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.

The post The Most Game-Changing Home-Based Care Blockbusters Of The Last Decade appeared first on Home Health Care News.

That’s why, as the year comes to a close, Home Health Care News wanted to take a look back and call attention to some of our favorite under-the-radar stories. These stories cover the most well-known companies in the industry, the conflict between conveners and home health providers, the final payment rule and much more.

Here are some of HHCN’s favorite hidden gems of 2023.

What An Amedisys-LHC Group Combination Under Optum Would Mean For The Home Health Market (June 9)

Arguably one of the biggest M&A stories to come out of the home health world earlier this year, was that UnitedHealth Group’s (NYSE: UNH) Optum arm acquired LHC Group, with a $5.4 billion price tag attached to the deal.

When Optum threw its hat in the ring for the chance to purchase Amedisys Inc. (Nasdaq: AMED), another home-based care giant, this news inspired HHCN to imagine what it would look like to have both companies under one umbrella.

We stacked up Amedisys’ and LHC Group’s home-based care assets, compared footprints, looked at each company’s non-home health services and more.

Since this story was released, UnitedHealth Group’s Optum has officially agreed to purchase Amedisys. This means that home health industry insiders and stakeholders will likely soon have a clearer picture of what these combined entities will actually look like. The deal is slated to close in 2024.

Gentiva Believes It Can Turn ‘Loss Leader’ Palliative Care Into ‘Game Changer’ (Oct. 4)

Historically, palliative care has been a tough business for home-based care providers. It has a difficult payer landscape, and it’s not a major money maker for providers.

“One of the things that we’re really trying to build out is an advanced palliative care model,” David Causby, CEO and president of Gentiva, said during Home Health Care News’ FUTURE conference in September. “Palliative care is very difficult today. It’s built on the physician Part B schedule. It’s a loss leader. There’s just not very good reimbursement.”

However, Gentiva — a company that was born out of the divested home care and hospice assets of what used to be Kindred at Home — believes that it will be able to crack the code.

“We personally feel that’s one of the greatest needs,” Causby continued. “One of the biggest spends in the health care system today are those patients that sit in that middle bucket that don’t qualify for home health and don’t qualify for hospice. That’s really where palliative should sit.”

Amedisys CEO Paul Kusserow: If Conveners Don’t Change, Their Day Is Coming To An End (Jan. 9)

The complicated — and at times antagonistic — relationship between home health providers and coveners is well-known across the industry. This year, providers have been more publicly vocal about their issues with conveners than ever.

Industry big-wig Paul Kusserow went on the record during the J.P. Morgan Healthcare Conference at the start of the year, where he issued a grave warning.

“Right now, I can take better care of the plan’s patients than a convener can,” he said during his appearance at the conference. “That’s the conversation we’ve been having. If they don’t change, their day is coming to an end.”

Operating Conditions Worsen As CMS Continues To Gaslight Home Health Providers (Nov. 15)

Every year, providers offer the U.S. Centers for Medicare & Medicaid Services (CMS) mountains of data and evidence for the agency to consider when finalizing the home health final payment rule. Providers have begun to believe that this data and testimony have fallen on deaf ears.

“Almost nothing changed,” VitalCaring President Luke James said during an HHCN webinar that took place in November. “There was adequate political pressure placed upon CMS. I believe the Senate Finance Committee hearing did a great job of highlighting the reality of what we’re facing here as an industry. The advocacy efforts did pay off in terms of reducing the overall cut that was ultimately levied on the industry in the final rule. But, unfortunately, getting into all the nuts and bolts, very little changed for us.”

What’s more, providers are still facing a number of challenges, such as high referral rejection rates and high LUPA rates.

‘We’re Going To Be Here For A Long Time’: Inside The Vistria Group’s Home-Focused Investment Strategy (Sept. 18)

The Vistria Group, a Chicago-based private equity firm, has been one of the most active PE players in the home-based care space. HHCN caught up with David Schuppan — the firm’s senior partner and co-head of health care — to learn more about the strategy behind the company’s vast home-based care portfolio.

Elimination Of Non-Competes Would Have ‘Major’ Effect On Home-Based Care World (Jan. 20)

The Federal Trade Commission’s (FTC) proposal to ban non-compete agreements could have big ramifications for the home-based care space.

“I definitely think it’s major. It’s extraordinarily significant,” Angelo Spinola, the chair of home care, home health and hospice at the law firm Polsinelli, previously told HHCN. “If you can’t stop a key executive from leaving and competing against you, that will have a significant impact on the industry.”

For now, it seems that the FTC has kicked the can to next year. In 2024, the FTC will formally vote on the ban. HHCN will continue to follow this story closely.

Longtime LHC Group Leader Keith Myers Breaks Down The Decision To Join Optum (Sept. 27)

The news that LHC Group was acquired by UnitedHealth Group’s (NYSE: UNH) Optum made waves at the start of the year, as mentioned above.

In September, Keith Myers took the stage at HHCN’s FUTURE conference to provide some insight into what the deal means for LHC Group’s next phase as a company.

“We’re now positioned as the home care platform within a broader provider network, and we’re able to work with other providers and participate in a risk model and care for more patients,” he said in the fall.

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Ultimately, the quotes chosen resonated the most with HHCN’s staff and readers. They were prescient, controversial, telling and highly relevant to provider struggles and opportunities.

They touched on the Centers for Medicare & Medicaid Services’ (CMS) home health payment rates, Medicare Advantage (MA) plans, operational realities and the future of home-based care in the U.S. 

The below remarks defined 2023 and struck a chord with the home-based care market.

“My concern is the game that we play with CMS. It’s a long, exhausting game. They come up with a proposed significant cut. The whole industry gets all worked up about it and runs to Washington. I’ve done this, and everybody in our business has. We lobby, lobby lobby, they get a lot of pressure, and then they come back with something that is just mediocre. It’s not enough for us to get Congress all worked up about it to pass legislation. But it’s enough to keep us in purgatory. We have to get through this dribbling sense of inadequate reimbursement.”

– Paul Kusserow, former CEO and current chairman of Amedisys (Jan. 24)

Kusserow told this to HHCN in January as he was handing off the CEO role once again. And, yet again, that game between the industry and CMS took place in 2023.

CMS proposed a net 2.2% reduction to CY 2024 home health payments in June, then finalized a 0.8% increase in November that still included permanent cuts.

Kusserow was right that CMS’ ability to come back with a “better” version of its proposed rule helps mitigate momentum the industry builds up in D.C., as Congress members have to turn their attention elsewhere.

Just a few months after his quote, UnitedHealth Group (NYSE: UNH) announced that it had to agreed to acquire Amedisys Inc. (Nasdaq: AMED) – a sign of things to come.

“Immediately, you feel a little sigh of relief as an operator just because we were expecting the full proposed cut. But then the further you read, you’re like, ‘This is trash. I’m not going to accept this for 2025 and beyond. It’s not happening.’”

– Summer Napier, the CEO of Healing Hands Healthcare (Nov. 15)

Napier told HHCN that on a November webinar highlighting the provider reaction to the final rule.

To Kusserow’s point, though, Napier urged other providers to not accept CMS’ “game,” and to continue fighting against long-term rate cuts in home health care.

“One of the things that we’re really trying to build out is an advanced palliative care model. Palliative care is very difficult today. It’s built on the physician Part B schedule. It’s a loss leader. There’s just not very good reimbursement. But we personally feel that’s one of the greatest needs. One of the biggest spends in the health care system today are those patients that sit in that middle bucket that don’t qualify for home health and don’t qualify for hospice. That’s really where palliative should sit.”

– David Causby, the CEO of Gentiva (Oct. 4)

Gentiva really began taking shape in 2023. A very recognizable name in home-based care, this iteration of the company was formed when Humana Inc. (NYSE: HUM) divested the hospice and home care assets of Kindred at Home (now CenterWell Home Health).

Causby, at HHCN’s FUTURE event, was most eager to chat about the company’s palliative care program. As he mentioned, palliative care has long been viewed as a valuable service for patients – but not necessarily for businesses.

At Gentiva, Causby believes the company can change that stigma.

“If it goes through at 80%, you’re going to see a vast majority of the small mom and pops go out of business. In states like Illinois, they’ll probably do OK, and maybe New York and Washington because you’re already there. In these other states, mainly the Southwestern states where you’re paying $7.25 an hour minimum wage, that’s where you’re going to have difficulty.”

Dirk Allison, the CEO of Addus (June 7)

Outside of the home health payment rule, the regulatory storyline that dominated headlines the most in 2023 was the Medicaid home- and community-based services (HCBS) proposed rule that would mandate 80% of all reimbursement be directed to workers.

As one of the largest providers of HCBS, Addus has been one of the loudest voices advocating against the rule, which it believes will affect smaller providers – and providers in certain markets – adversely and unfairly.

One of the biggest gripes providers have with the rule is the feeling that other investments – such as training – should be counted as investments toward workers, even if they’re not specifically wages.

“Home health is an enduring business. It goes through cycles. We’re going to be here for a long time.”

– David Schuppan, senior partner and co-head of health care at The Vistria Group (Sept. 18)

Private equity dealmaking has been way down in 2023, but the reality is that it has been down across health care — and across all industries. That’s due to macroeconomic factors. 

At points, though, it was hard to believe that certain PE firms weren’t shying away from home health care because of rate cuts and staffing concerns.

Schuppan – a part of The Vistria Group, one of the most active firms in home-based care – quelled some of those concerns in his sitdown with HHCN in September.

“I don’t see the rate of rejection going down in the short term. Those staffing challenges are going to take some time to address. I do think what’s interesting, though, is that when we go out and talk to providers, we’re starting to see providers really [honing in on] making their staff more efficient. They’re starting to reduce the administrative pieces of jobs so that those workers can focus more on clinical care.”

– Lissy Hu, the president of connected networks at WellSky (April 21)

Referral rejection rates were one of the most evident resulting issues from staffing shortages and rate cuts in home health care over the last year.

The rates reached all-time highs, all while CMS seemed to dismiss those rates as unalarming.

As a result, providers have had to find ways to make their staff more efficient. They’ve done so through technology, but also through allocating resources to payer partners that reimburse at a fair rate in Medicare Advantage (MA).

“This is the generational battle. The battle we’re having today with PDGM and the payment rates pales in comparison to what needs to be done as the plans continue to grow.”

– William A. Dombi, the president of the National Association for Home Care & Hospice (Oct. 6)

Over the past few years, tensions between MA plans and home health providers has steadily risen.

As CMS cuts payments in fee-for-service, and as MA penetration grows, providers are having to fight for fair rates from plans.

Their survival, long term, depends on that fight.

“To just say it directly, we want to partner with you. I love your feedback. … How do we get this right? How do we have a home health system … that partners with Medicare Advantage plans, both United and others, to really have a value-based system in home health?”

– Patrick Conway, the former CEO of Care Solutions at Optum, and current CEO of Optum Rx (June 15)

Conway was speaking directly to home-based care providers in the audience at a summer conference.

Providers listened closely, as Optum is set to become the largest provider of home health care in the country. It currently owns LHC Group, and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED).

UnitedHealth Group owns Optum, but also owns UnitedHealthcare, one of the largest insurers in the country. Home health providers deal with UnitedHealthcare in MA on a regular basis, and now, on the other side of its house, Optum is about to own about 10% of the home health market.

Providers remain split on what that means for the home health industry – whether it’s good, bad, or doesn’t matter.

“While they may look like they’re there to advocate for the home health benefit, they’re also there to advocate – more so – for Medicare Advantage, and around how Medicare Advantage plans can benefit over just one part of the home health benefit. I don’t think that it is great for us that they’re in this space at the level that they are. I think, in fact, it’s probably just the opposite.”

– Anonymous CEO (Aug. 28)

The above quote from a home health executive gets to the question above, which is: What does Optum becoming such a big player in home health care mean for the rest of the industry?

Multiple executives throughout the year told HHCN that they believed Optum may be beneficial in the fight in D.C. for better fee-for-service rates.

This executive disagreed, and pulled at some of the themes that have been giving other provider executives pause about Optum’s entrance.

“[Back in the ‘90s], when we’d make our rounds talking to people, and telling them that we were in the home care business, we were explaining to people that we weren’t repairing houses. To think where LHC has gone, and where the industry has gone, from then to now.”

Keith Myers, senior advisor, Optum; chairman & CEO Emeritus, LHC Group (Sept. 27)

While most of the quotes included here have an eye toward the future, this quote from Keith Myers – also at HHCN’s FUTURE event – draws back to the past.

There’s rate cuts, staffing shortages and a bevy of other concerns in the home health and home care spaces right now. But it’s worth considering just how far home-based care has come – since the 90s, and even since 2019.

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Bloomberg first reported the news late Tuesday, citing “people with knowledge of the matter.”

Based in Chicago, Help at Home is one of the largest providers of home- and community-based services (HCBS) in the country. It has more than 180 branch locations across 11 states, and provides care to more than 66,000 people via its 53,000 caregivers.

Private equity firms The Vistria Group and Centerbridge Partners – which bought a majority stake in Help at Home from WellSpring Capital Management in 2020 – are working with advisers to gauge interest in the provider.

Bloomberg’s sources said that Help at Home could be valued at “$3 billion or more,” and that a formal sale process could begin as soon as the first quarter of 2024. The Bloomberg report did add that there’s “no certainty” current deliberations will end up in a sale.

Representatives from Help at Home and The Vistria Group both declined to comment on the matter when reached by Home Health Care News. Centerbridge Partners did not respond to a request for comment by the time of publishing.

When The Vistria Group and Centerbridge originally took over, Help at Home’s executive team received a makeover. CEO Chris Hocevar, President Tim O’ Rourke and COO Ray Smithberger all joined the company in 2021.

COVID-19 had thrust home care into the spotlight, which resulted in more providers considering IPOs. At the time, Bloomberg that Help at Home was a candidate for a potential IPO.

Other companies, such as the home health provider Aveanna Healthcare Holdings (Nasdaq: AVAH), did go public. BrightSpring Health Services, another HCBS provider, pulled back on plans to go public, but is now reportedly once again planning an IPO.

Since 2020, Help at Home has been very acquisitive. Its most noteworthy buys came in 2022 when it acquired Edison Home Health Care and Preferred Home Care of New York.

Those immediately made Help at Home one of the largest home care providers in New York, as the company added 10,500 new clients and 12,000 new employees.

The company furthered its density in Pennsylvania in January of this year as well, adding Open Systems Healthcare – along with its 1,500 clients and over 2,000 caregivers – to its portfolio.

Help at Home’s footprint generally covers the Midwest, the Northeast and the Southeast.

“We’re looking at a lot of different transactions in a lot of different states,” Rich Tinsley, the chief development officer at Help at Home, told HHCN last year. “I’m not sure we want to jump across the country for a one-off state unless it made a lot of sense or had some size to it. We’re going to be diligent and disciplined around our geographic footprint. But if it makes sense and is a good platform as we enter a new state, we’ll do it.”

On The Vistria Group’s end, it is one of the most active home-based care backers in the country.

In addition to Help at Home, its portfolio includes: the home health providers Mission Healthcare and Vital Caring; the home health software company Medalogix; and the post-acute enablement company tango, among others.

Centerbridge Partners portfolio, on the other hand, also includes the large HCBS provider Sevita.

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Its investments back that up. Over the years, the company has built a diverse portfolio of home-based care assets that include home health and home care providers, vendors and a management services company.

Specifically, those assets include Help at Home, Mission Healthcare, Medalogix, Tango, St. Croix Hospice and VitalCaring, among others.

Home Health Care News recently caught up with David Schuppan, senior partner and co-head of health care at The Vistria Group, to talk about his company’s strategy, market headwinds and tailwinds, and the new home-based care “superpowers.”

The below conversation is edited for length, clarity and style.

HHCN: In your position, are you noticing any trends in the home health investment space?

Schuppan: From a high level, I don’t think any of them are novel.

Reimbursement, labor, cost of capital, regulation are all very different — not always in a good way — relative to what they have been for the past decade. All of those are making it more challenging to build your business and, naturally, they are having a chilling effect on new investment and M&A until providers better understand and adapt to this new normal. 

In your view, what are some of the key tailwinds that factor into the current home health investment space?

There are the trends demographically. Volume is immensely favorable for the populations that we treat. The site of service — the home — still remains the most favorable. 

Despite the difficulties, those are long-term secular winners, at least from an investment perspective. The dislocation that is caused by those four macro trends that I mentioned is also creating more opportunity now, but the risk and the thoughtfulness before pursuing them have both gone up immeasurably.

I think that’s why you’re starting to see deal flow fall off.

On the flip side, what are some of the other key headwinds that factor into the current home health investment space?

One that I haven’t mentioned is that you now have two emerging superpowers in home health — UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM).

The rest of the home health industry will need to better define and differentiate themselves with respect to market positioning, growth priorities, culture and outcomes, given the inherent scale, scope and capital advantages those larger entities possess.

That said, our experience would say that there’s always a strong opportunity for middle-market providers to thrive in this type of environment. Given the industry challenges over the past year, the interesting question for all of us is — who will those middle-market providers be?     

What kind of investment windows does Vistria have with its home health assets? The typical 3-5 years, or are these longer-term plays?

We tend to focus less on the timeframe and more about the company’s specific goals, whether those be economic or impact related, and the achievement of those goals, when the environment is, let’s say, more conducive to achieving them.

I think you’ve seen a lot of folks build and have liquidity in three years. My sense is that’s going to extend pretty materially, given the environment is more complex. We don’t try to handicap or put a timeframe on it.

We’ve seen your company invest on the home health on the provider side, and then with Medalogix on the clinical intelligence, data and software side of the industry. What other pieces of the puzzle do you guys have your eye on?

We’re big fans of taking a 360-view of supporting this site of service. We fundamentally believe that this is where people prefer to be and where value is created.

In addition to care provision, and skilled post-acute, as well as hospice and long-term support, we’ve also invested pretty significantly in what I’ll call the support services, or enabling services.

We’ve invested in risk enablement, through Tango, which is focused on helping improve access and value of in-home care, which is obviously a very important topic for those that pay for care, but also those who provide it and receive it.

We think that pharmacy is an underappreciated component of this. Most of the individuals we care for are polychronic. Retail and mail is not a great way to help them optimize their pharmacy use. We have a business called HomeFree Pharmacy that works with providers to provide integrated long-term care pharmacy at home.

We don’t brag about it enough, but Vistria Group, through our knowledge and learning services group, is one of the largest job creators of in-home talent, whether it be nurses, therapy, etc. Every one of our companies has a labor opportunity. We’re very fortunate to have specialists that help us either with training, or with actual creation of labor. Our education team is our secret sauce.

That 360-view allows us to, hopefully, be more intelligent about where we spend time, but more importantly, help the people that we are partnered with more effectively.

Vistria has a ton of interesting portfolio companies beyond home health, too. Behavioral health is well represented, for instance, with portfolio companies like Sevita, Beacon and Behavioral Health Group. Does having an in at those organizations benefit your work in home health at all? 

Not every company can do everything, so having partners that are willing to help you pilot, or do things that are not always natural, we found is immensely valuable.

The building blocks to value are not just medical and non-medical in-home care, but they’re also behavioral, they’re social, they’re pharma-related. Having partners, or best-in-class platforms, helps us collaborate towards a common solution where we can also leverage or capitalize on our relationships with those risk-bearing entities, whether those be health plans, ACOs or enablers.

Home health is an enduring business. It goes through cycles. We’re going to be here for a long time.

The post ‘We’re Going To Be Here For A Long Time’: Inside The Vistria Group’s Home-Focused Investment Strategy appeared first on Home Health Care News.

It has the providers – on the home care and home health care side – in Help at Home and Mission Healthcare. It has the technology in Medalogix, which is utilized by the majority of the largest home health players.

And now it has the Phoenix-based Professional Health Care Network (PHCN), a home health care management services company.

The move was foreshadowed by The Vistria Group’s new senior operating partner Nick Loporcaro – the former CEO of Landmark Health – last month.

“One area that intrigues me is home health benefit management,” Loporcaro told Home Health Care News. “You think about other models that exist in health care like management services organizations (MSOs), or similar organizations like that, that can help the industry get better organized and elevate it.”

Just over a month later, the firm announced it has made a majority investment in PHCN, which partners with both health plans and providers to provide management solutions and care coordination.

Brandon Cady, also relatively new to The Vistria Group and an operating partner, says the move was a direct reaction to a need for better organization in home health care as the industry moves toward value-based care.

“Given our areas of focus in home health on the provider side, and then with Medalogix on the clinical intelligence, data and software side of the industry, we really started to see patterns,” Cady told HHCN. “It was clear there was a need for a platform that could really accelerate the shift to value-based care and deal with some of the fragmentation issues that exist in home health.”

The Vistria Group is not alone in its interest in PHCN’s model, either. Both providers and payers are looking for this kind of platform, according to Cady.

Despite Medicare Advantage (MA) plans and other payers sometimes being at heads with home health providers, both do have similar incentives as value-based care becomes the goal in health care more generally, and specifically in home-based care.

“There’s actually a lot of shared interests and shared objectives,” Cady said. “But there’s also a gap in there. There needs to be a platform to really drive a different level of collaboration between the parties, drive more efficient data exchanges and really enable the movement in a very structured way to enable value-based care within home health care.”

The Vistria Group is banking on PHCN being that driver. In just a few years, its platform has gone from being responsible for 350,000 lives to 950,000 lives, mostly concentrated in the Western U.S.

“We really believe that one of the most important parts of this [equation] is bringing together a network of the highest performing home health providers,” Cady said. “And that really becomes the basis of the partnership: that PHCN, between payers and providers, can facilitate this at scale as well as anyone.”

While consolidation is largely inevitable in home health care, there’s a chance that platforms like PHCN’s could keep it from happening on a larger scale.

For instance, the ability for providers to create the right partnerships with payers – ones with fair rates and opportunities to capitalize off value-based care – could keep smaller agencies from being boxed out.

“Some amount of consolidation is inevitable,” Cady said. “But I do think the availability of a tech-enabled platform to automate the collaboration between payers and providers will help elevate providers.”

Still, it’s likely that the top-performing providers will be the ones most in alignment with payers, and thus the ones that will benefit most from a platform like PHCN’s. 

The Vistria Group has long been bullish on home-based care. Now that that sentiment is far more ubiquitous, its next goal is to find what it believes is still missing. 

In PHCN, it thinks it has that.

“What’s missing here is direct alignment from the payer, through the provider, in the best interest of the patient,” Cady said. “There needs to be direct alignment through reimbursement models. And that’s where there’s been a little slower progress in home health.”

The post Vistria Group Believes It Found the Platform That Will Elevate the Home Health Industry appeared first on Home Health Care News.

Amedisys completes a series of acquisitions

Amedisys Inc. (Nasdaq: AMED) recently completed a number of acquisitions.

The company announced that it has completed its purchase of Evolution Health and certain home health assets from AssistedCare Home Health and AssistedCare of the Carolinas.

Amedisys delivers a number of offerings including home health, hospice, personal care and high-acuity care services. The company’s footprint includes 350 care centers in 34 states and the District of Columbia, with an average daily census of about 74,000 patients.

Amedisys has acquired 100% of the ownership interests in Evolution Health. The company operates in 15 locations across Texas, Oklahoma and Ohio.

“Amedisys can now offer both home health and hospice services in more communities across Texas, Oklahoma and Ohio,” Chris Gerard, president and COO of Amedisys, said in a press statement. “Amedisys is proud to expand its presence in these health care communities and provide more comprehensive care by aligning with our Amedisys Hospice footprint in these markets.”

In a separate transaction, AssistedCare’s home health service lines have officially? transitioned to Amedisys. AssistedCare’s personal care services, intellectual and developmental disabilities, and private duty nursing services were not part of the deal.

Similar to the Evolution Health deal, Gerard noted that the AssistedCare Home Health and AssistedCare of the Carolinas acquisition allows Amedisys to align with the company’s hospice footprint in North Carolina.

“By continuing the great care provided by AssistedCare Home Health and AssistedCare of the Carolinas, Amedisys can now offer both home health and hospice services in more communities across North Carolina, including those in and around Wilmington and Greenville,” Gerard said. “Amedisys is proud to expand its presence in these healthcare communities and provide more comprehensive care.”

The Vistria Group invests in Professional Health Care Network

The Vistria Group — a private equity firm based in Chicago — has invested in Professional Health Care Network (PHCN), a home health care management services company.

“Since our founding, The Vistria Group has had a long-standing commitment to driving innovation and increasing access to high-quality, value-based healthcare that’s showcased through our portfolio companies,” David Schuppan, senior partner and co-head of health care at The Vistria Group, said in a statement. “The investment in PHCN was a strategic, three-fold decision, geared around increasing access to home health services, in addition to accelerating the shift towards value-based care and creating the premier network of home health providers.”

Phoenix-based PHCN partners with both health plans and providers. The company provides management solutions and care coordination.

“Our partnership with The Vistria Group will help us expand those collaborative efforts and continue to provide unique solutions that increase access and quality of home health services and drive success in our next chapter of growth,” Brian Sassi, CEO of PHCN, said in a press statement.

Owens & Minor completes Apria purchase

Owens & Minor Inc. (NYSE: OMI), a health care solutions company, completed its acquisition of Apria Inc. for a price tag of $1.6 billion.

Overall, the deal expands Owens & Minor’s home health care portfolio.

“We are excited to finalize the acquisition and for Apria to become part of Owens & Minor,” Edward A. Pesicka, president and CEO of Owens & Minor, said in a statement. “This portfolio expansion strengthens Owens & Minor’s position in the fast-growing home health industry and enhances our ability to support healthcare beyond the hospital for both new and existing patients.”

Indianapolis, Indiana-based Apria is an integrated home health care equipment provider that offers a wide range of products and services. As one of the largest providers in the home medical equipment arena, the company has roughly 280 locations across the U.S.

As part of the transaction, Apria will be combined with Owens & Minor’s Byram Healthcare business to form the new patient direct segment.

Additionally, Daniel J. Starck – who has served as Apria’s CEO – will lead the new segment.

CareCentrix rebrands its palliative care offering

CareCentrix has rebranded the Turn-Key Health palliative care solution to Serious Illness Care at Home.

“Serious illness care requires a whole-person approach that addresses the clinical and social needs of a patient and their family,” Terri Maxwell, general manager at CareCentrix, said in a statement. “Our program allows for better coordinated care that focuses on the full scope of a patient’s needs, helping them to remain independent in their homes while receiving high-quality care that is aligned with their goals and values.”

Hartford, Connecticut-based CareCentrix — a care management company that focuses on home-based care — manages care for 19 million members through its network of more than 7,400 locations in over two dozen states.

The company recently received a $330 million investment from Walgreens Boots Alliance (Nasdaq: WBA).

On Turn-Key’s end, it has provided palliative services nationally since 2016 and was purchased by CareCentrix in 2020.

Molina Healthcare partners with MedArrive

Molina Healthcare of Texas and MedArrive have formed a partnership to offer a program that provides in-home health care services to at-risk Molina members in the greater Houston area.

“Managing and navigating the intricacies of health care can be daunting, especially for underserved or elderly populations,” Chris Coffey, plan president of Molina, said in a statement. “Our partnership with MedArrive will better connect vulnerable members with the resources they need to improve their health outcomes while reducing visits to emergency rooms.”

Molina provides government-funded health care, serving members through Medicaid, CHIP, Medicare, Medicare-Medicaid and Health Insurance Exchange programs. The company has served 5.2 million members.

Meanwhile, MedArrive coordinates in-person care for health systems, Accountable Care Organizations and physician group partners via emergency medical services professionals, nurses and community health workers, among others. The New York-based company also has an array of virtual capabilities.

The partnership will connect pre-identified Molina Medicaid members with MedArrive’s field provider network of health care professionals. These providers will deliver a combination of home-based care services, diagnostics, health assessments and other preventive health measures.

The post Transactions: Amedisys Finalizes Several Acquisitions; Vistria Invests in PHCN appeared first on Home Health Care News.

Right now, there are three sections of home-based care that I see as core components to the concept: home health, hospice and personal care.

There are companies that offer one, two or all three services in some spots. But there’s a growing group of home-based care providers that are hellbent on building out the “three legs of the stool” in all the markets they serve.

With most hospice operators, palliative care also often tags along. In home health care, many providers see at-home palliative care as a logical service to offer, but monetizing it in a meaningful way has been anything but easy.

Hold that thought.

The job of any leader in this space – whether he or she is in a home-based care organization specifically, or in private equity, venture capital or a health system – is to predict what’s coming next.

In part, it’s a writer’s job too. And while I don’t have a crystal ball, I do have enough research and conversations (with people a lot smarter than I) under my belt to play prognosticator for a day.

Many correctly predicted the hospital-at-home wave, for instance, even prior to the pandemic. Others saw hospice as an emerging service line decades ago.

More types of care are being brought to the homefront, and the question I’ll try to answer below is: What’s next?

Where we are

None of this is to say the hospital-at-home trend is already over. On the contrary, it’s still in its infancy here in the U.S. Over the next five years, plenty of more providers will get involved in pilots that aim to shift hospital-level care into the home.

SNF at home, which I would consider synonymous with the idea of shifting higher-acuity care into the home, in general, was an idea that gained traction because of the pandemic, whereas hospital at home was already being explored.

So while hospital-at-home and SNF-at-home models are still finding their footing, they are here. It would not be a reach for anyone to dub those models as “the next frontier” for home-based care.

For instance, in a recent survey conducted by Home Health Care News and Homecare Homebase, responses from nearly 400 home-based care operators showed hospital-at-home and SNF-at-home models were the top care models providers were pursuing in 2022.

Where we’re going

The figure above can be viewed in two ways: that the smallest percentage-grabbing care models are relatively irrelevant or that they are the next trends and thus in the “innovators” stage of adoption, based on Everett Rogers’ “Diffusion of Innovations” theory.

Whereas hospital-at-home and SNF-at-home models are gaining higher “Q Scores” and becoming more feasible from an operational standpoint by the day, care types such as oncology care at home and pediatric care at home are relatively unexplored.

But even before the data from the HHCN-Homecare Homebase survey was released, I was beginning to believe those two care types, in particular, would be emerging frontiers in home-based care.

A private equity executive also told me recently that those were the two specific areas his firm was looking at moving forward.

The University of Utah’s Huntsman Cancer Institute’s Huntsman at Home program is a prime example of what at-home cancer care could be and has long been one of the only examples of it in practice.

When I wrote about the prospects of the model back in 2020, even experts believed wide-scale adoption was still years away.

“You can’t bring a radiation machine to somebody’s house to do proton therapy, you just can’t,” Rachel Cannady, the strategic director of cancer caregiver support for the American Cancer Society, told me at the time. “The top three cancer treatments are surgery, radiation and chemotherapy. Maybe there are times when you can get chemo infusions, but for the most part, those are in very controlled settings.”

But things are starting to change. Cancer care was – severely and sadly – delayed, put off and interrupted during the pandemic. It led providers to start thinking more about delivering care to patients in the home, even if in a some-here-some-there fashion.

Slowly, work is being put in to make it more of a reality. And the technology issues that Cannady was once worried about – reasonably so – are waning.

In July, the Children’s Oncology Group teamed up with Signify Health (NYSE: SGFY) to bring cancer care into the home, specifically for children – a hybrid between two of the frontiers we’re discussing.

“I really do think we’re going to see more cancer care in the home, and I think it’s part of a larger trend, where more and more specific disease categories will see additional home-based resources brought to bear for their patient populations,” Marc Rothman, the CMO of Signify, told me.

Then, in late January, Reimagine Care – a startup in-home cancer care enabler – announced that it had raised $25 million in a Series A.

“We think the level of capital that we raised – and the quality of the investors – would suggest that there is a strong belief … that now is the time for this to happen,” Reimagine’s CEO and co-founder Aaron Gerber told me.

Reimagine also polled health care executives before its Series A and found that close to 70% of them agreed that home-centered oncology care is gaining traction and represents a “real opportunity for growth.”

Pediatric care is in a similar stage, though it has always been feasible, unlike in-home cancer care.

While large providers such as Aveanna Healthcare Holdings (Nasdaq: AVAH) found a way to succeed with pediatric care in the home, few others have on a large scale. Mainly, that has to do with a difficult reimbursement landscape and, frankly, a lack of providers.

“My opinion on this particular issue is that it is a national problem — not just a local one,” Emily Wiechmann, the owner of the in-home pediatrics company First Day Homecare, told me last year. “There are just universally not enough home health providers in the private-duty nursing space to meet the demand of the medically complex infants and children.”

As the policy tailwinds continue to blow at home-based care providers’ backs, this is an area where many home health and home care providers could more seamlessly step in. They could do so without investing heavily in new technologies or partnerships that would be necessary to make something like in-home cancer care doable.

What else is out there

Palliative care is offered by a great deal of home health and hospice providers, but hasn’t yet been completely capitalized on. In part, that’s because there’s no real palliative care benefit, though that could eventually change.

“A growing body of clinical and economic research indicates that palliative care has the potential to generate substantial cost savings, with some estimates reaching into the hundreds of billions of dollars within the next two decades if access were to expand,” my colleague, Jim Parker, wrote in a recent Hospice News op-ed.

In the interim, it’s a good way to complete the continuum of service offerings for providers.

At-home kidney care also can not go without mention. In February, the value-based, home-focused kidney care company Somatus announced that it has raised more than $325 million in oversubscribed Series E financing.

Meanwhile, Monogram Health – a kidney care management company – recently raised $160 million in its Series B. CVS Health (NYSE: CVS) has also done considerable work to move kidney care into the home.

Finally, there’s also opportunities in home-based care generally to elevate the industry. Grabbing the aforementioned tailwinds and using them to lift the entire industry up on stilts – to gain that larger seat at the table – could yield great bottom-line results.

Nick Loporcaro, a senior operating partner at The Vistria Group, filled me in on this concept last week.

“One area that intrigues me is home health benefit management,” he told me. “You think about other models that exist in health care like management services organizations (MSOs), or similar organizations like that, that can help the industry get better organized and elevate it … that is really interesting to me.”

The post The Next Frontiers for Home-Based Care Operators appeared first on Home Health Care News.

He makes the transition from the provider side to private equity geared with decades of health care experience – and years of at-home care experience. Loporcaro led Landmark – an in-home medical care provider – until it was eventually sold to UnitedHealth Group’s (NYSE: UNH) Optum last year.

Prior to Landmark, Loporcaro spent nearly two decades with McKesson, a provider of pharmaceuticals, health information technology, medical supplies and care management tools.

As he gets his feet underneath him in his new role, he’s anything but short on ideas for the future of home-based care. He’s hoping his past experience will lend him success in private equity, which is increasingly becoming involved in the home-based care space.

Currently, The Vistria Group has its hands all over home-based care. It currently backs, among others: Mission Healthcare, a home health and hospice company; Medalogix, a home health predictive analytics platform; and Help at Home, one of the nation’s largest home care companies.

Home Health Care News sat down with Loporcaro to discuss why he made the leap, the future of home- and value-based care, and the other trends he’s most interested in moving forward.

You can read that conversation below, edited for length and clarity.

HHCN: What led you to transition from the provider space to the investor space?

Loporcaro: Prior to joining Landmark, I had spent the better part of 16 years at McKesson, being the acquirer of many companies. I decided I was going to jump the mothership and go run Landmark, which gave me a lot of exposure from another perspective — to a lot of private equity groups and the payer space.

We transacted with Optum and UnitedHealth Group, and initially I decided to stay on and help them in bringing a few other of their portfolio companies together under the auspices of home and community care. But I told them that I didn’t know that I wanted to continue to be an operator.

I was at a point in my life and my career where I had the good fortune for a couple things to line up. I was already on a couple of boards, and I am the chair of the Medalogix board. But I had some exposure to David Schuppan [senior partner and co-head of health care at The Vistria Group].

I met with Vistria’s co-chairmen and co-CEOs – Kip Kirkpatrick and Marty Nesbitt – briefly and just had a good feel for them and a couple of other private equity firms. So as I wrapped up at Optum at the end of the year, I decided to join the Vistria team for a couple of reasons.

One reason was the team and the folks that I was working with, as well as the fact that we’re opening up the Dallas office, which is home base for me. Then there was their focus on health care in this space.

I’m a huge proponent of the work we were doing at Landmark on longitudinal care. We saw the opportunity as we brought Landmark over to Optum to consider: How do you bring home health and hospice resources and attach them to that chassis?

I really do think there’s an opportunity here to elevate the home health space and hospice space into value-based care. That’s an area of focus for us. So it resonated with me. I’m dabbling in some other spaces as well, but home health care is probably where the majority of my time and interest is.

You were able to take Landmark all the way up to that point of sale. What lessons were you able to learn, on the provider side, being able to be there throughout that entire journey?

A couple of things. And some of this will sound altruistic, but please know that it’s sincere.

What drew me to Landmark is what draws a lot of providers to companies like Landmark. And it really is about keeping the patient as the North Star and being able to provide better care. A lot of people think it’s intuitive, right? Taking care of people at home – what could be better?

I remember when I first met Landmark’s founder, Adam Boehler, many years ago. He told me the Landmark story, and unbeknownst to Adam, I was in the process of transitioning my mom to assisted living back in Montreal, Canada. I literally looked at him, and I said, “So you have providers going to homes, like the old days?” And it hit me that this was sort of like back to the future, where we can provide that level of care in the home by leveraging today’s technologies and processes, doing it in an efficient and effective manner. Now, that’s the rosy story, right?

But it’s not for the faint of heart. I think you really need to appreciate that sending a provider into the home is what we used to call the tip of the iceberg. Illustrating the quality of care, I don’t think is that difficult. That is the intuitive part. Illustrating how you actually save for the overall system, that’s the difficult part. And it’s not just cost but also how you alleviate some of those pain points, and that’s where you need the systems, the actuaries, the analytics and everything that supports it as well.

What I learned on the Landmark side and dealing directly with payers is, again, it’s about making the patient the North Star. It’s not always obvious, and it’s not easy, but everything else will follow, and it truly does. But you’ve got to have that tenacity and that belief.

How does your experience leading a provider entity inform your approach to your work at Vistria?

You start understanding the providers’ motivation, and what it is that’s important and what it is we need to deliver. Now, from the investor perspective, we’re looking for companies that understand that, too. How do you best scale that and then balance what you want to deliver, but at the same time, remember we’re still a business? You still have to be able to grow it.

I used to put up this hokey slide and refer to it. It had the patient at the top, the payer in one corner, and then the shareholder in another. And I said that in order to give our patients everything they want and deserve, we’ve got to do it at a price point that the payers are willing to pay while delivering double-digit returns to our shareholders.

When you think about that, if you don’t deliver those returns, you don’t have the capital to invest in the services and the systems you need at a price point that payers are willing to pay.

As you understand each one of those components, it helps guide you to what are the best assets out there to look for, based on the thesis or themes in the industry that you want to build towards.

Value-based care is a buzz term right now in home-based care. How do you get to a point where it’s actually being implemented on a wide scale?

Three years ago, when I was invited to talk on a panel about value-based care, you could tell people were paying a little bit of lip service to it, right? But last year, you could feel that it was starting to be a little more real. And then this year at an event I attended, it was real. I think people were getting it.

If you don’t have data or analytics, and you’re not figuring out a way to get into value-based care, boy, are you going to get squeezed out of the equation at some point. And I say this very respectfully.

I think the home health industry is highly fragmented and has been relegated for a long time. It has struggled to elevate beyond a certain point, where providers are actually trying to negotiate rates based on the value they actually offer.

Some of the analytics we’re pulling out now – with our Medalogix platform, for instance – is showing and illustrating the value of home health and what that can deliver. You need to have those analytics.

I should preface this by saying I’m a huge proponent of value-based, risk-based population health. And there’s a way to wean the industry into it.

The contracting and the settlement process – that’s where we have an opportunity. There’s an opportunity to elevate this industry by demonstrating to the payer community that there’s true value. This is not just about, say, reducing the number of days of intervention. In fact, the irony is, you may want to increase it to get better value on the back end.

Are there any at-home businesses or service lines that you think there’s value in that maybe people haven’t explored as much just yet?

Yes. One area that intrigues me is home health benefit management. You think about other models that exist in health care like management services organizations (MSOs), or similar organizations like that, that can help the industry get better organized and elevate it.

Because when you have as many agencies as you do, from the provider-agency perspective, you have very little leverage in the conversation with payers. You’re dealing with the procurement-level folks, and I don’t mean that to be derogatory; that’s just where you are in the food chain.

But you can come back and be better organized, able to illustrate value and able to get into the risk-based arena. And it doesn’t have to be full upside and downside risk initially. It could be quality measures, anything.

So I think there’s an opportunity there in being able to do that without necessarily consolidating the whole space, but being able to offer those types of services. Now, all of a sudden, you’re up at the plan-sponsor level, you’re speaking to total cost of care and overall quality of delivery.

When I think about what’s out there, what you could create by leveraging those capabilities, that is really interesting to me.

You spoke a lot about direct contracting during your time with Landmark. I know some lawmakers, Sen. Warren (D-Mass.) in particular, have come out against the program. Could you share any perspective on the merits or flaws of the program?

*Editor’s note (March 2, 2022): This conversation took place before the U.S. Centers for Medicare & Medicaid Services announced the creation of the ACO REACH Model.

Respectfully, Sen. Warren and I don’t agree. As I said earlier, I’m a huge proponent of value-based, risk-based care and any form of that we can get.

I applaud CMMI and CMS for looking at models like this. I know there’s a group of individuals that aren’t terribly bought into Managed Medicare in any way, shape or form. But I really do believe it allows the opportunity to deliver a different type of care, where you’re less concerned about how many units or how many visits are delivered.

Because again, that’s almost counterintuitive. I could show you in my past experience instances where we probably would have done three or four times the number of visits that anybody could justify in a traditional model.

But in that construct when considering total cost of care, that’s in the realm of possibility. So all of that is to say, I hope direct contracting stays alive and they fine-tune it over time. I think it’s a great mechanism, and I hope to see it flourish.

The post ‘You’ll Get Squeezed Out’: Why Value-Based Care Is a Home Health Necessity appeared first on Home Health Care News.

The former CEO of Landmark Health, Nick Loporcaro, has joined the The Vistria Group as a senior operating partner for its health care team.

Loporcaro served as the CEO of Landmark, an in-home medical care provider, for over three years. The company was acquired by UnitedHealth Group’s (NYSE: UNH) Optum last year. 

The Vistria Group is a private equity firm based in Chicago, though Loporcaro will be a part of the company’s newly formed Dallas office.

Its current portfolio includes a wide range of home-based care companies, including: Mission Healthcare, a home health and hospice company; Medalogix, a home health predictive analytics platform; and Help at Home, one of the nation’s largest home care companies.

“Nick brings a wealth of life sciences and health provider experience, and, in particular, value-based care expertise,” David Schuppan, senior partner and co-head of health care at The Vistria Group, said in a press release. “He will help us realize several new partnership opportunities as well as support the leadership and development of our firm and our portfolio companies.”

AccordCare appoints first ever chief operating officer

The private-duty home care company AccordCare has named its first ever COO in Derek Nordman. 

The Marietta, Georgia-based AccordCare has locations in five states: Georgia, South Carolina, North Carolina, Connecticut and New York.

Nordman previously worked at Kindred at Home, one of the largest home health providers in the country and now a part of Humana Inc. (NYSE: HUM). At Kindred, Nordman served in seven different roles over nearly 17 years, including VP of operations and chief clinical officer. 

“I feel very fortunate to be joining such an innovative, impactful, and growth-orientated organization,” Nordman said in a press release. “Putting clients and families first is at the center of Accordcare’s values and perfectly matches my philosophy.”

The move comes as AccordCare attempts to become a nationally recognized provider.

“The new role of chief operating officer is a reflection of our commitment to continued growth and quality client-centered care,” AccordCare CEO Brandon Ballew said in the press release. “I have tremendous confidence in Derek’s ability to align AccordCare and its family of companies with ongoing operational expansion and oversee the successful delivery of home care in the communities we serve.”

ATI Advisory appoints new managing director

The Washington, D.C.-based ATI Advisory – a research and advisory firm – has appointed Kimberly Smathers as its managing director. Smathers will join ATI’s Medicare and Medicaid Integration and long-term services and supports (LTSS) innovation practice.

Smathers will lead ATI’s focus on vulnerable populations.

“My personal mission is to contribute to innovations in care that are equitable, person-centered, and sustainable,” Smathers said in a press release. “I’m eager to join ATI because of their clear commitment to meaningful work that evolves policy and business models in ways that improve the health and well-being of older adults and other complex populations.”

Smathers told Home Health Care News that at-home care solutions should – and can – be part of that “person-centered and sustainable” future. She previously served as the VP of The Lewin Group, which is a consulting firm that is a part of UnitedHealth Group’s Optum.

On ATI Advisory’s end, the company provides in-depth analyses and reports on health care in the U.S. Part of its research focus is at-home benefits being offered within MA plans, which HHCN has covered extensively in the past.

“We’re thrilled Kimberly is joining our team,” Allison Rizer, principal and practice lead at ATI, said in the press release. “Kimberly’s experience, creativity and leadership are heightened by her genuine passion for serving populations vulnerable to diminished physical, psychological and social outcomes.”

CareCentrix adds senior strategic clinical officer

The at-home care technology company CareCentrix has named Dr. Jonathan Gavras as its senior strategic clinical advisor to support “sales and growth initiatives.”

Gavras recently served as the president of the Florida market at Bright HealthCare. Before that, he was the chief medical officer of Blue Cross and Blue Shield of Florida.

“As we drive towards the next phase of CareCentrix’s growth, we are excited about adding Dr. Gavras’ deep understanding of clinical strategy, health plan operation, and pharmacy benefit management to our team,” CareCentrix CEO John Driscoll said in a statement. “Additionally, Dr. Gavras brings the unique experience of having been a health plan customer of CareCentrix – which will help our team continuously improve how we serve our plans, providers and most importantly our patients.”

Walgreens Boots Alliance (Nasdaq: WBA) last year announced a $330 million investment in CareCentrix.

BayCare announces CEO’s Retirement, New VP of Managed Care

BayCare, a Florida nonprofit health system that provides home care, announced that its president CEO – Tommy Inzina – will retire at the end of 2022.

The company has launched a nationwide search for his replacement.

“BayCare has a long tradition of planning for smooth transitions so there is no interruption in our mission to serve the community’s health,” Rick Colón, chairman of the BayCare board of trustees, said in a statement. “Tommy will continue his strong leadership of BayCare to give us the time to find the right person to take the helm of this exceptional, essential organization.”

Meanwhile, the company announced John Davis as the new vice president of managed care. He was previously the vice president of accountable care strategies at UnitedHealthcare. His new role began on Feb. 7.

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