The lion’s share of home health markets in the U.S. are dominated by only one or two owners.
This high degree of concentration is caused by health systems’ and corporate investors’ acquisitions of home health agencies, according to a study recently published in JAMA Network Open.
As part of the study, researchers analyzed 5,884 Medicare-certified home health agencies. The sample included 3,823 agencies in 256 metropolitan markets and 2,061 in 518 non-metropolitan markets.
In total, 694 agencies were affiliated with health systems, and 2,216 had corporate owners.
Overall, 23% of metropolitan and 56% of nonmetropolitan markets had one or two owners that accounted for the whole home health market.
Additionally, 70% of metropolitan and 93% of non-metropolitan markets had two or fewer owners that made up one-half of the market.
“Health systems and corporate investors have increasingly acquired [home health agencies],” researchers wrote. “While acquisitions may facilitate care coordination, they may also lead to fewer owners controlling the market, raising concerns over the quality of and spending on home health services.”
Aside from corporate investors, private equity investors remain interested in the home-based care space. In 2025, PE accounted for more than half — 61% — of all home-based care deals.
Dexter Braff, founder and president of health care M&A advisory firm The Braff Group, echoed this finding at Home Health Care News’ sister publication, Behavioral Health Business’,’s INVEST conference.
“Private equity needs to buy, and they need to buy fast,” Braff said. “It’s very likely that 2025 is going to be a big spike.”
More broadly, the home-based care space has been a site for increased consolidation.
In 2021, Atlanta-based data and technology firm LexisNexis Risk Solutions found that the top ten home health providers in the space accounted for more than 25% of the nationwide market share. At the time, its list of dominant home health players included Bayada Home Health Care, Elara Caring, Trinity Health at Home and AccentCare.
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