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2024healthcareservicesoutlook:Challengesandopportunities

Thehealthcareservicessectorhasseenrapidgrowthoverrecentyears.Despitethechallengesorganizationsmayfacein2024,opportunitiesforthesectorstillabound.

byNeilRao

December2023

Healthcareservicescomprisearangeof

organizations,fromtechnologycompaniesand

financialsponsorstopharmacies,thatfocusonthepayerandhealthsystemsmarkets.Overthepast

decade,eachofthesesegmentshasrapidlygrowninnumberofstand-aloneentitiesandtotalprofit

pools.Wesummarizeourviewsonwhat2024holdsforthesekeysegmentsbelow.

Healthcareservicesandtechnology

Threeareasstandoutintermsofopportunitiesandchallenges:

Dataanalyticsandartificialintelligence(AI).

GenerativeAIhasarousedinterestinhealth

servicesandtechnology,butusecasedevelopment

anddeploymentareintheirearlydays.1Payersandhealthsystemsthathavealreadyinvestedindataanalytics(aswellasrelatedinfrastructureandgovernance)arebeginningtodifferentiate

themselvesfromcompetitors.Weanticipate

agreaterfocusonusecasesthatenableclear,near-termoperationalvalue—forexample,AI

thatsupportsmorerapidthroughputofimagingequipment.Overcominghistory,especiallywith

healthsystemsforwhichinvestmentintechnology

hasunderwhelmedintermsofproductivitygains,willbeessentialforhealthservicestofulfillAI’spromise.

Outsourcing.Strategicplayers,especiallynot-

for-profithealthsystemsandpayers,arefacing

financialheadwinds.Whilemanyarereticentto

outsourcegiventheimpactonemployeeslocally,thecombinationofthefinancialvalueproposition,risinggapsincapabilities,andtheinabilityto

otherwiseaccessrequiredtalentisincreasingly

compelling.Outsourcingtransactionsofteninvolvelegacyprocessesthatbenefitfromscaleand

automation(forexample,transactionalfunctionssuchashumanresourcesandfinance),butweare

alsoseeingmorepointsolutionsandadoptionin

criticalhealthcare-specificbusinessfunctionssuchasrevenuecyclemanagement.

ProgrammaticM&A.Manyhealthcareservices

andtechnologycompanieshaveseensubstantialreductionsintheirmostrecentvaluations.SeveralhavehadtoshutdownorseekalternativesdespitecuttingR&Dspendingandloss-leadingcustomeracquisitionprograms.Strategicandprivateequity(PE)investorsnowhaveanopportunitytoaddbothtalentandcapabilitiesbyacquiringtheseentities

onfavorableterms;advantageousrefinancingfor

not-for-profithealthsystemsthrough2021may

enablenot-for-profithealthsystemstodiversifyasopportunitiesarise.

Privateequity

Globalprivateequitydealvolumeinhealthcare

roseabout8percentannuallyfrom2017to2022.Thisperiodincludesamaterialpull-backin2022,whendealvolumefell37percentyearoveryear.2Nevertheless,healthcare-focusedfundraising

remainedresilient,withthefirstquarterof2023fundraisingpostingthesecond-highestfirst-

quartertotalonrecord.3

Weseethefollowingtrendsin2024,especiallyasindustryexpectationsofvaluationsandanticipatedratesofreturncontinuetoreset:

Carve-outs.Ashealthcareorganizationshave

reducedR&Dspendingandcompletedportfolioevaluationsin2023,thesestrategicplayers

haveshownincreasinginterestindivesting

businessunitsthatarefurtherawayfromthecore.Simultaneously,PEfirmsandPE-backedassets

haveexpressedinterestinsegmentswithattractiveprofitpools.

Public-to-privatedeals.Reducedvaluations

haveincreasedthepotentialforopportunistic

buying,especiallyfrompublicassetsforwhichPEhasastrongvaluecreationthesis.WeexpectanincreasingnumberoftheseproposalstoincludepartnershipsbetweenPEandstrategicinvestors.

1WideradoptionofAIcouldleadtosavingsof5to10percentinUShealthcarespending,orabout$200billionto$360billionannuallyin

2019dollars.Formore,seeDavidM.Cutler,NikhilSahni,GeorgeStein,andRodneyZemmel,Thepotentialimpactofartificialintelligenceonhealthcarespending,NationalBureauofEconomicResearch,September2022.

2“McKinseyGlobalPrivateMarketsReview:Privatemarketsturndownthevolume,”McKinsey,March21,2023.

3LouiseFordham,“Chart:Fundraisingforhealthcare-focusedprivateequityisingoodshape,”PrivateEquityInternational,July3,2023.

2024healthcareservicesoutlook:Challengesandopportunities2

Pharmacy

Thepharmacymarkethasundergonemajor

changesinrecentyears,includingfromtheimpactoftheCOVID-19pandemic,theestablishment

ofpartnershipsacrossthevaluechain,andthe

introductionofnewpharmacymodels.Pharmacydispensingrevenueincreasedby9percentin

2022,to$550billion,andisprojectedtogrowata5percentCAGR,reaching$700billionin2027.4

Continuedpressureontheretailpharmacy.Retailpharmacieswillcontinuetofacereimbursement

challenges,laborshortages,inflationarypressures,andaplateauingofgenericsdispensingrates.To

addresstheseheadwinds,weexpectthatchainswill:

—continuetooptimizecoreoperationsthroughfurtherrationalizationofstorefootprints

—investintechnologyenablement,suchasmicro-fulfillmentcentersandrobotics,toexpand

workforcecapacityandstreamlinedispensingcosts,andAItooptimizepharmacistworkflows

—looktofurtherdiversifyandexpandrevenue

streamsbeyondthecoredispensingbusiness

throughtheprovisionofhealthcareservicesandtheintegrationofrecentlyacquiredassetsintoadeliveryecosystem

Growthinspecialtypharmacy.Specialtypharmacy

isoneofthefastest-growingsubsegments

withinpharmacy,withrevenuerisingmorethan9percentannually.5Thisisduetocontinuedgrowthinutilizationandpricingaswellasexpansionof

thetreatmentpipeline(forexample,cellandgene

therapiesandoncologyandrarediseasetherapies).Thegrowthisexpectedtobeoffsetpartiallyby

pressureonreimbursements,specialtygenerics,andincreasedadoptionofbiosimilars.Additionally,marginsamongspecialtypharmacyplayershave

beenaffectedbymanufacturercontractpharmacypressures,creatingheadwindsforlargercentral

fulfillmentspecialtypharmaciesandtailwindsforsomehealthsystem–ownedpharmacies.

Evolvingregulatorylandscape.Thepharmacy

segmenthasseenincreasedcallsfromregulators

toincreasetransparencyofdrugpricesandimproveaffordability.UndertheInflationReductionAct

of2022,theMedicareprescriptiondrugPartD

benefitisbeingredesignedthrough2024–25.Theredesignincludesanewbeneficiaryout-of-pocketspendingcapof$2,000andasubstantialincreaseinplanliability(from15percentto60percent)inthecatastrophicphaseofcoverage,increasingplans’

imperativetomanagehigh-costdrugs.Additionally,theCentersforMedicare&MedicaidServices

(CMS)issettorequirepharmacyrebatesunder

Medicarebesharedwithconsumersatthepointofsale;italsoannouncedthatpricetransparencyruleswillapplytoprescriptiondrugs.Thereareseveral

bipartisanbillsinCongressthatwouldmandate

increasedtransparencyrequirementsforpharmacybenefitmanagers(PBMs)inadditiontopotentiallybanningspreadpricingandPBM-retainedrebates.

Last,CMShasannouncedthefirsttendrugscoveredund