2026 Healthcare Delivery M&A Outlook

Industry report

Demographic growth, workforce constraints, and the migration of care into outpatient, home-based, and virtual settings continue to drive consolidation across healthcare delivery.

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Founders Group

Ali Naseer
Co-Founder & Partner
Ali@FoundersG.com (952) 797-4679
Matt Menzi
Co-Founder & Partner
Matt@FoundersG.com (301) 767-5616

EXECUTIVE SUMMARY

Healthcare consolidation remains active, with higher requirements for financial and clinical diligence

Demographics and site-of-care migration support demand; reimbursement, labor and regulatory execution determine which providers earn a premium.

Physician groups lead transaction volume
Specialty-practice combinations remain the largest source of reported healthcare-services transactions.
Care delivery continues to shift to lower-cost settings
Home, ambulatory and virtual settings continue to take share when they improve access and total cost.
Scale alone does not establish platform quality
Buyers want mature revenue-cycle controls, compliant clinical governance and repeatable local-market integration.
Labor availability is a primary operating constraint
Provider recruitment, retention, credentialing and productivity sit at the center of diligence.
Reimbursement creates valuation dispersion
Payor mix, rate visibility and coding quality can create wide valuation differences within one specialty.
Regulatory risk affects transaction certainty
State review, corporate-practice rules and antitrust scrutiny increasingly influence structure and timing.

SECTOR AT A GLANCE

Six delivery models account for most lower- middle-market activity

The common thread is clinical demand; the economics differ by provider model, reimbursement and site of care.

Exhibit 1

Investable lane	Business model	Primary buyer lens	Key risk
Specialty physician groups	Professional fees + ancillary services	Provider density, payor mix and local share	Physician concentration
Dental support organizations	Practice support + clinical production	Same-store growth and affiliation pipeline	Provider turnover
Behavioral health	Visits, programs and facility census	Access, outcomes and continuum of care	Clinical labor / payors
Home health, home care & hospice	Episodes, visits and caregiver hours	Branch density and reimbursement quality	Compliance / labor
Rehabilitation & outpatient therapy	Visits + contracted relationships	Clinic density, referrals and clinician productivity	Referral concentration
Infusion, ambulatory & diagnostics	Procedures, therapies and tests	Site-of-care savings and utilization	Drug / equipment economics

MARKET UPDATE

Buyer interest favors providers that expand access while maintaining clinical and financial control

Transaction volume remains steady, but buyers are concentrating capital in platforms with defensible reimbursement and measurable operating discipline.

300: Reported health-services transactions in the latest quarter
46%: Share of latest-quarter volume represented by physician groups
$28bn: Reported transaction value through the latest midyear period

Exhibit 2

Theme	Market interpretation	Owner evidence that matters
Site-of-care migration	Home, ambulatory and specialty settings can lower cost and improve convenience.	Show referral sources, outcomes, capacity and payor savings.
Provider scarcity	Clinical labor constrains growth across most delivery models.	Track recruiting funnel, ramp, turnover and productivity.
Value-based care	Risk-bearing and shared-savings models can create upside but add actuarial complexity.	Separate recurring economics from temporary benchmarks.
Regulatory scrutiny	States are increasing review of healthcare combinations and ownership structures.	Prepare structure, governance and quality evidence early.
Revenue-cycle discipline	Coding, denials and cash collection increasingly separate strong platforms.	Reconcile encounters to claims, collections and EBITDA.

PRIVATE DEAL ACTIVITY

Physician groups lead transaction volume, while home-based care accounts for several larger transactions

Reported activity is broad, with combinations spanning specialty practices, behavioral health, home care and outpatient settings.

2.9x: Physician-group volume versus the next-largest reported subsector
18%: Increase in physician-group transactions versus the comparable period
Home: One of the clearest destinations for scaled strategic capital

Exhibit 3

Activity category	Buyer activity	Implications for owners
Physician practices	Specialty groups are combining for local density, ancillaries and payor relevance.	Clinical autonomy and provider retention must be explicit.
Home-based care	Strategics and sponsors are assembling branch networks across home health, hospice and personal care.	Reimbursement, compliance and caregiver supply drive value.
Behavioral health	Buyers are adding outpatient, virtual and higher-acuity programs to complete the continuum.	Outcomes and clinical staffing matter more than bed count alone.
Outpatient networks	Clinic and ambulatory platforms are using tuck-ins to increase referral density.	Local-market share can matter more than national scale.
Technology-enabled care	Platforms are acquiring scheduling, engagement and workflow capability.	Technology must improve clinical or financial performance.

BUYER LANDSCAPE

The healthcare buyer universe includes provider platforms, payors, health systems and distributors

Provider platforms, payors, health systems and distributors compete when ownership creates strategic control of a care-delivery pathway.

Exhibit 4

Buyer type	Typical objective	What can create differentiated value	Common constraint
Sponsor-backed platforms	Build specialty or site-of-care density	Existing MSO, integration team and clinician model	Leverage, exit timing and regulatory review
Strategic healthcare companies	Control a specialty, referral stream or care pathway	Network synergies and lower capital cost	Portfolio fit and integration
Payors / risk platforms	Lower total cost and improve member access	Claims data and value-based economics	Antitrust and provider alignment
Health systems	Secure capacity and physician relationships	Local contracts, facilities and referral base	Capital constraints and governance
New platform sponsors	Back a credible regional or specialty anchor	Management, compliance and acquisition runway	Minimum EBITDA and provider dependence

VALUATION FRAMEWORK

Provider economics, reimbursement and retention determine the multiple

Headline specialty ranges are only a starting point; the normalized earnings base and post-close provider model often matter just as much.

5-8x: Common tuck-in band across mature delivery models
8-13x: Common platform band for institutional-quality assets
10x+: Possible where scarcity, growth and strategic fit are exceptional

Exhibit 5

Valuation lens	Why it matters	What strengthens the case
Provider alignment	Retention and compensation determine whether earnings survive the transaction.	Use signed agreements, clear incentives and realistic replacement cost.
Reimbursement	Payor mix, rates and coding quality shape both margin and risk.	Build service-line and payor-level waterfalls.
Organic growth	Same-site growth proves the platform is more than an acquisition vehicle.	Show new providers, ramp curves and mature-site performance.
Clinical quality	Outcomes, compliance and patient experience protect the franchise.	Track objective quality and complaint metrics.
Infrastructure	A platform needs centralized billing, recruiting, compliance and analytics.	Demonstrate scalable shared services and local accountability.

VALUATION FRAMEWORK | FOUNDERS GROUP INDICATIVE RANGES

Tuck-in and platform valuation ranges vary with clinical, reimbursement and integration risk

Ranges are Founders Group guideposts for profitable lower-middle-market providers—not quoted prices or a substitute for specialty-specific analysis.

Exhibit 6

Exhibit 7

Lens	What changes the outcome
Premium drivers	High organic growth; provider retention; favorable payor mix; strong local share; recurring referrals; clean compliance; ancillaries; mature MSO; measurable outcomes.
Discount drivers	Owner dependence; provider departures; weak billing; payor concentration; regulatory exposure; inconsistent quality; high de novo losses; aggressive add-backs.
Structure matters	Provider rollover, employment terms, earnouts, working capital, assumed liabilities and tax structure can change proceeds at the same headline multiple.

SELECTED ANNOUNCED TRANSACTIONS | SCALED PLATFORMS

Scaled transactions are increasing buyer control of specialty-care pathways

Selected transactions illustrate buyer appetite; they are not an exhaustive market sample.

Exhibit 8

Target / transaction	Buyer / ownership	Lane	Reported value	Strategic rationale
Retina Consultants of America	Cencora	Retina care	$4.6bn	Builds a scaled specialty-provider network
Amedisys	UnitedHealth / Optum	Home health / hospice	$3.3bn	Expands home-based care capacity
Enhabit	Kinderhook Industries	Home health / hospice	$1.1bn	Takes a national branch network private
EyeSouth retina business	Cencora / RCA	Retina care	$1.1bn	Adds specialty physicians and geographic density
U.S. Dermatology Partners + DermCare	Combined operations	Dermatology	Not disclosed	Creates one of the largest national groups
Talkspace	Universal Health Services	Behavioral health	Not disclosed	Combines virtual access with facility-based care
Emergency Care Partners	MidOcean structured equity	Emergency medicine	Not disclosed	Funds physician liquidity and continued acquisitions

SELECTED ANNOUNCED TRANSACTIONS | ADD-ONS AND CAPABILITIES

Add-on acquisitions are increasing local density and extending care delivery across settings

Most private practice and branch acquisitions remain undisclosed, making strategic fit the clearest public signal.

Exhibit 9

Target	Acquirer	Lane	Strategic rationale	Reported value
Family First Homecare	Aveanna	Pediatric home care	Adds caregivers, markets and referral density	$175.5m
Home-health and hospice branches	BrightSpring	Home-based care	Adds a complementary multi-state branch network	$239m
Tech Medical Home Care Services	Avid Health at Home	Personal care	Adds local density as the platform's eighth tuck-in	Not disclosed
Bene Dermatology	Dermatology Partners	Dermatology	Expands a regional physician network	Not disclosed
Ophthalmic Associates of Alexandria	Vision Innovation Partners	Eye care	Adds local physician capacity and referrals	Not disclosed
Clinical groups acquired by PAX Health	PAX Health	Behavioral health	Creates a multi-service regional platform	Not disclosed
Outpatient therapy clinics	National and regional therapy platforms	Rehabilitation	Increases clinic density and clinician coverage	Not disclosed

SUBSECTOR 1 OF 6

Specialty physician groups

Scarce providers and local clinical density support consolidation, but post-close compensation and retention determine whether value holds.

6.0-9.0x EBITDA: Indicative tuck-in valuation
9.0-13.0x EBITDA: Indicative platform valuation
Providers + ancillaries: Core economic model

Exhibit 10

Lens	Assessment
Buyer universe	GI Alliance; U.S. Dermatology Partners; Solaris Health; SENTA; EyeCare Partners; Retina Consultants of America; specialty strategics.
What buyers underwrite	Provider productivity; compensation; payor mix; ancillaries; referral concentration; local share; recruiting; coding; compliance; same-site growth.
Current market developments	Dermatology, ophthalmology, gastroenterology, urology, orthopedics and other specialties continue to consolidate through local and regional combinations.
Principal risks	Corporate-practice rules; provider departures; fee-schedule pressure; ancillary compliance; referral arrangements; de novo losses.

Selected market signal

Recent retina and dermatology combinations show growing strategic interest in scaled specialty networks, not only traditional sponsor roll-ups.

SUBSECTOR 2 OF 6

Dental support organizations

A repeatable affiliation and same-store growth model can earn a premium; weak provider retention and overbuilt corporate overhead cannot.

5.5-8.5x EBITDA: Indicative tuck-in valuation
9.0-13.0x EBITDA: Indicative platform valuation
Practices + shared support: Core economic model

Exhibit 11

Lens	Assessment
Buyer universe	Heartland Dental; Aspen Dental; MB2 Dental; Dental Care Alliance; Smile Doctors; Specialty Dental Brands; regional DSOs.
What buyers underwrite	Doctor retention; hygiene penetration; same-store growth; new-patient flow; payor mix; affiliation pipeline; clinic contribution; de novo maturity.
Current market developments	Large DSOs continue affiliating independent practices while specialty-focused models expand in orthodontics, oral surgery and pediatric dentistry.
Principal risks	Associate turnover; unsupported add-backs; Medicaid concentration; lease obligations; de novo drag; clinical-governance structure.

Selected market signal

Buyers increasingly distinguish between acquisition-led growth and mature-site organic performance when valuing DSO platforms.

SUBSECTOR 3 OF 6

Behavioral health

Persistent unmet need supports demand, while clinician supply, outcomes and payor authorization discipline determine quality.

5.0-8.0x EBITDA: Indicative tuck-in valuation
8.0-12.0x EBITDA: Indicative platform valuation
Visits / census + care continuum: Core economic model

Exhibit 12

Lens	Assessment
Buyer universe	Universal Health Services; Acadia; Summit BHC; Bradford Health; PAX Health; autism, SUD and outpatient behavioral platforms.
What buyers underwrite	Clinician capacity; census; length of stay; authorization; payor mix; outcomes; referral sources; denial rate; licensing; site contribution.
Current market developments	Platforms are combining virtual, outpatient, residential and acute capabilities to improve access and retain patients across care settings.
Principal risks	Clinical labor; reimbursement denials; incident history; patient acquisition cost; state licensing; census volatility; quality controls.

Selected market signal

The combination of a national behavioral provider with a virtual-care platform demonstrates strategic value in linking access channels with a broader continuum.

SUBSECTOR 4 OF 6

Home health, home care and hospice

Demographics and patient preference support home-based care, but labor, reimbursement and compliance create meaningful dispersion.

5.0-8.0x EBITDA: Indicative tuck-in valuation
8.0-12.0x EBITDA: Indicative platform valuation
Branches + caregiver capacity: Core economic model

Exhibit 13

Lens	Assessment
Buyer universe	Optum; BrightSpring; Aveanna; Addus; Pennant Group; Enhabit; Avid Health at Home; regional operators.
What buyers underwrite	Admissions; census; caregiver recruiting; visit utilization; reimbursement; branch contribution; star ratings; referral diversity; compliance.
Current market developments	Large strategic transactions and continuing branch-level tuck-ins show conviction in home-based care as part of a lower-cost delivery system.
Principal risks	Wage inflation; reimbursement cuts; audit exposure; clinician productivity; referral concentration; integration of acquired branches.

Selected market signal

Recent national transactions and branch acquisitions show that both scale and local caregiver density can attract capital.

SUBSECTOR 5 OF 6

Rehabilitation and outpatient therapy

Clinic density, clinician productivity and recurring referral relationships support consolidation across outpatient rehabilitation.

5.0-7.5x EBITDA: Indicative tuck-in valuation
8.0-11.0x EBITDA: Indicative platform valuation
Clinics + visits: Core economic model

Exhibit 14

Lens	Assessment
Buyer universe	U.S. Physical Therapy; Confluent Health; Ivy Rehab; Empower Physical Therapy; Upstream Rehabilitation; regional therapy platforms.
What buyers underwrite	Visits per clinician; reimbursement per visit; labor cost; referral concentration; cancellation rate; clinic maturity; workers' compensation exposure.
Current market developments	Platforms continue to fill regional density, add employer and specialty programs, and develop de novo clinic engines.
Principal risks	Therapist scarcity; reimbursement pressure; physician referral dependence; de novo losses; inconsistent clinic leadership.

Selected market signal

Strategic consolidators typically value local density and clinician capacity more than a scattered collection of small clinics.

SUBSECTOR 6 OF 6

Infusion, ambulatory and diagnostic sites

Lower-cost sites of care can command strong interest when utilization, payor contracts and clinical operations are defensible.

6.0-9.0x EBITDA: Indicative tuck-in valuation
9.0-13.0x EBITDA: Indicative platform valuation
Procedures / therapies + capacity: Core economic model

Exhibit 15

Lens	Assessment
Buyer universe	Option Care; Surgery Partners; United Surgical Partners; RadNet; U.S. Radiology; specialty infusion and ambulatory platforms.
What buyers underwrite	Procedure volume; capacity utilization; physician alignment; payor contracts; drug economics; prior authorization; equipment age; referral diversity.
Current market developments	Payors and patients continue to favor lower-cost outpatient settings, supporting investment in infusion, ambulatory surgery and diagnostics.
Principal risks	Drug spread changes; certificate-of-need rules; equipment capex; physician concentration; denials; site ramp and lease obligations.

Selected market signal

Strategic buyers seek assets that control an important site of care and can extend an existing specialty or referral network.

CONSOLIDATOR LANDSCAPE

Healthcare consolidation is concentrated in specialties, local networks and care pathways

Representative consolidators and ownership reflect the 2H26 market; the list is not exhaustive.

Exhibit 16

Lane	Representative sponsor-backed / private	Representative strategic / public	Typical acquisition logic
Physician groups	GI Alliance; USDP; Solaris; SENTA; EyeCare Partners	Cencora / RCA; McKesson specialty networks; health systems	Providers, ancillaries and local share
Dental	Heartland; MB2; Dental Care Alliance; Smile Doctors	Aspen Dental and large private DSOs	Affiliations, same-store growth and specialties
Behavioral	Summit BHC; Bradford; PAX; specialty platforms	Universal Health Services; Acadia	Continuum, access and clinician capacity
Home-based care	Avid Health at Home; regional sponsor platforms	Optum; BrightSpring; Aveanna; Addus; Pennant	Branches, caregivers and reimbursement
Rehabilitation	Confluent; Ivy; Empower; Upstream	U.S. Physical Therapy; regional health systems	Clinic density and clinicians
Ambulatory / diagnostics	Private infusion, ASC and imaging platforms	Option Care; Surgery Partners; USPI; RadNet; U.S. Radiology	Site-of-care savings and utilization

OWNER PREPARATION AND MARKET OUTLOOK

Integrate clinical and financial evidence for buyer diligence

Buyer diligence must establish the durability of historical EBITDA, clinician retention, payor relationships and patient demand.

Exhibit 17

	Preparation priority	Required evidence
1	Normalize provider economics	Bridge historical compensation to a sustainable post-close model by provider and location.
2	Reconcile the revenue cycle	Connect encounters, charges, claims, collections, denials and cash to the financial statements.
3	Prove same-site performance	Separate acquisitions and de novos from mature organic growth, margin and clinician productivity.
4	Secure provider alignment	Document retention, restrictive covenants, rollover expectations and clinical-governance roles.
5	Prepare compliance diligence	Organize coding, billing, licensing, quality, privacy, referral and corporate-practice materials.
6	Map the local buyer logic	Show which buyers gain specialty depth, geography, referrals, payor relevance or site-of-care control.

Founders Group outlook

Physician-practice volume should remain active, with higher scrutiny on provider alignment and organic growth. Home-based care and outpatient settings should continue attracting capital as care moves to lower-cost environments. Behavioral-health demand remains strong, but labor, authorization and clinical quality will separate premium platforms. Regulatory review will increasingly affect buyer selection, structure and certainty of close.

ABOUT THIS REPORT

Use this report as market context, not as a valuation opinion

A 2H26 view of private deal activity, consolidators, valuation context and owner priorities across Healthcare Delivery.

Methodology

Market observations reflect current transaction patterns, disclosed consideration and operating developments across healthcare delivery. Disclosed multiples are shown only when transaction value and a matching earnings measure were public. Founders Group indicative ranges triangulate private-market behavior, disclosed precedents and subsector judgment; they should not be read as a fairness opinion or valuation conclusion.

1: Market observations Current transaction patterns and operating themes.
2: Disclosed transactions Values are shown only when transaction consideration was public.
3: Indicative ranges Founders Group judgment based on size, quality and buyer behavior.

Exhibit 18

Term	Meaning in this report
Tuck-in	A smaller acquisition integrated into an existing platform. Strategic fit, geography, capability and customer density may influence value.
Platform	A business capable of standing alone as a buyer's sector anchor, with management, systems and a repeatable growth model.
Enterprise value / EBITDA	A valuation ratio comparing enterprise value with adjusted earnings before interest, taxes, depreciation and amortization.
Indicative range	A market guidepost rather than a quoted price. Actual outcomes depend on company-specific facts, structure and process.

Disclaimer

This material is for general informational purposes only and does not constitute investment, legal, tax, accounting or valuation advice, an offer to sell, or a solicitation to buy any security. Information is believed reliable but has not been independently verified and may be incomplete. Actual transaction outcomes depend on company-specific facts, market conditions, structure and process. Past transactions and market observations are not indicative of future results.

Founders Group

Ali Naseer
Co-Founder & Partner
Ali@FoundersG.com (952) 797-4679
Matt Menzi
Co-Founder & Partner
Matt@FoundersG.com (301) 767-5616

San Francisco · Denver · Minneapolis · New Yorkwww.foundersg.com

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Healthcare Delivery