Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services...

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Transcript of Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services...

Page 4: Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x 3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - - 3/5/2018

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Date Target Buyer(s) SegmentAmount

($ in Mil)

TEV/

Rev

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EBITDA3/28/2018 Albert Einstein Healthcare Network Jefferson Health System, Inc. General Providers - - -

3/21/2018 Children's Eye Care LLC MEDNAX, Inc. Specialty Providers - - -

3/21/2018 NxThera, Inc. Boston Scientific Corp. Medical Devices & Products 406.00 - -

3/19/2018 Vyaire Medical, Inc. Apax Partners (UK) Ltd. Medical Devices & Products 435.00 - -

3/16/2018 LifeScan, Inc. Platinum Equity LLC Medical Devices & Products 2,100.00 1.40x -

3/12/2018 Sarnova, Inc. Patricia Industries AB Medical Product Distribution 903.00 - -

3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x

3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - -

3/5/2018 EmergiNet LLC (Clinical Operations) Team Health, Inc. Specialty Providers - - -

2/14/2018 CardiacAssist, Inc. LivaNova Plc Medical Devices & Products 250.00 - -

1/21/2018 Bioverativ, Inc. Sanofi Medical Devices & Products 10,886.92 9.32x 23.13x

Strategic90%

Financial10%

Page 5: Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x 3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - - 3/5/2018

Strategic Buyer Inv. Date Select Corporate Acquisitions

MEDNAX 3/27/2018 ▪ Cool Springs Interventional PLLC

3/21/2018 ▪ Children's Eye Care LLC1/10/2018 ▪ Tri-Valley Neonatal Medical Group, Inc.10/18/2017 ▪ Synergy Radiology Associates, PA10/2/2017 ▪ Palm Beach Pediatric Urology P.A9/28/2017 ▪ Jefferson Radiology PC / Jefferson Imaging Associates LLC8/23/2017 ▪ Radiology Associates of South Florida PA6/20/2017 ▪ Greater Nashville Perinatology Plc

Quest Diagnostics 1/23/2018 ▪ MedXM MSO, Inc.

10/30/2017 ▪ California Laboratory Associates10/18/2017 ▪ Cleveland HeartLab, Inc.9/28/2017 ▪ Shiel Medical Laboratory, Inc.6/12/2017 ▪ Med Fusion LLC6/12/2017 ▪ ClearPoint Diagnostic Laboratories LLC

Envision Healthcare Corp. 3/1/2018 ▪ Chandler Radiology Associates LLP

7/5/2017 ▪ Infinity Healthcare, Inc.6/29/2017 ▪ Anesthesia Associates of New London PC3/7/2017 ▪ Imaging Advantage LLC1/6/2017 ▪ Emergency Professional Services PC1/4/2017 ▪ Sunshine Radiology LLC3/14/2017

Dermatology Center PCPharmScript 3/6/2018 ▪ ARxCare LLC

3/5/2018 ▪ Vinze Pharmacare, Inc.9/7/2017 ▪ Medcart Pharmacy

Financial Buyer Inv. Date Select Corporate Investments3/14/2017 ▪Dermatology Center PCGryphon Investors 3/9/2018 ▪ Newbury Park Dental Studio

3/7/2018 ▪ Accent Physical Therapy LLC3/7/2018 ▪ Champion Physical Therapy LLC3/7/2018 ▪ Professional Therapies of Roanoke, Inc.3/7/2018 ▪ West Rehab & Sports Mediicine, Inc.11/1/2017 ▪ Emergency Response & Training Solutions, Inc. 7/6/2017 ▪ OB Hospitalist Group, Inc.6/26/2017 ▪ Spine & Sport Foundation, Inc.3/14/2017

Dermatology Center PCCI Capital Partners 2/12/2018 ▪ Dermatology Associates, Inc.

11/13/2017 ▪ R. Todd Plott, M.D., P.A.

6/20/2017 ▪ Dermatology Associates of Oklahoma LLC

3/22/2017 ▪ Procare Physical Therapy, Inc.

Summit Partners 12/1/2017 ▪ CBM Pathology

11/1/2017 ▪ CytoPath PC

5/15/2017 ▪ Cleveland Skin Pathology Laboratory, Inc.

10/7/2016 ▪ The ALARIS Group, Inc.

ABRY Partners 11/22/2017 ▪ North Valley Dermatology

(U.S. Dermatology Partners) 11/21/2017 ▪ Center for Advanced Dermatology

10/16/2017 ▪ Medical Center Dermatology, PA10/16/2017 ▪ Lakeway Dermatology & Skin Cancer Center PA1/25/2017 ▪ Austin Dermcare Mso PLLC

SV Health Investors 3/6/2018 ▪ Dermone LLC (Clinics 9)(Clear Clinic & Schweiger Dermatology Management Co.) 9/12/2017 ▪ Island Dermatology PC

5/4/2017 ▪ Village Dermatology & Cosmetic Surgery LLC3/8/2017 ▪ Lower Manhattan Medical Associates PC

Page 6: Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x 3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - - 3/5/2018

-30%

-25%

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-15%

-10%

-5%

0%

5%

10%

15%

20%

Dental Products & Providers Medical Devices & Products Medical Product DistributionSpecialty Providers Pharma Services Practice ManagementProvider Services Long Term & Behavioral Care General ProvidersS&P 500

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

Change

YTD

Change

% of 52

Week High

Est.

Revenue

Growth

EBITDA

Margin

TEV/

Rev

TEV/

EBITDA

Price/

EPS

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NTM

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NTM

EBITDA

Zimmer Biomet Holdings, Inc. ZBH 22,151$ 109.04$ -9.6% -9.6% 81.7% 2.5% 36.0% 4.1x 11.3x 12.3x 4.0x 11.2x

Align Technology, Inc. ALGN 20,124 251.13 13.0% 13.0% 87.4% 32.5% 28.6% 13.2x 49.5x 88.7x 10.2x NM

DENTSPLY SIRONA, Inc. XRAY 11,439 50.31 -23.6% -23.6% 72.9% 7.1% 23.4% 3.2x 15.3x (7.4x) 3.0x 13.5x

Henry Schein, Inc. HSIC 10,330 67.21 -3.8% -3.8% 71.9% 8.1% 8.8% 1.0x 12.0x 25.1x 1.0x 11.4x

Cantel Medical Corp. CMN 4,647 111.41 8.3% 8.3% 90.1% 14.6% 19.2% 5.8x 31.1x 51.6x 5.0x 24.6x

Patterson Cos., Inc. PDCO 2,104 22.23 -38.5% -38.5% 46.0% (0.1%) 5.2% 0.6x 7.1x 8.6x 0.6x 9.6x

BIOLASE, Inc. BIOL 42 0.41 -4.8% -4.8% 28.0% 8.6% (30.9%) 0.6x NM (1.5x) 0.4x (1.5x)

Pro-Dex, Inc. PDEX 30 6.85 0.7% 0.7% 85.6% 10.0% 13.2% 1.0x 5.5x 11.9x 1.0x 8.9x

Milestone Scientific, Inc. MLSS 24 0.72 -39.0% -39.0% 40.0% 25.5% (63.2%) 1.9x NM (4.5x) 1.5x NM

Birner Dental Management Services, Inc. BDMS 13 7.00 3.7% 3.7% 45.2% NM (0.8%) 0.4x 54.0x (4.9x) NM NM

Segment Average $7,090 (9.4%) (9.4%) 64.9% 12.1% 4.0% 3.2x 23.2x 18.0x 2.9x 11.1xSegment Median $3,376 (4.3%) (4.3%) 72.4% 8.6% 11.0% 1.5x 13.6x 10.2x 1.5x 11.2x

Market Stats Operating Stats LTM Multiples NTM Multiples

Page 7: Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x 3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - - 3/5/2018

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

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Change

% of 52

Week High

Est.

Revenue

Growth

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Margin

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EPS

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NTM

EBITDA

Johnson & Johnson JNJ 343,780$ 128.15$ -8.3% -8.3% 86.4% 7.1% 25.7% 4.7x 14.3x NM 4.5x 12.3x

Medtronic Plc MDT 108,728 80.22 -0.7% -0.7% 89.4% 4.1% 31.9% 4.1x 13.1x 39.3x 4.0x 12.4x

Abbott Laboratories ABT 104,640 59.92 5.0% 5.0% 92.8% 14.3% 22.0% 4.5x 23.9x NM 4.0x 15.6x

Stryker Corp. SYK 60,041 160.92 3.9% 3.9% 94.7% 10.2% 27.2% 5.2x 19.0x 60.0x 4.8x 16.8x

Becton, Dickinson & Co. BDX 57,695 216.70 1.2% 1.2% 87.2% 36.7% 28.4% 6.5x 23.4x NM 4.3x 12.9x

Intuitive Surgical, Inc. ISRG 46,675 412.83 13.1% 13.1% 91.3% 15.2% 39.3% 13.4x 35.0x 72.8x 12.8x 29.7x

Boston Scientific Corp. BSX 37,688 27.32 10.2% 10.2% 91.3% 9.4% 27.7% 4.7x 17.9x NM 4.3x 14.9x

Baxter International, Inc. BAX 34,979 65.04 0.6% 0.6% 89.6% 7.7% 19.4% 3.3x 15.7x 50.5x 3.2x 13.4x

Edwards Lifesciences Corp. EW 29,303 139.52 23.8% 23.8% 97.4% 14.5% 29.6% 8.4x 26.3x 51.7x 7.6x 22.9x

Zimmer Biomet Holdings, Inc. ZBH 22,151 109.04 -9.6% -9.6% 81.7% 2.5% 36.0% 4.1x 11.3x 12.3x 4.0x 11.2x

ABIOMED, Inc. ABMD 12,884 290.99 55.3% 55.3% 95.6% 36.6% 31.3% 23.1x 83.5x NM 17.5x NM

Integra LifeSciences Holdings Corp. IART 4,344 55.34 15.6% 15.6% 95.1% 26.2% 23.6% 5.1x 22.5x 67.5x 4.0x 17.0x

Wright Medical Group NV WMGI 2,097 19.84 -10.6% -10.6% 62.9% 11.2% 17.8% 3.8x 36.3x NM 3.4x 23.5x

Market Stats Operating Stats LTM Multiples NTM Multiples

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

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YTD

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% of 52

Week High

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EBITDA

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EBITDA

Price/

EPS

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NTM

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EBITDA

Danaher Corp. DHR 68,385$ 97.91$ 5.5% 5.5% 93.4% 7.3% 24.9% 4.1x 17.1x 27.7x 4.0x 16.7x

Stryker Corp. SYK 60,041 160.92 3.9% 3.9% 94.7% 10.2% 27.2% 5.2x 19.0x 60.0x 4.8x 16.8x

McKesson Corp. MCK 29,067 140.87 -9.7% -9.7% 78.8% 4.5% 1.8% 0.2x 9.1x 6.4x 0.2x 8.3x

Cardinal Health, Inc. CAH 19,726 62.68 2.3% 2.3% 75.7% 5.5% 2.5% 0.2x 8.6x 10.9x 0.2x 8.3x

AmerisourceBergen Corp. ABC 18,938 86.21 -6.1% -6.1% 81.1% 11.7% 1.4% 0.1x 8.3x 19.5x 0.1x 8.4x

Henry Schein, Inc. HSIC 10,330 67.21 -3.8% -3.8% 71.9% 8.1% 8.8% 1.0x 12.0x 25.1x 1.0x 11.4x

Patterson Cos., Inc. PDCO 2,104 22.23 -38.5% -38.5% 46.0% (0.1%) 5.2% 0.6x 7.1x 8.6x 0.6x 9.6x

Owens & Minor, Inc. OMI 961 15.55 -17.6% -17.6% 44.5% 7.8% 2.2% 0.2x 7.6x 13.0x 0.2x 5.9x

Aceto Corp. ACET 234 7.60 -26.4% -26.4% 44.4% (2.5%) 7.0% 0.7x 7.0x NM 0.7x 9.0x

Market Stats Operating Stats LTM Multiples NTM Multiples

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($ in Mil)Price ($)

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Fresenius Medical Care AG & Co. KGaA FMS 31,444$ 51.08$ -2.8% -2.8% 88.2% 12.0% 15.5% 2.0x 12.3x 21.5x 1.8x 9.6x

DaVita, Inc. DVA 12,001 65.94 -8.7% -8.7% 81.7% 8.3% 20.8% 2.0x 10.1x 19.0x 1.9x 10.3x

Encompass Health Corp. HLS 5,611 57.17 15.7% 15.7% 96.4% 7.8% 21.3% 2.2x 10.2x 21.3x 2.0x 10.1x

MEDNAX, Inc. MD 5,251 55.63 4.1% 4.1% 79.7% 9.6% 16.7% 2.0x 12.1x 16.1x 1.8x 11.0x

Envision Healthcare Corp. AMSG 4,649 38.43 11.2% 11.2% 60.0% 9.4% 12.0% 1.5x 10.9x NM 1.3x 11.4x

LHC Group, Inc. LHCG 1,126 61.56 0.5% 0.5% 80.9% 16.6% 6.3% 1.2x 14.6x 22.1x 0.7x 7.1x

American Renal Associates Holdings, Inc. ARA 612 18.85 8.3% 8.3% 78.3% 9.8% 24.3% 1.9x 8.9x NM 1.7x 12.0x

AAC Holdings, Inc. AAC 281 11.48 27.6% 27.6% 87.9% 9.7% 12.7% 1.5x 12.4x NM 1.3x 6.4x

Market Stats Operating Stats LTM Multiples NTM Multiples

Page 8: Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x 3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - - 3/5/2018

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

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YTD

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TEV/

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HCA Healthcare, Inc. HCA 34,196$ 97.00$ 10.4% 10.4% 90.8% 5.8% 20.4% 1.6x 8.3x 16.3x 1.5x 8.1x

Universal Health Services, Inc. UHS 10,303 118.41 4.5% 4.5% 92.4% 15.0% 17.1% 1.5x 8.8x 15.2x 1.3x 8.5x

Tenet Healthcare Corp. THC 2,452 24.25 60.0% 60.0% 96.1% (5.6%) 15.9% 1.0x 8.6x NM 1.1x 7.6x

LifePoint Health, Inc. LPNT 1,832 47.00 -5.6% -5.6% 69.2% 1.9% 7.0% 0.8x 7.2x 18.7x 0.8x 6.5x

Community Health Systems, Inc. CYH 454 3.96 -7.0% -7.0% 37.7% (10.5%) (6.4%) 0.9x 13.7x NM 1.0x 9.2x

Market Stats Operating Stats LTM Multiples NTM Multiples

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

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YTD

Change

% of 52

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Est.

Revenue

Growth

EBITDA

Margin

TEV/

Rev

TEV/

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EPS

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WellCare Health Plans, Inc. WCG 8,622$ 193.63$ -3.7% -3.7% 87.3% 11.4% NM 0.3x NM 23.3x 0.3x 6.4x

HealthEquity, Inc. HQY 3,690 60.54 29.7% 29.7% 88.1% 26.5% 21.9% 15.0x 49.0x 78.6x 12.1x 30.8x

Market Stats Operating Stats LTM Multiples NTM Multiples

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

Change

YTD

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Est.

Revenue

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EBITDA

Margin

TEV/

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EBITDA

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EBITDA

Cerner Corp. CERN 19,241$ 58.00$ -13.9% -13.9% 78.5% 9.8% 28.5% 3.7x 12.3x 22.6x 3.4x 10.9x

Healthcare Services Group, Inc. HCSG 3,204 43.48 -17.5% -17.5% 77.4% 14.2% 7.1% 1.6x 23.0x 36.5x 1.5x 18.4x

Omnicell, Inc. OMCL 1,683 43.40 -10.5% -10.5% 78.3% 13.1% 14.4% 2.6x 30.0x 81.9x 2.3x 14.2x

HMS Holdings Corp. HMSY 1,396 16.84 -0.6% -0.6% 80.6% 10.2% 23.4% 3.0x 13.8x 35.8x 2.8x 11.9x

Evolent Health, Inc. EVH 1,066 14.25 15.9% 15.9% 51.8% 38.1% (0.9%) 2.1x NM NM 1.3x 29.0x

Providence Service Corp. PRSC 890 69.14 16.5% 16.5% 92.8% 2.0% 5.7% 0.5x 13.1x 22.6x 0.6x 11.1x

Market Stats Operating Stats LTM Multiples NTM Multiples

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

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YTD

Change

% of 52

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Est.

Revenue

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EBITDA

Margin

TEV/

Rev

TEV/

EBITDA

Price/

EPS

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EBITDA

CVS Health Corp. CVS 63,172$ 62.21$ -14.2% -14.2% 74.1% 3.5% 7.8% 0.5x 7.1x 9.7x 0.5x 7.1x

Express Scripts Holding Co. ESRX 38,791 69.08 -7.4% -7.4% 81.2% 1.3% 8.0% 0.5x 7.2x 8.9x 0.5x 7.0x

Perrigo Co. Plc PRGO 11,738 83.34 -4.4% -4.4% 86.9% 3.1% 21.3% 2.9x 12.9x NM 2.9x 12.3x

Magellan Health, Inc. MGLN 2,605 107.10 10.9% 10.9% 97.5% 33.3% 5.5% 0.5x 9.9x 23.7x 0.3x 6.7x

Allscripts Healthcare Solutions, Inc. MDRX 2,234 12.35 -15.1% -15.1% 76.6% 23.3% 9.1% 2.3x 16.0x NM 1.8x 9.2x

Market Stats Operating Stats LTM Multiples NTM Multiples

Page 9: Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x 3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - - 3/5/2018

Company Name SymbolMarket Cap

($ in Mil)Price ($)

Quarter

Change

YTD

Change

% of 52

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Est.

Revenue

Growth

EBITDA

Margin

TEV/

Rev

TEV/

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Acadia Healthcare Co., Inc. ACHC 3,459$ 39.18$ 20.1% 20.1% 72.1% 9.0% 20.6% 2.3x 11.5x NM 2.1x 10.1x

The Ensign Group, Inc. ENSG 1,354 26.30 18.5% 18.5% 89.9% 9.9% 7.7% 0.9x 11.6x 34.2x 0.8x 8.3x

National HealthCare Corp. NHC 908 59.63 -2.1% -2.1% 78.8% NM 11.6% 0.8x 8.0x 16.2x NM NM

Civitas Solutions, Inc. CIVI 578 15.40 -9.9% -9.9% 77.4% 8.4% 9.0% 0.9x 8.6x 49.7x 0.8x 7.5x

AAC Holdings, Inc. AAC 281 11.48 27.6% 27.6% 87.9% 9.7% 12.7% 1.5x 12.4x NM 1.3x 6.4x

SunLink Health Systems, Inc. SSY 10 1.37 -13.8% -13.8% 65.9% NM 2.6% 0.2x NM NM NM NM

Market Stats Operating Stats LTM Multiples NTM Multiples

Page 10: Healthcare Report Q1 2018...3/8/2018 Express Scripts Holding Co. Cigna Corp. Pharma Services 67,600.63 0.67x 9.27x 3/6/2018 ARxCare LLC PharmScript LLC Pharma Services - - - 3/5/2018

5.5x 5.8x 5.9x6.4x6.4x 6.6x 6.5x 6.7x

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0.0x

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2014 2015 2016 2017

$10-25mm $25-50mm $50-100mm $100-250mm