During the Jefferies Healthcare Conference, senior private equity investors gathered for a wide-ranging discussion on how capital, operating expertise, and long-term conviction are reshaping healthcare. Moderated by Michael Dodds, Managing Director at Jefferies, the panel explored deal structuring in a dislocated market, sector-specific value creation, regulatory complexity, and evolving exit pathways across healthcare services, pharma, and medtech. Participants included:
Michal Chalaczkiewicz, Investment Partner, GBL Advisors
Kate Briant, Founding Member and Senior Partner, CapVest Partners
Cathrin Petty, Co-Head of North American Private Equity, Global Head of Healthcare and a member of the Partners Board at CVC Capital
Silvia Oteri, Partner, Global Head of Healthcare, Permira
Opening Perspectives
Michael Dodds: To start, give us a sense of your platform’s approach to healthcare investing.
Michal (GBL): GBL is one of the largest investment holding companies in Europe. We are not a traditional PE fund. We invest balance-sheet capital and have a growing ambition to deploy more in private markets.
Cathrin (CVC): I’m the Co-Head of North American Private Equity, Global Head of Healthcare and a member of the Partners Board at CVC and I’ve been investing in this industry for 30 years. We love the healthcare sector (even with pressure on all sides).
Kate (CapVest): I am a founding member of CapVest and sit on our investment committee. We manage around 10 billion and healthcare is a significant part of the portfolio.
Silvia (Permira): I have been with Permira for 21 years and focused on healthcare for the past 12. Healthcare is one of our four core sectors. We have invested heavily in pharma and pharma services.
Topic 1: Deal Structuring in a Dislocated Market
Q: Deal volumes are down and deal sizes are up. What creative structures are getting transactions done today?
Kate: Buyer and seller valuation expectations are still apart. Our LPs are looking for DPI and creative structuring can unlock situations. We see more selling shareholders retaining a stake. This is common in the US and increasingly so in Europe because it aligns everyone. We also use deferred consideration tied to exit performance and vendor loans with zero coupon to bridge valuation gaps. There is more liquidity and capacity in private capital markets. As a mid-cap investor, we can bring that capital alongside us to deliver solutions.
Michal: Our acquisition of Affidea for example came from a long-term investor, so the structure was straightforward. The challenge was the macro backdrop. We acquired it during high volatility around the invasion of Ukraine. We quickly refined the strategy from diagnostic imaging to a fully integrated care provider and made a management change on day one to be able to deliver on the refined business strategy. Leverage matters. We used five times debt, but flexibility was the priority. Any capital structure needs enough headroom for geopolitical and economic uncertainty. People strategy drives value. Execution drives value. The board’s role is critical. At GBL we have a healthcare innovation committee, so we stay close to disruption.
Cathrin: This is the most complex investing environment I have seen in my 30-year history of investing in healthcare. It is an incredibly challenging environment to invest and to exit. Every transaction has been a bespoke solution of one kind or another. Ask yourself, how are you solving the specific needs of both the company and the investors?
Silvia: We have complexity in our DNA, but recently we have focused on more straightforward deals. Creativity for us is less about structure and more about shaping industries.
Team capability is essential. When I became sector head, I concentrated on building a great team. We spend so much time learning as a team, including countless Harvard Medical School courses! Ultimately, people need to choose who they are going to work with, be it management, investors, or founders so you need to be knowledgeable, creative and collaborative.
Topic 2: Undervalued Sub-Sectors and Consolidation Opportunities
Q: Which healthcare sub-sectors are undervalued or ripe for consolidation?
Michal: Ha – it feels like nothing is undervalued. We have almost 30 percent of our portfolio in healthcare services and want to diversify so we are looking at medtech and specialty pharma. Medtech valuations have normalized.
Silvia: Pharma was hit by uncertainty following Liberation Day. The subsectors of pharma services that were very dependent on biotech were already down. Public valuations are depressed. Private valuations are not necessarily. In medtech, supply-chain issues caused real strain. In pharma services, several subsectors still lack scaled players.
Topic 3: IPOs, Exits, and the Path to Liquidity
Q: With larger fund sizes, does the IPO matter more as an exit route?
Silvia: Yes. Funds are getting bigger, and the IPO must be considered. We have had strong strategic exits, including selling all our assets to large strategics. We are doing IPOs and considering them as the market comes back, but it starts with the right asset, and you need to build a great story over time.
Dodds: Agreed, we often position the IPO route for sponsors as a way to plan their next exit and shorten the monetization timeline.
Kate: Growth stories need long horizons. Public markets reward longer arcs than a typical three-year plan.
Cathrin: Management teams are cautious, focused inward, and large US strategics still hesitate despite access to capital. In Europe, we have to work harder to stimulate interest from both public markets and strategics.
Michal: I’d love to see more IPOs. A more robust group of listed healthcare services players would help with comparables and valuation benchmarks.
Topic 4: Continuation Vehicles and Holding Periods
Q: How are you thinking about continuation vehicles (CVs)?
Kate: Continuation vehicles help solve structural issues in PE. Given the lifecycle limitations of our funds, they allow us to stay with companies that we feel have a great long-term trajectory. We even recently recapped a continuation vehicle, call it a “CV squared!” They let you retain control and bring in passive LPs.
Cathrin: You want to keep your best companies. Healthcare growth cycles are long, from early R&D to commercialization, and some of our best assets were held for eight to ten years. Portfolio diversification enables you to return capital while holding winners.
Rapid-Fire & Audience Questions
Q: One word to describe the healthcare deal market in 2026.
Michal: recovery
Kate: improving
Cathrin: improving
Silvia: bipolar
Q: What matters more in a deal: clinical outcomes or EBITDA margin?
Michal: Clinical outcomes come first. Every board meeting starts with them.
Cathrin: If you build a great company with great outcomes you’ll have great EBITDA margins.
Silvia: Both are required for a successful business, but profitability supports investment in people, technology, and AI.
Q: Biggest mistake PE investors make in healthcare?
Michal: Forgetting the fundamentals when capital is cheap. We see this again and again.
Cathrin: Misjudging regulatory risk and leverage. We live in a highly regulated market. You need flexibility in your leverage structure otherwise you don’t have room to move.
Kate: Underestimating the capital intensity of healthcare.
Silvia: Underestimating complexity across regulation, team-building, and execution.
Q: If you were not in private equity, which healthcare job would you choose?
Michal: Veterinarian
Kate: Research
Cathrin: Wildlife documentary work (I failed in research, that is why I do PE!)
Silvia: Academia. I love learning. If not healthcare, maybe a piano player, but I already tried and failed…
Q: Do PE investors take enough risk?
Silvia: Probably not, but things are improving. Ten years ago, medtech deals triggered fears about recalls and implants. PE can never take VC-level risk. We can’t lose on nine deals and make it back from one.
Kate: PE has a limited timeframe, if you have a five-year hold on average and you make a misstep it can really affect your return, so it confines the risk you can take.
Cathrin: It depends on where you are on the journey. More portfolio diversification allows more R&D exposure with less vulnerability. We’ll never take the same risk that a VC can in biotech.
Q: Will there be significant geographic shifts in the next decade?
Cathrin: What we see from a regulatory perspective is a divergence of behaviors. You see protectionism, but also dislocation. The US is moving to accelerate the approval environment. Europe less so.
Michal: There is no better recipe than proper geographic diversification, whether like us at GBL that is across European headquarters or globally. We should not forget the US market though.
