Benefit Systems Valuation Multiples

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.

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.

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 2025 (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).

Siemens is a German industrial technology group headquartered in Munich that supplies automation, electrification, rail and healthcare equipment, software and services. It was founded in Berlin on October 1, 1847 by Werner von Siemens and Johann Georg Halske as Telegraphen-Bauanstalt von Siemens & Halske. The group reports through Digital Industries (factory automation and industrial software), Smart Infrastructure (buildings and electrical distribution), Siemens Mobility (rolling stock, signalling and rail systems) and Siemens Financial Services, and holds about 75% of separately listed Siemens Healthineers. It sells mainly to manufacturers, utilities, infrastructure owners, transit operators and hospitals, and in fiscal 2025 generated revenue of €78.9 billion and net income of €10.4 billion with about 327,000 employees. In 2020 it spun off Siemens Energy, keeping a 17.1% stake, and bought Varian Medical Systems for US$16.4 billion; in 2025 it added Altair Engineering for about US$10 billion, its largest acquisition, and Dotmatics for US$5.1 billion. Roland Busch has been chief executive since February 2021, and the shares trade on the Frankfurt Stock Exchange as a DAX member.

Disney operates in three global business segments: entertainment, sports, and experiences. Entertainment and experiences both benefit from the firm’s ownership of iconic franchises and characters. Entertainment includes the ABC broadcast network, several cable television networks, and the Disney+ and Hulu streaming services. Within the segment, Disney also engages in movie and television production and distribution, with content licensed to movie theaters, other content providers, or, increasingly, kept in-house for use on Disney’s own streaming platform and television networks. The sports segment houses the ESPN family of TV networks and streaming services. Experiences contains Disney’s theme parks, cruises, and vacation destinations and also engages in merchandise licensing.

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.

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.

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.

Medtronic is a global medical-technology company founded in 1949 and legally headquartered in Ireland, with major operating leadership in Minnesota. It develops and manufactures therapeutic and diagnostic devices for cardiovascular disease, diabetes, neurological conditions, spinal disorders, surgical care and other chronic health problems. Products include pacemakers, defibrillators, transcatheter heart valves, stents, insulin pumps, ablation systems, patient-monitoring equipment and surgical tools. Hospitals, clinicians and healthcare systems buy the company's devices, disposable supplies, software and related services. Medtronic earns most of its revenue from product sales and serves customers across the Americas, Europe, Asia and other international markets. The company is publicly listed and maintains a large global research, manufacturing and commercial organization. Its cardiovascular strategy includes minority investments, partnerships and acquisitions of specialist medical-device developers. Medtronic invested in CathWorks, co-promoted its FFRangio system and completed the acquisition of the remaining shares for $585 million in April 2026.

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.

Elevance Health remains one of the leading health insurers in the US, providing medical benefits to 45 million medical members at the end of 2025. The company offers employer, individual, and government-sponsored coverage plans. Elevance differs from its peers in its unique position as the largest single provider of Blue Cross Blue Shield branded coverage, operating as the licensee for the Blue Cross Blue Shield Association in 14 states. Through acquisitions, such as the Amerigroup deal in 2012 and MMM in 2021, Elevance's reach expands beyond those states in government-sponsored programs, such as Medicaid and Medicare Advantage plans, too. It is also an emerging player in pharmacy benefit management and other healthcare services.

Cigna primarily provides pharmacy benefit management and health insurance services. Its PBM and specialty pharmacy services, which were greatly expanded by its 2018 merger with Express Scripts, are mostly sold to health insurance plans and employers. Its largest PBM contract is with the Department of Defense (current contract through 2029), and it recently won a multiyear deal with top-tier insurer Centene. In health insurance and other benefits, Cigna primarily serves employers through self-funding arrangements, and the company operates mostly in the US with 17 million US and 2 million international medical members covered as of December 2024.

Boston Scientific focuses on 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.

Natera Inc is a diagnostic and research company with proprietary molecular and bioinformatics technology. The company's key product offerings include its Panorama Non-Invasive Prenatal Test (NIPT) which screens for chromosomal abnormalities of a fetus as well as in twin pregnancies, typically with a blood draw from the mother, Horizon Carrier Screening (HCS) to determine carrier status for a large number of severe genetic diseases that could be passed on to the carrier’s children, Signatera molecular residual disease (MRD) test, which detects circulating tumor DNA in patients previously diagnosed with cancer to assess molecular residual disease and monitor for recurrence; and Prospera, to assess organ transplant rejection.

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.

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.

Veeva is the global leading supplier of cloud-based software solutions for the life sciences industry. The company's best-of-breed offerings address operating and regulatory requirements for customers ranging from small, emerging biotechnology companies to departments of global pharmaceutical manufacturers. The company leverages its domain expertise to improve the efficiency and compliance of the underserved life sciences industry, displacing large, highly customized and dated enterprise resource planning systems that have limited flexibility. Its two main products are Veeva CRM, a customer relationship management platform for companies with a salesforce, and Veeva Vault, a content management platform that tackles various functions within any life sciences company.

Originally spun out of Hewlett-Packard in 1999, Agilent has evolved into a leading life science and diagnostic firm. Today, Agilent's measurement technologies serve a broad base of customers with its three operating segments: life science and diagnostics, cross lab operations consisting of consumables and services, and applied end markets. Over half of its sales are generated from the biopharmaceutical, chemical, and advanced materials end markets, which we view as the stickiest end markets, but it also supports clinical lab, environmental, forensics, food, academic, and government-related organizations. The company is geographically diverse, with operations in the US and China representing the largest country concentrations.

Humana is one of the largest private health insurers in the US, and the firm has built a niche specializing in government-sponsored programs, with nearly all its medical membership stemming from Medicare, Medicaid, and the military's Tricare program. Beyond medical insurance, the company provides other healthcare services, including primary-care services, at-home services, and pharmacy benefit management.

Water sells liquid chromatography, mass spectrometry, and thermal analysis tools. These analytical instruments provide essential information on various products, such as their molecular structures and physical properties, to help clients enhance the health and well-being of end users. As a percentage of sales in 2024, Waters generated 58% from biopharmaceutical customers, 31% from industrial clients, and 11% from academic/government institutions. In early 2026, Waters plans to merge with BD's life science and diagnostics business, which will substantially change those concentrations. Waters will wind up with more concentration in diagnostics (versus none now) and discovery-related life science tools.

Iqvia is the result of the 2016 merger of Quintiles, a leading global contract research organization, and IMS Health, a leading healthcare data and analytics provider. The research and development segment focuses primarily on providing outsourced late-stage clinical trials for pharmaceutical, device, and diagnostic firms. The technology and analytics segment provides aggregated information and technology services to clients in the healthcare industry, including pharmaceutical companies, providers, payers, and policymakers, as well as data and analytics capabilities for clinical trials, including virtual trials. The company also has a small contract sales business.

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.

Roper Technologies is a holding company focused on acquiring, managing, and developing niche market-leading technology businesses. The company operates a decentralized business model whereby each portfolio company operates independently from the others. Roper positions itself as a free cash flow compounder, whereby excess free cash flow generated by its portfolio businesses is repatriated to the parent company, which is then utilized to acquire additional businesses. Presently, the company operates 30 distinct businesses with over three-fourths of the revenue coming from software products and over two-thirds of revenue coming from recurring and reoccurring sources.

Live Nation is the largest live entertainment company in the world, serving as a concert promoter, venue operator, and ticketing platform. In addition, the firm generates revenue from sponsorships and advertising. With offices in 51 countries, Live Nation promotes concerts globally and it owned, operated, or had exclusive booking rights to more than 400 venues worldwide at the end of 2025, which the firm says makes it the second-largest operator of music venues globally. In 2025, Live Nation promoted nearly 55,000 events, drawing roughly 160 million fans. Ticketmaster is a dominant global ticketing service, selling nearly 650 million tickets in 2025.

ResMed is one of the largest respiratory care device companies globally, primarily developing and supplying flow generators, masks and accessories for the treatment of sleep apnea. Increasing diagnosis of sleep apnea combined with ageing populations and increasing prevalence of obesity is resulting in a structurally growing market. The company earns roughly two thirds of its revenue in the Americas and the balance across other regions dominated by Europe, Japan and Australia. Recent developments and acquisitions have focused on digital health as ResMed is aiming to differentiate itself through the provision of clinical data for use by the patient, medical care advisor and payer in the out-of-hospital setting.

Mettler-Toledo supplies weighing and precision instruments to customers in the life sciences (around 55% of sales), industrial (around 40%), and food retail (around 5%) industries. Its products include laboratory and retail scales, pipettes, pH meters, thermal analysis equipment, titrators, metal detectors, and X-ray analyzers. Mettler leads the market for weighing instrumentation and controls more than 50% of the market for lab balances. The business is geographically diversified, with the Americas accounting for about 37% of sales, Europe about 27%, China about 16% and the rest of the world about 20%.

Oriental Land is a prominent Japanese company primarily known for its ownership and operation of the Tokyo Disney Resort. It includes two theme parks, Tokyo Disneyland and Tokyo DisneySea, as well as hotels, shopping, and dining facilities. Oriental Land collaborates closely with The Walt Disney Company under a licensing agreement until 2076. This partnership has been instrumental in establishing Tokyo Disney Resort as one of the leading tourist destinations in Japan, attracting millions of visitors annually from domestic and international markets. Beyond its entertainment ventures, Oriental Land has also ventured into real estate development and operates Ikspiari, a retail and entertainment complex adjacent to Tokyo Disneyland.

Shenzhen Mindray Bio-Medical Electronics Co Ltd is a developer, manufacturer, and supplier of medical devices. The company is focused on the medical industry in the fields of Patient Monitoring & Life Support, InVitro Diagnostics, and Medical Imaging.

GE HealthCare Technologies is a leading medical technology firm with leading market share in imaging and ultrasound equipment. The company reports four major segments: imaging (45% of revenue), advanced visualization solutions (26%), patient care solutions (15%), and pharmaceutical diagnostics (14%). The company’s sales are geographically diverse, with the United States, EMEA, China, and the rest of the world accounting for 46%, 26%, 11%, and 17% respectively. We estimate approximately half of its revenue is recurring, which consists of servicing (about one third of revenue), pharmaceutical diagnostics (about 10%-15%), and digital solutions (just over 5%).

DexCom designs and commercializes continuous glucose monitoring systems for diabetic patients. CGM systems serve as an alternative to the traditional blood glucose meter process, and the company is evolving its CGM systems to provide integration with insulin pumps from Insulet and Tandem for automatic insulin delivery. DexCom's CGMs are available through medical equipment distributors as well as retail pharmacies.

Labcorp is one of the nation's two largest independent clinical laboratories, with roughly 20% of the independent lab market. The company operates approximately 2,000 patient-service centers, offering a broad range of 5,000 clinical lab tests, ranging from uncomplicated routine blood and urine screens to complex oncology and genomic testing.

Quest Diagnostics is a leading independent provider of diagnostic testing, information, and services in the US. The company generates over 95% of its revenue through clinical testing, anatomic pathology, esoteric testing, and substance abuse testing with specimens collected at its national network of roughly 2,300 patient service centers, as well as multiple doctors offices and hospitals. The firm also runs a much smaller diagnostic solutions segment that provides clinical trials testing, risk-assessment services, and information technology solutions.

Koninklijke Philips is a diversified global healthcare company operating in three segments: diagnosis and treatment, connected care, and personal health. Nearly 50% of the company's revenue comes from the diagnosis and treatment segment, which features imaging systems, ultrasound equipment, and image-guided therapy solutions. The connected care segment (under 30% of revenue) encompasses monitoring and analytics systems for hospitals, informatics business, and also houses the sleep and respiratory care segment. Personal health business (remainder of revenue) is mainly oral health and personal care product lines, which include electric toothbrushes and men's grooming and personal-care products.

Guardant Health, based in Redwood City, California, is a leader in liquid-based cancer tests for clinical and research use. The company's main franchises are Guardant360 for genomic profiling of tumors, Reveal for molecular residual disease testing, and Shield for colorectal cancer screening. Additionally, Guardant offers research development services such as regulatory approval consultancy and clinical trial referrals.

Sartorius Stedim Biotech is a leading provider of bioprocessing solutions. Its sells equipment and consumables for fermentation, filtration, fluid management, purification, and cell culture media for manufacturing biologic drugs and has a focus on single-use technology. It is a subsidiary of Sartorius AG, which has 71.5% ownership and 83% voting control. The business is geographically diverse, with 35% of sales from the Americas, 42% from Europe, the Middle East, and Africa, 15% from Asia excluding China, and 8% from China.

Steris is an Ireland-domiciled medical technology company focused on sterilization services and infection prevention. The company is the global leader in contract sterilization services, ensuring the safe delivery of single-use and implantable medical equipment to hospitals around the world. Steris also sells sterilizers, washer-disinfectors, and other decontamination equipment and supplies for use by care provider facilities and in biopharma manufacturing sites. Domiciled in the United States before its inversion to Ireland, the firm derives approximately 70% of its revenue from Healthcare Services, 19% from Applied Sterilization Technologies, or AST, and 11% from life sciences services after the divestment of its dental products business.

Tenet Healthcare is a Dallas-based healthcare services organization. It operates acute and specialty hospitals (50 as of December 2025) and hundreds of ambulatory surgery centers and other outpatient facilities across the US, primarily in the South. Through its Conifer segment, Tenet also provides revenue cycle management solutions.

Sonova is one of the world's largest manufacturers and distributors of hearing aids. The company is based in Switzerland and distributes its products in more than 100 countries through its internal sales team and independent retailers. It also sells cochlear implants and audio technologies.

Medpace is a late-stage contract research organization that provides full-service drug-development and clinical trial services to small and midsize biotechnology, pharmaceutical, and medical device firms. It also offers ancillary services, including bioanalytical laboratory services and imaging capabilities. The company was founded over 30 years ago and has more than 5,400 employees across 40 countries. Medpace is headquartered in Cincinnati, Ohio, and its operations are primarily based in the US, with additional presence in Europe, Asia, South America, Africa, and Australia. Cinven, a global private equity firm, acquired Medpace for $915 million in 2014 and exited its investment in 2018.

Zimmer Biomet designs, manufactures, and markets orthopedic reconstructive implants as well as supplies and surgical equipment for orthopedic surgery. With the acquisitions of Centerpulse in 2003 and Biomet in 2015, Zimmer holds the leading share of the reconstructive market in the United States, Europe, and Japan. Roughly two-thirds of total revenue is derived from sales of large joints; another fourth comes from extremities, trauma, sports medicine, and related surgical products. The firm spun out its dental and spine businesses in 2022.

Revvity is a global life sciences and diagnostics company formed in 2023 following the rebranding of PerkinElmer. The company operates in two segments: life sciences, which provides reagents and instruments for biopharma and academic research, and signals software, and diagnostics, which offers tools in immunodiagnostics and newborn and reproductive health. Revvity’s products and services are sold worldwide, with major markets in the US, Europe, and China.

Shionogi & Co Ltd is a specialty and generic drug manufacturing company. The company focuses on the manufacturing and distribution of pharmaceuticals, diagnostic reagents, and medical devices. The company engages in manufacturing, formulation, packaging, and analysis as part of its commercialization research that spans late-stage drug discovery through commercial production. It provides products and services in Japan, Europe, North America, and other regions.

Fisher & Paykel Healthcare is one of the three largest respiratory care device companies globally. It is the market leader in hospital use humidifiers, masks, and related consumables, and the number three player in the at-home treatment of sleep apnea using respiratory devices. Both the hospital and homecare markets for respiratory devices are growing strongly in the developed markets in which Fisher & Paykel has a presence. The company earns 42% of its revenue in the US, 27% in Europe, 21% in Asia-Pacific, and the remaining 10% in emerging markets. Fisher conducts its own R&D and has thousands of patents and pending applications. It manufactures in New Zealand and Mexico and has a multichannel distribution model.

JD Health is the largest healthcare e-commerce platform in China in terms of revenue. The company offers pharmaceutical drugs and healthcare products on its platform, both as a marketplace that connects merchants to consumers and as a first-party, or 1P, direct retailer. It also offers online consultation from real life doctors and separately partners with offline pharmacies that can provide location-based 24/7 delivery as part of an omnichannel initiative to complement its core e-commerce business. Its closest competitors are Alibaba Health and Meituan for its e-commerce business. As of Dec. 31, 2024, the platform has over 200 million active annual users and over 70,000 merchants. JD Health is 67.49% owned by its parent company, JD.com.

Pro Medicus is a healthcare IT company specializing in radiology imaging software. Its main product, Visage 7, is a clinical desktop application that radiologists use to view, enhance, and manipulate images from any device and make a diagnosis. Its main customers are US private academic hospitals. In fiscal 2025, Pro Medicus earned 90% of revenue in North America, 8% from Australia, and the remaining 2% in Europe.

In spring 2024, 3M spun out its legacy healthcare segment as a stand-alone firm, Solventum. At that time, the firm comprised four segments. The smallest one—purification and filtration—has since been sold. Now, medsurg is the largest business, contributing roughly 64% of consolidated revenue, and includes advanced wound care and wound prevention. Dental solutions (restorative composites and orthodontia) and health information systems (mainly revenue cycle management) each contribute 18% of total revenue.

Icon is a global contract research organization that provides outsourced clinical development services to pharmaceutical and biotechnology firms. Icon supports clients across late-stage clinical trials through the regulatory approval process and postmarket studies. Icon’s services include clinical trial management, patient recruitment, data analytics, laboratory services, and regulatory consulting. With more than 40,000 employees operating in over 50 countries, the company partners with life sciences firms to run clinical trials and bring new drugs to market.

Shanghai United Imaging Healthcare Co Ltd provides customers with high-performance medical imaging equipment, radiotherapy products, life science instruments, and medical digitalization and intelligent solutions. The company’s products include MRI systems, CT scanners, X-ray imaging equipment, molecular imaging systems, radiotherapy linear accelerators, and life science instruments.