Behind the Curtain: Motivations and Barriers of Industry Buyers in Their Search for Acquisitions
- Emin Beganovic
- May 8
- 3 min read
Updated: May 20
Insights from David Jackson, CEO of Choice Health at Home
Mertz Taggart recently launched its “Behind the Curtain” webinar series, aimed at providing agency owners with a transparent look at the inner workings of healthcare M&A. In our first session, David Jackson—Founding Partner & CEO of Choice Health at Home—shared his playbook for sustainable growth and acquisition success.
Joined by Mertz Taggart’s Cory Mertz and Michael Lloyd, Jackson detailed what strategic buyers are really looking for in today’s market—and how operators can position themselves for a premium outcome.
"If you're driving toward quality, you're already driving toward value-based care." – David Jackson, CEO, Choice Health at Home
From Therapist to CEO: Building a Scalable Healthcare Platform
Jackson’s journey began as a physical therapist inspired by personal family experiences. That early passion led to the founding of a rehab business in 2007, which evolved into today’s Choice Health at Home—a diversified provider spanning home health, hospice, personal care, and rehab, with thousands of employees across seven states.
“We started with three credit cards and a bad line of credit. But we had a vision—to deliver care in the home and build something that lasts.” – David Jackson
What Buyers Like Choice Health At Home Look For
Whether you're preparing to sell now or positioning for a few years down the road, here’s what stands out most to strategic buyers like Choice:
Compliance First
Buyers conduct compliance audits before anything else. A history of failed audits or unclear documentation is often a dealbreaker.
“Compliance precedes everything else. If there’s a red flag, it’s a non-starter.” – David Jackson
Quality Metrics That Matter
From HHVBP performance to CMS star ratings, quality metrics directly affect enterprise value. Jackson emphasized that quality and financial health are closely linked.
Well-Organized Financials
Accrual-based accounting, clean P&Ls, and clearly defined gross margins are critical. Jackson cautioned that “cash-based” books create complications during diligence.
“Get your financials in order. $2,500 a month with a good accountant could be the best investment you make pre-sale.” – David Jackson
Sustainable Payer Mix
Buyers expect your payer mix to align with your market. If you are in a market dominated by Medicare Advantage, yet 90% of your revenue comes from traditional Medicare, it can be concerning.
Home Health, Hospice, and Personal Care: Tailored Strategies for Each Sector
Jackson broke down his acquisition lens across each of Choice’s three core service lines:
Home Health
Top priorities: Compliance, CMS quality scores, gross margin structure, and alignment with local payer trends.
Bonus: Regional density can command a premium.
“Home health remains the most viable vehicle for reducing re-hospitalization and delivering care at the lowest cost.”
Hospice
Focus: Regulatory compliance is the #1 challenge in today’s transactions, especially in enhanced oversight states like Texas, Arizona, Nevada, and California.
Outlook: AI is creating real opportunities to automate compliance workflows and pre-screen documentation.
“We’re excited about AI’s ability to audit 100% of our hospice charts. Compliance in this sector is everything.”
Personal Care
Challenges: Labor compliance, Medicaid rate uncertainty.
Strategy: Diversification. Choice maintains a 60/40 Medicaid-to-private-pay mix to protect against policy swings.
“We want to care for people, regardless of what the government hands us. Being diversified helps us do that.”
The Value of Using an Advisor
As a buyer who has executed 20 transactions since recapitalization, Jackson had some clear advice for founders:
“You’ve built something valuable. When it’s time to sell, get help. A good advisor can prepare you, manage the process, and protect your interests.”
He added that some of Choice’s most successful deals came after initially being a backup bidder—only to win the deal when others fell short.
Looking Ahead: Growth in the Southwest and Beyond
Jackson and his team at Choice remain active buyers, with a current focus on home health and personal care assets in the Southwestern U.S. But their disciplined approach to building density, scalability, and long-term value will resonate in any geography.
“We're not just buying businesses. We're building infrastructure for the next decade of care.”
Watch the Full Webinar
Catch the full discussion between David Jackson, Cory Mertz, and Michael Lloyd for deeper insights: 👉 Visit this link.
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