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Understanding Mergers and Acquisitions in Behavioral Healthcare Part 1

By January 12, 2019November 24th, 2025No Comments5 min read

Michelle Davis, DBH, Assistant Director of the DBH Program, Cummings Graduate Institute for Behavioral Health Studies

Mergers and Acquisitions (M&A) refers to the purchase, consolidation, or restructuring of companies. Acquisition occurs when one company assumes more than 50% ownership of another company, this is the most common type of deal. When two companies are joined together to create a new company this is referred to as a merger, this happens less often (Snow, 2018).

For any transaction (the legal terminology for a deal) to take place there must be a buyer and a seller. The buyer is the acquirer, and the seller is generally referred to as the target company, during the M&A process. The terms buyer and seller are the legal terms that will be used when contract documents are executed. The “Buyer” of a company can come in many forms; Strategic Buyers are often looking to acquire a company with the intention of combining at least some part of the target company, while Financial Buyers are often Private Equity (PE) funds (large pools of money often from many sources), there may even be companies that are financially backed by outside PE money, and finally there are occasionally individuals who purchase companies, however, this is rare (Snow, 2018). The “Seller” of a company could be looking to obtain growth capital (raise money to invest in the business), recapitalize (sell part of the company but retain control), sell more than 50% to allow a change or control, or sometimes the seller is interested in only selling one division, brand, or certain assets, this is referred to as divesting.

M&A steps that occur along the way to a deal (Corporate Finance Institute):

  • The development of an acquisition strategy by acquiring companies
  • Strategic growth to be acquired with high value for target companies
  • Determining search criteria for potential acquisition/target companies
  • Assessing and value analysis of target companies
  •  Negotiations
  • M&A due diligence
  • Deal Closing

Each of the steps listed above are a general overview of an entire process and contain their own specific nomenclature. For example, when valuing a company an important term to know is EBITDA, this refers to earnings before interest, tax, depreciation, and amortization. Basically, the entire cash flow cycle of a business. This calculation is often used to determine the value of the company, making it important in negotiations; banks may want to know the EBITDA when considering a loan.

The due diligence phase is a very complicated process usually attended to by executives, attorneys, accountants, and bankers. Due Diligence process ideally addresses all elements of the contracts/deal structuring, financing, closing, and integration. A Due Diligence Checklist may have more than a hundred items on it requesting information on the corporation, operations, financial information, real estate holdings and other assets, inventory, purchasing, supply, intellectual property (IP), human resources, strategic plans, debt, financing, leases, etc., (Snow, 2019). The list can be exhaustive, and this particular step is very time consuming.

Once the steps associated with making the deal happen are completed, the deal is signed, and the money is transferred, the attorneys, bankers, and accountants have concluded their work and usually end their involvement. This is when the work associated with the process of integrating the respective companies begins.

Integration is a critical and often overlooked part of the entire M&A process. Sadly, many companies do a poor job with this process, and as a result many deals fail to reach their anticipated goals and synergies because of poor integration.

Lake Capitol (2017) reports in that, “according to collated research and a recent Harvard Business Review report, the failure rate for mergers and acquisitions (M&A) sits between 70 percent and 90 percent”. Reasons given for this failure rate include rushing due diligence, not adequately addressing corporate culture and power issues, over estimating the respective integration team’s ability to collaborate, undervaluing opinions and insights from lower-level managers.

When deals succeed in reaching the synergies and results that were hoped for it is usually due to proper and thoughtful handling of the post-merger integration process, including addressing organizational culture differences, comprehending and embracing the value added by the new company, and leadership being more focused on the next steps with integration less concerned about the excitement and public attention the deal may attract (Success and Fail Rate of Acquisitions, 2017).

In the second part of this series we will do a deeper dive into M&A in behavioral health. There has been a significant amount of M&A activity in the behavioral health space in the past few years, and industry analyst anticipate this trend to continue into 2019 and beyond. It is likely that individuals working in integrated care may be impacted by this.

References:

M&A Process – steps in the mergers & acquisitions process. (n.d.). Retrieved from https://corporatefinanceinstitute.com/resources/knowledge/deals/mergers-acquisitions-ma-process/

Snow, B. (2018). Mergers & Acquisitions for Dummies. Hoboken, NJ: John Wiley & Sons.

Success and fail rate of acquisitions. (2017). Retrieved fromhttp://lakeletcapital.com/blog/2017/3/15/success-and-fail-rate-of-acquisitions

Testimonials

As a member of the AAPI community, I’m very familiar with the barriers to mental health services and the need to break through the glass wall of cultural stigma that prevents many from receiving potentially life–saving treatment. I was the only Asian American person in my master’s cohort, the only Asian American person in many of my clinical work settings, the only Asian American person to walk into many of the professional settings that I pushed myself to show up to. In my current practice, I’m constantly reminded by my patients of how difficult it is to find an Asian American mental health provider, though this reminder constantly informs me that more needs to be done for my community. Day after day, I read stories of Asian American people who die by suicide as a consequence of our culture’s avoidance of mental health topics. As a DBH, my biggest goal is to use my expertise in whole–person care to amplify the conversation around mental health and help my community understand that mental healthcare is not a privilege that we are not entitled to, it is a crucial part of our healthcare that will manifest differently in us than what many Western psychology or psychiatry textbooks will describe, and that our unique experience of mental health issues are valid, important, and is time to be part of the larger conversation.

Willam Chum, LMHCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 16, 2022

The Doctor in Behavioral Health (DBH) program has changed my understanding of the subject and career path. Before this academic journey, my knowledge of behavioral health was primarily theoretical, including essential ideas and methods. However, the DBH curriculum combined intense academic research with practical application, helping me understand behavioral health from multiple angles. Recognizing mental health as part of total health changed my perspective. The biopsychosocial model, which showed how biological, psychological, and social variables affect mental health, was stressed in the DBH curriculum. This comprehensive approach made me realize how complex human behavior is and how important it is to address mental health issues. Effective interventions must target the individual’s surroundings, relationships, and life experiences, not just symptoms. The curriculum also gave me enhanced evidence-based practice training to execute successful solutions. Studies methods and data analysis classes improved my critical thinking and allowed me to evaluate and apply behavioral health studies. This gave me the confidence to contribute to the field’s knowledge base through practice and research.

Dr. Rhea Hill, DBH, LPCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - February 17, 2025

This program will change how you present to the world, not just as a professional but as an individual. Understand this is work but the work is worth it and the journey is undeniably transformative. If you are seeking a doctorate for the title, this is not the program for you. If you are seeking a doctorate to interrupt and disrupt the course of healthcare, then this is the program for you. You won’t find a more supportive program with professors who are dedicated to your success and your education. This program is not about the regurgitation of information. It is about the appropriate applied application of knowledge and information to push forward and become an advocate for equitable and quality care for all.

Brandy K. Biglow LMHC, CCTP, QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 5, 2024

The Doctor of Behavioral Health (DBH) program has definitely transformed my understanding of behavioral health. Understanding the links between physical and mental health has taught how to make better treatment decisions. The DBH program has also given me insights that otherwise would not be possible and allows me to view individuals through a lens that I was previously ignorant of. This program has helped me grow into a more confident individual, provider, and parent.

Cory H. Cannady, BCBA, LBADBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 13, 2024

The DBH program has reinforced my vision of viewing behavioral health (BH) as an integrated component of the healthcare system rather than a siloed service. As a practitioner in the focused BH realm of substance use disorder (SUD) treatment, I observe on a regular basis how identifying and serving SUD patients is often missed, ignored and stigmatized in primary healthcare, despite the fact that early intervention at these check-points often has the potential to intervene earlier and lessen the negative SUD outcomes frequently seen by the time a patient reaches specialty SUD services. Reinforcement received in my DBH program has motivated me to promote integration as a leader in my workplace and is a primary factor in considering the long-term trajectory of my individual career path.

Kenneth L. Roberts, MPS, LPCC, LADCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - November 5, 2024

Graduating from the DBH program has influenced and enhanced my approach to addressing behavioral health challenges and making a difference in the field by preparing me to become a serious business owner. Through the DBH program, I understand now that becoming a business owner not only assists me in reaping the financial benefits of working for myself, but the program also offers me a sense of freedom to make a difference in an individual’s life.

Dr. Rebecca K. Wright, DBH, LBA, BCBA, QBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - December 18, 2024

I have always wanted to pursue a higher degree but never found a program that met my needs. When I investigated the DBH program, I can honestly say I was excited. It was a program that would expand my knowledge in behavioral health but also how it relates to physical health. The philosophy of treating the whole person was exactly what I was looking for.

Elizabeth Nekoloff, M.Ed., LPCC-S, NCCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - January 16, 2025

Prior to obtaining my DBH, I practiced behavioral health within the boundaries of behavior analysis. The DBH degree has given me the ability to broaden my scope of competence allowing me to provide a higher quality of care to my clients through a person-centered approach, while still staying within my scope of practice. I was in the beginning stages of opening my business when I enrolled in the DBH program which set my trajectory towards being a stronger leader. The program equipped me with essential healthcare leadership and entrepreneurial skills, allowing me to ensure high-quality services for my clients and foster a supportive work environment for our staff. It has also given me the confidence to expand my business and pursue other healthcare ventures, reaching a broader range of patients in need.

Dr. Pauline Tolentino Pablo, DBH, BCBA, IBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - January 21, 2025

Although I have worked with many patients who have mental health diagnoses, or behaviors which make managing their medical diagnoses and day to day life difficult, the DBH program at CGI is broadening that knowledge and providing a deeper understanding of behavioral health and how best to help these individuals manage their health and improve their quality of life. This will allow me to provide and advocate for more meaningful and seamless integrated care, providing new tools for my intervention toolbox, and the confidence and skills to collaborate within and lead whole person focused interdisciplinary teams. I also anticipate building upon my knowledge as a nurse case manager and long time caregiver, as well as my personal passions and professional vision, learning about processes and operations, to be in position to start up and lead my own company one day, offering the services and care I know every person should have access to.

Hollie Wilson, MSN, RN, CCMDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 11, 2025

The DBH program will open opportunities for me to contribute to healthcare system innovation, particularly through trauma-informed care and integrated behavioral health settings. I will be better positioned to advocate for and implement holistic care models that improve health outcomes for underserved populations. Ultimately, this program will help me transition into higher-level roles, such as a director or consultant in behavioral health, where I can influence broader system changes and contribute to the future of healthcare delivery.

DeKyn Rashad Peters, MPH-CHES,BSW/BA,APCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 4, 2025

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