Healthcare Trends

KeyBanc Capital Markets (KBCM) and Cain Brothers, a division of KBCM, successfully closed the syndication of $855 million in Senior Secured Credit Facilities in support of Viant Medical Holdings, a portfolio company of JLL Partners and Water Street Healthcare Partners. 

The Credit Facilities consist of a $100 million Revolving Credit Facility, a $680 million First Lien Term Loan, and a $75 million First Lien Delayed Draw Term Loan. Proceeds will be used to refinance existing indebtedness and to pay transaction-related fees and expenses. 

Viant is a contract manufacturing organization specializing in medical device components. The company offers a broad range of capabilities that supports global medical device original equipment manufacturers’ production of devices for diagnostic, orthopedic, surgical, and other applications.

JLL Partners is a New York–based middle market private equity firm specializing in healthcare, industrials, and business services. Since being founded in 1988, JLL Partners has raised $5.8 billion across eight funds, working to accelerate growth and elevate its portfolio companies through organic growth initiatives, operational enhancements, and strategic M&A.

Founded in 2005, Water Street Healthcare Partners is a private equity firm focused exclusively on the healthcare industry. The Sponsor has ~$7.5 billion in AUM and is investing out of its fifth fund. Water Street is currently an investor in 21 healthcare companies across numerous healthcare subsectors.

Cain Brothers, a division of KeyBanc Capital Markets, served as the exclusive financial advisor to ProductLife Group on its acquisition of Halloran Consulting Group. 

Cain Brothers was engaged to serve as PLG’s exclusive financial advisor based on its deep experience across the regulatory and compliance consulting space and the broader pharma services continuum. Halloran represents PLG’s second acquisition in North America, a primary focus for the company, as it expands beyond Europe.

ProductLife Group’s mission is to support patient access to safe and effective healthcare solutions by delivering worldwide consulting and outsourcing services through the entire product life. Combining local expertise with global reach spanning more than 150 countries, PLG is the Life Sciences Industry reference strategic partner for the development, market introduction, and life cycle management of product portfolios, and the related business and digital transformation. With a goal of continuously improving the value delivered to teams and clients, PLG is committed to long-term partnership, innovation, flexibility, and cost efficiency.

Founded in 1998 by Laurie Halloran, Halloran is known as one of the largest specialty regulatory agencies of its kind, which allows for a differentiated proposition with an end-to-end solution that is strategic and tactical, all while retaining flexibility that meets every client’s needs. The team of 100 consultants supports sponsors from their first regulatory filing through commercialization.

KeyBanc Capital Markets and Cain Brothers successfully closed the syndication of $635 million in Senior Secured Credit Facilities in support of US Fertility Enterprises, a portfolio company of Amulet Capital Partners.

The Credit Facilities consist of a $60 million Revolving Credit Facility, a $550 million Term Loan, and a $25 million Delayed Draw Term Loan. Proceeds from the Credit Facilities will be used to refinance existing indebtedness and to pay transaction-related fees and expenses. This transaction represents US Fertility’s inaugural broadly syndicated facility.

KeyBanc Capital Markets and Cain Brothers were selected to serve as Left Lead Arranger and Administrative Agent due to our best-in-class leveraged finance platform, expertise in the women’s health space, and long-standing relationship with Amulet Capital Partners. 

US Fertility is the leading fertility group in the United States offering a broad range of assistive reproductive technology services and ancillary life sciences offerings. Since 2021, the Company has grown from ~85 physicians across 59 locations to the leading IVF platform in the nation with over 200 physicians across 105 treatment locations and 30+ embryology labs.

Amulet is a middle market private equity investment firm based in Greenwich, Connecticut, and Walnut Creek, California, focused exclusively on the healthcare sector. Amulet seeks to achieve long-term capital appreciation through privately negotiated investments in healthcare companies. Amulet focuses on those segments it believes have the most attractive long-term fundamentals with a target investment size between $25 million and $200 million.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Lakeview Health in its sale to Bradford Health Services, a portfolio company of Lee Equity Partners.

Cain Brothers was engaged to serve as Lakeview’s exclusive financial advisor based on its deep sector knowledge in substance use disorder treatment and the broader behavioral health sector. The transaction expands Bradford’s network of treatment centers to Florida and furthers its commitment to providing individuals with substance use disorders access to affordable, high-quality care.

Founded in 2001, Lakeview is a nationally recognized provider of addiction treatment and behavioral health services, offering a range of specialized programs across its campuses. With programs such as The Rose and The Star, which provide gender-specific treatment, Koru Spring, which provides care for patients with eating disorders, and Stepping Stone Center for Recovery, Lakeview is dedicated to delivering patient-centered care that addresses the unique needs of each individual. The organization is committed to helping patients achieve long-term recovery through evidence-based practices and a comprehensive continuum of care.

Founded in 1977 and based in Birmingham, Alabama, Bradford is a leading provider of substance use treatment and recovery services with a nationwide reach. Operating through a coordinated network of 40 facilities, Bradford offers affordable, evidence-based treatment throughout the entire spectrum of care, including early intervention, crisis response, intensive outpatient programs, partial hospitalization, residential care, inpatient detox, and transitional living and life skills programs.

Lee Equity Partners is a middle market private equity firm that partners with businesses in the financial and healthcare services sectors. Over nearly two decades, the firm has used its thematic-based investment strategy and deep sector knowledge to identify and partner with businesses in the financial and healthcare services sectors. Over nearly two decades, the firm has utilized its thematic-based investment strategy and deep sector knowledge to identify and partner with talented management teams to accelerate growth and build market-leading businesses. Additional information is available at www.leeequity.com.

Cain Brothers, a division of KeyBanc Capital Markets (KBCM), served as exclusive Buy-Side Advisor to Amulet Capital Partners on its acquisition of Genetics & IVF Institute (GIVF), Inc. KBCM arranged financing for the acquisition, led by the KeyBank Beach Point Direct Lending Program.

On September 6, 2024, Amulet announced it had acquired the GIVF, a leading provider of reproductive tissue banking and related reproductive technology services. The transaction includes significant co-investment from a consortium of Amulet Limited Partners. Financial terms of the transaction were not disclosed. 

Amulet is a middle market private equity investment firm based in Greenwich, Connecticut, and Walnut Creek, California, focused exclusively on the healthcare sector. Amulet seeks to achieve long-term capital appreciation through privately negotiated investments in healthcare companies. Amulet focuses on segments it believes have the most attractive long-term fundamentals, with a target investment size between $50 million and $150 million.

Founded in 1984, GIVF has grown into one of the world’s largest providers of frozen donor sperm and frozen donor eggs and a leading provider of cryostorage for embryos, sperm, and eggs in the United States. The Company currently operates leading multinational brands including Fairfax Cryobank and Fairfax Eggbank. GIVF will continue to be led by Co-CEOs Nadeem Malik and Sean Swindell.

Cain Brothers, a division of KeyBanc Capital Markets (KBCM), served as exclusive Buy-Side Advisor to Amulet Capital Partners on its acquisition of Genetics & IVF Institute (GIVF), Inc. KBCM arranged financing for the acquisition, led by the KeyBank Beach Point Direct Lending Program.

On September 6, 2024, Amulet announced it had acquired GIVF, a leading provider of reproductive tissue banking and related reproductive technology services. The transaction includes significant co-investment from a consortium of Amulet Limited Partners. Financial terms of the transaction were not disclosed. 

Amulet is a middle market private equity investment firm based in Greenwich, Connecticut, and Walnut Creek, California, focused exclusively on the healthcare sector. Amulet seeks to achieve long-term capital appreciation through privately negotiated investments in healthcare companies. Amulet focuses on segments it believes have the most attractive long-term fundamentals, with a target investment size between $50 million and $150 million.

Founded in 1984, GIVF has grown into one of the world’s largest providers of frozen donor sperm and frozen donor eggs and a leading provider of cryostorage for embryos, sperm, and eggs in the United States. The Company currently operates leading multinational brands including Fairfax Cryobank and Fairfax Eggbank. GIVF will continue to be led by Co-CEOs Nadeem Malik and Sean Swindell.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to ConnectiCare, a subsidiary of EmblemHealth, in its pending sale to Molina Healthcare (NYSE: MOH).

On July 23, 2024, Molina announced that it entered into a definitive agreement to acquire ConnectiCare, a wholly owned subsidiary of EmblemHealth. The transaction brings an established government business in a new state, recognized brand, and a statewide provider network to Molina’s current service offering.

The transaction is expected to close in the first half of 2025 following applicable federal and state regulatory approvals.

ConnectiCare is a leading health plan in Connecticut and has been dedicated to making the state a healthier place to live and work since the company was founded in 1981. ConnectiCare has a full range of products and services for businesses, municipalities, individuals, and those who are Medicare eligible, and leads the individual market in the state.

EmblemHealth is one of the nation’s largest nonprofit health insurers, with more than 3 million members and an 80-year legacy of serving New York’s communities. The company offers a full range of commercial and government-sponsored health plans to employers, individuals, and families, as well as convenient community resources. As a market leader in value-based care, EmblemHealth partners with top providers and hospitals to deliver quality, affordable care.

Molina Healthcare, a FORTUNE 500 company, provides managed healthcare services under the Medicaid and Medicare programs and through the state insurance marketplaces.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Get Well in its sale to SAIGroup.

Cain Brothers was engaged to serve as Get Well’s exclusive financial advisor based on its long-standing relationship and extensive knowledge of the healthtech and patient engagement spaces. As a SAIGroup company, Get Well will integrate SAIGroup’s award-winning, advanced Eureka AI platform into its patient experience.

Get Well is redefining digital patient engagement by putting patients in control of their health care, inside and outside the hospital. Get Well combines advanced navigation with high-touch care experiences to improve patient activation, loyalty, and outcomes and reduce the cost of care. Get Well serves more than 10 million patients annually at more than 1,000 hospitals and clinical partner sites, using longitudinal data analytics to better serve patients and clinicians. Get Well’s award-winning solutions were recognized again in 2024 by KLAS Research and AVIA Marketplace.

SAIGroup is a private firm investing in businesses with the potential to become leaders in enterprise AI. SAIGroup companies ConcertAI, SymphonyAI, and RhythmX AI deliver AI solutions that transform industries and bring value to companies, workers, healthcare professionals, and patients. The companies collectively represent a workforce of more than 4,000 talented engineers, data scientists, and industry/healthcare experts. SAIGroup is backed by a $1 billion commitment from founder and CEO Dr. Romesh Wadhwani, a noted entrepreneur and philanthropist.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to ArchCare, the Continuing Care Community of the Archdiocese of New York in connection with the transfer of ArchCare’s Managed Long-Term Care members and related key assets to VillageCare.

Cain Brothers was engaged to serve as exclusive financial advisor to ArchCare based on its deep expertise and experience in the managed care sector, especially within the not-for-profit space and New York market. The Cain Brothers team executed a targeted and highly competitive process to identify the optimal partner for ArchCare.

ArchCare is the Continuing Care Community of the Archdiocese of New York and one of the nation’s largest and most dynamic Catholic healthcare systems. ArchCare provides quality care to thousands of people of all faiths through its home and community-based and residential care programs, including health plans and nursing home alternatives, adult day care, long term skilled nursing care, short term rehabilitation, home care, assisted living, hospice, an acute care specialty hospital, and services for people with Huntington’s disease, HIV/AIDS, developmental disabilities, and other specialized care needs.

VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. VillageCare offers a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Physicians Health Plan of Northern Indiana. 

The planned acquisition of PHPNI expands Priority Health’s presence into Northern Indiana and Ohio. Financial proceeds of the transaction will advance the mission of the PHP Foundation and enhance its ability to support the health and wellness needs of unserved and in-need populations in Northern Indiana communities. 

The transaction is expected to close by the end of 2024 after required approvals are completed. 

Physicians Health Plan of Northern Indiana, Inc., headquartered in Fort Wayne, Indiana, is a leading commercial health plan offering employer-sponsored benefits to more than 52,000 members across Indiana and the Midwest. PHPNI is a community-based leader in providing cost-efficient and innovative health care solutions by acting with integrity and providing exceptional customer service. 

With over 30 years in business in Michigan, Priority Health offers an extensive portfolio of health benefit options for employer groups and individuals, including Medicare and Medicaid plans. Leveraging its broad network of primary care physicians in Michigan, Priority Health continues to be recognized as a leader in quality, customer service, transparency, and product innovation for more than 1.3 million members. 

Mike Elizondo
 

Overlake Medical Center & Clinics and MultiCare Health System announced an affiliation agreement, emphasizing its long-term commitment to delivering the highest quality, most advanced health care to communities across Washington. This transaction is subject to regulatory approval and customary closing conditions, with an anticipated closing date later in 2024.

Cain Brothers was retained by MultiCare as its advisor to assist through the affiliation process and negotiations with Overlake. Cain Brothers brought deep domain expertise in the hospital and health system sector and a strong understanding of the Washington health care market. Through this agreement, Overlake and its network of clinics will comprise the new North Sound region of MultiCare’s statewide network and will be the North Sound region’s flagship health system. The agreement includes continued local governance and management, ongoing community commitment and significant capital investment in the region.

MultiCare Health System is a not-for-profit healthcare organization that’s been caring for communities in Washington state since the founding of Tacoma’s first hospital in 1882. With more than 23,000 team members, including employees, providers, and volunteers, MultiCare has grown into one of the largest community-based, locally governed health systems in the state of Washington. MultiCare serves patients throughout the Pacific Northwest and includes a dozen award-winning hospitals as well as numerous primary care, virtual care, urgent care, pediatric care, and specialty services, including MultiCare Behavioral Health Network; MultiCare Indigo Urgent Care; Mary Bridge Children’s Hospital & Health Network; Pulse Heart Institute; MultiCare Connected Care, an accountable care organization; and MultiCare Rockwood Clinic.

Overlake Medical Center & Clinics is a not-for-profit regional health care system in Bellevue, Washington, serving the community since 1960. The health system includes a 349-bed hospital and a growing network of primary, urgent, and specialty care clinics throughout the region. Overlake is recognized locally and nationally for quality and safety, including recurring Leapfrog A ratings, Healthgrades’ Patient Safety Excellence Award, and recognition as a Best Regional Hospital by U.S. News & World Report in its Best Hospitals 2023–24 rankings. Overlake offers comprehensive advanced services, including a dedicated Cancer Center, Level lll Trauma Center, Childbirth Center, and Level lll NICU, cardiac, neurosciences, orthopedic, and mental health services. Employing more than 3,500 people, Overlake is dedicated to compassionate care for every life it touches.

Cain Brothers and KeyBanc Capital Markets successfully closed $116.0 million in Senior Secured Credit Facilities for Allied OMS.

The Credit Facilities consist of a $15 million Revolving Credit Facility, an $86 million Term Loan A, and a $15 million Delayed Draw Term Loan. Proceeds from the Credit Facilities will be used to support the next phase of growth for the Company, specifically partnering with future OMS practices, building de novos and satellite offices, and recruiting world-class practitioners into existing practices.

KBCM and Cain Brothers acted as Left Lead Arranger, Sole Bookrunner, and Administrative Agent on the transaction.

Allied OMS is a premier doctor-owned, doctor-governed oral and maxillofacial surgery platform that combines the best of private practice with the best of private equity. Grounded in clinical excellence, doctors in the Allied OMS network maintain essential roles in management, governance, and clinical practice and participate directly in the platform’s growth. Founded in 2020 in partnership with DuneGlass Capital, a healthcare services-focused independent sponsor, the Allied OMS network includes ~30 practices across 12 states, supported by a group of 60 experienced surgeons.

Cain Brothers, a division of KeyBanc Capital Markets, advised FilBen Group on the $30,685,000 FHA 232/223(f) refinancing for Wallkill Realty Partners d/b/a Braemar at Wallkill. The proceeds of the Loan will be used to refinance The Orange County Funding Corporation (New York) Assisted Living Residence Revenue Bonds, Series 2012.

The transaction will provide Braemar at Wallkill with a long-term, fixed-rate, low cost of capital. As a result of the refinancing, the tax-exempt public fixed-rate Series 2012 Bonds were redeemed at par. In addition, the refinancing will remove any ongoing financial covenants and public disclosure requirements related to the Series 2012 Bonds (e.g., Debt Service Coverage Ratio, Days Cash on Hand).

Braemar at Wallkill is licensed as an Adult Home, of which 120 beds are licensed as Assisted Living Residence and primarily serve private-pay residents, and the remaining 80 beds are licensed as Assisted Living Program and primarily serve Medicaid-eligible residents. Twenty-four of the ALR beds are licensed as Special Needs Assisted Living Residence and are operated as memory support beds.

The Facility was developed and is owned and operated by various affiliates of FilBen, an experienced and well-respected New York-based senior living developer with a track record spanning over 50 years. FilBen has developed more than 5,000 nursing home beds and 1,400 units of private pay senior housing in New York since its founding.