dorado, a newly built 107-bed state-of-the-art acute care hospital, from Triple-S Management and PRISA Group.

This transaction expands Orlando Health’s footprint outside of Florida and into Puerto Rico, a new market with significant opportunities to improve access and quality of care. The partnership will enhance healthcare in Puerto Rico, strengthen relationships between Orlando and Puerto Rican physicians, and provide interconnected healthcare to thousands who travel between the two locations. The transaction is a huge step in taking the newly built facility to its next level of excellence and benefiting all residents of Puerto Rico’s northern region while solidifying the efforts to promote medical tourism on the island.

As part of the transaction, Orlando Health is joining forces with Doctors’ Center Hospital, a leading health system on the island that will continue to manage the day-to-day operations of the hospital.  The hospital will rebrand as Doctors’ Center Hospital | Orlando Health Dorado. Orlando Health’s commitment to Puerto Rico, in partnership with DCH, creates a unique cross-market opportunity that raises the bar for high-quality healthcare delivery on the island.   

Cain Brothers was engaged to serve as Orlando Health’s exclusive buy-side advisor on the transaction.

Founded more than 100 years ago, Orlando Health is a not-for-profit health system with $8 billion of assets under management that serves the southeastern United States. Its 3,200-bed system includes 10 award-winning hospitals, 9 hospital-based ERs, 7 free-standing emergency rooms, and more than 4,200 physicians representing more than 100 medical specialties and subspecialties. In FY21, Orlando Health served more than 160,000 inpatients and 3.6 million outpatients.

Located just west of San Juan in Dorado, Puerto Rico, SHD is a newly built, state-of-the-art 107-bed acute care hospital that opened in March 2022. The medical complex includes 75 single patient private rooms and 20 suites, eight intensive care units, four neonatal intensive care units, and a 20,000 square foot multi-specialty clinic providing integrated, coordinated, and continued care to patients resulting in more effective treatments and an improvement in the health status of the area’s population.

Founded in 1959, DCH is one of the leading healthcare systems in Puerto Rico. Its network of hospitals, emergency rooms, modern multi-specialty clinics, and centers provide services to the north region of the Island, and its medical faculty consists of more than 500 doctors and 2,000 employees. Doctors’ is recognized for its patient-centered service driven by the highest standards of Safety, Excellence, and Compassion.