Healthcare Services Transactions Update – Q2 2025
Ankura presents an overview of healthcare services transactions announced or closed in the United States in the second quarter of 2025. After a 8.3% decline in the first quarter, total transactions increased by 3.0% in the second quarter of 2025. Transaction volumes fell 9.5% in the 2025 quarter compared to the 2024 quarter.
Notable transactions announced or closed in Q21
Ascension Health signed the decisive agreement on June 2, 2025 to acquire Amsurg for $3.9 billion, meaning a 3.6x price for revenue multiples and EBITDA multiples of 15.8x. Amsurg owns and operates the Walking Surgery Center (ASCS) throughout the US GI Alliance, a subsidiary of Cardinal Health, and signed a decisive agreement on April 30, 2025 to acquire Urology America. Concentra signed the decisive agreement on April 21, 2025 to acquire Pivot Onsite Innovation for $55 million. Pivot OnSite Innovations provides onsite occupational health services within US Bain Capital, which signed a decisive agreement on April 10, 2025 to acquire HealthEdge for $2.6 billion, implying a 6.5x price multiple revenue multiples and 30.2x price to multiples of EBITDA. HealthEdge is a service (SAAS) company software that provides digital solutions to health plans, providers and patients. Radnet, Inc. (NASDAQ: RDNT) was released on April 15, 2025. (NASDAQ: RDNT) was released on ICAD, Inc. We have concluded a decisive agreement to acquire (NASDAQ:ICAD) for approximately $3.61 per share. The purchase price means a company value of $85.8 million or a price of 4.4 times the revenue multiple. ICAD offers artificial intelligence (AI)-driven cancer detection solutions focused on breast cancer screening.
Important observations
Total trading activity for the second quarter of 2025 increased slightly over the last quarter of the healthcare services industry. However, these levels remain significantly below the activity observed over the past few years. Inflation continued to be easier in the second quarter, but potential buyers continued to address high borrowing costs as the Federal Reserve maintained its target federal funding rate.
Healthcare operators received mixed news on July 4, 2025, passing one big beautiful bill law (OBBBA). Tax clauses are generally beneficial to businesses, but OBBBA will cut $1 trillion from federal health funds over the next decade. For more information about OBBBA, we explore Ankura's article jumping into OBBBA's impact on the healthcare industry.
Despite hopes for a decline in regulatory barriers under the Trump administration, federal agencies have sent mixed signals about their intentions to oversee regulatory in certain health sectors. Several actions by federal agencies in the second quarter demonstrate an intention to increase surveillance. For example, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) held listening sessions to investigate anti-competitive practices in the pharmaceutical industry, the DOJ and the Department of Health and Human Services (HHS) resumed the false claims law working group, and the Directorate of Certificates (OIG) issued comprehensive advisory opinions for healthcare companies. In contrast, DOJ recently reached a settlement that allowed United Health Group to continue its acquisition of Amedisys. The settlement requires Amedisys and the United Health Group to sell 164 home health sites, but some experts believe the decision is the result of the Trump administration's business-friendly approach.
Investors also continue to face increased scrutiny of regulations at the state level, and could curb future healthcare acquisitions as laws have been passed or introduced in several states. Oregon has passed a new law widely considered to be the most restrictive in the country, significantly limiting its healthcare management services organization (MSO) model. Massachusetts has increased the requirement for transaction notifications, and California has reintroduced a bill targeting private equity investments in healthcare and MSO models despite being rejected last year.
As shown in the diagram below, recent healthcare acquisitions continue to be dominated by three sectors that make up 76.1% of second-quarter transactions: professional services (2), outsourced services (2), and behavioral health. The Professional Services sector has remained the most active sector in terms of total trading, as a result of continuing interest from health systems and private equity buyers, accounting for 54.9% of total trading volume.
In the Professional Services sector, most of the growth in transactional activity occurred in the dental sector. Much of the dental trading activity was driven by add-on acquisitions through private equity aid platforms such as Heartland Dental and MB2 Dental.
Behavioral health transactions fell approximately 10.2% in the second quarter. President Donald Trump's OBBBA was not passed until the end of the quarter, but investors may have hesitated to invest in the behavioural health sector due to their general reliance on Medicaid.
In specialized outpatient services, total transactions increased by 44.4%. Most transactions in this sector include the acquisition of small operators of diagnostic imaging centers or ASCS, but the industry also saw the announcement of Ascension Health's acquisition of Amsurg, one of the largest surgical center operators in the United States. The Amsurg acquisition continues the trend in health systems to make strategic investments in outpatient care.
Over the quarter, Ankura's trading advisory practices provided guidance on diverse transactions across the sector, including dental trading, behavioral health (autism services, addiction treatment, psychiatry), physician practice, and long-term care services.
Future outlook
Heading into the second half of 2025, health investors will closely monitor economic indicators, including inflation pressures, borrowing costs and regulatory requirements, at both federal and state levels. Although inflation has been declining since Trump took office, most industry participants are concerned that recent tariff announcements could lead to higher costs in the short term. The Federal Reserve is also expected to cut fees this September, which could spur trading activity.
We expect an impact from the OBBBA, and we expect regulatory scrutiny to increase trading activity later this year, along with a more focused approach to specific geographical regions and health sectors.
(1) Source: Published by Scope Research Healthcare M&A Volume Database, Scope Research. Capital IQ
(2) The Specialist Services Department includes dentistry, physical therapy, physician practice, emergency care, veterinary and other clinics. Outsourced services departments include billing, revenue cycles, management service organizations, marketing, staffing, and other services that are generally outsourced by healthcare practices.
