Most of private equity is a story about replacement. A fund buys a company, thanks the founder for their service, installs a new chief executive, and gets to work. Havencrest Capital Management runs the opposite play. The Dallas firm buys majority stakes in founder-owned healthcare companies and then does something counterintuitive for its industry - it keeps the founder in the building. The pitch is not "we can run this better than you." It is "you built something real, and we can help you build it bigger."
That pitch is aimed at a very specific slice of the economy: the lower middle market of American healthcare. Not the biotech unicorns chasing a blockbuster drug, and not the hospital systems with their own private-jet-scale balance sheets. Havencrest goes after the businesses in between - the home-care agencies, the clinical trial sites, the hospice teams, the nurse-staffing outfits doing somewhere between $3 million and $15 million or more in annual profit. The companies, in other words, that actually deliver care but rarely make headlines.
A physician who learned to read a cap table
The reason the founder-first pitch lands has a lot to do with who is making it. Havencrest was founded in 2018 by Christopher W. Kersey, who carries an unusual pair of credentials for a private equity manager: a medical degree from Emory and an MBA from Harvard Business School. Before finance, he trained as a physician. Before Havencrest, he spent years as a partner at Camden Partners, a long-running growth-equity firm, and served on healthcare boards including Johns Hopkins Medicine International, where he helped push the institution's partnerships abroad.
That background is not just resume decoration. When a founder sells their life's work, they are handing it to strangers who will decide its future. A buyer who has sat on the clinical side of the table - who understands why a hospice nurse's schedule matters or how a trial site actually enrolls patients - is a different kind of counterparty than a generalist spreadsheet jockey. It is a trust argument, and in healthcare, trust closes deals.
What Havencrest actually sells
Strip away the jargon and Havencrest does three things. It buys control of healthcare companies through buyouts and majority recapitalizations, which lets a founder take some money off the table without fully walking away. It writes minority growth-equity checks alongside like-minded co-investors when a founder wants capital but not a new majority owner. And it runs an in-house operating team - the Portfolio Resource Group - that parachutes into portfolio companies to help with the unglamorous work of scaling: hiring, sales and marketing, back-office systems, and add-on acquisitions.
The mechanics behind all of this are those of a classic private equity manager. Havencrest raises money from institutional investors - pension funds, university endowments, insurers, foundations - pools it into funds, and invests over several years. It earns a management fee on the committed capital and a share of the profits, the carried interest, when portfolio companies are eventually sold. The engine only works if those companies are worth meaningfully more on the way out than on the way in.
The portfolio nobody name-drops at parties
Havencrest's investments read like a tour of healthcare's back office. There is Avid Health at Home, a post-acute care platform built by acquiring non-medical home-care businesses market by market. There is Tekton Research, a clinical trial site network that partners with pharmaceutical companies and CROs running studies. There is Focus Staff, which supplies temporary nurses and allied staff to hospitals and health systems. There is Deep Centered Mental Health in behavioral health, and Paradigm Health in hospice and palliative care.
None of these is a household name, and that is roughly the point. Each is a real business with real cash flow serving demand that does not fade - aging patients need home aides, drug trials need sites, hospitals need staff. Havencrest's bet is that many small, well-run versions of these businesses can be stitched into larger regional platforms that are worth more than the sum of their parts.
Avid Health at Home
A home-care platform assembled through successive acquisitions across select U.S. markets.
Tekton Research
A trial site network partnering with global pharma and CROs on CNS and cardiometabolic studies.
Focus Staff
Temporary nurse and allied staffing for hospitals and integrated delivery networks.
Deep Centered Mental Health
Behavioral-health care for children and adults across individual, family and group settings.
Paradigm Health
Hospice and palliative care focused on patient-centered service.
OFFOR Health
A recent majority recapitalization, extending the firm's reach in care delivery.
How it differs from the pack
Havencrest is far from the only firm hunting founder-owned healthcare deals. It competes with the likes of Shore Capital Partners, Nautic Partners, Consonance Capital, Cressey & Company and other specialist middle-market shops. What it leans on to stand apart is the combination of a physician at the top, an operating team built in-house rather than rented, and a deliberately narrow focus - only healthcare, only the lower middle market, mostly founders. In a crowded field, specialization is the differentiator, and a doctor-led firm can credibly claim it speaks the seller's language.
The numbers, and the caveat
The headline figures are strong. Havencrest closed its second fund at a $356 million hard cap in 2022, above a $300 million target, and now reports more than $600 million under management. It has publicly cited first-fund performance of 65% net IRR and 3.2x net MOIC - the kind of returns that explain why existing investors re-upped at a rate above 100%.
The honest caveat is that these are the firm's own reported figures, and early private-equity returns can flatter before a fund fully exits its investments. Healthcare also carries its own weather: reimbursement rates shift, labor stays tight, and regulation can move a whole sector overnight. Havencrest's answer is to spread across sub-sectors - home care, trials, staffing, behavioral health, hospice - so no single policy change sinks the ship.
Where it fits in the market
Zoom out and Havencrest occupies a specific rung of the healthcare capital ladder. Venture firms fund the early, risky science. The mega-funds do the multi-billion-dollar hospital and pharma deals. Havencrest sits in the middle, buying profitable-but-small care-delivery companies and professionalizing them - the layer where a founder's instinct meets an institutional operating playbook. It is unglamorous work, done by a team of roughly 28 people out of an office on Dallas's McKinney Avenue, and it is aimed squarely at the part of healthcare that patients actually touch.
For a founder who has spent a decade building a home-care agency or a trial site and wonders what comes next, that is the whole appeal: a buyer who understands the business, will not gut it, and has the capital and the operators to help it grow. Whether the returns hold across a full cycle is the open question. The thesis - that the future of American healthcare is being built quietly, in the middle market, by founders - is a bet worth watching.