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Harris Williams & Co. Ltd is a private limited company authorised and regulated by the Financial Conduct Authority, 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 under company number 07078852. Directors: Mr. Ned Valentine, Mr. Paul Poggi, Mr. Thierry Monjauze and Mr. Aadil Khan.
Harris Williams & Co. Ltd Niederlassung Frankfurt (German branch) is registered in the Commercial Register (Handelsregister) of the Local Court (Amtsgericht) of Frankfurt am Main, Germany, under registration number HRB 96687, having its business address at Bockenheimer Landstrasse 33-35, 60325 Frankfurt am Main, Germany. Permanent Representative (Ständiger Vertreter) of the Branch Niederlassung: Mr. Jeffery H. Perkins.
www.harriswilliams.de
HEALTHCARE ITINDUSTRY UPDATE │ Q3 2017
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 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
EUROPE
Thierry MonjauzeManaging Director [email protected] +44 (0) 20 7518 8901
SOFTWARE / SAAS
Enterprise Software
Data and Analytics
Infrastructure andSecurity Software
IT and Tech-Enabled Services
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
Education Technology
Engineering SolutionsSoftware
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 fromhas been acquired by
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 byhas acquired
Undisclosed
Strategic Buyer
a wholly-owned affiliate of
have been acquired by
a portfolio company of
IAM assets of
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 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 Q3 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
population health
management
and data
analytics solutions
has been acquired by
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
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
WHAT WE’RE READING
3
Modern Healthcare 9/13/2017
Epic is making headway in the quest for interoperability and potentially fulfilling meaningful use requirements with a new way for patients to send their medical records to theirproviders. The new product, called Share Everywhere, allows patients to give doctors access to their medical records through an internet browser. That means doctors don'thave to have their own electronic health record systems and the information can be shared despite not having EHRs that can communicate.
Read the full article here.
EPIC ALLOWS PATIENTS TO SHARE MEDICAL RECORDS WITH NEW TOOL
Healthcare IT News 9/18/2017
The Large Employers’ 2018 Health Care Strategy and Plan Design Survey found virtually all employers (96%) will make telehealth services available in states where it is allowednext year. More than half (56%) plan to offer telehealth for behavioral health services, more than double the percentage this year. Telehealth utilization is on the rise, with nearly20% of employers experiencing employee utilization rates of 8% or higher.
Read the full article here.
ALMOST ALL LARGE EMPLOYERS PLAN TO OFFER TELEHEALTH IN 2018, BUT WILL EMPLOYEES USE IT?
Health Data Management 8/16/2017
Worldwide revenues for the augmented reality and virtual reality market are forecast to rise by 100% or more over each of the next four years, according to a new report fromIDC. In healthcare, experts predict that virtual reality and augmented reality technology will increasingly be implemented. According to Goldman Sachs, healthcare VRapplications are forecast to top $5.1 billion in sales by 2025, with 3.4 million active users, including 1.5 million medical professionals.
Read the full article here.
INVESTMENTS IN AUGMENTED AND VIRTUAL REALITY SKYROCKETING
Healthcare IT News
The variety of potential blockchain deployments in healthcare is getting wider. When ONC put forth its call for white papers in its blockchain challenge, for instance, it receivedmore than 70 submissions earlier this year, exploring everything from medication reconciliation to alternative payment models. Blockchain, if deployed wisely, could underpin anarray of new innovations that could help reduce costs, enable efficiency, protect privacy, and spur interoperability.
Read the full article here.
WHY BLOCKCHAIN COULD TRANSFORM THE VERY NATURE OF EHRS
9/18/2017
Health Data Management
Navicure and ZirMed, two large claims clearinghouses that also offer additional revenue cycle management services to healthcare providers and insurers, have agreed to adefinitive merger in a transaction in which Navicure will buy ZirMed. The timing was right for Navicure - there’s always downward pressure on pricing, and providers areconsolidating to get more leverage with insurers, so combining the companies gave both an enterprise-wide revenue cycle process and infrastructure.
Read the full article here.
NAVICURE AND ZIRMED TO MERGE TO CREATE A REVENUE CYCLE POWERHOUSE
9/15/2017
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
KEY HEALTHCARE MACRO INDICATORS
4
U.S. HEALTHCARE SPENDING(1)(2)
($ 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 Q2'17
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 | Q3 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 September 30, 2017
4.8x3.2x 5.5x
7.8x3.6x 10.8x
14.2x13.3x 19.6x
31.9x14.3x 33.3x
EV / 2017E EBITDA
EV / 2017E Revenue
EV / 2017E EBITDA
EV / 2017E Revenue
STOCK PRICE PERFORMANCE
STOCK PRICE PERFORMANCE
STOCK PRICE PERFORMANCE
5.1x3.1x1.9x
EV / 2017E Revenue
14.1x10.6x
EV / 2017E EBITDA
25.0x
Co
nsu
me
r H
ea
lth
ca
reEu
ro-H
CIT
KEY PUBLIC COMPS 2017E TRADING METRICS
KEY PUBLIC COMPS 2017E TRADING METRICS
4.9x3.4x 11.5x
22.7x13.9x 31.6x
EV / 2017E EBITDA
EV / 2017E Revenue
4.7x3.5x3.1x
14.8x12.4x 19.9x`EV / 2017E EBITDA
EV / 2017E Revenue
STOCK PRICE PERFORMANCE
STOCK PRICE PERFORMANCE
0%
100%
200%
300%
400%
Sep-12 Sep-13 Sep-14 Sep-15 Sep-16 Sep-17
S&P 500 Pharma
0%
50%
100%
150%
200%
Sep-12 Sep-13 Sep-14 Sep-15 Sep-16 Sep-17
S&P 500 Clinical & Administrative
0%
75%
150%
225%
300%
Sep-12 Sep-13 Sep-14 Sep-15 Sep-16 Sep-17
S&P 500 Euro HCIT
0%
50%
100%
150%
200%
Sep-12 Sep-13 Sep-14 Sep-15 Sep-16 Sep-17
S&P 500 Payer-Focused
0%
50%
100%
150%
200%
Sep-12 Sep-13 Sep-14 Sep-15 Sep-16 Sep-17
S&P 500 Consumer Healthcare
2017E TRADING METRICS
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
Consumer Healthcare
WEX Inc. $4,707 $6,886 $109.71 89.3% $1,174 15.3% $425 36.2% 16.2x 13.9x
HealthEquity Inc 2,769 2,558 45.77 83.3% 202 20.9% 62 30.6% 41.3x 31.6x
Benefitfocus, Inc. 985 1,038 31.60 74.4% 248 6.4% (3) NM NM NM
Castlight Health, Inc. 549 458 4.15 75.5% 115 13.3% (51) NM NM NM
Consumer Healthcare Median $1,877 $1,798 79.4% $225 14.3% $29 33.4% 28.8x 22.7x
PUBLIC COMPARABLES(7)
VALUATION AND OPERATING METRICS
As of September 30, 2017 ($ 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 $22,979 $22,885 $69.30 95.9% $4,995 7.2% $1,527 30.6% 15.0x 13.3x
athenahealth, Inc. 5,071 5,280 126.99 80.0% 1,151 13.8% 196 17.0% 26.9x 19.7x
Allscripts Healthcare Solutions, Inc. 2,480 4,188 13.73 98.3% 1,657 15.7% 257 15.5% 16.3x 11.7x
Quality Systems, Inc. 996 1,011 15.71 88.6% 518 5.2% 78 15.0% 13.0x 12.1x
Computer Programs and Systems, Inc. 390 532 28.35 78.4% 261 15.0% 29 11.3% 18.1x 11.0x
Median $2,480 $4,188 88.6% $1,151 13.8% $196 15.5% 16.3x 12.1x
RCM / Performance
Nuance Communications, Inc. $4,684 $6,415 $16.23 81.4% $1,980 1.5% $424 21.4% 15.1x 10.6x
Premier Inc. 4,548 7,765 32.37 88.7% 1,455 14.4% 432 29.7% 18.0x 14.9x
Evolent Health Inc 1,228 1,249 16.45 59.8% 362 42.2% 9 2.4% NM NM
Median $4,548 $6,415 81.4% $1,455 14.4% $424 21.4% 16.6x 12.7x
Other Administrative
Omnicell, Inc. $1,818 $1,986 $48.55 92.1% $680 (1.8%) $48 7.0% 41.7x 22.2x
Vocera Communications, Inc. 861 790 29.57 97.6% 145 13.2% (12) NM NM NM
HealthStream, Inc. 755 639 23.68 75.1% 238 5.5% 31 13.1% 20.4x 17.5x
Tabula Rasa Healthcare, Inc. 453 451 26.07 97.3% 109 15.7% 4 3.4% NM 25.0x
Median $808 $715 94.7% $191 9.3% $18 7.0% 31.1x 22.2x
Clinical / Administrative Median $1,523 $1,618 88.6% $599 13.5% $63 15.0% 18.0x 14.1x
Payer-Focused
Cotiv iti Holdings, Inc. $3,184 $3,813 $34.67 75.4% $652 4.3% $225 34.5% 16.9x 14.2x
Inovalon Holdings, Inc. 2,427 2,147 16.65 93.5% 420 (1.8%) 63 15.0% 34.0x 19.6x
HMS Holdings Corp. 1,601 1,790 19.05 82.6% 493 0.8% 107 21.7% 16.7x 13.3x
Payer-Focused Median $2,427 $2,147 82.6% $493 0.8% $107 21.7% 16.9x 14.2x
Pharma
Quintiles IMS Holdings, Inc. $20,450 $28,692 $95.07 95.1% $8,553 24.0% $1,581 18.5% 18.2x 14.3x
Veeva Systems Inc 7,899 7,174 56.17 82.5% 617 21.5% 153 24.7% 47.0x 33.3x
Medidata Solutions, Inc. 4,438 4,341 75.85 88.3% 509 9.8% 77 15.1% 56.6x 31.9x
Pharma Median $7,899 $7,174 88.3% $617 21.5% $153 18.5% 47.0x 31.9x
Euro
CompuGroup Medical SE $3,082 $3,450 $57.92 94.1% $622 0.4% $137 21.9% 25.3x 19.9x
EMIS Group plc 792 792 12.51 94.0% NA NA NA NM NM 12.4x
NEXUS AG 468 437 29.75 91.2% 124 4.4% 24 19.2% 18.4x 14.8x
Euro Median $792 $792 94.0% $373 2.4% $80 20.6% 21.8x 14.8x
Consolidated Median $2,427 $2,147 88.6% $514 11.5% $77 18.5% 18.2x 17.6x
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
NOTABLE HCIT M&A TRANSACTIONS(7)
7
Navicure’s pending 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: N/A
EV / Revenue: N/A
EV / EBITDA: N/A
Closed 11/1/17
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
Pamplona Capital Management’s acquisition of PAREXEL
PAREXEL is a leading global biopharmaceutical services company, providing a broad range of clinical research, consulting,medical communications, and technology solutions and services
PAREXEL’s purchase price represents a nearly 28% premium to their closing stock price on the date when deal speculationbegan
Given Pamplona’s significant experience in the pharmaceutical and healthcare industries, the acquisition will help PAREXELcapitalize on new and attractive market opportunities in the ever-evolving biopharmaceutical services sectorEnt. Value: $5.0B
Revenue: $2.4B
EV / Revenue: 2.1x
EV / EBITDA: 16.8x
Closed 10/2/17
PRA Health Sciences acquisition of Symphony Health Solutions
Symphony Health is a provider of data, analytics, and consulting solutions to the life sciences market
Symphony Health serves over 400 active customers spanning large pharma, biotechnology, government agencies, and othersectors
The acquisition will support PRA’s efforts in providing deep, data-driven insights to optimize global clinical studies and drugcommercialization
Ent. Value: $530.0M
Revenue: $200.0M
EV / Revenue: 2.7x
EV / EBITDA: 20.4x
Closed 9/6/17
Private Private
Private
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
12
15
19 21
Q4'16 Q1'17 Q2'17 Q3'17
Clinical / Administrative Payer-Focused
Pharma Consumer Healthcare
HCIT M&A AND PRIVATE PLACEMENT ACTIVITY AT A GLANCE
8
QUARTERLY M&A DEALS – LTM(8) LTM M&A DEALS BY SUB-SECTOR(8)
QUARTERLY PRIVATE PLACEMENT DEALS – LTM(8) LTM PRIVATE PLACEMENT DEALS BY SUB-SECTOR(8)
42 6
7
12 Clinical /
Administrative
Payer-Focused
Pharma
Consumer
Healthcare
14 16
23
13
Q4'16 Q1'17 Q2'17 Q3'17
Clinical / Administrative Payer-Focused
Pharma Consumer Healthcare
39
6
5
16 Clinical /
Administrative
Payer-Focused
Pharma
Consumer
Healthcare
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
M&A TRANSACTION ACTIVITY(7)(8)
As of September 30, 2017 ($ in millions, except per share amounts)
*HW&Co. confidential transaction
*Unpublished information
Closed Date Target Acquirer Business Description
Enterpise
Value
Implied
EV/Revenue
Implied
EV/EBITDA
9
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. * * *
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. * * *
10/17/17 T-System, Inc. Fidelity National Financial Prov ider of clinical documentation solutions for hospital emergency departments. $200.0 * *
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 4.8x *
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. * * *
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
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. * * *
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. * * *
04/27/17 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. $153.5 * *
03/31/17 Strenuus LLC Zelis Healthcare, Parthenon Capital Prov ider of network analytics and managed healthcare data for healthcare prov iders. * * *
M&A TRANSACTION ACTIVITY(7)(8)
As of September 30, 2017 ($ in millions, except per share amounts)
*HW&Co. confidential transaction
*Unpublished information
Closed Date Target Acquirer Business Description
Enterpise
Value
Implied
EV/Revenue
Implied
EV/EBITDA
10
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
M&A TRANSACTION ACTIVITY(7)(8)
As of September 30, 2017 ($ in millions, except per share amounts)
*HW&Co. confidential transaction
*Unpublished information
Closed Date Target Acquirer Business Description
Enterpise
Value
Implied
EV/Revenue
Implied
EV/EBITDA
11
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. * * *
03/28/17 Bracket Global LLC Genstar Capital LLC Prov ider of clinical research dev elopment solutions. * * *
03/16/17 Polyglot Systems, Inc. The Hearst Corp. Prov ider of medication assistance software. * * *
03/14/17 Verisys Corp. Spectrum Equity Prov ider of screening, monitoring, v erification and credentialing solutions. * * *
03/13/17 CarePayment Technologies, Inc. Crestline Inv estors, Cedar Springs Capital Prov ides patient financial engagement solutions. * * *
02/17/17 CareEv olv e.com, Inc. ELLKAY LLC Prov ider of a web-based healthcare portal prov iding clinical information. * * *
02/14/17 HealthDatix iGambit Prov ider of medical decision and risk management software. * * *
01/31/17 C30 Medical Corp., Inc. InTouch Technologies, Inc. Prov ider of telemedicine management and physician cov erage serv ices. * * *
01/30/17 Par Excellence Northlane Capital Prov ider of inv entory management serv ices for the healthcare sector. * * *
01/23/17 Health123 Samepage Health Prov ider of a health intelligence platform supporting clinical workflow. * * *
01/19/17 Seamless Medical Systems, Inc. GetWellNetwork, Inc. Prov ider of a mobile enterprise communications platform faciliating patient data exchange. * * *
01/19/17 Caret AssistRx, Inc. Prov ider of a web-based care management platform. * * *
01/01/17 Pharmatek Systems McKesson Pharmacy Optimization Prov ider of hospital pharmacy cost containment software and serv ices. * * *
12/01/16 Rev Spring, Inc. GTCR LLC Prov ider of accounts receiv able management and rev enue cycle management serv ices. * * *
11/30/16 Array Health Solutions, Inc. Vimo, Inc. Prov ider of priv ate health insurance exchange technology solutions. * * *
11/15/16 Emmi Solutions LLC Wolters Kluwer NV Prov ider of patient engagement and empowerment technology serv ices. $170.0 * *
11/01/16 Aldera Holdings, Inc. Ev olent Health, Inc. Prov ider of core administration solutions for healthcare payers and administrators. $35.0 * *
10/27/16 HealthMEDX LLC Netsmart Technologies Prov ider of home care, long-term care and rehab software solutions. $39.2 * *
10/21/16 Press Ganey Holdings, Inc. EQT Partners, HarbourVest Partners Prov ider of patient-experience measurement and performance analytics solutions. $2,284.5 * *
10/20/16 BioClinica, Inc. Cinv en Group Ltd. Prov ider of technology enabled clinical trial management serv ices. $1,400.0 5.6x 14.0x
10/13/16 QHR Corp. Loblaw Cos. Ltd. Prov ider of medical records software. $116.4 5.1x *
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
PRIVATE PLACEMENT ACTIVITY(7)(8)
Last 12 Months as of September 30, 2017 ($ in millions)
Closed Date Target Lead Investor(s) Business Description
Round /
Stage
Money
Raised
Raised to
Date
12
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
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
08/24/17 Weav e Communications Catalyst Inv estors Prov ider of patient communication software. B $17.0 $17.0
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 $241.7
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
PRIVATE PLACEMENT ACTIVITY(7)(8)
Last 12 Months as of September 30, 2017 ($ in millions)
Closed Date Target Lead Investor(s) Business Description
Round /
Stage
Money
Raised
Raised to
Date
13
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
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
05/10/17 Comprehend Systems Eminence Capital Prov ider of cloud-based clinical intelligence solutions. C $21.0 $47.4
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
PRIVATE PLACEMENT ACTIVITY(7)(8)
Last 12 Months as of September 30, 2017 ($ in millions)
Closed Date Target Lead Investor(s) Business Description
Round /
Stage
Money
Raised
Raised to
Date
14
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
01/17/17 Practo Tencent Holdings Prov ider of an online serv ice for scheduling appointments with doctors. D $55.0 $179.6
01/03/17 Solera (Health Network) Sandbox Industries, SJF Ventures Prov ider of chronic disease prev ention solutions. A $9.0 $12.0
12/15/16 Cota, Inc. Boston Millennia Partners Prov ider of healthcare data collection and data analysis serv ices. C $18.0 $21.7
12/12/16 Healthcare Interactiv e, Inc. Grotech Ventures, HMC-Virginia, Inc. Prov ider of administration tools and technology serv ices for the healthcare industry. A $8.0 $14.1
12/08/16 Vida Health, Inc. Canv as Ventures Prov ider of a mobile health coaching application. B $18.0 $23.0
12/08/16 Augmedix, Inc. McKesson Ventures, OrbiMed Prov ider of a smartglass-based physician productiv ity platform. B $23.0 $63.3
12/06/16 PatientPing, Inc. Andreessen Horowitz Prov ider of a real time medical notification platform. B $31.6 $41.2
12/01/16 MedNet Solutions, Inc. Arrowroot Capital Prov ider of web-based electronic data capture technology. B $16.5 $20.5
11/23/16 GNS Healthcare, Inc. Horizon Healthcare Serv ices, Celgene Prov ider of big data analytic serv ices for the healthcare industry. C $4.0 $29.0
11/15/16 CareCloud Corp. Blue Cloud Ventures Prov ider of cloud-based healthcare management serv ices. C $15.8 $120.1
10/31/16 Av izia, Inc. Blu Venture Inv estors, Blue Heron Capital Prov ider of a telehealth and remote conferencing software platform. A $17.1 $24.5
10/21/16 Carev iv e Systems, Inc. Undisclosed Prov ider of a clinical practice and patient engagement software. B $7.2 $702.0
10/13/16 Nordic Consulting Partners Silv ersmith Capital Partners Prov ider of healthcare information technology consulting serv ices.PE Growth /
ExpansionNA $38.3
10/13/16 Contessa Health, Inc. Noro-Moseley Partners Prov ider of home-hospitalization programs to manage episodic risk initiativ es. B $7.0 $10.5
10/12/16 Axial Healthcare, Inc. Oak HC/FT Prov ider of pain-management effectiv eness assessment solutions for healthcare prov iders. B $16.5 $26.3
10/11/16 Ev idation Health, Inc. B Capital Group Prov ider of a data analysis platform for the healthcare sector. B $15.0 $21.0
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
SUMMARY OF TECHNOLOGY IPOS
15
MARKET CAP AT IPO (LTM) 7 REVENUE GROWTH (1YR PRIOR TO IPO) 7OFFERING SIZE AT IPO (LTM) 7
RECENT U.S. IPO ACTIVITY (BY OFFERING SIZE) 7
Technology companies’ share of U.S. IPOshas fallen to a seven-year low with just 12IPOs completed year-to-date.
Record valuation levels in the privatemarkets, particularly for high qualitysoftware assets, have presented acompelling alternative to the IPO market asshareholders seek liquidity.11
18
7
11
5
15
3
8
0
2
9
4
5
6
1
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
$0 - 50M $50 - 100M $100 - 250M $250M +
2014 Total: 47 2016 Total: 152015 Total: 31 2017 YTD Total: 12
25%
46%
29%
< 25% 25 - 75% > 75%
38%
33%
29%
$0-50M $50-500M $500M-$1B $1B+
13%
6%
56%
25%
$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)
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
DEBT MARKET OVERVIEW
16
LBO LOAN VOLUME BY INDUSTRY9,10 MEDIAN LBO DEBT PERCENTAGES7
MIDDLE MARKET LBO LOAN MULTIPLES9,10 MIDDLE MARKET LBO VOLUME BY QUARTER9,10
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 3Q'17
FLD/EBITDA SLD/EBITDA Other Sr Debt/EBITDA Sub Debt/EBITDA
Median middlemarket LBO loanmultiples through 3Q2017 increased slightlyto 5.5x leverage,reaching close to 2007highs.
Middle market LBOloan volumeincreased to $2.7billion in 3Q 2017,representing a threeyear high.
Defined as Issuers with EBITDA of $50 Million or LessDefined as Issuers with EBITDA of $50 Million or Less
$1.6B$1.5B
$1.8B
$1.2B
$1.9B$2.0B
$0.4B
$0.9B
$1.2B
$0.7B
$0.9B$1.1B
$1.8B
$2.7B
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
Institutional Pro Rata
13.9%
5.4%
9.0%
9.2%
13.1%
19.0%
30.4%
Other
Restaurants
Services & Leasing
Home Furnishings
Retail
Technology
Healthcare
54% 50%
57% 55% 54%
60% 58%
56%
50%
55%
2008 2009 2010 2011 2012 2013 2014 2015 2016 3Q'17
2017 YTD New Issue LBO Loans Percentage of Total Purchase Price Technology
companies were thesecond largestrecipients of middlemarket LBO loansthrough 3Q 2017,representing 19.0% ofnew issuance.
Median LBO debtpercentagesincreased to 55% oftotal purchase pricethrough 3Q 2017.
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
HW&CO.’S TECHNOLOGY, MEDIA, & TELECOM GROUP
17
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HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
PAGE | 18
Healthcare & Life Sciences
Technology, Media & Telecom
OUR FIRM
PAGE |
HEALTHCARE IT
INDUSTRY UPDATE | Q3 2017
19
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