PwC Reveals Key Insights for ABA Buyers Amid Premium Valuations

The Firm

NEW YORK — PwC reported $56.9 billion in global revenue for the fiscal year ending June 30, 2025, up from $55.4 billion the prior year, according to the firm’s 2025 Global Annual Review. That places it second among the Big Four behind Deloitte, which posted $70.5 billion. PwC employs roughly 364,000 people across 149 countries, down from 370,000 a year earlier after a global headcount reduction of about 5,600 in FY2025.

The firm’s most recently disclosed segment-level breakdown, from FY2024, splits revenue across three service lines: Assurance ($19.5 billion), Tax and Legal ($12.6 billion), and Advisory ($23.3 billion). Advisory is the largest. The Deals platform sits inside it.

PwC’s Deals platform encompasses Financial Due Diligence, Deals Strategy and PE Value Creation, Deals Tax Consulting, Capital Markets Accounting Advisory Services (CMAAS), and Valuation. The platform serves corporate, entrepreneurial, and PE clients across mergers, acquisitions, alliances, IPOs, and divestitures. The firm itself was formed in 1998, through the merger of Price Waterhouse and Coopers & Lybrand. Both predecessor firms had roots in the nineteenth century.

Health Services Deals Leadership

PwC’s U.S. Health Services Deals team is led by Dan Farrell, Principal and U.S. Health Services Deals Leader. Farrell took over the role from Nick Donkar, who held it through the end of 2024 and into mid-2025. Glenn Hunzinger leads PwC’s broader U.S. Health Industries practice, coordinating consulting, deals, and advisory across the health ecosystem and hosting the firm’s Next in Health podcast.

The team focuses on payer, provider, and behavioral health transactions. It tracks deal flow across the entire health services sector and publishes annual and mid-year outlook reports that trade press, sell-side bankers, and PE deal committees treat as a baseline market read. The leadership change followed the same handoff cadence the firm has used in prior years.

“In health services, first movers who pair policy foresight with AI-driven execution will set the pace for the sector’s deals in 2026.” — Dan Farrell, U.S. Health Services Deals Leader, PwC (December 2025)

The 2026 Outlook on Behavioral Health

The Health Services Deals 2026 Outlook, published December 16, 2025, counted 910 health services M&A deals through year-end 2025, against announced deal value of roughly $46 billion through November 30. That compares with 1,373 deals at $62 billion in 2024 and 1,506 deals in 2023. The 2025 print is the lowest annual deal count since 2020.

The report identified three subsectors as still commanding strong multiples heading into 2026: ambulatory surgery centers, home-infusion services, and behavioral health platforms. PwC attributed the behavioral health placement to scalability and what the firm called favorable reimbursement direction. Both factors directly inform how PE sponsors evaluate ABA acquisition targets.

The outlook also flagged a structural PE shift away from reimbursement-exposed assets and toward software and services platforms supporting care delivery. For ABA-specific buyers, the implication runs two directions. Behavioral health platforms still draw capital. But pure clinical services exposure to Medicaid rate risk now competes with technology-enabled care models in deal selection, and that competition is sharpening.

Diligence Capabilities for ABA Transactions

PwC’s Financial Due Diligence team delivers quality of earnings (QofE) analysis, net working capital assessment, cash flow sustainability evaluation, and analysis of business drivers and industry-based issues for both buy-side and sell-side engagements. For ABA targets, the QofE work has to grapple with state-by-state Medicaid rate trajectories, payer mix stability, and supervision-ratio compliance. All three materially shape adjusted EBITDA.

The Deals Strategy and PE Value Creation team works with PE sponsors on pre-acquisition commercial diligence, post-acquisition value creation strategy, and portfolio optimization. Integration with the firm’s strategy consulting arm, Strategy&, allows financial and strategic diligence within a single engagement, a structure mid-market specialists rarely match. The Deals Tax Consulting practice handles tax structuring, multi-state tax implications of healthcare acquisitions, and the tax treatment of earnouts, non-compete agreements, and other deal-specific structures common in ABA transactions.

Multi-state ABA platforms often run dozens of subsidiary entities across states with different pass-through tax treatment. Tax diligence is not a check-the-box step. Healthcare actuarial and reimbursement consulting, run alongside the financial diligence team, models the financial impact of rate changes, payer mix shifts, and coverage policy modifications on provider revenue. For ABA platforms in states with pending rate cuts or accreditation mandates likely to trigger provider attrition and consolidation, that modeling translates regulatory exposure into adjusted EBITDA and forward-looking projections.

PwC’s Valuation practice rounds out the platform with fair value assessments, purchase price allocation analysis, and goodwill impairment testing. For PE-backed ABA platforms carrying substantial goodwill from prior add-on acquisitions, the valuation work helps buyers understand the composition and defensibility of the target’s asset base.

Where PwC Plays in ABA M&A

Like Deloitte, PwC’s primary engagement point in ABA M&A sits at the large-cap end. The firm’s fee structure, resource model, and partner-led engagement approach are built for institutional PE buyers and corporate acquirers evaluating platform-scale transactions. In behavioral health, that includes deals involving the largest multi-state ABA platforms, PE-backed roll-ups approaching or exceeding $1 billion in enterprise value, and cross-sector combinations where ABA is one component of a broader behavioral health or developmental disability platform.

For mid-market ABA transactions, PwC is engaged less often as the primary QofE provider. The firm shows up more commonly as an advisory layer for specific deal workstreams. PE sponsors may engage PwC for tax structuring, commercial diligence, or post-close integration strategy while a mid-market specialist handles the primary financial diligence. The tiered model reflects the math of mid-market deal fees against Big Four billing rates.

The firm’s distinctive contribution to ABA M&A goes beyond individual deal advisory. The annual Health Services Deals Outlook influences how PE sponsors think about subsector attractiveness, valuation benchmarks, and deal timing. When PwC names behavioral health a high-multiple subsector, that assessment is read by the deal committees and investment professionals who allocate capital to ABA platform acquisitions.

“Tech-enabled care, behavioral health and physician specialty platforms could see some of the most aggressive capital flows in years as acquirers look to scale models that can grow without adding labor.” — Dan Farrell, PwC (December 2025)

What ABA Stakeholders Take From It

For ABA practice owners considering a sale, PwC matters less as a likely advisor and more as the source of buyer-side framing. The firm’s published findings on deal multiples, subsector attractiveness, and volume trends help owners understand what acquirers are looking at and how they are pricing it.

For PE sponsors, PwC offers a combination of market intelligence and integrated transaction advisory that few mid-market shops can match. Annual deal tracking, named sector leaders with deep healthcare M&A experience, and a single platform spanning financial, tax, commercial, and strategic diligence make it a one-stop deal-execution partner for large-cap ABA transactions.

For the ABA industry broadly, PwC’s identification of behavioral health as a subsector commanding strong multiples reinforces the view that ABA remains an attractive investment category despite rising regulatory scrutiny. Whether that view holds will be tested by the deal pipeline through the first half of 2026.

PwC’s mid-year health services deals update, typically released in late June or July, will be the next data point. The firm’s 2026 outlook called for a rebound in both deal value and volume. The mid-year report will say whether that rebound arrived.

AT A GLANCE

SOURCES & REFERENCES