The 30 Largest Healthcare Deals of 2018: Who Got the Lowest Valuations?

We ranked the 30 largest healthcare services and information technology deals of 2018, according to our database, by valuation multiple. The lowest reported price to EBITDA multiples (10x or lower, sorted alphabetically) are listed below.

Aurora Diagnostics: Sonic Healthcare Limited announced it entered into an agreement to acquire Aurora Diagnostics, one of the leading providers of anatomical pathology services in the U.S., in December. Aurora is a frequent acquirer of hospital-based pathology groups and their associated independent laboratories, having accumulated 220 pathologists and 32 practices as of the announcement date.

BrightSpring Health Services: Louisville-based BrightSpring Health Services and PharMerica Corp, a KKR portfolio company, agreed to merge in December as well. Similar to Civitas below, BrightSpring (FKA ResCare) is a national provider of home- and community-based health and human services to complex populations, and is primarily funded by local and state governments.

Civitas Solutions: Publicly-traded Civitas Solutions agreed to be acquired by funds managed by Centerbridge Partners. Civitas, which primarily operates under the National MENTOR name, is a leading national provider of home- and community-based health and human services to individuals with intellectual, developmental, physical or behavioral disabilities and other special needs. In most of its markets the primary payer is local and state governments, which Moody's cites as a significant source of business risk.

Envision Healthcare: Envision, a national provider of physician and ambulatory surgery services, was acquired by global investment firm KKR. The acquisition occurred amid controversy surrounding the company's out-of-network billing practices.

Express Scripts: Cigna Corp. acquired Express Scripts, creating one of the biggest providers of pharmacy benefits and insurance plans in the United States. Express Scripts' inclusion on this list is almost exclusively due to the loss of Anthem, Coventry, and Catamaran as clients. Eliminating the income included in the historical results related to these transitioning clients results in a more robust 12.5x multiple.

LifePoint: Hospitals, with their high capital investment requirements, make up the remainder of this list. The 68-hospital LifePoint Health and RCCH HealthCare Partners, which is owned by private equity firm Apollo Global Management, merged in 2018, creating one of the largest healthcare providers in the country.

Mission Health: Mission Health, a six-hospital non-profit health system in western North Carolina, was acquired by HCA.

Oklahoma University Medical Center: OUMC, a large academic health system based in Oklahoma City, was sold by HCA to OU Medicine.

See who got the highest valuations here.