Positive signs are beginning to reappear in the middle-market healthcare sector. Q2 saw an uptick in M&A activity over the previous quarter indicating that the deal fatigue left over from the record setting Q4 2012 is relenting. The trend line of deal flow for the US Healthcare Sector has stayed ahead of the broader market with the sector producing a Q over Q increase in both deal count and deal value while the economy as a whole dipped in both categories. Expect that this trend will continue as the rollout of ACA forces CEOs to identify ways to address the inevitable changes. While public company valuations in the sector have lagged the broader S&P, the trend in deal flow is a positive sign for healthcare companies. An active M&A market will result in higher multiples and lower dividend and interest requirements for preferred equity and subordinated debt investments. However, whether you’re buying or selling questions abound in the sector as we navigate ACA implementation, sequestration, and interest rate trajectory.