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Examining recent M&A activity in health care

Gabriel Perna | December 22, 2020

Every quarter, Health Evolution will report on the biggest proposed and finalized mergers and acquisitions in the health care industry that occurred over the preceding three months. If we missed any deals, contact us here.

Thanks to the COVID-19 pandemic and subsequent recession, M&A activity in the health care sector will see a decline in deal volume and value after a few steady years of increasing activity.  

While the final numbers are not yet tallied, there was already a 33 percent decline in deal volume and a 91 percent decline in deal value from Q2 2019 to this year, according to data from CapIQ. There was a rebound in Q3 from the depths of the second quarter, but it was still down from 2019 and the last stretch of this year looks like it will fall well short of the number of deals that accumulated in Q4 2019, according to CapIQ’s early numbers.

In fact, thanks to COVID-related challenges, some hospitals and health systems abandoned deals all together. After announcing their intent to merge in June, Advocate Aurora Health and Beaumont Health called it off in October. It was actually the second M&A deal Beaumont called off in 2020—they also called off a deal with Summa Health. Sanford Health and Intermountain actually announced a merger and then called it off—all completely during the fourth quarter of 2020.

But while the pandemic has negatively impacted M&A, it hasn’t slowed down activity entirely. For one thing, the year featured the rise of special purpose acquisition companies (SPAC), which are shell companies created solely to merge with privately held businesses. SPAC acquisitions were frequently seen in health care in 2020, including the final months. Moreover, the autumn months featured a number of deals both large and small in health care, related to SPACs and other entities.

Here are some of the notable ones that were announced or finalized.

 

Providers

Ochsner Health completed a deal to acquire Lafayette General Health the two organizations announced in October. The deal creates a 35-hopsital system and includes a $465 investment across the Acadiana area in Louisiana for the next 10 years. This includes an immediate investment of $94 million at Ochsner Lafayette General Medical Center (LGMC), with a new tower that will feature six inpatient floors.

Sticking with Louisiana, CMC Health in New Orleans announced in October that it completed its acquisition of East Jefferson General Hospital in Metairie. LMC paid $90 million for the 420-bed hospital, and promised it will invest $100 million in its operations over the next five years. The acquisition allows East Jefferson General Hospital to pay off its current bond debt and satisfy all other outstanding financial obligations.

Orlando Health closed on its deal to acquire the Bayfront Health St. Petersburg hospital from Community Health Systems for a total $140 million, including several properties that Bayfront operates. According to the St. Pete Catalyst, Bayfront is the largest hospital in St. Petersburg, with 480 beds, and one of the largest employers, with 1,500 employees as of 2019.

RWJBarnabas Health in New Jersey announced its intent to acquire Trinitas Regional Medical Center, the two organizations announced in November. RWJBarnabas, which will take over as Trinitas’ corporate parent, says it will make significant investments in the Elizabeth-based hospital system. Terms of the deal were not disclosed.

In early December, Cleveland Clinic signed an agreement to acquire Mercy Medical Center from Sisters of Charity Health System. The hospital, based in Southeaster Ohio, is 476-bed facility. Mercy Medical Center will be the second Catholic-affiliated hospital to join the Cleveland Clinic health system, with Marymount Hospital in Garfield Heights, Ohio being the first.

Others: Over the past few months, the Federal Trade Commission has continued to try and block a number of major hospital deals. The agency, with help from state AGs, has tried to stop deals between Philadelphia-based Jefferson Health and Einstein Healthcare Network, New Jersey-based Hackensack Meridian Health and Englewood Health, and Tennessee-based Methodist Le Bonheur Healthcare and Dallas-based Tenet Healthcare…Speaking of Tenet, the national hospital company announced in December that it was acquiring 45 ambulatory surgery centers from SurgCenter Development (SCD) for $1.1 billion….Providence, R.I.-based Care New England rejected a $250 million bid from Pennsylvania-based StoneBridge Healthcare, according to The Providence JournalIn the senior living space, Deerfield Healthcare Technology Acquisitions Corp., announced it is merging with CareMax Medical Group and IMC Medical Group Holdings in a transaction with a combined consideration of $614 million….Atrium and Wake Forest Baptist Health finalized their $11 billion merger in October.

 

Payers

On the last day of September, UnitedHealth Group announced it was acquiring DivvyDose, an online pharmacy startup that competes with Amazon’s PillPack. According to CNBC, the acquisition price was $300 million. DivvyDose ships pre-sorted medications to patients with the dosage information and time and dates they should be taken on each packet. It’s another example of movement in the online pharmacy space with Amazon’s acquisition of PillPack, Walmart’s purchase of CareZone, and a recent funding into Alto Pharmacy being a few other major deals in this space.

Centene will acquire analytics company Apixio,  the insurer announced in November. The deal will bring Apixio’s AI capabilities to the St. Louis-based insurance company. The company’s AI tools take disparate, unstructured patient data (such as physician notes and medical charts), and creates and refines algorithms to extract insights to support payers’ and providers’ administrative activities. Centene also acquired PANTHERx, the largest specialty pharmacy in the U.S., which specializes in dispensing orphan drugs that treat rare diseases. Both deals were for undisclosed amounts.

Molina Healthcare, a managed care company based in Long Beach, California, entered into an agreement to acquire Affinity Health Plan in a deal valued at $380 million. The deal was announced in late September. Affinity is a Medicaid managed care organization serving members in New York City, Westchester, Orange, Nassau, Suffolk, and Rockland counties in New York.

Others: Cigna signed a multiyear deal with national medical group Envision Healthcare in Nashville, the two organizations announced in October….Guidewell, the parent company of Florida Blue, signed an agreement in November to become the majority stakeholder of New Directions Behavioral Health, a managed mental health organization based Kansas…Providence, the health system based in Washington state, and Anthem Blue Cross agreed on a joint-partnership operation with Vivity Health Plan (Vivity) in November… In December, a U.S. district judge gave preliminary approval for a $2.7 billion settlement from Blue Cross Blue Shield insurers. Final approval will take place in 2021.

Read more: How the Blues Antitrust settlement could shake up the health care industry

 

Life Sciences

While life sciences M&A has probably suffered the most of any health care sector from the pandemic recession, there are signs that it will come back to life in 2021. In one of the biggest deals of 2020, AstraZeneca, British/Swedish-based pharma company, announced it was acquiring Alexion, based out of Boston, for $39 billion, the companies announced in Mid December. The deal signals AstraZeneca’s interest in expanding its reach in rare diseases, which is what Alexion specializes in. It is subject to regulatory approvals in various countries and would likely close in Q3 of 2021.

In mid-December, Eli Lilly made an acquisition in the gene therapy space with a $1 billion deal to purchase Prevail Therapeutics, the companies announced. With this purchase, Eli Lilly promised to build out a new gene therapy team that will be anchored by Prevail’s portfolio of clinical-stage and preclinical neuroscience assets.

Agios Pharmaceuticals, based in Cambridge, Mass., said it will offload its oncology portfolio to Servier, an independent global pharmaceutical company, for $1.8 billion, the two companies announced. The deal will allow Agios to solely focus on accelerating and expanding its genetically defined disease portfolio. The deal could reach $2 billion in value if the drug vorasidenib hits certain goals.

Others: Novo Nordisk, based in Denmark, announced it was acquiring New Jersey-based Emisphere Technologies for $1.8 billion. Emisphere uses absorption-enhancing excipient to translate drugs into oral form, Novo said in a November release announcing the deal.Gilead Sciences announced it was acquiring a German biotech startup MYR Pharmaceuticals for $1.4 billion… In the research space, clinical trial health tech firm eResearchTechnology announced it was merging with Bioclinica…In November, Merck went on a spending spree. They announced a deal to buy OncoImmune for its COVID-19 treatment CD24Fc and a few weeks before acquired VelosBio for $2.75 billion.

 

Tech

In October, Livongo and Teladoc announced that their $18.5 billion merger was completed. The deal was announced in August and closed in less than three months, as the two organizations aim to leverage interest in telehealth and virtual health. At the same time, the former Livongo execs, led Chairman Glen Tullman and President Jennifer Schneider, MD, announced they were backing a new blank check health care technology company and are preparing an initial public offering of up to $500 million.

Read more: Why the Teladoc-Livongo merger is a wake-up call for CEOs on consumer health

Chicago-based EHR company Allscripts sold its CarePort care coordination business for $1.35 billion to WellSky. The $1.35 billion deal, which was announced in October, represents a multiple of greater than 13 times CarePort’s revenue over the trailing 12 months, according to the Allscripts press release announcing the deal. It was the second major sell off from Allscripts in the second half of 2020. In July, the EHR company sold its EPSi business to Strata Decision Technology for $365 million.

UpHealth Holdings, Cloudbreak Health and SPAC GigCapital2 announced a combined public digital health company at an enterprise valuation of about $1.35 billion in November. The company will be called UpHealth Inc. and will combine UpHealth’s patient care management, telemedicine and digital pharmacy services with Cloudbreak’s video consultation platform for doctors and patients.

Others: Dutch health tech company Philips acquired BioTelemtry, a Malvern, Penn.-based remote cardiac diagnostics and monitoring company, for a $2.8 billion, the companies announced in mid-December…. PointClickCare Technologies, a cloud-based post-acute EHR vendor, announced its plans to acquire Collective Medical, a care coordination tech company, for $650 million…In a $400 million deal, medication management solutions company CarepathRx announced its plans to acquire part of the University of Pittsburgh Medical Center’s (UPMC’s) Chartwell pharmacy subsidiary…AI startup Olive announced plans to acquire Verata Health, a software company focused on prior authorizations.

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 or on Twitter at @GabrielSPerna