Amid ‘Hyper-Competitive’ M&A Market, Trinity Health at Home Focuses on Private-Duty Expansion

Trinity Health at Home – one of the largest home health providers in the country – plans to expand its private-duty footprint and be more aggressive in a “hyper-competitive” acquisition marketplace this year.

Private-duty home care is not something that the Livonia, Michigan-based Trinity Health at Home currently offers at most of its ministries or locations, President and CEO Mark McPherson told Home Health Care News. But McPherson said the provider has been seriously looking to acquire about a half dozen private-duty organizations.

“Some are larger, and those would be a jumping off point for us to be able to scale,” McPherson said. “We’ve also looked at some smaller organizations with some talent and leadership, and have thought maybe we can scale that way. It’s something that Trinity does not have throughout its organization, and we feel like it’s really important [to have] to round out the care continuum.”


Broadly, home health providers like Trinity have increasingly sought to acquire home care services in order to care for a wider range of patients and address social determinants of health.

The plan to continue expanding falls in line with Trinity’s approach in 2021, when it ​​formally consolidated its national network of home health agencies with regionally owned affiliates. McPherson said the consolidation process of agencies in Syracuse, Fort Lauderdale, Philadelphia and Delaware in July was seamless.

“It’s gone really well,” he said. “We still have a lot of work to do, but I’d say that the actual integration portion of it has gone exceedingly well. We still have a couple of other locations that are still regionally owned that we still need to bring into Trinity Health at Home, so we’ll be looking to do a little bit more of that in fiscal year 2023.”


Trinity Health at Home is part of Trinity Health, a nonprofit health system that operates several dozen hospitals in 22 states, plus roughly 120 continuing care locations, including in-home care, hospice and senior living. Overall, the Trinity Health at Home network has upwards of 9,300 patients on census.

In terms of revenue, Trinity Health at Home is a $300 million business – just a portion of Trinity Health’s $19 billion organization.

Aside from expanding the private-duty division of the company, McPherson said general M&A expansion will be the top priority for the next 12 months.

McPherson said a slight shift in focus for more acquisition-based growth is part of Trinity Health at Home’s “enhanced growth strategy.”

“I think we were more passive in the past about acquisitions,” he said. “If someone were to bring us an offer, we would look at it. Now we’re being more proactive and seeking out acquisition opportunities as opposed to just waiting for somebody to present one to us.”

Trinity Health at Home has a list of possible acquisitions in each of its regions. But like for many in the industry, securing deals in the current M&A environment has proven tough.

“It’s a hyper-competitive market, I will say that,” McPherson said. “I wouldn’t say that we’re struggling to find opportunities, but if there’s one thing that I would like us to do [it’s] maybe capture a higher percentage of the ones we’re looking at. We’ve been able to acquire a few, but I would like us to get a little bit higher success rate on it. It’s just the nature of doing deals: You’re going to win some and you’re going to lose some.”

Money from private equity is driving up prices in the home care and hospice space, McPherson said, which is one of the challenges Trinity and other providers are facing.

Of the 152 and 166 home health, hospice and home care deals that took place in 2020 and 2021, respectively, PE accounted for a majority, according to data from M&A advisory firm Mertz Taggart.

“That’s making the marketplace even more competitive than what it’s been historically,” McPherson said. “So I think there’s been a change in the market dynamic that’s really made it the hyper-competitive market it is today.”

While growing Trinity’s reach will be a priority for the next year, McPherson added that sustaining its success is another focus for the provider as a whole.

McPherson said part of that assessment period has included what aspects of the organization’s future fit into the Home Health Value-Based Purchasing (HHVBP) Model.

HHVBP is set for a nationwide expansion in 2023. Trinity Health at Home already participated in the nine-state demonstration, with three of its locations.

McPherson said that it was a mixed bag in terms of each agency’s outlook during the demonstration.

He told HHCN one agency did exceptionally well throughout, while one did “pretty good.” The third struggled, though HHVBP “highlighted the things they needed to work on, and they really rose to the challenge,” before improving scores dramatically.

“I feel like we’re in a really good spot in terms of knowing what is going to impact HHVBP and our scores going forward,” he said. “We’re looking at things that are going to drive up our HHVBP scores like re-hospitalizations. We can work directly with the hospitals that are sending a great portion of our book of business to us and partnering with those hospitals to help improve those metrics.”

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