The Weekly Checkup: Week of June 15-19, 2026

Issue #11 | Week of June 15-19, 2026

44 announced transactions this week, down from last week's 56, with Services 21, Technology 23, and 4 platform deals. The technology count edging past services for the first time in several weeks reflects a busier-than-usual week in pharma software and clinical research deals.

Deal value: $12 billion | EV / EBITDA: ~17x

Thoreau Group, the healthcare investment platform backed by Apollo Global Management, announced the completion of its strategic growth investment in Ensemble Health Partners. In a detail that distinguishes the transaction from what prior reporting implied, Berkshire Partners, Warburg Pincus, and Bon Secours Mercy Health are all remaining as investors alongside Thoreau, which will become the controlling shareholder. Ensemble reported generates adjusted EBITDA in the low $700 million range, meaning it is one of the largest end-to-end RCM businesses in the country.

My take: Last week's reports described this as a sale, while the press release describes it as a strategic growth investment in which existing shareholders are rolling equity alongside the new majority investor. That is a materially different transaction: it implies that Berkshire and Warburg are not fully exiting at $12 billion, which either means they believe the business is worth more than $12 billion on a full-exit basis or that the transaction structure allocated a portion of the consideration to the existing investors in a way that allows them to participate in future appreciation. The $12 billion enterprise value implies ~17x EBITDA on $700+ million, consistent with every prior Ensemble transaction, as we laid out in last week's analysis. For the RCM category: the multiple stability across four transactions and a decade of extraordinary EBITDA growth is the observation that matters most. The institutional premium for scaled, mission-critical, high-switching-cost outsourcing platforms looks durable.

Thurston Group announced the unification of three existing portfolio companies, SGA Dental Partners, Gen4 Dental Partners, and Modis Dental Partners, into a single national dental support organization under the SGA Dental Partners name. The combined platform has more than 250 locations across 26 states with over 500 dentists in general and specialty practice, creating a top-10 DSO by size and scale.

My take: Thurston did not announce three acquisitions; it announced the operational and brand consolidation of three companies it already owned into one. The financial synergy thesis for combining three separate DSOs under common ownership is straightforward: shared services, unified payer contracting, brand consolidation, and management overhead reduction. The more interesting strategic question is why Thurston chose to do this now, in mid-2026, after holding these businesses separately for some period. The most likely answers are either an upcoming recapitalization or exit process that a single platform story simplifies, or a management bandwidth constraint that makes operating three separate DSOs less efficient than operating one at the same scale. The 250-location, 26-state footprint puts SGA Dental in the same tier as several PE-backed dental platforms that have already undergone recapitalizations. Thurston is also the backer behind Sensorium Clinical Research and Alpha Aesthetics Partners, making it one of the more active healthcare PE platforms of 2026 so far.

Deal value: $1.8 billion | EV / EBITDA: 12.0x to 13.85x

THL Partners completed the acquisition of Celerion Holdings from H.I.G. Capital for $1.8 billion. Celerion is a Lincoln, Nebraska-based CRO specializing in clinical pharmacology and early-stage drug development, with facilities in North America, Europe, and Asia running first-in-human to proof-of-concept studies alongside bioanalytical laboratory services. The EBITDA used by different sources ranges from $130 million (Octus) to $150 million (Axios), producing an implied multiple of 12.0x to 13.85x. H.I.G. ran the sale through Lazard and Bank of America.

My take: The EBITDA range dispute is worth flagging rather than picking a number and presenting it as precise. The $130 million and $150 million figures produce meaningfully different multiples (12x vs. 13.85x), and without audited financial statements we can’t really resolve it.

Deal value: $375 million | EV / Revenue: 4.7x | EV / EBITDA: 16.6x

Altaris announced the acquisition of Simulations Plus (Nasdaq: SLP) for $18.50 per share, a 26% premium to the 60-day VWAP. Simulations Plus generates approximately $80.5 million in estimated 2026 revenue and $22.5 million in adjusted EBITDA (a 28% margin), according to guidance included in the Q1 FY2026 earnings release. The company develops model-informed and AI-accelerated drug development software, with products covering PBPK modeling, population PK/PD analysis, and regulatory submission support. Altaris intends to merge Simulations Plus with Chemical Computing Group, an existing portfolio company providing advanced molecular design software, to create a scaled pharma computational software platform.

My take: The 16.6x adjusted EBITDA multiple on a public company with $80 million in revenue reflects the premium the market places on software businesses embedded in the drug development workflow. Simulations Plus's products are used to build the pharmacokinetic and pharmacodynamic models that support FDA regulatory submissions, which means switching away from them mid-development program is functionally impossible without restarting months of modeling work. That switching cost is the moat, and Altaris is paying a multiple that reflects it. The combination with Chemical Computing Group is the more interesting part: CCG provides molecular design software used earlier in the drug discovery process, while Simulations Plus serves the development and regulatory submission phase. The combined platform would cover discovery-to-submission computational workflows, which is a logical and differentiated software suite if the integration can be executed cleanly. The 26% premium to the 60-day VWAP is modest for a take-private, which suggests either that Simulations Plus was already trading at a reasonable premium to its fundamental value or that the competitive process was limited.

Deal value: $550 million | EV / Revenue: 7.6x

Medtronic completed the acquisition of Scientia Vascular, a Salt Lake City-based developer of neurovascular access and therapeutic devices, for $550 million upfront. Scientia generated FY2025 revenue of $72 million, up from $52 million in FY2024, representing 38% year-over-year growth. The acquisition integrates Scientia's microcatheter and guidewire portfolio with Medtronic's existing neurovascular business, and is expected to be minimally dilutive to Medtronic adjusted EPS in FY2027 and accretive thereafter.

My take: The 7.6x revenue multiple on a neurovascular access business growing at 38% year-over-year is reasonable for the category. Neurovascular access devices, which includes microcatheters, guidewires, and delivery systems for stroke intervention and cerebral aneurysm treatment, are technically demanding products where clinical outcome data and physician preference drive market share more than price. A business growing from $52 million to $72 million in a single year in a category where Medtronic is already the market leader has demonstrated that its products are gaining traction against entrenched competition. The "seamlessly integrating access and therapeutic portfolios" framing suggests Medtronic sees meaningful cross-selling opportunity, applying Scientia's access devices to procedures where Medtronic already has the therapeutic device on the other end of the catheter.

Lilly acquired 4E Therapeutics, an Austin-based neuroscience company developing MNK inhibitors for chronic pain. 4E's lead compound, 4ET1103, is the first MNK inhibitor developed for pain to reach human clinical trials, where it demonstrated a favorable Phase 1 safety profile. Lilly's eleventh acquisition of 2026.

My take: The Lilly acquisition pace has become the defining storyline of the 2026 pharma M&A year, and 4E Therapeutics is notable within that pattern for what it is not. It is not a vaccine, not an oncology ADC, not a cardiometabolic asset. It is a non-opioid pain mechanism in early clinical development, which represents a new category for Lilly's 2026 buying program. The MNK-eIF4E signaling pathway targeted by 4ET1103 is distinct from both the opioid receptor mechanisms that have dominated chronic pain pharmacology for decades and the peripheral nerve stimulation approach that Medtronic is pursuing through its SPR acquisition (Issue #7). Lilly is evidently comfortable accumulating early-stage pipeline optionality across multiple pain mechanisms simultaneously. For early-stage neuroscience companies with non-opioid pain assets and clean Phase 1 data, the market for that conversation is open.

I tracked 38 additional transactions this week, including Singlepoint Healthcare's acquisition of Healix Infusion (220-plus physician-owned infusion centers), the formation of OrthoTexas (70 surgeons across five DFW practices choosing independence rather than PE affiliation, a notable counter-trend worth watching), Abarca Health and LucyRx combining to form a 9-million-member modern independent PBM, Model N's acquisition of Kalderos (expanding its 340B GTN capabilities, a direct follow-on to the Pillr/CaptureRx 340B technology deal we noted in Issue #8), CVC Catalyst's acquisition of WillowWood (prosthetics manufacturer, Blue Sea Capital exit), and Biogen's acquisition of RayThera for up to $1 billion in immunology pipeline optionality. The complete list is available to subscribers.

Deal value: $10.8 million | EV / Revenue: 0.34x | EV / EBITDA: Not meaningful (operating at a loss)

This week's Vault deal comes from the audited financial statements and Medicare cost reports of a small-town North Dakota hospital acquisition that most deal trackers will never see.

What the press release said: Very little. Altru Health System, a Grand Forks, North Dakota-based nonprofit health system, announced the acquisition of CHI St. Alexius Health Devils Lake Hospital in Devils Lake, North Dakota. The press release described the combination as expanding Altru's regional network and ensuring continued access to care in the Devils Lake community.

What the audited financial statements and cost reports added: Atru’s recently released FY 2025 audit reveals a purchase price that was not previously public. The Medicare cost report for CHI St. Alexius Health Devils Lake, filed annually as a condition of Medicare participation, shows FY2025 facility service revenue of approximately $31.5 million and an operating loss of approximately $1.1 million. The hospital is a critical access hospital, meaning it is the sole provider of inpatient care within 35 miles and qualifies for Medicare cost-based reimbursement rather than the DRG prospective payment system.

Why Altru wants it: Devils Lake is approximately 85 miles from Grand Forks, which is Altru's home market and where its flagship hospital operates. The acquisition extends Altru's referral catchment area, keeps more patients within its system rather than traveling to Bismarck or Fargo, and satisfies its nonprofit mission to serve the health needs of the rural North Dakota community. For Altru, the financial case for this acquisition is not the hospital's current P&L; it is the avoided revenue leakage from patients who currently bypass Devils Lake and travel to competing systems for higher-acuity care, plus the eventual operating improvement achievable under Altru's shared services infrastructure.

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.

Location: Bensalem, PA | Asking Price: $1.4M | Revenue: $1.14M | Cash Flow: $436K | CF Margin: 38.3% | Price / Revenue: 1.23x | Price / Cash Flow: 3.21x

Two-location audiology practice in eastern Pennsylvania with a strong reputation for clinical excellence, comprehensive hearing and balance assessments, and a loyal patient base.

My take: Audiology is a consolidation story in progress: HearingLife, AudioNova, Starkey's retail network, and several PE-backed platforms have been active acquirers, but their typical target size is meaningfully larger than a two-location practice generating $1.14 million in revenue. A practice this size is most likely a tuck-in for an existing regional audiology operator, a strategic acquisition for a hearing aid manufacturer with a retail strategy, or solo buy. The 38% cash flow margin is strong for audiology, which typically runs at 25% to 35% at this scale. The central diligence question is audiologist dependency: if the patient relationships belong to a single audiologist who is also the seller, the transition plan is the most important element of deal structure.

Location: Calcasieu County, LA | Asking Price: $2.8M | Revenue: $4.98M | EBITDA: $720K | EBITDA Margin: 14.5% | Price / Revenue: 0.56x | Price / EBITDA: 3.89x

Blue Mist Rehab is a 25-year-old, fully Medicare-credentialed outpatient rehabilitation platform operating across three revenue channels: skilled nursing facility contract therapy, home health agency contract therapy, and an outpatient clinic. Services include physical therapy, occupational therapy, and speech-language pathology. 14 employees.

My take: The three-channel model is the a differentiator. Most outpatient therapy practices operate in a single care setting; Blue Mist generates revenue from SNF contract therapy, HHA contract therapy, and its own outpatient clinic, which creates both revenue diversification and something of a moat: SNF and HHA contracts require credentialing, compliance infrastructure, and clinical relationships that a single-site outpatient operator cannot easily replicate. The 14.5% EBITDA margin is below where a well-optimized outpatient therapy platform should produce but is consistent with a business that carries the overhead of managing multiple care settings simultaneously. The 3.89x EBITDA and 0.56x revenue ask is pretty cheap, and the "ideal PE add-on" framing in the listing title is likely accurate: a regional therapy platform with SNF and HHA contract infrastructure could absorb Blue Mist's three-channel revenue model and add meaningful clinical breadth to an existing outpatient-only footprint. Louisiana's therapy licensure requirements apply, and any CHOW for the SNF and HHA contract relationships should be confirmed with the relevant SNF and HHA operators rather than assumed to transfer automatically.

Location: Phoenix, AZ | Asking Price: $12.0M | Revenue: $3.0M | EBITDA: $2.0M | EBITDA Margin: 66.7% | Price / Revenue: 4.0x | Price / EBITDA: 6.0x

Founded 2023. Nine-person surrogacy consulting agency with US and international clientele and a whopping 66.7% EBITDA margin.

My take: A 66.7% EBITDA margin on a consulting business founded in 2023 with nine employees is the most unusual financial profile in this week's set. Surrogacy consulting is a cash-pay, high-ticket service (surrogacy arrangements can cost $150,000 to $200,000 or more in total, with the agency taking a fee for matching, coordination, and support services), which explains how a nine-person firm generates $2 million in EBITDA on $3 million in revenue. The three-year operating history is the central risk: this business was founded in 2023, during a period when surrogacy demand was elevated and international clients (particularly from countries where commercial surrogacy is restricted) were actively seeking US-based arrangements. Whether that demand is structural or cyclical, and whether the client pipeline is durable or episodic, are questions the three-year track record cannot fully answer. The regulatory environment for surrogacy is also actively evolving: several states have passed or are considering legislation that restricts or regulates commercial surrogacy arrangements, and Arizona specifically has had legislative activity in this area. A buyer should understand the jurisdictional risk of the agency's client base and arrangement structures before engaging on price. At 6.0x EBITDA the ask is not unreasonable for a business with these margins if the client pipeline is documented and recurring. At 4.0x revenue it assumes the current margin structure persists, which requires the regulatory environment to remain stable.

Location: Pennsylvania and California | Asking Price: $15.0M | Revenue: $10.7M (est. 2024) | EBITDA: $1.7M | EBITDA Margin: 15.9% | Price / Revenue: 1.40x | Price / EBITDA: 8.82x

Founded in 1993. Biostatistics and statistical consulting firm specializing in clinical research data analysis and reporting for pharmaceutical and biotech clients seeking FDA drug approval. Revenue growth from $5.3M in 2019 to an estimated $10.7M in 2024.

My take: A 33-year-old biostatistics consulting firm that has doubled revenue over five years might be sitting on a defensible expertise position in a category where the barriers to entry are high (statistical methodology recognized by FDA reviewers takes years to establish), or it might be highly dependent on a small number of large pharma clients whose renewal decisions dominate the revenue trajectory. The 15.9% cash flow margin on $10.7 million of revenue is a bit below where a pure-play consulting firm of this vintage would be expected to be, which suggests that the owner is investing heavily in staff to maintain FDA-recognized methodology expertise. The 8.82x EBITDA ask requires a buyer to believe the $1.7 million is stable and growing, and that it is a true EBITDA figure, after normalized, all-in comp. The business description notes the owner is willing to remain for transition, which is appropriate and probably necessary for a client relationship-dependent consulting firm. The CRO and pharma services market is active right now (Celerion at $1.8 billion this week is a much larger example), but smaller biostatistics-focused firms have attracted strategic acquirers as CROs look to expand their data and statistical capabilities.

Location: Riverside, CT | Asking Price: $4.0M | Revenue: $3.0M | Cash Flow: $913K | CF Margin: 30.5% | Price / Revenue: 1.33x | Price / Cash Flow: 4.38x

Specialized pharmaceutical market research firm with a global client base, serving pharmaceutical and biotech companies with market research and strategic insights.

My take: The 4.38x cash flow and 1.33x revenue ask is reasonable, and the Connecticut location paired with the "global client base" description suggests a firm that has built pharma client relationships through proximity to New York and New Jersey-based drug developers. Pharmaceutical market research is a category that has attracted some consolidation (Decision Resources Group, Evaluate, IQVIA's commercial analytics segment all compete at the large end), but the independent boutique market research firm with specialized pharma expertise is genuinely hard to find and harder to replicate. The 30.5% cash flow margin is strong for consulting and implies genuine pricing power with clients rather than a low-cost commodity offering. The primary due diligence question is the same as for any consulting firm: what percentage of the $3 million in revenue is under multi-year research retainer versus project-by-project, and how concentrated is it across the client base? A firm with 60% retainer revenue and five or more active clients is a very different business from one with 90% project revenue and two anchor clients.

That's it for Issue #11. Forward to one person, reply with feedback, and reach out directly if you are exploring a transaction, valuation, or FMV engagement.

Will Hamilton, CVA

Founder, Scope Research and HealthFMV

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