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<ul class="summary-list"><li>The healthcare market looks nearly ready for the next wave of IPOs.</li><li>Barclays' Jon Swope says IPO hopefuls should prepare by increasing the awareness of their companies.</li></ul>It's been a rough few years for healthcare initial public offerings. But the next wave of public healthcare companies looks to be on the horizon.At least two healthcare companies are considering public-market debuts in the not-so-distant future. The diabetes startup <a target="_blank" class="" href="https://www.businessinsider.com/exclusive-omada-health-confidentially-filed-s1-ipo-public-2024-10">Omada Health confidentially filed its S-1 this summer</a>. And the physical-therapy startup <a target="_blank" class="" href="https://www.businessinsider.com/hinge-health-s-1-morgan-stanley-ipo-2024-9">Hinge Health has hired banks including Barclays</a> as it prepares to file its S-1 confidentially.Hinge and Omada likely aren't the only healthcare companies <a target="_blank" class="" href="https://www.businessinsider.com/healthcare-startups-ipo-public-markets-reopens-2024-1">weighing an IPO as market conditions improve</a>.Jon Swope, a managing director in Barclays' healthtech division, told me he expects a pickup in healthcare IPOs in 2025 after a three-year drought.<div type="image" title="A headshot of Jon Swope." height="1200" width="846" msid="114356715" hostid="261" sizebytes="24914"></div>I spoke with him about what the next wave of healthcare IPOs could bring — and which healthcare startups are in the best position to test the public markets.The following has been edited for clarity and length.In the past few years there have been a number of take-privates and near-delistings in healthcare, as well as plenty of healthcare companies that have otherwise struggled in the public markets. What can we learn from those companies' challenges, and how might they impact the next round of healthcare IPOs?The whipsaw of the public markets over the last five years has created a challenging backdrop, even with the overall market improving.From 2019 through 2021, nearly 20 companies went public through IPOs or SPACs in healthtech. At its peak, the total market cap for healthtech and digital health was over $300 billion. Through both take-privates and declines in share prices, that's down to just about $90 billion.Large take-privates like Change Healthcare, Nuance, Cerner, Inovalon, and others are part of the story. The other part is that, on average, the companies that went public or were already public are down by about 80% — names like Teladoc, Accolade, and Health Catalyst.The enthusiasm that supported the last wave, with respect to the positive and innovative business models in healthtech and digital health, is not gone. It's just that these companies haven't been able to achieve growth with profitability. When there's a next set, there's going to be more of a focus on growth and profitability.You see that in the IPOs that happened this year: Waystar and Tempus. Waystar is large-scale, profitable, with growth, and Tempus has the promise of AI, high growth, and emerging profitability. Both have performed since their public debut.In the private sphere, many investors have leaned away from healthcare services and into healthcare AI. What models do you expect the healthcare market to favor in this next round of IPOs?There are three general categories that are investible in healthtech and digital healthcare. One is simply data and then technology and healthcare. Healthcare is arguably two decades behind every other industry in the adoption of technology. Whether it's software, tech-enabled models, or, importantly, the data opportunity and AI opportunity, tech and data infrastructure for healthcare is No. 1.No. 2 is consumer-centric models, such as some B2B2C models, the employer and payer digital-health models, or even direct-to-consumer models. Look at <a target="_blank" class="" href="https://www.businessinsider.com/inside-hims-founders-journey-to-go-public-via-spac-2021-1">the performance of Hims</a>, which has emerged from its post-SPAC purgatory.Consumer-centric healthcare is the future of healthcare, and it's becoming more of our collective reality. The companies with consumer-centric business models that deliver longitudinal engagement and outcomes, financial and clinical, for consumers and the payers of healthcare, both employers and insurance companies, are certainly on the list.No. 3 is value-based care. Much has been made of that as a category, tying together costs and outcomes. And while some of the brick-and-mortar value-based care companies have had their own challenges, support for the adoption of value-based care by providers will continue to be where healthcare is going.Are there models in healthcare that you think are perhaps not the best fit for the public markets right now?The less complex the elevator pitch, the better. While I can't say there's a model that's not a fit, what we heard from investors as things were bending in the wrong direction last boom cycle was: "Wait, what did I just buy? I'm not sure I fully understand this company's business model."Now you have to juxtapose that against the reality of healthcare, which is complex. So it's companies that can articulate a clear and simple story while also navigating the layers of the healthcare ecosystem in executing on their business model.That includes riding the existing rails. In the last five-plus years we've seen companies figuring out how to work with the payers and providers that make up the healthcare ecosystem to bring innovation and disruption to how we experience healthcare.Given the major slowdown in SPAC deals in the past few years and Nuvo's poor performance (<a target="_blank" href="https://www.bloomberg.com/news/articles/2024-08-22/newly-public-pregnancy-care-firm-nuvo-files-for-bankruptcy">and bankruptcy</a>) this year, could we see more SPAC deals for healthcare startups next year?It's a four-letter word for the foreseeable future. I imagine there will be SPACs created, and there are still others that haven't run out of time, but it's unlikely that we see companies using that vehicle that could go public the regular way.For startups that don't go public, will we see M&amp;A pick up in 2025? With large retailers like Walmart pulling away from healthcare, who are the potential buyers?M&amp;A is picking up already, as evidenced by volume this year, and it will continue to, particularly in an easing financing environment and macro backdrop where bid-ask spreads are narrowing.The consolidation activity is in three categories. First, there are the large-cap consolidators including retailers, payers, and Big Tech. There will be deals there, but there are only so many that will be done by that group, which is not much more than a dozen companies.The next is large-cap, and often private-equity-backed, healthtech consolidators. A number of them are private and will continue to be buyers.The third category is just smaller mergers of equals. Especially for enterprise sales, selling into payers or selling to providers, scale matters, and so size matters. We'll see small companies merge with other small companies to get there.Anything else startups should know that might impact this next cycle of IPOs?While these companies that went public in the last cycle may not have fulfilled their promises, they set the stage for an attractive IPO market by going public the right way — executing on the business and growing it, and increasing awareness around the company well in advance of an IPO.At the back end of the last boom wave there was a rush to go public, and SPACs were examples of that. I think that in the 2025, 2026, and 2027 IPO classes, there will be a number of companies that think about it the right way, not rushing to get to the public market.

2025 could bring a wave of healthcare IPOs. Here's what startups should know, according to a top banker.

<ul class="summary-list"><li>Goldman Sachs and Morgan Stanley have reportedly been tapped on a valuation of OpenAI.</li><li>The transformative AI startup is evaluating what it could take to become a for-profit company.</li></ul>As <a target="_blank" class="" href="https://www.businessinsider.com/goldman-sachs-3q-results-dealmaking-trading-resurgence-david-solomon-2024-10">third-quarter earnings demonstrated</a>, Wall Street dealmaking appears to be bouncing back after three years of lackluster activity.For bank bosses, it signals a return to vying for the <a target="_blank" class="" href="https://www.businessinsider.com/megamergers-deals-m-a-wall-street-comeback-2024-9">biggest M&amp;As</a>, IPOs, and debt-capital raises in hopes of the largest paydays for themselves and their firms. Yet, one of the most coveted projects on the Street right now is unlikely to mint much money for the investment banks involved — at least in the short term.Last week, the <a target="_blank" href="https://www.wsj.com/tech/ai/the-14-billion-question-dividing-openai-and-microsoft-71cf7d37">Wall Street Journal reported</a> that OpenAI and its longtime backer, Microsoft, have begun talks to determine how much money Microsoft stands to receive if OpenAI converted to a for-profit institution. The Journal reported that OpenAI tapped advisors at <a target="_blank" class="" href="https://www.businessinsider.com/goldman-sachs-2q-earnings-david-solomon-investment-banking-forecast-2024-7">Goldman Sachs</a>, and Microsoft, which has poured some $14 billion into the AI startup as a nonprofit, is relying on Morgan Stanley to facilitate the negotiations. Spokespersons for both Goldman Sachs and Morgan Stanley declined to comment or confirm their reported participation in the project.BI called up two Wall Street dealmakers who specialize in tech banking to walk us through what the process could look like, as well as a valuation expert on the faculty of the <a target="_blank" class="" href="https://www.businessinsider.com/wharton-data-science-class-upenn-madoff-diamonds-airbnb-finance-jobs-2022-3">Wharton School at the University of Pennsylvania</a>. They also shared a look at what it could mean for the banks that won this business, both in terms of pay and reputation. The two investment bankers – neither of whom are affiliated with Goldman, Morgan Stanley, OpenAI, or Microsoft — requested anonymity to preserve industry relationships.The experts said the OpenAI valuation process stands to be stressful and drawn out — potentially taking up to six months — and could come with little to no financial reward for the banks involved. That said, the job still represents a huge win for Goldman and Morgan Stanley's tech teams since they now stand at the front of the line for whatever comes next for OpenAI.Thanks to ChatGPT, San Francisco-based OpenAI stands at the forefront of the artificial-intelligence revolution, which is <a target="_blank" href="https://www.pwc.com/gx/en/issues/artificial-intelligence/publications/artificial-intelligence-study.html">projected</a> to contribute nearly $16 trillion to the world economy by 2030, according to consulting firm PwC. <a target="_blank" href="https://www.wsj.com/tech/ai/openai-nearly-doubles-valuation-to-157-billion-in-funding-round-ee220607?mod=article_inline">A recent fundraise</a> valued the company at more than $150 billion. After it converts to a for-profit company, it could seek to raise money through the stock market or make acquisitions — all of which could prove lucrative for its Wall Street partners.Even the banks that are not part of this process stand to win if the final valuation is high enough, said Michael Roberts, the finance professor at Wharton. "If it comes at a really high multiple, what does that mean? It means you can raise an enormous amount of money if you are an AI company," he said, adding: "If I go back 15 years, the place to be as an investment banker was in Silicon Valley. But this could be sort of the next Silicon Valley 3.0."Here's a look inside the process and what it means for the Wall Street dealmakers who won this business, according to the tech bankers and the finance professor.<h2 id="277fe458-53dd-471b-bcca-880ebd8043d7">The banks have different goals: 'You're going to do battle'</h2>Morgan Stanley's objective will be to secure the greatest equity for its client, Microsoft, while Goldman's goal may be the opposite — pitting the two sides against one another."You're going to do battle," said one of the sources — a senior tech banker at a midsize investment bank — about the bankers on either side of the negotiating table.The valuation could take as much as six months, depending on what legal snags crop up, these people said. Since there's no obvious precedent for valuing this company, the bankers will want to get creative, which could open the door to lots of debate.The tech banker at the midsize firm said the goal will be to find comparisons in the real world that would make a compelling case for what OpenAI could be worth. "You might look at some of the early days of the last couple of generations of very disruptive technologies," he said, citing Apple in its early iPhone era and Google "back in the early days of disrupting the search market."The second banker, a former executive at a large-cap investment bank who now handles some tech deals at a small, independent firm, said that the banks will do a "landscape analysis" and ask questions about whether OpenAI could one day take Google's place.Roberts, the Wharton professor, proffered the name of another disruptive tech company: Uber. As it redefined the ride-hailing industry, there were "enormous" variations in its valuation projections. For OpenAI, though, the situation could be even more complex since its impact on the economy stands to be more dramatic.<h2 id="f2400755-f31e-489f-891d-876291a5211f">Risks and rewards</h2>Two of the experts BI spoke to estimated that the banks' fees for their work on the valuation could be low, at under $25 million each, with one suggesting it could even be gratis due to the competitive nature of the business. A third expert estimated the fees would likely be greater than $25 million but under $100 million.For context, advising on an actual merger or big-ticket public offering can <a target="_blank" class="" href="https://www.cnbc.com/2021/07/04/banks-earn-650-million-in-fees-and-stock-gains-from-ipo-flurry.html">generate many multiples of that</a> for investment-banking advisors — to the tune of hundreds of millions.The fees, however, are not likely the focus. "The goal is to lock the relationship up," said the senior technology dealmaker at the midsize firm, noting that OpenAI and Microsoft are companies that bankers would kill to have as clients.This banker said <a target="_blank" class="" href="https://www.businessinsider.com/sam-altman-chatgpt-openai-ceo-career-net-worth-ycombinator-prepper-2023-1">Sam Altman</a>, the founder of OpenAI, appears to put a premium on trust and interpersonal relationships, which could be to Goldman's benefit. He has a reputation for being "loyalty-driven," said the banker, who has met Altman and knows his reputation through conversations with the tech community.Morgan Stanley, for its part, has enjoyed a relationship with Microsoft that stretches back years. In 2016, the firm was the <a target="_blank" href="https://www.businessinsider.com/microsoft-and-linkedin-bankers-2016-6">only advisor to Microsoft</a> on its $26 billion acquisition of social-networking-giant LinkedIn.This wouldn't be the first time banks have shown a willingness to play the long game in exchange for future potential gains.In 2022, a syndicate of banks led by Morgan Stanley <a target="_blank" href="https://www.businessinsider.com/how-elon-musk-was-able-to-buy-twitter-despite-risks-2022-4">assembled $25 billion in capital</a> to lend to Tesla founder Elon Musk to finance his acquisition of X, the social-media platform formerly known as Twitter. X's lackluster financial performance prevented some banks <a target="_blank" href="https://www.businessinsider.com/elon-musk-x-twitter-debt-financing-banks-2008-financial-crisis-2024-8">from offloading the debt</a>, leading to losses. However, the goal, as one banker said at the time, was to "get a foot in the door with the man and his business."The investment banker who formerly worked at a large-cap bank said potential drawbacks could include some banks being excluded from other AI deals for competitive reasons."The likelihood that Google would take a very stance and be less willing to work with them is probably high because whenever you're involved in something like this, you're 'under the tent,' and you're seeing a lot of very sensitive things about where something is going and not going," this person explained.Largely speaking, however, Wall Street is poised to win, Roberts said."Given how much money's at stake here, even the loser isn't really going to lose, are they?" he said, adding, "It's all relative."Are you an investment-banking insider? Get in touch with this reporter. Reed Alexander can be reached via email at ralexander@businessinsider.com, and SMS/the encrypted app Signal at (561) 247-5758.

Inside Wall Street's efforts to value OpenAI: Who's involved, how it could work, and what's at stake for the banks

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2025 could bring a wave of healthcare IPOs. Here's what startups should know, according to a top banker.

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Inside Wall Street's efforts to value OpenAI: Who's involved, how it could work, and what's at stake for the banks

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