Striving for Industrial Leadership

Investments

Medlogix – Medical Claims Management
 
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Key Information

Medlogix

Medlogix

Industry

Business Services

Company Headquarters

Lansdale, PA

Investment Date

August 2017

Website

www.medlogix.com

Founded in 1980 and based in Hamilton, NJ, Medlogix is a premier provider of medical claims management solutions to leading auto insurance carriers, administrators for workers’ compensation and group health insurers. Leveraging its proprietary technology platform and deep clinical expertise, medlogix offers a full suite of medical claims management services including pre-certification, independent medical exams, medical director review, medical bill and code review, and bill negotiation support as well as operates a proprietary PPO network in the northeastern United States.

Top Down Investment Thesis

Excellere’s investment in Medlogix is a result of the firm’s disciplined top down investment strategy, driven by several factors including i) rising medical costs driving an increase in auto and workers’ compensation claim severity, ii) persistence of improper billing and fraudulent claims within the auto and workers’ compensation industries, iii) carrier’s enhanced focus on effective loss prevention and cost containment solutions, and iv) growing utilization of outsourced service providers that improve efficiency and offer a quantifiable ROI.

According to the Insurance Research Council and National Insurance Crime Bureau, annual costs related to improper billing or fraudulent claims in the auto insurance and workers’ compensation industries are estimated to total up to $7.7 and $7.2 billion, respectively.  Despite a decline in claim frequency, since 2005 rising medical costs have driven an increase in claim severity (per claim cost) of 35.5% for bodily injury liability claims and 40.7% for workers’ compensation claims. Persistent claim fraud, rising medical costs and growth in claim severity are propelling the need for greater, more robust claims management and cost control measures among insurers and corporations; outsourced providers of medical claims management services offer an essential, highly effective loss containment solution. Medlogix’s medical claims management solutions and proprietary PPO network help carriers i) identify areas for cost savings tied to improper billing and limit leakage due to payment of fraudulent claims, ii) reduce administrative expenses associated with claims adjudication, and iii) lower medical treatment costs. Combined, the Company’s services deliver a more efficient and disciplined claims process, resulting in greater productivity and reduced severity for its customers.

Buy and Build Strategy

Medical claims management is a highly fragmented industry, which combined with continued trends in the outsourcing of non-core service functions by carriers, creates an attractive sector to employ a buy-and-build strategy. It is estimated that there are currently more than 500 outsourced medical claim service providers in the United States, the vast majority of which are regionally focused and family owned. Medlogix is focused on partnering with organizations known for service quality and excellence in complementary business lines and operating in favorable geographies.

To the extent you are interested in learning more about Medlogix, please contact Matt Hicks at , Ross Gundry at , or Nick Coleman at to discuss the medical claims management services sector further.

Two Labs Marketing – Pharmaceutical Services
 
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Key Information

Two Labs Marketing

Two Labs Marketing

Industry

Healthcare

Company Headquarters

Powell, OH

Investment Date

December 2016

Website

www.twolabsmarketing.com

Founded in 2003 and headquartered in Powell, Oho, Two Labs Marketing provides innovative solutions for pharmaceutical manufacturers’ most prevalent and complex commercialization challenges. The Company leverages its experience from more than 125 discrete product launches to design and implement proven commercial strategies that are customized to each product’s therapeutic class, distribution channel and patient access needs. Two Labs’ comprehensive portfolio of commercialization services incorporates best-in-class product launch, compendia strategy, trade management, state licensing, e-prescribing, and lifecycle management services. Through strategic partnerships with Two Labs, pharmaceutical clients are able to provide patients with access to critical therapies while optimizing the commercial potential of their brands.

Top Down Investment Thesis

According to the Centers for Medicare & Medicaid Services, pharmaceutical spending in the U.S. is forecasted to nearly double by 2025 to $615 billion annually. Market growth is being driven by a host of favorable demographic trends and the rapid emergence of specialty pharmaceuticals, including biologics and orphan drugs, some of which present promising new clinical options to today’s most significant therapeutic areas. As these revolutionary therapies continue to evolve, so too does the commercial environment and the ways in which pharmaceutical manufacturers must engage with patients, payers, prescribers and regulators to provide access to these treatments. Achieving a product’s full commercial potential requires pharma manufacturers to effectively communicate a product’s clinical value, resolve patient access and support challenges, select appropriate distribution channels and optimize their performance, and cope with ever-evolving regulations. In doing so, manufacturers require strategic partners with substantial expertise in product commercialization, as well as a detailed understanding of the dynamics specific to the product’s therapeutic area and competitive environment. For more than 13 years, Two Labs has been a trusted partner of pharma and biotech companies to manage the most critical details necessary for timely, successful product launches and optimized performance throughout the product lifecycle.

Buy and Build Strategy

Two Labs’ success has been built over many years based on unique service capabilities, exceptional customer service and deep expertise in product commercialization and support services. As a result, Two Labs benefits from exceptional customer loyalty and longstanding partnerships with its client base. Two Labs is a highly compelling platform for acquisitions due to the breadth and diversity of its customer base, and its proven ability to maintain strong customer relationships through a broad service offering that spans the duration of a product’s lifecycle. The Company is pursuing strategic acquisition opportunities in the pharmaceutical market access services industry, including companies with the following capabilities: (i) managed markets strategy and implementation, (ii) healthcare data aggregation and analytics, (iii) trade management, (iv) patient support services, (v) regulatory pathway and compliance consulting, (vi) government affairs / health economics and outcomes research, or (vii) medical science liaison outsourced agents.

To the extent you are interesting in learning more about Two Labs, please contact Brad Cornell at , Eric Mattson at , Mike Vieth at , or Mike Forsyth at .

Mentis – Neuro Rehabilitation
 
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Key Information

Mentis Neuro Rehabilitation

Mentis Neuro Rehabilitation

Industry

Healthcare

Company Headquarters

Houston, TX

Investment Date

January 2015

Website

www.mentisneuro.com

Mentis, founded in 2006 and headquartered in Houston, Texas, is a leading provider of inpatient and outpatient postacute neuro-rehabilitative care to persons with an acquired brain injury ("ABI"). The Company utilizes an interdisciplinary clinical model with customized modified care plans that focus on each patient’s specific behavioral, clinical and social deficiencies. The Company’s comprehensive services include a combination of neuropsychological services, 24-hour rehabilitative nursing, cognitive rehabilitation, physical therapy, speech and language therapy, occupational / vocational rehabilitation, recreational therapy, group therapy, and physical medicine and rehabilitation management. Mentis allows patients that have suffered an ABI to re-enter their homes, community and/or workforce in a shorter period of time with meaningfully enhanced outcomes and greater independence.

Top Down Investment Thesis

Acquired brain injury includes both traumatic brain injuries ("TBI") (commonly caused by falls, auto accidents, workplace injuries, and assaults) as well as strokes, tumors or other conditions whereby the brain is damaged from a lack of oxygen. An estimated 2.4 million people in the U.S. sustain a TBI and another 795,000 sustain an acquired brain injury from non-traumatic causes each year. Currently more than 6.4 million individuals in the U.S. live with a lifelong disability as a result of TBI or stroke. Patients suffering from an ABI typically undergo a long and exhaustive care process that spans from the highest acuity setting down through lower levels of care and rehabilitation depending on the progress of each individual patient. The ultimate end-point for a patient, depending on their level of rehabilitation and independence, can span from a full recovery and independent living to a very limited recovery that requires life-long custodial care. This broad span of outcomes has very material cost ramifications as long-term custodial care can run millions of dollars depending on the age of the patient when they sustain their injury.

Excellere’s investment in Mentis is a result of the firm’s disciplined top down investment strategy, driven by several factors including i) an increased national awareness of brain injury, ii) the increased survival rate of those who have sustained a TBI due to medical advances, iii) higher incidences of stroke in a growing aging population, iv) cost pressures associated with increased healthcare spending shifting more patients to post-acute, lower cost settings, v) a strong and stable reimbursement outlook for neuro-rehabilitative care, vi) a niche market with a unique and complex patient and referral base making it very difficult for other rehabilitation facilities and new market participants to successfully treat ABI patients, and vii) Mentis' outcomes-driven clinical model offers a clear value proposition to each constituency the Company serves (patients, families, referents and payers) by allowing patients to re-enter their homes, community and/or workforce in a shorter period of time with greater independence.

Buy and Build Strategy

Post-acute neuro-rehabilitation is an underserved and highly fragmented market consisting mainly of smaller local and regional providers. Throughout its growth, Mentis has demonstrated an ability to establish new de novo facilities using a systematic approach to new market evaluation, referral source education, licensing, payer contracting and local recruiting. This proven ability to open new facilities in a fragmented marketplace, combined with the opportunity to expand geographic coverage through new referral and payer relationships, expanded service offerings and enhanced technology, creates an attractive buy-and-build opportunity. Mentis is actively seeking strategic add-on acquisitions of post-acute neuro rehabilitative care providers that will enable the Company to broaden its geographic footprint and deepen its presence in the market.

To the extent you are interested in learning more about Mentis, please contact Ryan Glaws at or Matt Halverson at to discuss the neurorehabilitation services sector further.

TrialCard – Pharmaceutical Services
 
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Key Information

TrialCard Incorporated

TrialCard Incorporated

Industry

Healthcare

Company Headquarters

Cary, NC

Investment Date

December 2014

Website

www.trialcard.com

Founded in 2001, TrialCard Incorporated (“TrialCard” or the “Company”) provides specialized services that solve the market access challenges faced by the pharmaceutical industry. The Company offers customized solutions for clients that assist with prescription adherence and abandonment, sales force support, patient case management, reimbursement and clinical support, market share lift, product rescue, and loss of exclusivity challenges. TrialCard’s pharmaceutical manufacturer clients optimize revenue through a brand’s life cycle, while patients and providers benefit from better clinical outcomes and lower overall cost of care. TrialCard’s broad suite of services is enabled by the Company’s database of pharmacy-level transactions, data analytics capabilities, award-winning customer experience center, and proprietary program management processes; all of which enhance program efficacy and return on investment for its customers.

Top Down Investment Thesis

According to the New England Healthcare Institute, medication non-adherence is estimated to drive $290 billion in avoidable spending to the U.S. healthcare industry annually through unnecessary hospitalizations and additional medical risks. Seven percent of prescriptions are abandoned at the point of sale and between 33% and 50% of patients do not take their medications as prescribed. TrialCard’s portfolio of services helps drive patient access and adherence for pharmaceutical manufacturers, while simultaneously adding value across the healthcare delivery chain (i.e., pharmacies, patients and healthcare providers). One significant factor in non-adherence is the out-of-pocket cost burden on patients, thus co-pay programs and product vouchers have proven to be powerful tools in driving adherence. Patients are 2.3x more likely to refill physician prescribed medication when using TrialCard programs. Additionally, these programs generate actionable consumer insights while driving superior patient outcomes, which benefit physicians, patients and payers. Another significant cause of non-adherence is the complexities of specialty drugs relating to payer support, clinical coordination and drug administration. To address this issue, TrialCard’s specialty therapy hub provides assistance for patients in navigating the complex reimbursement challenges associated with specialty drug therapies such as prior authorization, benefits investigation and appeals processes. Through improving patient outcomes and lowering overall cost of care, increasing adherence generates benefits for all constituents in the healthcare system.

Buy and Build Strategy

The patient access and pharmaceutical adherence services industry is highly fragmented with a limited number of competitors providing a complete customer solution. TrialCard is well positioned to continue the expansion of its capabilities, customer relationships and technologies across the entire patient journey. The Company is pursuing strategic acquisition opportunities in the outsourced pharmaceutical support services industry, including the following existing and complementary capabilities: (i) specialty therapy hub services, (ii) tele-detailing, (iii) patient support / education, (iv) disease management, and (v) consulting and enhanced analytics.

To the extent you are interested in learning more about TrialCard, please contact Brad Cornell at or Mike Vieth at .

G2 Integrated Solutions – Integrity Management
 
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Key Information

G2 Integrated Solutions

G2 Integrated Solutions

Industry

Energy, Power & Infrastructure

Company Headquarters

Houston, TX

Investment Date

February 2014

Website

g2-is.com

G2 Integrated Solutions is a provider of asset integrity solutions to midstream and downstream energy companies, offering a suite of services designed to help clients manage risk within their existing transmission and distribution networks, demonstrate regulatory compliance, and extend the useful lives of their infrastructure assets. The Company leverages customers' internal data and records, its proprietary tools and methodologies, and a deep pool of highly trained professionals to solve complex operating problems for an extensive client base that includes a number of high profile North American pipeline operators and natural gas utilities.

Top Down Investment Thesis

Given the dramatic increase in activity in the domestic energy market, aging midstream and downstream infrastructure, and an increasingly stringent regulatory environment surrounding these assets, Excellere believes that there is an opportunity to establish a vertically integrated integrity management services provider that operates through a national footprint and broad suite of capabilities. Excellere’s investment into G2 Integrated Solutions is driven by a number of dynamics, including (i) the opportunity to deliver G2’s broad suite of advanced technical solutions to a diverse set of clients that are focused upon risk management solutions and regulatory compliance support, and (ii) attractive end market fundamentals, whereby new project build-out is resulting in an expanded installed base for service and an aging infrastructure is positioning high-quality integrity management services providers for future growth.

Increasing global demand, advancements in horizontal drilling and hydraulic fracturing technologies and new discoveries of economically viable basins have contributed to the continued emphasis on unconventional oil and gas production. In order to support this increased activity, energy companies are required to build infrastructure to integrate new producing regions into existing midstream and downstream networks, maintain and support aging infrastructure given increased throughput, and engineer complex solutions such as converting gas pipelines to liquids in order to respond to market conditions. Furthermore, given the increase in energy activity and the number of high profile catastrophic incidents, an increasingly stringent regulatory environment has evolved, which is driving higher compliance standards. As a result, the North American natural gas industry is currently projected to spend an estimated $20.0 billion annually through 2035 to build new infrastructure and maintain existing assets, resulting in substantial future opportunities for integrity management service providers with advanced technical capabilities and broad service offerings.

Buy and Build Strategy

The North American asset integrity market is highly fragmented with numerous independent product and service providers. As such, G2 Integrated Solutions is well-positioned to add complementary capabilities and extend its geographic reach via acquisitions. The fragmentation in this market, coupled with the increased importance of domestically produced oil and natural gas to the North American energy supply, has created an opportunity to build a full-scale integrity management solutions provider to midstream and downstream energy companies. Specific areas of interest within the systems integrity management industry include: (i) complementary high-end infrastructure engineering services, (ii) GIS products and services, (iii) data analytics and management, and (iv) safety services.

To the extent you are interested in learning more about G2 Integrated Solutions or the integrity management industry, please contact David Kessenich at or Brad Cornell at .

AIS Healthcare – Specialty Pharmacy
 
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Key Information

AIS Healthcare

AIS HealthCare

Industry

Healthcare

Company Headquarters

Clinton, MS

Investment Date

April 2013

Website

www.advancedinfusionsolutions.com

Advanced Infusion Services (“AIS”) is a compliance focused provider of patient-specific medications for chronic pain patients with intrathecal pumps and other chronic and acute conditions. Intrathecal drug delivery is a method of providing customized medications directly to a patient’s spinal cord through an implanted pain pump that is surgically placed under the skin of a patient’s abdomen. Founded in 1998, AIS operates out of its headquarters in Clinton, MS and provides services in more than 30 states.

Top Down Investment Thesis

Excellere’s investment in AIS is based upon (i) the non-discretionary need for intrathecal drug delivery for patients with chronic pain conditions that cannot be improved from further surgeries or oral pain medications, (ii) the highly recurring revenue model of intrathecal pain management, as the estimated 150,000 patients using this treatment receive 4 to 6 pain pump refills annually, and (iii) the highly-fragmented nature of the industry.

The U.S. chronic pain industry, at over $100 billion in annual spending, is characterized by numerous constituents trying to serve the 76+ million Americans suffering from pain linked to diseases and syndromes such as obesity, cancer, diabetes, arthritis, HIV-AIDS, failed surgeries, cerebral palsy, multiple sclerosis and countless other conditions. The industry is expected to continue growing due to (i) a rapidly growing geriatric population – “baby boomers” currently account for 30%+ of the U.S. population, (ii) continued and growing U.S. obesity, which contributes to chronic pain as body structures support heavier weights over time and wear down, (iii) increasing recognition of the therapeutic benefits of effective pain management (specifically, versusoral pain medications) and (iv) expected growth in surgical procedures (29% from 2010 to 2020).

Buy and Build Strategy

The intrathecal pain pump market is composed of approximately150,000 patients, and is expanding due to the increase in chronic pain patients as well as the recognition of intrathecal pumps as a safe and cost effective treatment methodology for patients that have exhausted other forms of therapy (e.g. continual oral medications and multiple surgeries). AIS’s platform is well positioned to grow both organically and through selective acquisitions due to its (i) compliance-centric model (including USP 797), (ii) growing and recurring patient base, (iii) diversified referral network and (iv) proven growth profile.

To the extent you are interested in learning more about AIS, please contact Ryan Glaws at .

PhyMed – Anesthesiology
 
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Key Information

PhyMed Healthcare Group

PhyMed Healthcare Group

Industry

Healthcare

Company Headquarters

Nashville, TN

Investment Date

July 2012

Website

www.phymed.com

Testimonial

“At PhyMED, we saw an opportunity to parlay the success of our proven model – focused on the provision of quality anesthesia care, service and patient safety – by expanding the breadth and depth of our services. The Board and senior management decided the time was right to find a partner that shared our vision for growth and passion for delivering unparalleled quality care to a broader market. We believe we found all that and more in Excellere as evidenced by their commitment to help the company achieve its goals and take it to the next level”

David Whitten
Chief Executive Officer

PhyMED is a leading provider of outsourced anesthesia, interventional pain management and other complementary services to hospitals, medical facilities and ambulatory surgery centers. Formed in 1994 and based in Tennessee, PhyMED is a top ten provider of anesthesia services in the United States.

Top Down Investment Thesis

Excellere’s investment in PhyMED is a result of a four year search for an anesthesia platform based on the firm’s disciplined top down investment strategy, driven by several factors including i) the non-discretionary nature of anesthesia services that carry a high degree of medical necessity as sedation is required for most surgical procedures, ii) a clear and deep value proposition to patients, surgeons, medical facilities and payers, and iii) the highly-fragmented nature of the industry.

The key customers for an outsourced provider of anesthesia services are the healthcare facilities, and more specifically the surgeons that anesthesiologists work with. For the medical facilities, a contracted or outsourced anesthesiology partner provides dedicated anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs), while reducing the need for internal resources dedicated to recruiting, credentialing, scheduling, billing, collections and compliance. For the surgeon and facility, there is significant value gained through access to a consistent staff of anesthesia professionals available in order to maximize the efficiency and throughput of the operating room, which is one of the most profitable areas of a hospital.

The U.S. anesthesia services industry is estimated at over $23.0 billion and growing at 4% per year, in line with growth in total surgical procedures and case reimbursement rate trends. The number of U.S. surgical procedures is projected to grow 29% from 2010 to 2020.

Buy and Build Strategy

The anesthesia services sector is highly fragmented and comprised of over 1,000 providers nationally. This fragmentation, combined with the opportunity to significantly enhance the value provided to its customers’ experiences and outcomes through the use of technology-driven solutions, suggests an immense opportunity to execute a customer-centric, buy-and-build strategy. Specific areas of focus within the outsourced anesthesia services sector include other compliance-focused anesthesia providers and complementary service lines such as interventional pain management and critical care coverage.

To the extent you are interested in learning more about PhyMED, please contact Matt Hicks at or Justin Unertl at to discuss the anesthesia services industry further.

IPT – Engineering Consulting
 
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Key Information

Integrated Petroleum Technologies (IPT)

Integrated Petroleum Technologies (IPT)

Industry

Energy, Power & Infrastructure

Company Headquarters

Lakewood, CO

Investment Date

June 2012

Website

www.iptengineers.com

IPT is an oil and natural gas engineering services firm specializing in the integration of modern well completion, hydraulic fracture stimulation and reservoir engineering technologies. The Company is comprised of practicing petroleum engineers with extensive operator and service company experience throughout the United States and in select international markets. IPT is considered one of the foremost thought leaders in the hydraulic fracturing industry with over 20 years of experience working in most basins and major shale plays. IPT not only provides highly technical consulting services that significantly influence the economics of a well, but also represent an independent third-party expert at the well site that helps to ensure that all parties are performing their respective duties in a safe and efficient manner.

Top Down Investment Thesis

Recent discoveries of oil and natural gas reserves, increasing global demand and the evolution of horizontal drilling and well completion technologies have spawned a substantial increase in exploration and production activity in the United States. According to the Annual Energy Outlook 2012 as published by the U.S. Energy Information Administration (“AEO12”), U.S. dependence on imported petroleum liquids is projected to decline by more than one million barrels per day by 2020 driven primarily by growth in domestic oil production. In addition, net petroleum imports as a share of total U.S. liquid fuels consumed is projected to drop from 49 percent in 2010 to 36 percent in 2035 as the United States continues to harvest its natural resources in pursuit of energy independence. Technological advances and the increasing commercial consumption of natural gas will also drive increased exploration and production activity. Since 2000, U.S. shale gas production has increased 17-fold, currently comprising approximately 30 percent of the total U.S. production, and is projected to comprise 49% of total U.S. production by 2035 (according to AEO12).

In order to unlock the potential of the oil and natural gas resources trapped in tight formations and shale plays, exploration and production companies have enlisted the services of hydraulic fracturing experts that employ advanced completion and stimulation techniques to optimize the output of their wells. The pressure pumping market, which includes hydraulic fracturing and other stimulation services provided to oil and gas exploration and production companies, is expected to grow from $16.7 billion in 2009 to $51.0 billion in 2012, driven in part by the effectiveness of these services to enhance well production.

Buy and Build Strategy

The oil and natural gas engineering services market is highly fragmented with a limited number of institutional service providers capable of managing national programs for customers. Furthermore, the majority of service providers offer only one solution to customers, rather than providing a fully integrated suite of capabilities that spans the lifecycle of an active well. This fragmentation, coupled with the limited service offerings of most industry participants, has created an opportunity to build an integrated solutions provider with a broad set of complementary capabilities to better serve customers. Specific areas of interest within the oil and natural gas engineering services industry include: (i) complementary high-end capabilities such as seismic processing or well design (ii) technology enabled solutions and software (iii) data collection, management and analytics, and (iv) regulatory compliance.

To the extent you are interested in learning more about IPT, please contact David Kessenich at or Brad Cornell at to further discuss the oil and natural gas services industry.

Personable Insurance – Insurance
 
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Key Information

Personable Insurance

Personable Insurance

Industry

Business Services

Company Headquarters

San Diego, CA

Investment Date

August 2011

Website

www.personableinsurance.com

Testimonial

“We were very fortunate to have found a capital provider like Excellere whose team is totally committed to the over-achievement of our business goals. The Excellere team understands what it takes to build a best-in-class industry leader in the insurance sector and have already helped us immensely in pursuing our strategic objectives.”

Kieran Sweeney
Chairman

Personable Insurance (“Personable” or the “Company”) is an independent agent-driven, specialist non-standard auto insurance provider. Personable has partnerships with multiple insurance carriers and relationships with over 3,000 independent agents in California, Florida, Georgia and Texas. The Company plans to expand its capabilities further via the organic extension of its service offerings and acquisitions of additional non-standard auto assets and businesses in a number of key strategic states.

Top Down Investment Thesis

Excellere’s investment in Personable is a result of the firm’s disciplined top down investment strategy, and is driven by several factors including (i) the non-discretionary, critical nature of insurance products and services, ii) the highly-fragmented nature of the industry and iii) the opportunity to create a highly-compelling value proposition to carriers, distributors, service providers and insured companies and individuals (“insureds”).

The insurance products and services industry can be segmented into carriers, distributors (agencies and brokerages) and service providers. Carriers receive premiums for providing insurance coverage and typically assume the risks covered by the policy. Depending on a primary carrier’s risk preference, the actual risk may be offloaded to reinsurers who assume all or part of the risk associated with a particular policy. Agencies and brokerages serve as the distribution channel for carriers by selling policies to individuals and businesses, and in some instances rendering services such as underwriting, claims management and customer relations on behalf of their carrier partners. Finally, service providers supply both carriers and distributors with outsourced services and expertise in select areas in which a carrier or distributor may not maintain a core competency.

Gross premiums in the U.S. are expected to exceed $1.5 trillion in 2010/11, and with continued economic recovery, each segment of the insurance sector is poised for expansion at varying growth rates.

Buy and Build Strategy

The insurance sector is highly fragmented and comprised of over 3,000 U.S. carriers, 35,000 distributors and 5,000 service providers. This fragmentation, combined with the opportunity to significantly enhance its customers’ experiences and outcomes through the use of technology-driven automated systems, has created an opportunity to execute a customer-centric, buy-and-build strategy. Specific areas of focus within the insurance sector include: Managing general agents (“MGAs”) in non-standard auto or other niche segments, rural and independent agencies, and service providers (specifically TPAs, loss control / underwriting support, subrogation, data providers and software providers).

To learn more about Personable or the insurance products and services industry, please contact Brad Cornell at or Justin Unertl at .

U.S. Water – Water Treatment
 
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Key Information

U.S. Water Services

U.S. Water Services

Industry

Industrial Technology & Services

Company Headquarters

St. Michael, MN

Investment Date

January 2011

Website

www.uswaterservices.com

Testimonial

“Excellere was chosen as our partner of choice due to their knowledge of our industry, partnership approach, and demonstrated ability to assist our company in our quest to become an industry leader.”

Allan Bly
CEO

U.S. Water Services (“USWS” or the “Company”) is one of the largest independent, fully-integrated, industrial / commercial water treatment companies in the U.S., serving a wide range of industrial, commercial and institutional accounts. The Company's chemicals division offers a comprehensive line of approximately 350 proprietary, branded and blended chemical products and support services. These chemicals improve production efficiency, reduce utility and maintenance costs, protect against contamination/corrosion, enhance compliance regulation and are non-discretionary purchases for customers providing highly predictable and recurring revenue for USWS. The Company's equipment division offers a complete line of engineered water treatment capital equipment (filtration, softeners, delivery systems, etc.), parts and consumable supplies (filters, membranes, etc.).

Top Down Investment Thesis

The increasing cost of water due to scarcity, quality challenges and environmental policies has driven manufacturers and other water users to employ increasingly sophisticated techniques to treat their water supply for industrial processes and/or discharge. Small and mid-sized businesses often do not have the in-house knowledge to apply more advanced technologies or properly adhere to the evolving regulatory environment. Leading water treatment providers offer customers this expertise on an outsourced basis and can provide the diagnostic support to continuously evaluate the clients' needs and offer proprietary chemical blends and engineered equipment to meet each customer's unique requirements.

Buy and Build Strategy

Having completed the recapitalization with Excellere in January of 2011, USWS is actively seeking to acquire and/or partner with other water treatment companies in the United States. Companies serving the food and beverage, utility, microelectronic and other commercial industries would complement USWS current customer base.

To the extent you are interested in learning more about U.S. Water Services, please contact David Kessenich at or Patrick O’Keefe at .

AxelaCare – Home Infusion
 
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Key Information

AxelaCare Health Solutions

AxelaCare Health Solutions

Industry

Healthcare

Company Headquarters

Lenexa, KS

Investment Date

December 2010

Website

www.axelacare.com

AxelaCare, headquartered in Lenexa, Kansas, is a leading provider of home infusion therapy services, including Intravenous Immune Globulin (“IVIg”), Hemophilia and other traditional home infusion services, such as Intravenous Antibiotics and Total Parenteral Nutrition (“TPN”). The company, which was founded by a team of proven industry veterans, is experiencing rapid growth and currently operates three pharmacies serving patients in 25 states. AxelaCare’s full service approach includes hands-on clinical management of the patient intake process to ensure that patients are able to begin therapies in a timely and efficient manner. This combination of outstanding clinical and pharmacy services, along with AxelaCare’s culture of patient advocacy and support, significantly differentiates the company from other industry participants.

Top Down Investment Thesis

Excellere’s investment in AxelaCare is a result of the firm’s disciplined top down investment strategy. In 2008, Excellere targeted the specialty pharmacy sector (including home infusion) as an attractive buy-and-build opportunity and spent the subsequent two years carefully seeking a partnership with an industry leading management team who shared a vision to build a truly differentiated company.

AxelaCare competes within the specialty infusion sector of the specialty pharmacy industry. Specialty infusion services primarily involve the intravenous (i.e., directly into veins or muscles, or under the skin) administration of medications to treat a wide range of acute and chronic health conditions. Physicians, hospital discharge planners and case managers generally refer patients to specialty infusion providers to continue their therapies at home or in other non-acute settings.

The market for specialty infusion is approximately $10 billion and growing at approximately 8% to 12% annually. This significant organic growth is driven by numerous factors including: (i) favorable demographic trends, (ii) a growing pipeline of new pharmaceuticals and therapies that are appropriate for infusion, (iii) patient preference for home care (especially in cases of chronic diseases), (iv) lower costs as compared to treating chronic illnesses in a hospital setting, and (v) technological advancements that have made delivering complex therapies in the home safer and more prevalent. Approximately 70% of the drugs now under development in the biotech pipeline will require some degree of specialized, hands-on administration via injection or infusion.

Buy and Build Strategy

The specialty infusion sector is highly fragmented, with an estimated 700 to 1,000 home infusion providers in the United States. This fragmentation, combined with the industry’s strong organic growth, creates an attractive buy-and-build opportunity. AxelaCare is actively seeking strategic add-on acquisitions of home infusion providers that will enable the Company to broaden its geographic footprint and deepen its presence in the attractive home infusion market.

To the extent you are interested in learning more about AxelaCare, please contact Ryan Glaws and or Justin Unertl at .

MTS – Medication Packaging
 
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Key Information

MTS Medication Technologies

MTS Medication Technologies

Industry

Healthcare

Company Headquarters

St. Petersburg, FL

Investment Date

December 2009

Website

www.mts-mt.com

MTS Medication Technologies (“MTS”) is a leading international provider of pharmaceutical adherence packaging solutions focused on the long term care, retail and nutraceutical markets. MTS designs, develops and manufactures proprietary pharmaceutical adherence packaging along with a complete line of highly specialized automated equipment to assist institutional pharmacies and long term care facilities with pharmaceutical dispensing, inventory management, and storage. MTS serves more than 8,000 customers in the United States, Canada, Europe, Australia, and the Middle East.

Top Down Investment Thesis

Pharmaceutical adherence packaging (i) increases patient compliance for their drug regimens; (ii) enables pharmacies to dispense drugs more efficiently/reliably and store/handle drugs properly; (iii) makes compliance easier for patients, who often must consume multiple drugs, multiple times per day to comply with their doctor’s prescribed regimen; (iv) provides physicians, through greater patient adherence, with the comfort that their prescriptions are being followed properly; and (v) reduces healthcare costs through fewer emergency room visits/deaths/hospital admissions related to non-adherence. Estimates indicate 28% of emergency room visits are related to the misuse of drugs; 70% of which are preventable and 24% of which result in hospital admissions. In addition, U.S. healthcare costs related to treating patients due to medication non-adherence is estimated to be $60-$100 billion annually (Healthcare Compliance Packaging Council).

Buy and Build Strategy

Partnering with Excellere to pursue a buy-and-build strategy, MTS is currently looking for acquisition opportunities that would enable the company to add more products and services to its existing customers, as well as increase its reach through new customers and distribution channels both domestically and internationally.

For more information regarding MTS please contact Matt Hicks at or Ryan Glaws at .

Advanced Pain Management – Pain Management
 
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Key Information

Advanced Pain Management

Advanced Pain Management

Industry

Healthcare

Company Headquarters

Milwaukee, WI

Investment Date

May 2008

Website

www.apm-wi.net

Testimonial

“We had two primary objectives for our transaction with Excellere. We wanted to diversify our net worth and find a partner to help us take our business to the next level. Excellere became instrumental in developing our growth strategy, improving our core processes and aligning our organization to become more scalable. Excellere was an invaluable extension of my team and I could not be more pleased with our partnership – we accomplished great things together.”

Vishal Lal
CEO

Advanced Pain Management (“APM”) is a Milwaukee-based, leading provider of interventional pain management services throughout Wisconsin. APM has the expertise to diagnose and treat a broad range of pain conditions, including pelvic, spine, neck, hip, cancer, diabetes, and obesity-related pain.

Top Down Investment Thesis

Chronic pain is estimated to cost the U.S. economy $90 to $100 billion per year. Costs continue growing due to increasing obesity, the aging population, and overall poor lifestyles. Interventional pain management (“IPM”) is a multidisciplinary approach for managing and eliminating pain and became more visible when it was granted a medical sub-specialty from the Centers for Medicare and Medicaid Services in 2003.

Interventional pain management develops customized plans, and uses minimally invasive outpatient procedures, such as nerve blocks, epidurals, and implants to help patients manage or eliminate pain. IPM is an attractive alternative to higher-risk heavy drug regimens that simply mask the pain or costly surgeries that require lengthy recovery and questionable long term outcomes. As a result, IPM offers an excellent value proposition to the patients, referring physicians, and payors

To learn more about Advanced Pain Management, please call David Kessenich at or Matt Hicks at .

ASI Government – Government Services
 
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Key Information

ASI Government

Industry

Business Services

Company Headquarters

Roslyn, VA (near D.C.)

Investment Date

March 2008

Website

www.asigovernment.com

Testimonial

“I learned three powerful lessons as an owner of a rapidly growing business. First, you must invest, and continue to invest, to grow. Second, the manner of that investment may change over time and you need to be disciplined but flexible. And, third, always choose your partners well, based on a foundation of integrity, excellence, and shared vision and commitment. We embarked on a nationwide search and chose Excellere Partners above all others; together, we are turning yesterday’s dreams into today’s realities. In short, Excellere delivers even more than they promise.”

Ann Costello
Co-Founder

ASI is a trusted advisor to the Federal Government, providing consulting services, productivity tools and training to over 56 clients within the Department of Defense, Homeland Security and Civilian agencies.

Top Down Investment Thesis

The dollar volume of Federal government purchases has grown by 63% over the past six years to approximately $425 billion (~8.5% growth). Meanwhile, the aging demographics of the federal workforce, high turnover among government employees and budgetary pressures have created greater demand for a trusted advisor to assist the Government in improving acquisition, program management and broader IT processes and outcomes.

Buy and Build Strategy

ASI is pursuing acquisition opportunities that will allow it to accelerate its geographic expansion into key markets (Huntsville, AL; San Diego, CA; etc.) as well as add additional differentiated service offerings for its clients within two general categories:Smaller,

  • Niche Service Providers – Government consulting and training companies that enhance and broaden ASI's current service offering.
  • Divestitures – There is an excellent opportunity to acquire the divisions of larger, diversified companies that are compelled to divest their acquisition support business units to eliminate conflicts of interest.

To learn more about ASI, please contact Patrick O’Keefe at .

MedExpress – Urgent Care
 
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Key Information

MedExpress Urgent Care

MedExpress Urgent Care

Industry

Healthcare

Company Headquarters

Morgantown, WV

Investment Date

June 2007

Website

www.medexpress.com

Testimonial

“When we considered our liquidity options, we wanted to find a financial partner with a track record and the ‘know how’ to help us realize our dream of expanding nationwide and becoming an industry leader. During our partnership with Excellere, we invested heavily in our infrastructure and grew the company ten-fold in size. Excellere’s passion for our vision has inspired our entire team.”

Frank Alderman
Co-Founder and CEO

MedExpress Urgent Care (“MedExpress”) is a leading provider of outpatient urgent care services. It currently operates urgent care centers in Pennsylvania, West Virginia, Colorado, and Florida. MedExpress delivers high-quality urgent care, including digital X-ray, laboratory work, EKGs, IV therapy, and minor surgery, and provides patients a greater level of convenience and flexibility than emergency rooms or primary care physicians. The clinics always have physicians onsite and are open daily to deliver flexible, efficient, and fast care.

Top Down Investment Thesis

Urgent care is an emerging model within the U.S. health care system. It is based on improved access to care delivered in a timely and cost effective manner. Many emergency departments have long wait times, and an antiquated primary care system leaves patients waiting days and sometimes weeks for an appointment. Urgent care provides a convenient and affordable health care solution for patients who need timely, high quality care. A typical urgent care center visit costs approximately 25 percent of a similar visit to a hospital emergency room. Because most visits to emergency departments are not for life threatening reasons, urgent care centers reduce healthcare costs significantly.

To learn more about MedExpress, please call David Kessenich at or Ryan Glaws at .