Earlier this month, the San Diego-based company completed its acquisition of Alliance Home Health & Hospice Care, a Medicare-certified home health and hospice organization in Pleasanton. The acquisition is Mission’s first outside of its traditional SoCal wheelhouse, CEO Paul VerHoeve told Home Health Care News.
“We’re really excited to expand Mission’s Southern California footprint into Northern California,” VerHoeve said. “And we’re looking forward to partnering with those guys and bringing them onto our platform, hopefully allowing them to do similar things to what we’ve done in [our market].”
Founded in 2009, the private equity-backed Mission cares for about 2,200 patients daily through 14 total offices across the Golden State. In addition to its new Pleasanton location, its network also includes a new de novo hospice in Orange County.
Although Mission originally launched as a home health-only company, it now offers co-located home health and hospice services everywhere it touches. The provider also rolled out a comprehensive palliative care line in its Ventura market during the COVID-19 pandemic to fill gaps in care.
“We found that there was an unmet need,” VerHoeve said. “A group of patients were kind of falling in between the cracks, going home with a lot of needs but not necessarily being able to be supported or followed accordingly.”
On top of its geographic-expansion push, Mission is likewise in the process of bringing that palliative care service to all of its locations, too, the CEO revealed.
“In our palliative care programs, we have a physician who is doing in-home visits as a part of that service, which, in many cases, is something that patients post-discharge aren’t getting with great frequency,” he said. “That really bolsters the care normally being provided, which would obviously be nursing, therapy and social services.”
The push toward palliative
Today, just a fraction of community-based palliative care programs in the U.S. are operated by home health providers. That’s partly because of reimbursement challenges, as there is currently no dedicated in-home palliative care benefit under fee-for-service Medicare.
Medicare Advantage (MA) is changing the palliative care landscape, however.
In 2020, there were 61 MA plans that offered home-based palliative care coverage, according to data from research and consulting firm ATI Advisory. In 2021, the total more than doubled to 134 plans.
Mission began testing the palliative care waters in the summer of last year. It did so to provide better, more integrated patient care, though several strategic considerations also factored into the decision, VerHoeve previously explained.
For starters, being able to offer palliative services allows Mission to maintain care for patients if their condition worsens and acuity levels rise. In many ways, palliative care is set up as a bridge between the provider’s home health and hospice arms.
“It’s not a service line that I think any company would get into as a service line to itself,” VerHoeve said. “But when you have the ability to get paid for the care and there’s the ability for many of those patients to transfer over to hospice at some point, we saw that as the way to have this all make sense.”
Its palliative care capabilities also give Mission an edge when it comes to referrals, as a physician may be more inclined to direct a patient to a provider that offers a full spectrum of care over a competitor that just does home health.
The rapidly growing service line also gets the attention of payers, VerHoeve noted.
“With the amount of managed care and at-risk plans in California, we’re seeing that there’s absolutely interest from those groups to have a palliative care offering,” he said. “And many are willing to actually pay for those services.”
Beyond California
Overall, there are 11 states with MA plans covering home-based palliative care in 2021, the ATI Advisory data shows. While California is not one of those states, many of its regional neighbors are, including Oregon, Washington, Idaho and Utah.
That could explain why Mission is starting to eye opportunities beyond its home state.
“We’re actively in due diligence on two other opportunities,” VerHoeve. “One that would give us an even larger footprint in California, then another that would give us a multi-state presence out in the West,” VerHoeve said.
For the moment, Mission plans to keep its geographic footprint to five or six Western states.
“There’s a lot more uniqueness within the Western states,” VerHoeve said. “We’ve got some very attractive acquisitions that we feel confident we’re going to be able to get to the finish line in the next 60 to 90 days.”
Contextually, all of these plans come as Mission simultaneously transitions to a new PE partner.
Prior to December 2020, Mission was backed by California-based private equity firm and investor HCAP Partners. Near the end of last year, HCAP exited its investment in Mission, with Chicago-based The Vistria Group stepping in to support the provider’s continued growth.
“We are extremely pleased with Mission Healthcare’s extensive accomplishments since our initial investment,” Nicolas Lopez, a principal at HCAP Partners, said at the time. “The company not only exhibited stellar growth, but improved its quality of care and became a top workplace in San Diego during our investment holding period.”
Vistria’s home health and hospice portfolio also includes Help at Home and Agape Care.
As for its new acquisition of Alliance, Mission had been in talks with the provider for the better part of a year, VerHoeve said. The pandemic somewhat delayed getting a deal done, largely due to travel restrictions and COVID-19’s general disruption.
The fact that Alliance already offered home health and hospice made it an attractive acquisition, VerHoeve added.
“They’re also a smaller company, so they’re very much in need of technology,” he said. “We’ll be moving them onto our EMR platform … with centralized intake plus more resources around revenue cycle and human resource management. All of those things are really additive to a smaller provider.”
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