Health Industries: Deals Recap and 2023 Outlook

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Tune into PwC's Next in Health for a discussion of lessons learned from deals in 2022 and what we can expect in 2023 and beyond. Topics include:

  • Increase in M&A that’s more aligned to previous years
  • Rethinking strategies and increasing innovation
  • The important role of Private Equity
  • Inflation Reduction Act implications

Topics: healthcare, payer, provider, pharma and life sciences, deals, M&A, innovation, health services, big pharma, private equity, investors, strategy, science, patient, patient care, Inflation Reduction Act, data, technology, care delivery, real estate, facilities, urgent care, senior care, divestitures, shareholders, C-suite, portfolios

Episode transcript

Find episode transcript below.


00:00:04:24 Welcome to HRI’s Next in Health podcast, I'm Igor Belokrinitsky, I'm a Principal with PwC Strategy&, where I get to help leading health organizations with their strategies and operating models.

00:00:16:24 Today's topic is Deals. And who better to take us through Deals than returning guest Nick Donkar and welcoming to the podcast Roel Van Den Akker. They are our deals leaders.

00:00:28:04 Nick leads our deals on the payer and provider side of our business and Roel leads our deals in the Pharmaceuticals and Medical device side. And they will talk about their lessons learned from deals in 2022 and their expectations for 2023. And they also have a report out, the deals outlook for next year and we'll link to that in the show notes.

00:00:49:13 And I can promise that this will be our fastest talking podcast for this year, so please stay tuned. So welcome Roel and welcome, Nick.


00:00:58:15 Thank you, Igor.


00:00:59:15 Thanks, Igor. Great to be here and I'm very happy to be sharing the stage with my good friend Roel.


00:01:03:08 Excellent. Well, let's skip the appetizers and get straight into the main course. What do you expect to see in the Deal Space in 2023?


00:01:12:13 Igor, your question is from an outlook perspective. I mean, we put out our thought leadership piece for '23 and we continue to be very optimistic about what M&A has in store for the sector in '23. If you think about the sector overall, balance sheets continue to be strong. The competition for unmet medical needs and differentiated science is ever greater.

00:01:32:19 And there is a statistic out there that says $200 billion of currently patent protected pharmaceutical sales is going off patent by the end of the decade. If you throw that in the blender, Igor, you have what we think a very attractive set up for M&A going into '23.

00:01:49:24 Companies will continue to compete for de-risked innovation and continue to have to source innovation externally in addition to what their R&D pipelines will have in store already.

00:01:58:09 So on a combined basis, that sort of solidifies our belief that '23 will be a very active year for the sector in which we'll see a pickup of M&A returning to levels that we've seen in years prior. So overall, we're very optimistic and we continue to expect that M&A will rebound from the lows that we saw in FY '22.


00:02:17:19 Thanks Roel. From a healthcare, care provider perspective, we share some of the same thoughts that Roel just alluded to and talked about around the robust nature and very optimistic in the payer provider space specifically as we think about '23 and beyond. And here's why: The underlying fundamentals of some of the tailwinds that are going to propel continued deals.

00:02:43:00 And again, while the deal market holistically saw a slight decline, health care, health services payer provider in '22, actually on a trailing 12 month basis through the most recent November period, was higher than the trailing fiscal '21 period of total deal volume.

00:03:02:00 And that's even with a lot of the headwinds that are out there, which were regulatory concern and rising interest rates and things tightening out from an overall deal market perspective.

00:03:13:08 So, if health services continues its quasi recession periods and that deals has to get done for a variety of reasons, we expect, again, as Roel said for that pharma life science perspective, we agree that in '23 the deal volume will continue to be robust. And the tailwinds that are going to propel that are, and we'll talk about this again later,

00:03:34:00 But there's a general theme here which one can play upon and that is continued companies, but their provider, life science, I mean, all these players rethinking their strategies.

00:03:43:00 There's tons of dry powder in the marketplace from a private equity perspective. And we'll dive into the private equity perspective here shortly. All of what you're going to cause for assets to be trading hands in '23.

00:03:54:14 So Igor, back to you. But I think overall, we're jumping out of our seats ready to get '23 started with the amount of activity we anticipate is going to happen.


00:04:03:17 That's fantastic and really interesting to hear about some of the fundamental forces that are driving deals like Roel you mentioned the hunger for innovation. We'll come back to '23 here in a second.

00:04:14:24 But let's close off 2022 first and would love to hear from you, what were some of your lessons learned from this year? What are some of the important things that you noticed this year? And Nick, I think you already started mentioning a few of them.


00:04:27:10 Sure.


00:04:28:10 Perhaps you continue.


00:04:29:06 Yeah, thanks Igor. It is sort of the play off that point, what we saw in '22. And again, we talked about the market being slightly down from the overall deals perspective of health care, M&A, fair provider ended up being very robust. And there are certain things were headwinds and tailwinds as we talked earlier.

00:04:44:10 Well some of the surprising things for me were some of the things from an innovation perspective around care, in healthcare tech and healthcare I.T. that continue to bubble up from a deal volume perspective, lots of great deals being considered, contemplated.

00:05:00:08 The other thing that I want to point out is the type of deals. While Roel and I are used to either large divestitures or large acquisitions with some of our corporate and private equity clients. I think the interesting thing and some of the things we saw in this past year is the reemergence of club deals with private equity players

00:05:16:06 for some of the larger health assets that traded hands, as well as the potential conversations and partnering that we saw in the marketplace holistically with typical private equity players reaching across the manner there and really shaking hands with all things, whether it be for profit, not for profit, corporates to think about joint ventures, innovative structures of deals.

00:05:38:10 And that was although we didn't see a lot of actual public information come to market around that, we felt it and we felt the conversations happening and those are some of the surprising things there.

00:05:49:05 And then I think the last piece before I turn it over to Roel, the last piece that I think was interesting is even in the midst of coming off of back to back COVID pandemic years, where if you were a health system or if you're a payer, you saw your volumes interrupted, you saw your costs exacerbate themselves.

00:06:04:10 Even in all of that, people were still able to reevaluate their strategies and focus on what's important to them.

00:06:11:18 And we'll talk about that. Has those implications, sort of the output of those conversations, strategically or otherwise, will have an impact for 23? But it was interesting to see the evolution of all these conversations happening, which is going to be, again, another feather in the cap for 2020 beyond. Roel may be, I'll turn it over to you to talk about your lessons learned in '22.


00:06:29:07 Yeah, Nick, I'll maybe single out two points that I think stood out for me in 22, and I think they play a little bit of where you left off. I think one, what continues to amaze me is not so much out of the deals point.

00:06:40:24 But it plays into deals is the amazing advances in science that the industry and the sector continues to make, right? Whether we talk about oncology or whether we talk about selling gene therapy, whether we talk about rare disease, it's just amazing to see the level of breakthrough science that's coming out of our industry and what continues in turn to fuel deals, right?

00:06:58:01 I made the comment in the prior remarks about the competition for late stage and de-risk sides being ever greater, but it's just fascinating to be part of that as a practitioner in the market to be talking to clients about that.

00:07:10:01 And it's really amazing to see how companies are making a difference in patient’s lives. Right. I think that's a real key point that stood out for me in '22, which I think is something that we can all rally around.

00:07:20:16 The second point I would make, Nick, in playing off your point and Igor, to address your question, is, I think in our sector we've seen a prevalence of deals in the 5 to $15 billion range from a headline perspective.

00:07:31:01 We've talked a lot about, you know, the regulatory pressures that are coming out of DC, the complications that have arisen around sort of larger combinations, attracting higher degree of regulatory scrutiny.

00:07:42:06 We spent a lot of time thinking about what it takes to get a deal in that zip code down. Particularly for late stage de-risked innovation in the biotech area where there's ever greater competition from some of the big pharma.

00:07:54:06 We think that takes a different playbook to make those deals successful. It is less about the synergies and the financial engineering, but it's more about winning hearts and minds, committing scientists to the cost, making sure that as an acquirer you have a brand name in the market that stands for innovation and that you're able, as a large organization, to both cultivate the Not Made Here Agenda as well as the Made Here Agenda.

00:08:16:20 And that's what I found fascinating in '22. We spent a lot of time talking about that with our clients, and I do expect us to continue that conversation, Igor, going into '23.

00:08:27:24 Because those capabilities are going to continue to be required to operate and be successful and victorious in this market that has an insatiable demand for shareholder returns and where there's only so much of late stage innovation out there to grab by means of in organic and inorganic ways.


00:08:42:18 Excellent. Excellent. And so back to the future, back to 2023, we've started talking about how value is going to be created through deals next year. But let's talk a little bit about who is going to be making deals.

00:08:55:01 And Nick has already started talking about this interplay between the strategic, the institutional investors and the PE/VC world. And so are they going to be enemies, partners, frenemies? What is that dynamic going to look like next year?


00:09:10:08 Yeah, or maybe I'll take that one. I think it's all of the above to a degree, to be perfectly candid. I mean, you know, Nick already alluded to the role of private equity in healthcare, and they've been around for a while. I think from a former life sciences perspective. I'm going to think of their impact sort of in two ways.

00:09:26:00 One is their subsectors would inform and life sciences as we define it, that have historically been of high interest to private equity, particularly on the CRO or to CDMO side. And I do expect their role in those subsectors to continue to play a very important role in '23.

00:09:42:24 As we all know, private equity is flush with cash, but the debt markets have effectively gotten in the way over the last couple of months for them to sort of get really engaged there.

00:09:52:17 We do see some semblance of normalcy returning to the debt markets in '23. Whether that's early or later in the year, remains a little bit to be seen.

00:09:58:01 But as that sort of semblance of normalcy returns to the debt markets, we do expect private equity to play an important role in some of those subsectors that have particularly been, you know, areas where they tended to play and continue to be suited to their investment models.

00:10:15:14 The second area where I see private equity probably playing a little bit of a bigger role in '23 is sort of looking at public companies, that perhaps from a shareholder return perspective, are not necessarily in the top quintiles.

00:10:27:24 As those debt markets open, as those sectors where they can play a role become more attractive, they're going to take a keen eye to, you know, companies that perhaps are not up there in terms of returns and see if they can take them private and play a bigger role.

00:10:42:15 So I continue there to see their role as omnipresent at various levels in the form of life sciences subsector of health care. But I'm curious to hear, Nick, what you're thinking about that from your end of the aisle as well.


00:10:53:15 Yeah, Roel. You beat me to the punch on the take private piece, right. I think that's an interesting phenomena because you and I know and we've lamented over the past 12 to 18 months, there hasn't been a lot of IPO, public market, capital markets movement across health services in particular.

00:11:09:11 Right? And I do think we're seeing and having conversations with a lot of our clients whereby they're looking at take private situations for the mere reason you referenced, right? Which is investor return and a different playbook. That is one element I wholeheartedly will jump on board with you there on that. I would also echo the comment you made around the debt market softening a little bit.

00:11:32:22 I mean, TBD, right, if we're being honest. But I think the third piece, which is probably more unique to health care, is that for the longest time, you've had these strategic slash institutional investors going off with their strategies and their thoughts and buying and buying; private equity doing the same thing. Well, at a certain point, a lot of the platforms that private equity has built up, whether they be physician practices or otherwise, they needed exit.

00:11:55:18 And oftentimes it is not the public markets, especially in the current environment. So how do they play together? And what we have seen is a couple of transactions last year we witnessed where you've got a not for profit health system or a faith based health system of nice size where they're doing joint ventures or co-investing in certain assets together.

00:12:13:01 Across all spectrums, whether it be patient care, whether it be a host of other technology driven things to improve care and otherwise, they've been hand-in-hand walking down the aisle together on some of those things and it's pretty invigorating.

00:12:25:06 So it shows Igor back to your opening remarks, that with the spirit of improved patient care, care delivery, patient experience and innovation, right, private equity can work with your traditional strategic and institutional investors, and we expect more of that to happen in '23 and beyond.


00:12:43:23 Very interesting. Very interesting. Roel, hopefully you've had a chance to catch your breath. I want to put you back on the spot. So we have another new factor on the table for next year's deals, which is the Inflation Reduction Act that has been passed. And I know you've been studying it to understand the potential implications on the life sciences space.

00:13:05:05 So any thoughts on how it's going to impact next year's deals, IPOs and other market developments?


00:13:10:21 Yeah, I know. It's a great question, Igor. Thank you for bringing it up. Listen, pricing relative to deals and IPOs in our sector is obviously of key importance, right? So reform the pricing. You know, it's sort of been an overhang to kind of our sector for a long, long time.

00:13:25:01 And I think there's a little bit of enhanced clarity that claims through the Inflation Reduction Act, that now sort of put things out a little bit more in the open.

00:13:33:06 Clearly, the impact is asymmetric like to some of the players that are active in the space. I think what we have now is at least clarity in terms of how pricing regulation will work going forward. And I think clarity is something that generally will be accretive or a tailwind to overall IPO activity and deal making in general terms.

00:13:54:00 So while the impact may not have necessarily been favorable to all the players, I do think the emergence of clarity on this front from a pricing perspective is something that is very welcome.

00:14:04:01 And part of our belief, as I said earlier, that 23 we'll see a pickup in activity levels from a deals perspective relative to the baseline of '22 is sort of anchored around the fact that, that clarity, you know, will generally be good and that transparency is now out there.

00:14:20:08 So again, I do expect people will study it as part of, you know, overall kind of M&A practices going forward. But I generally believe that the clarity that's been created through that piece of legislation is going to be a good thing for the industry. And it sort of fuels our belief that it will actually be accretive to sort of activity levels going on next year.


00:14:38:22 Very helpful. Very helpful. So let's maybe turn attention now to the payer provider space. And Nick, I know this is where you spend your time and I think of this space very simplistically as deals that have to do with people like roll ups of physician groups, deals that have to do with things like roll ups of facilities in real estate and then deals that have to do with data and technology.

00:15:02:18 And so in this kind of way of thinking about it, what is your outlook on the deals? And again, groups, real estate facilities and data tag, what do you expect to see next year?


00:15:13:20 Yeah, great question, Igor. And I like the way you broke it down into the different buckets. So it's care delivery i.e. people. It's where they deliver the care. And then is there a technology or a digital implication to either advancing the care or helping speed up the billing and processing of that from an efficiency perspective? So listen, I probably sound like a broken record.

00:15:35:03 You and I have had the pleasure of connecting on these deal podcast previously, and I said steadfastly that physician practices are still hot and I forecasted many times before either on this particular podcast and or us, you know, having a social meal together where I thought that just as soon as I thought physician practices we're going to sort of temper down a little bit from a pace perspective,

00:15:58:20 I again get surprised that if you pivot and look at our Deals Insight piece, which was just published, you'll see that physician practice volume again, not the volume of size, sheer billions of dollars of magnitude that Roel talked about from a pharma life sciences perspective. But when you think about just volume of number of practices and the roll ups that continue to happen, guess what, Igor?

00:16:20:14 It's still physician practices is leading the way from an overall volume perspective. And if we dive into that, it's across several subspecialties. So it's everything from oncology, to fertility, to plastics, to derm, to dental. Even in this day and age, dental is still a hot subsector, right? Physical therapy is right up there as well of just like transactions.

00:16:45:06 So that's the reality. And then forward looking, what do we expect to see with just the people aspect of this? Just when I thought we had taken fragmented markets and sort of aggregated them into nice sized chunks to help certain markets or help certain other strategic players in those geographies, there are still plenty out there to continue going.

00:17:03:01 So there's the buildup and the aggregation of those into a formal platform. And you see, most private equity firms have some sort of platform in this space. That's the first thing. Second thing, is those are getting pretty large. And so the exits now, how do they think about exiting? Is it exiting to another private equity firm? Is it exiting in the public markets?

00:17:21:08 Probably not right now or is it partnering with a strategic player, as we talked about earlier in that theme? And I think that could be a reasonable solution. Taking a pause here, pivoting quickly to real estate and facilities, I think when you think about clinic based sites, so urgent care, surgery centers, anything with facilities.

00:17:39:24 I think those continue to be very good investments, all sorts of senior care, senior home living, all of those subsectors continue to trade hands, whether they be to REITs and/or to other investors that are looking to do sale leasebacks, including hospital based facilities.

00:17:54:22 Those will always continue as you think about diversification of portfolio. And then lastly, I would say on the tech and digital category, we continue, like from the life science, we continue to see innovation. So whether it's the fragmented revenue cycle market, whether it's some other latest SaaS software, for billing and services, all of those things continue to trade.

00:18:14:03 And we're seeing nice substantive transactions currently in process. And I think even in '23, we should see a lot of those continue, so never a dull moment. I think the one area where we probably will see some other, is risk taking organizations and private equity taking risk on. What is a little bit different than what they've done previously,

00:18:32:11 that we're starting to see smattering of that certain geographies. So that sort of covers a bunch of different areas because it involves technology and involves people and it involves facilities to make sure that they can actually take and realize that risk.


00:18:43:00 Fantastic. You're really creating for us a very nuanced picture of next year's deals environment. And I wanted to see if we can add a few more brushstrokes to that picture and talk about divestitures. And what role do you see divestitures playing next year and what's going to drive divestitures next year?


00:19:00:18 I think divestitures is something from a topic perspective that we talked about a lot as a firm. And I think the way to think about this is really through the lens of capital allocation. You know, we've talked a lot about our expectations for '23, but it's really this sort of lens of generating value for shareholders and portfolio optimization.

00:19:19:11 That is a key topic for C-suite executives going into '23. So I do think having a clear view from a company perspective where you want to play, pivoting the organization to the areas where you have a real right to win, whether it's therapeutic areas, whether it's geographical markets, is going to be evermore important as companies embark on sort of this journey of delivering top shareholder returns.


00:19:42:08 I think as part of that sort of rubric, companies will increasingly think about where they don't have a right to win. And divestitures can be a very important tool to kind of unlock the value out of the areas where perhaps enterprises are suboptimized. Right?

00:19:57:01 So from our perspective, and I don't think this is unique to pharma life sciences, I'm curious to what Nick will have to say about this from his side.

00:20:04:07 But, you know, we will expect that we are expecting that this topic of divestiture is going to remain high on companies agendas. There are probably going to be natural impediments that make companies want to cling on to certain legacy portfolios, whether its cash flow reasons to invest in more emerging areas of the business or other inertia that may exist.

00:20:24:16 But we do believe, and we've done quite a bit of studying on this topic as PwC too that the organizations that are actually going to win on the quest for top quartile shareholder returns are the companies that are willing to take a very rigorous look across their portfolios and make decisions in terms of areas where they don't have a right to win or no longer want to play.

00:20:42:02 So, where does that leave us? I think our expectation as part of our somewhat bullish outlook on '23 from a deal market perspective is that from a pharma life science sector will continue to see enterprises shed non-core areas, products or therapeutic areas in their quest to deliberately stop shareholder returns, so proactive portfolio management, the ability to both divest and acquire at the same time.

00:21:07:04 We all see those as a very critical capabilities in the toolkit of C-suite executives in '23 to deliver in an ever more competitive market. But that's sort of my view on a pharma life sciences perspective. But Nick, why don't you share your thoughts on that front?


00:21:24:04 Yeah, Roel, I could not agree more, the theme of portfolio optimization, rationalization. If we take a step back, all health services, both payer and provider, have been going through this ever changing review of their current asset base strategically.

00:21:39:01 And this started at the beginning of the pandemic because they wanted to figure out, okay, gosh, how was the pandemic and the impact made? How do I need to think about this? Where do I want to play or not play?

00:21:46:07 As you said, Roel the right to win aspect. Do I have a right to win in certain markets or do I not have a right to win in certain markets? What all these participants in the health ecosystem thought about at that time is, Oh, we'll just do this now, we'll realign our strategy accordingly, and then we won't have to touch it for a few years because this is going to be the new norm.

00:22:05:15 What they're seeing is some rebounded, some did not rebound certain markets ebbed and flowed, geographies ebbed and flowed. The landscape has changed around investor returns and returns in general.

00:22:15:24 I think what they thought was going to be a once every three year type approach and a normal strategy review that is done by large organizations is now annual event, if not more frequent than that, just to sort of make sure they can take advantage of whatever the market has to bear.

00:22:31:00 And I think there are certain large systems all across for profit, not for profit, care provider alike that are actively using this opportunity with investor returns down and everything else as part of their portfolios to say, where do I want to play? Which was once an annual saying, well, biannual event is now a every quarter. Let's think through this, albeit not at the same level of depth and expertize, but I think it's advancing the conversation.

00:22:56:04 So I guess taking a step back, I couldn't be more in agreement and in concert with what Roel said around the importance of divestitures as a whole going forward, given all the headwinds that we talked about earlier and how those are playing out, to seek additional investment to try to monetize an asset or exit a geography that they don't think they can play in.

00:23:15:16 So I would say, although pharma and health services interplay for obvious reasons, I think one thing we're 100% solid on is the role divestitures will play going forward.


00:23:26:10 Very cool. Well, let's bring it all together. And I'll ask you as a last question to imagine a deals executive, perhaps one of your clients, and she's thinking about the next year and she's got her potential deal targets. She's got her deal partners, she's got her board.

00:23:43:01 She's got maybe some activist investors, some lenders, some internal stakeholders that are very interested in what's going to happen, the regulators and of course, her own fear of missing out. What advice, what words of wisdom would you give as she looks to the next year?


00:24:00:21 Maybe I'll take that one, Roel it and turn it to you. In my approach and this is largely a function of why I'm an accountant. So there's a conservatism inherently baked in there, right? So insert lasts across the board. But I think the first mover advantage may or may not be there right now. And I think given all of the, and I counted, there were at least six different qualifiers.

00:24:18:00 You had Igor, roughly around all the different headwinds and tailwinds and all the different things out there. I'll just stay true to the strategy. If you're a system that is not for profit or faith based, where by stay true to the mission, but be willing to do unnatural things that have unnatural conversations around investor partners or around markets or around investment sides, right.

00:24:41:08 That you normally wouldn't do. And there's an old adage that a former partner who had this role before May since retired, and he said, do you want to be at the table versus on the menu? And I think when you think about that holistically, you always want to be at the table to be able to have opportunities there.

00:24:58:10 Whether or not you act on them or not is sort of that thing. And I think given the headwinds in a tailwinds that we talked about previously, you at least want to make sure you sized up the market appropriately so that you're in the best position to move for your organization, whatever that movement is. And I would just say stay true to that, because otherwise there's no use.

00:25:16:07 If you had referenced FOMO as one of your plays there, Igor and I think that more often than not, some of the participants in this health ecosystem have a FOMO approach and then ultimately peel back three or four years later and look at that investment return and realize that that didn't pay off, right?

00:25:29:01 So stay true to the strategy and then take advantage of the current market conditions to the extent it's appropriate. Roel, I'll turn it over to you.


00:25:37:19 I agree with a lot of what you said, Nick. I mean, Igor, if I can add to it. Listen, I think the market continues to reward leaders. And like I said before, the competition for late stage innovation is ever greater. And it's tempting in the wake of that competition to perhaps take some national bads.

00:25:52:07 But I think the companies that can maintain discipline and maintain that capital discipline, both in terms of what they're willing to pay for assets, but also in light of sort of thinking about portfolio optimization and divestitures, those are going to be the winners. That's point one.

00:26:08:19 I think point two what I would highlight here. And probably my last point is really and again, is back to the point I made before. We see more deals in the 5 to $15 Billion dollar range, you know, the speed to unlocking value from those transactions, the importance thereof is ever greater.

00:26:24:11 So integration starts in diligence. We've talked a lot about that words our clients over the years, but that old adage can ring truer today. So it's really imperative on, you know, executives if they're doing these transactions to really deliver the value from them. And unlock this in a very expedited fashion and make sure that the enterprise is protected and that there's resilience across the enterprise throughout that journey.

00:26:45:10 Those are two things that I think Igor are not necessarily new. I mean, we've probably been talking about those for a number of years. I just do think that the importance of getting them right in an era of, you know, some turmoils and geopolitical pressure, higher competition for assets for pharma life science company is ever greater and the imperative to get that right is ever more important.

00:27:07:13 So those would probably be the two areas of advice that I would have for leaders going forward in '23.


00:27:14:16 This tremendous, really appreciate both of you coming and sharing your outlook for next year. It sounds like it's going to be a very dynamic and a very strategic market with more clarity and more appetite for innovation and room for someone to come in and lead and be strategic and be open-minded and get in the game. So thank you for sharing those thoughts with us.


00:27:35:17 Thanks Igor, for having us.


00:27:38:08 And a reminder once again that the Deal Outlook for 2023 is available via the show notes for this recording. And before you know it, we will have Nick and Roel back to talk about 2023 and reflect back on their predictions.

00:27:55:11 For more on these topics and other health industry insights driven by policy, innovation and care delivery changes, please visit our website at Until next time, this has been Next in Health.


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Jennifer Colapietro

Jennifer Colapietro

Cloud & Digital Leader, PwC US

Igor Belokrinitsky

Igor Belokrinitsky

Principal, PwC US

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