I N D U S T R Y I N S I G H T S : Healthcare Services Sector Update January 2018
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1 I N D U S T R Y I N S I G H T S : Sector Update January 2018
2 Sector Update January 2018 Highlights The S&P Index increased 8.2% over the last month, outperforming the S&P 500, which increased 5.6% over the same period. Over the past month: The best performing sectors were Acute Care Hospitals (up 13.3%), Distribution (up 10.2%), and Dialysis Services (up 9.3%). The poorest performing sectors were Specialty Managed Care (down 9.1%), Healthcare REITS (down 6.4%) and Assisted / Independent Living (down 4.4%). The current average LTM revenue and LTM EBITDA multiples for the industry overall are 2.23x and 14.5x, respectively. T H E S E C T O R S W I T H T H E H I G H E S T V A L U A T I O N M U L T I P L E S Consumer Directed Health / Wellness (4.52x LTM Revenue, 25.0x LTM EBITDA) HCIT (4.42x LTM Revenue, 24.5x LTM EBITDA) Hospital Vendors (2.20x LTM Revenue, 21.4x LTM EBITDA) Pharmacy Management (0.68x LTM Revenue, 20.5x LTM EBITDA) Page 2
3 Sector Update January 2018 Sector Update Market Sector # of Ag. Equity Average % Change LTM Multiples Earnings Ratio PEG Ratio Co's Mkt. Value 1 mo 12 mo Rev EBITDA LTM 2018E 2018E Providers Acute Care Hospitals 5 $51, % 19.2% 1.15x 8.5x 15.1x 14.1x 1.9x Assisted / Independent Living 3 2,187 (4.4%) (36.3%) 1.56x 11.5x NM NM NM Behavioral Heath 3 5, % 8.6% 1.01x 11.1x 21.8x 16.7x NM Dialysis Services 3 50, % 36.3% 1.89x 10.4x 29.4x 23.1x 1.6x Healthcare Staffing 2 3, % 40.9% 1.07x 13.5x 22.4x 19.3x (6.0x) Home Health / Hospice 7 9, % 37.5% 1.26x 14.9x 35.3x 23.8x 2.2x Rehabilitation 5 9, % 35.1% 1.93x 12.2x 30.3x 19.0x 3.8x Skilled Nursing 4 2, % (3.5%) 0.70x 8.8x 22.0x 13.4x 0.9x Providers - Other 4 10, % (27.7%) 2.05x 12.7x 31.5x 15.1x 1.2x Total / Average 36 $144, % 22.9% 1.40x 11.5x 26.0x 18.1x 0.8x Payors / Managed Care Commercial Managed Care 5 $444, % 49.0% 1.03x 12.7x 23.5x 18.5x 1.4x Government Managed Care 3 33, % 61.1% 0.31x 10.4x 24.3x 22.2x 1.0x Specialty Managed Care 2 5,338 (9.1%) (3.2%) 0.44x 7.1x 17.4x 11.8x 1.2x Total / Average 10 $483, % 49.2% 0.59x 10.1x 21.7x 17.5x 1.2x Consumer Directed Health / Wellness 6 $9, % 5.0% 4.52x 25.0x 24.8x 36.9x 1.7x HCIT 21 $53, % 25.8% 4.42x 24.5x 37.0x 34.1x 1.9x Other Outsourced Services Care Management / TPA 5 $6,796 (3.4%) 30.4% 1.44x 15.8x 21.4x 20.4x 1.4x Clinical Laboratories 6 40, % 22.5% 3.15x 16.8x 22.0x 17.9x 2.1x Contract Research Orgs 5 41, % 28.2% 3.87x 19.5x 23.5x 18.7x 1.3x Hospital Vendors 4 10, % 13.4% 2.20x 21.4x 31.2x 28.1x 2.0x Healthcare Consulting 2 1, % (14.3%) 1.43x 10.6x 21.8x 16.1x 1.2x Total / Average 22 $101, % 23.8% 2.42x 16.8x 24.0x 20.2x 1.6x Product Distribution 6 $96, % 8.4% 0.46x 10.9x 17.7x 14.1x 2.4x Pharmacy Management 3 47, % 19.0% 0.68x 20.5x 13.0x 17.8x 1.1x Total / Average 9 $143, % 11.9% 0.57x 15.7x 15.3x 15.9x 1.8x Healthcare REITS 16 $90,980 (6.4%) (10.1%) 12.38x 18.3x 24.0x 30.9x 7.1x Total / Average ($MM) 120 $1,027, % 17.8% 2.23x 14.5x 23.9x 20.8x 1.6x Page 3
4 Sector Update January 2018 Sector Update Market Indices Value at 1/31/2018 % Change 1 mo YTD 12 mo 36 mo S&P 500 2, % 5.6% 23.9% 41.5% NASDAQ Composite Index 7, % 7.4% 32.0% 59.9% Russell 2000 Index 1, % 2.6% 15.7% 35.1% S&P Composite 1500 Health Care Facilities (Sub Ind) % 10.7% 16.3% 14.1% S&P Composite 1500 Health Care Providers & Services (Industry) % 7.7% 33.0% 50.9% S&P Composite 1500 Managed Health Care (Sub Ind) 1, % 7.2% 49.1% 107.4% S&P Health Care Services Select Industry Index 9, % 8.2% 20.1% 20.6% Interest Rates Value at 1 mo 3 mo 12 mo 1/31/2018 ago ago ago LIBOR - USD - 6 months 1.97% 1.84% 1.58% 1.35% U.S. Treasury - 2 years 2.14% 1.89% 1.60% 1.19% U.S. Treasury - 5 years 2.53% 2.19% 2.01% 1.91% U.S. Treasury - 10 years 2.72% 2.41% 2.38% 2.45% U.S. Treasury - 30 years 2.94% 2.74% 2.88% 3.05% U.S. Prime Rate 4.50% 4.50% 4.25% 3.75% Capitalization Profile No. of Ag. Equity % Total %Ag. Eqty Average Stock Performance Co's Mkt. Value No. of Co's Mkt. Value 1 mo YTD 12 mo 36 mo > $5 billion 32 $888, % 86.5% 5.2% 5.2% 23.4% 41.5% $1 billion - $5 billion , % 11.2% 1.6% 1.6% 8.5% 23.7% $250 million - $1 billion 36 23, % 2.2% 2.7% 2.7% 20.7% 18.0% $100 million - $250 million % 0.0% (1.6%) (1.6%) 9.3% (15.6%) < $100 million % 0.0% 4.0% 4.0% (23.1%) (22.0%) Total / Average ($MM) 120 $1,027, % 100.0% 2.4% 2.4% 7.8% 9.1% Page 4
5 Sector Capital Update Markets Industry January Insights Q Market Performance Performance of Market Indices for Latest 36 Months 180 S&P 500 NASDAQ Composite Index Russell 2000 Index S&P Health Care Services Select Industry Index /31/15 4/30/15 7/31/15 10/31/15 1/31/16 4/30/16 7/31/16 10/31/16 1/31/17 4/30/17 7/31/17 10/31/17 1/31/18 Page 5 Source: S&P Global Market Intelligence
6 Sector Capital Update Markets Industry January Insights Q Sector Change Average % - 1 Month Change Specialty Managed Care Care Management / TPA Assisted / Independent Living Healthcare REITS Skilled Nursing Behavioral Heath HCIT S&P 500 Rehabilitation Providers - Other Healthcare Consulting Consumer Directed Health / Wellness Contract Research Orgs Commercial Managed Care Pharmacy Management Home Health / Hospice Distribution Dialysis Services Healthcare Staffing Hospital Vendors Clinical Laboratories Government Managed Care Acute Care Hospitals (13.0%) (8.0%) (3.0%) 2.0% 7.0% 12.0% 17.0% Page 6
7 Sector Capital Update Markets Industry January Insights Q Sector Change Average % - 12 Month Change Providers - Other Assisted / Independent Living Specialty Managed Care Healthcare REITS Healthcare Consulting Skilled Nursing Hospital Vendors Behavioral Heath Distribution Contract Research Orgs HCIT S&P 500 Clinical Laboratories Acute Care Hospitals Pharmacy Management Consumer Directed Health / Wellness Healthcare Staffing Home Health / Hospice Dialysis Services Rehabilitation Care Management / TPA Government Managed Care Commercial Managed Care (60.0%) (40.0%) (20.0%) 0.0% 20.0% 40.0% 60.0% 80.0% Page 7
8 Consumer Directed Health / Wellness HCIT Hospital Vendors Pharmacy Management Contract Research Orgs Healthcare REITS Clinical Laboratories Care Management / TPA Home Health / Hospice Healthcare Staffing Providers - Other Commercial Managed Care Rehabilitation Assisted / Independent Living Behavioral Heath Distribution Healthcare Consulting Dialysis Services Government Managed Care Skilled Nursing Acute Care Hospitals Specialty Managed Care Sector Capital Update Markets Industry January Insights Q Multiples Overview of Subsector EV/LTM EBITDA 30.0x 25.0x 25.0x 24.5x 21.4x 20.5x 19.5x 20.0x 18.3x 16.8x 15.8x 14.9x 15.0x 13.5x 12.7x 12.7x 12.2x 11.5x 11.1x 10.9x 10.6x 10.4x 10.4x 10.0x 5.0x 8.8x 8.5x 7.1x 0.0x Page 8
9 Sector Update January 2018 For the detailed January trading multiples for individual healthcare services companies, please contact one of our professionals below. Brooks Dexter Managing Director Head of Healthcare M&A Los Angeles Eric Coburn Managing Director New York Laca Wong-Hammond Managing Director New York Philip Smith Managing Director Minneapolis Jordan Lampos Director Los Angeles Adam Stormoen Director Minneapolis About Duff & Phelps Duff & Phelps is the premier global valuation and corporate finance advisor with expertise in complex valuation, disputes and investigations, M&A, real estate, restructuring, and compliance and regulatory consulting. The firm s more than 2,000 employees serve a diverse range of clients from offices around the world. For more information, visit M&A advisory, capital raising and secondary market advisory services in the United States are provided by Duff & Phelps Securities, LLC. Member FINRA/SIPC. Pagemill Partners is a Division of Duff & Phelps Securities, LLC. M&A advisory and capital raising services in Canada are provided by Duff & Phelps Securities Canada Ltd., a registered Exempt Market Dealer. M&A advisory, capital raising and secondary market advisory services in the United Kingdom and across Europe are provided by Duff & Phelps Securities Ltd. (DPSL), which is authorized and regulated by the Financial Conduct Authority. In Germany M&A advisory and capital raising services are also provided by Duff & Phelps GmbH, which is a Tied Agent of DPSL. Valuation Advisory Services in India are provided by Duff & Phelps India Private Limited under a category 1 merchant banker license issued by the Securities and Exchange Board of India. Copyright 2018 Duff & Phelps LLC. All rights reserved.
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