Your Last 100 Target Names Cost You Something. 11 of 12 Healthcare Investment Banks Cannot Say What.

Eleven of twelve healthcare investment banks could not tell me what their origination costs them or what it returns. Take that same question to your own desk for the next ninety seconds.

Pull your last hundred target names. How many hours went in, how many survived ownership and contact verification, what is your cost per usable contact. If you cannot produce that in under a minute, you are the thirteenth firm in this study and the rest of this issue is about you.

I spent two months asking bankers one question: how does a name get onto your target list. The hours after the database export decide the outcome, and almost nobody prices them. No firm names, no banker names; the firms appear as shapes. Two of the bankers here subscribe to this newsletter.

Method. Fifteen conversations with twenty-four plus professionals across twelve healthcare investment banks and M&A advisory firms, July through August 2026. Participants came through my own network, so treat this as directional. Counts refer to firms.

Firms naming the play as part of their current process, out of twelve; most run several at once. Referral counts only firms naming a standing referral network or program; a one-off warm path is not counted, and counting it would make six.

Ten of the twelve pay for at least one commercial database, and that supply side is consolidating under them. In August 2025 one vendor acquired a second sourcing platform and folded it into a third bought months earlier, as reported at the time, so several of these firms now may pay two line items to one company.

Four of the twelve refuse to cold-call on brand grounds. One MD called it a call center posture that burns the trusted-advisor position. Six run cold email anyway, and one called its own version spraying and praying.

Seven of the twelve described the same failure in different words. A database returns rows with ownership blank. Which entity is the parent, who the right contact is, whether that person decides anything, whether the business is near a transaction at all. A person establishes it by hand.

Healthcare is unusually good at attaching a correct name to the wrong object: a location when the assignment needs the parent company, a professional entity when the economics sit in the MSO.

One associate put a number on it that nobody else could: four hours for fifty good contacts, on top of live deals. A VP elsewhere ran it and threw the output away.

Two bankers reached for the same shelf when I asked who handles the scrub: an offshore research firm doing desktop work and list cleanup. One pays for it, the other calls it the standard move among the sponsors he covers, and neither is satisfied. On a recent pitch that shop handed back twelve precedent transactions marked relevant. Two were wrong, one an insurance company classified as a provider. He now reviews every line himself.

His analysts are generalists rotating across three unrelated sectors a month, so whoever checks the healthcare list has never seen one. He checks it again.

I asked every firm how many hours this takes and what it converts at. Eleven had an answer for neither. We never calculated it. We don't track the stats. And from the most candid: we don't do a sophisticated job of return on investment, because one closed deal always seems to pay for everything.

Origination is the only work in the building with no fee attached, so it never gets measured. What goes unmeasured goes unbudgeted, and on your desk that shows up as the scrub you run at nine at night with nothing to bill it to. You cannot defend a line item you have never priced.

That firm shut down its funded business development budget and replaced it with a referral program with named partners plus one rule: close a deal, then go hard at every company in the country that looks like it. It named no commercial database at all. Its only stated constraint was a return hurdle on every dollar, so treat this as directional. The sequence is the part you can copy: price the channel, then spend against the number. It lines up with what I wrote about why a business development hire fails when the pipeline is built in the wrong order.

Give your own second pass one job: kill rows. Four questions, in order, with the burden of proof on every name you keep. Anything still standing after all four you can hand a partner.

Physician owners. You are hard to find on purpose. As of January 2026, 82 percent of practicing physicians work for a hospital or a corporate entity, according to the Physicians Advocacy Institute and Avalere, a figure carried independently in the trade press. The independent owners left are exactly who the tooling sees worst. Without a directory listing or a search presence, you are invisible to every process above.

Funds and platforms. The bank bringing you a deal runs a referral network, a database screen, and a human cleaning up under deadline. When a banker says a process was broadly marketed, ask how the list was built and who checked it. Here the honest answer was an analyst at night between two live deals. It is the capacity problem I wrote about in running a 2026 pipeline with 2020 headcount.

I went into these conversations calling myself a partner and an advisory layer. No banker used that language back. They compared me to a database subscription, an offshore research firm, and the fully loaded cost of one more analyst. They were right and I was slow. This is a vendor category with an incumbent, a price band, and a line item next to the CRM renewal. Which is why i’m sneaking this i here if you’re paying attention. I am building an ‘analyst-in-a-box’. Check out maps.healthcaremai.com. Beta testing will start soon shoot me a note if you’re interested in being part of a small exclusive group. Anyway, that is where the last two months went. Two new clients arrived in the same window, both through a referral.

If you would rather walk through it live, book a call.

-Shawn