Founded in 1997 and based in Pacheco, CA, Biocare Medical (“Biocare”) is an oncology-focused developer of immunohistochemistry (“IHC”) and molecular reagents, as well as the associated instrumentation.  With a product portfolio of patented and licensed products, Biocare offers a comprehensive suite of reagents, equipment, and lab services to clinical laboratories, research organizations, and pharmaceutical manufacturers.  Serving nearly 2,000 customers worldwide with a catalogue of over 2,000 unique product SKUs, customers rely on Biocare’s product quality and consistency for their research and clinical needs.

Top Down Investment Thesis

Excellere’s investment in Biocare is a result of the firm’s disciplined top down investment strategy, driven by several factors including i) a compelling value proposition to medical and research professionals who can better identify cancer with enhanced specificity, ii) attractive industry growth driven by increasing cancer incidence rates and expanding testing and research needs, iii) IHC’s position as the most widely used platform in histopathology and standard of care for cancer diagnoses, and iv) the buy-and-build opportunity within a highly fragmented industry sector that Excellere pursued for approximately five years and established a list of over 100 acquisition candidates and industry relationships.

The reagents industry is large, global and fast growing with several drivers providing attractive tailwinds.  Biocare’s primary end-market is cancer research and detection, one of the most attractive sub-segments within the broader life sciences tools sector.  According to LEK, worldwide cancer incidence is expected to grow 2.4% per annum to nearly 17.1 million new cancer diagnoses in 2020.  Increases in the total number of new cancer diagnoses are driving an expanding number of U.S. biopsy procedures and ultimately growing consumption of reagents.  The worldwide IHC and molecular diagnostics market is expected to grow to $2.4 billion by 2021, reflective of approximately 5% annual growth driven by cancer incidence rate growth, development of new biomarkers, and pricing increase within the currently primary technology for the cancer diagnostic value chain.

Buy and Build Strategy

Consumable life science and diagnostic tools remains a highly fragmented industry with a multitude of organic and acquisition growth opportunities.  Since inception, Biocare has remained focused on providing world class immunohistochemistry and molecular products solely focused on the attractive, growing oncology market with an emphasis on cancer research, diagnostics, and monitoring.  Biocare’s significant historical investments in its research and development capabilities, manufacturing footprint, strong executive team and a global sales force provides the scale required to serve a substantial worldwide customer base.

To the extent you are interested in learning more about Biocare, please contact Ryan Glaws at , Justin Unertl at , or Nick Coleman at to discuss the life science tools sector further.

Founded in 2003 and headquartered in Powell, Ohio, 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 .

LucidHealth is a leading provider of professional radiology services to hospitals, clinics and outpatient imaging centers, completing over 1.7 million interpretations per year.  Powered by the belief that all patients should have access to the highest quality of subspecialized imaging care, regardless of facility size or location, LucidHealth leverages its internally developed, industry-leading workflow technology and clinical processes to provide the highest-quality, subspecialized care for patients and referring physicians.  Founded in 1980 and based in Ohio, LucidHealth is a top ten provider of radiology services in the United States.

Top Down Investment Thesis

According to WallStreet Research, United States commercial healthcare spending on the radiology industry is over $200 billion per annum and is expected to grow at a 10% CAGR from 2015-2020, driven by constantly evolving imaging technologies and the overall expansion of healthcare.  Imaging and radiology services are one of the largest spend categories at hospitals, representing nearly 10% of total U.S. commercial healthcare spending each year.  Hospitals are continuing to outsource highly subspecialized services such as radiology due to operational challenges associated with keeping them in-house.  In addition to challenges related to recruiting, retention, and billing, hospitals often are forced to pay for full-time employees regardless of whether there is enough volume to justify an on-staff physician.  Outsourced models allow hospitals to benefit from high-quality subspecialty providers, while enjoying the flexibility of only paying for services that are needed.

With the implementation of PQRS and transition to MACRA and other reforms, payers have become increasingly focused on monitoring quality outcomes to justify reimbursement, and LucidHealth is well positioned to benefit from these changes due to its investments in technology and infrastructure.  In turn, this is propelling growth in imaging services as a way to increase efficiency and drive elevated clinical outcomes.  Radiology is a leading driver of key hospital metrics such as patient safety, emergency department throughput, length of stay, referral patterns and overall patient experience.

Excellere’s investment in LucidHealth is a result of the firm’s disciplined top down investment strategy, driven by several factors including i) expectations for the continued outsourcing of radiology services, ii) an increased aversion to malpractice liability from misdiagnosis, iii) relative stability in radiology reimbursement rates for professional services, and iv) increased focus on quality outcomes within the medical community.

Buy and Build Strategy

Radiology is one of the most fragmented medical subspecialties, which combined with positive outsourcing trends, makes it an attractive subsector to employ a buy-and-build strategy.  It is estimated that there are currently more than 3,000 radiology groups in the United States, with only the top 15 in the country having more than 65 radiologists in their practice.  LucidHealth is focused on partnering within radiology service providers with a culture of compliance, best-in-class patient outcomes, and a patient-first approach clinically and operationally.

To the extent you are interested in learning more about LucidHealth, please contact Patrick O’Keefe at , Justin Unertl at , or Nick Coleman at to discuss the radiology services sector further.

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.

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 .

Advanced Infusion Solutions (“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 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.

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 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 (“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 .