After a record-setting year in 2016, the Physician Medical Group sector got off to a swift start in  2017, with a deal that is telling of changing healthcare paradigms, especially the shift from inpatient to outpatient care.

Only two weeks into the new year, and seven transactions have been announced for physician practices and management companies. Envision Healthcare Corp. (NYSE: EVHC), the entity that officially combined Envision Healthcare Holdings and AmSurg Corp. (NASDAQ: AMSG) on December 1, 2016, announced three practice acquisitions in the first week alone. Privately held Dermatology Associates, Family Care Partners and Platinum Dermatology Partners announced one deal each. Then the big guns came out.

On January 9, 2017, UnitedHealth Group‘s Optum (NYSE: UNH) acquired Surgical Care Affiliates, Inc. (NASDAQ: SCAI), for a total of nearly $3.3 billion. The price consists of $57.00 per share for SCA’s outstanding common stock, to be funded between 51% and 80% with UNH common stock, with the final percentage to be determined at UNH’s option, and the remainder in cash. SCAI also carries $974.61 million in debt on its balance sheet.

The multiples are on the high side, at least in this deal, with 2.8x revenue and 12.1x EBITDA.

Surgical Care Affiliates’ business model is to partner with health plans, medical groups and health systems to develop and optimize surgical centers through majority or minority ownership. At the time this deal was announced, it operated 205 surgical facilities, including ambulatory surgery centers and surgical hospitals, in partnership with 3,000 physicians.

The move puts Optum in direct competition with Envision Healthcare, which now operates more than 257 ambulatory surgery centers in 34 states, and provides physician services, primarily anesthesiologists, to 450 healthcare facilities in 29 states.

Then there’s Tenet Healthcare (NYSE: THC) and its United Surgical Partners International division. In March 2015, Tenet made a deal with Welsh, Carson, Anderson & Stowe to acquire a 50.1% stake in USPI, with a path to full ownership of USPI over the next five years through a put/call structure. The upfront price was $425 million.

At the time of the announced, the joint venture had ownership interests in 244 ambulatory surgery centers, 16 short-stay surgical hospitals and 20 imaging centers in 29 states.

Surgical Care Affiliates will become part of the OptumCare platform, which has 20,000 affiliated physicians and hundreds of care facilities. This acquisition positions the combined organization as a comprehensive provider of ambulatory care services, while continuing expansion of SCA’s networks of ASCs and surgical hospitals in partnership with leading health systems, medical groups and health payers. The combination also expands Optum Care’s capabilities in outpatient surgical procedures.

Surgical Care Affiliates spent much the last year bolstering its title as one of the largest providers of outpatient surgery in the United States. In 2016, it picked up 15 surgical facilities, and one digital health company, for a total of $175.4 million.