The Weekly Checkup: Week of May 25-29, 2026

Issue #8 | Week of May 25-29, 2026

35 announced transactions this week, another quieter week on volume (holiday), with Services 22, Technology 13, and a relatively strong 6 platform deals. The deal count is light, but the stories are not.

Eli Lilly announced three acquisitions in a single press release on Monday, bringing its 2026 total to ten acquisitions in five months. The combined deal value for the three new targets is up to $3.83 billion, and the move into infectious disease represents a category expansion rather than a continuation of the cardiometabolic and oncology assets that have defined most of Lilly's prior deal activity this year. When a company with Lilly's pace buys three vaccine developers simultaneously, it is worth asking what they know about the category that the market does not.

Tractor Supply acquired VIP Petcare, the largest provider of mobile veterinary care in the United States, from PetIQ. Financial terms were not disclosed, but the deal mirrors one from Issue #1 when we covered Chewy's acquisition of Modern Animal and asked whether retail-to-veterinary delivery could work where retail-to-human healthcare delivery largely has not. The Tractor Supply answer to that question is different from Chewy's and is well worth examining on its own terms.

HCA Healthcare announced an agreement to acquire The College of Health Care Professions, a Texas-based allied health training institution serving 8,000 students annually across ten campuses. No financial terms were disclosed. It is the most unusual acquisition HCA has made in years, but the logic is not complicated once you understand where hospital systems are sourcing their clinical labor.

Ernest Health acquired Reunion Rehabilitation Hospitals, a seven-facility IRF network across Arizona, Colorado, Texas, and Florida, expanding from 38 to 45 facilities. This is a direct follow-on to the Select Medical analysis from Issue #6, where I argued the IRF segment was a premium asset in the blended multiple.

George Washington University signed a definitive agreement to offload its Medical Faculty Associates physician practice group to UHS, which will house it in a new nonprofit entity called Capital Medical Group. UHS, which just acquired Talkspace, is now accumulating physician practice liabilities alongside digital health assets in the same month after several relatively quiet years. Could be a trend worth watching.

Dental had another multi-deal week. Premier Care Dental Management announced two acquisitions in the same week in the latest edition of the batch-close behavior, now in its fifth consecutive week across this newsletter's tracking.

Curevo: up to $1.5B | LimmaTech Biologics: up to $780M | Vaccine Company: up to $1.55B | Combined: up to $3.83B

In a single Monday press release, Lilly announced definitive agreements to acquire all three: Curevo, which is developing a next-generation shingles vaccine that matched the immune response of the standard of care in Phase 2 while cutting side effects by more than half; LimmaTech Biologics, which is developing vaccines against bacterial pathogens including Staphylococcus aureus, Neisseria gonorrhoeae, and Chlamydia trachomatis; and Vaccine Company, a preclinical company developing a vaccine against Epstein-Barr virus. The three deals bring Lilly's 2026 acquisition total to ten companies.

My take: When I called Lilly's fourth consecutive weekly biotech acquisition a pattern worth naming in Issue #7, I was understating it. Ten acquisitions in five months, across at least four distinct therapeutic categories, is a capital deployment pace that has not been seen at this scale from a large pharma company in recent memory. The infectious disease pivot is the analytically interesting part. Lilly's prior 2026 acquisitions were largely concentrated in cardiometabolic, oncology, and gene therapy. Vaccines are a different business: different manufacturing, different regulatory pathway, different commercial channel, different payer dynamics. All three targets address pathogens where primary infection is associated with serious downstream sequelae that either Lilly treats or wants to treat. Shingles is linked to elevated stroke and dementia risk. EBV is linked to multiple sclerosis and several malignancies. Staph is the leading cause of surgical-site infection. Lilly's framing is "prevent disease at its source rather than treat its consequences": if you can prevent the infection that leads to the chronic condition, you reduce the patient pool for the chronic condition treatment while capturing the prevention market. For early-stage biotech companies in any indication where Lilly has an existing commercial interest, the 2026 deal pace means the strategic conversation is open across a wider range of categories than it has ever been.

VIP Petcare operates community clinics in approximately 2,700 retail locations across 39 states, including 1,700 Tractor Supply locations, serving more than one million pets annually.

My take: The Chewy/Modern Animal comparison from Issue #1 is relevant context, but the structures are quite different. Chewy bought a brick-and-mortar veterinary chain and is now responsible for building out clinical operations in locations it owns or leases. Tractor Supply is internalizing a mobile, clinic-in-clinic model that already operates inside 1,700 of its own stores, using infrastructure that exists rather than infrastructure that needs to be built. Tractor Supply is not buying real estate or building clinics, it is bringing inside an existing partner that was already generating traffic at its locations. The model also differs from the human healthcare retail playbook in an important way: veterinary services have a more straightforward regulatory environment than human primary care, no managed care contracting complexity, and a consumer who is accustomed to paying out of pocket. As I have said many times, the business of taking care of pets is way better than the business of taking care of people. VIP Petcare's pricing is reportedly more than 50% below a traditional veterinary visit, which positions it as a value-oriented product for the exact demographic Tractor Supply serves. The question for analysts is whether internalizing a clinical service operation changes Tractor Supply's operational profile in ways that complicate the retail model.

Financial terms undisclosed. CHCP is a Texas-based allied health educator serving 8,000 students annually across ten campuses, offering more than 20 accredited programs including Medical Assisting, Sonography, Surgical Technology, Radiologic Technology, and Medical Coding and Billing.

My take: This is a workforce acquisition dressed up as an educational one. HCA is not acquiring CHCP because it wants to be in the education business. It is acquiring CHCP because allied health worker shortages are a direct operational constraint, and owning the training pipeline gives HCA a first-look and preferential placement advantage for the workers coming out of it. For anyone tracking healthcare labor economics, the HCA/CHCP deal joins a small but growing list of health systems that have concluded the most effective solution to the allied health labor shortage is not higher wages but earlier-in-the-pipeline intervention. The difference from similar investments by Ascension and Providence is that this is a full acquisition of an accredited degree-granting institution, which comes with different regulatory standing: the Department of Education, accrediting bodies for each program type, and state licensing agencies all have jurisdiction. The strategic logic is sound but the execution complexity is higher than a typical tuck-in acquisition.

Ernest Health announced a definitive agreement to acquire Reunion Rehabilitation Hospitals, a seven-facility IRF network in Arizona, Colorado, Texas, and Florida, expanding from 38 to 45 rehabilitation hospitals.

My take: In Issue #6, walking through the Select Medical take-private, I noted that the IRF segment was a premium piece of the blended multiple: 16% year-over-year revenue growth, 86% occupancy at same-store facilities, and a comparable public multiple from Encompass Health that implies 9x to 12x EBITDA for a clean standalone IRF operator. Ernest Health's move to acquire seven more IRFs in Sun Belt states is consistent with that. Arizona, Colorado, Texas, and Florida are high-growth, favorable-demographic markets for post-acute rehabilitation, and the Sun Belt migration trends driving occupancy gains at existing IRFs are not reversing. The pace of IRF platform expansion across multiple buyers in the same quarter, including Select Medical's recapitalization via WCAS and now Ernest's Reunion acquisition, suggests the category is attracting institutional capital at valuations the blended public market multiple for Select Medical did not fully reflect. For owners of standalone IRF facilities in growth markets, the relatively small strategic buyer pool is more active today than it was 18 months ago.

George Washington University signed a definitive agreement to transfer its financially distressed Medical Faculty Associates physician practice group to UHS, which will house it in a new nonprofit entity called Capital Medical Group. MFA physicians and staff are expected to be hired by the new entity, which will deliver care at GW Hospital and Cedar Hill Regional Medical Center.

My take: Academic medical center arrangements are among the most complicated in healthcare, and MFA's situation helps illustrates why. Academic practice groups carry the overhead of research, teaching, and clinical operations simultaneously, with clinical revenue expected to subsidize academic and educational functions that do not generate direct revenue. When you add cost inflation and payer reimbursement pressure to the equation, universities that own the medical group (but not the health system) face a choice: continue subsidizing the practice or let your partner assume the operational burden. This can either be accomplished through an academic affiliation agreement with clinical, operational, and mission support funding (reach out to me if you’d like to discuss these further) or through a straight divestiture / reorg. GWU is choosing the latter. The Capital Medical Group nonprofit structure is presumably designed to preserve the academic affiliation while giving UHS operational control, but there is governance complexity with a for-profit health system running a nonprofit physician group at an academic medical center. MFA is not the only university-affiliated practice group running structural deficits, and the number of institutions looking for an exit from direct physician employment obligations is something to watch. Another thing to watch here is UHS’s re-emergence as a dealmaker with two major deals in three months after several quiet years.

I tracked 30 additional transactions this week, including behavioral health pharmacy (Altruix / Frazier Healthcare Partners, WindRose's exit of the 32,000-patient, 17-pharmacy behavioral health platform), mobile imaging (Heritage Imaging / Align Capital Partners, platform formation in mobile diagnostic imaging for rural and critical access hospitals), cardiology (Florida Heart Associates / Lee Health, 16-cardiologist group plus ASC absorbed by the Southwest Florida health system), and dental (PCDM's two-deal week, five consecutive weeks of batch-close behavior tracked in this newsletter). The complete list, with the financial detail Scope is known for, will be available to premium subscribers when that tier launches.

Location: Pennsylvania | Asking Price: $23.0M | Revenue: $22.7M | SDE: $3.03M | SDE Margin: 13.3% | Price / Revenue: 1.01x | Price / SDE: 7.60x

2025 gross revenue $22.7M, SDE $3.03M. 2024 revenue $21.6M, SDE $3.14M. Pennsylvania state Medicaid reimbursement rate increasing 13% in July 2026.

My take: The pending 13% Medicaid rate increase is the most important number in this listing, and the seller is pricing it in to some extent: a home health agency in Pennsylvania generating $22.7 million in revenue with a 13% rate increase coming in July 2026 is a materially different asset than the trailing financials suggest. If that rate increase flows through to EBITDA at a reasonable margin, the effective forward earnings base is meaningfully higher than the 2025 SDE of $3.03 million, and the 7.60x trailing SDE multiple becomes more defensible, and possibly cheap, on a forward basis. The central diligence question is what percentage of the revenue is tied to the state Medicaid program receiving the rate increase versus commercial or Medicare revenue. A buyer should demand a payer mix breakdown before engaging on price. The 1.01x revenue multiple is at the low end of where home health has been trading for small platform-ish assets, reflecting the thin SDE margin and Pennsylvania's competitive dynamics. Pennsylvania's CHOW process for home health agencies is CMS-supervised and can take 90 to 120 days, which should be modeled into deal timing. For a buyer with existing Pennsylvania home health operations or back-office infrastructure that can absorb this book, the July rate increase creates a near-term earnings catalyst that is not visible in the trailing numbers.

Location: Las Vegas, NV | Asking Price: $20.0M | Revenue: $5.82M | Cash Flow: $3.35M | CF Margin: 57.5% | Price / Revenue: 3.44x | Price / Cash Flow: 5.97x

Scalable RCM platform with nationwide client reach across multiple specialties.

My take: The 57.5% cash flow margin on a medical billing business is the first number that demands explanation. Standard medical billing and RCM businesses run at 15% to 25% EBITDA margins at this revenue scale: the difference between a 20% and 57% margin is either very low staff count relative to revenue (suggesting automation-heavy or offshore operations), significant owner compensation normalization that may understate the operational burden, or perhaps a revenue figure that includes pass-through collections inflating the top line without proportionate cost. A buyer needs to understand which of these explains the gap before any price discussion is meaningful. If the margin is genuine and reflects a technology-differentiated platform with scalable operations, the 3.44x revenue ask is reasonable for an RCM business growing in the right specialties. If the margin relies on a key-man cost structure that disappears on ownership change or on offshore staffing carrying compliance risk, the multiple is aggressive. Carlyle's acquisition of Knack and EqualizeRCM that we covered in Issue #5 highlights the fact that the category attracts institutional capital at premium multiples when the platform economics are genuine.

Location: Texas | Asking Price: $48.5M | Revenue: $60.0M (est. 2025) | EBITDA: $7.0M (est. 2025) | EBITDA Margin: 11.7% | Price / Revenue: 0.81x | Price / EBITDA: 6.93x

Texas specialty pharmacy seeking strategic partners with extensive healthcare industry experience. 2025 estimated gross revenue $60M, estimated EBITDA $7.2M.

My take: Specialty pharmacy is one of the more valuation-sensitive categories in healthcare services because the multiple depends almost entirely on what the pharmacy dispenses and to whom. A specialty pharmacy dispensing oncology, rare disease, or immunology drugs through a narrow network contract trades at a very different multiple than one dispensing diabetes injectables through an open network. The 0.81x revenue and 6.93x EBITDA ask are on the conservative end of where legitimate specialty pharmacy platforms have been trading, which either means this is an appropriately priced asset or that the payer contracting and therapeutic mix present risks the seller has already priced in. The listing description calling for "strategic partners with extensive healthcare industry experience" typically means the buyer needs to satisfy payer network or licensing requirements, or the seller expects the buyer to have existing managed care relationships that can be leveraged for preferred access. Key diligence priorities are the payer mix and network status (preferred specialty pharmacy contracts with major PBMs are the primary value driver), the therapeutic category concentration, the 340B contract pharmacy component if any, and the Texas state pharmacy board change-of-ownership process. At $60 million in revenue this is a meaningful platform, and the ask is not unreasonable for the right buyer.

Location: Metro Minneapolis/St. Paul, MN | Asking Price: $8.0M | Revenue: $3.54M | Cash Flow: $2.11M | CF Margin: 59.5% | Price / Revenue: 2.26x | Price / Cash Flow: 3.79x

Home and Community-Based Services 245D business providing employment services and 24-hour emergency assistance in the Minneapolis-St. Paul metro. Three categories of employment services. Owner works remotely with strong staff in place. Buyer must qualify with current experience in the 245D space.

My take: The 59.5% cash flow margin and the 3.79x cash flow multiple, taken together, describe a business generating exceptional earnings relative to its cost base, and the most likely explanation is the employment services model rather than direct care delivery. Minnesota's 245D licensure covers a range of HCBS services, and employment-focused services for people with disabilities tend to carry better margins than residential or skilled care because staffing ratios are lower and overhead is lighter. The "buyer must qualify with current experience" disclosure is not marketing language: Minnesota's Department of Human Services has specific requirements for 245D license transfers, including demonstrated experience, background studies, and compliance documentation, and an unqualified buyer cannot close this transaction regardless of price. The remote owner model is a genuine operational plus: a business generating $2.1 million in cash flow with the owner working remotely has demonstrated it can run without owner-operator involvement. The Minneapolis-St. Paul metro is a strong market for disability services: dense population, organized advocacy community, and a state that funds HCBS at above-average rates. For an existing 245D provider looking to add scale or a disability services platform entering the Minnesota market, the 3.79x cash flow ask is reasonable.

Location: New Jersey (undisclosed) | Asking Price: $5.0M | Revenue: $2.92M | Cash Flow: $927K | CF Margin: 31.7% | Price / Revenue: 1.71x | Price / Cash Flow: 5.39x

Multi-location practice combining interventional pain management and interventional radiology, including minimally invasive embolization therapies. Three providers, three main facilities.

My take: The combination of pain management and interventional radiology in a single practice entity is unusual and analytically interesting. Most pain management practices handle the procedural side through their own ASC relationships or hospital affiliations, but interventional radiology as an in-practice capability adds a revenue stream that is typically inaccessible to standalone pain practices. Embolization therapies specifically, including uterine fibroid embolization, prostate artery embolization, and genicular artery embolization for knee pain, have been among the faster-growing procedure categories in outpatient interventional medicine over the last three years, and a practice that has built the equipment infrastructure and referral network for these procedures has a competitive moat that most pain management practices lack. The 5.39x cash flow ask is reasonable for a three-provider, three-location group with specialty procedure capability, depending on the treatment of physician compensation. New Jersey's physician practice regulations are less restrictive than neighboring New York, but Stark and AKS compliance for the radiology ancillary services need to be verified: the in-office provision of imaging and interventional procedures by the same group that refers them is a well-established model under the in-office ancillary services exception, but the documentation requirements are specific and need to be clean before any ownership transfer.

That's it for Issue #8.

See you next Tuesday.

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.