Industry Consolidation: Building a Stronger Home-Based Care Systemby Jamie Daugherty, Executive Director The structure of home-based care continues to change. Home health, hospice, and in-home care organizations are joining larger systems, acquiring other providers, developing regional networks, and forming new strategic partnerships. Recent reporting shows that hospice merger and acquisition activity is again approaching pre-pandemic levels. An industry analysis published in September projects approximately 44 hospice transactions during 2026, which would represent a new post-pandemic high. At the same time, regulatory scrutiny and more extensive due diligence are making some transactions take longer to complete. The broader home-based care market has been somewhat uneven. Transaction volume declined during the second quarter of 2026, but the quarter also included two of the largest home-based care transactions on record. Together, these trends demonstrate continued confidence in the importance and long-term growth of care delivered in the home. For Oregon providers, consolidation is not a distant national trend. It is one part of a broader evolution in how organizations are responding to workforce challenges, rising operational costs, changing payer expectations, and increasing demand for home-based services. Why Organizations Are Pursuing Scale Home-based care organizations are being asked to do more in an increasingly complex environment. Providers must recruit and retain qualified employees, invest in technology and cybersecurity, maintain strong compliance programs, meet expanding quality-reporting requirements, and respond to changing reimbursement models. These responsibilities require expertise and resources that can be difficult to build and sustain. For some organizations, joining or developing a larger system provides access to:
Consolidation can also help create a more complete continuum of care. An organization that provides home health, hospice, personal care, palliative care, or other community-based services may be better positioned to support patients as their needs change. These benefits can strengthen an organization’s ability to serve its communities and invest in the future. Consolidation Takes Many Forms Consolidation does not describe a single business model. It may involve the acquisition of a local agency by a national organization, the combination of two nonprofit providers, or the expansion of a regional health system. It can also include affiliations, joint ventures, management agreements, shared-service arrangements, and partnerships that allow organizations to collaborate while retaining separate ownership. Independent providers, regional organizations, nonprofit systems, hospital-affiliated programs, and national companies each bring different strengths to Oregon’s care delivery system. Larger organizations may offer scale, specialized expertise, sophisticated technology, and access to capital. Smaller and locally governed providers may offer deep community knowledge, flexibility, and relationships developed over many years. Many organizations successfully combine these characteristics by maintaining strong local leadership within a larger structure. The question is not which organizational model is best for everyone. It is whether the model supports high-quality care, a sustainable workforce, regulatory compliance, and dependable access for the communities being served. Strong Organizations Strengthen the Entire Sector Consolidated organizations can bring valuable resources and perspectives to an industry association. They often have experience operating across different markets, responding to varied payer requirements, implementing technology at scale, and developing workforce and compliance systems. Their participation can help the broader provider community understand national trends and identify practices that may be adaptable to organizations of different sizes. Local and independent organizations contribute equally important perspectives. They help ensure that policy discussions reflect Oregon’s rural communities, regional workforce differences, local referral environments, and the practical effects of state and federal requirements. OAHC is strongest when these perspectives come together. Although organizations may differ in size, ownership, service area, or structure, they share many of the same priorities: caring for patients safely, supporting employees, maintaining financial sustainability, reducing unnecessary administrative burdens, and protecting access to care. An Increasingly Complex Regulatory Environment The current national Medicare enrollment moratorium for new home health agencies and hospices adds another consideration to the changing market. Since May 13, 2026, CMS has halted new initial enrollments and the enrollment of new branch or practice locations in these provider categories. Existing organizations must continue meeting all enrollment, reporting, and revalidation requirements. The moratorium does not prevent existing providers from completing permitted changes of ownership, but it makes regulatory planning and careful review especially important. Across the industry, buyers and potential partners are placing greater emphasis on documentation, billing practices, survey history, quality outcomes, enrollment records, and compliance systems. This should not be viewed only as a transaction issue. Strong compliance protects patients, supports organizational stability, and strengthens public confidence in the entire home-based care sector. Preparing for the Future Not every organization is pursuing a merger or acquisition, but every leadership team and board should understand how the market is changing. Useful questions include:
These are strategic questions, not indications that an organization should follow a particular path. Thoughtful planning allows leaders to evaluate opportunities based on mission, patients, employees, and long-term sustainability. Moving Forward Together Consolidation will continue to influence home-based care, but it is only one part of the industry’s future. The strength of Oregon’s system will depend on organizations of different sizes and structures working together. Large systems, regional organizations, community nonprofits, and independent providers all have an important role in ensuring that Oregonians can receive care where they most want it—at home. OAHC provides a place where these organizations can learn from one another, address shared challenges, and speak with a stronger collective voice. Our members may operate under different models, but we are united by a common purpose: protecting access to high-quality home-based care and building a sustainable future for the patients, families, and communities we serve. |