Things are moving quickly in the home health index (HHI) and post-acute index (PAI).
In February, UnitedHealth Group’s (NYSE: UNH) Optum officially acquired LHC Group. In early June, Optum submitted a bid for Amedisys Inc. (Nasdaq: AMED).
In April of 2021, Humana Inc. (NYSE: HUM) fully acquired Kindred at Home after initially investing in the company in 2018. Leaders from Optum and Amedisys expect their deal to close at some point in 2024. If all goes as planned, the three largest home health providers will have all been bought up by large payers in just three years.
But there could be even more ahead. Last month, Enhabit Inc. (NYSE: EHAB), one of the only remaining independent home health and hospice providers on the public market, announced its launch of a strategic review process, which could result in a sale.
The bidders remain unknown publicly, and it will be interesting to see whether – if sold – it ends up with a payer, health system or financial sponsor.
“These acquisitions of some of the largest home health companies proves how valuable at-home care capabilities are in this day and age,” says Ben Bogan, partner and managing director at Stoneridge Partners. “It also proves that the current headwinds are strong, both for small and large providers.”
The S&P was down 1.7% in July. The HHI was up 1.9%, while the PAI was down marginally again, by less than 1%.
Home Health Index
Amedisys’ stock is likely to steadily fluctuate for the remainder of the year based on regulatory inquiries into its pending agreement with Optum. In August, the Department of Justice (DOJ) filed a request for additional information regarding the deal.
Meanwhile, home health insiders are keeping a close eye on Enhabit. The company first needed to resolve its Tax Matters Agreement with Encompass Health Corp. (NYSE: EHC), which it spun out of in July of last year. On Aug. 23, the company officially announced a strategic review process was underway.
“Enhabit is a leader in a valuable industry, providing a better way to care where patients prefer to receive their care,” the company wrote in a statement. “The Enhabit board and management team are aligned in their belief that the best way to enhance value for stockholders is to comprehensively review the company’s strategic alternatives, including a potential sale of Enhabit. We will pursue the pathway that enhances value for our stockholders and ensures we can continue to deliver exceptional care to our patients.”
Enhabit stock has been up and down. In August, its price decreased from July by 6.7%. Amedisys, on the other hand, was up 3.2% in that time.
Post-Acute Care Index
The Pennant Group (Nasdaq: PNTG) was up 4.17% in August. Addus Homecare Corporation (Nasdaq: ADUS) was down 4.41%
Pennant has continued hitting the M&A trail. It acquired an Idaho-based home health provider in June, and then acquired an Arizona-based hospice provider on the first day of September.
Afterward, the company suggested that M&A will remain a vital part of its growth strategy in the near-term future.
“[Pennant CEO Brent Guerisoli] reaffirmed that Pennant continues to pursue opportunities to acquire high quality home health, hospice and senior living businesses throughout the United States,” a press release read.
Pennant recently brought on a new CFO – Lynette Walbom – who also pointed to M&A as a current company focus.
“The [home health] industry is one where I think that there’s a lot of growth opportunity,” she told Home Health Care News in June. “I love the idea of being able to provide life-changing services, which is what Pennant is about.”
Quote of the Month
“It’s easy for us to pretend it’s not happening, but ignoring mental health conditions is not an option, because they have a potential serious outcome. The National Institute of Mental Health reports that more than 90% of people who die from suicide have depression and other mental disorders, or a substance abuse disorder. – Debbie Streier, Regional President/CEO of Avera Marshall Regional Medical Center
Read the Full Article Here: Let’s be Mindful of Mental Health, All Year Long
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:
Company | 8/31/23 | 1 mos change | YTD change | 8/31/22 | 8/31/21 |
Amedisys | 93.75 | +3.20% | +12.22% | 118.45 | 183.45 |
Enhabit | 12.81 | -6.70% | -2.66% | – | – |
HH Index* | 53.28 | +1.90% | -56.55% | 139.96 | 185.11 |
S&P | 4507.66 | -1.77% | +16.25% | 3955 | 4522.68 |
Addus | 87.70 | -4.23% | -11.85% | 89.22 | 89.92 |
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) | 2023 | 2022 | 2021 |
Amedisys | 3450 | 4450 | 5940 |
Enhabit | 1220 | – | – |
HH Index Total | 4670 | 10330 | 11690 |
Addus | 1470 | 1570 | 1540 |
Enterprise Value (EV), aka Selling Price, as Percent of Revenue
Company | 2023 | 2022 | 2021 |
Amedisys | 155% | 201% | 271% |
Enhabit | 115% | – | – |
HH Index Average* | 135% | 229% | 270% |
Addus | 147% | 174% | 189% |
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:
Company | 8/31/23 | 1 mos change | YTD change | 8/31/22 | 8/31/21 |
---|---|---|---|---|---|
Amedisys | 93.75 | +3.10% | +12.22% | 118.45 | 183.45 |
Addus | 87.70 | -4.41% | -11.85% | 89.22 | 89.92 |
Pennant | 11.98 | +4.17% | +9.11% | 15.67 | 30.57 |
Brookdale | 4.25 | +17.18% | +55.68% | 4.40 | 7.30 |
Enhabit | 12.81 | -7.18% | -2.66% | 16.60 | – |
Aveanna | 1.44 | -20.14% | +84.62% | 1.82 | – |
Enterprise Value (EV)
EV (in M) | 2023 | 2022 | 2021 |
---|---|---|---|
Amedisys | 3450 | 4450 | 5940 |
Addus | 1470 | 1570 | 1540 |
Pennant | 677 | 767 | 1170 |
Brookdale | 526 | 555 | 624 |
Enhabit | 1220 | – | – |
Aveanna | 1590 | – | – |
Enterprise Value (EV), aka Selling Price, as Percent of Revenue
Company | 2023 | 2022 | 2021 |
---|---|---|---|
Amedisys | 155% | 201% | 271% |
Addus | 147% | 174% | 189% |
Pennant | 135% | 169% | 276% |
Brookdale | 182% | 210% | 206% |
Enhabit | 115% | – | – |
Aveanna | 87% | – | – |
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 September 2023 | Stoneridge Partners)
Recent Transactions From Around The Country
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Wellsky, a health and community care technology company acquired Experience Care, a technology company offering a suite of software solutions for post-acute and long-term care providers.
SOLD by Stoneridge!!!
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The Pennant Group, Inc., the parent company of the Pennant group of affiliated home health, hospice, home care and senior living companies, has acquired Valor HospiceCare (“Valor”), which provides skilled hospice services in Tucson, Green Valley, and Sierra Vista, Arizona. Stoneridge Partners, Ben Bogan and Ted Cohen, provided sell side M&A advisory services with this transaction. See press release here.
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.
Do you know of any acquisitions that have taken place? We are interested in your comments. Contact us at Stoneridge Partners.
$9M+ in revenue with $1.8M in EBITDA. 4 locations with 30 years in the community. Strong tenured staff conducting over 27,000 appointments annually. CON state...
Hospice. 100+ ADC. Accredited. No CAP or regulatory issues.
$5M in revenue. Located in Northern/Richmond VA. Health system-owned Medicare home health and hospice. Growing organization.
Non-medical Home Care agency. $2M+ in revenue. Medicaid. Profitable.
Non-medical Home Care agency. $3M+ in revenue. Multiple offices.
Hospice. 100+ ADC. Multi-location. No CAP or regulatory issues.
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.
Medicare-certified home health. Opportunity to establish home health presence in Texas. Minimal census.
$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...
$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....
$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.
Non-medical home care franchise. $2M in revenue. 60% private pay. 20% EBITDA. Houston market.
Medicare/Medicaid-certified home health agency. $1.4M in revenue. District 9. Profitable. Accredited.
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...
Home Care Agency. $12M in revenue. 97% Medicaid. Highly profitable agency with strong growth trajectory.
$3.2 million in revenue. JCAHO accredited Home Health company. Showing remarkable growth trends and is very profitable.
Home Health & Hospice with $4.5M in revenue. Medicare/Medicaid certified. Excellent growth potential in large service area.
Hospice with $2.4M+ in revenue. Medicare/Medicaid certified. Full complement of staff in place.
Home care agency. $30M+ in revenue. 95% Medicaid. Platform opportunity.
$3M pediatric agency in Chicago. Long-term management in place.
Medicaid-certified home care. Minimal census. Opportunity to establish home care presence in Texas.
Hospice business. Low census. The license covers all of Clark County (Las Vegas and Henderson)
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.
$2M revenue home care agency. 100% private pay. Primarily non-medical. Skilled designation, not Medicare-certified. W-2 caregivers. Region 8. Accredited.
Profitable private-duty home health agency in Northern Virginia. $1.5M in revenue. 20+ years in the community.
Profitable home care franchise with consistent sales growth. Revenue of $1.3M. Great reputation within the community.
$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.
Medicare-certified home health agency. District 7. Census of approximately 30 patients. Accredited.
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 / Popular
Medicare-certified home health agency. District 3. Approximately $700k in revenue. Accredited.
Medicare-certified home health agency. District 5. Minimal census. Accredited.
Home Health Index September 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.