Deal Or No Deal: The Futures Of 3 Home-Based Care Companies

Most buyers in home health and personal care are signaling they’ll be more active in the M&A market this year.

That’s according to a new Mertz Taggart report, which included responses from over 50 potential home-based care buyers. Nearly 80% said they planned to be more acquisitive in 2024 compared to 2023.

But some of the biggest deals – or potential deals – are already well underway.

Waud Capital announced Thursday that it had acquired Senior Helpers – one of the largest home care companies in the country – for an undisclosed sum. That deal is intriguing for the rest of the personal care market for a few reasons, which we’ll get to below.

At the same time, the last two pure play home health and hospice providers on the public market are in periods of limbo.

Enhabit Inc. (NYSE: EHAB) is nearing the end of its strategic review process, which will likely end up in a merger or sale.

Meanwhile, UnitedHealth Group’s agreed-upon deal with Amedisys Inc. (Nasdaq: AMED) is under further scrutiny from the Department of Justice.

In this week’s exclusive, members-only HHCN+ Update, I take a closer look at three of the major home-based care deals that have happened, or could happen, this year.

The waiting game

Multiple times over the past few months, I predicted that Enhabit Inc. (Nasdaq: EHAB) would finish its strategic review prior to its March 7 fourth-quarter earnings call, which took place later than it had in the past.

That prediction did not come to fruition.

“The board, with the assistance of our advisors, is being comprehensive in its assessment of strategic alternatives, and discussions with interested parties are ongoing,” Enhabit CEO Barb Jacobsmeyer said on the company’s fourth-quarter earnings call. “We are in the later stages of our strategic review, but don’t intend to disclose developments unless and until we determine further disclosure is appropriate or necessary. We will not be commenting beyond that.”

Instead, Enhabit’s earnings call mirrored past earnings calls: it acknowledged its year-over-year contraction, while also honing in on its new payer contracts and improved hiring numbers.

“We are making significant progress demonstrating our value proposition to payers, as we negotiate new agreements with improved rates and are successfully shifting Medicare Advantage volumes into our payer innovation agreement,” Enhabit CFO Crissy Carlisle said during the call. “The revenue and adjusted EBITDA impact from this volume shift has not been enough to overcome the financial impact from the erosion of Medicare fee-for-service volume.”

That Enhabit problem, which forced a strategic review, is a problem most home health providers are facing.

But the company is making legitimate strides, and will be better off for the difficult transition it’s making now. The duties of its payer innovation team will eventually be the duties of one or more people at every home health agency.

Earlier reporting indicated that Enhabit would have a harder time finding a seller, and that it may end up with a private equity firm.

I do not think that is the case anymore, however, and believe there’s a larger chance now it’ll land in the hands of a strategic, which would be very significant. Enhabit, merged with one of the other top home health providers in the country, would create a home health powerhouse similar to the likes of Optum (if the Amedisys deal is completed).

Speaking of, Optum and its parent company – UnitedHealth Group (NYSE: UNH) – are still waiting on the Amedisys acquisition to go through.

As I wrote last month, that could take even longer than UnitedHealth Group’s acquisition of LHC Group, which took about 11 months. The 11-month mark for the Amedisys deal is upcoming in May.

So, for right now, Amedisys is not behind schedule comparatively. But, in addition to a general DOJ antitrust investigation into UnitedHealth Group, the DOJ is now reportedly considering a lawsuit to block the Optum-Amedisys deal.

It’s unclear how likely the DOJ nixing the Optum-Amedisys deal is at this point.

If it were to be blocked by the DOJ, however, legal processes would draw the timeline of the deal out significantly.

And, if the deal were actually blocked, it would be a massive deal for the home health industry. While Optum would still have LHC Group under its belt, it would end the company’s more massive home health land grab.

It would stop one of the most significant consolidations of home health assets we’ve seen in modern history. It could also change how payers and retailers, in general, view home health assets as M&A targets in the future.

For now, the states of Enhabit and Amedisys put the home health industry in a strange position. The two largest, public-facing assets representing the industry have relatively unclear futures.

Both are here, in the first place, largely due to Medicare Advantage (MA) penetration.

Part of the reason Amedisys opened its ears to acquisition opportunities in the first place was the shifting landscape of home health payment.

While smaller companies can sometimes be more nimble than the larger ones, Amedisys and Enhabit leaders’ recognition of that existential crisis – and difficulties dealing with it – is a troublesome foreshadowing for the thousands of other home health agencies.

Home care activity

An M&A expert recently told me to expect more personal home care dealmaking soon, as did Best of Care CEO Kevin Smith.

We have our first major deal of the year in the space now, with Waud Capital acquiring Senior Helpers. Sneakily, there has been a lot of turnover among the largest home care franchises over the last few years.

Honor acquired Home Instead in 2021. In the same year, Advocate Aurora Enterprises acquired Senior Helpers and Wellspring Capital Management acquired Interim HealthCare’s parent company Caring Brands International. Last September, The Halifax Group acquired Comfort Keepers from Sodexo.

BrightStar Care Executive Chairwoman and Founder Shelly Sun told me her company could be on the move in the next three to five years. And now, Senior Helpers is on the move again. 

I’m a tad surprised that Waud Capital went after a home care franchise to kickstart its home care platform, but for Senior Helpers, the deal makes a whole lot of sense.

Without the financials at hand, a private equity firm with significant home care interest is a far better place for a home care franchise than a health system undergoing a significant integration process. Advocate Aurora merged with Atrium Health in December of 2022.

Waud Capital put $100 million behind Steve Jakubcanin – a Cornerstone Health Group, AccentCare and Kindred veteran – earlier this year. Jakubcanin will serve as the executive chairman of Senior Helpers post-acquisition.

Increased home care interest in private equity may be taking hold due to reimbursement struggles in home health care. Investors interested in home-based care models may prefer – for the time being – providers more insulated from rate risks.

“I think we’re already seeing a little bit of that,” Rebecca Springer, lead health care analyst at PitchBook, told HHCN recently regarding that trend. “It’s not a full pivot, but we’ve definitely seen private-duty deals come through. Home- and community-based services deals have had a slow uptick in interest for a little while now. I think that’s because it’s an alternative to home health and hospice, but also because there’s a lot of green space there.”

Similarly, Havencrest Capital Management also recently started its own home care platform, Avid Health at Home. The firm began with an acquisition of For Papa’s Sake Home Care, and has since been very acquisitive across the country.

I expect Senior Helpers to similarly add on – whether in service lines or through home care acquisition – in the near-term future.