AccentCare, Seasons Finalize Merger Aimed at Streamlining Patient Care

AccentCare and Seasons Hospice & Palliative Care have cleared all regulatory hurdles and officially merged, the post-acute care providers announced Tuesday.

The Dallas, Texas-based AccentCare is ranked as the fifth-largest home health provider in the nation in terms of overall market share, according to LexisNexis statistics. Similarly, the Rosemont, Illinois-based Seasons is listed as the fifth-largest hospice provider in the U.S.

The two providers — along with AccentCare’s private equity sponsor, Advent International — were able to finalize their merger agreement in a little over a month’s time. The companies initially unveiled their industry-shaping plans on Nov. 16, with AccentCare CEO Steve Rodgers digging into the strategy during the Home Health Care New Capital+Strategy event on Dec. 8.

“We’ve had a very successful hospice business internally at AccentCare,” Rodgers said at the event. “But it hasn’t necessarily been one at scale.”

Prior to the merger, those operations formed “about a $70 million hospice business,” the CEO noted. That number will grow substantially with Seasons, which offers compassionate care through 31 programs in 19 states.

AccentCare leadership began identifying areas to invest in last year. After deciding to “go big” on hospice, the company weighed tuck-in options while also reviewing some of the larger, high-quality providers up for grabs.

Seasons’ reputation, investment in its workforce and geographic footprint made it a natural fit, Rodgers said.

“From a culture standpoint, they’re very culturally aligned with AccentCare, which is one of the No. 1 things we always look for,” he said. “The second piece, though, really had to do with them being in big urban marketplaces, just like AccentCare tends to be in larger urban marketplaces.”

Together, the combined organization will operate more than 225 sites of care across 26 states, employing nearly 30,000 workers.

Additionally, the merged enterprise will maintain several dozen joint ventures and partnerships with health systems, physician practices and payers.

The combined AccentCare-Seasons will be headquartered in Dallas, with its hospice division still based out of Rosemont. It will care for more than 175,000 patients and families each year.

“Season gives us the whole continuum of care, kind of across the board, in addition to being able to supplement these partnerships we have out there in the marketplace,” Rodgers said. “We can bring new services into [those partnerships].”

Seasons subsidiaries included in the merger include Health Resource Solutions, a home health provider in Illinois, Nebraska and Indiana with a patient census of about 2,500. Gareda, a personal care business in Illinois that serves about 4,500 clients a year, is also included.

“The last piece, I’d say, that got us excited about [Seasons] is they have a very mature palliative care group,” Rodgers added. “And I think we all know that the complexity of the patients we are responsible for taking care of is increasing.”

Guggenheim Securities served as the exclusive financial advisor to Seasons Hospice & Palliative Care in the transaction.

“We’re thrilled to head into the New Year as one organization,” Seasons CEO Todd Stern said in a Tuesday press release. “The impact that we’re able to have together, with combined resources and new technologies, will only enhance the patient experience and quality of care for the individuals we serve and the partners who count on us.”

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Beyond the Pandemic: 9 Overlooked Stories from 2020

The ongoing COVID-19 pandemic dominated headlines in 2020 — and rightfully so.

But there were plenty of other storylines that defined the year, including the launch of the Patient-Driven Groupings Model (PDGM), the conclusion of a hotly contested presidential election and the execution of multiple industry-shaping transactions.

These are nine of the most overlooked stories from 2020, as determined by Home Health Care News. All of these stories were popular amongst our readers, but HHCN considers these stories “overlooked” because they didn’t capture quite the same attention they would have in any other year.

1. “NAHC’s Dombi: Agencies Aren’t Panicking in the Streets Over PDGM”

It was relatively early into PDGM’s first year, but it nonetheless became clear in March that the overhaul wasn’t as devastating as many initially predicted. “We’ve not heard anything about large closures of agencies or any kind of panic in the streets,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told HHCN at the time. “And strangely enough, the one thing we’re surprised we haven’t heard so far is the cash flow impact.”

Yes, PDGM presented numerous challenges — and the model certainly still has its flaws. For the most part, though, home health providers large and small met those difficulties with a combination of creativity and perseverance.

2. “Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021”

Related to PDGM is the plan by the U.S. Centers for Medicare & Medicaid Services (CMS) to phase out Requests for Anticipated Payment (RAPs) entirely in 2021. While home health operators knew about this plan way back in 2019, new details emerged about stiff financial penalties for late no-pay RAPs moving forward. If an agency submits a no-pay RAP one day late next year, the result could be a 20% reduction to its 30-day payment amount.

3. “Aging-in-Place Company Amedisys to Acquire AseraCare Hospice for $235 Million”

The pandemic may have delayed some home health, hospice and home care M&A activity, but it didn’t stop it entirely. In fact, there were multiple industry-shaping deals that took place in 2020, including Amedisys Inc.’s (Nasdaq: AMED) $235 million deal for Compassionate Care Hospice, announced in April. This was a huge acquisition for Amedisys, which now ranks as a top-five home health and hospice provider in terms of market share. “AseraCare is a great hospice company,” Amedisys CEO and President Paul Kusserow told HHCN. “When we decided that hospice was a business line we wanted to move forward in back in 2016, we actually approached AseraCare. But they weren’t for sale.”

4. “AccentCare, Seasons Hospice to Merge”

Another M&A blockbuster from 2020: the planned merger between AccentCare Inc. and Seasons Hospice & Palliative Care. After joining forces, the combined AccentCare-Seasons enterprise will be among the five largest home health and hospice providers in the nation. “This is incredibly complimentary to our own approach toward strategic markets and being very focused on working with large health systems,” AccentCare CEO Steve Rodgers told HHCN in November.

5. “LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity”

Over the past four years, the home health industry has steadily advanced its position in Washington, D.C., and within the administration of President Donald Trump. Come January, there will be a new team in the White House that’s led by President-elect Joe Biden. While his administration will bring plenty of new perspectives on health care policy, home health providers will likely maintain their standing.

6. “Caregiver Turnover Rate Falls to 64% as Home Care Agencies ‘Flatten the Curve’”

Turnover remained a trouble spot for most home care agencies, though the overall turnover rate actually improved year over year, according to Home Care Pulse. Better pay and benefits, plus stronger training programs that enable career advancement, are just some of the reasons caregivers are staying in their positions for longer.

7. “Medicare Advantage Startup Clover Health Slated to Go Public in a $3.7 Billion SPAC Deal”

There could be multiple headlines here at No. 7. The main takeaway? This year was the year of the special purpose acquisition company (SPAC), or blank-check company. In October, Clover Health announced it was going public through a SPAC. Most recently, Deerfield Healthcare Technology Acquisitions Corp. (Nasdaq: DFHT) announced it was acquiring CareMax Medical Group and IMC Medical Group Holdings, then combining them in a blank-check company of their own. There were other SPAC plays, too, with 2021 certain to bring several more.

8. “Senior Helpers, BrightStar Are Venturing Out of the Home to Serve Seniors. Here’s Why.”

Home care operators continued to take bold steps in 2020, thinking outside the box and expanding into new services lines. Senior Helpers and BrightStar Care were two good examples of that trend, with each making progress on its home care-adjacent businesses. For Seniors Helpers, that is its Town Square franchising model. For BrightStar care, it’s the company’s senior living franchise strategy. “We saw that many of our clients, as they progressed and had a change in condition, had higher-acuity needs,” BrightStar Care CEO Shelly Sun said during an HHCN event. “The family wanted to be able to move them out of the home to something with more socialization. They were looking for recommendations from us for assisted living facilities or, in many cases, dementia and memory care communities in their area.”

9. “In-Home Care Agencies May Look to Cut Costs by Scrapping Brick-and-Mortar Offices”

To be fair, this one definitely has to do with COVID-19. But it’s somewhat of an overlooked and indirect aspect of the pandemic. In 2020, businesses across industries shifted operations from physical offices to remote setups, typically without any major problems. Moving forward, it will be interesting to see if cash-strapped home care agencies decide to cut costs and jettison the traditional office.

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‘They’re Calling Us Up, Asking for Help’: How Health System Struggles Factored into the AccentCare-Seasons Merger

The coronavirus didn’t directly lead to the recently announced merger between AccentCare Inc. and Seasons Hospice & Palliative Care, but it played a pretty prominent role.

On Monday, Dallas-based AccentCare and Rosemont, Illinois-based Seasons revealed they’ll soon join forces to create a new post-acute care powerhouse. While the decision to merge made sense due to the companies’ similar geographic footprints, their complimentary services and a variety of other reasons, it was also a strategic response to the changing needs of the U.S. health care system.

“I think there are a few overlying trends that are taking place in the marketplace that we’ll … be better positioned to take advantage of,” AccentCare CEO Steve Rodgers told Home Health Care News.

Since the start of November, the United States has had more than 2 million new coronavirus infections, bringing the nation’s grand total to more than 11 million cases since spring. Health systems and hospitals are once again nearing a breaking point, with many already at max capacity or stretched dangerously thin on the staffing front.

In fact, just a day before AccentCare and Seasons unveiled their merger plans, Rodgers was on the phone with the COO of a major health system in the Upper Midwest. During the call, the health system executive noted how one of its hospitals had dozens of incoming COVID-19 patients at a time when 35 ICU nurses were out because of community-related coronavirus exposure.

“They’ve got about 35 to 40 patients they need to get out of the hospital that they’re asking for help with,” Rodgers said.

To extend capacity and redirect patients, more and more health systems are turning to in-home care providers like AccentCare, Seasons and others. Their pursuit of innovative home-based care models started to pick up in 2019, but it has since intensified due to the coronavirus.

For proof, one need only look at the several hospital-at-home programs that have popped up over the past eight months, with the latest example being Quincy Medical Group in Illinois, which has its own program in the works. “A number of” health systems have specifically asked AccentCare to accelerate their hospital-at-home activities, Rodgers confirmed.

“[COVID] has elevated the complexity of the patients coming out of the health systems,” he said. “And what you need is a greater and a wider breadth of capability to be able to take care of those patients.”

Alone, AccentCare and Seasons were already two of the biggest post-acute care players in the home health and hospice spaces, with each delivering a wide range of services. Together, though, they’ll be better able to care for those high-acuity patients coming from their health system partners.

The two companies expect to finalize their merger before the end of 2020, pending regulatory approval. Once they do, the combined enterprise will offer home health, hospice and personal care services across 225 sites of care in 26 states, employing nearly 30,000 workers.

Overall, the AccentCare-Seasons combination will have more than 60 partnerships with health systems and physician practices, collectively providing care to more than 175,000 patients and families annually.

“Health systems are beginning to feel it,” Rodgers said. “And they’re calling us up, asking for help.”

Moving forward, in-home care providers with a breadth and depth of services will be best positioned for hospital-at-home models and similar opportunities related to shifting care away from acute settings. In all likelihood, the merger between AccentCare and Seasons will be followed by even more industry-shaping deals to come, with technology also factoring into the equation.

“The other thing that you’re going to continue to see is just an acceleration of technology into the home,” Rodgers said. “If you’re a larger organization, you’re more able to make the investments in the technology and the services that you can use to support your strategic partners out there.”

In addition to strengthening its ability to take on complex patients from acute settings, AccentCare’s merger with Seasons gives it newfound access to physician services, another advantage in today’s health care ecosystem.

“One of the more difficult areas for us to coordinate is physician services,” Rodgers said. “Seasons brings a very advanced medical group practice in each state they do business in. Although that practice is very hospice-focused now, we see it as an opportunity to be able to expand our capabilities into more complex populations, to supplement the community-based physician services that are available.”

Internally, AccentCare is beginning to once again feel the impact of the COVID-19 virus across some of its markets, particularly around staffing. The company — backed by private equity firm Advent International — currently operates across more than 179 locations in 17 states.

It was among the very first home health providers to speak publicly about the coronavirus and its response strategy.

“We’re beginning to see pickup in a number of marketplaces, especially with those that have positive diagnoses above 50 per 100,000, or 100 per 100,000,” Rodgers said. “You’re seeing an increase in employee absenteeism associated with positive cases out there.”

Seasons Hospice & Palliative Care is also feeling the effects of the current surge, CEO Todd Stern told HHCN. Continued access to patients in facility-based settings has been one specific challenge, he noted.

“We’re seeing a little bit more of the restricted access,” Stern said. “But the demand continues to be there.”

Seasons offers end-of-life care services to more than 30,000 patients a year, with operations spanning 19 states and 31 Medicare-certified programs.

“There’s no shortage of need for our services,” Stern said. “It’s quite the opposite.”

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AccentCare, Seasons Hospice to Merge

AccentCare Inc. and Seasons Hospice & Palliative Care are merging.

Dallas-based AccentCare — owned by global private equity firm Advent International — is among the five largest home health providers in the country, according to industry data. The Rosemont, Illinois-based Seasons holds the same distinction in the U.S. hospice market.

“Accentcare is doing very, very well,” Todd Stern, CEO of Seasons, told Home Health Care News. “Seasons was not out, determined to find a partner. This is a marriage of opportunity.”

Once finalized, the merger between AccentCare and Seasons will reshape the post-acute care market, with the combined entity being one of the deepest around in terms of geographic footprint and portfolio of services. The companies are expected to publicly announce their agreement late Monday, with financial terms of the deal not disclosed.

There are several advantages to the merger, AccentCare CEO Steve Rodgers told HHCN.

By teaming up, AccentCare and Seasons will be better equipped to serve patients and referral sources as individuals’ needs change, for example. The move is likewise “extremely complimentary,” with AccentCare’s home health footprint closely matching Seasons’ hospice footprint, especially in major metropolitan areas.

“This is incredibly complimentary to our own approach toward strategic markets and being very focused on working with large health systems,” Rodgers said. “Todd and I both have a focus on being in large urban marketplaces. If you just go down the list of cities where we have a very significant presence now, we’re in the top cities in the United States. We’re in Boston, Chicago, Dallas, Houston, San Francisco, Los Angeles, Denver — and the list goes on.”

AccentCare delivers home health, hospice, personal care and care management services to more than 145,000 patients and clients annually, doing so across more than 179 locations in 17 states. In addition to growing organically, the company has landed several strategic partnerships with payers and health systems over the past few years, with its latest being a sizable joint venture with Fairview Health Services in Minnesota.

Advent International acquired AccentCare in May 2019 from its former PE backer, Oak Hill Capital Partners.

“Advent is a world-class private equity organization,” Rodgers said. “They’ve been incredible partners of ours, both in continuing to shore up the base infrastructure in the organization over the last 16 months as well as in preparing us to faze into a very significant opportunity like this.”

Seasons Hospice & Palliative Care offers end-of-life care services to upwards of 30,000 patients a year. Its current operations span 19 states and 31 Medicare-certified programs, inclusive of 22 facility-based and freestanding in-patient centers.

“Together, we can deliver a superior patient and family experience, ultimately serving our continuum of care partners even better, many of which want multiple service lines and multiple forms of care,” Stern said. “Our ability to take multiple service lines in common markets and innovate with the collective expertise made this a marriage worth doing.”

The combined AccentCare-Seasons enterprise will operate over 225 sites of care across 26 states, employing nearly 30,000 workers. It will have over 60 total partnerships with health systems and physician practices, collectively providing care to more than 175,000 patients and families each year.

AccentCare and Seasons expect to finalize the merger before the end of 2020, pending regulatory approvals. While they wait for that to happen, leaders from both organizations have started to execute upon their integration strategy, which will likely require ample time and resources considering the transaction’s sheer size.

Rodgers will serve as CEO of the new AccentCare-Seasons enterprise, which will keep AccentCare’s current headquarters of Dallas.

Stern will lead the hospice department — operating out of Rosemont — once AccentCare’s hospice services are combined with Seasons’ existing operations. He will also serve as executive vice chair of the combined organization.

On a broader level, Monday’s news adds to what has been a red-hot stretch for post-acute care dealmaking, particularly for hospice assets, which have typically come with hefty price tags. Last week, for instance, Addus HomeCare Corporation (Nasdaq: ADUS) announced a $192 million acquisition of Queen City Hospice and its affiliate, Miracle City Hospice.

AccentCare looked at many of the hospice businesses that came on the market, Rodgers said. Its leadership team started talking with Seasons toward the end of last year, however, and a merger seemed to make perfect sense.

“Todd and I got to know each other over the course of the year,” he added. “I think we had a mutual respect for each other and our organizations. I think we started getting excited about what we could do together. As we got into the late summer and early fall, things started taking off for us.”

While both CEOs declined to comment on financial details, Rodgers noted that the combined company should have annual revenues somewhere in the range of Encompass Health Corporation (NYSE: EHC) and LHC Group Inc. (Nasdaq: LHCG), which were ranked as fourth- and third-largest home health providers in 2019 by LexisNexis Risk Solutions.

“Let’s just say we’ll be fast approaching that general size and breadth,” Rodgers said.

For context, Encompass Health’s home health and hospice segment reported $1.09 billion in net services revenues in 2019. LHC Group, meanwhile, recorded $2.08 billion in net services revenues last year.

Until the merger is completed, all patients will continue to have access to their same care routines and will continue to use their current insurance plans. Each organization will share updates with patients and partners before any changes taking place, Rodgers and Stern noted.

In addition to Fairview, AccentCare’s existing joint ventures include partnerships with Asante, a large health system based in Oregon. That list also includes relationships with Baylor Scott & White Health, UCLA Health and several others.

With more than 30 strategic partnerships, Seasons has similarly made a name for itself with health systems, hospitals and payers. Moving forward, the merger should only benefit those partnerships, according to Stern.

“The hope that this is only positive,” he added. “There are some customers in the continuum of care that want all services, right? And there are some that just want parts. For those that want parts, nothing will change. For those that want more, I think we have a lot of opportunity to offer more to existing customers and care partners on both sides of the care aisle.”

Subsidiaries covered in the agreement include Health Resource Solutions, home health provider in Illinois, Nebraska and Indiana with a patient census of about 2,500. Gareda, a personal care business in Illinois that serves about 4,500 clients a year, is also covered.

This is a developing story. Please check back shortly for additional updates.

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