What are the best Healthcare Services Middle Market Investment Banks (excluding biotech)?
Rank the firms: William Blair, Houlihan Lokey, Wells Fargo, Raymond James, TripleTree, Harris Williams, Suntrust, Stifel, Baird, Lincoln International.
I think it goes tier in order of names: 1: HL, WB, HW, TripleTree (pure play), Cain Brothers (pure play) 2: Lincoln International, Wells Fargo, Raymond James, Baird, BMO, SunTrust, Stifel
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I believe Leerink and MTS Health Partners should also be included here.
Leerink and MTS do very little healthcare services. I am not talking ECM or biotech.
Ok, not an expert on healthcare banking. Had just heard their names associated with healthcare banking a lot. Looks like you know your stuff though regarding healthcare banking.
MTS does do healthcare services work and it is one of their stated focuses, but I think they have been more successful in the life sciences space as of late. They're also moving on an upward trajectory, so I would not be surprised if they started running more HC services m&a down the road.
Leerink is, as you said, biopharma and ECM focused. If you're interested in that, they're top tier.
Leerink expanding into services and M&a with new hires from gugg citi etc
mts does a lot of services I believe
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Jeffries and Cantor
Excluding Jefferies. Cantor only does biotech.
Idk where you heard cantor only doing biotech. They do every vertical within healthcare. Biotech, biopharma, healthcare services, even healthcare REITS. I’d include them in your tier 1 after Sage brought over all the Jefferies folks
@OP I know that your post says middle market, but from your perspective did you include all of Wells Fargo Healthcare Services in your ranking or just the middle market portion of the firm?
I’m only talking about IB healthcare services not corporate banking etc
Right, but Wells also has a middle-market unit (but probably not well known/strong). But based on your response I am guessing you meant their regular healthcare services arm.
Can we agree that while Suntrust, BMO, and Stifel are all Generalist healthcare groups, it is mainly run by Ecm and not M&A?
yes this is accurate. services are not as big for these firms. I have spoken with quite a few people on their HC team and their HCS team is very small, yet growing.
Tier 1: Jefferies, WB, Cain, HW, Piper, HL
Tier 2: TT, Baird, Lincoln, Cowen, BMO, Lazard MM, Ray Jay
Boutiques: Coker, Brentwood (few I am forgetting)
FWIW, there is a ton of shuffling going on in MM HC. Cain just lost a couple key services MDs, TT is trying to really grow its services segment, but is known more for HCIT and has a mixed reputation, BMO lost some guys.
Would you add RBC in order next to Jefferies and is this list in order?
No idea. Haven't heard or seen RBC in pitches, so not sure what they do HC-wise (could be up-market)
What is the mixed reputation on TT?
Good industry knowledge, poor M&A processes
Curious where you see Cain in 2021.
One of the best deal flows of any MM banks in terms of facilities/services.
really never heard of Piper Healthcare Services
Check Pitchbook or CapIQ. Off the top of my head, PJ did BHG, Krueger-Gilbert, Covenant Surgical, Pinnacle Treatment and one or two other ASCs.
Depending on the specific sector in HC, I would say that Ziegler, Evercore, Jefferies, and HL are the front runners. They are the most nimble in the TRUE middle market...including the lower end
Jefferies shouldn't even be in the MM conversation
Which is why they were excluded to begin with.
Did you just throw in Ziegler with the likes of Evercore, HL and Jefferies?
We are talking about just Healthcare MM. Not MM in totality. Ziegler dominates the NFP market place with ~40% market share (Bond issuance and Advisory).
As a former Cain Brothers client, I'd recommend them. Their tone has changed a bit since the KeyBank acquisition, but they still know how to find and source deals.
If looking for DCM, Cain does well...but Ponder & Co. seems to service all of the large Health Systems. Wells also has a strong team in Philly on the healthcare side.
For boutiques, CapstoneHeadwaters led a couple of sell-side deals in the area recently that garnered eye-popping returns (aka stupid multiples I wouldn't even pay when drunk).
Have heard good things about Ziegler but have never worked with them directly.
Echoing your comment on CapstoneHeadwaters. They've sent over a few teasers for niche healthcare service companies. We pursued one but couldn't bring ourselves to bid upwards of ~14x EBITDA.
Have never heard of these guys being competitive in the MM, but to your points, they seem to have one HC MD that is just crushing it the past couple of years.
I work in CD for a Healthcare Services company.
For "Middle Market Banks" I see the following : TT, HL, WB, HW, Cain, Lincoln, DCF and Ziegler.
I've never seen anything from WF, actually wasn't even aware they were active in the Healthcare Services space.
But who’s wants to work at DCF or Ziegler....
I seem to be a lot of mentions regarding TT as of late - curious what your updated view is regarding them (lateral if it makes a difference)?
I haven't really heard much from them since I left Corporate Development. I did see they got acquired by Capital One, so not sure if that has caused any changes.
Also, to help answer the OPs original question. I've seen TT, WB, HW, and Cain with the better mandates.
Provident Healthcare if you're also going to be including lower middle market
They are pretty bad. Edgemont Partners is better.
Provident is garbage
Why?
Provident sells some platforms to respectable MM PE firms; but they mostly do a lot of add-ons for the portfolio companies of some of the buy-and-build PE firms in Boston like Summit and Audax.
Jefferies is the best healthcare services shop on the street. They dominate the sponsor-backed HC services market.....surprised you excluded them on the list.
HL, WB, HW - I would say these guys are up and coming
BMO used to be a solid shop - if you do a quick screen, DB hired away the deal guys...
HC Wainwright is up there.
Guggenheim and Jefferies HC services are top notch
Yet another useless ranking thread
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