Shrink to Grow: What the Top 30’s Great Reshaping Means for Exits

This year’s Top 30 Companies report is chock full of intelligent insights and useful information. We always look forward to reading this annual review, because the choices these giant firms make ripple through the entire value chain, including the small and mid-market entities we advise. This year, when we examine the Top 30, the most consequential story is not product- or technology-related but structural. Many of the companies are taking themselves apart and reassembling the pieces to create a smaller, sharper, and more focused organization. After a generation of building ever-larger conglomerates, the prevailing strategy has been inverted. The new mantra is “shrink to grow.” In MBA school, it is known as “focus on what you know.” For any owner contemplating an exit in the next two to five years, understanding this shift is no longer optional—it is now an essential part of preparing an exit strategy. 

Less Is More

Scale was the main strategy for most of the past 20 years. The formula involved diversifying the portfolio, adding (bolt-on) adjacent businesses, and assembling a medtech conglomerate that could weather any single market’s downturn. That logic, however, has reversed. Many Top 30 mainstays are actively shedding businesses—divesting, spinning off, and carving out entire divisions—to concentrate capital and management attention on a smaller number of higher-growth franchises.

The data confirms a genuine trend rather than a handful of isolated moves. EY’s 2025 Pulse of the MedTech Industry report found that medtech companies are divesting slower-growth businesses to focus on higher-potential markets, directing capital toward fewer but larger transactions. The average medtech deal was roughly $497 million in the 12 months ending June 30, 2025—about 72% above the prior decade’s average. That appetite for scale only accelerated through the year: EY’s 2026 M&A Firepower report found medtech deal spending up 116% in 2025, a surge driven by larger, higher-conviction transactions rather than sheer deal count. The driving force behind the reshaping is no secret: public markets reward focus. The conglomerate discount is real, and a clean, fast-growing pure play almost always commands a richer multiple than the same assets buried inside a diversified parent. As the classic M&A adage goes, “the sum of the parts is less than the total value of the individual pieces.”

Reshaping Roll Call

The list of 2026 divestitures (thus far) reads like a Top 30 roll call. Medtronic is carving out its diabetes business as a standalone (MiniMed) to better focus on its higher-margin cardiovascular, neuroscience, and surgical franchises. Johnson & Johnson is spinning off its orthopedics division in a move executives describe as “shrinking to grow faster,” and Siemens Healthineers is hinting it may unhand its diagnostics segment to concentrate on imaging and Varian-anchored cancer care. In addition, Becton Dickinson is combining its biosciences and diagnostics businesses with Waters Corp. in a $17.5 billion deal and Baxter International’s kidney care business (Vantive ) is now under management by investment firm Carlyle. Solventum—born only two years ago from 3M’s healthcare spinoff—sold its Purification and Filtration unit to Thermo Fisher Scientific to pay down debt and refocus. And Edwards Lifesciences sold its Critical Care unit to BD to reinvent itself as a pure-play structural heart company.

The common thread among these divestitures is unmistakable: shed the slower-growing, lower-synergy businesses, and double down on focused core competencies.

The Flip Side: Concentrated, Capability-Building M&A

Reshaping is not only about selling. The same giants are buying aggressively, but with a precision that looks very different from past diversification deals. Abbott’s $21 billion acquisition of Exact Sciences, for example, marked a decisive move to deepen its presence in cancer diagnostics. Boston Scientific Corp. extended its lead in interventional and neurovascular care $14.5 billion deal for Penumbra. Danaher entered the patient monitoring realm with its $9.9 billion purchase of Masimo and Stryker Corp. bought Inari Medical to expand its portfolio deeper in Neurovascular and Endovacular as they continue to break into the high-growth peripheral vascular disease market.

None of these is a grab for breadth. Each deepens a deliberately chosen lane and in many cases, the capital freed up by a divestiture is precisely what funds the focused acquisition. This is portfolio management at its most disciplined: Companies divest businesses where they lack leadership and acquire assets that strengthen their position in markets where they aim to lead. Some of these Top 30 companies will purposefully leave a market if they can’t be in the “top three” of a given sector with a clear path to dominance. 

From product launches to M&A and manufacturing trends, the MPO Source delivers the medtech news you need twice a week. Subscribe here!

Why This Matters to Small and Mid-Market Owners

The portfolio reshaping trend is not limited to billion-dollar multinationals. This business strategy is reaching the mid-market in three distinct ways.

First, every divested unit becomes a new, independent competitor, and frequently a new acquirer. A carve-out may or may not exist as a standalone entity for very long, and many that are backed by private equity will be hungry for bolt-on acquisitions. This scenario is already playing out in certain segments with key players, as evidenced by VB Spine. 

Second, where the giants concentrate, valuation follows. When the largest strategics publicly declare a focus area—structural heart, cancer diagnostics, peripheral vascular, surgical robotics—they are indicating where strategic demand and premium multiples are migrating. That signal is enormously valuable for companies operating in one of those lanes.

Lastly, the strategic acquirers are back in force. After a quieter stretch, the buyers who ultimately set valuations are active again, and passivity will not be rewarded. Medtech-focused private equity firms are positioned to act as fast followers, capitalizing opportunistically on rising market multiples and valuations. Lower middle market owners who wait for the market to come to them may risk missing the window without even recognizing it.

Value = Strategic Fit + Timing: A Giant Shopping List

At MedWorld Advisors, our guiding principle is that Value = Strategic Fit + Timing. The Top 30’s reshaping makes both halves of that equation more legible than they have been in years.

Consider strategic fit. The giants are, in effect, publishing their shopping lists. From J&J’s concentration on cardiovascular, Edwards’ commitment to structural heart, and Abbott’s expansion in diagnostics to Boston Scientific’s focus on interventional care—each divestiture indicates precisely what those acquirers want to own and what they no longer value. Companies that can fit cleanly into a declared priority are far more valuable to that buyer than the same business would have been three years ago. The same dynamics are at play with OEM suppliers (think Ametek, Integer, etc.) as they grab market share to serve these newly aligned Top 30 market dynamics.

Timing is important as well. These windows do not stay open indefinitely. When a strategic declares a focus area, appetite for assets in that lane intensifies, but it eventually cools as the buyer fills its gaps. For companies operating in a lane a giant has just left, the most likely buyer may now be a private equity sponsor, which changes potential deal preparation and approach. Reading the reshaping correctly can reveal not only who the buyer is, but when to move. Some good starting points follow.

• Companies should map their lane to the giants’ declared priorities to determine whether they operate in an area the Top 30 is interested in or one they are stepping away from.
• Watch the carve-outs closely. Each newly independent unit is both a potential competitor and a potential partner, roll-up vehicle, or acquirer.
• Build a strategic-fit story now. Companies should be able to articulate, in an acquirer’s own terms, exactly how they can advance their focused strategy.
• Respect the timing window. Align the start of any process with the moment an acquirer’s appetite in a company’s chosen lane is greatest.
• Know the full buyer universe. If strategics have rotated out of the ability to make acquisitions in a company’s space, a private equity partner may well be the premium path to exit.

The Bottom Line for Medtech Leaders

The most important takeaway from the 2026 MPO Top 30 report is not embedded in any one transaction but rather the pattern among the ranked firms. The giants are reshaping themselves in public, and in doing so they are broadcasting—more clearly than at any point in recent memory—what they value, what they are discarding, and where the next wave of premium multiples will land. For a small or mid-market owner, that is an extraordinary gift: a published map of strategic fit and timing, free for the reading.

The companies that thrive in this environment will be those that treat the reshaping not as distant industry news but as a direct signal about their own positioning and their own exit. For leadership teams assessing how the Top 30’s M&A activity and private equity’s dry powder may influence their company’s valuation, the right time to have that conversation is long before a transaction is contemplated. Take advantage of the strategics’ very public business strategy—it may not happen again for quite some time.

More from MedWorld Advisors: Why Reshoring, State-Level Growth, and Tariffs are Reshaping Medtech M&A Value

Florence Joffroy-Black, CM&AA, and Dave Sheppard, CM&AA, are managing partners at MedWorld Advisors, a global M&A advisory firm serving the medical technology and life-science industries. Florence can be reached at [email protected]. Dave can be reached at [email protected].