The Deals that Defined Behavioral Health Investment in 2022

Dealmaking has made behavioral health one of the most interesting segments of the health care sector. And 2022 was no exception even after a historic 2021.

Behavioral Health Business has identified a handful of deals that caught our eye as we look back at the year that was 2022. Not all of them are big-dollar blockbusters — although we have a few of those. These deals stand out because they are emblematic of the year or were in some way in a category of their own.

The parties in these deals range from titans of their respective spaces to upstarts. They also operate several settings including traditional, facility-based care, the behavioral health tech space and even the governmental space.

Regardless of size, setting or segment, this year’s list of the most interesting behavioral health deals reflects a vibrant future for the industry at large.

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Optum acquires Refresh Mental Health

While official figures for the deal were never released, many speculated that Optum acquired Refresh Mental Health for over $1 billion. News of the deal broke in March.

The megadeal acted as a stylistic counter to outpatient mental health giant LifeStance Health Group Inc. (Nasdaq: LFST). Lifestance exited from private equity ownership to the public markets in an IPO that wrapped during the summer of 2021.

Refresh Mental Health’s sale to Optum added to the health care and health services organization’s burgeoning behavioral health offerings. At that point, it had already acquired or invested in AbleTo and Mindstrong.

It also represented yet another move by a payer to run a health care company, an increasingly common trend.

Refresh Mental Health is poised to more closely integrate with primary care providers, CEO Steve Gold said at a BHB conference. The company is also positioned to provide services to other Optum customers if they are identified as needing mental health services.

Akili Inc. IPO goes public via SPAC

Akili Interactive Labs went public through a special purpose acquisition company (SPAC) deal. The deal was announced at the end of January. At the time of the deal Akili was valued at $1 billion. Akili closed the deal with Social Capital Suvretta Holdings Corp. I. in August. By then, the deal garnered $163 million in proceeds.

The Boston-based startup created a prescription video game, called EndeavorRx, aimed at improving attention function in children with ADHD. In 2021, the company landed an FDA 510(k) clearance for the technology. It has also begun research on using video-game therapy for adults with depression.

Akili shares spiked to $37.58 in August. As of December 15 Akili’s shares trade at $1.63, a free fall of 96%.

Public markets haven’t been terribly kind to the stock price of recent behavioral health entrants, echoing some trends seen in 2021.

Talkspace Inc. (Nasdaq: TALK) went public with a SPAC formed by the investment firm of its now-chairman Doug Braunstein — Hudson Executive Investment Corporation. It’s down 94% from its high of $12.45 in February 2021 to $0.73 as of the writing of this article, according to data maintained by Yahoo Finance.

Talkspace is at risk of being delisted.

Amazon.com Inc. acquires One Medical

The tech, retail and logistics giant Amazon.com Inc. (Nasdaq: AMZN) found the next industry that it can seek scale: outpatient health care. It announced a deal to acquire the hybrid primary care provider One Medical (Nasdaq: ONEM) for $3.9 billion.

The deal allows the behemoth company to continue to grow its health care efforts. As of Wednesday, the company had a market cap of $931 billion and had compiled $365 million in revenue through September 2022. Amazon has systematically moved into new segments and scaled giant offerings since getting its start as a book retailer. These include a cloud and tech services business (Amazon Web Services), music and video streaming services and online sales fulfillment to name a few.

Amazon had previously dabbled in health care services with Amazon Health. The company has shelved that effort following the announcement of the One Medical deal.

One Medical offers behavioral health services. Leading into the deal, its leaders announced plans to expand those offerings. Most recently, the company launched Healthy Mind, which is focused on mental well-being and resilience. The company first entered the behavioral health space in April of 2020 with Mindset by One Medical, a virtual coaching program designed to help promote mental health.

The deal gives Amazon a direct line, albeit through a bit of a backdoor, into the behavioral health space.

ARC Health’s series of investments

ARC Health was an active acquirer in 2022. The company was born in 2021 after its predecessor Advanced Recovery Concepts landed investment from Chicago-based private equity firm Thurston Group.

Its deal history signals that this is yet another private equity-backed platform company making a consolidation play in the outpatient mental health space.

Based in Cleveland, Ohio, ARC Health announced six acquisitions in 2022 and named a new CEO in August, Vincent Morra. Its latest deal was with Ann Arbor, Michigan-based Lotus Consulting.

ARC Health currently has more than 320 psychiatrists, psychologists and therapists. It works with patients in Connecticut, Georgia, Michigan, Minnesota, New York, North Carolina, Ohio, Tennessee, Virginia and Washington, D.C.

When ARC Health was founded, Patrick J. Haynes III, CEO and chairman of Thurston Group, said that it would have an aggressive growth strategy and was “poised to expand nationally.”

Headspace Health opts to buy rather than build

Deals in the behavioral health tech space came up short of analyst expectations. However, the record-setting levels of investment in 2020 and 2021 have given many startups and incumbents ample capital.

The San Francisco-based mental wellness and on-demand virtual behavioral health company announced two deals that built out targeted parts of its platform.

In January, Headspace Health acquired Francisco-based startup Sayana Inc. The deal gave Headspace stronger artificial intelligence tools, bolstered its self-help programs and added to its ability to respond to user check-ins.

In September, Headspace Health acquired Shine Inc. The deal bolsters Headspace’s ability to access and serve diverse populations: 80% of the Shine team identifies as Black, Indigenous or as a person of color.

The company rolled out a unified enterprise mental health and well-being in November. The new platform embodies the fusion of Headspace Health’s progenitors — Headspace and Ginger.io. That deal closed in October 2021.

Action Behavior Centers sells to Charlesbank Capital Partners

NexPhase Capital LP sold Austin-based Applied Behavior Analysis (ABA) therapy provider Action Behavior Centers LLC to the middle market investment firm Charlesbank Capital Partners.

News of the deal broke in August. The deal reportedly valued Action Behavior Centers at about $840 million valuation and with a roughly 14x multiple.

“This is at a period of time when there’s been a lot of people talking about the autism business where there have been some discussions about some providers stumbling a little bit,” Dexter Braff, president of the M&A consulting firm The Braff Group, told BHB in an interview. “There’s been some discussion about challenges and some consolidators stumbling a bit. … If I’m an ABA provider, I like that deal. It shows strength.”

It was one of the few big-dollar deals in the autism space in 2022. It also reflected the hot multiples that existed this year and in 2021. While multiples are expected to cool, they will remain high compared to the historic averages while deal volume remains elevated, experts say.

Action Behavior Centers is also interesting because it is both large and fast-growing. It made the Inc. 5000 list in 2022 by posting revenue growth of 1,249% from 2018 to 2021.

Acadia Healthcare Co. Inc. acquires CenterPointe Behavioral Health System

Another rare blockbuster deal for 2022: Franklin, Tennessee-based Acadia Healthcare (Nasdaq: ACHC) acquired CenterPointe Behavioral Health System. The latter operates four inpatient hospitals with 260 acute care beds, 46 specialty beds, and 10 outpatient locations in the Missouri cities of St. Louis, Kansas City and Columbia.

The deal flashed the potency of Acadia Healthcare as an acquirer. After offloading its United Kingdom business, the company teased its intent to make consolidation plays in the U.S. Acadia is already the largest pure-play behavioral health provider in the U.S. And this talk of active growth and acquisition has spanned two CEOs. But in the earliest days as CEO, Chris Hunter has reiterated the company’s low leverage as an asset the company would lean on.

Hunter and other CEOs recently spelled out a more encompassing growth strategy that focuses more on building facilities on their own and through joint ventures as well as increasing bed counts at existing facilities.

Revelstoke Capital Partners’ acquisition of Monte Nido & Associates

Monte Nido & Affiliates, a national eating disorder treatment provider, sold to Denver-based health care-focused private equity firm Revelstoke Capital Partners in July.

The Beverly Hills, California-based Levine Leichtman Capital Partners previously owned Monte Nido. It made its first investment in 2015.

The deal to acquire Monte Nido reportedly values the company at around $725 million, Axios Pro reports.

Candy Henderson, CEO of Monte Nido, told BHB the company would seek to scale up with M&A and organic moves. Monte Nido had five brands and 45 facilities in 15 states at the time of the deal.

Eating disorder treatment is highly specialized care that is hard to access. Most of the new entrants into the space — who have landed significant venture funding rounds — are focused on digital services.