The Weekly Checkup: Week of April 20-24, 2026

Issue #3 | Week of April 20-24, 2026

Welcome back.

48 announced transactions this week, matching Issue #1's count exactly and a meaningful step up from last week's 41. Services and Technology were dead even at 24 apiece. 8 platform deals, 39 add-ons, and one SPAC reverse merger, which is the healthiest platform-creation rate we've tracked in the first three issues. The platform-to-total ratio is now 17%, versus 5% last week and 12% in Issue #1, which suggests either (a) sponsors who were sitting on dry powder have started deploying it or (b) the deals that had been slow-walking through year-end finally closed. The specific deals below point more toward (a) than (b).

A few storylines worth previewing. Apollo took a minority stake in McKesson Medical-Surgical at a $13 billion EV, one of the largest healthcare distribution transactions in recent memory and a useful read on how public-company carve-outs are being priced. TA Associates announced an 809 million pound take-private of AMS Group at a 12.7x EBITDA multiple. Roche paid $595 million for SAGA Diagnostics, a useful data point on molecular residual disease diagnostics. CVC Capital Partners and GTCR agreed to take Teleflex private, which would be a substantial PE platform in medical devices. Eli Lilly bought another biotech, Kelonia Therapeutics, marking the third consecutive week of Lilly biotech activity and a pattern worth flagging for anyone advising mid-stage biotech sellers.

For the Vault this week, we walked through Kinderhook's $1.1 billion take-private of Enhabit, which makes sense given that the full Goldman Sachs fairness opinion dropped last week and the 10-year financial projections tell a story most press-release-driven summaries will miss.

Let's get into it.

Deal value: $13.0 billion (100% EV) | EV / Revenue: 1.14x | EV / EBITDA: 11.82x

Apollo agreed to make a $1.7 billion investment for a 13% ownership interest in McKesson's Medical-Surgical Solutions segment, implying a 100% enterprise value of approximately $13.0 billion. Using segment revenue of $11.4 billion and adjusted EBITDA of $1.1 billion from McKesson's investor day presentation, the implied multiples are 1.14x revenue and 11.8x EBITDA.

My take: Two things worth noting. First, 11.8x EBITDA on a medical-surgical distribution business is a genuine data point because distribution almost never trades publicly as a pure-play, and the clean segment disclosure McKesson provides makes this one of the better comparable transactions for anyone valuing a medical-surgical, dental, or physician-office distribution platform. Second, the minority structure is the interesting part. Apollo is taking 13% rather than taking the whole segment, which tells you something about McKesson's strategic intent: the company wants capital partnership and validation rather than a full divestiture, and Apollo is getting a large sponsor-scale asset with a public-company parent still on the hook for operational execution. Expect this structure to appear more often in healthcare distribution and pharmacy services over the next 18 months. The segments inside large public healthcare companies (McKesson, Cencora, Cardinal, CVS, Walgreens) have valuations embedded in their parent companies that are likely higher than the sum-of-the-parts public market is currently awarding, and minority capital is the path of least resistance to surface that value.

Deal value: $809 million | EV / Revenue: 2.72x | EV / EBITDA: 12.66x

TA Associates made a 280 pence per share offer for Advanced Medical Solutions Group PLC, a U.K.-listed surgical and wound care device maker, valuing the company at approximately 600 million pounds ($809 million). Using LTM revenue of $297 million and EBITDA of $64 million from AMS's 2024 annual report and 2025 interim report, the implied multiples are 2.72x revenue and 12.7x EBITDA.

My take: Second UK public-to-private medical device transaction in recent weeks, and the 12.7x multiple is a useful reference point alongside last week's Avanos deal at 14.7x. A pattern is emerging where mid-cap device companies with international footprints and margin expansion runway are getting bid in the 12x to 15x EBITDA range, which is well above the 9x to 11x historical range for stable, low-growth device businesses. AMS runs a 21.5% EBITDA margin, which is the kind of structural profitability that earns the premium. The same logic doesn't apply to device companies running sub-15% margins; those continue to trade in the high single-digit multiples regardless of revenue growth profile. If you're advising a device seller right now, the margin profile matters more to the exit multiple than the growth rate, and that's the inverse of what you'd expect in a rising-rate environment.

Deal value: $595 million | EV / Projected 2028 Revenue: 3.97x

Roche agreed to acquire SAGA Diagnostics for $595 million, a molecular residual disease diagnostics company. The 3.97x multiple is against Roche's projected 2028 revenue of $150 million for the asset, not current revenue.

My take: The multiple looks reasonable only if you accept the 2028 revenue projection, which is a question worth asking. MRD is one of the hottest categories in oncology diagnostics because it sits at the intersection of adjuvant therapy decisions and post-treatment surveillance, both of which are clinical use cases payers are increasingly willing to reimburse. Roche is paying for the platform and the pipeline, not the current book of business. For comparables, Foundation Medicine's recent partnership with SAGA was itself an earlier signal of strategic interest, and MRD assays from Natera, Guardant, and Exact Sciences trade at forward revenue multiples well above this one. The 4x forward revenue figure for a strategic acquisition of a category leader is, if anything, on the low end of the range for diagnostics with this kind of category runway. The risk is execution on the 2028 number. Claims and reimbursement cycles in molecular diagnostics have historically taken longer than buyer models assume.

Teleflex announced an agreement to be acquired by CVC Capital Partners and GTCR. A transaction of this size, if consummated, would rank among the largest medical device take-privates in recent years.

My take: Pricing and structure weren't disclosed in enough detail to underwrite a multiple, but the signal matters. Two large sponsors teamed up for a platform transaction in a segment where public market appetite has been inconsistent, and the add-on opportunity set in medical devices is deep enough to support sponsor-scale deployment. Combined with the Avanos, AMS, and Stryker/Amplitude deals of the last three weeks, medical devices is the single most active platform-level category right now, and the thesis is consistent across deals: clean cap table, international expansion runway, margin-improvement levers, and product line breadth that supports add-on acquisitions.

Third consecutive week Lilly has announced a biotech acquisition, following Centessa in Issue #1 and CrossBridge Bio in Issue #2.

My take: This is now officially a pattern and not a series of coincidences. Three biotech acquisitions in three weeks across cardiometabolic, ADC oncology, and now in vivo CAR-T gene therapy suggests Lilly has a list, a budget, and a timeline. The strategic message to biotech sellers in Lilly's focus areas is unambiguous: engage now or watch the comp set fill up. Strategic buyers are rarely this systematic in public unless they have internal conviction that the current window is short.

43 additional transactions this week including notable activity in physician practices (Cancer Care Specialists / Cancer Center Oncology Medical Group, MyEyeDr. / Lumina Vision Partners, AQUA Dermatology / Steele Dermatology), hospitals (Shannon Health / Scenic Mountain, WVU Health / Fulton County), managed care (UnitedHealth / Alegeus), and CROs (THL Partners / Celerion, Veristat / Certara Regulatory Writing). The complete list, with the financial detail Scope is known for, will be available to premium subscribers when that tier launches.

Deal value: $1.1 billion (100% EV) | EV / Revenue: 1.01x | EV / EBITDA (2025E adjusted): 10.0x

Kinderhook Industries agreed to take Enhabit private at $13.80 per share in February, valuing the company at approximately $1.1 billion. With the definitive proxy statement and the Goldman Sachs fairness opinion now public, we updated our Scope database entry from LTM 9/30/2025 figures to the adjusted 2025 estimates disclosed in the fairness opinion: revenue of $1.088 billion and adjusted EBITDA of $110 million (a 10.1% margin). That adjustment produces a 1.0x revenue and 10.0x EBITDA multiple on the transaction.

What the proxy added beyond the press release. The April 14 DEFM14A includes a 10-year financial projection (page 68) used by Goldman Sachs in its fairness analysis, and the shape of that forecast is the most informative part of the entire filing. Revenue growth is modest (low to mid-single digits, consistent with home health market growth and some accretion from de novo ramp). EBITDA margin expansion is striking, rising several hundred basis points over the projection period. Revenue grows, but EBITDA grows materially faster.

Why the margin expansion is the real story. Revenue growth of 3-5% annually is not what drives a Kinderhook return on this asset. Margin expansion from approximately 10% to something meaningfully higher is. Four mechanics drive it, in roughly descending order of contribution:

Why it matters for practitioners. A 10.0x EBITDA multiple on a home health and hospice platform with a 10% margin looks, at first read, like a reasonable but unexciting exit. Reading the projections changes the read considerably. If the 2030 margin is 300 to 500 basis points higher than 2025, the implied 2030 EBITDA is 40 to 60% higher than the 2025 figure, and the sponsor math (even at modest revenue growth) produces a return profile that's well above benchmark. For anyone valuing a home health, hospice, or combined platform right now, the Enhabit fairness opinion is a mandatory data point. The press release number ($1.1 billion, 1.0x revenue) tells you one story. The projections tell you why Kinderhook was willing to pay.

Scope Research's valuation database has approximately 2,900+ healthcare M&A transactions with disclosed or derived revenue and EBITDA multiples going back to 2010. The underlying source documents, including fairness opinions, proxy statements, cost reports, CON filings, bond disclosures, and audited financials, are what make those figures reliable.

In honor of Enhabit, all six listings this week are home care businesses, showcasing the range of sub-segments that fall inside the category.

Location: Louisiana | Asking Price: $2.8M | Revenue: $5.0M | Cash Flow: $720K | CF Margin: 14% | Price / Revenue: 0.56x | Price / Cash Flow: 3.9x

25-year-old outpatient rehab platform providing physical therapy, occupational therapy, and speech-language pathology across three revenue channels: SNF contract therapy, home health agency contract therapy, and an outpatient clinic. 14 employees including contractors. SBA pre-qualified. Owner's daughter (DPT, Dry Needle Certified) is clinically differentiated and expected to be retained. Owner willing to stay on as 5% stakeholder managing PR and SNF/HHA relationships.

My take: This is the most structurally interesting listing of the six and probably the biggest gap between ask and intrinsic value, depending on how the contract base diligence shakes out. Three revenue channels feeding a single Medicare PTAN is genuinely differentiated, and contract therapy relationships with SNFs and home health agencies are sticky when they've been in place for 30 years. The near-term diligence questions are channel-by-channel: the SNF Building 1 contract is newly renewed for 5 years and is worth the most in acquisition value, while the Building 2 and Building 3 contracts are in renewal negotiation with renewals "waiting on owner signature" per the listing. A buyer should not close until those contracts are signed. The 3.9x cash flow ask is a PE-add-on price, not a strategic platform price. For a PE-backed therapy consolidator (there are several active right now in both SNF-embedded and home-based rehab), this would likely trade at 5x to 7x with appropriate contract diligence. For a first-time buyer, the complexity of contract therapy accounting and PTAN transferability makes this not a beginner's deal.

Location: Minnesota | Asking Price: $31.0M | Revenue: $26.0M | Cash Flow: $5.5M | CF Margin: 21% | Price / Revenue: 1.19x | Price / Cash Flow: 5.6x

15+ years in business with year-over-year growth. Full service line (PCA, respite, companion, homemaking). Seller requires buyer to be an existing home care operator who has already navigated the CMS change of ownership (CHOW) process.

My take: The CHOW restriction is unusual and it meaningfully narrows the buyer pool, which probably explains the 5.6x cash flow multiple. Home care platforms at this scale ($5M+ cash flow) with clean 10+ year track records typically trade in the 7x to 9x range to strategic buyers. The CHOW-eligible buyer universe is smaller than it appears because many PE-backed home care platforms structure their acquisitions through an existing management services entity rather than a direct license transfer, which may or may not satisfy the seller's restriction depending on the specific legal structure. The 21% CF margin is on the high end for Minnesota PCA, which predominantly runs through state-managed Medicaid waiver programs with capped rates, and the margin profile is worth diligencing carefully. The Minnesota PCA rate methodology has been in legislative flux for several years, and the 2026 rate updates will materially affect the go-forward margin profile.

Location: Ohio | Asking Price: $4.0M | Revenue: $3.3M | Cash Flow: $884K | CF Margin: 26% | Price / Revenue: 1.20x | Price / Cash Flow: 4.5x

Nearly 100% Ohio Medicaid (ODM) census serving Cincinnati, Dayton, and surrounding areas. Strong relationships with case managers.

My take: A 26% cash flow margin on a predominantly Ohio Medicaid book is high for the payer mix, and the listing's "do not respond if you require a CIM" framing is a signal that the seller is looking for a buyer who can move quickly on limited information, which is itself a yellow flag worth calling out. Ohio Medicaid home health rates have been under pressure for several years, and a 100% Medicaid book carries both concentration risk and rate-cut risk that should be reflected in any valuation. A disciplined buyer needs a thorough payer mix breakdown (ODM managed care vs. fee-for-service, which managed care plans are dominant, which specific services are being billed), a rate comparison to current Medicaid fee schedules, and a patient retention analysis. The 4.5x cash flow ask is appropriate for the risk profile if diligence confirms the margin, and generous if it doesn't. For a home health consolidator with existing Ohio Medicaid billing infrastructure and a MCO contracting team, this is a reasonable bolt-on at the ask.

Location: Los Angeles, CA | Asking Price: $2.5M | Revenue: $2.7M | Cash Flow: $600K | CF Margin: 22% | Price / Revenue: 0.93x | Price / Cash Flow: 4.2x

1,200 square foot facility serving LA County's aging population. Full accreditation and Medicare certification.

My take: The LA hospice market is saturated, scrutinized, and competitive. California has been the epicenter of hospice-specific fraud enforcement over the last three years, and Los Angeles specifically has been subject to a federal moratorium on new Medicare hospice provider enrollments. That moratorium affects two things simultaneously: it depresses the value of new hospice licenses (because you can't get one) and it supports the value of existing, clean, Medicare-certified LA hospices (because the supply is frozen). The 4.2x cash flow ask is at the low end of where clean LA hospices have been trading, which is worth a closer look. The diligence priority is survey history: CMS survey deficiencies, any past 855A revocations, and any pending ZPIC or UPIC reviews. An LA hospice with a clean survey history is probably underpriced at 4.2x given the moratorium backdrop. An LA hospice with a troubled survey history at any price is a landmine.

Location: Northern Virginia | Asking Price: $12.0M | Revenue: $11.0M | Cash Flow: $2.0M | CF Margin: 18% | Price / Revenue: 1.09x | Price / Cash Flow: 6.0x

Founded 2014. ~90% of revenue from private-pay companionship and personal care services in the Northern Virginia market.

My take: Private-pay Northern Virginia non-skilled home care is one of the more attractive sub-segments in home-based services right now for three reasons: the demographic profile (aging, affluent population with willingness and ability to pay cash for high-touch services), the reimbursement simplicity (no Medicare or Medicaid billing headaches), and the margin durability (cash-pay rates can be repriced annually without navigating state fee schedules or managed care contracts). The 6.0x cash flow ask is consistent with where cash-pay private-duty home care platforms of this scale have been trading. The 18% CF margin is realistic but below the best-in-class operators in this space, who run 22-25%. A buyer should focus diligence on caregiver retention (the single biggest operational constraint in private-pay home care), client concentration, and the rate card relative to Northern Virginia market benchmarks. There's a reasonable case that a disciplined operator could move this from 18% to 22% margin in 18 months through pricing discipline alone.

Location: SW Florida | Asking Price: $3.25M | Revenue: $3.2M | Cash Flow: $441K | CF Margin: 14% | Price / Revenue: 1.03x | Price / Cash Flow: 7.4x

Established 2013. Joint Commission accredited with a VA contract. Both skilled and non-skilled home care, serving private pay, commercial, and VA patients. 11 employees. Owner retiring.

My take: Two interesting features here: the Joint Commission accreditation and the VA contract. Joint Commission accreditation is meaningful in home health because many commercial payers and MA plans now require it, and the re-survey timeline is long enough that a buyer inheriting a recently re-accredited agency gets real value. The VA contract is the more interesting asset because VA home health contracts are not easy to get (they run through VA Community Care Network regional contractors like Optum Serve or TriWest) and they carry higher per-episode rates than Medicare in many cases. The 7.4x cash flow ask is aggressive for $441K of cash flow and a 14% margin, but the VA contract and Joint Commission status arguably justify a premium if both are transferable without re-certification. The diligence priority is what percentage of revenue comes from the VA contract specifically (because if it's meaningful, the contract transferability is the whole deal) and what the renewal timeline looks like. CHOW for VA contracts is not automatic and the process can take 6 to 12 months, which a buyer should plan around.

That's it for Issue #3.

See you next Tuesday.

Will Hamilton, CVA Founder, Scope Research and HealthFMV

The Weekly Checkup is published every Tuesday morning. It is written for general informational purposes. Engagements through Scope Research or HealthFMV require a separate agreement.