Cain Brothers Newsletters: Industry Insights

Central Maine Healthcare and Prime Healthcare Foundation have finalized their affiliation agreement, allowing the residents of central, western, and Midcoast Maine to continue to have access to the highest-quality, most advanced health care in the region. 

Cain Brothers was engaged by Central Maine Healthcare as its exclusive advisor based on its expertise in the hospital and health system sector and strong understanding of the New England market. Cain Brothers engaged with parties interested in continuing CMH’s mission and finalized an affiliation agreement with Prime Healthcare Foundation. Terms include continued local governance and management, ongoing community commitment, and significant capital investment, and are subject to regulatory approval.

Central Maine Healthcare is an integrated health system serving more than 400,000 residents and includes 600 physicians and advanced practice professionals in more than 40 locations, as well as Central Maine Medical Center in Lewiston, a 250-bed, not-for-profit, Level III Trauma Center that serves as the base for LifeFlight of Maine, the state’s only medical helicopter. CMH also operates the Bridgton and Rumford hospitals, two 25-bed critical-access hospitals serving the Lakes Region and River Valley communities, respectively.

CMH includes two long-term care communities, Bolster Heights, an 84-bed assisted living facility, and Rumford Community Home, an 85-bed, active-living community, as well as Maine’s first nursing and medical imaging programs, Maine College of Health Professions. 

Prime Healthcare is one of the nation’s leading health systems, serving more than 2.6 million patient visits annually. With nearly 45,000 employees and physicians, Prime operates 44 hospitals and more than 300 outpatient locations in 14 states. Fourteen of the company's hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Based in Ontario, Canada, Prime is nationally recognized for quality care and has been named a Top 10 and Top 15 Health System by Truven Health Analytics. Its hospitals have been named among the nation’s “100 Top Hospitals” 69 times and have received more Patient Safety Excellence Awards from Healthgrades than any other health system in the past eight years. 

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Theoria Management in its new platform partnership with Amulet Capital Partners.

Theoria Management retained Cain Brothers based on its experience in primary and post-acute care, expertise in value-based care, and relationships with the relevant investors. Cain Brothers, along with the Company’s founder, designed and executed a targeted process to find the ideal partner to help the Company deliver on its long-term vision. This successful process continues Cain Brothers’ strong track record of representing founder-led businesses in partnering with private equity firms.

Theoria Management is a tech-enabled management service organization supporting a comprehensive medical group practice dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical clinical relationships. Theoria’s affiliated medical groups offer a broad scope of services including multispecialty physician services, telemedicine, chronic care management, and remote patient monitoring.

Amulet Capital Partners 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, focusing on those segments it believes have the most attractive long-term fundamentals. Amulet currently manages approximately $2.7 billion in assets and is investing out of its third fund, which was oversubscribed and closed in July 2024 with approximately $1.2 billion in capital commitments.

KeyBanc Capital Markets and Cain Brothers, a division of KeyBanc Capital Markets, closed the syndication of $390 million of Senior Secured Credit Facilities in support of LifeStance Health (NASDAQ: LFST), which was taken public in 2021 by TPG and who retains a significant equity stake.

The financing consists of a $100 million Revolving Credit Facility and a $290 million Term Loan A. Proceeds will be used to refinance the Company’s existing private credit structure.

LifeStance is one of the nation’s largest providers of virtual and in-person outpatient mental healthcare for children, adolescents, and adults experiencing a variety of mental health conditions. The Company’s mental health services span across psychiatric evaluations and treatment, psychological and neuropsychological testing, and individual, family and group therapy. LifeStance and its supported practices employ 7,200+ psychiatrists, advanced practice nurses, psychologists, and therapists through more than 550 centers across 33 states.

TPG is a leading global alternative asset management firm, founded in San Francisco in 1992, with $229 billion of assets under management and investment and operational teams around the world. TPG invests across a broadly diversified set of strategies, including private equity, impact, credit, real estate, and market solutions, and its unique strategy is driven by collaboration, innovation, and inclusion. TPG teams combine deep product and sector experience with broad capabilities and expertise to develop differentiated insights and add value for its fund investors, portfolio companies, management teams, and communities.

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

IU Health has sold its health plan to Elevance Health Inc. (NYSE: ELV), with transaction proceeds enabling IU Health to focus on its core health system and serve the health and wellness needs of the Indiana community. The sale strengthens Elevance’s presence in Indiana and improves access to high-quality care. This transaction also further enhances the robust relationship between IU Health and Elevance. The transaction closed on December 31, 2024.

Indiana University Health, headquartered in Indianapolis, is a leading network in the state of Indiana offering top-tier primary and specialty care. IU Health Plans is an established managed care plan known for its local brand, community involvement, high-touch customer service, and extensive product offerings. It offers Medicare Advantage plans in 36 counties to 19,000 members and fully insured commercial plans to 12,000 members.

Headquartered in Indianapolis, Elevance Health offers an extensive portfolio of health benefits through its various health plans, including Medicare and Medicaid plans. Leveraging their broad network of associates and a strategic focus on care provider enablement and digital solutions, Elevance Health continues to be recognized as a leader for its consumer-centered health system for more than 37 million members nationally.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to AdventHealth in its pending acquisition of ShorePoint Health Port Charlotte and certain assets of ShorePoint Health Punta Gorda from affiliates of Community Health Systems, Inc. (NYSE: CYH).

AdventHealth signed a definitive agreement to purchase 254-bed ShorePoint Health — Port Charlotte and certain assets of ShorePoint Health — Punta Gorda from affiliates of Community Health Systems, Inc. for $265 million. Based north of Fort Myers, Florida, ShorePoint Health also includes related businesses, such as physician clinic operations and outpatient services. The transaction is expected to close in the first quarter of 2025, subject to regulatory approvals and closing conditions.

AdventHealth is a connected system of care for every stage of life and health. A shared vision, common values, focus on whole-person health, and commitment to making communities healthier unify the system's hospital campuses in diverse regions throughout nine states. AdventHealth owns or manages 50 hospitals in nine states with reported consolidated revenues of $18.9 billion for the past 12 months ending September 30, 2024.

Community Health Systems, Inc. owns or leases 69 affiliated hospitals in 15 states, with more than 11,000 beds, and operates more than 1,000 sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers, and ambulatory surgery centers. CHS reported consolidated revenues of $12.6 billion for the past twelve months ending September 30, 2024.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to EmblemHealth in the sale of its subsidiary, WellSpark, to Vitality.

Cain Brothers was engaged by EmblemHealth to sell its wholly owned subsidiary, WellSpark, because of its long-standing relationship and employer health expertise. On November 19, Vitality announced the acquisition of WellSpark and its intention to integrate WellSpark’s coaching solutions, offering Vitality’s employer and health plan clients access to a range of new services and additional tools to support their health and well-being. 

WellSpark is a health coaching company and digital platform that provides wellness solutions to employers as part of their benefits offerings. Since its beginning in 2013, the company has helped its members live healthier and more fulfilling lives by providing human-to-human support, intervening early for chronic condition management, and breaking biopsychosocial barriers that prevent its members from making lasting change.

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 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.

Guided by a core purpose of making people healthier, Vitality is the leader in improving health to unlock outcomes that matter. By blending industry-leading smart tech, data, AI, incentives, and behavioral science, Vitality inspires healthy changes in individuals and organizations. As one of the largest health and well-being companies in the world, Vitality brings a dynamic and diverse perspective through successful partnerships with the most forward-thinking insurers and employers.

More than 35 million people in 41 markets globally engage in the Vitality program.

Cain Brothers served as financial advisor to Steward Health Care during its Chapter 11 bankruptcy process to identify buyers and manage the sale of up to 17 hospiinals across seven states. Cain Brothers was retained based on its extensive knowledge of the hospital & health system sector, real estate expertise, and demonstrable ability to execute complex transactions.  

Odessa Regional Medical Center has 225 beds and approximately 250 physicians on staff, with over 700 employees. ORMC offers advanced diagnostic imaging technology, emergency care, innovative surgical procedures, maternity care, comprehensive cardiac services, and general medical care. Scenic Mountain Medical Center is a full-service, acute care, 146-bed community hospital. Specialized services include cardiology, orthopedics, maternity, diagnostic imaging, emergency care with a 24/7 Level IV Trauma Center, wound care, and women’s health and breast care services.

Cain Brothers targeted buyers interested in owning and operating hospitals in West Texas. The successful acquisition by Quorum Health preserves community jobs and continues providing of care to current and future patients of ORMC and SMMC.

Steward Health Care was one of the largest private hospital systems in the U.S., operating more than 30 hospitals in eight states supported by multi-specialty provider groups with more than 1,700 providers and operations in 11 states. Steward had previously entered real estate sale/leaseback transactions with Medical Properties Trust for many of its hospitals.

Quorum Health is a leading operator of general acute care hospitals and outpatient services in the U.S., operating a diversified portfolio of 12 affiliated hospitals in rural and mid-sized markets across nine states with an aggregate of 924 licensed beds. Through its network of hospitals, physician practices and health care providers, the company is focused on addressing the critical health care needs of patients in their local communities.

Cain Brothers served as financial advisor to Steward Health Care during its Chapter 11 bankruptcy process to identify buyers and manage the sale of up to 17 hospitals in seven states. Cain Brothers was retained based on its extensive knowledge of the hospital & health system sector, real estate expertise, and demonstrable ability to execute complex transactions.  

Founded by the Dominican Sisters of the Presentation in 1906, Saint Anne’s Hospital in Fall River, Massachusetts, is a full-service, acute care Catholic hospital with 211 beds and satellites in Fall River, Attleboro, Swansea, and Dartmouth, Massachusetts. The hospital provides inpatient and outpatient clinical services to patients from surrounding Massachusetts and Rhode Island communities. Morton Hospital in Taunton is a 144-bed acute care community hospital serving patients and families in southeastern Massachusetts.

Cain Brothers targeted buyers interested in owning and operating hospitals in the southern Massachusetts and Rhode Island region. The successful acquisition of the Saint Anne’s and Morton hospitals by Lifespan preserves community jobs and continues providing of care to current and future patients in the region.

Steward Health Care was one of the largest private hospital systems in the U.S., operating more than 30 hospitals in eight states supported by multi-specialty provider groups with more than 1,700 providers and operations in 11 states. Steward had previously entered real estate sale/leaseback transactions with Medical Properties Trust for many of its hospitals.

Lifespan is Rhode Island’s largest health system and employer with five hospitals and about 16,000 employees. In October 2024, Lifespan was rebranded to Brown University Health to expand on its 55-year affiliation with the Ivy League.