Time for integration in the healthcare sector Companies change the profile of the sector, with a high stake in digital transformation
The pressure of the pandemic for new ways to care for the patient, the technological mismatch in relation to other sectors of the economy and the ease of capitalization created the perfect environment for an unprecedented movement in the Brazilian health market.
Backed by the country’s chronic need to expand, improve and make access to healthcare cheaper, companies have been changing the profile of the sector, with high stakes in digital transformation, integration and consolidation. Trends that permeate all links in the chain, from hospital networks to health plan operators and diagnostic analysis clinics, and which should continue throughout this year.
Last year, these trends were reflected, for example, in the business combination between the Hapvida and NotreDame Intermédica (GNDI) groups, a R$ 53.4 billion transaction, which created a mega company; in the acquisition, for R$ 15.6 billion, of SulAmérica, an insurance company that has 4.5 million users of health and dental plans, by Rede D’Or Luiz, the largest hospital group in the country; investment of R$ 3.7 billion by Dasa to buy seven hospitals – Inova (SP), Carmo (RJ), Bahia (BA), São Domingos (MA) and three from the Leforte group – in addition to Clínica Amo, for oncology, two diagnostic medicine companies, one for portfolio management and another for health insurance brokerage. Other examples are the six Fleury acquisitions – the clinical analysis laboratories Pretti and Bioclínico, from Espírito Santo, and Marcelo Magalhães, from Pernambuco; the Pacaembu Infusion Center, the Moacir Cunha Eye Clinic and the Vita Clinic, for orthopedics and physiotherapy, with a total investment of R$ 940 million – and the advancement of Raia Drogasil beyond the pharmacy business. According to consultancies that monitor mergers and acquisitions (M&A) movements in Brazil, in 2021 the health sector broke records in the number of transactions. KPMG studies show that the number of transactions in the segment of hospitals and clinical analysis laboratories increased from 52 in 2016 to 137 in 2021. In February this year alone, according to Kroll, 12 of the 123 transactions announced are in the health equipment and services. A study by Bain & Company indicates that the sector’s share of total M&A transactions in Brazil was much higher last year (17.3%) than in 2020 (5.4%). “It became easier to raise money: IPOs exploded in recent years, interest rates were lower, it was more necessary to finance and companies were well capitalized to buy”, says Luiz Frota, a partner at Bain. “While the transaction between Hapvida and GNDI, valued at $9.6 billion, justifies this historic leap, it was a busy year,” he says.
Alexandre Pierantoni, head of corporate finance at Kroll, also highlights the importance of IPOs and follow-ons in the capitalization of companies: “Most of the operations were to raise funds for companies or make acquisitions because the market demanded investments in technology, modernization. ” The industry has had to reinvent itself not just in the backbone, but in “complementing services and products to meet the patient’s experience or need across the lifecycle,” he says. Scale gains to reduce costs, search for synergies and complementarity also explain the movement in the sector, says André Pimentel, partner at Performa Partners, a consultancy specializing in M&A and restructuring. “But the most recent trend is the pursuit of consolidation.” This is what is observed in the case of Hapvida and GNDI. The former grew in the Northeast and North, while Notre Dame advanced strongly in São Paulo, Rio and Rio Grande do Sul.
“Despite being regionally strong, they lacked national competitiveness. By coming together, they achieve national reach,” he says. According to Jorge Pinheiro, president of the Hapvida System, the combination between the companies took place because both have trajectories in the area of supplementary health that have consolidated them as a national reference. “United, they are even bigger and allow more access to healthcare for Brazilians.” In addition to the deal, concluded earlier this year, Hapvida’s portfolio includes eight acquisitions made in 2021 – including hospitals Madrecor, in Uberlândia (MG), Viventi, in Brasília (DF), Otaviano Neves, in Belo Horizonte and Cetro , from Alagoinhas (BA), in addition to the HB Saúde group, whose acquisition is awaiting completion. In total, the investment is R$ 2.8 billion. In February, the company announced the acquisition, for R$ 300 million, of the Smile group, which operates in Maceió (AL), João Pessoa (PB), Campina Grande (PB) and Brasília. The Hapvida system currently has 84 hospitals, 75 emergency services, 294 medical clinics and 262 diagnostic centers.
From Belo Horizonte (MG), Mater Dei decided, three years ago, to move to other regions.