The autism services and pediatric therapy segments of the behavioral health industry (ABA, occupational and speech therapy, etc.) continue to be a hot spot for healthcare investors despite some recent bumps in the road. This is an article about the valuation multiples paid by investors for autism services and pediatric therapy businesses of different sizes, and what that says about the market for this specific type of business, healthcare services in general, and valuations across almost every industry. The key take away is that the multiple paid depends on many different factors depending on the size of the business, and the size of the business itself is perhaps the most important (see chart below graphing EBITDA or owner cash flow multiples by size).
Middle Market Autism and Pediatric Therapy EBITDA Multiples
As a smaller, fast-growing niche within the healthcare industry, there isn't a "bulge bracket" for autism services and pediatric therapy groups... yet. As for the middle market, investor interest exploded in the 2017-2021 time period, with several publicly-disclosed platform investments by private equity sponsors. When you hear about industry EBITDA multiples in the 12x to 18x range, this is the portion of the market being referred to. Multiples have since contracted, but remain elevated compared to many other businesses within the healthcare industry and beyond. The theory is that autism and pediatric therapy are large, growing, and fragmented niches with improving payer coverage, and are therefore ripe for companies to open up de novos and "roll up" smaller practices regionally and across the country.
Lower Market Autism and Pediatric Therapy Valuation Multiples
At the very low end of the market, businesses are priced based on revenue and "owner cash flow" or "seller discretionary earnings" multiples, which is business profit + owner compensation + any other owner benefits. Owner cash flow multiples, in particular, can vary widely based on a number of factors, including risk, growth opportunities, and the level of owner involvement, which can range from a full-time developmental pediatrician to total absentee ownership. However, the relatively tight range of owner cash flow multiples from ~2x to 3.5x within the autism services and pediatric therapy lower market indicates relatively uniform levels of owner involvement, risk, and opportunities for growth.
What About the Lower Middle Market?
Based on the first chart in this article, it appears as if the lower middle market doesn't exist. This couldn't be further from the truth, as activity in the lower middle market remains active. The issue is a lack of publicly available market data. If this data were available, it would likely show a wide range of implied multiples, as this portion of the market contains a mix of the other two levels - some practices of this size still rely on a heavily involved owner and have significant geographical and service line concentration (valued closer to lower market), while others have an owner that has removed from the clinical side of the business and have demonstrated the ability to grow profitably (valued closer to middle market).
About Scope Research
The Scope Research Healthcare M&A Valuation Database currently has financial details for 113 behavioral health deals going back to 2010, 79 of which include reported EBITDA multiples. The behavioral health data can be purchased individually, while our affordable annual subscriptions provide access to all of our healthcare M&A databases and segments, including the active listings database, updated continuously.
We also have similar datasets for all segments across the healthcare industry. Don't hesitate to will@scoperesearch.co with questions about your specific situation.
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