Cain Brothers Newsletters: Industry Insights

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Retina-Vitreous Associates Medical Group (“LA Retina”) on its strategic affiliation with Retina Consultants of America (“RCA”), a leading management services organization of retina specialists. Financial terms were not disclosed.

Cain Brothers was engaged to serve as LA Retina’s exclusive financial advisor due to its extensive history of advising physician practices, expertise in ophthalmology and retina, and deep relationships with the relevant buyers. Cain Brothers conducted a competitive marketing process to identify the right partner for LA Retina. This transaction continues Cain Brothers’ strong record in the multi-site physician services sector and is the eighth retina specialty practice Cain Brothers has represented since 2020.

Founded in 1977, LA Retina provides comprehensive medical and surgical care for retinal, macular, and vitreous conditions across Southern California. The practice also offers advanced diagnostic imaging, intravitreal injections, laser treatments, and access to clinical research trials for patients with complex eye diseases. LA Retina’s 11 board-certified and fellowship-trained ophthalmologists take an individualized approach to care that enables patients to receive personalized treatment plans focused on preserving and restoring vision.

RCA is a network of leading retina specialists with the mission of saving sight and improving patient lives through innovation and the highest quality care. Through RCA’s physician-centered practice management model, physicians continue to drive clinical care and practice culture, while benefitting from the business expertise, resources, and shared best practices available through RCA. Physicians across the RCA network conduct more than 2 million visits annually, delivering high-quality care to patients in 23 states. For more information about RCA and its network of practices, please visit www.retinaconsultantsofamerica.com. 

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Tenor Health Foundation in its pending acquisition of three hospitals from affiliates of Community Health Systems, Inc. (NYSE: CYH). Cain Brothers was also engaged to arrange debt financing associated with the transaction.

Tenor Health entered into a definitive agreement to acquire 186-bed Regional Hospital of Scranton and 122-bed Moses Taylor Hospital in Scranton, Pennsylvania and 369-bed Wilkes-Barre General Hospital in Wilkes-Barre, Pennsylvania from Commonwealth Health, a subsidiary of Community Health Systems. Rosemawr Management is providing the acquisition financing.

The transaction is subject to customary regulatory approvals and closing conditions and is expected to close in the fourth quarter of 2025. Terms are not being disclosed.

With a mission rooted in advancing equitable and innovative care, Tenor Health Foundation was formed to identify, own, manage, and turn around financially challenged hospitals. They are committed to the needs of a community, providing compassionate care, and delivery quality patient outcomes.

Community Health Systems owns or leases 70 affiliated hospitals in 14 states, with more than 10,000 beds, and operates more than 1,000 sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. CHS reported consolidated revenues of $12.6 billion for the last 12 months ending 9/30/2025.

Cain Brothers, a division of KeyBanc Capital Markets, is serving as the exclusive advisor to CommonSpirit Health in its sale of Trinity Health System. CommonSpirit and University of Pittsburgh Medical Center have publicly announced the signing of a non-binding letter of intent to integrate Trinity into the UPMC system.

Cain Brothers was engaged based on our expertise in the hospital and health system sector and strong understanding of the local market.  Cain Brothers engaged with parties interested in continuing Trinity’s mission, leading to a letter of intent with UPMC. Over the next several months, both parties will work towards a definitive agreement, pending customary regulatory review and approvals.

CommonSpirit Health is one of the nation’s largest nonprofit Catholic health systems, delivering over 20 million patient encounters annually across 138 hospital-based locations and 2,300 care sites. Serving 24 states, CommonSpirit Health employs 160,000 team members, including 45,000 nurses and 25,000 physicians.

Trinity Health System, based in Steubenville, Ohio, is a member of CommonSpirit. With a full network of hospitals, physician practices, and specialty services across the Ohio Valley, Trinity Health System is committed to improving community health with excellence and faith-driven service.

UPMC is a leading nonprofit health care provider and insurer headquartered in Pittsburgh. With 100,000 employees and 5,000 physicians, UPMC operates 40 hospitals and 800 outpatient sites across Pennsylvania, New York, Maryland, and overseas. UPMC’s insurance services cover more than 4 million members. UPMC invests nearly $2 billion annually in community benefits, the most of any health system in Pennsylvania.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to HonorHealth in its proposed acquisition of Evernorth Care Group from The Cigna Group.

Cain Brothers advised HonorHealth throughout a competitive process, providing strategic guidance, diligence support, and transaction execution. The transaction expands HonorHealth’s footprint in the Phoenix area and underscores its commitment to delivering coordinated, high-quality care.

HonorHealth is a leading health system with a 100+ year legacy of providing care to the more than 5 million people across the greater Phoenix area. The system operates nine acute care hospitals and a broad network of primary, specialty, and urgent care locations. HonorHealth focuses on expanding access and enhancing care delivery through strategic partnerships and innovation.

Evernorth Care Group provides care to patients in 18 locations across the Phoenix area, serving nearly 200,000 patients. The organization has a 50-year history of providing integrated, high-quality, affordable care and is recognized for its team-based, patient-centered model.  

The Cigna Group (NYSE: CI) is a global health company serving individuals and communities worldwide through its divisions, including Cigna Healthcare and Evernorth Health Services.

KeyBanc Capital Markets and Cain Brothers, a division of KeyBanc Capital Markets, successfully closed the syndication of Senior Credit Facilities for MDVIP, Inc., a portfolio company of Goldman Sachs Asset Management and Charlesbank Capital Partners.

The Credit Facilities consist of a $70 million Revolving Credit Facility and $910 million Term Loan B. Proceeds were used to refinance existing indebtedness and fund a shareholder distribution. KBCM acted as Joint Lead Arranger and Joint Bookrunner.

Founded in 2000, MDVIP is a leading provider of membership-based private healthcare services that offers members highly personalized preventative care and related services through its national network of affiliated physicians. MDVIP provides comprehensive, advanced health screenings and diagnostic tests that are not typically covered by commercial insurance or Medicare. 

GSAM is one of the world’s leading investment managers. With more than 2,000 professionals across 34 offices globally, GSAM delivers investment and advisory solutions to institutional and individual investors. Its strategies span asset classes, industries, and geographies, including fixed income, money markets, public equity, commodities, hedge funds, private equity, and real estate.

Charlesbank, founded in 1998 and based in Boston, Massachusetts, is a private equity firm focused on middle-market investments. The firm targets opportunities across a broad range of sectors, including technology, healthcare, financial services, industrials, consumer, media, and infrastructure, with a geographic focus on the U.S., Canada, Asia, Israel, and the U.K. 

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to ChristianaCare in its acquisition of Crozer Health’s outpatient centers in southeastern Pennsylvania.

ChristianaCare was the successful bidder in a highly competitive bankruptcy auction to acquire five ambulatory surgery and outpatient centers in Delaware County, Pennsylvania, that were part of the Crozer Health regional health system. Cain Brothers was engaged to serve as financial advisor to assist with financial due diligence, valuation, and bankruptcy auction strategy and tactics due to its deep experience with strategic and tactical M&A advisory. Crozer is subsidiary of Prospect Medical Holdings, which filed for bankruptcy protection. The transaction complements ChristianaCare’s plans for expansion in the service area. 

ChristianaCare is a nonprofit regional healthcare system that provides healthcare services to all of Delaware and portions of the bordering counties in Pennsylvania, Maryland, and New Jersey. The system includes an extensive network of primary care and outpatient services, hospitals, and specialized centers of excellence. ChristianaCare reported consolidated revenues of $3.1 billion for the past 12 months ending June 30, 2024.

Crozer Health was one of the largest private hospital systems in Pennsylvania, operating multiple hospitals, primary care clinics, and outpatient centers across the state. Crozer Health was a subsidiary of Prospect Medical Holdings, a California-based national network of hospitals and affiliated medical groups, that filed for Chapter 11 Bankruptcy in January 2025.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Streamline Health Solutions (Nasdaq: STRM) on its sale to MDaudit.

Cain Brothers was retained by Streamline Health as its exclusive financial advisor and to deliver a fairness opinion to its Board of Directors based on its extensive knowledge of the HealthTech and revenue cycle management sector. Cain Brothers worked with the Streamline Board of Directors to design and execute a broad auction process to identify the optimal buyer.

Streamline Health enables healthcare organizations to proactively address revenue leakage and improve financial performance. Streamline delivers integrated solutions, technology-enabled services and analytics that drive compliant revenue leading to improved financial performance across the enterprise. Streamline supports several leading health systems, including Memorial Hermann, Baylor Scott & White, MedStar Health and Honor Health.

MDaudit, a portfolio company of Bregal Sagemount and Primus Capital, is a leading healthcare technology provider that partners with the nation’s premier healthcare systems to reduce compliance risk, improve efficiency, retain revenue, and enhance communication between cross-functional teams.

Cain Brothers, a division of KeyBanc Capital Markets, and KeyBanc Capital Markets, Inc. acted as Joint Lead Arranger and Joint Bookrunner.

On July 31, 2025, KeyBank Beach Point Direct Lending Program and KeyBanc Capital Markets successfully closed $565 million of Senior Secured Credit Facilities in support of Audax Private Equity and Parthenon Capital Partners’ acquisition of Elevate Patient Financial from Frazier Healthcare Partners and The Edgewater Funds.

Elevate is a leading provider of revenue cycle management solutions to hospitals and health systems across the United States. Formerly known as MedData, the Company provides innovative, specialized technology to address the most complex challenges of the revenue cycle. Offerings include eligibility & enrollment, self-pay, complex claims, and accounts receivable services. With clients and offices coast-to-coast and state-specific experience in all 50 states, Elevate is a trusted RCM partner to nearly 1,700 client facilities with over 11.5 million patient accounts each year.

Audax is a Boston-based private equity firm focused on investing in U.S. middle market companies across the business services, consumer, financial services, healthcare, industrials, and software sectors. Founded in 1999, Audax has grown to ~$19 billion in assets under management, successfully completing over 175 platform investments and 1,400+ add-on acquisitions.

Founded in 1998, Parthenon is a private equity firm specializing in the business, financial, and healthcare services segments. Since inception, Parthenon has partnered with world-class management teams to complete over 50 platform acquisitions, with 200+ additional tuck-ins, representing over $5 billion in value across core sectors.

Cain Brothers, a division of KeyBanc Capital Markets, served as financial advisor to Beacon Health System in its acquisition of Ascension Southwest Michigan, including the Borgess Health System.

On behalf of Beacon, Cain Brothers proactively approached Ascension about divesting Borgess Health. Following numerous discussions, the assets were formally marketed and the persistence of the Cain Brothers team, along with a thoughtful RFP response, positioned Beacon as the best partner. The transaction closed on July 1, 2025.

Founded in 2011, Beacon Health has grown to a nine-hospital not-for-profit system in northern Indiana and southwest Michigan. Beacon is headquartered in South Bend and employs more than 8,000 associates throughout the region at over 74 different locations.

Borgess is a not-for-profit health system consisting of four hospitals, 35 outpatient clinics, and one ambulatory surgery center. The largest facility is a 422-bed acute care hospital in Kalamazoo. Borgess has more than 2,700 associates, including 261 providers.

Ascension is one of the nation’s largest not-for-profit health systems, with approximately 99,000 associates, 23,000 aligned providers, 94 wholly-owned or consolidated hospitals, and ownership interests in 27 additional hospitals. Ascension also operates 30 senior living facilities and a variety of other care sites offering a range of services.

Cain Brothers and KeyBanc Capital Markets served as Joint Lead Arranger and Joint Bookrunner on the transaction due to its industry expertise and long-standing relationship with the Company, as well as leading debt capital markets capabilities.

Radiology Partners is a leading physician-owned and -led radiology practice, offering 24/7/365 on-site and remote diagnostic and interventional services to a diverse base of hospital and outpatient imaging facility customers across all 50 states. The Company focuses on clinical value, technology enablement and outstanding service, offering technology, AI tools, and “around the clock” subspecialty coverage to its customers. Radiology Partners is a partner of choice for leading US health systems, serving all top 10, and 17 of the top 20 largest systems in the country.

NEA is a global venture capital and growth equity firm focused on helping entrepreneurs build transformational businesses across multiple stages, sectors, and geographies. With more than $26 billion in cumulative committed capital since the firm’s founding in 1977, NEA invests in technology and healthcare companies at all stages in a company’s lifecycle, from seed stage through IPO. The firm’s long track record of successful investing includes more than 230 portfolio company IPOs and more than 390 mergers and acquisitions.

Whistler is a Nashville-based private equity firm focused on growth equity and growth buyouts in the healthcare industry and related tech-enabled services verticals. With over $1.8 billion in assets under management, the firm partners with world class leadership teams, supporting them with strategic resources and capital, with a particular focus on deploying or expanding investments in technology-enabled and data-driven opportunities.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive advisor to Allied OMS on its minority recapitalization by 65 Equity Partners, while KeyBanc Capital Markets served as exclusive debt advisor to raise senior debt facilities.

Leveraging a longstanding relationship with management and expertise in the dental sector, Cain Brothers worked with the Company’s leadership to pursue a strategic partnership that aligned with Allied OMS’ strategic vision. The investment by 65 Equity Partners positions the Company for its next phase of growth while preserving its doctor-led model and operational independence.

In parallel, KBCM advised on a new senior credit facility to refinance the Company’s debt facility and provide capital to support continued expansion. The new financing is comprised of a $165 million Term Loan, a $20 million Revolving Credit Facility and a $60 million Delayed Draw Term Loan.

Allied OMS is a doctor-owned, -led and -governed MSO that partners with oral and maxillofacial surgery practices across the U.S. Combining the autonomy of private practice with the scale and sophistication of institutional support, Allied OMS empowers surgeons to lead the future of their specialty. The Company currently supports surgeons in 50+ locations and maintains doctor leadership across all major committees and its Board of Directors.

65 Equity Partners is a global investment firm that supports founders in their growth journey. With $3.3 billion in funds under management and a mandate to invest in entrepreneur-led businesses, 65EP backs companies across healthcare, technology, consumer, industrials, and business services. The firm is backed by Temasek and has offices in Singapore, London, Paris, San Francisco, and New York.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive advisor to Allied OMS on its minority recapitalization by 65 Equity Partners, while KeyBanc Capital Markets served as exclusive debt advisor to raise senior debt facilities.

Leveraging a longstanding relationship with management and expertise in the dental sector, Cain Brothers worked with the Company’s leadership to pursue a strategic partnership that aligned with Allied OMS’ strategic vision. The investment by 65 Equity Partners positions the Company for its next phase of growth while preserving its doctor-led model and operational independence.

In parallel, KBCM advised on a new senior credit facility to refinance the Company’s debt facility and provide capital to support continued expansion. The new financing is comprised of a $165 million Term Loan, a $20 million Revolving Credit Facility and a $60 million Delayed Draw Term Loan.

Allied OMS is a doctor-owned, -led and -governed MSO that partners with oral and maxillofacial surgery practices across the U.S. Combining the autonomy of private practice with the scale and sophistication of institutional support, Allied OMS empowers surgeons to lead the future of their specialty. The Company currently supports surgeons in 50+ locations and maintains doctor leadership across all major committees and its Board of Directors.

65 Equity Partners is a global investment firm that supports founders in their growth journey. With $3.3 billion in funds under management and a mandate to invest in entrepreneur-led businesses, 65EP backs companies across healthcare, technology, consumer, industrials, and business services. The firm is backed by Temasek and has offices in Singapore, London, Paris, San Francisco, and New York.