Health Care Giants Are Falling Short Of Home-Based Care Disruption

The biggest retailers were zealous in their pursuit of home-based health care initiatives. But there’s little evidence to suggest that pursuit has been successful, at least thus far.

This week, CVS Health (NYSE: CVS) announced that it was laying off 2,900 workers. Simultaneously, reports surfaced of Glenview Capital – a significant shareholder in the company – emerging as an activist investor.

Reuters then reported that CVS Health is exploring a potential breakup of its business. CVS Health has multiple segments, including retail, pharmacy, insurance through Aetna and health care services.

Health care services is where the company took a stab at home-based health care for the first time. In addition to acquiring the community- and senior-focused primary care provider Oak Street Health for over $10 billion last year, it also acquired the home-focused value-based care platform Signify Health for $8 billion.

“CVS’ management team and Board of Directors are continually exploring ways to create shareholder value,” a CVS spokesperson told Reuters. “We remain focused on driving performance and delivering high quality healthcare products and services enabled by our unmatched scale and integrated model.”

For payers, investors and retailers alike, home-based care looked like a worthwhile frontier to explore during the pandemic. For retailers like CVS Health and Walgreens Boots Alliance (Nasdaq: WBA) specifically, their success administering the COVID-19 vaccine to Americans gave them hope that community-based health care would be a somewhat smooth path forward.

That has not been the case, for Walgreens, CVS Health, or a slew of others.

In this week’s exclusive, members-only HHCN+ Update, I revisit the plight of retailers delving into home-based care, and consider who will be the beneficiaries of health care moving to the home.

Support in the home

The overarching idea is simple. The United States has an aging population, and more seniors than ever want to receive their health care in the home.

Plus, home-based health care tends to be cheaper than facility-based care. Traditional personal care services enable seniors to age in place and prevent further health problems related to activities of daily living struggles. Home health care ensures smooth transitions home from the hospital, keeping patients out of more costly brick-and-mortar settings.

Other home-based care is becoming popular too. Home-based care for younger Americans. Skilled nursing facility care in the home (SNF at Home). Hospital-at-home care. Primary care at home. Oncology care at home. Kidney care at home. In-home health assessments and evaluations.

Broadly, these types of care are more consumer-focused, a departure from the care that forced Americans to uproot their lives for a day, week or even months to receive the health care they needed.

For the sake of designation, I refer to Medicare-certified home health care and personal care services – through Medicaid, private pay or the VA – as “traditional” home-based care services.

As more non-traditional at-home care has proliferated, there was some sense of concern from traditional providers that more cash-strapped entities could disrupt two long standing industries.

That still could be the case, as home health and home care providers tend to be – on average – behind the curve on technology and future-facing business practices.

But in the last quarter of 2024, that disruption doesn’t seem any closer than it did in 2019.

Walmart (NYSE: WMT), which wanted to “support people aging in their homes,” has largely ditched its health care services plan. Amazon launched Amazon Care – which had an at-home care component – and then did away with it shortly thereafter. Best Buy (NYSE: BBY) is still mostly smooth sailing, but it intended from the start to be a technology partner more than anything.

Then there’s CVS Health and Walgreens, which both made massive bets – strategically and monetarily – on health care services.

Both began to shrink their retail footprints, hoping to become more health care providers than corner stores.

Walgreens invested over $6 billion in VillageMD, another home- and community-focused primary care provider. It also acquired CareCentrix, a post-acute technology company. An affiliate of the company was also a significant backer of BrightSpring Health Services (Nasdaq: BTSG), one of the largest home-based care providers in the country.

But then, earlier this year, CEO Tim Wentworth announced that the company would be undergoing a “strategic review of its assets.”

“We are now meaningfully looking at the entire portfolio of assets that we have to ensure that everything we have is going to drive the growth that we aspire to deliver,” he said at the time.

The company shuttered 160 VillageMD locations after aggressively expanding in years prior.

The investment firm KKR also acquired Walgreens’ remaining shares in BrightSpring.

Both CVS and Walgreens have had multiple leaders look over their health care divisions over a short period of time.

While CVS owns Oak Street Health and Signify Health – a similar portfolio to Walgreens’ backing of VillageMD and CareCentrix – it also purchased Aetna for $70 billion back in 2018.

Aetna’s leader was also recently ousted by CVS Health.

While Glenview Capital – the rumored activist investor – said it was not pushing for a breakup of the company, other news outlets reported that CVS’ board has already discussed that option.

Not long ago, CVS Health was considered a potential buyer for some of the remaining standalone home health companies. It had an obvious interest in home-based care, and also owned Aetna. Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH), two of Aetna’s top competitors, own home health assets of their own.

“I think, over time, we’ll look at what other assets [we need],” CVS Health CEO Karen Lynch said in 2023. “As you think longer-term, around the corner, there might be additional opportunities in the home.”

Now that idea appears to be off the table.

Walgreens and CVS Health both wanted to become health care services players, and they are. Thus far, though, they’ve stumbled. They are not yet successful players, nor successful home-based care players.

What it all means

Legacy home-based care providers love the industries they’re in, and they know there’s plenty of future opportunity.

But they also know all the challenges that come along with reaching that opportunity: staffing woes; the delicate intimacy of providing care in the home; turbulent payment environments; and the barriers to growth and scale.

There are over 10,000 home health agencies in the U.S., while there are more than 30,000 home care agencies, according to best estimates.

Consolidation has been projected for more than a decade, but has never come in a significant way.

Payers like Humana and UnitedHealth Group own two of the largest home health companies in the country in CenterWell Home Health and LHC Group. But that still only grants them access to a small slice of the home health pie.

For instance, after UnitedHealth Group acquired LHC Group, it then agreed to purchase Amedisys Inc. (Nasdaq: AMED), another one of the top home health providers. But even with both agencies under its belt, the company will likely have less than 10% of market share in the industry.

There is more startup activity in home health care and home care than ever. A couple of those businesses may have a shot at disrupting.

But, for now, the large health care companies taking a shot at home-based care have failed to make waves.

That could be because of their size, or because of the complexities that come with delivering good home-based care.

Either way, for now, most of the opportunity that lies ahead still remains for the taking. And the legacy operators have as good of a chance as anyone to capitalize.