Services
Health System Partnership Advisory Services
Juniper was founded to offer nonprofit organizations the same level of transaction expertise demanded by larger industrial companies. We are the only experienced team focused full time on transactions for nonprofit clients without conflict or distraction.
Hospital M&A
Our team is recognized for having adapted corporate merger and acquisition practices and discipline for the not-for-profit hospital industry. We have worked with all types of nonprofit hospital owners including community 501(c)3, governmental and religious, and have represented large multi-state systems, academics, small systems, large rurals, safety net and critical access hospitals. We understand the central role that access and other non-financial objectives play in hospital transactions and we have a track record of achieving superior outcomes for our clients.
Independence Assessments
We focus on empowering hospitals and boards with the knowledge and insights necessary for making informed decisions based on real world input. A little over half of our clients decide not to pursue transactions. We are known for our experienced, honest advice, which includes telling clients when they are better positioned to meet their objectives without a transaction. We assist clients in deciding whether or not to pursue partnerships with services that include 1) strategic financial advice; 2) review of actionable alternatives; 3) debt capacity; 4) value and available market terms; 5) ability to meet non-financial objectives. Advisory services are customized based on client need, whether through senior executive discussions, board education, or a collaborative strategic retreat.
Partnerships & Affiliations
Transactions where no ownership has changed include Joint Operating Agreements, Management Agreements, clinical affiliations (both operational and contracting), purchasing groups, information technology consortiums, back-office partnerships and many other forms of contractual arrangement. We advise our clients on the pros and cons of these agreements and how they can advance the organization’s mission relative to no partnership as well as partnership alternatives.
Joint Ventures
Juniper leads the industry in the use of joint ventures to create value, improve quality and increase access. We have achieved many "first-in-industry" joint ventures for our clients and are experienced in all forms of joint ventures such as 1) Buyer Joint Ventures where an academic medical center and for-profit organization team up to acquire a community hospital; 2) Seller Joint Ventures where a community hospital sells majority ownership to a for-profit or not-for-profit buyer while maintaining significant governance; and, 3) Buyer and Seller Joint Ventures.
Non-Acute Services
We have significant experience with managed care plans, behavioral health, physician groups, senior living, intellectual and developmental disability services, ambulatory surgery centers, medical office buildings, dialysis, and numerous other areas. Like acute care, mission and access are typically central features of transactions involving non-acute businesses and we understand how to maximize these without sacrificing financial outcomes.
Board Education
Health system boards are facing increasing complexity and evolving responsibilities, especially when navigating transformative decisions such as mergers and acquisitions. Juniper Advisory helps board members assess their roles in this shifting landscape, equipping them with the tools to make informed decisions. By starting with Board education, we ensure leaders are equipped to make decisions that align with both short-term goals and long-term strategy. With unmatched expertise in governance and strategy, Juniper works closely with health systems to navigate challenges, identify opportunities, and position organizations for successful partnerships. Leaders must carefully balance financial stability, patient care quality, and long-term growth when deciding on a partnership. Identifying the right partner and model involves evaluating financial metrics, cultural compatibility, and the potential for improved healthcare delivery, while addressing concerns from stakeholders about job security and operational changes. Juniper plays a crucial role in educating leaders on the M&A market, providing insights into market trends, consolidation dynamics, and regulatory influences.
Our Approach
We have honed our iterative process over decades and adjust it for each client based on their situation and objectives. We ground our approach in our core value of transparency.
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