Across home-based care, companies like Traditions Health, Honor, HomeWell and others are seeing tremendous growth.

In fact, the industry is well-represented on the Inc. 5000 2024 ranking of the fastest-growing private companies in the country. This year, 29 companies in the broader home-based care space made appearances on the list. 

In order to decide who makes its list, Inc. 5000 ranks U.S.-based private companies by examining percentage revenue growth over the last three years.

Vytalize Health — Hoboken, New Jersey

— Rank: 1

— Growth: 90,779%

— Climbing to the No. 1 spot is Vytalize Health, an accountable care organization (ACO) and value-based care platform that works with physicians and primary care practices. The company touts in-home care as one of its key solutions.

Monogram Health — Brentwood, Tennessee

— Rank: 3

— Growth: 43,848%

— Monogram Health is a value-based specialty provider of in-home care and benefit management services for individuals living with polychronic conditions, including chronic kidney and end-stage kidney disease.

Upward Health — Hauppauge, New York

— Rank: 6

— Growth: 30,722%

— Upward Health is an in-home primary care and behavioral health care company. The company works with health plans to aid its members.

UltraCare Services — Beverly Hills, California

— Rank: 103

— Growth: 3,109%

— UltraCare Services non-medical personal care company that offers care to seniors and disabled veterans.

DSP Connections — Salem, Oregon

— Rank: 172

— Growth: 2,217%

— The company offers in-home support for children and adults with intellectual and/or developmental disabilities.

AvevoRx — Greensboro, North Carolina

— Rank: 581

— Growth: 776%

— AvevoRx provides specialty infusion pharmacy services in the home for patients.

Nurturing Angels Home Care — Greenville, Delaware

— Rank: 731

— Growth: 658%

— Nurturing Angels Home Care delivers personal care services to seniors based in Maryland and Delaware.

connectRN — Waltham, Massachusetts

— Rank: 928

— Growth: 545%

— connectRN’s platform helps nurses and other health care professionals find work, particularly in skilled nursing facilities (SNFs) and in the home health space.

Fortis Home Health and Hospice — Murray, Utah

— Rank: 1,239

— Growth: 417%

— The company is a home health and hospice provider serving Indiana and Utah.

Wellthy — New York, New York

— Rank: 1,284

— Growth: 404%

— Wellthy is an employee caregiver benefit provider. The company helps individuals manage caregiving responsibilities.

TLC HomeCare Services — Carterville, Illinois

— Rank: 1,285

— Growth: 404%

— TLC HomeCare Services is a locally owned home care agency in Southern Illinois. The company offers services such as meal prep, companionship, light housekeeping and more.

Entrusted Pediatric Home Care — Austin, Texas

— Rank: 1,434

— Growth: 358%

— Entrusted Pediatric Home Care is a pediatric home health company that offers care across Texas.

CARESPHERE — Bethlehem, Pennsylvania

— Rank: 1,653

— Growth: 314%

— The company is a home-based care provider that delivers personalized medical and social support statewide.

HealthFlex Hospice — Oakland, California

— Rank: 1,732

— Growth: 302%

— The company provides various in-home health care services, including home health and hospice care.

Honor Technology — San Mateo, California

— Rank: 1,774

— Growth: 296%

— Founded in 2014, Honor is a home care technology company. It owns Home Instead, one of the largest home care franchises in the country.

Daily Dove Care — Philadelphia, Pennsylvania

— Rank: 2,076

— Growth: 252%

— The company is a provider of home care in Philadelphia. It offers services such as nursing, personal care, rehabilitation, clinical care and more.

Sprout Therapy Group — Liverpool, New York

— Rank: 2,113

— Growth: 248%

— Sprout Therapy Group delivers home health care, rehab and special education for children.

Elder Care Homecare — Scarsdale, New York

— Rank: 2,207

— Growth: 236%

— The company offers a variety of home-based care services throughout Westchester County, Long Island and New York City.

IntellaTriage — Brentwood, Tennessee

— Rank: 2,367

— Growth: 220%

— IntellaTriage is a provider of after-hours nurse triage solutions for home health and hospice providers.

Traditions Health — Nashville, Tennessee

— Rank: 2,389

— Growth: 218%

— Traditions Health is a home health, hospice and palliative care provider with a footprint that spans across 130 locations and 18 states. It cares for more than 25,000 patients per year.

TLC Skilled Care — North Palm Beach, Florida

— Rank: 2,592

— Growth: 197%

— TLC Skilled Care is a home-based care company that offers respite care, companion care, behavioral health services and more.

Elite Homecare — Spartanburg, South Carolina

— Rank: 2,900

— Growth: 175%

— In addition to home care services, Elite also has day centers and transportation services under the company’s umbrella.

HomeWell Franchising — Burkburnett, Texas

— Rank: 3,620

— Growth: 131%

— HomeWell is a home care franchise company that has locations across the U.S.

WellSprings Home Care Ltd — Downingtown, Pennsylvania

— Rank: 3,691

— Growth: 127%

— WellSprings is focused on delivering high-end luxury care. The company offers live-in care, dementia care and more.

Pediatric Home Service — Roseville, Minnesota

— Rank: 3,838

— Growth: 120%

— Pediatric Home Service is an independent home health care agency that serves children with complex needs.

HHAeXchange — New York, New York

— Rank: 4,060

— Growth: 111%

— HHAeXchange is a home care technology platform and an aggregator of EVV data for payers and providers.

The Perfect Companion — Phoenix, Arizona

— Rank: 4,112

— Growth: 108%

— The Perfect Companion offers concierge home care services for seniors.

BrightStar Care — Gurnee, Illinois

— Rank: 4,308

— Growth: 100%

— Chicagoland-based BrightStar Care offers personal home care as well as supplemental staffing and home health care. It has over 15,000 caregivers and 5,700 registered nurses within its network.

Total Care Connections — Tempe, Arizona

— Rank: 4,852

— Growth: 78%

— Total Care Connections is a provider of home care and private nursing services.

The above list is based on an HHCN review of the Inc. 5000 ranking. If your company was on the Inc. 5000 list and operates in the home-based care space but wasn’t noted above, please reach out to HHCN.

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In the spring, it completed an affiliation process with Trustbridge, which formed the largest nonprofit post-acute provider organization in the state of Florida.

The Clearwater, Florida-based Empath Health offers hospice, home health care, palliative care, grief services, Program of All-Inclusive Care for the Elderly (PACE), adult day services, primary care services and more. It is the parent company of 17 affiliates and two philanthropic foundations.

On its end, West Palm Beach-based Trustbridge offers palliative care, hospice care, support services, pharmacy services and durable medical equipment.

Since completion of the affiliation process, the company has focused on integration, synergistic opportunities and determining how best to deliver care to the communities it serves.

One of the people at the helm of this transition is Tarrah Lowry, Empath Health’s chief operating officer and Trustbridge’s interim president. Home Health Care News recently caught up with her at the National Association for Home Care & Hospice’s (NAHC) Financial Management Conference in Las Vegas.

During the conversation, Lowry provided an update on integration efforts, industry challenges and how the combined companies are now better equipped to take on these pain points.

HHCN: We are at NAHC FMC, so I have to ask, what are the biggest financial or operational challenges for home health providers right now? How are these pain points impacting Empath Health specifically?

Lowry: One of the things, being in Florida, is that pre-claim review has just been extended. That just adds more work and time to all of our claims before they go out. Just getting paid by everyone that you’re contracted with is huge, and then also just the auditing processes that go on.

How is Empath Health navigating these challenges?

One of the things that has been wonderful is we’ve brought together all of the different organizations that have come together as Empath health, so we’ve got a lot of talent. We’re really picking from all of the organizations where someone has a lot of experience with billing, and we have wonderful financial staff that are looking through things and keeping us going.

What impact has the completion of the Empath Health, Trustbridge affiliation process had on the company? What has that experience been like?

Anytime organizations come together, you’re merging cultures. I think that one of the greatest assets is the culture at Empath Health, and the one at Trustbridge, really merge well together.

Culturally, we’re a great fit for one another, and we’ve got a lot of talent on both sides. Being able to bring everyone together has been wonderful. Anytime you bring organizations together, there’s always growing pains of getting everyone on the same systems, adopting the same policies and procedures, all those things that are kind of done in the background. There is a lot of work that most of the colleagues, probably, don’t see happening. But it’s been a very positive experience so far.

Where are the biggest opportunities for collaboration between the Empath side and the Trustbridge side?

Trustbridge was a very large hospice and palliative care provider on the east coast of Florida, but that was all of the service lines that were being offered. Empath Health has the whole care scope of all different types of services. Trustbridge was super excited to be able to learn more about those types of things and bring some of those into our markets.

We were selected to be a part of the GUIDE Model program with CMMI. We have a whole team that’s working on getting that going, and figuring out which areas that we serve would be the best to start that in. There’s so many people that are living with dementia, and they have a lot of needs. We’re very excited that CMMI has come up with this program.

Talking about the affiliation process leads me to ask: What’s Empath Health’s appetite for M&A these days? Is the company open to pursuing deals, and if so, what are you looking for in terms of acquisition targets?

We’re looking at the full life care continuum, and we’re trying to see what the needs are of all of these patients. So we’re very open to new business partners and new ideas.

A good example would be, we have PACE programs. We are now doing the GUIDE Model program. We are just starting a partnership for I-SNP. We’re really looking at how we can best care for people where they are, and at the level of care that they need during that time.

We would be open to expansions, but it’s really based on what the needs are in the communities we serve. We’re not wanting to just grow, just to grow. We’re really trying to be thoughtful of which communities need our services. We’re not necessarily setting out to be the biggest — but we do want to be the best.

Looking ahead, what are going to be the biggest financial drivers at Empath Health over the next few years?

For home health, we are being very deliberate in our growth and the communities that need our services. Empath Health is a four star home health provider, and we’re very proud of that. We have a lot of opportunities to partner in different communities with some of the hospitals, they’ve asked us to be their preferred provider. There’s a lot of activity going on, but we’re trying to be very deliberate.

What are some of your goals for the rest of the year?

We are just right on the heels of the merger with Trustbridge, so our biggest goal is still integration — integrating our cultures, integrating our colleagues, so that everyone feels a part of Empath Health.

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The home health sector saw at least 10 deals, while the hospice sector saw at least nine, according to the M&A firm Mertz Taggart. Home care dealmaking was a bit down, with only seven confirmed transactions in the quarter. Many of these transactions, of course, include more than one service line.

“We’re seeing optimism around a thaw in dealmaking,” Mertz Taggart Managing Partner Cory Mertz wrote.

It’s also worth noting that more confirmed deals from the second quarter will likely trickle in over the coming months.

While 20 deals is nothing to write home about, it’s up significantly from the 13 that Mertz Taggart reported in the first quarter.

The Pennant Group (Nasdaq: PNTG) remained one of the more active acquirers in the home-based care space. It announced deals for the Utah-based South Davis Home Health & Hospice and the Texas-based Nurses On Wheels.

In addition, it announced a partnership with Hartford HealthCare at Home, which will allow it to open up home health operations on the East Coast for the first time.

“We have the resources focused and dedicated to the East Coast, they’re all going to be focused and dedicated on this venture in the foreseeable future,” Pennant President and COO John Gochnour recently told Home Health Care News. “We can foresee a time when it makes sense to grow further on the East Coast, because we have a service center developed out there, we have a group of people who are part of those communities and are excited to continue to make a deeper impact.”

Vitas Healthcare’s acquisition of Covenant Care, for a reported $85 million, was also a highlight in the quarter.

As for the deals that were announced but not finalized, Amedisys Inc. (Nasdaq: AMED) agreed to divest locations to VitalCaring. That deal is contingent on the Amedisys-UnitedHealth Group (NYSE: UNH) deal closing, however.

The New York-based HCS-Girling agreed to acquire the personal care operations of Addus Homecare Corp. (Nasdaq: ADUS) in New York, as well as the Florida-based home health provider Pinnacle Home Care.

Home health cuts don’t appear to be going away, which could affect M&A for the rest of 2024. But, at the same time, National Association of Home Care & Hospice President William A. Dombi said Monday that he expects a less harsh final rule for 2025.

Meanwhile, interest rates – which have cooled M&A across industries for a couple of years now – are likely to come down in the near-term future.

That could also lead to private equity activity ticking back up. Mertz noted that, in the second quarter, PE was involved in a smaller proportion of deals than usual.

There’s likely another reason for that, too, however.

“We saw fewer private equity-backed strategic transactions hit the wire relative to the whole,” Mertz wrote. “This is primarily tied to the tightened credit markets, and an increasing number of smaller, in-market transactions that don’t get reported.”

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As one of these next generation leaders, RJ Gagnon is making a name for himself at Andwell, but it doesn’t end with him. The company has already set its sights on developing the next set of future leaders.

“Our organization has really focused on development of leadership,” Gagnon said Monday during a panel discussion at the National Association for Home Care & Hospice’s (NAHC) Financial Management Conference. “When we look at our budgets, sometimes that’s one of the things that’s first cut. That’s something we need to invest in.”

Formerly Androscoggin Home Healthcare + Hospice, Andwell is a nonprofit operator that offers home health, hospice, palliative, behavioral health and pediatric care services. The company employs over 500 workers across all 16 counties in Maine.

Along with cultivating the next crop of leaders, companies are figuring out how best to work with a multi-generational workforce.

Currently, UVA Continuum Home Health has four different generations that make up the organization’s staff. Catherine Harris, the home health director at UVA Continuum Home Health, has learned to accommodate individuals based on what stage they’re at in life.

This also gave Harris the opportunity to listen and learn from her more experienced colleagues.

“When you think generationally, you’re really thinking about where that person is in life,” she said during the discussion. “My younger partners are just starting to have kids. They’re taking leave, [it’s about] giving space for that, and celebrating that, versus the generation before us, the baby boomers … who are preparing to retire. Am I listening to them? Am I focused on the lessons that they’ve learned? Because if we’ve learned nothing, it’s that history constantly repeating itself.”

UVA Continuum Home Health is an academic home health agency associated with the University of Virginia in Charlottesville. The organization serves several cities across the state.

Matt Chadwick, CFO of Well Care Health, stressed the importance of not bringing preconceived notions to the workforce when working with multiple generations.

“It’s about, [for example], not going in with the perception that a younger person might know technology better than the older person, but listening to their concerns, hearing what their skill sets are and really trying to find the right space for them,” he said.

Well Care Health is a Wilmington, North Carolina-based provider of home health and hospice services. The company serves more than 4,000 patients, and employs more than 600 employees. It operates across 40 counties in North Carolina and South Carolina.

Chadwick noted that it has been important for Well Care Health to make sure they are placing people in the roles where they’ll succeed the most.

At VNS Health, leaders began to notice a higher turnover among younger nurses. The company sought to address this by establishing a nursing grad program six years ago that emphasized mentorship.

“They’re learning about home care,” Sarani Doshi, vice president of corporate financial planning and analysis at VNS Health, said. “They’re getting their feet wet and taking care of patients in the homes for real now, and we’re giving them the tools they need to be successful, to grow and develop in the way that they’d like to.”

New York-based VNS Health is a full-service home-based care organization. The company has almost 40,000 daily patients.

VNS Health has seen less turnover among younger nurses after the implementation of the program.

Additionally, the company has begun developing closer partnerships with New York area nursing schools, according to Doshi.

“We’re spending a little bit more time in the school, educating students around home care, the value of home care and the benefits of home care, and providing scholarships to students who are showing interest in coming into home care post-graduation,” she said. “That, coupled with our nursing graduate program, has started to gain some traction, and we’re seeing some of that affect turnover and retention.”

Ultimately, Gagnon believes that it’s imperative to set employees up for success by taking professional development seriously.

“We need to let the teams know that they matter,” he said. “We have management meetings where the first half is business as usual. The second half is very direct leadership development with strategies where we bring in facilitators. We are investing in that team. That lets them know, ‘We want you to be successful.’ Our No. 1 job is for our team to be successful.”

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“We’re in the Medicare-certified home health business, and we’re in the private-duty business, and we’ve had palliative care for a very long time,” she told Home Health Care News. “But what we’ve been working on at Alivia is a more comprehensive solution.”

Jacksonville, Florida-based Alivia Care provides home health care, hospice care, personal care, palliative care, advanced care planning and Program of All-Inclusive Care for the Elderly (PACE) services across Northern Florida and Southern Georgia.

At Alivia Care @ Home, a more comprehensive solution means patients having the opportunity to take part in a goals of care discussion, while simultaneously receiving care.

“We really wanted to develop something where we could begin to assess, while delivering excellent home health care, if it’s time to perhaps do a goals of care discussion, and bring in our palliative team,” Ponder-Stansel said. “Whether or not the person ever wants hospice, or needs anything more from palliative care, it’s an opportunity to hear more about the stage of their illness, ask some questions and get some good information.”

The main impetus behind the program was the company’s discovery that roughly 55% of patients who are receiving Medicare-certified home health are also going to be hospice appropriate within a year, according to Ponder-Stansel.

The idea behind Alivia Care @ Home is that there is no wrong door for patients to enter.

“We may interact with them at different stages of their illness, or in different ways,” Ponder-Stansel said. “Each service stands on its own, but then for patients who really need more of a progressive system, more help, they can be put together in a way that meets the patient’s needs differently, than just say, episodic care for home health, which we do too. This is just a novel way to put them together in a manner that follows the patient and really meets a gap in care right now.”

Currently, each service has its own revenue stream, but Ponder-Stansel says that Alivia Care @ Home was designed with future value-based care goals in mind.

“If we’re in that space, where we’re working with an existing ACO to help take over the management of their high needs patients — because that’s something that a lot of the general track, REACH ACOs struggle with — then this is the exact kind of solution that would be able to not only get excellent outcomes for the patient, but also help you with any-value based or risk-based reimbursement,” she said. “Because you’re avoiding events and costs that really don’t improve the patient outcomes through this care navigation.”

Ultimately, Ponder-Stansel believes that there’s an opportunity for home health providers, that also have hospice under their belt, to train their home health staff on what progressive illness looks like.

“I think all of us along the continuum are focused very much on preventing readmissions, and really helping patients not have to go back to the hospital,” she said. “If we’re just doing episodic care, and just thinking transactionally, we may miss the fact that somebody we’re caring for is at the stage where they do need some help understanding they have another choice, and how to find that resource. I just think it’s a great opportunity for some great training.”

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“This is a significant acquisition in Pennant’s history,” Pennant CEO Brent Guerisoli said in a press statement. “We are excited to make this investment because of the quality of Signature’s people and operations. Its locations, its philosophy, and its culture are a perfect complement to our existing operations in the Pacific Northwest. A key tenet of Pennant’s disciplined growth strategy is that we make acquisitions from a foundation of strength, where we have solid existing leaders and well-performing operations.”

Signature provides home health and hospice services in the Pacific Northwest, and has locations throughout Oregon, Washington and Idaho. The company has more than 650 home health and hospice staff members.

The deal allows Pennant to continue to increase its presence in Washington and Idaho. It also will add seven additional locations to Pennant’s Oregon footprint.

On its end, Eagle, Idaho-based Pennant is a holding company of independent operating subsidiaries located across the U.S., with a network that includes 115 home health and hospice agencies and 54 senior living communities.

Overall, Signature rakes in annual revenue of $78 million.

Additionally, Signature home health admissions checks in at over 12,000. The company has an average daily hospice census of more than 300.

“The deal should contribute an incremental +13% of revenue, +25% home health admissions, and +3% hospice ADC,” an analyst note from Stephens read.

The acquisition agreement includes two separate transactions — the sale of Signature’s Washington and Idaho assets and the sale of its Oregon assets. The former is slated to close on Aug. 1, 2024, while the latter is expected to close Jan. 1, 2025.

“We have known Signature and its leaders for years, including through the acquisition of their Northern Utah and Eastern Idaho locations several years ago,” John Gochnour, president and COO of Pennant, said in the press statement. “We have great respect for the talented team they have built and its impact on many communities across Oregon and Washington that we don’t currently serve. As we transition these operations into the Pennant fold, we are pleased to deepen our presence in these key states and to provide Signature’s leaders and staff the opportunity to benefit from our innovative operating model and leadership development programs, while also implementing clinical and operational best practices that will benefit patients and their communities.”

Gochnour noted that Pennant will remain bullish when it comes to M&A. In terms of potential acquisition targets, the company plans to go after strategic and underperforming home health, hospice and senior living operations of all sizes.

Most recently, Pennant developed a partnership with Hartford HealthCare at Home, the home health and hospice arm of Hartford HealthCare. The company will offer management and consulting services as part of the partnership. That deal took Pennant into the East Coast for the first time.

In May, Pennant announced that it acquired the Davis County, Utah-based South Davis Home Health and South Davis Hospice. The move allowed Pennant to expand in Utah.

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A name for the combined organizations is still to be determined. For now, it is being referred to as the NAHC-NHPCO Alliance.

“The NAHC-NHPCO Alliance will be the leading authority and unifying voice of the care at home community,” NAHC Board Chair and Chair-Elect of the Alliance Kenneth Albert said in a statement. “The leadership of both organizations have worked for 18 months to make this happen and the talented staff at NAHC and NHPCO are already hard at work integrating the two organizations. Together, we will make home the center of health care.”

NAHC and NHPCO are two of the largest home-based care advocacy organizations in the country.

“This alliance between NHPCO and NAHC will create the most powerful voice the care at home community has ever had,” NHPCO Board Chair and Vice Chair-Elect of the Alliance Melinda Gruber said in a statement. “For members, it means access to the best education and expert advice, as well as a strong advocate for sensible policies that help providers deliver the best possible care to the millions of Americans who need it the most.”

William A. Dombi, the president of NAHC and one of home-based care’s most prominent advocates, will remain active in his role until the end of the year.

After the merger is completed, he will be retiring.

“The affiliation of NAHC and NHPCO is a historic event,” Dombi said in a statement. “Unifying the voice of health care at home has been a longstanding goal of NAHC, as it is the essence of the original formation of NAHC in 1982. Combining our two organizations will significantly strengthen that voice for the benefit of our members and the patients they serve.”

The integration process is also expected to take until the end of the year, according to the organization.

A “robust” search for a CEO of the new organization is also underway, with “dozens” of candidates being considered. 

NAHC and NHPCO first began to explore a potential combination at the beginning of last year.

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There’s some feeling that sidelined private equity firms will eventually have to enter the game, but that may not be the case.

For one, interest rates have still not come down. But also, the “dry powder effect” – and available money being ready to be deployed by PE firms – can sometimes be overstated, Rebecca Springer, the lead health care analyst at Pitchbook, told Home Health Care News.

“I think it’s really easy to overstate the pressure of the dry powder effect,” she said. “I hear the narrative a lot, that there’s a lot of dry powder, and therefore deals have to get done. There is always a lot of dry powder. And it’s not correlated, if you look historically at deal activity. In reality, managers have a lot of flexibility in how they deploy capital, they can deploy into existing portfolio companies, they can do smaller deals, they can wait. There is pressure, especially from the [limited partner] base, to deploy capital, but more to a much greater extent to return capital.”

Pitchbook released its Q1 health care services report last week.

The report showed extremely low deal activity, in home-based care and across the health care industry. The estimated health care services PE deal count for the first quarter was 158, putting 2024 on a slower pace than the past four years.

It is worth noting, however, that deal activity generally picks up in the back half of the year. Last quarter, there were 235 PE health care deals, for reference.

It’s also worth remembering that dry powder on its own does not push across deal activity, Springer said. She did say, however, that there are more signs of PE dealmaking activity picking up, but it’s tough to pinpoint when exactly that will lead to more deals.

“I think dealmakers are actively looking at potential opportunities,” Springer said. “There’s more conference attendance, more proactive thesis development happening. But we’re still expecting that deal processes are going to take a while, and that larger platforms are still going to want to sit back a little bit and see what the Fed does, as well as wait for some other platforms to trade and see where multiples come in. There’s no real big hurry to get deals done.”

Springer also acknowledged that dealmaking generally picks up later on in the year, a trend she expects to continue in 2024.

“I think processes will continue to slowly ramp up throughout the year, we’ll start to see announcements probably in late 2024 for some bigger processes – that would be my best guess,” she said. “I always want to hedge that a little bit. But it looks like that’s approximately the timeline for there to be lower interest rates as well.”

Home-based care dealmaking

Health care dealmaking has been about in line with home-based care dealmaking over recent quarters.

In the first quarter, there were fewer than 15 home care, home health and hospice deals, according to data from the M&A firm Mertz Taggart.

In addition to the macroeconomic headwinds, home-based care investors are also seeing regulatory uncertainty, specifically with home health payment rates and the now finalized 80-20 provision from the Medicaid Access Rule.

The next home health proposed payment rule is expected early this summer. The 80-20 provision, on the other hand, is finalized – but it won’t be implemented for another six years.

That’s why Springer doesn’t expect the 80-20 provision to impact dealmaking significantly in the near-term future.

“I think that it probably doesn’t have a huge effect,” she said. “I think if you were going to be investing in Medicaid home- and community-based services, you’re already the type of investor who’s willing to do some regulatory due diligence and be really thoughtful about what geographies you’re diving into.”

For home-based care investors still inclined to get into the business right now, Springer did also say she believes there’s some untapped potential in hospice.

“We believe there is still a good investment opportunity in hospice, which has fared better than home health in recent CMS fee schedules, and particularly in palliative care, which is increasingly seen as an important component of VBC,” the Pitchbook report read.

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Andy Johnston has joined AccentCare’s executive leadership team as its new president of hospice and personal care services, a newly created role at the company.

“Andy is a highly respected leader who has proven operational experience in large, multi-site health care organizations,” AccentCare CEO Laura Tortorella said in a press statement. “He will play a critical role in advancing and further strengthening our hospice and [personal care services] operations, so that we can continue to deliver exceptional quality and care to the patients and families we serve.”

AccentCare is one of the largest home health and hospice providers in the country. The Dallas-based company also provides personal home care, palliative care and other home-based care services. Its footprint includes 250 locations across 31 states and the District of Columbia, and it serves more than 200,000 individuals each year.

Before joining AccentCare, Johnston was at United Surgical Partners International for more than 20 years. He served in various roles, including chief operating officer — East, chief development officer, and most recently, chief administrative officer.

As president of hospice and personal care services, Johnston will be in charge of operations and growing these businesses.

“The team at AccentCare truly puts the care of our patients and their families at the center of everything they do,” Johnston told Home Health Care News in an emailed statement. “That level of care and commitment was important to me and a big part of why I chose to join. I’m excited at the direction we are headed and the opportunities for growth.”

In recent years, AccentCare has been making moves to revamp its executive leadership team.

The company promoted Dr. Balu Natarajan to the roles of executive vice president and chief medical officer back in January. His primary focus is clinical care operations and patient experience initiatives.

Earlier that month, the company named Saurabh Gupta its chief financial officer to lead financial strategies and execution.

In the company’s biggest recent shakeup, Tortorella joined AccentCare as its new CEO last fall. She previously served as COO of Steward Health Care.

AccentCare’s former CEO — Steve Rodgers — had served in the role for more than a decade.

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Every year, home health providers await the release of the U.S. Centers for Medicare & Medicaid Services’ (CMS) proposed payment rule. While home health providers are likely months away from seeing a proposal, it’s worth examining if what’s happening in other care settings could offer a clue of what to expect.

CMS released the 2025 proposed payment rules for hospice and skilled nursing facilities (SNFs) in March.

On the hospice side, the proposed rule included a 2.6% increase in the per diem base rate.

Aside from the pay raise for hospices, the proposal also included a market basket index update, and notable changes to some of the geographic areas subject to particular indices.

“There are rural areas that became urban and urban areas that became rural in the new CBSs — core based statistical areas,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News.

CMS also proposed moving forward with the Hospice Outcomes & Patient Evaluation (HOPE) tool, a patient assessment instrument that has been in the works for years, one that will replace the Hospice Item Set.

Still, Dombi has largely described the hospice proposed payment rule for 2025 as “plain vanilla.”

“In some respects, it’s ho-hum,” he said. “There’s nothing really dramatic or game-changing there. At the same time, as people start filtering through the proposal, and start hitting some of those issues, such as the HOPE instrument and the RFI relative to a new payment model, they get a little more curious about it. There certainly hasn’t been any high-level negatives.”

Though the proposed rule for hospice didn’t inspire extreme positive or negative reactions, Dombi pointed out that he has seen uniform disappointment in reaction to the 2.6% inflation update from providers. Many felt this was too low.

“It’s a disappointment in terms of the number, but it’s a number which can change,” Dombi said. “It’s a number which is pretty much based upon data subject to a forecasting instrument which has perplexed people for decades.”

Dombi also noted that one of the more interesting aspects of the proposal was the request for information regarding system reform on the payment model.

“CMS taking a step into further payment reform for hospice is one thing we’ve all been watching for,” he said.

Notably missing was anything related to program integrity efforts, which Dombi noted was something that providers have expressed a need for.

Dombi believes that there are some connections between the hospice proposed payment rule and the upcoming home health proposal.

“The core based statistical area, and the inflation update, are probably the only clues that we could get out of the hospice rule,” he said. “It might show some sort of understanding of what to expect in the home health rule.”

Another reason home health providers may want to keep their eyes on this proposed rule is that many of these organizations also have hospice service lines. Leaders at these organizations need to factor in the hospice rule to determine what the impact will be on their overall business.

“Those companies that have both home health and hospice can start planning for 2025 — at least preliminary planning,” Dombi said.

SNF proposed rule

The proposed rule for SNF operators includes an increase to payment rates by approximately 4.1%, or $1.3 billion.

Joel VanEaton — executive vice president of PAC regulatory affairs and education at Broad River Rehab — believes that this is a mostly positive update.

“There were comments from people [saying] it’s not enough to cover costs in the world we find ourselves in now, but it is a good thing for skilled nursing facilities that we didn’t have a reduction this year,” he told HHCN. “The last two years, we’ve had a 2.3% parity adjustment to our case mix indexes. We did have payment updates, but that parity adjustment took away some of that.”

The other big change was related to the wage index. For SNFs, wage indexes are essentially based on the geographical location of the facility, and the hospital wage data that’s associated with that geographical location.

Similar to hospice, changes to CBSs meant that some counties went from urban to rural and vice versa.

“There were some wide swings in relation to the impact of the wage index, but fortunately, a couple of years ago CMS put in place a permanent 5% cap on reductions in wage index,” VanEaton said.

Aside from those who believe the 4.1% increase isn’t enough, the reaction to the SNF proposed rule has mostly been positive, according to VanEaton.

“It’s a positive thing that you’re not going to end up worse off than you were the prior year,” he said.

In general, the connections between home health and SNFs may be less obvious than the ones with hospice.

But it is of note that, for now, home health providers seem to be getting the short end of the stick when it comes to annual payment updates.

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