Pre-Claim Does Not Trouble Home Health Investors
Pre-Claim Does Not Trouble Home Health Investors
Despite looming challenges associated with a possible new pre-claim review demonstration and other regulatory uncertainties on the horizon, home health care stocks performed well in June, according to the latest update of the Home Health Index by Stoneridge Partners.
The Index tracks market values of Amedisys (Nasdaq: AMED) and LHC Group (Nasdaq: LHCG), two of the largest publicly traded and independent home health care companies in the United States.
Overall, the Index gained 11.79% in June compared to the previous month, substantially outperforming the S&P 500, which fell about 0.94% in the wake of international trade tariffs put in place by the Trump administration.
“There’s a lot of uncertainty out there for investors right now in terms of policy,” Stoneridge Partners President Rich Tinsley said. “Despite what’s going on internationally, though, investors seem pretty confident in the home health industry domestically.”
Baton Rouge, Louisiana-based Amedisys’ stock jumped by 13.08% in June compared to the previous month. Year to date, Amedisys’ stock climbed to an impressive 64.48%, according to the Index.
LHC Group’s stock also saw a spike in June, increasing by 10.50%. The Lafayette, Louisiana-based company’s year-to-date share value was up 39.33% as well.
Stock prices for both companies have been buoyed in the early part of July after the Centers for Medicare & Medicaid Services (CMS) proposed increasing Medicare payments to home health agencies by 2.1%, or $400 million, in calendar year 2019. The agency also released more information about a new payment framework coming in 2020, providing investors with more visibility into what that change will entail.
“Home health providers certainly have momentum moving forward into July,” Tinsley said.
In addition to Amedisys and LHC Group, the Index also highlights Addus HomeCare (Nasdaq: ADUS), though it does not include the Frisco, Texas-based company in its monthly report because most of its revenue comes from Medicaid rather than Medicare.
While stock prices for Amedisys and LHC Group rose in June, prices for Addus dipped slightly, falling by 2.66% compared to the previous month. Year to date, Addus’ stock prices were still up by 62.93%, however.
Quote Of The Month
“This (At-home personal care) is not an out-of-control, costly benefit, it’s a pretty predictable benefit and one that’s pretty essential to ensuring people’s ability to maintain their independence and continue living at home.” – Researcher Karen Davis
Read the Full Article Here: Fresh Research Supports a Medicare Benefit for At-Home Personal Care
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:
- LHC Group (LHCG)
- Amedisys (AMED)
This graph compares the percentage of the Home Health Index to the percentage change in the S&P 500 Index going back to 2002.
This is a 12 month trailing chart of the HH Index compared to the actual prices of the individual companies that make up the chart.
This graph displays HH Index performance since 2002.
This graph compares the HH Index to the price of Addus stock (non-Medicare).
(Home Health Index July 2018 | Stoneridge Partners)
Here are the results of the stock prices for the past two years:
|Company||6/30/18||1 mos change||YTD change||6/30/17||6/30/16|
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)||6/30/18||6/30/17||6/30/16|
|HH Index Total||5830||4479||3234|
Enterprise Value (EV), aka Selling Price, as Percent of Revenue
|HH Index Average*||226%||152%||115%|
Multiples of EV/EBITDA
Think of this as selling price as a multiple of EBITDA.
|HH Index Average*||25.19||21.45||15.44|
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 it’s reporting. (Home Health Index July 2018 | Stoneridge Partners)
Recent Transactions From Around The Country
- Humana and private equity firms TPG Capital and Welsh, Carson, Anderson & Stowe acquired Curo Health Services in the latest effort by the insurer to grow its outpatient medical services for seniors.
- Netsmart, one of the largest providers of behavioral health electronic records (EHR’s) in the United States, has acquired the home care and hospice solutions of Change Healthcare, formerly known as McKesson Homecare and McKesson Hospice.
- Humana and private equity firms TPG Capital and Welsh, Carson, Anderson & Stowe completed their planned acquisition of Kindred Healthcare.
- Insurer Anthem, Inc. has completed its acquisition of Aspire Health, the nation’s largest provider of non-hospice, community-based palliative care.
SOLD!!! by Stoneridge
- Stoneridge Partners, Partner Benjamin Bogan, provided sell side M&A advisory services in the sale of Alpha Health in Kissimmee, Florida to Trilogy Healthcare.
- Stoneridge Partners, Partner Joseph Lynch, provided sell side M&A advisory services in the sale of Accommodation Healthcare, LLC of Houston, TX to D&S Residential Holdings.
Exclusively Listed For Sale By Stoneridge Partners
|State||Agency Profile||Status||Reference Number
|Arizona||$2+ million home care agency in Southern Arizona. Diverse payor sources (Medicaid/Private Pay/ W/C. Diverse referral sources. Great reputation.||Available|
|California||$11 million multi-location addiction treatment center. Located in Southern California. 21% bottom line. Strong growth trends. JCAHO accredited.||Available|
|California||Medicare certified Home Health agency that was established in 2003. $2 million annual revenue in 2018. PDGM revenue neutral. Located in Southern California. Clean business with no ADR's.||Available|
|Colorado||Opportunity to establish Medicare home health agency. Denver market. ACHC accreditation until 2022.||Available|
|Connecticut||$6 million Medicaid/Medicare agency. Nice growth trend. Stable margins, great surveys.||Available|
|East||Healthcare testing laboratory. $7 million revenue, $4 million EBITDA. 16 employees, multiple state licenses.||Available|
|East||Opportunity to buy a leading franchisor in the assisted living referral space. 10+ existing franchisees. Perfect business for the entrepreneur who can scale a predictable, simple and low expense business. 3 year average income of $134,000. Owner near retirement.||Available|
|Florida||$9.5 million Home Health Agency. Very strong operationally, clinically, and financially. 99% of revenue comes from traditional Medicare.||Available|
|Florida||$1.6 million revenue. Pediatric Medicaid agency.||Available|
|Florida||Medicare certified home health agency. District 10. Census: Minimal. Accredited.||Available|
|Georgia||ID/DD Services. $1 million revenue. Residential and Day Services. Atlanta Suburb.||Available|
|Illinois||$5.5 million accredited Medicare agency located in northeastern Illinois. Strong bottom line. 4 1/2 star rating by CMS.||Available|
|Louisiana||Boutique full service clinical laboratory specializing in preventative diagnostic testing.|
Medicare & Medicaid certified, and insurance contracts in over 20 Southeast States. Several unique programs and innovative technologies.
|Maryland/DC/Virginia||Opportunity to establish a Medicare home health agency. N. Virginia with large service area. Low census, motivated seller.||Available|
|Massachusetts||Medicare and Medicaid certified Home Health agency. |
$13+ million in annual revenue and growing. Diverse payor mix. Strong Management in place. Accredited.
|Michigan||Medicare home health and hospice agency. $10 million annual revenue. Attractive referral relationships.||Available|
|Michigan||$2 million ID/DD. Profitable. Existing management team in place. Greater Detroit area.||Available|
|Michigan||$1.5 million private duty home health agency in eastern Michigan. Profitable and well positioned for additional growth. Self-sufficient staff in place. 82 long-term clients.||Available|
|Minnesota||$9 million Medicaid agency. Consistent growth & profitability. Recent rate increase. Attractive Medicaid margin.||Available|
|New York||LHCSA in five boroughs. Approx. $20 million revenue. Long history in the community.||Available|
|New Mexico||$2.5 million New Mexico home health agency. 87% Medicare. Long history in the community. Staff in place.||Available|
|North Carolina||$1 million ID/DD Agency. Long-term client base. Growth potential with real estate. Strong margins.||Available|
|South||28 bed, IOP capacity of 40, full continuum SUD treatment center, dual diagnosis, pending JCAHO. $4+ million revenue, highly competitive in network contracts, average census of 30. Existing marketing relationships with county, parole, local hospitals, churches and universities. Solid business in desirable location, little competition, good opportunity.||Available|
|South||Full continuum, JCAHO accredited, co-occurring, SUD treatment center on 100+ acre horse ranch. 16 beds, 22 staff. $1.5 million EBITDA on $3.5 million revenue. In-network. Good reputation, great contracts/rates, solid opportunity. Census is great.||Available|
|South||National growth opportunity. No direct competition for niche market. Unique program and strong branding. PHP/IOP with census and revenue growth. Seeking strategic partner||Available|
|Southwest||$5+ million outpatient treatment center. Fully accredited. 37 beds. Recently revamped to increase growth and margin. Great census, UR, acquisition and solid numbers. Out of network and transitioning some in network.||Available|
|Southwest||64 bed full continuum treatment center in 2 Southwest US metropolitan cities.|
$4 million pro forma EBITDA run rate. 3rd location set to open May 2019. Run rate based on 30% occupancy with significant growth expected. Strong infrastructure to support growth trajectory.
|South-Atlantic||$12+ million in annual revenue. Home Health Agency (HHA) and Adult Day Care Center (ADC). HHA (represents 85% of revenue). ADC (represents 15% of revenue). HHA is primarily Medicaid business but is Medicare-certified. Accredited.||Available|
|South Texas||Hospice. $3.5 million in annual revenue. Accredited. Clean: No cap or regulatory issues.||Available|
|Tennessee||Very rare opportunity in a CON state. Located in Davidson County in Nashville, TN. Projected 2019 revenue in excess of $800,000.||Available|
|Texas||Three Hospice companies with affiliated home health. $6 million total revenue. South, South Central, and South East Texas locations.||Available|
|Texas||$5.3 million Medicaid agency in San Antonio, TX. 16.5% EBITDA. CHAP accredited. Staff in place for a smooth transition.||Available|
|Texas||$4 million home health agency. Dallas/Ft. Worth based. Full staff in place. Medicare and managed care with great contacts.||Available|
|Texas||$3.5 million Medicare certified home health agency. Located in San Antonio, TX. Fully staffed & CHAP accredited. Branch office included in sale||Available|
|Texas||Medicare home health agency and hospice. San Antonio, Dallas, Austin. $3 million revenue, multiple provider numbers. Great opportunity for existing Texas providers.||Available|
|Texas||$2.6 million revenue Home Health agency in East Texas. Great local reputation, with strong financials. 2018 adjusted EBITDA $606,000. Has second license with minimal census available.||Available|
|Texas||$2 million Medicare home health agency in Austin, TX. Offers outstanding reputation and strong management & clinical teams. CHAP accredited & consistently Top 100 or Top 500 Home Care Elite for past 8 years.||Available|
|Texas||$1.7 million Medicare home health agency. Located in Southwest Houston. Well-established with predictable referral sources. Very profitable.||Available|
|Texas||$1 million Medicare certified agency. Licensed in 7 counties in the Houston area. 80% is traditional Medicare.||Available|
|Texas||Home Health agency in Texas. Near Sam Houston National Forest. Clean license with minimal census and minimal revenue.||Available|
|USA||New software application. Potential investment opportunity. Great test results.|
Helps connect those in recovery socially. Helps connect therapists to patients. Facilitates total successful recovery and gathers important helpful data.
|Virginia||$2.3 million revenue Physical Therapy and Wellness operation. 95% cash pay. Potential to franchise Nationwide. 2018 EBITDA $257,000.||Available|
|West||Premier provider of primary mental health services for adolescents aged 13-18. 2 locations. In process of growing in-network contracts.||Available|
|Florida||Medicare/Medicaid certified home health agency. $2.5 million annual revenue. 5-star. Accredited. District 10.||Under Contract||
|Florida||$1.5 million non-skilled private duty home health business. Strong management team in place. District 1.||Under Contract||
|Illinois||Hospice. Census in mid-70's. Accredited. Chicago area.||Under Contract||
|Kentucky||Medication-assisted clinic. IOP counseling for substance abuse and co-occurring disorders. Profitable with strong team in place. 150 clients. 95% Medicaid.||Under Contract||
|Kentucky||Medication-assisted Treatment center. Suboxone only. Strategic location between Louisville and Lexington, Kentucky. Great reputation with strong clinical team in place. 110 clients with room to expand and grow, minimal marketing. In-network contracts. Clients come in twice a month and pay $150 per visit for counseling. Owners are near retirement and will help with the transition.||Under Contract||
|New York||$13 million revenue LHCSA. 30-year history. Licensed in all 5 boroughs.||Under Contract||
|North Carolina||$5 million Medicaid agency. CAP/PCS services. Long history, quality services.||Under Contract||
|Pacific Northwest||Full continuum in Washington State. $3,625,000. revenue with $1,100,000 EBITDA. States has moved from BHO to MCO for Medicaid. Co-occurring, Medicaid paid, 40 bed facility, 40 employees, census is very strong.|
Outpatient is full. Opportunity for marketing. SUD mental health gambling. Equine therapy and other perks.
|Southwest||$25 million in annual revenue. Provider of Waiver and ICF ID/DD Services. Statewide Platform. Strong management team. Excellent reputation for quality services.||Under Contract||
|Texas||$5.3 million all Medicaid Home Care company located in Houston, TX. 20%+ year over year revenue growth since 2016. Nice bottom line.||Under Contract||
|Texas||$3+ million hospice agency based in Dallas/Fort Worth. Well established. Clinically clean and growing. Full staff in place.||Under Contract||
|Texas||$2.2 million Dallas-area Medicare home health agency. 22% bottom line. Well-established with a very clean compliance record. Full management team in place.||Under Contract||
|Texas||$1.4 million revenue pediatric therapy business. Company provides Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST) to disadvantaged and disabled children in near a major metropolitan city in Texas and the surrounding counties. Positive reputation for providing quality help in an environment comfortable to the child. Founded in January 2008 as an investment for the owner. Average census is 190 patients with a goal of 225 for calendar year 2019.||Under Contract||
|Virginia||$6 million Medicare certified agency in Northern Virginia.||Under Contract||
Do you know of any acquisitions that have taken place? We are interested in your comments. At the top of this column is a “Contact Tab” with a section for comments. These can be sent anonymously and the return email address can be left blank.
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Home Health Index July 2018 | Stoneridge Partners