BrightSpring Health Services completes Haven Hospice acquisition

BrightSpring Health Services (Nasdaq: BTSG) announced earlier this month that it has finalized its $60 million acquisition of the assets of North Central Hospice and Haven Medical Group, which collectively make up Haven Hospice.

The deal was first announced in June, and was finalized as of Sept. 1.

Importantly, the deal helps BrightSpring bolster its hospice footprint in Florida, which is a Certificate of Need (CON) state.

“We are excited to welcome Haven Hospice into BrightSpring, expanding our existing hospice services into the CON state of Florida,” BrightSpring President and CEO Jon Rousseau said in a statement. “The delivery of compassionate hospice care is critical for patients and their families, and we’re committed to delivering that to high-need Floridians. Our hospice services have been rated in the top five percent for quality in the industry, and with this expansion of services to Florida, we can provide high-quality care to more patients and their families during the most difficult time in their lives.”

BrightSpring, since going public earlier this year, has been an active acquirer. The Louisville, Kentucky-based company provides a wide range of home-based care services across all 50 states.

Compassus, OhioHealth finalize partnership

Compassus – one of the largest home health providers in the country – has finalized its partnership with OhioHealth.

Under the partnership, Compassus has acquired ownership interest in four home health locations and three hospice locations that were formerly led and managed by Ohio Health, which is a large nonprofit health system.

The partnership between the two will be dubbed OhioHealth at Home in partnership with Compassus. It was originally announced in June.

“We are excited to officially launch OhioHealth at Home in partnership with Compassus, bringing high-quality, patient-centered home health and hospice care to our communities,” Compassus CEO Mike Asselta said in a statement. “Our coordination with the community and OhioHealth hospitals in Marion, central Ohio Lexington and Athens will ensure patients receive seamless, comprehensive care right in the comfort of their homes.”

Compassus provides home health, home infusion, palliative, hospice and home care services across 30 states.

One of its main growth drivers over the years has been joint ventures and partnerships with large, regional health systems like OhioHealth.

Agape Care Group bolsters hospice footprint in four states

Agape Care Group, which is a portfolio company of Ridgemont Equity Partners, has acquired Crossroads Hospice locations in Oklahoma, Missouri, Kansas and Georgia.

Based in Spartanburg, South Carolina, Agape provides home-based hospice and palliative care services. Its family of brands already provided care across South Carolina, Alabama, Georgia, North Carolina, Kansas, Louisiana, Missouri, Oklahoma and Virginia.

Crossroads Hospice will continue operating independently in Tennessee, Ohio and Pennsylvania.

“The addition of Crossroads Hospice solidifies our decision to expand into the Kansas, Missouri and Oklahoma markets, where we have spent more than a year building the infrastructure to support this acquisition,” Agape Care Group CEO Troy Yarborough said in a statement. “We welcome the talented team members from Crossroads and look forward to focusing on care delivery and better serving patients in the Kansas City, St. Louis, Lenexa, Warrensburg, Oklahoma City and Atlanta markets.”

Advanced Home Health Care acquires Mobile Nursing Services

Advanced Home Health Care earlier this month announced that it has agreed to acquire Mobile Nursing Services, a home health provider based in Fort Madison, Iowa.

Based in Burlington, Iowa, Advanced Home Health Care provides services across the Southeastern part of the state.

“The acquisition allows Advanced Home Health to consolidate resources and provide the high-level of services both Advanced Home Health and Mobile Nursing customers rely upon to stay at home,” according to local news reports.

Advanced Home Health provides a variety of services in the home, including home care, home health care and pediatric care.

Cardinal Health to buy Integrated Oncology Network for $1.1 billion

Cardinal Health (NYSE: CAH) announced last week that it has agreed to acquire Integrated Oncology Network (ION), which is a physician-led independent oncology network. The deal is worth $1.115 billion.

Based in Dublin, Ohio, Cardinal Health is one of the largest health care companies in the country. Of late, it has significantly expanded its At-Home Solutions business. Now, it is diving deeper into oncology, which has also shifted further toward home- and community-based settings in recent years.

ION has more than 50 locations across the country. It provides “a complete and integrated continuum of care,” including diagnostic testing, radiation oncology, medical oncology, urology and other ancillary services.

As part of the transaction, ION will become part of Navista, Cardinal Health’s oncology practice alliance.

“Driving growth in specialty continues to be a top priority, and we’ve made investments to expand our offerings through both Navista and our acquisition of Specialty Networks,” Cardinal Health CEO Jason Hollar said in a statement. “With their proven model providing extensive support of community oncology across the cancer care continuum and healthcare ecosystem, we’re confident Integrated Oncology Network will further accelerate our oncology strategy and enable us to create value for providers and patients.”

Part of ION’s business model is “meeting patients where they are.”

“Integrated Oncology Network and Cardinal Health share a mission of helping community oncology practices deliver world-class patient care and a world-class patient experience to patients and families close to home,” ION CEO Barry Tanner said in a statement. “This partnership will give community practices the tools and technology they need to enhance and grow that mission and make a positive impact on patient outcomes.”

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Top home health leaders maintain that they’re operating in a space filled with “tons of opportunity.”

Payment uncertainty and other contemporary operating dynamics can muddy the waters, but there’s a way through those challenges, those leaders believe.

“I’m going to sound delusional,” Pinnacle Home Care CEO Shane Donaldson told me on stage last week at Home Health Care News’ FUTURE conference. “But I think [the home health industry] is in a great place for the future.”

At the conference, many of the same talking points were hit: Medicare Advantage (MA), fee-for-service rate cuts and staffing.

But providers are on the brink of their third straight year of rate cuts, and are about a decade into significant MA penetration in most cases. The staffing situation ebbs and flows, and providers are used to that, too.

As I talked to home health leaders in one-on-ones and on stage last week, I filled a whole page of notes related to what providers were bullish on.

Donaldson is bullish on the entire industry. Other leaders, too, are bullish – and offered specifics on where they feel like they can score some ‘wins’ in the near-term future to keep their patients happy and their margins healthy.

Those notes, quotes and other takeaways from last week’s FUTURE conference in Nashville, Tennessee, are the topic of this week’s exclusive, members-only HHCN+ Update.

Tons of opportunity

Pinnacle Home Care is one of the largest home health providers in the state of Florida. The New York-based HCS-Girling recently acquired Pinnacle, as both companies look to accelerate their growth goals.

At some point, Donaldson said that he believes HCS-Girling – along with Pinnacle – will have a home-based care footprint all along the East Coast.

Donaldson believes that home health providers will have the ability to optimize operations so much over the next few years that CMS will have to again consider large cuts to payment. He said it would be a “good problem to have.”

“I have a belief that in the not-too-distant future, if we take advantage of the current technologies, when we submit our cost reports, the problem we will have is that our margins are too high,” Donaldson said. “With artificial intelligence, robotic process automation, predictive analytics – all of these things that we have at our fingertips now are going to make life so much easier.”

Donaldson was essentially suggesting that margins will improve so much because of newly available technology that the Centers for Medicare & Medicaid Services (CMS) will again feel the need to chop rates.

Even if that sounds “delusional” – as Donaldson warned it would – many providers feel the same about certain technology advancements.

Take the aforementioned issues plaguing home health care. Scheduling is the leading cause of turnover in the industry, and there’s now AI solutions to address that. That improves retention, and, in turn, staffing. The same goes for AI that helps reduce clinicians’ documentation time.

Predictive analytics can help better manage patients with chronic conditions, which will help in the Home Health Value-Based Purchasing (HHVBP) and in value-based arrangements with other payers.

Those are just a few examples. And, of course, it won’t just be that easy.

But nearly every vendor was enthusiastic about these new offerings at the conference. This time, their enthusiasm was matched by providers.

By driving down operating costs, providers will also be better able to take on MA members that come with a lower – or currently non-existent – margin. Compassus CEO Mike Asselta suggested on stage that providers needed to go through some “maturation” before realizing all of the opportunity that lies ahead of them.

That mostly had to do with presenting value to payers, however.

In that arena, providers are already figuring out ways to better deal with payers, even if a better way is walking away from agreements entirely.

“I would suggest that providers really look at their [payer] strategy,” Interim HealthCare COO Rexanne Domico also said on stage. “What are the regional opportunities? What are other national opportunities? Where can you find that upside that’s not necessarily wholly dependent upon the big managed care providers? There’s some opportunity that’s still out there.”

Almost every provider still agrees that working with health plans in home health care is not easy.

But, anecdotally, providers told me that they’ve had a much better go at it when working with regionally focused plans.

“Some of our best partners are those regional partners,” Well Care Health COO Rebecca Higbee said on stage. “Those local partners where you can speak to the actual decision makers of the plan.”

Oftentimes, within national health plans, the decision makers on home health rates are siloed from the head decision makers. The rate setters are most interested in keeping costs down, while the head decision makers may see more home health access as a better long-term strategy.

That disconnect leads to snags in negotiations between national MA plans and home health providers.

“It’s really difficult when you’re speaking with large payers,” Higbee continued. “You’re not going to change their mind about the directives that they’ve been given. You’re not going to change their mind about the plan that they have laid out for the next quarter. But you can speak to the medical director of a local plan and really get their buy-in, in terms of the quality and the return for them.”

Domico also said that she believes there’s room for providers to get “more creative” in how they approach different payers, specifically around the presentation of home health care’s value.

A slew of leaders told me that they were encouraged by Enhabit’s (NYSE: EHAB) termination of its contract with UnitedHealthcare earlier this month.

Providers want to work with big payers, but they also need better rates – at least for now.

“I would just say that my heart was warm the other day when Enhabit walked away from the table with UHC,” Donaldson said. “I think that we’ll look back on that as being a significant event.”

The post ‘Opportunity Is Still Out There’: AI, Regional Payers And The Other Factors Exciting Home Health Leaders appeared first on Home Health Care News.

Home-based care leaders are gaining some gusto. They are at the helm of the organizations that should, theoretically, be the beneficiaries of an overload of demand over the next decade.

In the past, providers have pleaded for a “seat at the table” in the health care continuum. But, to a certain extent, they now hold the cards.

That may not always be evident, particularly in conversations with Medicare Advantage (MA) plans and the Centers for Medicare & Medicaid Services (CMS).

But with the right tools and strategy, providers have the leverage to potentially change the course of those conversations, and also vouch for themselves on much higher ground.

“I think all of us would love to see this industry mature and take hold of the advantage that we’re creating for the U.S. health care system and for Medicare Advantage payers,” Compassus CEO Michael Asselta told me on stage Thursday at Home Health Care News’ FUTURE conference in Nashville. “But there’s a maturation that we all have to undergo to capture that opportunity.”

What home health providers need to do to mature, and what that maturation could lead to, is the topic of this week’s exclusive, members-only HHCN+ Update.

A maturing industry

On the first panel of the FUTURE conference Thursday, the home health leaders on stage stripped themselves of the woe-is-me mentality that can sometimes hamstring the industry.

Asselta – who is relatively new to the industry, having joined Compassus in May – acknowledged the gap between providers and the significant opportunities that could be waiting for them in the near- to long-term future.

One of the first recommendations that he had was building out what he called “wraparound services” in addition to home health care.

“These recurring hospital visits are very expensive,” Asselta said. “Managed care understands this already, and they’re willing to reimburse us. So we have to ask. We have to build and ask. We have to weave things together a little differently for traditional Medicare, and that is providing reimbursable services under our umbrella. That means expanding, it means growing up quite a bit, and that’s sort of a theme we’ve heard, too.”

Based in Brentwood, Tennessee, Compassus provides home health care, home infusion, palliative care and hospice care. It has about 7,000 team members and more than 270 “touch points” across 30 states.

Outside of wraparound services, Axxess CEO John Olajide acknowledged the need for providers to collect and utilize data in a more practical manner.

“You cannot accomplish what you want with the payers – or whoever the stakeholder is – if you don’t have data. And to have data, you need to have the right technology,” Olajide also said on stage. “If there’s not a large data set, there’s not a lot of information to leverage in [those conversations].”

Founded in 2007 and based in Dallas, Axxess is a home health technology company.

Gentiva CEO David Causby offered up an example.

The company’s home-based palliative care business can take a payer’s most at-risk patients, which readmit to the hospital at a 30% clip, and get that number down below 10%, Causby said.

That ability, plus the data, creates leverage.

“For the industry to continue to move forward, … I think you have to scale companies,” Causby also said on stage. “You’ve got to be sophisticated. You’ve got to have a playbook on effective and efficient operations. You’ve got to be innovative. You’ve got to have data.”

Based in Atlanta, Georgia, Gentiva provides palliative care, hospice care and other home-based care services via about 600 locations across 38 states.

“You’ve got to stop being the downstream, waiting for the phone to ring,” Causby continued. “Move up, and truly show the value add. There’s no doubt, over the next 30 to 50 years, this will be the fastest-growing sector in the health care space. For those that are willing to get out there, get after it, do it the right way, be very fundamentally sound in how you operate and take the lead on innovation, technology and analytics – those are the people that will be successful in this space.”

Home-based care providers are in the right business, the right setting. But that alone won’t be enough.

Providers across the home-based care continuum need to take the next step.

“We need to continue to press for a discussion around what leverage we’re bringing to the managed care payer,” Asselta said. “Can we collectively, as an industry, start to say, ‘Hey, look, if I deliver X results, you can hold me accountable for Y. And I don’t know if we’re going to be able to change the narrative until we’re unwilling to take rates that don’t reflect the value that we provide.”

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HCS-Girling Backs Pinnacle Home Care

HCS-Girling and Pinnacle Home Care announced earlier this month that the two companies have a definitive agreement to enter into a strategic partnership. Financial terms of the deal were not disclosed. 

The New York-based HCS-Girling provides home health and home care services, and Pinnacle Home Care is one of the largest home health providers in the state of Florida.

“Pinnacle is an important provider in the Florida market, having established a reputation for excellent clinical quality and a very strong corporate culture,” Jeffrey and Agnes Shemia, the co-CEOs of HCS-Girling, said in a statement. “HCS-Girling and Pinnacle both share a unique founding story as clinician-founder-led platforms. We are extremely excited about this partnership and the ability to service patients across geographies, working hand in hand with Shane and the Pinnacle leadership team to provide best-in-class care.”

Together, the two companies will “link the care continuum across two growing markets,” according to the release.

“Pinnacle and Girling are a perfect match with meaningful cultural overlap,” Pinnacle Home Care Founder and CEO Shane Donaldson said in a statement. “Both businesses are founder- (and clinician-) owned and operated and privately held. Both organizations recently celebrated 20 years of service in their respective communities, an important marker in how far both have come in their journeys as health care providers. Pinnacle looks forward to serving our patients, staff and referral partners for the next 20 years.”

HCS-Girling also recently acquired the personal care operations of Addus HomeCare Corp. (Nasdaq: ADUS) in New York.

Pinnacle’s chief sales officer said that the partnership with HCS-Girling will bring the company “considerable balance sheet strength.” The leadership teams will remain the same at each organization.

“We are so proud of our Pinnacle Family and all that we have achieved over the past several years,” Pinnacle President Michael Froning added. “Growth across the Florida home health market has not come without challenges, including the COVID-19 pandemic, as well as PDGM and RCD. As Pinnacle developed our longer-term strategies, we knew that future growth would require larger capital support, but we actively chose not to follow the path of our competitors to be acquired by a payvider or private equity, or the publicly traded home health providers.”

BrightSpring Health Services acquires Haven Hospice

On Monday, BrightSpring Health Services (Nasdaq: BTSG) announced a definitive agreement to acquire Haven Hospice, a Florida-based operator that provides services in North Central Florida.

The deal was worth $60 million, according to BrightSpring, and expands its service capabilities in a Certificate of Need (CON) state.

The company has closed multiple home-based care deals in 2024 already.

“We are excited to welcome Haven Hospice into BrightSpring, bolstering our existing hospice care line of business and expanding our hospice services into the CON state of Florida,” BrightSpring President and CEO Jon Rousseau said in a statement. “The delivery of compassionate hospice care is critical for patients and their families, and we’re committed to delivering that to high-need Floridians. It is extremely difficult to enter the Florida hospice market, and with this recent expansion of services, we can now provide high-quality care to more patients and their families during the most difficult time in their lives.”

In addition to hospice care, the Haven acquisition will also allow BrightSpring to provide advance care planning and palliative care. The deal is expected to close in the third quarter.

Compassus and OhioHealth enter home health, hospice partnership

The home-based care provider Compassus has formed a partnership with the health system OhioHealth. Specifically, the former will manage the latter’s home health and hospice service lines.

“We’re proud to collaborate with OhioHealth to deliver high-quality, patient-centered home health and hospice care to ensure patients and families have the support they need wherever they call home,” Compassus CEO Mike Asselta said in a statement. “As our teams come together, we’ll continue to focus on patients, partnership and innovation to deliver superior care.”

The Brentwood, Tennessee-based Compassus provides home health care, home infusion, palliative care and hospice care services. Its 7,000 employees provide care across 30 states.

The company also entered into a similar agreement with Bon Secours Mercy Health earlier this year.

As a part of the agreement, Compassus will “manage operations as both organizations work to ensure smooth continuity of care for patients and families.”

The OhioHealth network includes 15 hospitals, more than 200 ambulatory sites and home-based care services that serve patients in 50 counties in Ohio.

Northrim Horizon acquires Noble Hospice and Palliative Care

The private equity firm Northrim Horizon has acquired Noble Hospice and Palliative Care. Terms of the deal were not disclosed.

The deal took place through Northrim’s portfolio company ITC, which is a personal care provider, according to Hospice News.

“As long-term business builders, we try to view the world in decades as opposed to three-to-five years, which allows us the luxury to block-out short-term noise in markets,” Jack Lawson, Northrim operating partner and Noble’s new CEO, told Hospice News. “We believe hospice is an enduring segment within the broader home care industry and provides essential services to patients in a cost-effective and preferred setting. We are big believers that the best long-term care meets patients where they are.”

The Arizona-based Noble’s network includes a patient census of about 200.

“Noble has a strong track-record of growth, an experienced clinical and operations team and an enduring, patient-focused model of care that makes for a fantastic entry-point in the industry,” Lawson said. “We believe Noble Hospice has a business model and standard of care that will stand the test of time.”

HHAeXchange acquires Cashé

The New York-based home care technology platform HHAeXchange has acquired Cashé Software, a Minnesota-based home care operations and billing company.

“Today marks an exciting milestone as we join forces with Cashé. In addition to its robust product set, the company shares HHAeXchange’s passion for homecare, technology and innovative software,” HHAeXchange CEO Paul Joiner said in a statement. “Home care agencies need purpose-built technology to support them in delivering quality care. We are thrilled to partner with the Cashé team to collaborate on our vision of delivering the most comprehensive solution that drives operational efficiency, increases compliance, and improves health outcomes.”

Cashé already works with more than 400 home care agencies in Minnesota, according to the press release.

“For 20 years, Cashé has been focused on ensuring our customers can rely on our software to help them deliver the best care in the home,” former Cashé President Praba Manivasager, who will join HHAeXchange’s leadership team, said in a statement. “This commitment is strengthened by our partnership with HHAeXchange, and we look forward to working together as a team to accelerate our vision of building the software platform that sets the standard for efficient workflows and insightful data.”

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The Pennant Group secures 2 more acquisitions

The Pennant Group has completed two acquisitions thus far in May.

Announced first was its acquisition of the Davis County, Utah-based South Davis Home Health and South Davis Hospice.

“This acquisition provides us with an opportunity to further expand in the state of Utah, and will complement our agencies throughout central and northern Utah,” Pennant CEO Brent Guerisoli said in a statement. “We continue to be the provider of choice in these communities, and this opportunity expands our ability to provide life-changing hospice services to residents of Davis County and its surrounding communities.”

Based in Eagle, Idaho, Pennant is a holding company of independent operating subsidiaries, including 112 home health and hospice agencies and 53 senior living communities spanning 14 states.

Guerisoli also reiterated the company’s commitment to more transactions in the near-term future, and two weeks later, the company announced another hospice acquisition.

Pennant also acquired the Corpus Christi, Texas-based Nurses on Wheels, a provider of hospice services.

“We are excited to expand the reach of our hospice operations in south Texas,” Guerisoli said in a statement. “Our strategy of empowering local leaders to meet the needs of local communities has resonated deeply across our platform and we look forward to bringing our innovative operating model and high-quality resources to enhance the services offered in South Texas.”

Family Resource Home Care acquires Specialty Service Solutions

The Liberty Lake, Washington-based Family Resource Home Care has acquired Specialty Service Solutions.

Specialty Service Solutions is also a home care provider, and will integrate into Family Resource’s existing footprint in the Moses Lake, Washington area.

“Specialty Service Solutions is a fantastic addition to our growing Moses Lake operation. We’ve been aware of their strong presence and reputation in the market for quite some time and the ability to integrate them into our company is an honor,” Family Resource CEO Hector Barragan said in a statement. “Their team brings additional market intelligence and expertise that will be valuable as we continue to expand our services in central Washington.”

Family Resource provides home care services across 35 locations spanning Washington, Idaho and Oregon.

“After founding Speciality Service Solutions, LLC in 2017 with over 20 years in health care, I was motivated by the desire to provide a needed service that makes a difference in people’s lives,” Emilie Milburn, the founder and owner of Specialty Service Solutions, said in a statement. “I’m excited to be able to integrate my business with Family Resource, while retaining roles for all of my office and caregiving staff with Family Resource Home Care.”

Milburn will stay on as the branch manager for Family Resource in Moses Lake.

Compassus, Bon Secours Mercy Health finalize joint venture

In February, Compassus and Bon Secours Mercy Health announced that they would be partnering on a home health and hospice venture across five states.

As of early May, that joint venture agreement has been finalized.

“Together, Compassus and Bon Secours Mercy Health will support continuity of care while providing patients and families with options to receive hospice and home health at home or in residential care facilities,” Compassus COO Laura Templeton said in a statement. “The BSMH health system is an innovator and leader in care, which make this joint venture an ideal partnership. As mission-aligned organizations, we are committed to upholding the high standards of care that BSMH patients are accustomed to and that Compassus is known for across the country.”

The Brentwood, Tennessee-based Compassus provides home health, hospice, palliative care and home infusion services to more than 100,000 patients annually across more than 250 locations in 29 states.

In the agreement with Bon Secours Mercy Health, it will operate and manage 10 home health agencies and 11 hospice operations on behalf of the health system. Those locations span Florida, Illinois, Kentucky, Ohio, South Carolina and Virginia.

Arden Home Health & Hospice acquires Mid-Delta Home Health

The Hattiesburg, Mississippi-based Arden Home Health & Hospice has acquired Mid-Delta Home Health, which is a “40+ year family-owned, Mississippi business covering predominantly the Mississippi Delta and surrounding areas,” according to the two companies.

Arden Home Health & Hospice was founded in the fall of 2023, and has quickly added to its portfolio.

“As of May 1, 2024, Arden is now the largest home health and hospice company that is proudly owned, headquartered, and operating in the State of Mississippi,” the company said.

Community Based Care acquires HCBS provider

The home- and community-based services (HCBS) provider Community Based Care has acquired CustomCARE, a Minnesota-based home care provider.

Community Based Care providers home care and I/DD support to over 5,000 clients in Florida, North Carolina, Ohio, Rhode Island and Virginia. It has over 3,000 team members.

Meanwhile, CustomCare provides HCBS services across 87 counties in Minnesota.

“We are thrilled to welcome CustomCARE into the Community Based Care Family of Providers,” Community Based Care CEO Mike Kotzen said in a statement. “This partnership aligns perfectly with our mission to provide high quality, personalized care to the families and individuals we serve. By combining resources, we will further enhance our ability to deliver comprehensive home care solutions on a greater scale that promotes independence, dignity, and well-being for all our clients by bringing the care they need to the place they love, their home.”

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“Compassus continues to build national momentum in executing its shared mission with long standing provider and payer partners to expand access to best-in-class home-based care services,” Pat Ryan, executive chairman at Compassus, said in a press statement. “Mike’s experience driving operational excellence at scale and employer-of-choice initiatives will be a tremendous asset in advancing these goals.”

Compassus is one of the largest home-based care providers in the country. The Brentwood, Tennessee-based company provides home health, hospice, palliative and home infusion services across more than 270 locations in 30 states.

Asselta takes over for David Grams, who has served as Compassus’ CEO since 2022. Grams will step into an interim advisory role to aid with the transition. Grams succeeded Jim Deal in the role of CEO.

Prior to joining Compassus, Asselta was chief operating officer of U.S. care delivery and president of Fresenius Kidney Care at Fresenius Medical Care North America. He spent almost eight years at the company.

Before Asselta’s time at Fresenius Medical Care North America, he served in leadership roles at companies like Quest Diagnostics (NYSE: DGX) and SelectQuote Senior.

“Mike has an impressive track record of operating and growing multi-site health care service organizations that provide the highest quality of care, and I am confident he is the right person to lead Compassus as it continues to broaden access to integrated, home-based care services in partnership with market-leading health systems and payor organizations,” Ryan said.

Last year, Home Health Care News named Compassus one of its six home health providers to watch.

One of the reasons Compassus earned a spot on the list was due to its consistent growth. The company showed up in Inc. 5000’s list of fastest-growing U.S. companies in 2021, 2018 and 2017. That growth has been driven by both de novos and acquisitions.

At the start of the year, the company formed a joint venture with Bon Secours Mercy Health, a Ohio-based health system.

A month prior to this, Compassus and Ascension announced the expansion of their Tennessee-based home health partnership, Ascension Saint Thomas at Home.

Asselta hopes to continue building on these accomplishments.

“Compassus has a strong reputation for excellence and high-quality, home-based care across the country, which continues to be realized through its integrated care model and growth in market-leading partnerships,” Asselta said in the press statement. “I am honored to have the opportunity to lead the organization into this next phase alongside a highly accomplished management team of passionate and compassionate leaders. Together, we will continue working to transform lives and deliver person-centered care where people live through our ‘Care for who I am’ mission.”

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Thanks to impactful, large-scale transactions over the last decade, the collective face of home-based care has changed forever.

Traditional providers in both home health care and personal home care have merged. Payers became involved in the home-based care space like never before. Of late, retailers have too.

But it’s often easy to forget how the current landscape became what it is.

Below, Home Health Care News takes a look at some of the most important and impactful deals in home-based care over the last decade – deals that explain, in part, where the home health and home care industries are today.

‘Big time’ provider deals

This past decade’s first blockbuster remained one of the most impactful throughout the last 10 years.

In 2014, April Anthony’s Encompass Home Health & Hospice was acquired by HealthSouth Corporation for $750 million. HealthSouth took a swing at home health and hospice, merging an in-patient facility business with a post-acute care business.

Four years later, HealthSouth would rebrand completely, taking on the home health and hospice entity’s name. Encompass Health Corp. (NYSE: EHC) still exists today, but is again without post-acute care capabilities.

The HealthSouth-Encompass deal is like a few other deals in home health care, in that it set off a domino effect and a winding life cycle of a home health entity.

Anthony left Encompass Health in 2021, and after her home health and hospice company operated as a segment within the larger organization for nearly a decade, Encompass Home Health & Hospice was spun off into its own public company: Enhabit Inc. (NYSE: EHAB).

That happened in 2022, and two years later, Enhabit may land in the hands of a different owner after it concludes its own strategic review. Anthony now runs VitalCaring, which is backed by her, The Vistria Group and Nautic Partners.

Over the decade, larger health care organizations like Encompass Health have also bundled up services, and also unbundled them.

For instance, Brookdale Senior Living (NYSE: BKD) had one of the largest home health footprints for a long time. After COVID-19 woes, however, it offloaded that to a health system eager to get into home health care: HCA Healthcare (NYSE: HCA). LHC Group would later acquire some of the assets jointly owned by Brookdale and HCA Healthcare.

Ascension Health, too, teamed up with TowerBrook to buy the home health and hospice provider Compassus in 2019.

A theme that has been a mainstay, and will likely remain a mainstay, is health systems changing course on their strategic planning – and deciding whether to own home health care themselves or focus on core operations and partner with home health care instead.

“You’re seeing a lot of these facility-based providers divesting or spinning off assets,” Chaz Bauer, director at Fifth Third Securities, told Home Health Care News. “They realize they have fundamentally two different businesses. They’re very related and intertwined. But fundamentally, you have these facility-based businesses that are very centralized models, very capital intensive. Whereas home-based care businesses, they’re very decentralized; they’re very capital-light. Part of the motivation there – in unbundling – is they can unlock value for their shareholders by splitting those businesses.”

But then there’s the M&A that has come from within the home health sector itself.

For instance, “the merger of equals” that turned LHC Group into a true home-based care powerhouse.

In late 2017, LHC Group agreed to merge with Almost Family in a $2.4 billion transaction. A straight line can be drawn from that deal to UnitedHealth Group’s (NYSE: UNH) acquisition of LHC Group, which was finalized in 2023.

LHC Group and Almost Family’s merger is not an anomaly, either. Not long after, Great Lakes Caring, National Home Health Care and Jordan Health Services combined in a three-way merger to create another one of the largest home health companies in the U.S.: Elara Caring.

That deal was powered by the PE firms Blue Wolf Capital Partners and Kelso & Company.

PE money in home-based care has turned a lot of sizable providers into powerhouses. The aforementioned PE firms – Blue Wolf, Kelso, Vistria and Nautic – have all played a part in that, in the transactions mentioned already and otherwise.

That will also continue, particularly as some of the holding periods of the largest companies turn over. There’s also a chance, however, that PE firms direct more attention to other parts of home-based care – like personal care – given the uncertainty surrounding home health payment rates.

In home care, Vistria and Centerbridge Partners uplifted Help at Home, turning it into one of the largest providers of home- and community-based services (HCBS) in the country.

Waud Capital recently acquired the large home care franchise Senior Helpers. Wellspring Capital Management acquired Interim HealthCare’s parent company Caring Brands International in 2021. Last September, The Halifax Group acquired Comfort Keepers from Sodexo.

PE has always been involved in home care. Bain Capital’s 2018 creation of Arosa, one of the largest non-franchised home care companies in the country, is one past example.

In the future, it’ll be interesting to see if PE will drive more large-scale, impactful deals like it has in home health care over the last decade.

Payers enter the fold

Any commentary on the biggest deals in home-based care over the last decade needs to note increased payer involvement.

Enter Humana Inc. (NYSE: HUM).

When people think of the company’s home-based care investments, most go straight to its takeover of Kindred at Home.

But let’s take a step out of the last decade, just for a second.

In 2011, Humana acquired the home-based care provider SeniorBridge, which was doing just $72 million in annual revenue at the time. When that deal was announced, it was not exactly frontpage news. But one could argue that kickstarted a chain of investments that changed the M&A landscape in home-based care forever.

“SeniorBridge fills a growing market need and is consistent with Humana’s focus on delivering clinical care for seniors in their homes,” Michael B. McCallister, Humana’s chairman and CEO at the time, said in a statement. “Acquiring SeniorBridge will immediately expand Humana’s existing clinical capabilities with the addition of SeniorBridge’s national network of 1,500 care managers. The company does a terrific job of reducing hospital readmissions and emergency-room utilization, all while helping seniors achieve lifelong well-being.”

Humana’s home-based care thesis was already there, but the SeniorBridge deal was likely the deal that set the stage for what eventually became CenterWell.

“The deal was a game changer. I was initially surprised by the size of the transaction. It was pretty small by Humana standards,” Mertz Taggart Managing Partner Cory Mertz told HHCN. “It didn’t take long for Humana to tout the savings SeniorBridge created for their membership, saving it billions of dollars within the first couple years of the deal, by keeping their members at home and out of the hospital.”

Nearly 13 years later, Humana is one of the largest home health providers in the country through CenterWell Home Health.

The company, with the help of the PE firms TPG Capital and Welsh, Carson, Anderson & Stowe (WCAS), acquired and merged Kindred at Home and Curo Health Services. Yet another home health and hospice powerhouse was formed, this time under the watch of one of the largest payers in the country.

In 2021, Humana opted to take over a remaining 60% of the enterprise (it had previously owned 40%), which was worth over $8 billion at the time.

In 2022, it divested the hospice and home care operations of Kindred to Clayton, Dubilier & Rice (CD&R). Those divested assets became what is now known as Gentiva, led by David Causby, the former CEO of Kindred at Home.

The home health assets Humana held onto are now under CenterWell Home Health. CenterWell, overall, includes primary care, pharmacy and home health services.

In 2024, most large payers – namely the ones with large MA memberships – have some sort of home-based care capabilities. That was not the case when Humana acquired SeniorBridge way back when.

“This has been an ongoing development, and it’s really just vertical integration,” Bauer said. “The thought is: why not get into that downstream, and then be able to more directly control those costs and quality outcomes on the payer side?”

The other heavily involved payer is the only one that has a leg up on Humana in MA: UnitedHealth Group.

UnitedHealth Group’s Optum already had a variety of health care provider assets, but it decided to make its first big home-based care splash early in 2022 when it announced the $5.4 billion acquisition of LHC Group.

While payers liked the thought of vertical integration, large providers like LHC Group were also recognizing an existential threat to home health business: MA penetration. More MA beneficiaries meant fewer traditional Medicare beneficiaries, which meant a less sturdy financial leg to stand on.

UnitedHealth Group further cemented its interest not long after, when it made a $3.3 billion all-cash offer for Amedisys. That deal was agreed to in June of 2023, but is still pending.

Though UnitedHealth Group may have to divest some Amedisys assets to finalize the deal, the company will most likely have the largest home health market share when that deal closes. Estimates suggest Optum will have about 10% of the U.S. home health market under its belt.

Not only are payers now involved in the home health industry, but they are also creating scale.

“You can make an argument that Optum acquiring LHC group, and now Amedisys, is a scale transaction, like ones we’ve seen before,” Bauer said. “Because it puts together two of the largest providers to make an industry leader.”

New kids on the block

Like payers before them, another group of companies is now firmly involved in home-based care investment: retailers.

In fact, they’re so invested, they may not be labeled as just retailers five to 10 years from now.

CVS Health (NYSE: CVS) has a new health care services segment dubbed CVS Healthspire. Walgreens Boots Alliance (Nasdaq: WBA) has the same with its U.S. Healthcare segment.

Both of those segments are arguably the future of their respective parent organizations. And both include home-based care services.

Payers and retailers have different business models, but tend to want the same thing: pharmacy, primary care and home-based care services.

In 2020, Walgreens made an over $1 billion investment in VillageMD, a home- and community-focused primary care provider. After subsequent investments, it has backed VillageMD with over $6 billion.

After that, Walgreens found its next health care services asset in the health-at-home solutions platform CareCentrix. Though he is no longer in the position, CareCentrix’s former CEO, John Driscoll, was the initial leader of Walgreens new U.S. Healthcare segment.

“We continue to see strong results and potential for growth from our partnership with CareCentrix. Our full acquisition further accelerates our transformation to become a consumer-centric health care company, leveraging innovative platforms that extend our capabilities into fast-growing segments of health care,” former Walgreens CEO Roz Brewer said at the time. “CareCentrix is key to offering services to our patients at every stage of the care continuum, and to driving long-term, sustainable growth as part of our U.S. Healthcare strategy.”

Not to be outdone, CVS Health agreed to acquire the home- and value-based care enabler Signify Health in 2022 for $8 billion. Shortly after that, it got its primary care provider, too, with the over $10 billion acquisition of Oak Street Health.

While none of these assets are traditional home health or home care assets, this retailer involvement represents a seismic change in U.S. health care – and home-based care is a major part of it.

These companies could go after more assets in the future, or they could become major partners for those traditional providers.

Honorable mentions

It’s impossible to highlight every deal, but there are some that don’t fit perfectly into “themes” that are still worth mentioning.

The home care technology company Honor acquired the home care franchise brand Home Instead in 2021, for instance. In lieu of strictly partnering with providers to see its vision through, Honor opted to purchase Home Instead to speed up the process. The jury is still out on that deal, however.

Prior to agreeing to become a part of Optum, Amedisys also made plenty of deals that turned it into a multi-billion-dollar business.

It acquired the hospital-at-home platform Contessa Health in 2021 for $250 million.

It acquired Compassionate Care for $340 million in 2018, and AseraCare Hospice in 2020 for $235 million. Those two deals significantly bolstered its hospice arm.

Modivcare (Nasdaq: MODV) entered into the personal care game in a real way with its $575 million acquisition of Simplura Health Group in 2020 and its $340 million deal for CareFinders Total Care in 2021.

BrightSpring and PhaMerica completed a merger in 2019 that eventually led to today’s BrightSpring Health Services (Nasdaq: BTSG), which is now a public home-based care company.

Finally, Aveanna (Nasdaq: AVAH) – formerly a pediatric provider – entered into the home-based senior care world with its $345 million acquisition of Comfort Care Home Health in 2021 and its acquisition of Accredited Home Care for about $200 million later that year.

Addus Homecare Corporation (Nasdaq: ADUS) has executed several high-profile transactions of its own, most recently acquiring Tennessee Quality Care in a $106 million deal.

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Artificial intelligence is likely to be a society- and business-altering technological development.

But, just like the advent of the internet before it, AI’s emergence will undoubtedly lead to as many empty promises from business leaders as it does actual use cases.

That’ll particularly be the case in the early innings of AI, which I believe we are currently in.

At any health care conference over the last five years or so, AI chatter was as ubiquitous as COVID-19 chatter was during the early days of the pandemic. But I’d often come away from that chatter with no more information on how providers planned to put AI to use than I had before.

This year is likely to be one of the first where a good chunk of providers are actually putting AI to use, however. That’s why, in Home Health Care News’ trends for 2024, we included the prediction that “providers will find ways to more seamlessly and strategically integrate AI.”

Over the last few months, I have tried to cut through the empty promises and ask providers directly: How are you currently using AI, or how do you foresee your organization using it in the near-term future?

More direct questioning, unsurprisingly, led to more direct answers.

In this week’s exclusive, members-only HHCN+ Update, I hope to take you behind the curtain on providers’ AI strategies across home-based care.

An AI prologue

First things first, every provider I talk to about AI generally starts off with a similar opening statement on AI, which is that they do not believe AI or other technology will be able to replace hands-on, human care.

Particularly in the early innings, that seems like the right mindset.

“We hear so much about tech in the home,” Visiting Nurse Health System CEO Dorothy Davis told me. “Not that I don’t think that’s an important piece, but I think the revolution is going to be on the consumer side and on the caregiver side. Tech is an enablement. If the user and the person impacted doesn’t understand it, the tech means nothing.”

That’s a key caveat. If AI cannot be implemented in a way that can be understood by a select few people – or in some cases a large group of people – then it is useless.

It’s also generally useless, particularly for generative AI, if there is not good data to feed into it.

Providers can’t go from an archaic operation with no data tracking capabilities to a future-facing, AI-embedded operation in one jump.

“I often describe data as the clay,” Guillaume Vergnolle, a senior data scientist at AlayaCare, told me on stage at Aging Media Network’s Continuum conference. “It’s your best material to come up with an [AI] solution. You need the right kind to come up with the solutions. So, when it comes to the retention problem, make sure that you’re actually collecting the right data to mirror what you’re trying to solve.”

AlayaCare is one of the home-based care vendors aiming to help providers out with AI. Its commitment to AI solutions – along with WellSky’s, for instance – is a heavy indication that providers will soon be further along with practical implementation.

Where AI will be useful

Compassus COO Laura Templeton told me that she sees AI becoming useful in two areas in the near-term future: documentation and scheduling.

“We currently have a couple of work streams right now — one being for clinicians — around how AI can make their job and role easier or better,” Templeton said. “We’ve been looking closely at how to consolidate and optimize processes by utilizing AI tools.”

Compassus leaders were the first to divulge AI use cases to me in December at the Continuum conference.

“We’ve piloted several scheduling programs where we’re using our clinicians at the top of their license, and where we are sending the right clinician, at the right time, to the right place,” Templeton continued. “Scheduling is one area that comes to mind where I’m excited to see what AI can do.”

Indeed, scheduling is one area where providers could use advanced help.

After all, staffing is a top concern for nearly all home-based care providers. Within that, most leaders will say the key issue they’re trying to solve is retention. Within that, scheduling is the No. 1 reason that home health workers turnover.

“We’re having humans doing things that humans don’t have to do, scheduling being one of those,” VitalCaring President Luke James told me. “Medical records. Systems work. Where can we apply some generative AI and some kind of workflow technology that can take most of it out of the hands of humans? Reacting to the exceptions only, for instance.”

Axle Health, a home health scheduling platform, announced a $4.2 million funding round Thursday.

James also mentioned documentation, which Jordan Holland – the VP of value-based contracting at Compassus – also dove into in December.

“Clinical documentation has always been a big one — which has a lot of different layered potential use cases,” he said at Continuum. “There’s the idea of talk-to-text, but then there’s also talk-to-text to other discrete fields. Talk-to-text is great, but is that actually going to help you facilitate filling out an OASIS form? There’s an added layer to that because that talk-to-text then gets submitted to another party.”

James added that VitalCaring “has to get more efficient in the back office with rates continuing to fall.”

That is the core driver of a lot of home health providers’ AI strategies: finding ways to become more efficient to avoid fallout from any rate cuts from the Centers for Medicare & Medicaid Services (CMS).

Alivia Care CEO Susan Ponder-Stansel is taking the same approach, but through a different lens.

A provider that has gone deep into value-based care over the last few years, Alivia Care wants to find ways to up reimbursement through better outcomes.

“We want to really be able to stratify risk and create a patient profile,” Ponder-Stansel told me. “There are certain algorithms that you can develop to say, ‘Okay, when these particular things happen, you need an extra visit, you probably need to do a med rec.’ Because all those things downstream help prevent that rehospitalization, help prevent that adverse outcome. So that’s what we’re looking at.”

Elara Caring CEO Scott Powers, meanwhile, told me that stripping caregivers and home health aides of non-value work is the “No. 1 use case” that he sees coming to fruition.

The home care side

Personal home care providers are generally approaching AI a bit differently, which is interesting to note.

For instance, Home Helpers sees it helping most on the marketing side, particularly for franchises.

“We use AI in our franchise-development process around identifying potential new franchisees, and doing some specific psychographic targeting,” Home Helpers President and CEO Emma Dickison said during a HHCN webinar last year. “Internally, for the team, where we see the biggest lift with AI … is in the marketing department. But there are just so many applications.”

Similarly, BrightStar Care isn’t writing big AI checks yet, but is, for now, using AI-enabled chats on its website to help out with back-office functions and to get feedback from clients.

But there also are rate concerns for these home care providers, some of which are similar to home health providers’ concerns.

For those that are diving further into Medicare Advantage (MA), for instance, there’s a need for more efficient processes to make MA beneficiaries worthwhile clients from a business sense.

“I think you just have to prioritize where you can make the biggest difference on the margins,” Kristen Duell, the EVP of experience and innovation at FirstLight Home Care, told me. “We need to create automation in certain areas, leveraging technology and leveraging machine learning so that we can reduce overhead costs – and sometimes field costs – so that we can take on those health plan [clients]. We need it to make economic sense.”

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Through the new JV, Compassus will manage operations for 10 home health agencies and 11 hospice operations across five states.

The news of the joint venture comes on the heels of Compassus’ partnership expansion with Ascension, and its Ascension Saint Thomas at Home arm.

It’s been a point of emphasis for Compassus to partner with companies that have aligning visions and missions. Compassus CEO David Grams told Home Health Care News his company was able to ground itself in that commitment with BSMH.

“Our society is aging and people want to be receiving care in their home,” Grams said. “Which was amplified and ratified by the pandemic. There’s a recognition on the part of health care providers that we need to increase access, advance clinical outcomes and be good stewards of resources. I think these partnerships are grounded in those objectives.”

The Brentwood, Tennessee-based Compassus provides home health, hospice, palliative and home infusion services to more than 100,000 patients annually across more than 250 locations in 29 states.

BSMH is the fifth-largest Catholic health system in the United States, according to a joint press release from the two organizations. The health system’s 60,000 employees offer services through more than 1,200 care sites in seven states.

“As the dynamic health care environment continues to evolve, we want to make sure we keep our patients at the center of everything we do,” BSMH COO Don Kline said in a statement. “Finding the right partner for this important, specialized work has been essential to ensuring continuity of care well into the future. We are confident that we have identified a mission- and vision-aligned partner in Compassus that will help to fulfill our important commitment to caring for patients at every stage of life.”

Compassus and BSMH will each hold a 50% stake in the JV. Under the agreement, BSMH will maintain ownership of its existing hospice assets in specific locations, while Compassus will manage the operations.

An undisclosed number of the health system’s employees will transfer to work at Compassus, Grams said.

Partnerships like these, he said, should help the caregiver capacity issue that continues to be a headwind in home-based care.

“The demand side of home-based care is not going to have any problems,” Grams said. “We have a conversion in the space and that’s because there’s not enough caregiver capacity. In increasing that caregiver capacity, you create an opportunity for the health system to do well.”

Compassus is also in talks with other health systems about future potential joint ventures, Grams noted.

“We’re in discussions with other organizations and we’re excited about the ongoing opportunity to partner with additional health systems to advance their success in a value-based care world,” he said.

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On Wednesday, Compassus and Ascension announced the expansion of their Tennessee-based home health partnership, which is dubbed Ascension Saint Thomas at Home.

Subsequently, Ascension Saint Thomas at Home’s service area now covers 17 Tennessee counties in the mid and west parts of the state.

“We are fortunate to have found a great partner in Ascension and are proud of the partnership we’ve formed and its impact on expanding home-based care access in many communities,” Compassus CEO David Grams said in an email to Home Health Care News. “Since initially partnering with Ascension Saint Thomas in Tennessee last October, our goal has been to provide home health care for more Tennesseans. We’re grateful to be expanding that partnership and will continue to look for opportunities to bring sought-after home-based care services to more communities.”

Compassus is one of the largest home-based care providers in the country. The Brentwood, Tennessee-based company provides home health, hospice, palliative and home infusion services across more than 250 locations in 29 states. It is backed by the private equity firm Towerbrook Capital Partners and Ascension.

On its end, Ascension is one of the largest private health care systems. The organization’s portfolio includes 250 sites of care, 13 hospitals and a network of JVs, medical practices, clinics and specialty facilities.

Compassus and Ascension Saint Thomas first rolled out their JV partnership last October in eight counties.

“Our partnership with Ascension allows us to reach more people in need of home-based care,” Grams said. “While both of our organizations are adept at offering this care on our own, by joining forces we are able to ensure patients across the continuum have access to the right care at the right time by identifying those who could benefit from the care earlier on in their journey. Additionally, we gain the additional support of the clinical and operational teams who work together to achieve shared objectives supporting patient experience and quality of care.”

The Pennant Group enters health system JV

The Pennant Group has formed a home health JV with John Muir Health. The two companies officially closed on the partnership on Jan. 1, 2024.

John Muir Health is a nonprofit integrated health system that serves communities across San Francisco’s East Bay region.

Eagle, Idaho-based Pennant is a holding company of independent operating subsidiaries located across the U.S., with a network that includes 99 home health and hospice agencies and 51 senior living communities.

As part of the JV, the two organizations will offer skilled nursing, therapy, home health aide and medical social work services across the Bay Area. The JV will operate under the name Muir Home Health.

“We are thrilled to begin operating this joint venture,” Pennant CEO Brent Guerisoli said in a press release. “Muir Home Health will bring together the deep experience of one of the Bay Area’s premier health systems with Pennant’s deep experience in managing and supporting the delivery of life-changing home health services. This collaboration will create a unique continuum of care that will benefit Bay Area residents for many years to come.”

On its end, John Muir Health will contribute its home health business to the JV, which will be majority-owned and managed by a Pennant subsidiary. Meanwhile, Pennant Services Inc. will provide operational and administrative support services for the JV.

“We selected Pennant because of their established track record for providing high-quality home health care and commitment to customer service and their employees,” John Muir Health President and CEO Mike Thomas said in the statement. “Our new joint venture will expand access to home health care in the area and enable deployment of care pathways, the latest protocols, and best practices developed by Pennant through operation of its home health agencies nationwide.”

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