• Middle-market healthcare M&A deal volume has declined 15% quarter over quarter while median deal valuation rose over 20%
• Ongoing economic uncertainty and rising cost of capital has caused up-market buyers to pursue smaller add-ons for current platforms as large platform investments become less attractive
• Healthcare Services deal volume has remained resilient through Q2 (47% of Healthcare M&A volume) despite economic headwinds
• For outpatient/alternate site services, ACA has seen retail and patient payment models becoming more attractive as buyers seek to mitigate fee-for-service risks
• Buy-and-build volume remains strong, specifically within the physician services segment (orthopedics, plastic surgery, women's health, etc.), as several large platforms are expected to transact in 4Q 2023 – 1Q 2024
• ACA remains optimistic about the Healthcare M&A outlook given financial buyers are still sitting on large amounts of capital to be deployed and competition for attractive deals moves further down the market

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