The home health and post-acute public markets have been volatile, and fascinating, over the last year.

June was no exception. The presumed arms race between Option Care Health (Nasdaq: OPCH) and Optum for Amedisys Inc. (Nasdaq: AMED) didn’t turn out to be much of one. Optum’s all-cash deal, valuing Amedisys at about $3.3 billion, was enough to win shareholders over.

The biggest obstacle to the deal being finalized will likely be any potential Federal Trade Commission (FTC) challenges, as Optum – with Amedisys and LHC Group under its belt – would own two of the largest home health companies in the country and about 10% of the overall home health market.

While 10% of a market wouldn’t be considered much in most industries, in a fragmented home health space, it would be.

Elsewhere, there were rumors of potential sales and plenty of transaction activity.

“There are a lot of factors affecting the post-acute and home health markets right now, both positive and negative,” says Ben Bogan, partner and managing director at Stoneridge Partners. “By year end, the public market could look completely different than it looked just two or three years ago.”

The HHI was up 18.74% in June, while the PAI was up 3.96%. The S&P was up 6.47% month over month.

Home Health Index

Amedisys was up over 20% in June, edging toward Optum’s agreed-upon purchase price: $101 per share.

Enhabit Inc. (NYSE: EHAB) – one of the only true home health companies left on the market – was also up 6.88%, in part due to industry belief that the company might explore a sale.

Though Enhabit spun off from Encompass Health Corporation (NYSE: EHC) just a year ago, one of its shareholders is already urging it to explore strategic alternatives. AREX Capital Management wrote an open letter to the Enhabit board in June.

“Given Enhabit’s objectively challenged execution and share price performance, the board should fully explore the potential delivery of substantial and fair value to shareholders through a sale of the Company,” AREX wrote. “We are highly confident that a full and fair strategic alternatives review will make it very clear to the board that, as compared to the risks and potential rewards inherent in the status quo, a sale is the obvious way to maximize value for all shareholders.”

Enhabit’s leaders have not publicly responded to the letter, and it’s unclear whether they will explore a sale. If they did, there would likely be suitors.

One possible buyer is Option Care Health, which may be interested after losing out on Amedisys. CVS Health (NYSE: CVS) has hinted at further home-based care transactions. Optum may even be interested, though the FTC would likely block further home health consolidation underneath its umbrella.

If Enhabit did sell, virtually no more independent home health and hospice companies would exist on the public market.

Post-Acute Care Index

In June, companies across the post-acute care index were up marginally.

Addus Homecare Corporation (Nasdaq: ADUS) was up 2.83% and the Pennant Group (Nasdaq: PNTG) was up 2.33%. Aveanna Healthcare Holdings (Nasdaq: AVAH) was up a whopping 43.22%, though that only represented a 51-cent hike in its stock price.

Addus and Pennant were also responsible for two noteworthy transactions during the month.

The former acquired Tennessee Quality Care — a home health, hospice and private duty nursing provider – for $106 million.

Tennessee Quality Care serves an average daily census of about 1,800 patients through 17 locations. Though a diversified provider, the company’s biggest service line is home health care.

Conversely, home health care is Addus’ smallest service line. One of its core strategies is building out that home health segment to layer home health, hospice and personal care on top of each other in core markets.

Later in the month, the Pennant Group expanded its Idaho footprint by acquiring three agencies under the Bluebird brand: Bluebird Home Health, Bluebird Hospice and Bluebird Home Care. Terms of the deal were not disclosed. Pennant has remained one of the most active acquirers in the home health market over the last few years.

“Bluebird’s operations fit uniquely within the strong continuum of care we have successfully built in Idaho over the last 12 years,” Pennant President and COO John Gochnour said in a statement. “This transition brings with it a strong group of operational and clinical leaders and outstanding clinicians who have made a meaningful impact in Southwest Idaho’s health care continuum over the last few years.”

Quote of the Month

“We have done everything possible to get Medicare to understand the disastrous consequences of its actions. We have presented hard facts, deep legal analyses, and extensive data to Medicare that demonstrate the errors in its policies to no avail. As a last resort, we have filed this lawsuit to protect Medicare beneficiaries and the home health agencies that care for them.” – William A. Dombi, President of NAHC in regards to its lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additional cuts expected over the next several years.

Read the Full Article Here: The National Association for Home Care & Hospice Sues Medicare to Preserve the Home Health Service Benefit

See It To Believe It!

The Stoneridge Partners Home Health Index (HH Index) is updated monthly and measures the performance of these two publicly traded home health companies, all listed on the NASDAQ:

*NOTE: LHC Group was officially delisted from the Nasdaq when UnitedHealth Group’s (NYSE: UNH) acquisition of it was finalized. While LHC Group is now gone from the HHI, Enhabit has been added in the past year. The numbers below are reflected as such.

  • Amedisys (AMED)
  • Enhabit (EHAB)

Here are the results of the stock prices for the past two years:

Company6/30/231 mos changeYTD change6/30/226/30/21
Amedisys91.44+20.43%+9.46%105.12244.93
Enhabit11.50+6.88%-12.61%
HH Index*51.47+18.74%-58.02%130.43222.60
S&P4450.38+6.47%+14.77%3785.384297.50
Addus92.70+2.83%-6.79%83.2887.24

Although we track the performance of Addus, they are not included in our HH Index because very little of their revenue comes from Medicare.

Enterprise Value (EV)

EV (in M)202320222021
Amedisys342042108310
Enhabit1180
HH Index Total4600989014570
Addus160015801510

Enterprise Value (EV), aka Selling Price, as Percent of Revenue

Company202320222021
Amedisys153%189%392%
Enhabit111%
HH Index Average*132%220%347%
Addus164%178%193%

The Stoneridge Partners Post-Acute Care Index is updated monthly and measures the performance of these six publicly traded post-acute care companies, all listed on the NASDAQ:

  • Aveanna (AVAH)
  • Amedisys (AMED)
  • Addus (ADUS)
  • The Pennant Group, Inc. (PNTG)
  • Enhabit (EHAB)
  • Brookdale Senior Living Inc. (BKD)

Here are the results of the Post-Acute stock prices for the past two years:

Company6/30/231 mos changeYTD change6/30/226/30/21
Amedisys91.44+20.43%+8.17%105.12244.93
Addus92.70+2.83%-6.32%83.2887.24
Pennant12.28+2.33%+10.05%12.8140.90
Brookdale4.22+22.32%+51.74%4.547.90
Enhabit11.50+6.88%-10.81%22.97
Aveanna1.69+43.22%+74.59%2.26

Enterprise Value (EV)

EV (in M)202320222021
Amedisys342042108310
Addus160015801510
Pennant6897031490
Brookdale522564652
Enhabit1180
Aveanna1640

Enterprise Value (EV), aka Selling Price, as Percent of Revenue

Company202320222021
Amedisys153%189%392%
Addus164%178%193%
Pennant142%157%369%
Brookdale185%210%207%
Enhabit111%
Aveanna91%

This graph displays Post-Acute Care Index performance starting late 2019.

The above calculations are based on selling price being defined as Enterprise Value (EV), with data provided by Capital IQ. Enterprise value is defined as market cap plus debt, minority interest and preferred shares, minus total cash and cash equivalents. EBITDA is calculated using methodology which may differ from that used by a company for its reporting. (Home Health Index July 2023 | Stoneridge Partners)

Recent Transactions From Around The Country

  • Elara Caring, the only full-scale, multi-state home health provider of clinical and personalized services across the patient continuum, has closed on its acquisition of Assisted Daily Living, a 50-person, privately owned skilled home healthcare provider based in Warwick, Rhode Island.
  • Addus HomeCare Corporation has acquired Tennessee Quality Care – a home health, hospice and private duty nursing provider
  • The Pennant Group has acquired Bluebird Home Health, Bluebird Hospice and Bluebird Home Care — three agencies under the Bluebird brand — that offer home health, hospice and home care services in Idaho.

SOLD by Stoneridge!!!

  • Stoneridge Partners is proud to announce the successful sale of a home health in Florida.

View Stoneridge closed transactions on our website

Exclusively Listed For Sale By Stoneridge Partners.

Do you know of any acquisitions that have taken place? We are interested in your comments. Contact us at Stoneridge Partners.

Hospice.  100+ ADC.  Multi-location.  No CAP or regulatory issues.

 Hospice /  Texas / New

Large multi-discipline pediatric therapy practice.  $5+M in revenue.  Multiple offices with a wide geographical footprint.  Full compliment of management and staff in place.

 Other /  Multi-State / New

Medicare-certified home health.  Opportunity to establish home health presence in Texas.  Minimal census.

 Home Health /  Texas

$14.9M in revenue with $3M of EBITDA.  Second largest residential treatment provider for SUD in KY.  Over 350 beds for residential, PHP, IOP, and OP...

 Behavioral Health /  Kentucky

$4.1M+ in revenue with $1.7M+ of EBITDA.  Community-based outreach program offering mental health services to primarily children and adolescents.  High barrier to entry; accreditation required....

 Behavioral Health /  Ohio

$4.5+M Houston-based Medicaid home care company.  Established 13 years ago.  Excellent HHSC contracts are in place, resulting in an impressive bottom line.  Fully staffed.

 Home Care /  Texas

Non-medical home care franchise.  $2M in revenue.  60% private pay.  20% EBITDA.  Houston market.

 Home Care /  Texas

Medicare/Medicaid-certified home health agency.  $1.4M in revenue.  District 9.  Profitable.  Accredited.

 Home Health /  Florida

Behavioral health, therapy, and educational services business.  $1.8M in revenue with over $600,000 EBITDA.  Services include ABA, early intervention services to children aged 0-21, and...

 Behavioral Health /  Pennsylvania

Home Care Agency.  $12M in revenue.  97% Medicaid.  Highly profitable agency with strong growth trajectory.

 Home Care /  Kansas

$3.2 million in revenue.  JCAHO accredited Home Health company.  Showing remarkable growth trends and is very profitable.

 Home Health /  Texas

Home Health & Hospice with $4.5M in revenue.  Medicare/Medicaid certified.  Excellent growth potential in large service area.

 Other /  Arizona

Hospice with $2.4M+ in revenue.  Medicare/Medicaid certified.  Full complement of staff in place.

 Hospice /  Texas

Home care agency.  $30M+ in revenue.  95% Medicaid.  Platform opportunity.

 Home Care /  New Mexico

$3M pediatric agency in Chicago.  Long-term management in place.

 Home Health /  Illinois

Medicaid-certified home care.  Minimal census.  Opportunity to establish home care presence in Texas.

 Home Care /  Texas

Hospice business.  Low census.  The license covers all of Clark County (Las Vegas and Henderson)

 Hospice /  Nevada

Non-medical home care franchisee.  $9.6+M in revenue.  50% Medicaid/30% Private Pay/ 14% VA/ 6% Misc.  Experienced management team to stay post-transition.

 Home Care /  Multi-State

Hospice.  45+ ADC.  Rio Grande Valley.  No CAP or regulatory issues.

 Hospice /  Texas

$2M revenue home care agency.  100% private pay.  Primarily non-medical.  Skilled designation, not Medicare-certified.  W-2 caregivers.  Region 8.  Accredited.

 Home Care /  Florida

Profitable private-duty home health agency in Northern Virginia.  $1.5M in revenue.  20+ years in the community.

 Home Health /  Virginia

Profitable home care franchise with consistent sales growth.  Revenue of $1.3M.  Great reputation within the community.

 Home Care /  Iowa

$40M+ home care agency with 20+% AEBITDA.  Primarily private-duty, non-medical (90%).  Medicaid waiver programs.  40% family caregivers.  Multiple locations.

 Home Care /  Pennsylvania / Popular

Medicare-certified home health agency.  Houston/Kingwood area.  Approximately $600k in revenue.  Accredited.

 Home Health /  Texas

I/DD provider offering SCL & FHP services.  $3M in revenue.  Recent rate increase.

 I/DD /  Kentucky

I/DD residential services.  $11M in revenue.  Highly profitable agency with long-standing reputation.  Community Residential Services (CRS) 4-bed model & Integrated Community Supports (ICS) apartment settings.

 I/DD /  Minnesota

Well established home health agency.  $4M in revenue.  Fully staffed.  Profitable.  Good history of compliance.

 Home Health /  Missouri

Home Health CON in Montgomery County.  Profitable agency generating over $1.3M in revenue.  95%+ Medicare.  Built in marketing relationship and growth potential.

 Home Health /  Maryland

Skilled Home Health & Private Duty. $4.4 million in revenue. 22% census increase over last year. Established over 23 years.

 Home Health /  Florida

Medicare/Medicaid Home Health agency. $8 million in revenue. Long history in the community.

 Home Health /  Oklahoma

86 patient hospice located Northeast of Houston, TX. $4M+ in revenue with 20% + adjusted EBITDA. Full staff in place. Excellent record of compliance.

 Hospice /  Texas

Medicare-certified home health agency. District 7. Census of approximately 30 patients. Accredited.

 Home Health /  Florida

Hospice. 150 ADC. Strong growth. Expertly run with administrative team willing to stay involved. No CAP or regulatory issues.

 Hospice /  Southwest

Mental Health Treatment Center. $1.1M in revenue. Long-established, profitable practice. Full spectrum of medical treatment and therapy services.

 Behavioral Health /  Indiana

Medical Staffing Agency. $4.6M in revenue. Established over 25 years. Excellent rapport with regional hospital network.

 Other /  Kentucky

Medicare home health agency.  Health system relationship.  Rare KY CON opportunity, multiple counties

 Home Health /  Kentucky / Popular

Home health with $8M in revenue.  Medicare/Medicaid-certified.  90+% traditional Medicare/episodic.  Services central Texas and licensed for entire state.  Strong management team in place.

 Home Health /  Texas / Popular

Medicare-certified home health agency.  Houston-area.  Minimal census.

 Home Health /  Texas

Medicare-certified home health agency.  District 3.  Approximately $700k in revenue.  Accredited.

 Home Health /  Florida

Medicare-certified home health agency.  District 5.  Minimal census.  Accredited.

 Home Health /  Florida

Home Health Index July 2023 | Stoneridge Partners

From Ben Bogan, Publisher of “Home Health Index.” Ben can be reached at [email protected] or (239) 561-0826, and toll-free at 800-218-3944. Previous editions of this monthly newsletter can be searched for at the bottom of the home page of the Home Health Index. Links to Google Finance: Amedisys | LHC Group