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M&A

2021 saw a big rebound for M&A activity in health care

Gabriel Perna | January 12, 2022

When it comes to M&A, 2021 was the year of the rebound for many sectors within health care. 

According to PwC, pharmaceutical and life sciences M&A rebounded in 2021 with an increase of 52 percent in deal volume from 2020 and a 46 percent increase in deal value. Kauffman Hall found that while the number of hospital M&A deals shrunk from 2021 to 2020, the deals included more mega-mergers (transactions in which the seller or smaller partner by revenue had more than $1 billion in annual revenue). When it comes to health services M&A, PwC said that outside of hospitals, every other sector saw growth in both deal value and deal volume. Through mid-November, deal volume was up 57 percent year over year and deal value was up 227 percent. A few weeks before the end of the year, White & Case’s analysis determined that deal value was on pace to break a record.  

All in all, it was a fruitful year for M&A. And 2022 could be an even bigger year, according to PwC’s experts quoted in the above reports. “The pandemic’s not over but health services and private equity firms are finding plenty of opportunities to invest and grow. That said, resilience and unlocking value are front and center as competitive and regulatory pressures loom,” said Nick Donkar, US Health Services Deals Leader.  


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Glenn Hunzinger, US Pharmaceutical & Life Sciences Consulting Solutions Leader at PwC, said:  
“We should see an exceptional level of activity across all sectors in 2022 as companies look to further their growth agenda. Biotech and smaller medical device deals should continue in the first half of the year, with the second half poised for larger deals driven by a need for scale and an expected settling of the regulatory landscape.” 

Here are some of the major deals of Q4 2021.  

Providers 

Oak Street Health bought specialty virtual care provider RubiconMD for $130 million in October. Rubicon’s specialist network covers major specialties including cardiology, nephrology, and pulmonology. The company will be integrated into Oak Street’s existing care model. “The average patient experience to access specialty care is poor; it’s frustrating, confusing and slow to navigate health plan networks and jump through hoops for authorizations and billing,” Geoff Price, co-founder and chief operating officer at Oak Street Health, said during a call announcing the acquisition.  

In October, Jefferson Health and Einstein Healthcare finalized their merger completing a process that began three years prior. The deal had faced a lawsuit from the FTC that was eventually denied by an appellate court and later dropped. “The culmination of the multiyear process of bringing two great organizations with more than 300 combined years of service, clinical excellence and academic expertise is not just a merger,” said Stephen Klasko, MD, former president of Thomas Jefferson University and CEO of Jefferson Health (he retired at the end of 2021). In November Jefferson also acquired the remaining 50 percent stake in Health Partners Plans (HPP) from Temple University Health System for $305 million. 

Another deal was closed when LifePoint Health and Kindred Healthcare finalized their transaction to merge in late October. The two companies agreed to break off a new company, ScionHealth, which will consist of 79 hospital campuses in 25 states, including Kindred’s 61 long-term acute care hospitals and 18 of LifePoint’s community hospitals. Meanwhile, LifePoint will combine its 65+ remaining hospital campuses as well as its network of physician practices and outpatient centers with Kindred’s rehabilitation and behavioral health businesses. “With the launch of ScionHealth and growth of LifePoint Health, our organizations will advance healthcare for the communities we serve, while building upon Kindred’s legacy and commitment to the Louisville business community as a strong corporate citizen, significant employer, and care innovator,” said Benjamin A. Breier, CEO of Kindred Healthcare, who, upon close, departed Kindred Healthcare as a result of the transaction. 

Tenet Healthcare continued its buying spree of ambulatory surgery centers when it acquired SurgCenter Development’s ambulatory business for approximately $1.1 billion. It’s the second deal that Tenet has made with SurgCenter. The two sides inked a $1.1 billion deal in December of 2020. It also acquired nine ambulatory surgery centers from Compass Surgical Partners. The new deal between Tenet and SurgCenter will expand Tenet’s ASC subsidiary, United Surgical Partners International’s (USPI’s) reach to more than 440 facilities across 35 states. Through the arrangement, the company will expand its presence in markets including Florida and enter new markets, such as Michigan.  

Other deals…HCA Healthcare finalized the sale of 47 Brookdale Health Care Services agencies to Lafayette, La.-based LHC GroupHCA also finalized the sale of Redmond Regional Medical Center in Rome, Georgia to AdventHealth. In 2021, HCA sold five Georgia hospitals for a total of $1.5 billion…City of Hope cancer institute acquired Cancer Treatment Centers of America for a reported $390 million. 

 

Tech 

One of the biggest, most headline-grabbing deals in the health care world occurred when Oracle bought EHR giant Cerner for $28.3 billion. The deal putting together a legacy tech company with a legacy health IT company follows the Microsoft acquisition of Nuance that occurred earlier in 2021 (and is still awaiting final approval). “Working together, Cerner and Oracle have the capacity to transform healthcare delivery by providing medical professionals with better information—enabling them to make better treatment decisions resulting in better patient outcomes,” said Larry Ellison, chairman and chief technology officer, Oracle, in a statement. 

Read more: Oracle, Cerner and the EHR innovation opportunity ahead 

Athenahealth was sold to Bain Capital and Hellman & Friedman for a reported $17 billion. The company was sold by Veritas Capital and Elliott Investment Management, which took the company private back in 2019 in a deal valued at $5.9 billion after an activist campaign led by Elliot. Athenahealth’s co-founder and longtime CEO Jonathan Bush was forced to resign amid allegations including domestic abuse and sexual harassment. Current chairman and CEO Bob Segert will continue to lead Athenahealth and said the recent sale was a significant milestone for the EHR company.  

In October, TransUnion, a credit report agency, sold its health care data and analytics business to nThrive for $1.74 billion in cash. Later in December, nThrive completed the transaction and said it would combine the assets of TransUnion and its current offerings to create an “end-to-end” revenue cycle management solution. In 2021, TransUnion Healthcare generated approximately $190 million in revenue and served 1,850 hospitals and 650,000 physicians. 

Babylon, a digital health company, began trading on the New York Stock Exchange in October after going public through its a business combination with Alkuri Global Acquisition Corp., a special purpose acquisition company.  The organization later bought Higi, a consumer health engagement company,​ for an undisclosed price. The goal is to combine Babylon’s technology platform with Higi’s remote monitoring capabilities.  

Other deals…23andMe bought Lemonaid Health, a virtual care and pharmacy provider, for $400 million….Best Buy finalized its deal to acquire Current Health for $400 million. Read more: Current Health CEO on what’s exciting, and scary, about being acquired by Best BuyHeadspace and Ginger finalized their merger to create Headspace Health in October. Read more:Headspace, Ginger merge to form Headspace Health: An interview with CEO Russell GlassAnd this week Headspace acqired AI-driven mental health and wellness company Sayana…Virgin Pulse, the employer wellness arm of Virgin Group, announced it acquired Welltok for an undisclosed price…Lightbeam Health acquired CareSignal, which offers remote patient monitoring, for an undisclosed price. 

 

Life Sciences 

Pharma giant Johnson & Johnson announced it was splitting into two companies: one focused on consumer health and the other on pharmaceutical and medical device products. The pharma/med device side would generate, according to Johnson & Johnson’s estimates, close to $77 billion in annual revenues, while the consumer health division would bring in $15 billion annually. The company based these estimates on numbers from 2021 revenues.  J&J says that the planned transition will take 18 to 24 months. Incoming CEO Joaquin Duato, who is set to take over from current chief Alex Gorsky in early 2022, will continue to lead Johnson & Johnson’s pharma/med device business after the separation. It’s unclear who will be CEO of the consumer business.   

Read more: How GE and J&J breakups impact the larger health care world 

Merck completed an $11.5 billion transaction to acquire Acceleron Pharma in one of the biggest biotech deals of 2021. The acquisition faced obstacles through antitrust challenges and a revolt from one of Acceleron’s activist investors. But at the end of the quarter, it had gone through and as a result gave Merck more potential medications for rare diseases and its cardiovascular pipeline, which are Acceleron’s specialties. The company has a drug approved by the FDA that treats a group of bone marrow cancers as well as anemia associated with the blood disorder beta thalassemia. It also has a drug candidate to treat pulmonary arterial hypertension (PAH). It was the first deal for Merck under new CEO Rob Davis, who replaced outgoing CEO Kenneth Frazier in July.  

Australian-based pharma company CSL acquired Vifor Pharma for $11.7 billion. Vifor has developed medications in the areas of iron deficiency, nephrology and cardio-renal therapies. Paul Perreault, CEO of CSL, said in a release: “Vifor Pharma will also expand our presence in the rapidly growing nephrology market, while giving us the opportunity to leverage our complementary scientific expertise.” 

Pfizer announced it acquired Arena Pharmaceuticals for $6.7 billion. Arena is a clinical stage company developing innovative potential therapies for the treatment of several immuno-inflammatory diseases. Arena’s portfolio includes diverse and promising development-stage therapeutic candidates in gastroenterology, dermatology, and cardiology, including etrasimod, an oral, selective sphingosine 1-phosphate (S1P) receptor modulator currently in development for a range of immuno-inflammatory diseases including gastrointestinal and dermatological diseases. Mike Gladstone, Global President & General Manager, Pfizer Inflammation and Immunology: “Utilizing Pfizer’s leading research and global development capabilities, we plan to accelerate the clinical development of etrasimod for patients with immuno-inflammatory diseases.” 

Other deals… Sanofi entered into an agreement to acquire Amunix Pharmaceuticals for $1.1 billion to add to its immuno-oncology pipeline…Novo acquired Dicerna Pharmaceuticals for $3.3 billion. Dicerna has RNAi technology that enables access to intracellular disease targets across hepatic and extrahepatic cell and tissue types…In October, Takeda acquired GammaDelta Therapeutics for an undisclosed price. 

Payers 

As usual, the payer space was a little less active than the other sectors within health care. There were a few deals in the fourth quarter of 2021.  

Molina Healthcare acquired AgeWell New York’s Medicaid Managed Long Term Care business for approximately $110 million. 

Cigna said it will sell its life, accident and supplemental benefits business in seven countries in the Asian Pacific region to insurance company Chubb in a deal valued at $5.75 billion. David M. Cordani, president and CEO, Cigna:  “We are proud of our success in building these life, accident and supplemental benefits businesses in Asia Pacific and improving the well-being and sense of security of our customers throughout the region.” 

Anthem announced in November it is acquiring Integra Managed Care for an undisclosed sum from Personal Touch Holding. Integra provides home health services to 40,000 Medicaid enrollees based in New York. “The acquisition aligns with our goal of growing Anthem’s Medicaid business, while serving our members with a comprehensive and coordinated approach to care,” Felicia Norwood, executive vice president of Anthem’s government business division, said in a news release. 

Zing Health, a Medicare Advantage health plan startup, finalized its agreement to acquire Lasso Healthcare 

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email at gabrielp@healthevolution.com or on Twitter at @GabrielSPerna