Continuing Medical Education Q3-2023 Industry Report - Navagant research report

Sector Update Q3 2023

The Future of Continuing Medical Education: Digital Delivery, Mandated Demand, and Simulation in Online & Continuing Medical Education

Online attendance at CME events rose from 46% before COVID-19 to 91% after, 48 states mandate specific CME requirements, and the market is projected to reach $12.7 billion by 2028. Deal volume settled at 34 transactions in 2022 from 41 in 2021, with private equity taking 62% of them.

Online & Continuing Medical Education 12 Min Read 18-Page Report
Brief Summary The Future of Continuing Medical Education: Digital Delivery, Mandated Demand & Simulation, Q3 2023
Navagant Online & Continuing Medical Education Practice
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Continuing medical education is the accredited training clinicians are required to complete to keep practising. That requirement is what makes it a business rather than a discretionary spend: 48 states mandate specific CME requirements that must be met to remain compliant with the state medical board, which gives providers a recurring, predictable revenue relationship with every licensed professional in their specialty.

Post-pandemic, healthcare systems worldwide were disrupted, but CME providers adapted and delivered new ways of learning, and the sector showed strong resistance amid an uncertain economic landscape. Increased competitiveness among healthcare professionals and consistent expansion of the healthcare industry fueled growth. The clearest structural change is channel: online attendance at CME events went from 46% of respondents before COVID-19 to 91% after, and it has not gone back. What buyers are now paying for is the technology core underneath that channel.

Key Industry Takeaways

How Digital Delivery, Mandated Licensure Requirements, and Simulation Technology Are Reshaping Continuing Medical Education M&A

01

Tech-enabled providers are the preferred targets. Tech-enabled education providers and companies with a technology core capable of building interactive platforms are the most sought-after targets. In 2022, over 15% of all acquisition targets in the sector could either provide outsourcing services for those technologies or had already integrated them into their platforms.

02

Licensure requirements create predictable demand. The growing need for healthcare professionals, combined with the array of CME requirements practitioners must meet to maintain licensure, is driving industry growth. 48 states mandate specific CME requirements that must be met to remain compliant with the state medical board, which gives industry participants a high degree of revenue predictability.

03

E-learning will dominate the market. E-learning is expected to dominate the market as adoption of digitized CME training programs increases. 87% of healthcare practitioners surveyed reported using online CME platforms more frequently after the pandemic.

04

Medical devices and informatics open adjacent demand. New technologically advanced home monitoring devices give more healthcare professionals reason to engage with the expanding medical device sector. As technology changes healthcare, there will be greater need for healthcare informatics professionals to create, analyze, and manage new technologies.

05

Infectious disease programming saw a step change. Since the onset of COVID-19 there has been increased demand for CME programs on infectious diseases delivered online, a category that barely registered as a standalone product line before 2020.

06

Sponsors took the majority of the 2022 buyer set. Strategic buyers continue to play a pertinent role, but private equity buyers have shown increasing interest, accounting for 62% of 2022 deals. From 2018 through the second quarter of 2023, add-on acquisitions took up to 60% of all buyouts.

07

Buyers want the full credential stack. Increasing consolidation in the CME market is partly driven by acquirers’ goal of providing a full stack of services spanning education, certification, and career advancement rather than a single course catalog.

08

Volume held up through the 2023 slowdown. The sector recorded 34 M&A transactions in 2022, down from 41 in 2021, and activity has proven resilient through recent economic headwinds in 2023.

$12.7B
Projected global CME market size by 2028
91%
Share attending online CME events since COVID-19, up from 46% before
34
CME M&A transactions in 2022, down from 41 in 2021
62%
Private equity share of 2022 transactions

CME Industry Outlook

The global continuing medical education market is expected to reach $12.7 billion by 2028, growing at a 6.25% CAGR. CME is one of the crucial parts of the healthcare industry, because healthcare professionals need to keep up to date with changes in the medical field and treatment options relevant to their area of expertise. That continuous expansion of knowledge and skills improves patient care while creating a required recurring transaction relationship between health professionals and CME providers.

Online and Blended Delivery Is Replacing the Classroom

Healthcare is one of the industries where acceptance of online and blended learning is replacing traditional classroom instruction at pace. Increased internet coverage and the evolution of medical gadgets have helped the medical education system adapt to new media, and they have been the main driving force of CME market growth. Courses are more readily available across mediums than ever, which has diversified the user base. CME providers are also combining information technology such as 3D gaming, artificial intelligence, and virtual simulation with core education content to help practitioners acquire knowledge in a more engaging and interactive way.

Who the Users Are

Physicians accounted for 78.3% of survey responses, followed by midwives at 7.3% and paramedics at 5.7%. Within the physician group, 57.5% are hospital doctors, 17.3% private practice employees, 17.2% private practice owners, and 8.0% other employments. That mix matters commercially. Hospital-employed clinicians are typically reached through institutional contracts, while the roughly one third in private practice are an individual-subscription market, and the two require different go-to-market models.

Exhibit 1
The Global CME Market Is Projected to Reach $12.7 Billion by 2028
Continuing Medical Education Industry Income 2018 2023P $12.7B 2028 $0 $5 $10 $15 U.S. Dollars in Billions 1.4% CAGR 1.4% CAGR 6.25% CAGR 6.25% CAGR
Source: MarketWatch. The 2018 and 2023P bars are shown as plotted in the source chart, which does not print those values. Both CAGR callouts are reproduced as printed.
Exhibit 2
Physicians Are Roughly Four Fifths of CME Users, and Nearly a Third of Those Physicians Sit in Private Practice Rather Than a Hospital
CME User Breakdown 78.3% 8.7% 7.3% Physicians Other, students, nurses Midwives Paramedics Source does not print the residual segment values
Physician CME User Breakdown 57.5% 8.0% 17.2% 17.3% Hospital doctors Other employments Private practice owners Private practice employees
Source: ResearchGate. The user-breakdown chart lists six categories but prints values for only three; the remaining 8.7% is shown here as a single residual segment.
Exhibit 3
How the Market Segments: By Delivery Method, By Provider Type, and By Specialty
By Delivery Method
Classroom training, e-learning, journals, scheduled series, and others.
By Providers
NPOs, publishing companies, schools of medicine, healthcare delivery systems, and others.
By Specialty
Oncology, cardiology, infectious disease, orthopedic, dental, primary care, general surgery, and others.
Source: Arizton Advisory & Intelligence.

Key Trends and Drivers

Migration Toward Digital and Hybrid Delivery

The challenges posed by the pandemic underscored the importance of ongoing professional development outside traditional in-person events. Because of social distancing and the expansion of virtual offerings, 87% of healthcare practitioners surveyed reported using online CME platforms more frequently after the pandemic. Survey data shows the shift plainly: 46% of respondents attended online CME events before COVID-19, against 91% since.

The initial move away from face-to-face was about social distancing and minimizing infection risk. The continued rise in online adoption coming out of the pandemic is different in kind. It reflects users having discovered the flexibility and cost efficiency of registering for online CME, which is why the channel shift has held rather than reversed.

Rising Medical School Enrollment Against a Persistent Shortage

For the past 20 years the number of medical school applicants has moved by 2% or 3% a year. From 2021 to 2022 it rose 17.8%. Matriculants have risen every year in the series, from 21,869 in 2019 to a projected 23,904 in 2023. With more graduates competing, students are motivated to complete extra CME hours to demonstrate interest and strengthen residency applications. About 3% of all CME users in 2021 were current medical students.

The shortage on the other side of the equation is the more durable driver. Even with enrollment growth, the AAMC projects the United States will face a shortage of up to 124,000 physicians by 2034. To expand the multitasking capability of the existing workforce and help clinicians acquire diversified skills, 48 states mandate specific CME requirements to remain compliant with the state medical board, which provides a high degree of revenue predictability for industry participants.

Next-Generation Providers Go Beyond a Digitized Platform

The technology trend is moving toward combining cognitive science with 3D gaming technology so physicians can learn virtually. Conventional formats focused only on knowledge acquisition, including printed materials, live webinars, and discussions, are no longer sufficient on their own. Technologies that let learners apply what they have learned in a simulated environment and build situational decision-making skills are what the report expects to reshape the market.

Exhibit 4
Online Attendance Nearly Doubled After COVID-19, and Medical School Matriculants Have Risen Every Year Since 2019
Attendance of Online CME Events 46% 54% Before COVID-19 91% 9% Since COVID-19 0% 20% 40% 60% 80% 100% Percentage of All Respondents Yes No
Medical School Matriculants Evolution 21,869 2019 22,243 2020 22,666 2021 22,879 2022P 23,904 2023P 21,000 22,000 23,000 24,000 Number of Matriculants Vertical axis begins at 21,000, as in the source chart
Sources: ResearchGate (online attendance); AAMC (matriculants). The matriculants axis begins at 21,000, as in the source chart, which magnifies the year-over-year change. 2022 and 2023 matriculant figures are projections.

Segment Highlight: Gamification and Simulation

Gamification takes design elements from traditional games and applies them to a non-game setting. Over the past 20 years, medical education games, mobile applications, and virtual patient simulations have been developed for both preclinical and clinical training, and their use has risen alongside the availability of online learning platforms. Medical professionals can use virtual patient simulations to practise diagnostic skills, surgical procedures, and critical decision-making. The global healthcare gamification market is currently valued at $1.3 billion and is growing at a 42.8% CAGR to reach $7.7 billion by 2027.

The medical simulation segment is expected to grow at a 14.6% CAGR between 2020 and 2025 to reach $3.8 billion globally. The demand for preclinical simulations rose specifically to improve clinical competence and reduce malpractice cases and diagnostic mistakes. Medical errors account for 251,000 deaths a year in the US, the third leading cause behind heart disease and cancer. Virtual training simulations act as a distance-learning replacement for apprenticeships, letting practitioners build diagnostic, surgical, and treatment administration skills in a risk-free environment before applying them in real scenarios.

Exhibit 5
Healthcare Gamification Is Compounding at 42.8% Toward $7.7 Billion and Medical Simulation at 14.6% Toward $3.8 Billion
Global Healthcare Gamification Market $0.9 2021 $1.3 2022P $7.7 2027P $0 $5 $10 U.S. Dollars in Billions 42.8% CAGR 42.8% CAGR
Global Medical Simulation Market $1.9 2020 $2.2 2021 $2.5 2022P $2.9 2023P $3.3 2024P $3.8 2025P $0 $1 $2 $3 $4 $5 U.S. Dollars in Billions 14.6% CAGR 14.6% CAGR
Sources: Newswires (gamification); Markets and Markets (medical simulation).

Segment Deal Highlights

Gamification, May 2020: Brainlab acquired Level Ex for an undisclosed amount. Brainlab is a digital medical technology pioneer founded in 1989 and headquartered in Munich. Level Ex is regarded as one of the most innovative gaming companies and one of the healthcare industry’s unexpected disruptors, with a user base of more than 600,000 medical professionals including half of all US medical students. It keeps providers current in their specialties by presenting the ongoing challenges of practising medicine as highly rated mobile games carrying CME credit. The acquisition enabled strategic expansion of the Brainlab business and broadened its reach, and Level Ex planned to grow its team to serve global demand and partners that already included 6 of the top 10 pharmaceutical companies.

Simulation, December 2021: RELX Group subsidiary Elsevier B.V. acquired Shadow Health, Inc. for an undisclosed sum. Elsevier is an information analytics provider specializing in science and health. Shadow Health develops healthcare education software providing simulated medical scenarios to increase practitioner effectiveness, letting users train for clinical settings through measured improvement in practical application, patient interaction, and personal empathy. The acquisition enhanced Elsevier’s portfolio of digital health solutions with a focus on accessible healthcare training. Shadow Health CEO David Massias said the pandemic had brought the need for virtual simulations in nursing and healthcare education into sharp focus, and that investing in better training for nurses produces better outcomes for patients.

M&A Overview

The CME market saw a decline in M&A in 2022, with 34 transactions against 41 the previous year. Deal flow was expected to remain strong and stable through 2023 even under less favorable macroeconomic conditions, and the 14 transactions logged through August are consistent with a market that slowed in pace without breaking. The 2021 peak of 41 stands well above the 25 recorded in each of 2019 and 2020.

Rising Interest from Financial Buyers

In 2022, private equity buyers accounted for 62% of total CME transactions, up from 11% in 2021. From 2018 through the second quarter of 2023, add-on acquisitions took up to 60% of all buyouts, reflecting sponsors’ urge to scale their related holdings rather than build new platforms. On the 2022 base of 34 deals, the printed buyer mix works out to sponsor add-ons at 38.2%, private strategics at 26.4%, sponsor platform investments at 20.6%, and public strategics at 14.7%.

The number of strategic transactions remains relatively stable, and a few large strategics have been consolidating aggressively. HMP Global alone completed seven acquisitions since 2019.

High-Tech CME Companies Are Getting More Attention Than Ever

Traditional CME content creators remain sought-after targets, but companies with their own technology architecture and high margins are fast becoming the preferred ones. Businesses that can use virtual reality simulation, video game technology, or other complex computational algorithms to build interactive and engaging content are heavily targeted. In 2022, over 15% of all acquisition targets in the sector could either provide outsourcing services for those technologies or had already integrated them into their platforms. With institutional adoption of simulation and gamified solutions increasing, both the gamification market and the medical simulation segment should continue to expand, with consolidation driven by M&A activity.

Exhibit 6
Deal Volume Settled at 34 Transactions in 2022 From a 2021 Peak of 41, and Sponsor Add-Ons Were the Largest Single Buyer Group
Continuing Medical Education M&A Volume 28 2018 25 2019 25 2020 41 2021 34 2022 14 2023 YTD 0 10 20 30 40 50 Number of Transactions
2022 Buyer Breakdown 38.2% 14.7% 20.6% 26.4% STRATEGIC Private Public FINANCIAL Platform Add-on Base: 34 transactions completed in 2022
Sources: PitchBook (transaction volume); PitchBook and Navagant Research (buyer breakdown). 2023 volume is year to date as of the report date. Buyer-breakdown shares are as printed in the source chart; financial buyers total 58.8%, reported in the text as 62%.

When looking at the Online & Continuing Medical Education space, the main drivers of multiples is competition from private equity-backed strategics that are looking to add domain expertise, different revenue models, and breadth across the B2C and B2B markets. This has carried over into adding a full range of products and services to these professionals including online test preparation, content, and tutoring for high-stakes exams. As a result, most deals in both online and continuing medical education are pushed into double digit EBITDA multiples, or aggressive revenue multiples, depending on the stickiness of the subscriber base.

Navagant Case Study

Navagant served as the exclusive sell-side advisor to the Neuroscience Education Institute on its sale to HMP Global in July 2023, the largest of the two Navagant transactions in this report and the one closest to the center of the CME market. The firm received a USA Deal of the Year award for the transaction.

Exclusive Sell-Side Advisor to NEI Global · USA Deal of the Year

Neuroscience Education Institute acquired by HMP Global

Company Background

Founded in 2000 by Dr. Stephen Stahl and based in Carlsbad, California, the Neuroscience Education Institute is a leading provider of psychopharmacology-focused education, helping physicians, nurse practitioners, physician assistants, and other clinicians meet CME requirements and professional education goals. NEI represents the industry standard for central nervous system medical education, delivered through highly attended conferences and widely subscribed digital learning solutions. More than 45,000 mental health professionals return to the company for their continuing education.

Process Highlights

NEI sought a partner to help accelerate growth and execute a series of growth initiatives to further scale the business while maintaining its industry reputation. HMP Global is an omnichannel leader in healthcare content, events, and education, producing accredited medical education events and evidence-based clinical content across a range of therapeutic areas, and is a portfolio company of Susquehanna Growth Equity.

Successful Outcome

The combination pairs NEI’s institutional knowledge in CNS-focused CME with HMP Global’s existing conference portfolio and broader healthcare education solutions, giving the business enhanced learning experiences for clinicians and improved reach to pharmaceutical customers. Navagant received a USA Deal of the Year award for the transaction.

Navagant’s outstanding expertise and unwavering dedication were instrumental in successfully navigating the sale of our medical education company. Their strategic guidance and negotiation skills ensured a seamless process, resulting in a highly favorable outcome. We wholeheartedly recommend Navagant for their exceptional services in mergers and acquisitions. Steve Smith, CEO, NEI Global

Notable Transactions

July 2023: HMP Global, an omnichannel leader in healthcare content, events, and education and a portfolio company of Susquehanna Growth Equity, completed its acquisition of NEI Global for an undisclosed amount. NEI sought a partner to accelerate growth and execute growth initiatives while maintaining its elite industry reputation. The acquisition adds an essential partner to HMP Global’s healthcare education offerings, helping clinicians meet CME requirements and professional education goals. Navagant was the sole financial advisor to NEI.

January 2023: HealthStream (Nasdaq: HSTM), a provider of workforce and provider solutions for the healthcare industry, completed its acquisition of Electronic Education Documentation System, LLC (EEDS) for $7 million. EEDS is an online continuing education tracking system for healthcare professionals, and the acquisition adds to HealthStream’s growing marketplace of applications, giving customers more choice in the solutions best suited to their needs.

December 2022: TrueLearn, a digital learning and analytics platform focused on training healthcare professionals in medicine, nursing, and therapy and a portfolio company of LLR Partners, acquired APEX Anesthesia Review for an undisclosed amount. APEX had long wanted a partner that would let it reach its goals faster and support the innovation and growth needed along the way. Its platform helps learners hit performance goals in less time through memorable learning experiences that foster mastery of concepts relevant to clinical practice. The acquisition is a key part of TrueLearn’s strategy to bring best-in-class learning tools to new segments of healthcare education, and TrueLearn’s analytics deliver added value for both SRNAs and the institutions that rely on APEX through the licensure process. Navagant was the sole financial advisor to APEX.

Public Company Data

There is no pure-play public CME company of scale, so the comparable set mixes healthcare workforce platforms with education publishers and consumer learning names. That produces a very wide range. Doximity trades at 15.3x revenue on a 44% EBITDA margin and 22% growth, an outlier that pulls the mean well above the median. HealthStream, the closest operational analogue at 2.8x revenue and 14.0x EBITDA, is the more useful reference point for a CME asset with recurring institutional contracts. Wiley, Pearson, and Stride anchor the low end between 1.2x and 1.7x revenue. Three of the nine names had EBITDA too small or negative to produce a meaningful multiple.

Market Capitalization ($) LTM EV / LTM (x)
Company Price ($) as of 8/4/23 % of 52-Wk High Market Cap EV Revenue Gross Margin % EBITDA EBITDA Margin % 1-Year Rev. Growth Rev. EBITDA
Chegg9.4831.5%1,1062,30875275%25033%-4%3.1x9.2x
Doximity35.1374.0%6,8936,90741987%18444%22%15.3xNM
HealthStream23.3584.3%72374627066%5320%5%2.8x14.0x
John Wiley & Sons34.6564.0%1,9032,7622,02066%42221%-3%1.4x6.5x
Learning Technologies Group1.0956.4%860862736NM15321%131%1.2x5.6x
Pearson10.9891.4%7,8127,8274,73447%82217%12%1.7x9.5x
Stride37.0178.2%1,5912,1071,80936%28216%11%1.2x7.5x
Udemy11.3765.9%1,6551,66165356%(48)20%2.5xNM
Wilmington3.6484.3%31531514721%3222%2%2.1x9.7x

Source: PitchBook, as of August 8, 2023. $USD in millions, except share price.

EV = enterprise value. LTM = last twelve months. NM = not meaningful.

EV / RevEV / EBITDA
Mean3.0x7.1x
Median1.9x6.7x
Harmonic Mean1.6x6.4x

Select Transactions

The table below covers 51 CME transactions from January 2022 through August 2023, spanning accredited medical education providers, healthcare communications and marketing agencies, simulation and platform developers, credential tracking systems, and the healthcare staffing and insurance businesses that sit alongside them. Enterprise value is shown where disclosed. Highlighted rows are Navagant transactions, and CF denotes confidential terms.

Date Target Acquirer Target Business Description EV ($mm) EV / Revenue EV / EBITDA
Jul 11, 2023 Elentra Achieve Partners Developer of an e-learning platform.
Jul 11, 2023 Neuroscience Education Institute HMP Global Operator of a medical education company. CF CF CF
Jun 28, 2023 LiV Agency Clinical Education Alliance Provider of medical education services. $13.5
Jun 15, 2023 I.V. Nurse Consultants Dynamic Access Provider of medical consultation services.
Jun 1, 2023 ECS Billing and Consulting South Howard, Wershbale & Co. Provider of billing, revenue cycle management and consulting services.
Apr 28, 2023 Liberum (Educational Software) Management Developer and provider of online education solutions.
Apr 12, 2023 Makara Health Berkshire Partners Provider of healthcare communication services. $394.0
Apr 3, 2023 CiiTECH Tenacious Labs Operator of a cannabis therapeutics platform. $0.3 8.2x
Mar 8, 2023 Grupo Saned Medscape Provider of health and medical information services.
Feb 8, 2023 Strategik & Numerik Bpifrance Provider of healthcare communication services.
Jan 18, 2023 Synetic Life Sciences Intermediate Capital Group Provider of strategic consultancy services.
Jan 16, 2023 Grupo MedCof Wise Up chain Provider of medical education training.
Jan 4, 2023 Venel Institute Lehigh Valley Health Network Provider of educational and training services.
Jan 3, 2023 Michigan Professional Insurance Exchange Constellation (Commercial/Professional Insurance) Operator of an insurance company.
Jan 2, 2023 Sociedade Educacional e Cultural Sergipe DelRey Afya Educacional Provider of medical education services based in Aracaju, Brazil. $157.3
Dec 31, 2022 EEDS HealthStream Developer of a medical education tracking system. $7.0
Dec 29, 2022 Med Learning Group DW Healthcare Partners Provider of medical education services.
Dec 22, 2022 Springboard Healthcare Cornell Capital Operator of a healthcare travel staffing and education company.
Dec 15, 2022 Spear Education Avista Capital Partners Provider of education and training services.
Dec 14, 2022 Apex Anesthesia Review LLR Partners Provider of high-stakes exam preparation and learning support for SRNAs. CF CF CF
Dec 5, 2022 Boards & Beyond ATP Private Equity Partners Developer of an online learning platform.
Dec 1, 2022 Concorde Career Colleges Universal Technical Institute Operator of a post-secondary educational institution. $50.0
Nov 29, 2022 Adaptrack Platform AMS Management Developer of a practice management platform.
Nov 28, 2022 Agora Cours iXO Private Equity Operator of preparatory class centers. $4.6
Oct 20, 2022 Health Media Network Checkedup Provider of digital point-of-care marketing services.
Oct 13, 2022 Benezon Medxoom Provider of healthcare advocacy and consulting services.
Oct 5, 2022 Rendia Balance Point Capital Developer of engagement software.
Sep 21, 2022 Dignity Health Global Education Premier Provider of online education services.
Sep 13, 2022 Rimasys AO Foundation Developer of medical algorithms and devices.
Aug 11, 2022 TME BCN Aptitude Health Operator of a network of clinicians, researchers, educators and companies.
Jul 26, 2022 Rockpointe Clinical Education Alliance Operator of a science-based medical education company.
Jul 25, 2022 Evolve Medical Education Morgan Stanley Capital Partners Developer of an educational program.
Jul 6, 2022 Curtis Learning Renovus Capital Partners Provider of education and training services.
Jun 29, 2022 Suny Downstate The Allure Group Operator of a medical center. $160.0
May 26, 2022 BioTE Medical Haymaker Acquisition III Developer of bioidentical hormone replacement optimization therapy and complementary nutraceuticals. $678.0 4.7x
May 18, 2022 CloudCME HealthStream Developer of a cloud education platform. $8.1
May 10, 2022 Body Interact Médisup Sciences Developer of a medical learning platform.
May 10, 2022 SimforHealth Capital Export Provider of digital simulation.
May 4, 2022 IPETH Bpifrance Provider of education services.
Apr 28, 2022 Blake Austin College Brent L. Mills Provider of healthcare education and training.
Mar 11, 2022 Hardwork Medicina Yduqs Provider of medical education services. $10.1
Feb 22, 2022 Clirnet Services LifeScience Logistics Operator of a medical education platform.
Feb 7, 2022 Applied Medico-Legal Solutions Risk Retention Group Kilter Finance Provider of casualty insurance services.
Feb 7, 2022 Medical Marketing Solutions Group Red Nucleus Operator of a medical education company.
Jan 25, 2022 Seattle Study Club TerraMar Capital Operator of a dental study club chain. $15.0
Jan 20, 2022 Orion Immersive Medical Realities Provider of AR/VR design and consultancy services.
Jan 19, 2022 BroadcastMed 424 Capital Operator of a digital medical broadcasting platform. $30.6
Jan 14, 2022 CareerCert GTCR Provider of healthcare education and professional training programs.
Jan 11, 2022 Interactive Health International Canadian Space Agency Operator of an online interactive medical education platform.
Jan 10, 2022 MJH Life Sciences BDT & Company (Private Equity) Provider of healthcare information and resources.
Jan 1, 2022 Interactive Health International WUTIF Capital Operator of an online interactive medical education platform.
Navagant transaction Source: PitchBook, company press releases. CF = confidential.

Disclosed transaction multiples only. One transaction disclosed a revenue multiple and one disclosed an EBITDA multiple.

EV / RevEV / EBITDA
Mean7.2x12.6x
Median7.2x13.7x
Harmonic Mean7.1x11.7x

Buyer Universe

Navagant has followed buyers that have been highly acquisitive in the space as well as those that have completed notable CME transactions. Our industry expertise and network gives us insight into this buyer universe, including the companies’ industry positions and growth perspectives.

Buyer Universe
Leading Strategic Buyers: CE Healthcare
Afya
AmplifyHealth
Ascend Learning
Clinical Education Alliance
Medical Realities
Medscape
NURSE.com
pri-med
rn.com
Buyer Universe
Leading Strategic Buyers: CE Diversified
American Safety Council
CAE
CPI
Health & Safety Institute
Kaplan
Knowfully Learning Group
Simplify Compliance
Stride
UWorld
WebCE
Buyer Universe
Leading Strategic Buyers: Diversified Education Providers
Adtalem Global Education
Cornerstone OnDemand
Ebix
McGraw Hill
RELX
Skillsoft
Studer Group
Wiley
Wolters Kluwer
Buyer Universe
Leading Strategic Buyers: Healthcare Service Providers
Advocate Aurora Health
AmerisourceBergen
Cerner
CHG Healthcare Services
HCA Healthcare
HealthStream
SCP Health
Soliant
The Delta Companies
TRC
Buyer Universe
Leading Financial Buyers
Alpine Investors
Avathon Capital
Bain Capital Double Impact
DNS Capital
Falfurrias Capital
Francisco Partners
GreyLion Capital
The Halifax Group
HKW
Housatonic Partners
Hudson Hill Capital
Huron Capital Partners
Inverness Graham
Leeds Equity Partners
Morgan Stanley Global Private Equity
New Harbor Capital
Primus Capital
Pritzker Private Capital
Providence Equity
Quad Partners
Renovus Capital
Revelstoke Capital Partners
RSE Ventures
The Riverside Company
Silversmith Capital Partners
Solamere Capital
Report Contributors

Meet the Team Behind This Report

Jacob Voorhees
Managing Director
jacob@navagant.com  ·  617-216-1543

With over two decades of experience, Jacob is the Managing Director of Navagant, having been a key contributor since its inception. Leading as Managing Director and Co-Founder, he has played a vital role in establishing Navagant’s strong brand presence, building relationships with clients and servicing them with integrity. Demonstrating a remarkable talent for deal-making and unwavering dedication to his clients, Jacob has earned recognition as a leader in various industries, most prominently the Education and Training industry. He began his career at Rabobank International and later focused on software and direct marketing industries with Andersen Corporate Finance LLC. Then, in 2003, he founded Capstone Partners and led its Education and Training Practice until 2023, when he co-founded Navagant.

Shawn Keenan
Managing Director
shawn@navagant.com  ·  312-550-5304

Shawn is a Founding Member and Managing Director of Navagant and brings over 19 years of experience to the firm. Shawn has led execution efforts on 70+ transactions resulting in over $3.5 billion of proceeds for clients. He assists owners of middle-market companies in achieving their strategic growth objectives, exit strategies, and liquidity goals. Formerly, he served as a Managing Director of Capstone Partners in the Education and Training practice. His investment banking career began with Raymond James, where he focused on deal execution and client development for both public and private companies. Shawn’s previous experience includes serving as an officer in the US Navy where he served as a destroyer navigator and communications officer, student naval aviator, and fleet Tomahawk cruise missile officer.

Jeff Bache
Director
jeff@navagant.com  ·  804-627-2848

Jeff is a Director at Navagant and has over 15 years of Capital Markets, M&A, and Corporate Finance experience across Consumer & Retail, Diversified Industrials, Energy, Logistics & Transportation, Business Services, and Specialty Finance industries. Prior to joining Navagant as a Founding Member, Jeff was a Vice President in Capstone Partners’ Education and Training practice and a Senior Vice President in BB&T Capital Markets’ Debt Capital Markets Origination team, where he was integral in expanding the Bank’s Corporate Banking initiative. He began his career as an Analyst in the BB&T Capital Markets M&A team serving a wide variety of industries.

Sachin Raval
Vice President
sachin@navagant.com  ·  248-469-5786

Sachin is a Vice President at Navagant. Prior to Navagant, he was an Associate at Capstone Partners, an Analyst at DC Advisory, and a Summer Analyst at Sagent Advisors. He holds a BBA in Finance from the University of Michigan, Ross School of Business, and is a FINRA Series 79 and Series 63 registered representative. Sachin is based in Chicago, IL.

Cherry Huang
Associate
cherry@navagant.com  ·  845-553-2828

Cherry is an Associate at Navagant. Prior to Navagant, she was an Analyst in Capstone Partners’ Education and Training practice. She has interned at Allied Millennial Partners as an investment banking analyst and at the Shenzhen Stock Exchange as a fixed income analyst. Cherry holds an MS in Education from Harvard University and a BA in Economics from Emory University, and has passed all three levels of the CFA program.

Endnotes & Sources

  1. The George Washington University School of Business. Why We Need Healthcare Professionals. Accessed July 20, 2023.
  2. PitchBook. CME transaction and buyer-type data. Accessed July 20, 2023.
  3. PitchBook. CME transaction volume by year. Accessed July 20, 2023.
  4. IMARC Group. Continuing Medical Education (CME) Market Share, Size, Growth, Opportunity and Forecast 2023-2028. Accessed July 20, 2023. https://www.imarcgroup.com/continuing-medical-education-market
  5. ResearchGate. Expectations of Participants of Continuing Medical Education. Accessed July 20, 2023.
  6. National Library of Medicine. Impact of COVID-19 on Continuing Medical Education: Results of an Online Survey Among Users of a Non-profit Multi-Specialty Live Online Education Platform. Accessed July 20, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226076/
  7. National Library of Medicine. Impact of COVID-19 on Continuing Medical Education (ibid). Accessed July 20, 2023.
  8. AAMC. AAMC Medical School Enrollment Survey. Accessed July 20, 2023. https://www.aamc.org/media/47726/download
  9. AAMC. U.S. Physician Shortage Growing. Accessed July 20, 2023. https://www.aamc.org/news/us-physician-shortage-growing
  10. Newswires. Healthcare Gamification Market Size Worth USD 7,733 Million by 2027. Accessed July 20, 2023.
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  13. PubMed. Gamification in medical education (ibid). Accessed July 20, 2023.
  14. Brainlab. Level Ex and Brainlab Join Forces to Accelerate the Future of Healthcare. Accessed July 20, 2023.
  15. Cravath, Swaine & Moore LLP. RELX’s Acquisition of Shadow Health. Accessed July 20, 2023.
  16. PitchBook. Private equity buyout and add-on activity, 2018 through Q2 2023. Accessed July 20, 2023.
  17. Morrison Foerster. M&A in 2021 and Trends for 2022. Accessed July 20, 2023.
  18. Business Insider. HMP Global Announces Landmark Acquisition of Neuroscience Education Institute (NEI). Accessed July 20, 2023. https://markets.businessinsider.com/news/stocks/hmp-global-announces-landmark-acquisition-of-neuroscience-education-institute-nei-1032437826
  19. Business Wire. HealthStream Acquires Electronic Education Documentation System, LLC dba “eeds”. Accessed July 20, 2023. https://www.businesswire.com/news/home/20230103005165/en/HealthStream-Acquires-Electronic-Education-Documentation-System-LLC-dba-%E2%80%9Ceeds%E2%80%9D
  20. TrueLearn. TrueLearn Acquires APEX Anesthesia Review, a Leading Training Platform for the Anesthesia Nursing Community. Accessed July 20, 2023.
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