Near term: REASONABLY STABLE / POSITIVE
Long term: POSITIVE / UPSIDE
Drivers/Factors:

• Amidst COVID-19, some, presumably temporary operational/marketing headwinds: e.g., potential for LUPA increases; some visit cancellations by patients, less marketing access to referral sources, fewer elective procedures in hospitals that require home health; some caution or infections among nurse staff
• Some PDGM-related reimbursement and recert pressures being at least partially offset by recently enacted accelerated payments from Medicare
• Industry remains highly fragmented with few players with significant scale; PDGM dynamic likely to result in even more consolidation
• Access to skilled caregivers improving due to reduced demand from hospitals
• Demand remains attractive for home health as a mitigant to inpatient/institutional care options
• Longer term skilled home care demand expected to grow significantly based on demographics, shifting more care towards the home and away from institutional settings; and potential for telehealth flexibility

Near term: REASONABLY STABLE / POSITIVE
Long term: MEANINGFUL UPSIDE
Drivers/Factors:

• Amidst COVID-19, some, presumably temporary logistics/marketing/operational headwinds, but on a relative basis, a more stable segment than other (e.g., center-based and physician based) segments
• Personal Home Care acts as a lower-cost complement or alternative to residential senior living, behavioral health and long-term care sectors
• Increasingly attractive patient-directed services generally pairs a patient with a family member to provide care thereby reducing risk of spreading COVID-19
• Federal government recently increased FMAP percentages to support program funding; governors and legislatures relaxing regulations to accommodate new enrollments in home and community-based programs; Medicare Advantage also a growth opportunity
• COVID-19 exposing the risks communicability in institutional settings. Demand for long-term care far exceeds supply of institutional beds

Near term: REASONABLY STABLE / POSITIVE
Long term: POSITIVE / UPSIDE
Drivers/Factors:

• Amidst COVID-19, some, presumably temporary logistics/marketing/operational headwinds, but on a relative basis, a more stable segment than many other healthcare sectors
• Potential for further urgency to care for, maintain and monitor medically complex children at home vs. institutional/outpatient care with exposures
• Among the more stable home health segments from a reimbursement/regulatory perspective
• Unique specialty that adult-oriented home health providers tend to struggle with

Near term: UPSIDE / POSITIVE
Long term: MEANINGFUL UPSIDE
Drivers/Factors:

• Amidst COVID-19, some, presumably temporary logistics/marketing/operational headwinds, but on a relative basis, a more stable segment than many other healthcare sectors
• Significant, recent investments in and around physician-led home health
• Ability to make immediate medical changes and potentially avoid adverse events and emergency institutional visits
• Could be strong in combination with telehealth and home health/home care
• Payers supportive

Near term: REASONABLY STABLE / POSITIVE
Long term: POSITIVE / UPSIDE
Drivers/Factors:

• No significant, current industry issues to deal with other than marketing/operational headwinds with respect to marketing and providing services (some more issues for SNF-based hospice services)
• Remains an attractive sector with home-based hospice services at a medical and cost advantage vs. institutional end-of-life care
• No change in future growth outlook between organic growth and growth from consolidation
• Ongoing, growing interest in the continuum of care from home health to hospice
• Some role potential for telehealth in combination with hospice as well
• CMS just proposed a 2.6% payment increase for hospice for FY’21, another incremental positive

Near term: SIGNIFICANT UPSIDE
Long term: SIGNIFICANT UPSIDE
Drivers/Factors:

• Recent, significant legislation supporting reimbursement and implementing favorable regulations
• Payers and hospital systems supportive
• Technology is there and can be implemented
• Improved, regular patient monitoring and oversight of great importance
• Excellent supplement to home health and home care visits
• Opportunity to further reduce re-hospitalizations and adverse events
• Other applications likely to show growth: e.g., PERS adding telehealth capabilities, utilization of tele-health by Medicare Advantage, tele-behavioral health, use within SNFs and ALF; telehealth in Medicaid waiver context, etc.

Near term: SIGNIFICANT UPSIDE
Long term: POSITIVE / UPSIDE
Drivers/Factors:

• Increased consumer urgency to have proper, basic medical products and supplies at home
• Potential ongoing reluctance to go to brick and mortar retail to procure these products
• Low cost products relative to perceived medical and assistive benefits
• Consumable supplies easy to secure for prescribed and non-prescribed equipment
• Ease of use and growing e-commerce affinity among population

Near term: SIGNIFICANT UPSIDE
Long term: POSITIVE / UPSIDE
Drivers/Factors:

• Accelerated patient preference for direct delivery of home medical supplies: convenience, safety, continuity of supply reorders
• Broad increase in telehealth likely to also result in increased telephonic prescriptions, further expanding access to direct-to-patient home medical supplies
• Improved medical outcomes with recurring re-supply complemented by telephonic interactions with patient to educate and guide
• Home medical supply providers will be viewed more positively post COVID-19 and will provide cross-sell opportunities for telemedicine and other in-home services
• Ongoing adoption of home-delivered Continuous Glucose Monitoring & Insulin Pump therapy supplies for Type I diabetics will remain attractive. The Type II market will present extraordinary growth opportunities to service tens of millions of patients in the home.

Near term: POSITIVE / UPSIDE
Long term: MEANINGFUL UPSIDE
Drivers/Factors:

• Putting select, current operational dynamics aside, potential for reduction in historical reimbursement and regulatory pressures to ensure patients have access to core, needed medical equipment at home
• Not a nursing-based business; delivery and drop-off of equipment without significant patient interaction
• CMS has removed non-invasive ventilation from Medicare competitive bidding, an added positive
• At a low point in number of providers after years of substantial pressure; potential for upside now
• Relatively low-cost products compared to medical benefit and stabilization of patient at home
• Chronic diseases/long-term medical conditions are best treated at home and typically require assistive, therapeutic and supportive medical equipment and products
• Ongoing technological improvements lowering product cost

Near term: POSITIVE / UPSIDE
Long term: MEANINGFUL UPSIDE
Drivers/Factors:

• Some current, presumably temporary headwinds related to COVID-19 (e.g., in the arena of patient interaction, new patient referrals and clinic or home-based custom work)
• Attractive, long-term demographic and chronic condition trends that favor mobility, custom mobility and home modification products and services; home (and vehicle) modification particularly under-penetrated
• Post-COVD-19, even more considerations around home-based mobility and home-modification solutions (as well as other technologies, like PERS and telehealth) to keep patients assisted and safe within their home environment
• Ongoing technological improvements lowering product cost
• While complex mobility products have solid payer recognition and reimbursement, wheelchair accessible vehicles, van modification and home modifications remain largely private pay segments today

Near term: REASONABLY STABLE / POSITIVE
Long term: POSITIVE/UPSIDE
Drivers/Factors:

• Current, presumably temporary headwinds given COVID-19 (e.g., some reduction in hospital referrals, patient and infusion nurse safety dynamics; fewer elective procedures).
• Chronic infusion really cannot be delayed; some movement of patients from center to home IV
• Long-term upside driven by home health tailwinds and increased patient safety provided in home settings particularly for medically at-risk patients
• Long-term upside supported by new drug pipeline, including infusible specialty drugs

Near Term: POSITIVE / UPSIDE
Long Term: MEANINGFUL UPSIDE
Drivers/Factors:

• Continued availability and home delivery of medications for patients with chronic conditions has been a priority during COVID-19 shelter-in-place orders
• Home delivery services and adherence packaging will see increased interest post-COVID-19
• Existing specialty drugs proving to be recession-resistant particularly for homebound patients
• Pharmacies focused on mental health, group homes and other institutional settings will experience continued investment and robust M&A activity