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Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which is a private limited company incorporated under English law with its registered office at 5th Floor, 6 St. Andrew Street, London EC4A 3AE, UK, registered with the Registrar of Companies for England and Wales (registration number 07078852). Harris Williams & Co. Ltd is authorized and regulated by the Financial Conduct Authority. Harris Williams & Co. is a trade name under which Harris Williams LLC and Harris Williams & Co. Ltd conduct business.
www.harriswilliams.com
HEALTHCARE ITINDUSTRY UPDATE │ Q4 2017
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
HARRIS WILLIAMS & CO. TECHNOLOGY, MEDIA & TELECOM (TMT) OVERVIEW
1
Fintech
Healthcare IT
KEY CONTACTS
HCIT
Sam HendlerManaging [email protected]+1 (617) 654-2117
Dan LinsalataVice [email protected]+1 (617) 654-2122
UNITED STATES
Jeff BistrongManaging [email protected]+1 (617) 654-2102
Mike WilkinsManaging [email protected]+1 (415) 217-3411
Tyler DewingManaging [email protected]+1 (617) 654-2133
EUROPE
Thierry MonjauzeManaging [email protected]+44 (0) 20 7518 8901
SOFTWARE / SAAS
Enterprise Software
Data and Analytics
Infrastructure andSecurity Software
IT and Tech-EnabledServices
Data Center andManaged Services
INTERNET & DIGITAL MEDIA
Online Marketing
Consumer Internet
Digital Media and Content
eCommerce and Retail
Mobile
HW&CO. TMT GROUP FOCUS AREAS
SELECT RECENT HW&CO. TMT TRANSACTIONS
TMT VERTICAL FOCUS AREAS
25+ year history with over 120closed transactions in the last24 months
Over 260 professionals acrosseight offices in the U.S. andEurope
Strategic relationships in Indiaand China
10 industry groups
KEY FACTS
HW&Co. OfficeNetwork Office*
*Harris Williams has exclusive relationships with Somerley Group and YES Bank as part of its global network.
Public Sector and Non-Profit
Supply Chain, Transportation,and Logistics
Professional Services
Human CapitalManagement
2017
HARRIS WILLIAMS & CO. (HW&CO.) GLOBAL ADVISORY PLATFORM
has received a growth
investment from
has received a majorityInvestment from
has acquiredhas been acquired byhas been acquired by has been acquired byhas received an investment from
has been acquired byhas been acquired by
Undisclosed
Strategic Buyer
has acquired
a wholly-owned affiliate of
have been acquired by
a portfolio company of
IAM assets of
has been acquired by
Beijing, Shanghai, and Hong Kong
Mumbai and New Delhi
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
HARRIS WILLIAMS & CO. HEALTHCARE IT OVERVIEW
2
SELECT HW&CO. HEALTHCARE IT TRANSACTIONS
PATIENTS
EMPLOYERS
INSURERS
CARE DELIVERY
ORGANIZATIONS
CLINICIANS
Patient-Facing Solutions
Care Delivery: Operational Efficiency
Care Delivery: Clinical / Acute
Care Delivery: Clinical / Non-Acute
Care Delivery: Clinical / Post-Acute
Pharma & Devices
Revenue Cycle Management
Population Health & Risk Management
HW&Co. Healthcare IT Taxonomy
Please contact HW&Co. for proprietary detailed HCIT market map
HW&CO. Healthcare IT Market Map
OUR PRACTICE
Harris Williams & Co. is a leading advisor to the Healthcare IT industry. Our global practice includes professionals across the firm from Harris Williams & Co.’s Technology, Media &Telecom Group and Healthcare & Life Sciences Group.
Harris Williams & Co.’s TMT Group is dedicated to providing superior merger & acquisition and capital markets advisory services to market leading companies. We are pleased to issue the Q4 2017 Healthcare IT Sector Update, which provides commentary and analysis on the current HCIT M&A environment and market trends.
ABOUT THE SECTOR
Provider of
computer-aided
design / computer-
aided
manufacturing
software for the
dental industryhas received a majority
investment from
Provider of a
comprehensive
suite of security
tools spanning
single sign-on,
context
management,
provisioning, and
data governance
for hospitals and
integrated delivery
networks
IAM assets of
have been acquired by
Provider of
revenue cycle
management and
EDI solutions
has been acquired by
Undisclosed Strategic Buyer
a wholly-owned
affiliate of
a portfolio company of
has received
a strategic investment
from
Provider of
technology-
powered nutrition
education and
behavior change
solutions for the
health and fitness
industries
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
WHAT WE’RE READING
3
Healthcare IT News 12/8/2017
With newly-issued mobile communications tools not meeting the needs of current healthcare employees, they resort to using workarounds, such as sending unsecured texts frompersonal phones. Additionally, a survey by Journal of Hospital Medicine found that 80% of employees still use a hospital-issued pager, due to the ease of use and previousknowledge and understanding. In order to enforce the use of these new technologies, organizations need to require ongoing training as well as more reliable networks.
Read the full article here.
SEEKING A UNIFIED APPROACH TO MOBILE CARE COLLABORATION
Healthcare IT News 12/19/2017
Even through workstations on wheels, care team workflows still remain fragmented due to the need to access patient data and clinical information from multiple disparatesystems. This is turn then breaks down the fundamental human flow of care as well as leaving patients with the perception that the clinician’s primary focus is on the technology,and not them. In the long term, the best approach lies in reducing the number of factors and unifying the myriad applications for more efficient communications and care.
Read the full article here.
CLINICIANS STILL STRUGGLE TO QUICKLY ACCESS EHRS AT POINT OF CARE
Modern Healthcare 11/19/2017
Net neutrality means everyone sending data is treated the same by carriers like Verizon and others; no one can pay or be charged more for faster transmission speeds andnone can be barred from sending data. Telehealth and electronic record data exchange are the two primary areas of healthcare that will suffer were internet service providersallowed to charge higher prices for faster transmission speeds, say those who back net neutrality.
Read the full article here.
HERE'S WHY HEALTHCARE SHOULD BE TALKING ABOUT NET NEUTRALITY
Becker’s Hospital Review
With the revenue cycle continually evolving, more technology solutions have emerged to keep pace. Key trends to keep an eye on in 2018 include mega-mergers, technologysolutions, patient financial experience and affordability, and end-to-end revenue cycle solutions. In regards to technology, newer solutions are expected to be geared towardsrisk adjustment tracking and coding, emphasizing the importance of healthcare providers partnering with vendors.
Read the full article here.
FOUR HEALTHCARE REVENUE CYCLE TRENDS TO WATCH IN 2018
12/19/2017
Health Data Management
One of the top issues carrying over from 2017 is data breaches, an issue that the healthcare industry continues to struggle with. As the pace of attacks in early-2017 approachedover a breach a day, the trust in healthcare providers has decreased, with more data becoming exposed. Other hurdles for the industry include the transition to value-basedcare as well as consolidation, where failed mergers of four of the largest insurers has garnered significant attention.
Read the full article here.
HOW THREE MAJOR CHALLENGES WILL SHAPE HEALTHCARE IT IN 2018
12/15/2017
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
KEY HEALTHCARE MACRO INDICATORS
4
U.S. HEALTHCARE SPENDING(1)(2)
($ in trillions)
U.S. AGING POPULATION(3)
(percent age 65 and older)
HIGH-DEDUCTIBLE HEALTH PLAN ENROLLMENT(4)
(enrolled lives in millions)
PRIMARY CARE SUPPLY(5)
(number of physicians in thousands)
U.S. EMR ADOPTION – HOSPITAL(6)
(percent adoption by EMRAM stage)
U.S. EMR ADOPTION - AMBULATORY(6)
(percent adoption by EMRAM stage)
16.0%
17.0%
18.0%
19.0%
20.0%
$0.0
$1.0
$2.0
$3.0
$4.0
$5.0
$6.0
'09 '11 '13 '15 '17P '19P '21P '23P '25P
National Health Expenditures
HC Expediture as % of GDP
12.6% 12.4% 13.0%
16.1%
19.3% 20.0% 20.2%
1990 2000 2010 2020P 2030P 2040P 2050P
3.2 4.5
6.1
8.0
10.0 11.4
13.5
15.5
17.4
19.7 20.2
'06 '07 '08 '09 '10 '11 '12 '13 '14 '15 '16
683 723
794 821
57%
49%
37% 33%
'00 '05 '13 '16
Total Physicians (in 000s) % Independent
'12 '13 '14 '15 '16 Q3'17
Stage 0 Stage 1 Stage 2 Stage 3
Stage 4 Stage 5 Stage 6 Stage 7
'12 '13 '14 '15 Q2'17
Stage 0 Stage 1 Stage 2 Stage 3
Stage 4 Stage 5 Stage 6 Stage 7
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
HCIT PUBLIC MARKET VALUATIONS(7)
5
Ph
arm
a
KEY PUBLIC COMPS
Pa
ye
r Fo
cu
sed
KEY PUBLIC COMPS
Clin
ica
l /
Ad
min
istr
ative
KEY PUBLIC COMPS
2017E TRADING METRICS
2017E TRADING METRICS
Min MaxMedian
Legend
As of December 31, 2017
4.2x3.1x 5.3x
6.8x3.8x 10.8x
13.6x12.9x 17.1x
28.3x15.0x 32.3x
EV / 2017E EBITDA
EV / 2017E Revenue
EV / 2017E EBITDA
EV / 2017E Revenue
STOCK PRICE PERFORMANCE
STOCK PRICE PERFORMANCE
STOCK PRICE PERFORMANCE
4.9x3.1x1.8x
EV / 2017E Revenue
13.6x10.4x
EV / 2017E EBITDA
31.0x
Co
nsu
me
r H
ea
lth
ca
reEu
ro-H
CIT
KEY PUBLIC COMPS 2017E TRADING METRICS
KEY PUBLIC COMPS 2017E TRADING METRICS
5.0x3.4x 11.5x
23.9x15.9x 31.9x
EV / 2017E EBITDA
EV / 2017E Revenue
4.4x3.2x 5.5x
20.0x15.4x 24.6x`EV / 2017E EBITDA
EV / 2017E Revenue
STOCK PRICE PERFORMANCE
STOCK PRICE PERFORMANCE
0%
100%
200%
300%
400%
Dec-12 Dec-13 Dec-14 Dec-15 Dec-16 Dec-17
S&P 500 Pharma
0%
50%
100%
150%
200%
Dec-12 Dec-13 Dec-14 Dec-15 Dec-16 Dec-17
S&P 500 Clinical & Administrative
0%
75%
150%
225%
300%
Dec-12 Dec-13 Dec-14 Dec-15 Dec-16 Dec-17
S&P 500 Euro HCIT
0%
50%
100%
150%
200%
Dec-12 Dec-13 Dec-14 Dec-15 Dec-16 Dec-17
S&P 500 Payer-Focused
0%
50%
100%
150%
200%
Dec-12 Dec-13 Dec-14 Dec-15 Dec-16 Dec-17
S&P 500 Consumer Healthcare
2017E TRADING METRICS
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
PUBLIC COMPARABLES(7)
VALUATION AND OPERATING METRICS
As of December 31, 2017 ($ in millions, except per share amounts)
6
Stock Performance
Current % of LTM TEV / EBITDA
Mkt Cap TEV Price LTM High Revenue % Growth EBITDA Margin LTM 2017E
Clinical / Administrative
EMR
Cerner Corporation $22,930 $22,613 $68.98 93.4% $5,086 7.9% $1,552 30.5% 14.6x 13.4x
athenahealth, Inc. 5,433 5,587 135.76 85.6% 1,179 12.1% 200 16.9% 28.0x 20.7x
Allscripts Healthcare Solutions, Inc. 2,694 4,463 14.91 98.1% 1,714 16.6% 275 16.0% 16.2x 12.2x
Quality Systems, Inc. 893 915 14.03 79.1% 524 6.0% 78 14.8% 11.8x 11.0x
Computer Programs and Systems, Inc. 409 552 29.70 82.1% 263 6.7% 30 11.6% 18.1x 11.2x
Median $2,694 $4,463 85.6% $1,179 7.9% $200 16.0% 16.2x 12.2x
RCM / Performance
Nuance Communications, Inc. $4,830 $6,603 $16.64 83.5% $1,939 (1.6%) $375 19.3% 17.6x 10.4x
Premier Inc. 4,267 7,114 29.78 81.6% 1,532 13.2% 441 28.8% 16.1x 13.7x
Evolent Health Inc 974 839 13.05 47.5% 409 31.6% 20 4.8% 42.6x NM
Median $4,267 $6,603 81.6% $1,532 13.2% $375 19.3% 17.6x 12.1x
Other Administrative
Omnicell, Inc. $1,952 $2,136 $51.45 92.9% $690 2.7% $47 6.8% 45.3x 24.6x
Vocera Communications, Inc. 854 787 29.22 90.7% 153 11.5% (12) NM NM NM
HealthStream, Inc. 733 610 22.99 72.9% 244 5.1% 34 13.9% 18.0x 16.1x
Tabula Rasa Healthcare, Inc. 526 557 29.50 80.2% 118 16.1% 4 3.0% NM 31.0x
Median $794 $698 85.4% $198 8.3% $19 6.8% 31.6x 24.6x
Clinical / Administrative Median $1,463 $1,526 82.8% $607 9.7% $62 14.8% 17.8x 13.6x
Payer-Focused
Cotiv iti Holdings, Inc. $2,993 $3,633 $32.59 70.9% $670 4.2% $243 36.3% 14.9x 13.6x
Inovalon Holdings, Inc. 2,181 1,899 14.95 84.0% 431 (0.6%) 85 19.7% 22.3x 17.1x
HMS Holdings Corp. 1,414 1,575 16.82 80.5% 495 2.2% 106 21.4% 14.8x 12.9x
Payer-Focused Median $2,181 $1,899 80.5% $495 2.2% $106 21.4% 14.9x 13.6x
Pharma
IQVIA Holdings Inc $21,315 $30,165 $102.48 92.6% $9,514 23.0% $1,794 18.9% 16.8x 15.0x
Veeva Systems Inc 7,950 7,192 55.85 82.0% 651 19.6% 160 24.6% 44.9x 32.3x
Medidata Solutions, Inc. 3,845 3,722 65.77 76.5% 529 8.8% 83 15.6% 45.1x 28.3x
Pharma Median $7,950 $7,192 82.0% $651 19.6% $160 18.9% 44.9x 28.3x
Consumer Healthcare
WEX Inc. $5,868 $8,066 $136.74 100.0% $1,210 9.6% $443 36.6% 18.2x 15.9x
HealthEquity Inc 2,799 2,574 46.14 83.4% 216 21.0% 67 31.0% 38.4x 31.9x
Benefitfocus, Inc. 853 918 27.35 73.7% 253 4.1% 1 0.2% NM NM
Castlight Health, Inc. 522 440 3.90 70.9% 124 16.5% (50) NM NM NM
Consumer Healthcare Median $1,826 $1,746 78.6% $234 13.0% $34 31.0% 28.3x 23.9x
Euro
CompuGroup Medical SE $3,568 $3,943 $67.04 97.7% $631 1.5% $141 22.3% 28.0x 24.6x
EMIS Group plc 850 850 13.43 98.9% NA NA NA NM NM NA
NEXUS AG 482 452 30.57 87.4% 128 6.1% 25 19.4% 18.2x 15.4x
Euro Median $850 $850 97.7% $379 3.8% $83 20.9% 23.1x 20.0x
Consolidated Median $2,181 $2,136 83.4% $526 8.4% $84 19.1% 18.1x 19.0x
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
NOTABLE HCIT M&A TRANSACTIONS(7)
7
BV Investment Partner’s Acquisition of Precision Nutrition
Provider of technology-powered nutrition education and behavior change solutions for the health and fitness industries
Following the strategic investment, BVIP will support PN’s organic growth plan which includes further penetrating the fitnessprofessional end market, expanding into additional end market segments, and further investing in the ProCoach online contentand business software platform
Ent. Value: NA
Revenue: N/A
EV / Revenue: N/A
EV / EBITDA: N/A
Closed 11/14/17
Navicure’s Merger with ZirMed
ZirMed is a provider of web-based revenue cycle management solutions to the healthcare sector
Navicure and ZirMed have consistently been ranked Best in KLAS and have been recognized by healthcare market researchfirm Black Book as top performers in their respective markets
As a result of the merger, the combined company will be well positioned for further innovation in the revenue cyclemanagement industry through leveraging their respective solutions to create an enterprise-wide RCM system
Ent. Value: $750.0M
Revenue: NA
EV / Revenue: NA
EV / EBITDA: NA
Closed 11/1/17
Fidelity National Financial’s Acquisition of T-System
T-System is a leading provider of clinical documentation and coding solutions to hospital-based and free-standing emergencydepartments and urgent care facilities
T-System’s solutions are currently used in about 40% of US emergency departments and urgent-care centers
Fidelity National Financial will be able to further accelerate the future growth of T-Systems through multiple acquisitions andtransitioning the Company to a recurring revenue business model
Ent. Value: $200.0M
Revenue: NA
EV / Revenue: NA
EV / EBITDA: NA
Closed 10/17/17
Allscripts’ Acquisition of McKesson’s Enterprise Information Solutions Business
McKessson's Enterprise Information Solutions business is a provider of clinical and financial solutions supporting the full scope ofcare delivery processes
This acquisition further advances Allscripts strategy to offer the most comprehensive and high performing health IT solution suite
Allscripts will invest in and continue to offer Paragon as the integrated EHR and revenue cycle management solution for thesmall hospital market segment, while Allscripts Sunrise will continue as the primary platform for larger institutions, typically withhighly complex service line needsEnt. Value: $185.0M
Revenue: NA
EV / Revenue: NA
EV / EBITDA: NA
Closed 10/2/17
Private Private
Private
HW&Co.
Confidential
HW&Co.
Confidential
HW&Co.
Confidential
HW&Co. Confidential
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
HCIT M&A AND PRIVATE PLACEMENT ACTIVITY AT A GLANCE
8
QUARTERLY M&A DEALS – LTM(8) LTM M&A DEALS BY SUB-SECTOR(8)
QUARTERLY PRIVATE PLACEMENT DEALS – LTM(8) LTM PRIVATE PLACEMENT DEALS BY SUB-SECTOR(8)
53
3
6
16 Clinical /
Administrative
Payer-Focused
Pharma
Consumer
Healthcare
16
23
12
20
Q1'17 Q2'17 Q3'17 Q4'17
Clinical / Administrative Payer-Focused
Pharma Consumer Healthcare
37
9
4
21
Clinical /
Administrative
Payer-Focused
Pharma
Consumer
Healthcare
15
19 18
26
Q1'17 Q2'17 Q3'17 Q4'17
Clinical / Administrative Payer-Focused
Pharma Consumer Healthcare
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
M&A TRANSACTION ACTIVITY(7)(8)
*HW&Co. confidential transaction
*Unpublished information
Closed Date Target Acquirer Business Description
Enterpise
Value
Implied
EV/Revenue
Implied
EV/EBITDA
9
Pending Sanav ida SL Innov est Global, Inc. Prov ider of 24/7 telehealth solutions. * * *
Pending NexSched LLC Medfusion, Inc. Prov ider of patient self-scheduling solutions. * * *
Pending Wellhealth HealthCare Partners of Nev ada Prov ider of a messaging platform for medical practices. * * *
Pending LeonardoMD Azalea Health Prov ider of web-based practice management and EHR software. * * *
12/31/17 Net Health Systems, Inc. The Carlyle Group; Lev el Equity Prov ider of electronic medical records solutions for specialized outpatient care. * * *
12/18/17 Ev etpractice Henry Schein Prov ider of cloud-based v eterinary software. * * *
12/18/17 Delta Health Technologies LLC Salo Solutions, Inc. Prov ider of home health, hospice, and priv ate duty solutions. * * *
12/14/17 Brighter, Inc. Cigna Corp. Prov ider of an online marketplace that connects members with dentists. * * *
12/13/17 Connect Healthcare Doctor.com Prov ider of SaaS prov ider directory and reputation management solutions. * * *
12/07/17 Vitalhealth Software BV Royal Philips NV Prov ider of cloud-based electronic health solutions for chronic diseases. * * *
12/05/17 Forcare Holding BV Royal Philips NV Prov ider of interoperability and workflow solutions. * * *
11/29/17 Remedy Health Media LLC Topspin Management LLC Prov ider of consumer health and wellness solutions. * * *
11/14/17 Arcadian TelePsychiatry LLC MYnd Analytics, Inc. Prov ider of an online mental health serv ices platform. * * *
11/14/17 Precision Nutrition, Inc. BV Inv estment Partners LLC Prov ider of technology-powered, nutrition education, and behav ior change solutions. * * *
11/08/17 Exym Alpine Inv estors Prov ider of electronic health record software for mental health clinics. * * *
11/01/17 ZirMed, Inc. Nav icure, Bain Capital Prov ider of web-based rev enue cycle management solutions to the healthcare sector. $750.0 * *
10/26/17 Caradigm (IAM Assets) Impriv ata Prov ider of a comprehensiv e suite of security tools for hospitals and integrated deliv ery networks. * * *
10/24/17 mProv e Health, Inc. Bracket Global; Genstar Capital Prov ider of mobile health tracking software. * * *
10/17/17 T-System, Inc. Fidelity National Financial Prov ider of clinical documentation solutions for hospital emergency departments. $200.0 * *
10/16/17 iMedicWare, Inc. ECL Group LLC Prov ider of practice management solutions for ophthalmologists. * * *
10/12/17 Foresight Medical LLC Paradigm; Summit Partners Prov ider of surgical management software. * * *
10/11/17 Prognosis Health Information Systems LLCAzalea Health Innov ations; Intersouth
Partners; Kayne Anderson Capital Prov ider of clinical enterprise software for rural and community hospitals and health systems. * * *
Last 12 Months as of December 31, 2017 ($ in millions)
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
10/11/17 Tea Leav es Health LLC Welltok, Inc. Prov ider of a cloud-based marketing and analytics solutions for the healthcare industry. $90.0 * *
10/10/17 Med Help International, Inc. Merck & Co., Inc. Prov ider of an online health serv ice platform that connects people with medical experts. * * *
10/10/17 Carena, Inc.Av izia; Healthquest Capital
Management; Northwell VenturesProv ider of telemedicine solutions. * * *
10/02/17Mckesson (Enterprise Information Solutions
Business)Allscripts Healthcare Solutions, Inc. Prov ider of clinical and financial solutions supporting the full scope of care deliv ery processes. $185.0 * *
09/29/17 PAREXEL International Corp. Pamplona Capital Management Prov ider of biopharmaceutical serv ices. $4,918.9 2.1x 16.8x
09/06/17 Symphony Health Solutions Corp. PRA Health Sciences, Inc. Prov ider of data, analytics and consulting solutions to the life sciences market. $530.0 2.7x 20.4x
09/05/17 Amazing Charts LLC Constellation Software, Inc. Prov ider of electronic health records management software solutions. * * *
08/25/17NantHealth (Patient Engagement
Solutions Business)Allscripts Healthcare Solutions, Inc. Prov ider of a patient and prov ider engagement platform. $194.9 * *
08/23/17 Practice Insight Undisclosed Prov ider of rev enue cycle management and EDI solutions. * * *
08/21/17 Veracity Innov ations LLC Carl Zeiss Meditec Prov ider of a cloud-based platform software for analyzing and performing eye surgery. * * *
08/16/17 EagleDream Health, Inc. Quality Systems, Inc. Prov ider of SaaS healthcare analytics assisting in the transition to v alue-based reimbursement. $26.0 * *
08/16/17 RemitDATA, Inc. eSolutions, Francisco Partners Prov ides web-based solutions for the healthcare industry. * * *
08/13/17 Senosis Health Inc. Alphabet, Inc. Prov ider of a mobile health monitoring application. * * *
08/10/17 A Place for Mom General Atlantic Prov ider of a network that connects families to senior liv ing serv ice prov iders. * * *
08/01/17 eAudit Solutions, Inc. MedImpact Holdings, Inc. Prov ider of pharmacy audit software and serv ices. * * *
08/01/17 InVentiv Group Holdings, Inc. INC Research Holdings, Inc. Prov ider of contract drug dev elopment serv ices to pharma, biotech, and & medical dev ice compnies. $4,199.0 1.8x 16.5x
07/14/17 Becker's Healthcare Pamlico Capital Prov ider of business and legal information for hospital executiv es. * * *
07/14/17 Best Doctors, Inc. Teladoc, Inc. Prov ider of a telehealth platform. $440.0 $4.8 *
07/13/17 Global Healthcare Exchange LLC Temasek Holdings Prov ider of cloud-based technology and serv ices designed to track hospital supplies. $1,800.0 * *
07/12/17 Constellation (Health IT Business) MTS Healthcare LLC Prov ider of a broad range of healthcare technology information software and serv ices for physicians. * * *
07/11/17 MedApprov ed LLCTractManager, Arsenal Capital
ManagementProv ider of strategic sourcing and contract lifecycle management solutions. * * *
07/05/17 AllCall Connect LLC ResMed, Inc. Prov ider of a liv e-calling solution for CPAP patient resupply. * * *
M&A TRANSACTION ACTIVITY(7)(8)
*HW&Co. confidential transaction
*Unpublished information
Closed Date Target Acquirer Business Description
Enterpise
Value
Implied
EV/Revenue
Implied
EV/EBITDA
10
Last 12 Months as of December 31, 2017 ($ in millions)
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
M&A TRANSACTION ACTIVITY(7)(8)
*HW&Co. confidential transaction
*Unpublished information
Closed Date Target Acquirer Business Description
Enterpise
Value
Implied
EV/Revenue
Implied
EV/EBITDA
11
06/29/17 Kinnser Software, Inc.Mediware Information Systems, TPG
CapitalProv ider of home health, hospice, and home care software. * * *
06/23/17 Praxify Technologies, Inc. AthenaHealth Prov ider of care management workflow solutions. $63.0 * *
06/14/17 Quantum Health Great Hill Partners Prov ider of consumer nav igation serv ices and care coordination. * * *
06/06/17 WhiteCloud Analytics, Inc. Relias Learning Prov ider of healthcare performance management solutions. * * *
06/01/17 Medicalis Corp. Siemens Healthineers Prov ider of clinical decision support software. * * *
05/23/17 PartsSource, Inc. Great Hill Partners Prov ider of medical parts and supplies procurement solutions for medical prov iders. * * *
05/22/17 Hospice Management LLC Optima Healthcare, Alpine Inv estors Prov ider of cloud-software for post-acute care prov iders. * * *
05/04/17 PolicyStat LLC iContracts Prov ider of SaaS-based policy management software. * * *
05/03/17 Zirmed (Analytics Business) Koan Health LLC Prov ider of v alue-based care analytics. * * *
04/26/17 Clockwise.MD DocuTAP, Warburg Pincus Prov ider of online patient scheduling and wait-time transparency solutions. * * *
04/25/17 Source Medical Solutions, Inc.Surgical Information Systems, Norwest
Equity PartnersProv ider of ambulatory surgery center software and serv ices. * * *
04/24/17 OncoVerse LLC BTG Prov ider of patient collaboration solutions. * * *
04/18/17 ArroHealth CIOX Health, New Mountain Capital Prov ider of chart retriev al and risk adjustment serv ices for health plans and prov ider groups. * * *
04/18/17 Eliza Corp. HMS Holdings Corp. Prov ider of online automated healthcare communications serv ices. $170.0 2.8x 14.2x
04/14/17 Entrada, Inc. Quality Systems, Inc. Prov ider of clinical documentation and data interchange solutions. $34.0 2.9x *
04/05/17 Adv anced Practice Strategies, Inc. Relias Learning Prov ider of an e-learning and testing platform for healthcare prov iders. * * *
04/03/17 Essen BioScience, Inc. Sartorius AG Prov ider of integrated healthcare communication and management software. $320.0 5.3x *
04/03/17 Cov erMyMeds LLC McKesson Corp. Prov ider of software that automates patient prescription submission. $1,400.0 29.5x *
04/03/17 Jiff, Inc. Castlight Health, Inc. Prov ider of a cloud-based application platform to manage patients. $153.5 * *
03/31/17 Strenuus LLC Zelis Healthcare, Parthenon Capital Prov ider of network analytics and managed healthcare data for healthcare prov iders. * * *
03/31/17 Clearv iew Staffing Software, Inc. Healthcaresource HR, Inc. Prov ider of workforce management solutions to the healthcare industry. * * *
03/29/17 Ev eryMov e, Inc. higi, BlueCross BlueShield Ventures Prov ider of cloud-based consumer health engagement solutions. * * *
Last 12 Months as of December 31, 2017 ($ in millions)
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
PRIVATE PLACEMENT ACTIVITY(7)(8)
Last 12 Months as of December 31, 2017 ($ in millions)
Closed Date Target Lead Investor(s) Business Description
Round /
Stage
Money
Raised
Raised to
Date
12
12/22/17 Artemis Health F-Prime Capital Partners Prov ider of benefits analytics solutions. B $22.7 $32.2
12/21/17 CredSimpleMeridian Street Capital, Healthy
Ventures, othersProv ider of a cloud-based credentialing platform. A $6.6 $9.3
12/12/17 Senscio Systems Undisclosed Prov ider of chronic illness self-health management solutions.Late-Stage
VC$5.8 $7.9
12/11/17 Phreesia Undisclosed Prov ider of a SaaS patient intake management platform. B $34.0 $118.7
12/06/17 HealthiPASS FCA Venture Partners Prov ider of healthcare payment solutions. A $7.2 $9.3
12/06/17 CedarMartin Ventures, Founders Fund, and
Thriv e CapitalProv ider of healthcare payment solutions. A $12.8 $12.8
12/01/17 Rev el Health TT Capital Partners Prov ider of a healthcare engagement platform.PE Growth /
Expansion$17.5 $17.5
11/29/17 UpWell Signal Peak Ventures Prov ider of an online wellness management platform. PE Growth /
Expansion$20.2 $20.2
11/15/17 Health IQ Andreessen Horowitz Prov ider of health knowledge measurement solutions. D $34.6 $79.8
11/14/17 SyapseAscension Ventures, GE Ventures and
HealthboxProv ider of precision cancer care software solutions. D $30.0 $69.5
11/14/17 Collectiv e Medical Kleiner Perkins Prov ider of care management solutions. A $47.5 $47.5
11/13/17 Ambra HealthCanaan Partners, CHL Medical Partners,
othersProv ider of a cloud-based medical imaging platform.
PE Growth /
Expansion$7.4 $54.5
11/08/17 Welkin Health Thriv e Capital Prov ider of a digital patient relationship platform. A $8.0 $10.0
11/03/17 PrognosMerck Global Health Innov ation and
Safeguard ScientificsProv ider of health monitoring solutions. C $20.5 $43.2
11/02/17 Ranger Health Holt Ventures Prov ider of a mobile platform that offers a database of top physicians and hospitals. A $10.0 $10.0
10/18/17 PipelineRx CareFusion, Swisslog Holding Prov ide of online telepharmacy solutions.PE Growth /
Expansion$15.4 $36.2
10/18/17 BaseHealth HBM Healthcare Inv estments Prov ider of predictiv e health management solutions. C $8.5 $17.5
10/13/17 Health Catalyst Norwest Venture Partners Prov ider of healthcare data warehousing, analytics, and outcomes improv ement solutions.Late-Stage
VC$25.0 $236.4
10/10/17 Weav e Communications Catalyst Inv estors Prov ider of patient communication solutions. B $19.8 $49.5
10/10/17 ESO Healthcare Connected Accel-KKR Prov ider of electronic health record and data exchange solutions.Late-Stage
VC$15.5 $41.4
09/26/17 Av aility Francisco Partners Prov ider of a healthcare engagement platform.PE Growth /
ExpansionNA NA
09/14/17 Call9 Redmile Group Prov ider of a telemedicine platform connecting on-site clinical care specialists to remote physicians. B $24.0 $34.1
09/12/17 Ieso Digital Health Draper Esprit, Touchstone Innov ation Prov ider of digital mental health deliv ery solutions.Late-Stage
VC$23.3 $31.9
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
PRIVATE PLACEMENT ACTIVITY(7)(8)
Last 12 Months as of December 31, 2017 ($ in millions)
Closed Date Target Lead Investor(s) Business Description
Round /
Stage
Money
Raised
Raised to
Date
13
09/07/17 Antidote Merck Global Health Innov ation Fund Prov ider of an online platform facilitating patient participation in clinical trials.Late-Stage
VC$11.0 $35.4
08/21/17 GNS Healthcare Amgen Ventures Prov ider of precision medicine and population health analytics. C $6.0 $33.1
08/16/17 MedAwareBecton, Dickinson & Co., Gefen Capital,
OurCrowdProv ider of electronic medical records and electronic prescribing solutions. A $8.0 $10.4
08/16/17 Artemis Health F-Prime Capital Partners Prov ider of benefits analytics solutions. B $16.0 $25.5
08/11/17 Buoy Health F-Prime Capital Partners Prov ider of a personalized health-check platform. A $6.7 $9.2
08/01/17 Babyscripts Ysios Capital Prov ider of a v irtual care platform for obstetrics. B $5.7 $7.6
07/31/17 DocASAP Cohen Priv ate Ventures Prov ider of medical and dental scheduling software.PE Growth /
Expansion$8.6 $10.2
07/19/17 ProtenusKaiser Permanente Ventures, F-Prime
Capital PartnersProv ider of patient data security solutions. A $7.0 $8.1
07/11/17 BinaryFountain HLM Venture Partners Prov ider of patient experience solutions. A $19.9 $25.6
06/28/17 Your.MD Ltd. Orkla Ventures Prov ider of a personalized health assistance application. Early Stage $10.0 $17.3
06/27/17 Glooko Georgian Partners Prov ider of a diabetes patient-monitoring platform. C $35.0 $71.0
06/20/17 CirrusMD, Inc. Colorado Impact Fund Prov ider of telemedicine solutions. A $7.0 $10.0
06/19/17 FraudScope, Inc. Spider Capital, GRA Venture Fund Prov ider of a SaaS platform aimed at reducing healthcare billing fraud. Seed $1.5 $1.5
06/19/17 Chartspan Cypress Growth Capital Prov ider of patient compliance management and care coordination solutions. C $16.0 $21.2
06/14/17 Omada Health Cigna Prov ider of a digital diabetes therapeutics program. C $50.0 $127.5
06/12/17 Alto PharmacyGreenoaks Capital, Jackstone Square
VenturesProv ider of a digital pharmacy platform designed to simplify medication access. B $23.0 $28.9
06/07/17 Digital Pharmacist, Inc. Activ ate Venture Partners Prov ider of an online platform that enables communication between patients and pharmacies. B $6.5 $13.5
06/06/17 Outcome HealthGoldman Sachs Inv estment Partners,
CapitalG, Balyasny Asset ManagementProv ider of a health intelligence platform. B $600.0 $610.0
06/01/17 Bright Health Greenspring Associates Prov ider of a health insurance serv ice platform. B $160.0 $241.7
05/31/17 Carrum Health, Inc. Wildcat Venture partners Prov ider of a bundled payment platform for employers. Seed $6.5 $54.4
05/28/17 ClearDATA Networks, Inc. Heritage Group, HLM Venture Partners Prov ider of cloud computing, platform, and information sercurity serv ices. C $25.0 $79.3
05/25/17 DocPlanner Enern Inv estments Prov ider of online platform for physician booking. D $15.0 $51.8
05/24/17 Medrio Questa Capital Prov ider of eClinical and electronic data capture solutions. C $30.0 $33.6
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
PRIVATE PLACEMENT ACTIVITY(7)(8)
Last 12 Months as of December 31, 2017 ($ in millions)
Closed Date Target Lead Investor(s) Business Description
Round /
Stage
Money
Raised
Raised to
Date
14
05/22/17 Lemonaid Health Nov artis Venture Fund, Hikma Ventures Prov ider of tele-health serv ices. A $12.0 $17.6
05/19/17 Upfront Healthcare Serv ices, Inc. Nashv ille Capital Network Prov ider of physician scheduling software. A $5.6 $5.6
05/10/17 Modernizing Medicine Warburg Pincus Prov ider of a mobile, cloud-based electronic health record system.PE Growth /
Expansion$231.0 $321.5
05/10/17 Clov er Health Google Ventures Prov ider of a health insurance platform. D $130.0 $425.0
05/10/17 Comprehend Systems Eminence Capital Prov ider of cloud-based clinical intelligence solutions. C $21.0 $47.4
05/09/17 Updox TT Capital Partners Prov ider of a healthcare CRM connectiv ity platform. B $12.7 $17.0
04/06/17 OM1 General Catalyst Partners Prov ider of outcomes measurement and predictiv e analytics solutions. A $15.0 $20.3
04/06/17 drchrono Runa Capital Prov ider of an EHR platform for patient health insurance v erification and medical billing. A $14.0 $19.2
04/04/17 Amino Highland Capital Management Prov ider of healthcare transparency solutions. C $25.0 $44.4
03/29/17 higi BlueCross BlueShield Venture Partners Prov ider of health tracking solutions. B NA $40.0
03/29/17 SHYFT Analytics Optum Ventures Prov ider of data, analytic and mobile solutions for the life sciences industry. B $7.5 $39.0
03/20/17 Aetion Flare Capital, Lakestar Prov ider of medical ev idence software. A $11.2 $11.2
03/16/17 Liv ongo General Catalyst Partners, Kinnev ik Prov ider of a web and mobile based chronic disease management platform. D $52.5 $132.0
03/14/17 MindCare Solutions Epiphany Health Ventures Prov ider of remote healthcare and behav ioral health serv ices for mentally challenged patients. A $23.0 $23.0
03/08/17 Alignment Healthcare LLC Warburg Pincus Prov ider of clinical care coordination and risk management solutions.PE Growth /
Expansion$115.0 $115.0
03/01/17 Medisafe Octopus Ventures Prov ider of a personalized medication management platform. B $14.5 $21.5
02/17/17 Kyruus Mercy Health Foundation Prov ider of an information exchange platform matching patients with the best suited doctors. C $10.0 $59.8
02/14/17 Sense.ly Mayo Clinic, Chengwei Capital Prov ider of a patient engagement platform. B $8.0 $11.5
02/03/17 Comprehend Systems Eminence Capital Prov ider of a cloud-based suite supporting clinical assessment and CRO ov ersight and collaboration. C $14.8 $45.6
02/01/17 PointClickCare Corp. Dragoneer Inv estment Group, JMI Equity Prov ider of SaaS EHR software for long-term post-acute care prov iders.PE Growth /
Expansion$85.0 $85.0
02/01/17 HealthRev eal GE Ventures Prov ider of a cloud-based, chronic disease analytics platform. A $10.8 $10.8
01/25/17 Kensci Ignition Venture Partners Prov ider of population health risk management solutions. A $8.5 $8.5
01/24/17 Redox RRE Ventures Prov ider of a platform helping EHRs and health systems to manage cloud connections. B $9.0 $9.0
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
15
SUMMARY OF TECHNOLOGY IPOS
Technology IPOs rebounded in 4Q 2017after the underperformance of Snap andBlue Apron in 3Q 2017, which caused manypotential IPO candidates to re-evaluatetiming.
As the stock market completes one of itsbest years in history, driven largely byoutperforming technology stocks, bothtechnology startups and unicorns areincreasingly viewing the public markets as apotentially interesting source of liquidity.
Notable technology companies such asSpotify and Dropbox, both who havealready filed for an IPO, will test the IPOmarkets in 2018.
35%
50%
15%
< 25% 25 - 75% > 75%
30%
30%
40%
$0-50M $50-500M $500M-$1B $1B+
10%
10%
65%
15%
$0 - 50M $50 - 100M $100 - 250M $250M +
(All tech IPOs over the last 12 months) (All tech IPOs over the last 12 months) (All tech IPOs over the last 12 months)
11
18
7
11
5
15
3
8
0
2
9
4
5
6
1
8
1Q-14 2Q-14 3Q-14 4Q-14 1Q-15 2Q-15 3Q-15 4Q-15 1Q-16 2Q-16 3Q-16 4Q-16 1Q-17 2Q-17 3Q-17 4Q-17
$0 - 50M $50 - 100M $100 - 250M $250M +
2014 Total: 47 2016 Total: 152015 Total: 31 2017 Total: 20
MARKET CAP AT IPO (LTM) (7) REVENUE GROWTH (1YR PRIOR TO IPO) (7)OFFERING SIZE AT IPO (LTM) (7)
RECENT U.S. IPO ACTIVITY (BY OFFERING SIZE) (7)
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
16
22.2%
4.2%
8.2%
10.7%
10.8%
15.5%
28.4%
Other
Buildings Materials
Manufacturing
Retail
Services & Leasing
Technology
Healthcare
54% 50%
57% 55% 54%
60% 58%
56%
50% 53%
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
4.0x
3.4x
3.8x 3.8x
4.3x
4.7x 4.7x
5.6x
4.5x
3.3x
4.2x 4.3x4.5x
4.8x
5.3x 5.3x 5.3x5.5x
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
FLD/EBITDA SLD/EBITDA Other Sr Debt/EBITDA Sub Debt/EBITDA
DEBT MARKET OVERVIEW
2017 New Issue LBO Loans Percentage of Total Purchase Price
Median middlemarket LBO loanmultiples in 2017increased slightly to5.5x leverage.
Middle market LBOloan volumedecreased to $1.1billion in 4Q 2017,bringing total volumein 2017 to $6.8 billion.
Technologycompanies were the second largest recipients of middle market LBO loans in 2017, representing 15.5% of new issuance.
Median LBO debtpercentagesincreased slightly to53% of total purchaseprice in 2017.
Defined as Issuers with EBITDA of $50 Million or LessDefined as Issuers with EBITDA of $50 Million or Less
$1.5B
$1.8B
$1.2B
$1.9B$2.0B
$0.4B
$0.9B
$1.2B
$0.7B
$0.9B$1.1B
$1.8B
$2.9B
$1.1B
3Q'14 4Q'14 1Q'15 2Q'15 3Q'15 4Q'15 1Q'16 2Q'16 3Q'16 4Q'16 1Q'17 2Q'17 3Q'17 4Q'17
Institutional Pro Rata
LBO LOAN VOLUME BY INDUSTRY(9,10) MEDIAN LBO DEBT PERCENTAGES(7)
MIDDLE MARKET LBO LOAN MULTIPLES(9,10) MIDDLE MARKET LBO VOLUME BY QUARTER(9,10)
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
HW&CO.’S TECHNOLOGY, MEDIA, & TELECOM GROUP
17
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HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
PAGE | 18
Healthcare & Life Sciences
Technology, Media & Telecom
OUR FIRM
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q4 2017
19
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1. Centers for Medicare & Medicaid Services
2. Office of the Actuary
3. U.S. Census Bureau
4. America's Health Insurance Plans
5. Accenture
6. HIMMS Analytics
7. FactSet
8. PitchBook
9. PNC Capital Markets
10. S&P LCD stats
SOURCES
DISCLOSURES