Encompass, Amedisys, LHC, Aveanna, Optum, BrightSpring — major operators absorbed roughly 60% of disclosed 2025 deal value. PDGM-clean agencies with low LUPA rates and cap-clean hospice books are still trading at premium multiples, but the buyer balance sheets fill quickly. The owners getting top quartile in 2027 prepared their PEPPER, OASIS, and CON files in 2026.
Start with a 15-minute call · NDA first · no prep neededThe agencies that sell at top-quartile multiples in 2027 are the ones whose OASIS coding and cap reserves were clean in 2026.
PDGM transition exposed the agencies that built around volume and the agencies that built around clinical depth. Buyers in 2026 underwrite to clean PDGM-period case-mix, low LUPA rates, defensible OASIS coding, and a documented PEPPER profile. Hospice operators add cap exposure to the list — agencies running close to the aggregate or inpatient cap get priced as workout situations regardless of revenue size.
Five active buyer categories:
Three biggest discount factors. Hospice cap exposure (running near or in cap excess). PDGM-era LUPA rate above industry median. Referral concentration above 40% from one or two sources. All three are fixable but require 12-24 months of intentional remediation that's hard to fake.
The agencies getting strong multiples in the next three years share three traits: PDGM-clean case-mix with documented coding methodology, hospice cap utilization comfortably below thresholds, and diversified referral sources where no single source is more than 25% of admissions.
Encompass Health, Amedisys, LHC Group, Pennant Group, Aveanna, BrightSpring (PharMerica). Most active acquirers, with the deepest balance sheets and most defined geographic priorities. Pay top of market for PDGM-clean agencies in priority states.
Optum/UnitedHealth has been the largest payor acquirer of home health since 2023. Other major payors have started deploying capital. Vertical integration plays prioritize MA enrollment markets and clinical scope. Multiples slightly below pure-play strategics but cleaner balance-sheet outcomes.
State or region-focused PE platforms paying 7-9× EBITDA for clean agencies. Often the right fit when the national strategics aren't actively buying your geography. Closes typically faster than strategic processes.
Hospital systems buying for vertical integration into post-acute care. Pay premium for agencies already in their referral network. Highly idiosyncratic and geography-locked, but worth approaching if you have a major hospital system referral relationship.
Tuck-in acquirers expanding within their existing footprint. Fastest closes — often 90-120 days from LOI to signing. Lower headline multiples but better cultural fit and cleaner Medicare 855 transitions.
Consolidators focused specifically on hospice (Compassus, AccentCare, VITAS Healthcare). Pay premium for cap-clean books with strong inpatient and routine home care diversification. The right fit if hospice is your primary service line.
We review last 24 months of financials, PDGM-period case-mix, OASIS coding patterns, LUPA rate, hospice cap utilization (where applicable), referral source distribution, and Medicare audit history. Output: a written valuation memo with comps from disclosed deals in your service line and geography.
Outreach to national strategics, payor-owned platforms, PE-backed regionals, hospital-system home health divisions, independent regional tuck-ins, and hospice-specialty consolidators where relevant. Process runs under NDA before any public listing.
CHOW (Medicare 855A change of ownership) timing, CON transfer applications, state license filings, and DEA/board changes get sequenced against PSA signing. The regulatory tail in home health and hospice is longer than other healthcare service M&A — 90-180 days post-PSA is normal. We keep that tail from killing the deal.
Medicare-certified home health agencies trade at roughly 6-9× EBITDA at the lower middle market level. Hospice agencies typically trade at 7-11× EBITDA, with cap-exposure-clean operators at the top of the range. Personal care (non-Medicare, private pay or Medicaid waiver) trades at 4-6× EBITDA. The biggest valuation drivers: PEPPER outlier status, Medicare cap proximity for hospice, and CON transferability where applicable.
PDGM (Patient-Driven Groupings Model) shifted home health reimbursement from therapy-volume to clinical-grouping based payment. Agencies that adapted their OASIS coding and clinical documentation early earn premium multiples. Agencies still showing high-LUPA rates or unfavorable case-mix scoring trade at sharp discounts. Buyers will pull your last 8 quarters of PDGM-period claims data and case-mix in week one of diligence.
Hospice cap exposure is the single largest discount factor in hospice M&A. Buyers want 24+ months of cap calculations showing you're well below the aggregate and inpatient caps with margin. Agencies in or near cap excess get priced as workout situations. The fix takes 18-24 months of intentional patient mix management.
Depends on state. CON transferability rules vary widely — some states allow transfer with notice, some require state department of health approval, some treat ownership change as a new CON application. The timing of CON approval is one of the largest deal-killers in home health M&A. We sequence the CON application against signing so close doesn't slip 90+ days waiting on a state agency.
Five buyer types. National strategics (Encompass Health, Amedisys, LHC Group, Pennant Group, Aveanna). Insurance-owned platforms (Optum/UnitedHealth has been the most active payor acquirer). PE-backed regional platforms. Hospital-system home health divisions buying for vertical integration. Independent regional operators running tuck-ins. Major chains drove ~60% of disclosed 2025 deal value.
Buyers pull your PEPPER report, ADR (Additional Documentation Request) history, RAC audits, CERT findings, and any open MAC reviews on day one. Outlier status on any of those metrics — high readmission, high LUPA, claims edit failures — translates directly to working capital reserves the buyer demands. Agencies with clean five-year audit histories command 1-2 turn premiums over peers with active findings.
If 40%+ of your admissions come from one or two referral sources (a single hospital system, a single SNF chain, a single physician group), buyers price the firm with referral-loss reserves. The discount runs 15-30% off comparable diversified agencies. Diversification takes 12-24 months of intentional referral relationship building and shows up clearly in claim-source data buyers will request.
10-16 months from engagement to close. Pre-engagement preparation (cleaning up OASIS coding, documenting compliance program, building the case-mix story) is separate. The deal itself: 4-8 weeks of CIM and outreach, 8-12 weeks of LOI and clinical/regulatory diligence, 10-16 weeks from signed PSA to close (the long tail is CON approval, license transfers, and Medicare 855 changes of ownership).
CHOW (Change of Ownership) is the Medicare 855A filing required when an agency changes ownership. CMS processes CHOW filings in 60-180+ days depending on regional MAC workload. The CHOW filing has to be timed correctly relative to PSA signing — file too early and you're still on the hook if the deal collapses; file too late and close slips. We coordinate with the buyer's compliance counsel to get CHOW timing right.
Two differences. We use proprietary data infrastructure to surface qualified buyers across all five categories simultaneously, not the 6-10 names a regional boutique keeps in their rolodex. And we represent owners exclusively — never buyers — so when we negotiate, our incentive isn't split between getting your deal closed and keeping a buyer relationship for next year.
No prep on your end. NDA before any specifics get discussed. The output is a written valuation range based on your case-mix, cap profile, referral structure, and buyer-pool fit — not a sales pitch.
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