By Asif Shahinsha, Executive Director, TH Global Capital Healthcare & Life Sciences Investment Banking:
I spend a significant portion of each year at conferences – not for the panels or the branded lanyards, but because there is no substitute for reading a room. When thousands of operators, investors, buyers, and builders converge in one place, the aggregate signal is almost always more revealing than any single data point you can find in a research report.
This spring, two conferences stood out: SCOPE 2026, the clinical trial ecosystem’s defining annual event, and HIMSS26, the flagship gathering of the global healthcare IT community in Las Vegas. I came away from both with a sharpened view of where capital is flowing, which operators are pulling ahead, and critically for the work we do at TH Global Capital Healthcare and Life Sciences Investment Banking, what separates an asset worth backing from one that only looks good on a teaser.
This piece covers both. It is long, deliberately so. If you are involved in M&A, PE investment, or strategic positioning across pharma services or healthcare technology, I hope it earns the read.
PART ONE
SCOPE 2026: The Clinical Trial Industry Is Re-Pricing Itself
SCOPE has always been a useful barometer for where the CRO and pharma services sector is heading. But this year felt different. There was a palpable sense that the market is in the middle of a genuine repricing — not just of multiples, but of what ‘good’ actually looks like in a clinical trial services business.
Three themes ran through virtually every substantive conversation I had.
- Access-Ready Trials Have Become Table Stakes for Premium Valuations
For years, Health Economics and Outcomes Research (HEOR) and market access planning were treated as downstream activities, i.e. things pharma companies dealt with after a drug was approved, not during the trial itself. That boundary has effectively collapsed.
Payers, particularly in Europe, where the EU Joint Clinical Assessment (JCA) framework is now live, are scrutinising trial design at a level of granularity that was unthinkable five years ago. They want comparative effectiveness evidence, not just placebo-controlled data. They want Real-World Evidence (RWE) frameworks embedded from protocol design, not retrofitted after the fact. They want to see that the sponsor and their CRO partner understood the reimbursement environment before a single patient was enrolled.
From a valuation standpoint, this shift is material. Assets with genuine HEOR and market access integration, the ability to design trials with payer-grade evidence generation built in, are commanding 10–20% premiums over functionally equivalent CROs that treat clinical operations and access as separate disciplines. When I see an asset with a credible track record on NICE/G-BA submissions or prospective RWE studies supporting label expansion, that capability belongs in the investment thesis, not in the footnotes.
Conversely, a CRO that positions itself primarily as a ‘regulatory approval expert’ without any mention of patient access is increasingly being read as a business that is behind the curve — regardless of how many Phase III completions it can cite.
“The question is no longer whether a trial will get approved. The question is whether it will get paid for and whether your CRO understood that from day one.”
- Production-Grade AI Has Arrived and the Gap Is Widening
AI was everywhere at SCOPE, as it has been at every healthcare conference for the past three years. But this year something had changed in the nature of the conversations. The pilot era is over. The market has lost patience with roadmaps.
The businesses that are pulling ahead are not those that can demonstrate a prototype or reference an AI partnership announcement. They are the ones that can point to AI deployed in production across more than a quarter of their active studies, with documented evidence of what it is delivering: time savings, cost reduction, query rates, database lock timelines. The difference between ‘we have AI capabilities’ and ‘here is our measured ROI’ is now the difference between a standard multiple and a premium one.
The use cases that are generating the most commercial traction are not the speculative ones. They are the operationally proximate ones: AI-assisted protocol authoring that reduces amendment cycles, automated EDC build that cuts study setup time by weeks, eTMF quality control that catches deviations before they become inspection findings, and feasibility simulation that actually improves site selection accuracy rather than just replicating what a CRA would have done manually.
The valuation framework I came away with is fairly direct: pilots only, no documented ROI = no premium. One or two production use cases with measurable output = perhaps 10% uplift. Three or more use cases at scale with demonstrated ROI = 20 to 30% premium, particularly for software-enabled platforms.
- AI-powered protocol authoring / optimisation
- Automated EDC study build
- eTMF quality control automation
- Feasibility simulation and patient matching
- Literature monitoring for pharmacovigilance
AI only performs as well as the data it runs on. The assets that will sustain their AI advantage are those investing now in clean, standardised, well-governed data infrastructure and not those layering AI tools on top of fragmented legacy systems.
- Site Relationships Are Now a Competitive Moat or an Existential Liability
The third theme was perhaps the most operationally nuanced, but it has significant implications for how we think about SMOs and ISNs specifically.
The industry average for site startup is still hovering around 7.5 months. Businesses that can demonstrate a consistent track record below five months are not just operationally impressive – they are commanding a 15 to 25% valuation premium, especially in the ISN and SMO segments where the roll-up thesis depends on repeatable execution at scale.
What is driving the gap is not just technology, though technology matters. It is the nature of the site relationship itself. Businesses that have invested in long-term site partnerships, i.e unified sponsor experience models, single point of contact, coordinated communication, integrated eISF and SSO infrastructure, are producing fundamentally better outcomes than those treating each study as a transactional engagement. When site satisfaction scores and NPS are tracked and reported, when sites choose to work with you because the experience is better rather than because you were the lowest bidder, the compounding effect on enrollment speed and data quality is real.
The implication for deal underwriting is straightforward: ask to see site startup time distributions, not averages. Ask whether NPS is tracked. Ask whether key sites are contracted as preferred partners or re-engaged study by study. The answers will tell you a great deal about the durability of the operational model.
The PE Lens: Where the Opportunity Actually Sits
Stepping back from the thematic analysis, the SCOPE market map continues to point to a clear hierarchy of investment attractiveness. Site Ownership Networks remain an attractive segment by virtually any measure: clear roll-up playbook, strong unit economics at 20–25% EBITDA margins and exit multiples of 11–15x EBITDA to large CRO or strategic buyers. The playbook of acquiring regional ISNs with 5–15 sites at $50–150M enterprise value and building to 30–40 sites over five years remains compelling.
The FSP and BPO hybrid segment ranks second, driven by the 90%+ adoption rate of functional service models among biopharma organisations and the significant offshore arbitrage opportunity with 60–70% labour cost savings available to businesses that can successfully build India or Philippines-based delivery infrastructure around an onshore client-facing model.
Tech-enabled patient recruitment rounds out the top three. With 80% of trials still experiencing enrollment delays, the pain point is acute and the premium for proprietary patient databases, AI-matching technology, and genuine digital marketing capability is well-supported by recent transaction comparables.
The key questions, to summarize are: Does this asset have access-ready capabilities? Is AI deployed in production with documented ROI? Is site startup consistently below five months? Does it have a diversity enrollment track record? And can it demonstrate patient retention above industry benchmarks? A business that scores well across these dimensions is a premium asset. One that scores poorly on two or more is not a discount opportunity but potentially, a structurally challenged business.
PART TWO
HIMSS26: Digital Health’s Reckoning with Reality
If SCOPE is the clinical trials industry taking its own temperature, HIMSS is the broader healthcare technology ecosystem doing the same, at a rather different scale. More than 24,000 healthcare and technology leaders converged in Las Vegas from March 9–12.
This year, the energy was different from recent vintages. More grounded. More serious. The infectious optimism of the AI hype cycle was still present, but it was tempered by a growing collective honesty about how hard implementation actually is, and how far most organisations still must travel.
- AI Moved from Hype to Accountability and the Humility Was Refreshing
If HIMSS25 was about what AI could theoretically do for healthcare, HIMSS26 was about what it has actually done so far, and the gap between those two things turned out to be a more interesting conversation than anyone’s launch announcement.
The proliferation of AI agents drew significant attention. Oracle rolled out a new agent across 30 specialties to assist physicians with note drafting and next-step suggestions. Amazon expanded access to its agentic health assistant beyond One Medical clinics to broader consumer channels. Samsung announced a collaboration with Verily Life Sciences combining Galaxy Watch biosensor data with Verily’s precision health platform for real-world research evidence generation. The announcements were substantive. But what struck me more was the tone of the conversations that surrounded them.
There was noticeably more humility in the hallways than in the press releases. People who have been deep in AI implementation, in EHRs, in clinical workflows, in revenue cycle, were openly acknowledging that we are in the early innings of a genuine technological revolution, and that no one can credibly claim to have a complete playbook yet. That honesty is healthy. It is also, from an investment perspective, a more useful signal than confident projection. The businesses that will win in healthcare AI are not necessarily the ones with the most sophisticated models. They are the ones with the change management capability, the clinical governance, and the data infrastructure to actually deploy and sustain those models in complex institutional environments.
“The question at HIMSS26 wasn’t whether AI works. It was whether your organisation can actually make it work, and that is a much harder question.
- Cybersecurity Is the Unresolved Crisis That Everyone Knows About and No One Has Solved
The Change Healthcare cyberattack which ultimately affected more than 190 million Americans and disrupted virtually the entire US hospital billing infrastructure, shall cast a long shadow over the conference for years. The sheer scale of what a single successful ransomware attack can do to a system as interconnected as US healthcare has fundamentally shifted how boards and C-suites are thinking about security investment.
The cybersecurity track at HIMSS26 was extensive, covering zero-trust architecture, IoMT and medical device security, HIPAA risk analysis, ransomware resilience, and the emerging challenges of operational technology (OT) security in clinical environments. The scope of topics reflected the scope of the problem: healthcare’s attack surface is enormous, its legacy infrastructure is deeply vulnerable, and its appetite for connectivity, driven by EHR integration, remote monitoring, and digital health platforms. continues to expand that surface faster than most organisations can defend it.
What I found most instructive was the consensus view on where the real gaps are. Technical controls have improved. Governance has not kept pace. The human element, insider risk, social engineering, credential management, remains the most common attack vector. And the gap between large health systems that can afford sophisticated security infrastructure and smaller hospitals and practices that cannot is widening, not narrowing.
From an M&A perspective, cybersecurity posture is now a first-tier diligence issue in any healthcare IT transaction. Any asset that processes protected health information without a mature incident response and business continuity capability is carrying material risk that should be reflected in valuation.
- Care Is Moving to the Home and the Data Infrastructure Must Follow
The extension of federal approvals for telehealth through 2027 and hospital-at-home waivers through 2030 may not have generated the most dramatic press coverage at HIMSS, but they may prove to be among the most consequential policy developments for the healthcare technology sector in this decade.
Hospital-at-home is not a niche programme. It is a fundamental restructuring of where acute care is delivered, and the data and technology implications are substantial. When a patient is receiving IV antibiotics and continuous monitoring in their living room rather than a hospital bed, the requirements for remote monitoring infrastructure, EHR integration, clinician communication tools, and real-time safety oversight are all amplified. The Samsung/Verily collaboration I mentioned earlier is one example of how wearable and precision health platforms are beginning to build the evidence base that will be needed to sustain and scale these models.
Zoom’s announcement that 300-plus healthcare organisations are now using its customer experience solutions for patient communication, alongside new capabilities for frontline clinical coordination, reflects the broader pattern. The infrastructure of the hospital is being disaggregated and redistributed. The companies that understand how to make that work, not just technically, but operationally, regulatorily, and from a data governance perspective, are building genuinely durable competitive positions.
The interoperability challenge that sits underneath all of this remains formidable. The European Health Data Space is moving in a similar direction on the other side of the Atlantic, creating both obligations and opportunities for providers and technology vendors. The organisations that have invested in clean, interoperable data infrastructure are not just better positioned for regulatory compliance but also, they are better positioned for every AI, analytics, and care delivery innovation that will follow.
The Investment Signal from HIMSS26
HIMSS consistently reinforces the investment thesis for recurring-revenue healthcare IT businesses with genuine regulatory tailwinds and high switching costs. That thesis remains intact. What HIMSS26 added was nuance about where within that universe the premium opportunities sit.
RWD and RWE platforms are seeing growth rates of 14–17% CAGR with strategic value that extends beyond their standalone revenue — they are acquisition targets for CROs, pharma, and large health systems simultaneously, which creates competitive tension in deal processes that supports valuations. eCOA and ePRO platforms are benefiting from FDA and EMA’s increasing acceptance of patient-reported outcomes as primary endpoints, a regulatory tailwind that is still in early innings. And RBQM software — risk-based quality management — is seeing adoption driven by ICH E6(R2) mandates and a proven ROI of 30–40% reduction in on-site monitoring costs.
The caveat I would add, and it applies across all of these categories, is that the AI hype premium is beginning to compress. Assets that raised capital at elevated valuations on the strength of AI positioning alone are facing harder questions about what the AI actually delivers in production. The businesses that will sustain premium valuations are those that can demonstrate documented, measurable impact — not those that can describe a compelling roadmap.
Closing Thoughts: The Convergence Is Real
For investors, the implication is that the easy version of this market, where any asset with a healthcare technology label and a double-digit growth rate attracted premium capital is behind us. The businesses that will generate the best risk-adjusted returns over the next cycle are those where the operational differentiation is genuine, the AI story is grounded in documented performance, and the regulatory environment creates durable tailwinds rather than just near-term demand.
I am genuinely energised by what I saw at both conferences. The problems being solved are real and at least in the segments we focus on at TH Global Capital Healthcare and Life Sciences Investment Banking, reflects a market that is maturing without losing its dynamism.
I would welcome a conversation with founders who are operating business that are addressing these variables.