HealthKeeperz, a home and community-based health care service provider based in Pembroke, North Carolina, announced in early March its plans to sell its home health business to BAYADA Home Health Care (BAYADA). The transaction was expected to be completed by the end of March, with a focus on minimizing the impact on current HealthKeeperz employees, patients and partners.

The deal was facilitated by Agenda Health, a faith-based, healthcare-focused M&A advisory firm based in Austin, Texas.

Founded in 1966, HealthKeeperz provides palliative care, equipment and services that combine medical care with emotional and spiritual support for the patient and their family. As part of an integrated health system, HealthKeeperz offers end-of-life dignity across North Carolina through a team of 150-plus caregivers.

BAYADA Home Health Care, which transitioned to a not-for-profit organization in 2018, is headquartered in the Philadelphia MSA and provides nursing, rehabilitative, therapeutic, hospice and assistive care services to children, adults and seniors in the comfort of their homes. BAYADA provides community-based services from more than 50 locations.

The acquisition will allow BAYADA to expand its operations in North Carolina, where it provides services from more than 50 locations across the state. As part of the deal, the HealthKeeperz Fayetteville and Laurinburg home health locations will transition to BAYADA locations, and HealthKeeperz will concentrate on areas of healthcare where it has long-term strategies to scale and innovate, such as hospice care.

The competitive bidding process was initiated by Agenda Health, which led to multiple offers, with BAYADA ultimately being selected as the best partner for HealthKeeperz Home Health.

“BAYADA was selected as the winner of our process based on the strength of their offer and the culture fit the sellers see between BAYADA and their organization,” said Alex Veach, Director of Transactions Services at Agenda Health.

In terms of regulatory and licensing considerations specific to North Carolina, Mr. Veach pointed out that North Carolina is one of 35 states with a Certificate of Need (CON) program, which imposes a barrier to entry for buyers moving into the state. Before opening, expanding or offering a new type of service, health providers are required to obtain permission from a state board. This regulation fosters competition among providers in states with CON programs.

BAYADA’s decision to acquire HealthKeeperz’s home health business was influenced by CON opportunities that are few and far between, especially at the size and quality of Healthkeeperz.

“I feel that this along with the fit HealthKeeperz is in their current footprint, made this a perfect fit for them,” added Mr. Veach.

Mr. Veach discussed the thriving Home Health & Hospice (HH&H) market in North Carolina.

“We see tremendous opportunity in the North Carolina home health market. It’s a state that buyers are very interested in and willing to present aggressive offers for.”

According to data captured in the LevinPro HC database, there were two HH&H deals in North Carolina announced during the first quarter. There were only two North Carolina HH&H transactions announced last year, and considering we’ve already reached that, we expect this number to grow in 2023.

The other North Carolina deal announced during the first quarter was Healthcare Equipment Inc.’s acquisition of Powell Medical, a provider of pediatric-focused custom rehab and durable medical equipment, in January for an undisclosed price.

Mr. Veach believes that healthcare is an ever-changing landscape.

“We see tremendous opportunities for owners to continue to capitalize on the strength of the market for home healthcare investment.”

However, Mr. Veach also mentioned staffing as a prevalent issue for agencies in the HH&H market.

“Almost every owner we talk with cites staffing as a prevalent issue they deal with on a day-to-day basis. This poses a challenge for agencies looking to grow, but we look forward to the innovative solutions that will address this problem in the future,” he said.

One additional point to consider is the potential impact of this acquisition on patients and their families. BAYADA’s expansion in North Carolina could mean increased access to home health care services for those who need it, particularly in rural areas where access to health care can be limited. This acquisition could also lead to new job opportunities for healthcare workers in the state. Additionally, with HealthKeeperz focusing on hospice care, this sale could result in improved and more specialized services for patients who require end-of-life care.

The acquisition of HealthKeeperz’s home health business by BAYADA Home Health Care is a reflection of the competitive landscape of the home healthcare market in North Carolina, with the state being highly sought after by buyers. It also highlights the importance of cultural fit and the need for buyers to find partners who will take great care of their employees and continue their legacy of excellent patient care.