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Jan 16 2025
Management

Mergers and Acquisitions: An Overview of Notable Healthcare M&A Activity in Q4 2024

Major updates include increasing vigilance related to antitrust and the DOJ’s blocking of UnitedHealth’s merger with Amedisys.

While mergers and acquisitions in the health services industry declined by 9% through Nov. 15, 2024 (compared with the same period in 2023, according to a recent report from PwC), deal activity is still robust compared with that before the onset of COVID-19, with annual deal volume nearly 70% higher than the pre-pandemic trendline.

However, the Federal Trade Commission is increasing scrutiny of premerger notification forms to better detect illegal mergers and acquisitions that violate antitrust laws. The agency finalized changes to the form that requires more information to identify deals that may require an in-depth antitrust investigation.

“Premerger review is a critical task for the antitrust agencies, and to do it well, we need information about each deal’s potential antitrust risk,” said Shaoul Sussman, associate director for litigation in the FTC’s Bureau of Competition in a press release. “This rulemaking is a much needed update to address changes in the marketplace that have undermined the agencies’ ability to detect and prevent illegal mergers, while at the same time creating a more efficient review process. The Bureau thanks the entire cross-agency team that has worked tirelessly on this important rulemaking.”

Q4 2024 saw a few deals canceled or put on hold due to antitrust concerns. Despite this, in its 2025 U.S. deals outlook, PwC stated that there is optimism for increased deal activity in 2025 due to the pro-business stance expected from the new administration.

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Here is some of the notable M&A activity that occurred among healthcare providers in Q4 2024:

UnitedHealth Group and Amedisys

In November, the Department of Justice released a statement announcing its intent to block UnitedHealth Group’s $3.3 billion acquisition of Amedisys, a home health and hospital provider operating in more than 30 states, due to concerns that eliminating competition between the two entities would have negative impacts on patients, insurers and nurses.

“We are challenging this merger because home health and hospice patients and their families experiencing some of the most difficult moments of their lives deserve affordable, high quality care options,” said Attorney General Merrick Garland in a press release about the antitrust lawsuit. “The Justice Department will not hesitate to check unlawful consolidation and monopolization in the healthcare market that threatens to harm vulnerable patients, their families, and health care workers.”

EXPLORE: Get the technology side of mergers and acquisitions right.

While UnitedHealth has proposed to divest assets in hundreds of markets to VitalCaring Group, the DOJ’s complaint states that this action won’t eliminate the merger’s threat to competition.

“Even if VitalCaring were an adequate buyer, the divestiture does not resolve the competitive overlap in over 100 home health and hospice markets across 19 states and the District of Columbia, accounting for well in excess of $1 billion in total commerce,” states the DOJ in its complaint. “Nor does the divestiture address the harm to thousands of home health and hospice nurses in labor markets across 18 states. And the divestiture creates a new presumptively anticompetitive and illegal overlap around Biloxi and Gulfport, Mississippi.”

According to Reuters, UnitedHealth Group and Amedisys have extended the closing deadline to whichever is earlier: 10 days following a final court decision or Dec. 31, 2025.

Union Hospital and Terre Haute Regional Hospital

Union Health and Terre Haute Regional Hospital, both located in Terre Haute, Ind., withdrew their merger application in November. The deal was opposed by the Federal Trade Commission, which released a statement in September urging the Indiana Department of Health to deny it due to concerns over higher costs, lower wage growth for hospital workers and worse healthcare outcomes for Indiana consumers.

“Recognizing the [Certificate of Public Advantage] process is a very complex, innovative approach to improving access and quality health care for area residents, we believe it is best to withdraw the current application to allow time for Union Health and Terre Haute Regional to continue to work with IDOH, to ensure the benefits, including improved access, quality, prevention and early intervention, are outlined in the new application,” Union Health said in a statement on the matter.

Risant Health and Cone Health

In December, Risant Health, a nonprofit organization created by Kaiser Foundation Hospitals, completed a transaction with Cone Health, a system based in Greensboro, N.C., with locations across the state. As part of the deal, Risant Health is now the only corporate member of Cone Health. No purchase was made, and Cone Health will maintain its name, board, leadership and medical staff.

This is the second health system to join Risant Health, following Geisinger earlier in 2024.

“As part of Risant Health, Cone Health will build upon its long track record of success making evidence-based health care more accessible and affordable for more people. The people across the Triad will be among the first to benefit,” said Cone Health President and CEO Dr. Mary Jo Cagle in announcing the move.

READ MORE: These tips can help healthcare CIOs navigate IT integration during M&As.

Rady Children’s Hospital and Children’s HealthCare of California

Two pediatric health systems in Southern California made progress toward a merger announced in December 2023. In November 2024, California Attorney General Rob Bonta conditionally approved the merger of Rady’s Children’s Hospital and Health Center, which operates Rady Children’s Hospital in San Diego, and Children’s HealthCare of California, which operates Children’s Hospital of Orange County and CHOC at Mission. The combined entity will be called Rady’s Children’s Health.

The conditions require the organization to maintain services in both Orange County and San Diego County for 10 years, preserve competition by refraining from anticompetitive practices and limiting price increases, and continue to provide charity care and community benefits.

“Our children deserve access to affordable specialized medical services that support their health and well-being,” said Bonta in a statement. “These conditions ensure that Southern California families retain access to quality, affordable pediatric care during the most difficult times in a child’s life.

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Orlando Health and Tenet Healthcare

At the start of the quarter, Tenet Healthcare announced the sale of its majority ownership in Brookwood Baptist Health to Orlando Health. The approximately $910 million sale includes five hospitals located in Birmingham, Ala.: Brookwood Baptist Medical Center, Citizens Baptist Medical Center, Princeton Baptist Medical Center, Shelby Baptist Medical Center and Walker Baptist Medical Center.

The system consists of more than 1,700 beds, 7,300 employees, 70 clinics and approximately 1,500 affiliated physicians.

“There is a need and opportunity for a private, not-for-profit healthcare system in this market,” said David Strong, president and CEO of Orlando Health in a statement announcing the deal. “We believe this is a new day in healthcare for our organizations and look forward to making Brookwood Baptist the best healthcare system in Alabama.”

Brown University Health

Brown University Health in Providence, R.I., formerly called Lifespan, completed its $175 million acquisition of Morton Hospital in Taunton, Mass., and Saint Anne’s Hospital in Fall River, Mass., in early October. As a result, both hospitals will be integrated fully into the Brown University Health system. Patients will benefit from a shared electronic health record according to a press release about the deal.

Astrana Health and Prospect Health System

In November, Astrana Health announced a definitive agreement to acquire certain assets and business of Prospect Health System in Los Angeles. The $745 million deal would include the health system’s California-licensed healthcare service plan, medical groups across several states, pharmacy and Foothill Regional Medical Center, an acute-care hospital with 177 beds.

“This strategic transaction will significantly expand our provider network and enhance our ability to offer increased access, quality, and value for our members. Prospect’s established presence in key markets also opens new opportunities for Astrana, particularly in geographically adjacent Orange County, California, where we today have limited operations,” said Brandon K. Sim, president and CEO of Astrana.

CONSIDER: Strengthen technology partnerships in healthcare mergers and acquisitions.

Summa Health and General Catalyst

Summa Health in Akron, Ohio, signed a definitive agreement with private equity firm General Catalyst’s Health Assurance Transformation in November, outlining HATCo’s acquisition of the health system.

“As part of HATCo, Summa Health will be better positioned to build upon our existing strengths and capabilities while also benefiting from new opportunities and technology. Our goals are to expand access to care and improve the experience for our patients, providers and staff,” said Dr. Cliff Deveny, president and CEO of Summa Health, in a statement.

According to the press release, HATCo will purchase Summa Health for $485 million. In addition to eliminate existing debt, the deal will help fund a new community foundation. The private equity firm will also invest $350 within the first five years of the move for resources and technology investments to drive growth.

Krohn Clinic and Black River Memorial Hospital

On Dec. 30, multispecialty group Krohn Clinic and Black River Memorial Hospital merged, creating Black River Health in Black River Falls, Wis. According to a statement about the union, the decision to move forward with the deal was in response to growing health outcome challenges in Jackson County.

The organizations will maintain their independence while working as a unified entity.

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