Home-Based Care Public Company Roundup Q4 2024
- Emin Beganovic
- Apr 7
- 8 min read
Mertz Taggart follows the publicly traded home-based care companies and reports on their earnings calls each quarter. As a group, public company performance and share price serve as a proxy for industry performance and investor sentiment, respectively. Historically seen as the “ultimate consolidators”, the publicly traded home-based care trading multiples have a downstream effect on lower middle market home-based care M&A.
Addus Homecare (Nasdaq: ADUS)
Highlights
Addus reported strong operating results in Q4 2024, with total revenue increasing by 7.5% to $297.1 million from $276.4 million in Q4 2023. This growth was driven by a combination of solid organic expansion and contributions from recent acquisitions.
The personal care segment, representing 74.1% of total revenue, experienced a 5.8% organic growth in Q4 2024 compared to Q4 2023, driven by strong demand and favorable reimbursement across its markets. In Q4 2024, the company successfully expanded its caregiver workforce while maintaining historically low turnover rates.
Home health admissions saw steady growth in Q4 2024, supported by increased physician referrals and expanded partnerships with payers. The company continued to invest in technology and care coordination efforts to enhance service delivery and improve patient outcomes.
The company had strong operating cash flow in Q4 2024 enabling them to pursue acquisitions while maintaining disciplined expense management and stable margins.
Key Financial Figures
M&A Activity
Addus continued to grow through strategic acquisitions, completing two major transactions in 2024. The Gentiva Acquisition, finalized on December 2, 2024, expanded the company’s personal care business, while the acquisition of Upstate Home Care Solutions on March 9, 2024, further strengthened its presence in key markets.
Acquisitions completed in 2024 contributed $22.6 million in net service revenues for the year, highlighting the company’s successful execution of its acquisition strategy. This compares to $18.8 million in net service revenues from acquisitions completed in 2023.
“As we continue to look for acquisitions that align with our growth strategy, our primary objective is to find operations and markets where we can leverage our strong personal care presence and add clinical services so we can offer all three levels of home-based care,” CEO Dirk Allison stated.
Guidance
Illinois' FY 2025 budget raises in-home care service rates to $29.63 per hour, effective January 1, 2025, benefiting AddusHomeCare's revenue and profitability in the state.
The company had a strong Q4 2024, however, Federal Medicare and Medicaid funding changes may modestly impact future momentum.
Aveanna Healthcare (Nasdaq: AVAH)
Highlights
Revenue for Q4 2024 totaled $422.2 million, reflecting a 9% increase compared to Q4 2023. Aveanna achieved growth across all three operating divisions, with Private Duty Services increasing 10% & Medical Solutions rising 5% y-o-y.
EBITDA for the quarter was $54.9 million, representing a 70% increase y-o-y. This growth was primarily driven by higher core volume, an improved payer rate environment, and the successful implementation of cost-reduction initiatives.
Aveanna recognizes that the primary challenge remains the labor environment, particularly the shortage of available caregivers. In the past quarter, the company made notable progress in caregiver hiring and retention, positively impacting service capacity and financial performance.
Key Financial Figures
M&A Activity
Aveanna CEO Jeff Shaner stated, “We feel like we have not only stabilized the company but put the company back on the rightful path for growth and success. And we believe it’s time for us to reenter the M&A market.”
The company plans to close transactions in 2025, focusing on acquisitions within the Private Duty Nursing and Home Health & Hospice segments as part of its inorganic growth strategy.
Guidance
In 2024, Aveanna has secured 12 state rate increases for Private Duty Services, with additional states expected to implement increases in early 2025. The company has worked closely with the California Governor, Medi-Cal Department, and the Legislature to highlight how private duty nursing rate investments reduce healthcare costs and will continue partnering with California officials to pursue further rate increases in the 2025/2026 budget.
Aveanna has provided full-year 2025 guidance as follows: Revenue range - $2.1 - $2.12 billion and an adjusted EBITDA range of $190 - $194 million owing to the expected continued organic volume growth, improved clinical outcomes, and enhanced profitability into 2025
The company had a good Q4 2024, however, Federal Medicare and Medicaid funding changes may modestly impact future momentum.
The Pennant Group, Inc. (Nasdaq: PNTG)
Highlights
The company achieved total revenue of $188.9 million in Q4 2024, marking a 29.4% increase compared to the same period in 2023. This growth reflects strategic investments in leadership, occupancy enhancements, improved revenue quality, and operational efficiencies.
The Home Health segment continued to show strong growth, with quarterly revenues reaching $78.6 million, a 50% increase year-over-year. Total home health admissions increased by 40.9%, while Medicare home health admissions increased by 30.1%.
The Hospice segment achieved a 17% increase in revenue year-over-year, supported by improvements in hospice programs and the successful integration of recent acquisitions, which have helped differentiate its operations within the community. Hospice admissions increasing by 21.7%.
The Senior Living segment generated $46.9 million in revenue, representing a 29% increase over the prior year quarter.
Key Financial Figures
M&A Activity
In August, PNTG completed the first phase of its planned acquisition of Signature Group, LLC operations (Washington and Idaho assets). This acquisition added four home health agencies and one hospice agency to the Company’s portfolio. According to PNTG’s President & COO, John Gochnour, “The integration and transition of these operations is proceeding well, and we are starting to unlock additional value by implementing our unique operating model, sharing best practices, and providing world-class support from our service center.”
The Oregon assets of Signature represent the second and larger portion of the transaction, with preparations for closing on January 1, 2025.
Guidance
Considering the company’s geographic distribution and the finalized wage index updates, Pennant anticipates a net neutral effect on per-episode reimbursement under the 2025 Final Rule.
PNTG has provided full-year 2025 guidance as follows:
Revenue: Range of $800 million to $865 million
Adjusted EBITDA: Range of $63.1 million to $68.2 million
Management's projections account for reimbursement adjustments and exclude acquisition-related costs and other non-core expenses, emphasizing a focus on operational performance and cash flow.
The company had a strong Q4 2024, however, Federal Medicare and Medicaid funding changes may modestly impact future momentum.
Enhabit Home Health & Hospice (Nasdaq: EHAB)
Highlights
The company reported net service revenue of $258.2 million for Q4 2024, a slight decrease of $2.4 million (0.9%) compared to the same period in 2023.
Home Health revenue declined by 4% y-o-y. Non-Medicare admissions dropped 20.1%, driving total admissions growth of 4.8% year-over-year. Of these non-Medicare visits, 45% are now under payer innovation contracts at improved rates. However, while admissions grew, recertifications declined due to more admissions from acute care facilities with shorter stays and a changing payer mix in congregate living settings. This drop in recertifications was the main factor in the revenue decrease.
Hospice revenue grew by $6.8 million or 13.3% year-over-year, driven by higher patient days and increased Medicare rates. Since January 2024, the average daily census has risen during the year 2024.
Key Financial Figures
M&A Activity
The company remains limited by its credit agreement, which restricts acquisition opportunities due to current debt levels. As Enhabit Senior Vice President and Treasurer Jobie Williams stated, “We have focused this year on accelerating cash and paying down debt, and our success can be seen in our results. Our leverage decreased for the third quarter in a row. We ended the third quarter with a leverage ratio of 4.8 times.”
Guidance
Enhabit has provided guidance for full-year 2025 as follows:
Revenue: Range of $1,050 million to $1,080 million
Adjusted EBITDA: Range of $101million to $107 million
This guidance reflects its long-term growth strategy in home health and hospice. Stabilized Medicare census, a renegotiated national contract, and a growing hospice segment highlight its strengthened market position. These developments reinforce its commitment to operational and financial improvement in 2025.
The company had a strong Q4 2024, however, Federal Medicare and Medicaid funding changes may modestly impact future momentum.
The company had a good Q4 2024, however, Federal Medicare and Medicaid funding changes may modestly impact future momentum.
BrightSpring Health Services, Inc. (NASDAQ: BTSG)
Highlights
BTSG total revenue in Q4 2024 was $3.02 billion, representing 27% growth from the prior year period.
Pharmacy Solutions segment revenue was $2.4 billion, achieving growth of 33% year-over-year. Within the segment, Infusion and Specialty revenue showed a 22% increase compared to last year. And home and community pharmacy revenue grew of 11% year-over-year.
The Provider Services segment had revenue of $655.8 million, representing growth of 11% compared to the prior year period. Home health revenue was $1041.3 million for 2024, growing 13%, over 2023, with average daily census rising close to 45,000. This growth was driven by strong clinical quality, including 30-day readmission rates that are 60% lower than the national average, particularly notable in the company’s emerging primary care services. Community and rehab care revenue was $1,470.9 million for 2024, representing growth of 6.4% year-over-year.
Gross profit increased across all segments compared to Q4 of last year. EBITDA reached $263.9 million, reflecting a 9% year-over-year growth.
Key Financial Figures
M&A Activity
During the nine months ending September 30, 2024, BTSG completed seven acquisitions across its Pharmacy Solutions and Provider Services segments, aimed at expanding its services and geographic reach.
On September 1, 2024, BTSG announced the acquisition of North Central Florida Hospice, Inc. ("Haven Hospice"), which provides hospice and palliative care services throughout Florida. As CEO Jon Rousseau stated, “Towards the end of the third quarter, we announced the closing of the Haven Hospice acquisition, and we look forward to expanding our quality care to high-need patients in Florida. Our hospice business continues to show strong growth, with excellent patient satisfaction, currently holding an 84% overall care rating according to the Consumer Assessment of Healthcare Providers and Systems.”
Guidance
BTSG has provided revenue and Adjusted EBITDA guidance for the full year 2025 as follows:
Revenue: Range of $11.6 billion to $12.1 billion
Adjusted EBITDA: Range of $545 million to $560 million, reflecting anticipated growth of 18.4% to 21.7% compared to 2024.
The company had a good Q4 2024, however, Federal Medicare and Medicaid funding changes may modestly impact future momentum.
Option Care Health, Inc. (NASDAQ: OPCH)
Highlights
OPCH reported Q4 2024 revenue of $1,346.4 million, a 20% increase from $1,124.4 million in Q4 2023, driven by strong growth in its rare and orphan portfolios and continued expansion in established therapeutic categories.
Gross profit was $568.4 million, or 19.9% of net revenue, up 9% from $100.3 million in Q4 2023. Gross profit continues to improve, and spending leverage is strengthening, with SG&A down nearly 1% year-over-year. EBITDA reached $104.5 million in 2024, reflecting a 4% increase from $100.3 million in the last year.
While Hurricane Helene impacted operations in the Southeast at the end of Q3 continuing to Q4, it did not materially affect overall results.
The company generated $323.4 million in cash flow from operations during 2024, reflecting a 13% drop from $371.3 in 2023. The company ended the quarter with cash balances of $412.6 million. There was also a decline in cash flows from financing activities as the company refinanced its debt securing $50.0 million in proceeds, which was offset by a $250.0 million stock repurchase over the year.
Key Financial Figures
M&A Activity
2024 was another quiet year for acquisitions for Option Care. But that is changing. Though it is a Q1 announcement, it is worth noting Option Care acquired Intramed Plus in January 2025. Intramed Plus is a home-based and AIC provider with pharmacy infrastructure and four locations in South Carolina.
The company paid a multiple of EBITDA in the “mid-teens” according to CFO, Mike Shapiro. Shapiro added further that Option Care expects this to normalize down into the low-teens fairly quickly, as a result of cost synergies.
Option Care raised its revenue and EBITDA targets by $100 million and $5 million respectively, primarily as a result of the Intramed deal. They were quick to point out the $5 million in incremental EBITDA was after cost-synergies.
Intramed will allow Option Care to further expand its advanced practitioner model.
Guidance
OPCH has provided revenue and Adjusted EBITDA guidance for the full year 2025 as follows:
Revenue: Range of $5.3 billion to $5.5 billion
Adjusted EBITDA: Range of $450 million to $470 million
Cash flow from operations: $320 million
Overall positive guidance, despite the $60 million to $70 million anticipated gross profit reduction as a result of the STELARA price change, which goes into effect January 1, 2026.
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