Health Tech: Zelis’ M&A ambitions

Strained debt markets and staffing shortages have tamped down private equity-led activity in healthcare services, according to a PitchBook report on Q3 M&A in the sector.

Why it matters: In the final quarter of the year, several health care services processes remain in market, at varying levels of activity, Claire writes.

State of play: These deals remain in market:

• New State Capital-backed United Medical Systems, a provider of mobile medical equipment for urology, is exploring a sale via Houlihan Lokey.
• Founder-owned dental support organization Dentive is seeking a private equity buyer via Houlihan Lokey.
• BC Partners-backed dental products provider Zest Dental Solutions is on the block with SVB Securities and UBS.
• Founder-run compounding pharmacy Empower Pharmacy is running an auction led by Cantor Fitzgerald.
• Pamplona Capital-backed clinical trial solutions provider Calyx is exploring a sale through Jefferies.
• Silver Oak-backed DSO Smile Partners USA is for sale via Piper Sandler.
• Lee Equity-backed IVF provider Inception Fertility is in a process led by Moelis.
• Linden Capital-backed behavioral business Pinnacle is for sale in a closely watched Lincoln International-led process, which has been fairly quiet since the summer.

By the numbers: PitchBook estimates 211 PE-led deals this quarter, down 10.6% from the same period last year.

• PitchBook projects a total of 725 sponsor-led deals in health care services from Q1-Q3, down from a whopping 1,004 in 2021.
• That 725 figure exceeds 2020’s full-year deal number of 721, however.
• U.S. private equity firms are sitting on some $62 billion in dry powder, translating to about $150 billion in cumulative company EV, PitchBook estimates.

The big picture: Last year was marked by sky-high valuations and a frenzy of dealmaking as investors sought to recoup losses from 2020.

• That bull market has since reset itself, and private equity now faces competition from digital and brick-and-mortar retailers like Amazon, Walmart, Walgreens and CVS.

Yes, but: PE deal activity in the lower middle-market remains strong, with platforms aggressively pursuing add-on buys, the report says.

• Middle-market multiples have relaxed slightly, to pre-pandemic levels, the report says.

Of note: Without the promise of a rich price tag, sponsors aren’t rushing portfolio companies to the auction block as they were last year, the report notes.

• Combine that with the pinched debt markets, and it’s no wonder health care services M&A has felt muted.

The bottom line: Dealmaking sources have told Claire they’re waiting until early 2023 to launch processes, in hopes that the syndicated loan markets recover — which may make for a sluggish Q4.