Home Health Care 2016-2017

  • ID: 3891814
  • Report
  • Region: Global
  • 208 Pages
  • Darwin Research
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Home Health is an $86 Billion Growth Industry with a Rapidly Expanding Pool of Potential Customers

FEATURED COMPANIES

  • AccentCare, Inc.
  • Almost Family, Inc.
  • American HomePatient
  • BAYADA Home Health Care
  • Intrepid USA
  • Lincare Holdings
  • MORE
Our report examines the current state of the market and future potential for home health care. Included you will find:

Project Scope:

- Current state of the home care environment, including trends and factors affecting growth
- Company profiles: strategies, news, financials, market penetration, organizational structure and more
- The Affordable Care Act and implications for home health care
- Primary research with our home care industry executive panel, including their perspective on the outlook for their firms and the industry; current and expected future use of technology, and experience with accountable care organizations and value-based contracts
- Primary research of consumer attitudes, awareness and usage of home health care and private duty
- Opportunities, threats and critical success factors
- Analysis of Medicare and Medicaid expenditures, current and projected

Chapter 1 is a detailed overview of the home care industry.
Chapter 2 discusses how home care is financed, with a particular focus on Medicare and other forms of payment for home health care.
Chapter 3 we highlight and analyze top home care companies
Chapter 4 reviews the results of our latest Home Care Executive Panel survey completed in September 2015, addressing key concerns and opportunities from an insider perspective.
Chapter 5 includes primary consumer research about patient and caregiver experience with home health and private duty care.
Chapter 6 addresses key industry issues and opportunities, and we conclude with recommendations for home care companies in Chapter 7.

Version 2.3 is the 8th revision to this report. We believe that we have the most comprehensive analysis of the industry to date - a sentiment echoed by many of our clients over the years. Whether you are an industry veteran or new to the market, within these pages you’ll find insights, fresh perspectives, and a keen understanding of where the market is headed in the years to come.
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FEATURED COMPANIES

  • AccentCare, Inc.
  • Almost Family, Inc.
  • American HomePatient
  • BAYADA Home Health Care
  • Intrepid USA
  • Lincare Holdings
  • MORE
Project Scope

Executive Summary

1 Understanding Home Health Care
- Definition
- Perspective
- Home Health Consumers
- Providers
- Market Demand
- Supply Chain: Supply Side
- Supply Chain: Demand Side
- Competitive Environment
- Visiting Nurse Organizations

2 Financing Home Health Care
- Federal Funding
- Funding Sources
- Reimbursed Services
- Home Health and the Affordable Care Act
- Future Funding

3 Home Care Market Leaders
- AccentCare, Inc.
- Addus HealthCare, Inc.
- Almost Family, Inc.
- Amedisys, Inc.
- American HomePatient
- Apria
- BAYADA Home Health Care
- HCR ManorCare
- Intrepid USA
- Kindred Healthcare Inc.
- Lincare Holdings
- Maxim Healthcare
- National HealthCare Corp.
- PSA Healthcare
- Rotech Healthcare, Inc.
- VITAS Healthcare

4 Home Care Executive Panel Survey
- Methodology and Demographic Characteristics
- Key Findings: Outlook
- Key Findings: ACOs and Value-Based Contracting
- Key Findings: Technology

5 Consumer Survey: Attitudes, Awareness and Experience
- Methodology
- Limitations
- Demographic Characteristics
- Results: Home Health Care
- Key Findings: Home Health Care
- Results: Private Duty
- Key Findings: Private Duty
- Discussion

6 Outlook

7 Conclusion

Appendices
A: Trade Associations
B: Home Care Franchising Companies
C: State Population Growth, Rank
D: Number of Home Health Units by State, PTU Score
E: Executive Outlook, By Company Size and Type
F: Technology Services, By Company Size and Type

List of Tables:
Table 1.1 Common Diagnoses Upon Admission
Table 1.2 Top Private Duty Franchises by Number of Locations
Table 1.3 Most Saturated State Markets
Table 1.4 Least Saturated State Markets
Table 1.5 Buyers and Suppliers of Home Health Care
Table 1.6 Top Home Health Suppliers
Table 2.1 Medicare Home Health Benefits Coverage
Table 2.2 Medicaid Enrollment Trends
Table 3.1 AccentCare Locations and Market Penetration
Table 3.2 Addus Revenue and Operating Margin, 2011-2014
Table 3.3 Addus Locations
Table 3.4 Almost Family Revenue and Net Income, 2011-2014
Table 3.5 Almost Family Locations and Market Penetration
Table 3.6 Almost Family Brands
Table 3.7 Amedisys Revenue and Operating Income, 2010-2014
Table 3.8 Amedisys Locations and Market Penetration
Table 3.9 Apria Locations
Table 3.10 BAYADA Locations and Market Penetration
Table 3.11 HCR ManorCare Locations
Table 3.12 Intrepid USA Locations and Market Penetration
Table 3.13a Kindred Revenues and Income, 2010-2014
Table 3.13b Kindred Revenues by Division, 2010-2014
Table 3.14 Other Kindred Home Care and Hospice Brands
Table 3.16 Kindred Hospitals and Nursing Center Facilities
Table 3.17a LHC Revenue and Net Income by Division, 2014
Table 3.17b LHC Revenue and Net Income by Division, 2013
Table 3.18 LHC Locations and Market Penetration
Table 3.19 LHC Hospital Partnerships
Table 3.20 Maxim Locations and Market Penetration
Table 3.21 Rotech Locations
Table 3.22 VITAS Locations and Market Penetration
Table 4.1 Services Offered
Table 5.1 Familiarity With Home Health Care
Table 5.2 Personal Experience With Home Health Care
Table 5.3 Favorability of Home Health Care
Table 5.4 Likely to Use Home Health Care
Table 5.5 Familiarity and Likely to Use Home Health Care
Table 5.6 Previous Experience and Likely to Use Home Health Care
Table 5.7 Finding a Home Health Care Provider
Table 5.8 Familiarity With Home Care
Table 5.9 Personal Experience With Home Care
Table 5.10 Favorability of Home Care
Table 5.12 Likely to Use Home Care
Table 5.13 Familiarity and Likely to Use Home Care
Table 5.14 Previous Experience and Likely to Use Home Care

List of Figures:
Figure 1.1 Medicare Part A & Part B Average Payment Per Day
Figure 1.2 Continuum of Care
Figure 1.3 How Home Health Care Is Delivered
Figure 1.4 Home Health Care Services Number of Firms and Establishments
Figure 1.5 U.S. Population Growth Projections, 2015-2050
Figure 1.6 Over-65 Population, 2012 Census Update
Figure 1.7 Over-65 Population High Growth States, 2000-2010
Figure 2.1 Trends in Persons Served, Visits per Person Served, Visit Charges
Per Person Served, Percent Change from Previous Year
Figure 2.2 Trends in National Health Expenditures, Medicare Expenditures and
Medicare Home Health Expenditures, Percent Change from Previous Year
Figure 2.3 Home Health Care Total Expenditures by Source of Funds, 2012
Figure 2.4 Distribution of Home Health Care Insurance Expenditures, 2012
Figure 2.5 FY 2013, Medicare Spending Distribution
Figure 2.5a FY 2013, Medicare Spending Distribution Part A
Figure 2.5b FY 2013, Medicare Spending Distribution Part B
Figure 2.6 Projected Medicare Expenditures on Home Health Agencies, 2015-2024
Figure 2.7 Medicaid Historical and Projected Benefit Expenditures
Figure 2.8 Distribution of Home Health Services, 2012
Figure 3.1 Addus Weekly Adjusted Closing Price, 2012 to Present
Figure 3.2 Amedisys Market Penetration
Figure 3.3 Amedisys Weekly Adjusted Closing Price, 2012 to Present
Figure 3.4 Kindred Home Health Market Penetration
Figure 3.4 LHC Home Health Market Penetration
Figure 3.6 LHC Group Weekly Adjusted Closing Price, 2012-2015
Figure 3.7 Maxim Home Health Market Penetration
Figure 4.1 Executive Panel Composition
Figure 4.2 Annual Revenue of Participating Companies
Figure 4.3 Primary Business
Figure 4.4 12-Month Outlook: Key Indicators
Figure 4.5 Large Companies Ready for Expansion
Figure 4.6 External Forces Influencing Business Outcomes
Figure 4.7 2015 Financial Outlook
Figure 4.8 Familiarity with ACOs
Figure 4.9 Knowledge of Specific ACOs in Region
Figure 4.10 Met with an ACO
Figure 4.11 Will be a 2016 ACO Partner
Figure 4.12 Experience with ACOs, by Company Size
Figure 4.13 Experience with ACOs, Home Health vs. Private Duty
Figure 4.14 Confidence in Profitably Contracting with ACOs
Figure 4.15 Experience with Risk, by Company Size
Figure 4.16 Bundled Payment Participation
Figure 4.17 Effect on Revenues and Profit
Figure 4.18 Had Risk-Sharing Contract
Figure 4.19 Effect on Revenues and Profit
Figure 4.20a Technology Services Provided
Figure 4.20b Technology Services Provided
Figure 5.1 Education
Figure 5.2 Gender
Figure 5.3 Age
Figure 5.4 Income Distribution
Figure 5.5 Region Figure 5.6 Familiarity with Home Health Care
Figure 5.7 Had Personal Experience With Home Health Care
Figure 5.8 Opinion Favorability of Home Health Care
Figure 5.9 Awareness of Medicare Coverage of Home Health Care
Figure 5.10 Likely to Use Home Health Care Within 12 Months
Figure 5.11 Finding a Home Health Care Provider
Figure 5.12 Familiarity With Home Care
Figure 5.13 Had Personal Experience With Home Care
Figure 5.14 Opinion Favorability of Home Care
Figure 5.15 Awareness of Medicare Coverage of Home Care
Figure 5.16 Likely to Use Home Care Within 12 Months
Figure 5.17 Finding a Home Care Provider
Figure 5.18 Awareness of Selected Companies
Figure 5.19 Long-Term Care Insurance Coverage
Figure 6.1 Period Life Expectancy at Age 65, Historical and Forecast
Figure 6.2 ACO Growth: Medicare vs Commercial
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FEATURED COMPANIES

  • AccentCare, Inc.
  • Almost Family, Inc.
  • American HomePatient
  • BAYADA Home Health Care
  • Intrepid USA
  • Lincare Holdings
  • MORE
Two factors led to the birth of home health care as a business: private health insurance, which was introduced in the 1940s, and Medicare, which offered to pay for home health services, in 1965. It’s important to note that not long ago in the United States, all health care was delivered in the home. Early in the 20th century, on the heels of the second Industrial Revolution, we began to accept the idea that health care would be provided in a building-a doctor’s office, a hospital or some specialized facility for psychiatric care. By the early 1950s, house calls had all but disappeared.

Today, home health is an $86 billion growth industry with a rapidly expanding pool of potential customers. To put it in context, in 2011 the pharmaceutical industry posted $610 billion in revenue-Pfizer, the top pharma company at the time, posted $65 billion in revenue that year. Total health care industry expenditures in 2012 were $2.8 trillion. That makes home health care about 3% of the pie today, with an ever-expanding share coming over the next decade.

To be sure, home health care can be a confusing business to understand because it often means different things to different people. Home health care refers to medical care provided in the home. Private duty care is provided by commercial caregivers and home health aids, usually to seniors who have difficulty taking care of themselves, to help them maintain a sense of independence. Hospice care is specialized care for the dying, usually in the last six months of life.

Home health care represents more than 60% of the market, with roughly $45 billion in annual revenue. Hospice care accounts for $17 billion annually and private duty care another $6 billion annually.

Services Provided:

The actual care given to patients varies significantly from state to state and within states. Home health care can reduce the length of a hospital stay following a surgery, which translates to substantial cost savings. One day of home health care is about one-third of the cost of a skilled nursing facility and 8% of the cost of a hospital visit. In fact, providers are incentivized by visit and for keeping people out of the hospital-a problem that has led to a wave of lawsuits brought by the U.S. Justice Department against agencies for overbilling for unnecessary home visits.

Hospice has been a target of similar federal investigations and indictments for keeping people too long in hospice care; the government argues that those patients never should have been in hospice care to begin with. (Providers disagree, claiming that high-quality hospice care is what helps extend life.)

Patients receiving home health care can be elderly individuals with a chronic medical condition such as diabetes, severe heart disease or chronic obstructive pulmonary disease, or younger individuals with a disease that has progressed to debilitation. Younger patients who have a neurodegenerative disease or physical or mental limitations or who require constant medical care are also candidates for home health care. Provider reimbursement is by Medicare or Medicaid.

Today, 7.6 million Americans receive some form of community-based health care for disabilities, chronic care or hospice care. The majority of home health care users are over the age of 65 and frequently have multiple chronic health conditions. According to a 2011 study by the Centers for Disease Control and Prevention (CDC), home health care consumers have the following characteristics:

- Most are over the age of 65 (68.7%)
- A majority live with family members (68.5%)
- More women received care than men (64%)

The CDC found that in 2007, 1,459,900 home health care patients received care every day, up from 1,355,300 in 2000. The majority of care was provided through proprietary home health care agencies, which in 2000 provided only 34.1% of patient care. Voluntary nonprofit agencies saw a decline in business, down from 56.6% in 2000.

The home health care industry is highly fragmented, with no major company having greater than 5% market share. Top commercial providers include Amedisys, LHC Group, Gentiva (now owned by Kindred Healthcare), Apria, Lincare and American HomePatient. Within the private duty segment, franchising has proved to be an attractive model, with low startup costs and comparatively rapid return on investment. Leading franchisors include Home Instead, ComfortKeepers and Visiting Angels. With 45,000 caregivers in all 50 states, Home Instead is roughly a $1 billion company.
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- AccentCare, Inc.
- Addus HealthCare, Inc.
- Almost Family, Inc.
- Amedisys, Inc.
- American HomePatient
- Apria
- BAYADA Home Health Care
- HCR ManorCare
- Intrepid USA
- Kindred Healthcare Inc.
- Lincare Holdings
- Maxim Healthcare
- National HealthCare Corp.
- PSA Healthcare
- Rotech Healthcare, Inc.
- VITAS Healthcare
Note: Product cover images may vary from those shown
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