Last year was widely considered the year of the blockbuster health system merger, with Tenet-Vanguard, HCA-IASIS, and CHS-HMA each announcing consolidation deals. For many, it appeared that 2014 would result in more strategic moves from industry players looking to expand their continuums of care to maximize patient reach and smaller players seeking the stability of a larger entity. Others believed there would be greater consolidation among long-term care and outpatient care providers, speaking to the importance of providing alternatives to emergency room care and preventing hospital readmissions.

However, the surprising trend of 2014 may be the prevalence of unsolicited bids and outright hostile takeover attempts, a pill some are finding too bitter to take. Three such bids, profiled below, were officially rejected in the month of May alone. Most proposed consolidation deals remain collaborations driven by mutually agreed upon terms, but unsolicited bids have garnered as much attention as the aforementioned health system mega-mergers from 2013. The back-and-forth nature of the proposals has played out in the international media, leading to interesting discussions as to how smaller entities can survive post Affordable Care Act, and if larger entities solely focused on merger and acquisition activity will be able to sustain growth.

One of those entities is pharma giant Pfizer. Between January and May 2014, the company has made four attempts to acquire United Kingdom-based AstraZeneca, all of which have been rejected.  The best and final offer bid made by Pfizer of $93 per share, or $117 billion, was still considered undervalued by AstraZeneca. Pfizer's acquisition strategy included the dual goals of increasing its portfolio and moving its headquarters to the U.K. to benefit from a lower tax structure. Though Pfizer was unable to close the deal, there is still a chance the world's No. 1 pharmaceutical company could increase its portfolio and clout. Per British law, Pfizer can make another bid for AstraZeneca in six months.

In other deal news, Valeant Pharmaceuticals International made an unsolicited play to acquire Botox manufacturer Allergan. The $53-billion bid, described as hostile by some, was rejected with no intent to negotiate. Several analysts and industry insiders believe Valeant's growth strategy, which includes acquiring smaller players, is unsustainable, and Allergan believes this gives credence to its outright rejection.

Unsolicited bids are also emerging in the long-term and home healthcare sector, which has become increasingly more important as the Baby Boomer generation is aging. Kindred Healthcare, a leader in post-acute care, made an unsolicited bid for home health provider Gentiva Healthcare Services worth $573 million plus any outstanding debt.  Gentiva rejected the bid, wishing to remain independent, and went as far as creating a rule which prohibits any company from acquiring more than 15 percent share. It was announced in June that Kindred Healthcare was acquiring a 14.9 percent stake, making it Gentiva's largest shareholder.

These failed and modified transactions represent what could become an even bigger M&A trend, as powerful organizations bid to become more powerful through acquisitions.. For some, the unsolicited bids will be met with a fight to remain independent.

For the latest news on healthcare M&A, follow Sarah Wilson on Twitter: @SarahWilsonHLI.

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