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For more information, visit www.tresvista.com US HEALTHCARE – INDUSTRY UPDATE Healthcare Spend per Capita for OECD Economies Recent Healthcare Deals Factors Driving Healthcare Dealmaking Rise of Digital M&A: Driven by a consumer-oriented shift, digital health M&A has surged as the industry trends toward convenient care Proliferation of Healthcare Technology and Outsourcing: Increased administrative burdens have led to healthcare tech and outsourcing being employed to improve efficiency and control costs Ever-growing Payors: PE groups have accounted for an increasing share of healthcare services M&A across all sub-sectors Evolving Providers: Scale has increased, leading to M&A volume concentrating in larger deals Company Investor Company Investor Investor Company Investor Company $993Mn Source: Pitchbook Source: Wells Fargo - A Review of Key Factors Driving Healthcare Dealmaking USA $10,209 per capita 6.4% of GDP Canada $4,826 per capita 10.6% of GDP Japan $4,717 per capita 9.0% of GDP France $4,902 per capita 9.5% of GDP Switzerland $8,009 per capita 11.3% of GDP Germany 5,728 per capita 9.4% of GDP UK $4,246 per capita 10.6% of GDP New Zealand $3,683 per capita 13.3% of GDP Austria $5,440 per capita 10.6% of GDP Sweden $5,511 per capita 11.3% of GDP Belgium $4,774 per capita 10.6% of GDP Netherlands $5,386 per capita 10.8% of GDP Australia 4,543 per capita 13.9% of GDP Source: OECD, www.worldpopulationreview.com GDP data as of 2019 Trends for the Healthcare Industry in 2019 Healthcare Cybersecurity ~32,000 intrusion attacks per day per organization, compared to 14,300 per organization in other industries Ageing and Lifestyle Factors The ageing population (those over 65 years old) is set to increase by 8%, from 559 million in 2015 to 604 million in 2020 Precision Medicines ~65% of patients prescribed the world’s top 5 selling drugs didn’t respond to the therapy Exponential Technologies to Improve Hospital Performance ~45% of hospitals with negative margins in 2011 were still negative in 2015 Source: Deloitte - 2019 US and Global Health Care Industry Outlook and Medcity News - Five innovation trends that will impact the healthcare industry in 2019 Issues for the Healthcare Industry in 2019 Source: Deloitte - 2019 US and Global Health Care Industry Outlook Investing in digital innovation and transformation Using new care delivery models to improve access and affordability Adapting to change in consumer needs, demands, and expectations Maintaining regulatory compliance and cybersecurity Recruiting, developing and retaining top talent Creating financial sustainability in an uncertain health economy $75Mn $540Mn $1.4Bn
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Page 1: US HEALTHCARE INDUSTRY UPDATE - ACG Global Healthcare... · Source: Deloitte - 2019 US and Global Health Care Industry Outlook and Medcity News - Five innovation trends that will

For more information, visit www.tresvista.com

US HEALTHCARE – INDUSTRY UPDATE

Healthcare Spend per Capita for OECD Economies

Recent Healthcare Deals Factors Driving Healthcare Dealmaking

Rise of Digital M&A:Driven by a consumer-oriented shift, digital health M&A has surged as the industry trends toward convenient care

Proliferation of Healthcare Technology and Outsourcing:Increased administrative burdens have led to healthcare tech and outsourcing being employed to improve efficiency and control costs

Ever-growing Payors:PE groups have accounted for an increasing share of healthcare services M&A across all sub-sectors

Evolving Providers:Scale has increased, leading to M&A volume concentrating in larger deals

Company Investor Company Investor

Investor Company InvestorCompany

$993Mn

Source: Pitchbook Source: Wells Fargo - A Review of Key Factors Driving Healthcare Dealmaking

USA$10,209 per capita

6.4% of GDP

Canada$4,826 per capita

10.6% of GDP

Japan$4,717 per capita9.0% of GDP

France$4,902 per capita

9.5% of GDP

Switzerland$8,009 per capita11.3% of GDP

Germany5,728 per capita9.4% of GDP

UK$4,246 per capita

10.6% of GDP

New Zealand$3,683 per capita13.3% of GDP

Austria$5,440 per capita10.6% of GDP

Sweden$5,511 per capita

11.3% of GDP

Belgium$4,774 per capita

10.6% of GDP

Netherlands$5,386 per capita10.8% of GDP

Australia4,543 per capita13.9% of GDP

Source: OECD, www.worldpopulationreview.comGDP data as of 2019

Trends for the Healthcare Industry in 2019

Healthcare Cybersecurity~32,000 intrusion attacks per day per organization, compared to 14,300 per organization in other industries

Ageing and Lifestyle FactorsThe ageing population (those over 65 years old) is set to increase by 8%, from 559 million in 2015 to 604 million in 2020

Precision Medicines~65% of patients prescribed the world’s top 5 selling drugs didn’t respond to the therapy

Exponential Technologies to Improve Hospital Performance~45% of hospitals with negative margins in 2011 were still negativein 2015

Source: Deloitte - 2019 US and Global Health Care Industry Outlook and Medcity News - Five innovation trends that will impact the healthcare industry in 2019

Issues for the Healthcare Industry in 2019

Source: Deloitte - 2019 US and Global Health Care Industry Outlook

Investing in digital innovation and transformation

Using new care delivery models to

improve access and affordability

Adapting to change in consumer needs,

demands, and expectations

Maintaining regulatorycompliance and cybersecurity

Recruiting, developing and retaining top talent

Creating financial sustainability in an

uncertain health economy

$75Mn

$540Mn$1.4Bn

Page 2: US HEALTHCARE INDUSTRY UPDATE - ACG Global Healthcare... · Source: Deloitte - 2019 US and Global Health Care Industry Outlook and Medcity News - Five innovation trends that will

For more information, visit www.tresvista.com

TresVista is the leading provider of high-end outsourced support for asset managers, investment banks, research firms, and corporates. TresVista delivers operational efficiencies and cost savings to its clients while providing them with dedicated teams to support them across various functional activities. Services include investor

relations, fund raising, deal sourcing, deal execution, valuation, research, financial modeling, portfolio management, marketing and legal support.

ABOUT TRESVISTA

US HEALTHCARE – INDUSTRY UPDATE

Quarterly M&A Activity in US Healthcare

IRR for Healthcare Focused PE Funds Capital Invested in US Healthcare Deals

(29%)

(11%)

3% 1% 4%

8%

9%

11% 12%

14% 15%

(26%)

(10%)

6%

(2%)

5% 6%

11%

10% 11% 14%

16%

(52%)

(32%)

2%

13% 16%

19% 22% 26% 25%

16%

23%

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Buyout PE Growth-Expansion Co-Investment

Source: Pitchbook

2008 2009 2010 2011 2012 2013 2014 2015 20182016 2017

Avg. Capital Invested per Deal – Strategic ($B)Avg. Capital Invested per Deal – PE ($B)

Source: Pitchbook

$38

$139

$18

$280

$57

$99

$66$80

$36

$69

$37$43 $47

$81

$62

$258

$67

$287

$65

$91

$69

$130

Source: Pitchbook

1Q 15 2Q 15 3Q 15 4Q 15 1Q 16 2Q 16 3Q 16 4Q 16 1Q 17 2Q 17 3Q 17 4Q 17 1Q 18 2Q 18 3Q 18 4Q 18

324

218

315 326 298 337 296 241 210 282 241 244 237 260 192213 159

213

262 272

292

241

262

252

283

280290 296

312

301 328

261

Strategic Buyer PE Buyer

Affordable Care Act (ACA) – An Update

ACA: Medicaid Expansion States

32%It has helped me and/or my family

32%It has not helped or hurt me and/or my family

20%It has hurt me and/or my family

16%I don’t know

Source: PwC Health Research institute consumer survey, September 2018 and CNN – 4 ways Obamacare is changing for 2019

ACA: Medicaid Non-Expansion States

It has not helped or hurt me and/or my family

It has helped me and/or my family

I don’t know

It has hurt me and/or my family

12%

20%

43%

25%

1. Impact: Less robust coverage on individual and non-group markets due to greater availability of non-conforming plans Implication: Payors, providers could triage patients to lower-cost care options such as telehealth/in-home nurse visits

2. Impact: ACA provision for monetary penalties on manufacturers that charge more to go into effect in JulyImplication: Attention on drug prices to increase despite slowdown in rule-making

3. Impact: Insurance regulations are falling to states, creating a mosaicImplication: Stakeholders should closely follow state regulatory decisions when pursuing new opportunities

Impact of Recent Changes

US Healthcare Services M&A (by Size)

2008 2009 2010 2011 2012 2013 2014 2015 2018*2016 2017

$100M-$250M $250M-$500M $1B-$5B$500M-$1BUnder $100M $5B+

Source: Pitchbook* As of November 08, 2018


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