Alternate Health Valuation Multiples

Alphabet is a holding company that wholly owns internet giant Google. The California-based company derives slightly less than 90% of its revenue from Google services, the vast majority of which is advertising sales. Alongside online ads, Google services houses sales stemming from Google’s subscription services (YouTube TV and YouTube Music, among others), platforms (sales and in-app purchases on Play Store), and devices (Chromebooks, Pixel smartphones, and smart home products such as Chromecast). Google’s cloud computing platform accounts for roughly 10% of Alphabet’s revenue. The firm’s investments in up-and-coming technologies such as self-driving cars (Waymo), health (Verily), and internet access (Google Fiber) make up the rest.

Microsoft develops and licenses consumer and enterprise software. It is known for its Windows operating systems and Office productivity suite. The company is organized into three equally sized broad segments: productivity and business processes (legacy Microsoft Office, cloud-based Office 365, Exchange, SharePoint, Skype, LinkedIn, Dynamics), intelligence cloud (infrastructure- and platform-as-a-service offerings Azure, Windows Server OS, SQL Server), and more personal computing (Windows Client, Xbox, Bing search, display advertising, and Surface laptops, tablets, and desktops).

Oracle provides enterprise applications and infrastructure offerings through a variety of flexible IT deployment models, including on-premises, cloud-based, and hybrid. Founded in 1977, Oracle pioneered the first commercial SQL-based relational database management system, which is commonly used by the world’s largest companies for high-volume online transaction processing workloads. Besides databases, Oracle also sells enterprise resource planning platforms and cloud infrastructure that play an increasingly important role in large language model training and inferencing.

Johnson & Johnson is the world's largest and most diverse healthcare firm. It has two divisions: innovative medicine and medtech. These now represent all of the company's sales following the divestment of the consumer business, Kenvue, in 2023. After restructurings in 2023-24, the drug division focuses on three main therapeutic areas: immunology, oncology, and neurology. Geographically, just over half of total revenue is generated in the United States.

Cisco Systems is the largest provider of networking equipment in the world and one of the largest software companies in the world. Its largest businesses are selling networking hardware and software (where it has leading market shares) and cybersecurity software such as firewalls. It also has collaboration products, like its Webex suite, and observability tools. It primarily outsources its manufacturing to third parties and has a large sales and marketing staff—25,000 strong across 90 countries. Overall, Cisco employs 80,000 people and sells its products globally.

UnitedHealth Group is one of the largest private health insurers and provides medical benefits to about 51 million members globally, including 1 million outside the US as of December 2024. As a leader in employer-sponsored, self-directed, and government-backed insurance plans, UnitedHealth has obtained massive scale in medical insurance. Along with its insurance assets, UnitedHealth's Optum franchises help create a healthcare services colossus that spans everything from pharmaceutical benefits to providing outpatient care and analytics to both affiliated and third-party customers.

Alibaba is the world's largest online and mobile commerce company as measured by gross merchandise volume. It operates China's online marketplaces, including Taobao (consumer-to-consumer) and Tmall (business-to-consumer). The China retail e-commerce platform is the most valuable cash flow-generating business at Alibaba. Additional revenue sources include China wholesale e-commerce, international retail and wholesale e-commerce, local consumer services, travel services, cloud computing, digital media and entertainment, Cainiao logistics services, and other businesses.

Palantir is an artificial intelligence, analytics, and automated decision-making company that leverages data to drive efficiency across its clients' organizations. The firm serves commercial and government clients via its Foundry and Gotham platforms, respectively. Palantir works only with entities in Western-allied nations and reserves the right not to work with anyone that is antithetical to Western values. The company was founded in 2003 and went public in 2020.

Siemens is a multi-industry company focused on the areas of automation, electrification, mobility, and healthcare. Its top three geographic regions—the United States, Germany, and China—contribute over half of group revenue. Siemens has a 71% investment in separately listed Siemens Healthineers. Recent portfolio activity included the listing of Siemens Energy, spinning out its power and gas and Siemens Gamesa business divisions in 2020.

Incorporated in 1911, International Business Machines, or IBM, is one of the oldest technology companies in the world. It provides software, IT consulting services, and hardware to help business customers modernize their technology workflows. IBM operates in 175 countries and employs approximately 300,000 people. The company has a robust roster of business partners to service its clients, which includes 95% of all Fortune 500 companies. IBM’s products, including Red Hat, watsonx, and mainframes, handle some of the world’s most important data workloads in areas like finance and retail.

Founded in Germany in 1972 by former IBM employees, SAP is the world’s largest provider of enterprise application software. Known as the leader in enterprise resource planning software, SAP’s portfolio also includes software for supply chain management, procurement, travel and expense management, and customer relationship management, among others. The company operates in more than 180 countries and has more than 400,000 customers, approximately 80% of which are small to medium-size enterprises.

Thermo Fisher Scientific sells scientific instruments and laboratory equipment, diagnostics consumables, and life science reagents. The firm operates through four segments as of year-end 2024 (revenue figures include some cross-segment revenue): analytical technologies (17% of sales); specialty diagnostic products (11%); life science solutions (23%); and lab products and services, which includes CRO services (the remainder).

Dell Technologies is a broad information technology vendor, primarily supplying hardware to enterprises. It focuses on premium and commercial personal computers, as well as enterprise on-premises data center hardware. It holds top-three market shares in its core markets of personal computers, peripheral displays, mainstream servers, and external storage. Dell has a robust ecosystem of component and assembly partners, and also relies heavily on channel partners to fulfill its sales.

Palo Alto Networks is a platform-based cybersecurity vendor with product offerings covering network security, cloud security, and security operations. The California-based firm has more than 80,000 enterprise customers across the world, including more than three fourths of the Global 2000.

Intuitive develops, produces, and markets a robotic system for assisting minimally invasive surgery. It also provides the instrumentation, disposable accessories, and warranty services for the system. The company has placed more than 10,000 da Vinci systems in hospitals worldwide, with more than 6,000 installations in the US and a growing number in emerging markets.

AppLovin is a vertically integrated advertising technology company that acts as a demand-side platform for advertisers, a supply-side platform for publishers, and an exchange facilitating transactions between the two. About 80% of AppLovin’s revenue comes from the DSP, AppDiscovery, while the remainder comes from the SSP, Max. AppLovin’s primary tool for future growth is AXON 2, which is an ad optimizer operating within the DSP that allows advertisers to place ads according to specified return thresholds.

Salesforce provides enterprise cloud computing solutions. The company offers customer relationship management technology that brings companies and customers together. Its Customer 360 platform helps the group deliver a single source of truth, connecting customer data across systems, apps, and devices to help companies sell, service, market, and conduct commerce. It also offers Service Cloud for customer support, Marketing Cloud for digital marketing campaigns, Commerce Cloud as an e-commerce engine, the Salesforce Platform, which allows enterprises to build applications, and other solutions, such as MuleSoft for data integration.

Abbott manufactures and markets cardiovascular and diabetes devices, adult and pediatric nutritional products, diagnostic equipment and testing kits, and branded generic drugs. Products include pacemakers, implantable cardioverter defibrillators, neuromodulation devices, coronary stents, catheters, infant formula, nutritional liquids for adults, continuous glucose monitors, and immunoassays and point-of-care diagnostic equipment. Abbott derives roughly 60% of sales outside the United States.

Shopify offers an e-commerce platform primarily to small and medium-size businesses. The firm has two segments. The subscription solutions segment allows Shopify merchants to conduct e-commerce on a variety of platforms, including the company’s website, physical stores, pop-up stores, kiosks, social networks (Facebook), and Amazon. The merchant solutions segment offers add-on products for the platform that facilitate e-commerce and include Shopify Payments, Shopify Shipping, and Shopify Capital.

CrowdStrike is a cloud-based cybersecurity company specializing in next-generation security verticals such as endpoint, cloud workload, identity, and security operations. CrowdStrike’s primary offering is its Falcon platform that offers a proverbial single pane of glass for an enterprise to detect and respond to security threats attacking its IT infrastructure. The Texas-based firm was founded in 2011 and went public in 2019.

S&P Global provides data and benchmarks to capital and commodity market participants. Its ratings business is the largest credit rating agency in the world and S&P's largest segment by profitability. S&P's largest segment by revenue is market intelligence, which provides desktop, data and advisory solutions, enterprise solutions, and credit/risk solutions mostly in the financial-services industry. S&P's other segments include energy (formerly commodity insights, this segment includes Platts and other data), mobility (Carfax), and indexes. S&P plans to spin off mobility in 2026.

In 1984, Danaher's founders transformed a real estate organization into an industrial-focused manufacturing company. Then, through a series of mergers, acquisitions, and divestitures, Danaher now focuses primarily on manufacturing scientific instruments and consumables in the life sciences and diagnostic industries after the late 2023 divestiture of its environmental and applied solutions group, Veralto.

Altria comprises Philip Morris USA, US Smokeless Tobacco, John Middleton, Horizon Innovations, and Helix Innovations. Through its tobacco subsidiaries, Altria maintains the leading position in cigarettes and smokeless tobacco in the United States and the number-two spot in machine-made cigars. The company's Marlboro brand is the leading cigarette brand in the US with 42% annual share in 2024. Beyond its core business, it holds an 8% interest in the world's largest brewer, Anheuser-Busch InBev and a 41% stake in cannabis manufacturer Cronos. It also acquired vaping company Njoy Holdings in 2023 and operates a joint venture with Japan Tobacco in the heated tobacco category for the US.

Intuit serves small and midsize businesses with accounting software QuickBooks and online marketing platform Mailchimp. The company also operates retail tax filing tool TurboTax, personal finance platform Credit Karma, and a suite of professional tax offerings for accountants. Founded in the mid-1980s, Intuit enjoys a dominant market share for small-to-midsize business accounting and self-serve tax filing in the US.

Stryker designs, manufactures, and markets an array of medical equipment, instruments, consumable supplies, and implantable devices. The product portfolio includes hip and knee replacements, extremities, endoscopy systems, operating room equipment, embolic coils, hospital beds and gurneys, and orthopedic robotics. Stryker remains one of the three largest competitors in reconstructive orthopedic implants and holds the leadership position in operating room equipment. Roughly one-fourth of Stryker's total revenue currently comes from outside the United States.

Adobe provides content creation, document management, and digital marketing and advertising software and services to creative professionals and marketers for creating, managing, delivering, measuring, optimizing, and engaging with compelling content multiple operating systems, devices, and media. The company operates with three segments: digital media content creation, digital experience for marketing solutions, and publishing for legacy products (less than 5% of revenue).

Cadence Design Systems is a provider of electronic design automation software, intellectual property, and system design and analysis products. EDA software automates and aids in the chip design process, enhancing design accuracy, productivity, and complexity in a full-flow end-to-end solution. Cadence offers a portfolio of design IP, as well as system design and analysis products, which enables system-level analysis and verification solutions.

Synopsys is a provider of electronic design automation software and intellectual property products. EDA software automates and aids in the chip design process, enhancing design accuracy, productivity, and complexity in a full-flow end-to-end solution. Synopsys’ comprehensive portfolio is benefiting from a convergence of semiconductor companies moving up the stack of technologies toward systems-like companies, and systems companies moving down-stack toward in-house chip design. The resulting expansion in EDA customers alongside secular digitalization of various end markets benefits EDA vendors like Synopsys.

One of the largest medical-device companies, Medtronic develops and manufactures therapeutic medical devices for chronic diseases. Its portfolio includes pacemakers, defibrillators, transcatheter heart valves, stents, insulin pumps, spinal fixation devices, neurovascular products, advanced energy, ablation laser therapy, and surgical tools. The company primarily markets its products to healthcare institutions and physicians in the United States, Western Europe, and Japan. Foreign sales account for roughly 50% of the company's total sales.

ServiceNow Inc provides software solutions to structure and automate various business processes via a SaaS delivery model. The company primarily focuses on the IT function for enterprise customers. ServiceNow began with IT service management, expanded within the IT function, and more recently directed its workflow automation logic to functional areas beyond IT, notably customer service, HR service delivery, and security operations. ServiceNow also offers an application development platform as a service.

Tata Consultancy Services is a leading global IT services provider based in Mumbai, India. Founded in 1968, it is one of the first companies to leverage a global delivery model that helps clients outsource their IT needs to offshore labor. The company boasts a wide range of offerings, including IT consulting, managed services, and business process outsourcing.

Fortinet is a platform-based cybersecurity vendor with product offerings covering network security, cloud security, zero-trust access, and security operations. The firm derives a majority of its revenue through sales of its subscriptions and support-based business. The California-based firm has more than 800,000 customers across the world.

Boston Scientific produces less invasive medical devices that are inserted into the human body through small openings or cuts. It manufactures products for use in angioplasty, blood clot filtration, kidney stone management, cardiac rhythm management, catheter-directed ultrasound imaging, upper gastrointestinal tract diagnostics, interventional oncology, neuromodulation for chronic pain, and treatment of incontinence. The firm markets its devices to healthcare professionals and institutions globally. Foreign sales account for roughly 36% of the firm's total sales.

Moody’s, along with S&P Ratings, is a leading provider of credit ratings on fixed-income securities. The ratings segment, Moody’s Investors Service, includes corporates, structured finance, financial institutions, and public finance ratings. MIS represents a majority of the firm’s profit and often (depending on bond issuance levels) a majority of the firm's revenue. The other segment, Moody’s Analytics, consists of decision solutions, research and insights, and data and information.

Datadog is a cloud-native company that focuses on analyzing machine data. The firm's product portfolio, delivered via software as a service, enables clients to monitor and analyze their entire information technology infrastructure, from servers to applications and Python scripts. Datadog's platform can ingest and analyze large amounts of machine-generated data in real time, allowing clients to utilize it for a variety of applications throughout their businesses to ensure uptime and latency objectives.

Cloudflare is a software company based in San Francisco, California, that offers security and web performance offerings by utilizing a distributed, serverless content delivery network, or CDN. The firm’s edge computing platform, Workers, leverages this network by providing clients the ability to deploy and execute code without maintaining servers.

Strategy Inc is a bitcoin treasury company and a provider of business intelligence services. It is designed to provide investors varying degrees of economic exposure to Bitcoin by offering a range of securities, including equity and fixed-income instruments. The company also provides industry AI-powered enterprise analytics software. It has one reportable operating segment: the Software Business, which is engaged in the design, development, marketing, and sales of the company's enterprise analytics software platform through cloud subscriptions and licensing arrangements and related services (i.e., product support, consulting, and education). Geographically, the company operates in EMEA, U.S. and Other Regions, of which maximum revenue is derived from U.S..

CoreWeave Inc is a modern cloud infrastructure technology company that offers the CoreWeave Cloud Platform which consists of proprietary software and cloud services that deliver the automation and efficiency needed to manage complex AI infrastructure at scale. Its platform supports the development and use of ground-breaking models and the delivery of the next generation of AI applications that are changing the way of living and working across the globe.

RELX is a global provider of information-based analytics and decision tools for professional and business customers in various industries. The company serves sectors such as science and medical research, risk management, and legal. In addition, RELX organizes large-scale digital and face-to-face events such as industry trade shows. Around 60% of revenue is generated in North America and about 20% in Europe.

Founded in 2012, Snowflake is a fully managed platform that consolidates data hosted on different public clouds for centralized analytics and governance. Snowflake’s cloud-native architecture allows users to independently scale the compute and storage layers, providing customers with optimized performance at lower costs. The company’s data lake and data warehouse products support a variety of use cases, including business analytics, data engineering, and artificial intelligence. Snowflake is widely used by Fortune 2000 companies in financial services, media, and retail sectors.

Founded in 1982, Autodesk is a multinational software company best known for pioneering computer-aided design, or CAD, with its AutoCAD product. Nowadays, Autodesk provides design software for a variety of verticals, including architecture & construction, manufacturing, and media & entertainment. Autodesk products have been used in some of the world's most iconic landmarks, like Burj Khalifa, and well-known movie titles like Avatar.

Baidu is the largest internet search engine in China with over 50% share of the search engine market in 2024 per web analytics firm, Statcounter. The firm generated 70% of core revenue from online marketing services from its search engine in 2024. Outside its search engine, Baidu is a technology-driven company and its other major growth initiatives are artificial intelligence cloud, video streaming services, voice recognition technology, and autonomous driving.

Spun off from Baxter International in 2000, Edwards Lifesciences designs, manufactures, and markets a range of medical devices and equipment for advanced stages of structural heart disease. It has established itself as a leader across key products, including surgical tissue heart valves, transcatheter aortic valves, and transcatheter mitral and tricuspid valve technologies. The firm derives about 60% of its total sales from outside the US.

Nebius is a vertically integrated cloud provider focusing on AI and high-performance computing. It is a carve-out of the previous Russian tech firm Yandex, following the Russian sanctions since the Ukraine-Russia war. Nebius designs and operates its own data centers and servers across Europe and the US, with a total capacity of several hundred megawatts. In September 2025, Microsoft became a major Nebius client under a multiyear $17 billion revenue agreement to provide computing capacity.

Siemens Healthineers is engaged in therapeutic imaging, radiotherapy, laboratory, and point-of-care diagnostics. The imaging segment (56% of sales in fiscal 2025) includes magnetic resonance imaging, computed tomography, X-ray systems, molecular imaging, and ultrasound. The Varian segment (18% of sales) offers radiotherapy and other oncology solutions. The diagnostics segment (19%) includes in vitro diagnostics and point-of-care diagnostics. The advanced therapies (now part of precision therapy) segment (9%) products are designed to support image-guided minimally invasive treatments in cardiology, interventional radiology, and surgery. The Americas represents 44% of total sales, Europe, Middle East, and Africa 32%, and Asia-Pacific, including China (11%), the remainder.

Idexx Laboratories primarily develops, manufactures, and distributes diagnostic products, equipment, and services for pets and livestock. Its key product lines include single-use canine and feline test kits that veterinarians can employ in the office, benchtop chemistry and hematology analyzers for test-panel analysis on-site, reference lab services, and tests to detect and manage disease in livestock. The firm also offers vet practice management software and consulting services to animal hospitals. Idexx derives roughly 35% of its revenue from outside the United States.

Celestica Inc offers supply chain solutions. The company has two operating and reportable segments: Advanced Technology Solutions (ATS) and Connectivity & Cloud Solutions (CCS). The ATS segment consists of the ATS end market and is comprised of the Aerospace and Defense, Industrial, health tech, and Capital Equipment businesses. Its Capital Equipment business is comprised of the semiconductor, display, and robotics equipment businesses, and the CCS segment consists of Communications and Enterprise end markets, The Enterprise end market is comprised of its servers and storage businesses. The company generates a majority of its revenue from the Connectivity & Cloud Solutions segment.

Constellation Software is an acquirer, manager, and developer of vertical market software, or VMS, businesses globally. VMS differentiates from horizontal software in that it provides mission critical solutions within a specific industry for customers in a particular market. Constellation operates through a decentralized model in which each business operates as its own independent entity. Managers of individual businesses are incentivized to optimize their business for returns on invested capital and revenue growth. Excess cash generated by the individual businesses is repatriated to portfolio managers who focus on allocating as much capital as possible on new acquisitions. As of 2025, Constellation consisted of over 1,000 individual businesses and 64,000 employees.