Strategic Insights for Healthcare and Private Equity in 2026 with Holly Buckley of McGuireWoods 12-5-25

Summary

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Podcast Summary: Becker Business – Strategic Insights for Healthcare and Private Equity in 2026

Host: Scott Becker
Guest: Holly Buckley, Chair of Healthcare at McGuireWoods
Date: December 5, 2025

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Episode Overview

In this concise yet insightful episode, Scott Becker welcomes Holly Buckley to discuss the pressing themes shaping healthcare and private equity as they move into 2026. Focusing on margin pressures, evolving regulatory complexities, leadership strategies, and sector trends, Buckley draws from her front-line experience advising organizations navigating a turbulent healthcare landscape. The conversation zeros in on how businesses and investors can thrive amid regulatory shifts and market uncertainty, with particular attention to the emergence of AI, sustained activity in core sectors, and practical leadership tactics for sustainable growth.

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Key Discussion Points and Insights

1. Defining Pressures: Margin Squeeze & Cost Challenges

[01:38–02:30]

• Holly Buckley opens with the "increased margin pressure" faced by healthcare providers, as reimbursement rates, especially from Medicaid, keep getting squeezed.
• Expense management remains crucial; while the intensity of labor cost discussions has cooled compared to previous years, these costs continue to be a factor.
• Memorable Quote:

  “Providers are really having to watch margins very, very closely. And that's always true in health care, but it feels more so the case across the board now than it has in a long time.”
  — Holly Buckley [01:45]

2. Leadership Strategies in Uncertain Times

[02:30–04:53]

• Buckley emphasizes the importance of discipline and deliberate execution over rapid, high-risk moves.

• Five years ago, broad consolidation was a workable strategy; today’s winners are those with focus, vision, and an ability to build best-in-class businesses.

• The most effective leaders are executing core strategies methodically, prioritizing incremental improvements and consistently "blocking and tackling."

• Memorable Quote:

  “It's really that people are doing things very deliberately…having real strategy and vision for what the business needs to be doing and then executing on it.”
  — Holly Buckley [03:10]

• Big risks are largely being avoided; success is coming from careful execution, not bold gambles.

• Memorable Quote:

  “Across the board I'm not seeing a lot of big risks being taken. It's more the deliberate step by step that I'm seeing prevail.”
  — Holly Buckley [04:53]

3. Regulatory and Reimbursement Landscape

[05:03–07:08]

• Regulatory scrutiny continues to intensify, especially at the state level; state laws are having outsized impacts on deal timelines—even small deals—due to low or nonexistent financial thresholds.
• Some investors are steering clear of states with especially onerous or unpredictable requirements, fearing major changes at exit.
• The newest California laws codify practice standards and expand requirements for deal disclosures, prompting more pre-deal strategizing.
• Memorable Quote:

  “We're seeing investors not go into certain states where those laws are very stringent and impose very long timelines… Something that two, three years ago was not really on most folks' radar.”
  — Holly Buckley [06:15]

4. Sectors & Technologies to Watch for 2026

[07:08–08:55]

• AI: Both in clinical delivery and back office roles, AI’s impact will keep growing, even if most current deals are small-scale. Buckley is especially enthusiastic about this evolving landscape.
• Longevity & Concierge Medicine: Paired with women's and men's health, these are burgeoning areas with significant discussion and emerging investment, although not yet massive deal volume.
• Staples Remain Strong: Home health, hospice, and dental continue to see robust activity, offering proven, lower-risk plays.
• AI in Legal Practice: Effects on day-to-day law and client experience are already being felt and will be a focus next year.
• Memorable Quote:

  “We're going to see more and more AI enabled solutions… that's going to be a super interesting area.”
  — Holly Buckley [07:25]

5. Deal Outlook for 2026

[08:55–09:54]

• The market finally picked up mid-2025 after a long lull. Now, deal pipelines are strong, with sustained inflow of new deals and processes.
• Private equity funds have dry powder to deploy, and a robust—if not "gangbusters"—year is expected in 2026.
• Memorable Quote:

  “We really did get busier… I believe the pipeline is going to be pretty strong next year. There's a huge amount of dry powder still out there.”
  — Holly Buckley [09:10]

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Notable Quotes & Timestamps

• Holly Buckley on Margin Pressures:
  "Providers are really having to watch margins very, very closely... it feels more so the case across the board now than it has in a long time." – [01:45]

• On Leadership:
  "It's really that people are doing things very deliberately…having real strategy and vision for what the business needs to be doing and then executing on it." – [03:10]
  "It's more the deliberate step by step that I'm seeing prevail." – [04:53]

• On Regulation:
  "We're seeing investors not go into certain states where those laws are very stringent and impose very long timelines..." – [06:15]
  "This is just something that two, three years ago was not really on most folks' radar." – [06:58]

• On AI and Sector Hotspots:
  "We're going to see more and more AI enabled solutions… that's going to be a super interesting area." – [07:25]

• On Deal Flow:
  "I believe the pipeline is going to be pretty strong next year. There's a huge amount of dry powder still out there." – [09:10]
  "2026 is going to be... a really robust deal making year." – [09:48]

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Useful Segment Timestamps

• Margin pressures and sector overview: [01:38–02:30]
• Effective leadership approaches: [03:07–04:53]
• Regulatory risks and deal impacts: [05:18–07:08]
• Emerging sector and technology trends: [07:19–08:55]
• Deal outlook for 2026: [09:01–09:54]

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Episode Tone & Final Thoughts

Throughout the episode, Holly Buckley maintains a pragmatic, precise, and optimistic tone, providing clear observations for both operators and investors. Her advice is grounded—eschewing hype for measured, actionable guidance—and Scott Becker’s conversational questions create a flow that draws out candid, tactical expertise for listeners navigating the next wave of healthcare business challenges.

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Transcript

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[Scott Becker]

This is Scott Becker with the Becker Business and Becker Private Equity Podcast. Today we're going to talk to Holly Buckley, the chair of health care at McGuire woods, and talk about a strategic view of the health care and private equity business. So a strategic view of health care and private equity. Holly, I'm going to ask you four or so questions. We'll just try and get you to give us relatively brief answers on each one of them. When you look across healthcare today, health systems, physician groups, PE platforms, what are the themes or pressures that you feel are most defining as we head into 2026?

[Holly Buckley]

Yeah, I think one of the core themes that I'm hearing a lot is just really increased margin pressure is reimbursement pressures through Medicaid and other reinvestment continue to put downward pressure on providers. There's a lot of other expense pressures and I think providers are really having to watch margins very, very closely. And that's always true in health care, but it feels more so the case across the board now than it has in a long time. And so I think that's one. I think we've seen less discussion this year than last year and the prior year on labor costs. But I think that's still a very real concern. But I think it feels less pointed than it has in past years.

[Scott Becker]

Yes. And you spend a lot of time and. Right. I think I could not agree more in terms of margin pressure being a key, key issue for everybody, whether PE investing in health care, health systems, physician groups and across the board. And we hear that constantly. I think that's Right on. You work with a lot of leadership teams, both leading organizations, navigating today's challenges. When you think about the best leaders, the best that you work with, talk a little bit about what do you see the best leaders doing in this environment.

[Holly Buckley]

Yeah, I think it is that the best and this is going to sound really kind of captain obvious, but it's really that people are doing things very deliberately as opposed to kind of cobbling things together, I think having real strategy and vision for what the business needs to be doing and then executing on it. I think. And again I said it was a captain obvious comment, but it really is true. I think if we look five years ago the macro environment was very different such that just a pure consolidation strategy seemed to work out pretty well for many and that's just not enough. Now it really needs to be more of a strategy around what do we do well, how do we focus on that, how are we going to grow, how are we going to build infrastructure and how are we going to make our business a best in class business? And those folks are winning and surviving and doing well. And the folks that don't execute on core strategy and essentially know what they're doing are the ones where things seem to be falling apart more.

[Scott Becker]

Thank you. And how much is it not taking big risk investing in people? What do you see out there that's working with certain teams versus other teams?

[Holly Buckley]

Yeah, I'm not seeing folks taking really big risks necessarily. It's more executing on core strategy and the blocking and tackling on a day by day basis that I seeing work really well. It's every day figuring out what are we doing well and how do we capitalize on that.

And continue moving in the right direction.

I frankly across the board I'm not seeing a lot of big risks being taken. It's more the deliberate step by step that I'm seeing prevail.

[Scott Becker]

Thank you. No, and I love that. Regulation reimbursement, what trends are you watching and what are investors thinking about now from a regulation and reimbursement standpoint?

[Holly Buckley]

Yeah, I would say on the regulation front it continues to be a lot of these state laws and we've seen a slowdown on the amount of New York laws being enacted, but they really are having a much more real impact on transaction, I'd say not execution but on timelines. And so more and more states now have their pre transaction filing notices and they're really, really broad and the dollar thresholds for many of them are either non existent or very low. So unlike the federal HSR law, the state laws can pick up much smaller transactions. And, and we're seeing investors not go into certain states where those laws are very stringent and impose very long timelines. And even with the thought of even though it's relatively bad right now, it may be navigable but maybe when we come to exit it's going to be even worse because the state's just very active in terms of legislation. And so we are seeing a lot more thought and planning going into deals because of these laws. The most recent was the California laws and they were a lot more mild than the proposed law from last year, but they essentially codified certain corporate practice of medicine and dentistry laws but also expanded the pre closing notice of material change transactions. And so we're having a lot of discussions on those with clients as they look at new investments and where they may seek to grow to see if they're going to be viable with these laws is just something that two, three years ago was not really on most folks radar.

[Scott Becker]

No, literally. Fascinating. And Holly, when you look at next year, what are you most focused on and excited about as you start moving towards next year?

[Holly Buckley]

Oh well, in terms of market segments, it has to be AI and it's still early stages and there's a lot of startup that are kind of a little bit smaller than we often deal with. But kind of the impact of AI on health care, whether it's delivery or back office, we're going to see more and more AI enabled solutions that are, that are trading. And so that's going to be a super interesting area. There's a few other segments that I think we're going to continue to see a fair amount of growth and action in such as longevity medicine along with kind of concierge medicine. They often go hand in hand. I personally think it's super interesting and fun, but it's still in its infancy from a kind of deal perspective. Along with women's health and men's health, which can kind of fall into the same types of practices and investments. But I think not huge deal flow but huge interest and discussion around them. We continue to see massive amounts of activity in areas like home health and hospice and even dental which are less, less exciting but still good, good staples. And then outside of kind of investment kind of going back to AI, just the changes in a legal industry with AI and how that's changing day to day life and practice and the client experience is going to be an area that we are thinking a lot about next year and really looking to capitalize on.

[Scott Becker]

Thank you very, very much. And do you expect a busy deal year next year in the private equity healthcare sector?

[Holly Buckley]

I do. I think that, you know, for the last several years you've been asking me that same question of what do you see as the outlet? And it's been like it's going to get busy. It's going to get busy. And then I'd say as of July this year, the switch kind of flipped and we really did get busier. And it's been consistently busy since kind of middle of the year this year. But we're continuing to see a good amount of incoming, Lois, and processes kicking off such that I believe the pipeline is going to be pretty strong next year. And we all know there's a huge amount of bright powder still out there and.

Funds holding companies are really in a spot now where they need to trade. And so I do anticipate that 2026 is going to be not kind of a gangbusters year, but I'd say a really robust deal making year.

[Scott Becker]

Thank you very, very much. Holly Buckley, chair of Healthcare at McGuire Woods. We appreciate you so much as always joining us on the Becker Private equity and Business podcast.

[Holly Buckley]

Thank you.

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