[Updated] The Top 10 Largest Home Health, Hospice Providers in 2020

Kindred at Home remained at the top of the home health care mountain in 2020, checking in as the largest provider in the country, according to the latest annual ranking from LexisNexis Risk Solutions.

Kindred specifically captured nearly 6% of the national market share last year. Kindred at Home is part of Humana Inc. (NYSE: HUM).

Beyond Kindred, the list of the largest five home health providers also remained unchanged from 2019 to 2020, according to the Atlanta-based data and technology firm LexisNexis Risk Solutions. That’s not entirely surprising, as most in-home care operators paused M&A activity while dealing with the uncertainty caused by the COVID-19 pandemic.

In order, the largest five home health providers in 2020 were Kindred, Amedisys Inc. (Nasdaq: AMED), LHC Group Inc. (Nasdaq: LHCG), Encompass Health Corp. (NYSE: EHC) and AccentCare Inc.

LexisNexis Risk Solutions — a part of global analytics company RELX (NYSE: RELX) — releases a ranking of the top 100 largest home health and hospice providers each year. The list is based on 2.2 billion medical claims and patient-volume data from the LexisNexis MarketView claims database.

“Decision-makers in the hospice and home health markets require detailed insights about market share and positioning to make strategic decisions that support growth,” Sean Larson, the senior director of market and product strategy for LexisNexis Risk Solutions, said in a press release. “With the challenges of the COVID-19 pandemic, lower reimbursements, new entrants in the market and consolidation trends, our solutions provide valuable guidance for stakeholders to stay informed and competitive.”

After the five home health operators already mentioned, the next-largest providers, in order, were: Bayada Home Health Care, Brookdale Senior Living Solutions, Elara Caring, Interim HealthCare Inc. and Trinity Health at Home.

Bayada and Brookdale switched places from 2019 to 2020, with Bayada taking over the No. 6 spot. Elara Caring and Interim both moved ahead of Trinity Health at Home.

Overall, the top five providers represented about 20.3% of the overall home health market in the U.S. last year. The top 10 accounted for over 25% of the nationwide market share.

While there wasn’t much change among the largest home health providers year over year, that may soon change.

For starters, the historic M&A action that many believed would come from the implementation of the Patient-Driven Groupings Model (PDGM) is likely still on its way. Industry insiders expected the payment overhaul to push small- and medium-sized home health agencies out of the market in 2020, but many were able to stay afloat thanks to government assistance in the form of CARES Act funds and Paycheck Protection Program (PPP) loans.

Some — if not all — of the 10 largest home health providers will look to acquire such agencies once these lifelines go away.

The 2021 list from LexisNexis Risk Solutions may also look drastically different due to potential shakeup within the current top 10.

Encompass Health, for example, recently announced that it was exploring “strategic alternatives” for its sizable home health and hospice segment. Brookdale did the same, with the senior living operator looking to possibly cash-in on its valuable home health and hospice lines.

The PE-backed AccentCare, meanwhile, continues to acquire both home health and hospice assets at an aggressive pace. In November, AccentCare announced plans to merge with Seasons Hospice & Palliative Care, listed as the fifth-largest hospice provider in 2019.

The top-10 largest hospice providers in 2020 were: Vitas Healthcare, Kindred Healthcare, HCR ManorCare, Amedisys, Seasons Hospice & Palliative Care, Curo Health Services, Compassus, Compassionate Care Hospice, Lifepath Hospice and Hospice of the Valley.

Amedisys finalized its acquisition of Compassionate Care Hospice in February 2019. That deal is not reflected in the LexisNexis 2020 ranking.

The LexisNexis ranking is only based on Medicare fee-for-service patient volume.