Aveanna Healthcare Holdings Inc. (Aveanna) operates as a diversified home care platform focused on providing care to medically complex, high-cost patient populations.
The company directly addresses the most pressing challenges facing the U.S. healthcare system by providing safe, high-quality care in the home, the lower-cost care setting preferred by patients. The company’s patient-centered care delivery platform is designed to improve the quality of care its patients receive, which allows them...
Aveanna Healthcare Holdings Inc. (Aveanna) operates as a diversified home care platform focused on providing care to medically complex, high-cost patient populations.
The company directly addresses the most pressing challenges facing the U.S. healthcare system by providing safe, high-quality care in the home, the lower-cost care setting preferred by patients. The company’s patient-centered care delivery platform is designed to improve the quality of care its patients receive, which allows them to remain in their homes and minimizes the overutilization of high-cost care settings, such as hospitals. The company’s clinical model is led by its caregivers, primarily skilled nurses, who provide specialized care to address the complex needs of each patient it serves across the full range of patient populations: newborns, children, adults, and seniors. The company has invested significantly in its platform to bring together best-in-class talent at all levels of the organization and support such talent with industry-leading training, clinical programs, infrastructure, and technology-enabled systems, which are increasingly essential in an evolving healthcare industry.
Service Offerings
The company provides a broad range of home care services. It seeks to meet a full range of care needs for patients while minimizing the complexity and potential disruption to patient care associated with procuring multiple types of care services from a number of independent providers. This positions the company as the provider of choice for patients, families, referral sources, and payers.
Segments
The company provides its services through three segments: Private Duty Services (‘PDS’); Home Health & Hospice (‘HHH’); and Medical Solutions (‘MS’).
Private Duty Services segment
Private Duty Services segment predominantly includes private duty nursing (‘PDN’) services, as well as pediatric therapy services. The company’s PDN patients typically enter its service as children, as its most significant referral sources for new patients are children’s hospitals. It is common for the company’s PDN patients to continue to receive its services into adulthood, as approximately 30% of its PDN patients are over the age of 18.
Private Duty Nursing
The company is the largest provider of PDN services in the United States. It provides a range of services for medically complex children and young adults with a wide variety of serious illnesses and conditions, including chronic respiratory failure requiring tracheostomy and/or mechanical ventilation, cerebral palsy, cystic fibrosis, congenital anomalies, failure to thrive, and anoxic brain injuries. The company’s caregivers, a majority of whom are registered nurses and licensed practical nurses, monitor an individual’s condition, administer medications and treatment regimens, provide enteral and other forms of tube feeding, monitor and maintain ventilators, administer pain management treatments, and coordinate other forms of medical care. The length of service for a patient under its care can be three or more years until the patient graduates from the need for a feeding tube, ventilator, or tracheostomy. This affords the company the distinct ability to improve outcomes and control costs. However, many of the company’s highest acuity patients remain on its services for ten or more years. The company’s PDN services typically last four to 24 hours a day. The company’s services are provided by its nursing staff up to 24 hours a day, seven days a week, with multiple nurses dedicated to its highest need patients.
The company’s services typically commence upon a patient’s discharge from the newborn intensive care unit or pediatric intensive care unit. While it focuses primarily on pediatric PDN services, it continues to provide PDN services to its patients as they mature into adulthood. The majority of adult PDN patients have aged out of eligibility for pediatric PDN through Medicaid and are typically eligible to receive continued PDN services under Medicaid waiver programs.
The company also administers payer-authorized respite care (a form of non-medical personal care) and related services primarily to patients with intellectual and developmental disabilities or special needs. In this non-clinical business, the family primarily recruits and supervises the care provider. The company oversees the administration of payroll taxes, provides cardiopulmonary resuscitation training and/or first aid certification, and the U.S. Department of Justice clearance for the care provider. The company’s non-clinical business has had highly stable reimbursement historically, allowing for durable, profitable growth. While the company’s non-medical caregivers generally earn at or above the minimum wage, this has not historically been a source of risk to its margins, as its non-clinical reimbursement rates generally have mechanisms to adjust commensurate with state and local changes in applicable minimum wages.
Pediatric Therapy
The company provides physical, occupational, and speech therapy services to assist pediatric patients in healing and achieving their highest level of functionality. The company’s therapy patients include those with developmental delays resulting from neurological, orthopedic, cardiovascular, and musculoskeletal conditions. These services can be delivered at home or in a clinic setting. Typical conditions treated include feeding/swallowing disorders, bone/joint disorders, and eye/hand coordination impairment. Similar to the company’s enteral services, many of its PDN patients also require in-home therapy, and the company is able to deliver differentiated levels of service and efficiency as a ‘one-stop shop provider.’
Home Health & Hospice segment
This segment provides home health, hospice, and specialty program services to predominantly elderly populations seeking compassionate care and assistance with activities of daily living in the home. The company’s home health services help its patients recover from surgery or illness, live with chronic diseases, and prevent avoidable hospital readmissions. The company assists patients and their families in understanding their medical conditions, how to manage these conditions, and how to maximize the quality of their lives while living with a chronic disease or other health condition. The company’s adult home health services improve the quality of life of its patients, save costs for the healthcare system, and result in better clinical outcomes, including low re-hospitalization rates, when compared to institutional settings of care.
The company’s Medicare-certified hospice services are designed to provide comfort and support for those who are dealing with a terminal illness. It provides a full range of hospice services designed to meet the individual physical, spiritual, and psychosocial needs of terminally ill patients and their families. Individuals with a terminal illness, such as heart disease, pulmonary disease, Alzheimer’s, or cancer, may be eligible for hospice care if they have a life expectancy of six months or less. The company’s hospice services are primarily provided in the patient’s home, and are also provided in skilled nursing facilities and inpatient hospice units where clinically appropriate. The key services provided through its hospice agencies include pain and symptom management accompanied by palliative medication, emotional and spiritual support, inpatient and respite care, homemaker services, and dietary counseling. The company also provides personal care services, which include non-medical assistance with activities of daily living, and can help seniors avoid costlier downstream medical costs and hospitalizations.
Medical Solutions segment
This segment provides needed supplies to patients requiring enteral nutrition services or respiratory care. Enteral nutrition, also known as tube or intravenous (‘IV’) feeding, is a way of delivering nutrition directly to the stomach or small intestine on an as-needed basis. Many of the company’s PDN patients also require enteral nutrition. The company’s ability to serve as a single-source provider to its patients, families, and referral sources provides added cost savings and convenience relative to sourcing from multiple providers.
The MS business serves patients who have short or long-term disabilities and require a supply of infant, pediatric, and adult formulas. The company provides a wide selection of supplies, such as feeding pumps, g-tubes, feeding bags, syringes, IV poles, ventilators, oxygen, and pulse oximeters. The company’s distribution model provides a streamlined, single-provider experience, enabling patients to seamlessly access one of the largest selections of enteral formulas, supplies, and pumps in the industry. In addition to providing the required supplies for enteral therapy, the company offers same-day (24 hours a day, seven days a week, and 365 days a year) patient and caregiver education both in-hospital and at-home, by a registered nurse, registered dietitian, or customer service technician.
Growth Strategy
The company’s strategies are to increase volumes within its existing footprint; leverage its scale and capabilities to drive value-based care arrangements in partnership with its managed care organization payer partners; expand private duty services, home health, and hospice presence through acquisitions; cross-sell enteral services to its PDN and home care patient base; and reinvest in its platform to optimize performance and deliver data-driven results.
Government Regulation
The company’s business is subject to extensive federal, state, and in some instances, local regulations and standards, which govern, among other things: Medicare, Medicaid, TRICARE (the Department of Defense’s managed healthcare program for military personnel/retirees and their families), and other government-funded reimbursement programs; reporting requirements, certification and licensing standards, and in some cases, Certificate of Need (‘CON’) requirements for certain home health agencies and hospices.
The company’s home health and hospice agencies and caregivers must comply with regulations promulgated by the U.S. Department of Health and Human Services (‘HHS’), and Centers for Medicare & Medicaid Services (‘CMS’) in order to participate in the Medicare program and receive Medicare payments.
As a provider under the Medicare and Medicaid systems, the company is subject to various federal anti-fraud and abuse laws, including without limitation, the federal anti-kickback statute, 42 U.S.C. § 1320a-7b (the ‘Anti-Kickback Statute’).
The Health Insurance Portability and Accountability Act, as amended by the Health Information Technology for Economic and Clinical Health Act (collectively, ‘HIPAA’) requires the company’s covered entities to comply with standards for the exchange of health information within the company and with third parties, such as payers, business associates, and patients.
On July 12, 2024, the company reported to the HHS Office of Civil Rights (‘OCR’) a HIPAA security incident involving approximately 10,482 individuals related to unusual activity on certain of the company’s email accounts.
The HHS, CMS, Department of Justice (‘DOJ’), and other federal and state agencies continue to impose intensive enforcement policies and conduct random and directed audits, reviews, and investigations designed to ensure compliance with applicable healthcare program participation and payment laws and regulations. As a result, the company is routinely the subject of such audits, reviews, and investigations.
The company’s compliance program focuses on laws and regulations related to the federal False Claims Act, the Stark Law, the federal Anti-Kickback Statute, and their state counterparts, and overall adherence to healthcare laws and regulations pertaining to fraud, waste, and abuse, privacy, billing, and collection.
History
Aveanna Healthcare Holdings Inc., a Delaware corporation, was incorporated in 2016.