Home Health Index April Update

Home Health Index April Update

The home health and post-acute care indices were both down in April, which turned out to be one of the more eventful months in quite some time.

Enhabit Inc. (NYSE: EHAB) finalized its strategic review and opted to remain an independent public company. A report surfaced that Amedisys Inc. (Nasdaq: AMED) would be divesting a large portion of its footprint prior to being acquired by UnitedHealth Group (NYSE: UNH). And the long-awaited Medicaid Access Rule was finalized, including the much-disputed “80-20” provision.

The 80-20 provision — which will force home- and community-based services (HCBS) providers to direct 80% of reimbursement to wages — won’t be implemented for another six years. In the meantime, there will likely be legal challenges.

“The implementation gives providers much more time to find out how they are going to approach this,” says Joe Lynch, Partner and Managing Director at Stoneridge Partners. “At the same time, it allows more time for states, providers and other advocates to challenge it, and keep it from being implemented entirely.”

Providers were generally okay with the Medicaid Access Rule, but found that the 80-20 provision overshadowed much of the good included in the rest of the rule.

The home health index was down 1.64% in April, while the post-acute care index was down 3.27%. Comparatively, the S&P was down 5.84% month over month.

Home Health Index

Enhabit Inc. (NYSE: EHAB) concluded its strategic review in early May, which first began in August of 2023. Most were expecting a sale or merger by the end of that, but neither came to fruition.

The company was down over 15% in April, and its stock continued to fall after the announcement.

“We believe macro headwinds including, among other things, uncertain regulatory developments including Medicare reimbursement policies throughout the health care industry and an evolving antitrust landscape, a difficult health care operating environment, and persistently high interest rates ultimately stifled possibilities for a transaction that would enhance shareholder value,” Leo Higdon, the chairperson of Enhabit’s board, said in a statement. “Considering this, and other strategic alternatives reviewed with advisors during the review process, the Board determined the best way to enhance shareholder value at this time is to continue to operate as a standalone business.”

Enhabit left the door open for a sale in its earnings call the following day, saying that the board would continue to consider options best for shareholder value.

But for now, it will remain an independent, publicly traded company.

Meanwhile, a report surfaced suggesting that Amedisys would be offloading part of its footprint to satisfy the DOJ, ahead of it being acquired by UnitedHealth Group (NYSE: UNH).

According to the report, the plan is to divest more than 100 locations.

Post-Acute Care Index

While Addus HomeCare Corp. (Nasdaq: ADUS), Aveanna Healthcare Holdings (Nasdaq: AVAH) and BrightSpring Health Services (Nasdaq: BTSG) were all down slightly in April, one provider, once again, stood out.

The Pennant Group (Nasdaq: PNTG) remains one of the top gainers in the post-acute care space in 2024. It was up over 6% in April. While some of its home-based care peers have struggled mightily with Medicare Advantage (MA) penetration of late, Pennant has not.

“It comes back to this idea that health care is local, and that those decisions are made on the local level,” Pennant President and COO John J. Gochnour said in May at the RBC Global Healthcare Conference. “Our strategy for the last 12 years that we’ve been around as a company has been to meet the needs of the community. So even before some of these changes, we were taking and building a network of insurance contracts. That business is lower margin, but it meets the needs of the community. And if we meet the needs of the community, then we’re going to also receive those higher-margin patients.”

The Pennant Group has been able to draw a harder line in the sand when negotiating with payers, and has achieved per-visit rate increases of 10% to 15% over the last two years, its leaders said.

That’s ultimately enough to create sustainability in its home health revenue mix moving forward.

“I think the payers are recognizing that this is not a commodity business, there is a real need to partner with high-quality providers in the communities,” Pennant CEO Brent Guerisoli also said. “That’s also why these discussions have gone favorably for us, because they recognize the value of [partnering with] a quality provider.”

Quote of the Month

“Prioritizing our mental health is of utmost importance. It shapes how we engage with the world – our community, family, and work. We can only be present for others when we are able to care for ourselves,” – Ann Teng, DO, MPH, Chief Wellness Officer at UHS.

Read the Full Article Here: Prioritizing Mental Health Is Not Selfish

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:

  • Amedisys (AMED)
  • Enhabit (EHAB)

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

Company 4/30/24 1 mos change YTD change 4/30/23 4/30/22
Amedisys 92.05 -0.12% -3.17% 80.30 127.65
Enhabit 10.09 -15.46% -2.51% 12.25
HH Index* 51.07 -1.64% -3.10% 46.28 146.75
S&P 5035.69 -5.84% +5.57% 4169.48 4117.75

Enterprise Value (EV)

EV (in M) 2024 2023 2022
Amedisys 3380 3120 4660
Enhabit 1090 1290
HH Index Total 4470 4410 10570

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

Company 2024 2023 2022
Amedisys 150% 140% 210%
Enhabit 104% 119%
HH Index Average* 127% 130% 238%

The Stoneridge Partners Post-Acute Care Index is updated monthly and measures the performance of these seven 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)
  • Brightspring (BTSG)

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

Company 4/30/24 1 mos change YTD change 4/30/23 4/30/22
Amedisys 92.05 -0.12% -3.17% 80.30 127.65
Addus 96.15 -7.48% +3.55% 81.74 84.28
Pennant 20.91 +6.12% +50.22% 13.87 16.39
Brookdale 6.79 +2.65% +16.67% 4.29 6.18
Enhabit 10.09 -15.46% -2.51% 12.25
Brightspring

Aveanna

10.69

2.25

-1.68%

-10.67%

-16.04%

1.23

Enterprise Value (EV)

EV (in M) 2024 2023 2022
Amedisys 3380 3120 4660
Addus 1690 1910 1450
Pennant 959 731 823
Brookdale 573 518 584
Enhabit 1090 1290
Brightspring

Aveanna

5490

1730

1550

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

Company 2024 2023 2022
Amedisys 150% 140% 210%
Addus 159% 200% 168%
Pennant 176% 154% 187%
Brookdale 191% 189% 213%
Enhabit 104% 119%
Brightspring

Aveanna

62%

91%

89%

This graph displays 24 months of Post-Acute Care Index performance.

The above calculations are based on selling price being defined as Enterprise Value (EV), with data provided by Yahoo Finance. 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 April 2024 | Stoneridge Partners)

Recent Transactions From Around The Country

  • Nevada-based 1Care Hospice, part of 1Care Health, acquired Reset Behavior Health
  • Arden Home Health & Hospice acquired Mid-Delta Home Health
  • The Pennant Group, Inc acquired Utah-based South Davis Home Health and South Davis Hospice.

SOLD by Stoneridge!!!

  • Stoneridge Partners is proud to announce the successful sale of a Home Care Agency in Kentucky
  • Stoneridge Partners, Ben Bogan & Ted Cohen, provided sell side M&A advisory services in the Pennant Group and Nurses on Wheels transaction. Press release

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.

Skilled home health agency.  Servicing Central Florida for over 20 years.  Census approximately 35.

 Home Health /  Florida

Houston-based home health company.  $7+M in revenue.  Profitable.  Well established within the community.  Showing positive growth trends.

 Home Health /  Texas

Occupational therapy practice with 2 offices in Southern California. Hand and upper extremity specialists.  20-plus years in the community.  Strong referral relationships.  Management and staff...

 Other /  California

Hospice.  100+ ADC.  Accredited.  No CAP or regulatory issues.

 Hospice /  Pennsylvania

$5M in revenue.  Located in Northern/Richmond VA.  Health system-owned Medicare home health and hospice.  Growing organization.

 Home Health

Non-medical Home Care agency.  $2M+ in revenue.  Medicaid.  Profitable.

 Home Care /  Tennessee

Non-medical Home Care agency.  $3M+ in revenue.  Multiple offices.

 Home Care /  Pennsylvania

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

 Hospice /  Texas

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

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

$4.5+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

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

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

 Home Health /  Florida

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.

 Home Health /  Florida

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

 Home Health /  Florida

Home Health Index April 2024 | Stoneridge Partners

From Joe Lynch, Publisher of “Home Health Index.” Joe 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.