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As part of our Behind the Curtain webinar series, we’re committed to giving agency owners a transparent, unfiltered view of what drives M&A activity in home-based care. In this session, we welcomed Rich Tinsley, Chief Development Officer at Help at Home, to share how one of the nation’s largest personal care providers thinks about acquisitions, integration, and value. Hosted by Michael W. Lloyd and Cory Mertz of Mertz Taggart, the conversation covered everything from culture and compliance to rate stability, integration, and why some deals never make it past the finish line. The Help at Home Playbook Help at Home is a 50-year-old company founded in Chicago, now operating in 11 states with more than 60,000 clients and over 60,000 caregivers. The company focuses almost exclusively on personal care services in the home and has more than doubled in size over the last four years through a mix of organic and acquisition-driven growth. Tinsley emphasized Help at Home’s density-driven strategy: “We believe in density… we are one, two or three in every state that I mentioned. Probably one in 80% of them and then two or three in the others. That’s by design.” That density is designed to make Help at Home a stronger partner to states and payers, and to support higher-quality, more consistent care at the local level. What Makes a Deal Attractive? When evaluating acquisitions, Help at Home focuses on three core attributes: culture, compliance, and economics. 1. Culture: The First Gate Across small tuck-ins, mid-sized platforms, and larger transactions, culture is the starting point. “Culture is the number one thing we look at.” Help at Home is looking for owners who are caregiver- and client-focused, not just chasing short-term financial results. That shows up in the way sellers talk about why they started, why they’re exiting, and what they find hardest about the business. “We are very focused on customers and caregivers. We believe that our business is very, very hard… But the reality is the P&L… is pretty simple. The secret behind that is the culture and being caregiver and client focused.” When culture is weak at the top, Tinsley noted, it tends to bleed into compliance, operations, and even caregiver behavior. 2. Compliance: Intent and Discipline The second lens is compliance — both on the client side and the employee side: Regulatory adherence Hiring and onboarding Documentation and file quality Help at Home audits client and caregiver files and expects clear evidence that the organization is trying to do things the right way. “We want people to want to be compliant. We want them to do their best. We understand people make mistakes… but we want to make sure the quality is there.” Systematic caregiver pay issues or improper treatment of employees are particularly challenging because of the long-tail liability they create. 3. Economics: Performance and Sustainability Only after culture and compliance clear the bar does Help at Home focus on economic performance: Revenue and margin profile Rate environment Growth trajectory High margins can be attractive, but not if they’re clearly temporary or disconnected from caregiver wages: “When you start talking about 20 to 30% margins, those aren’t sustainable right long term… we’ll give you some credit for it… but we also will perform it at what we think is a longer window of what we think the rates really will be.” In other words, they’re buying the sustainable business, not a short-term spike. How Help at Home Evaluates States and Markets Beyond the individual agency, Help at Home pays close attention to state-level dynamics: Payer structure (managed care vs. traditional Medicaid) Historical rate behavior and predictability Support for home- and community-based services Labor environment and ability to recruit at viable wage levels “We like stability or at least a plan. It’s okay to have changes… we like that. But the more stable in the way it’s planned… that makes it hard or easier for us to get our density and do what we want to do.” Even when a first acquisition in a state is compelling, Help at Home wants to know whether it can double or triple its presence over time. Opportunistic entry — such as inheriting a smaller footprint in a new state as part of a larger deal — is common, but follow-on density still matters. Deal Flow, Filtering, and LOIs Help at Home evaluates far more deals than it closes, with a dedicated development team of six to seven professionals screening opportunities before they ever reach LOI. “We look at more deals than we can do. We look at more deals than we want to do, right? But you’re trying to find the right ones.” The team: Reviews each opportunity Brings it to Tinsley in weekly calls Runs multiple rounds of questions and analysis before issuing an LOI Pre-LOI work can take a week to several months, depending on how prepared and responsive the seller is. Internally, Help at Home also secures approvals at the same level that would ultimately sign off at closing, to minimize surprises later. On volume, Tinsley estimated: “Somewhere between 5 to one and 10 to one. It depends on the market.” Common Deal Snags — and What Actually Kills Deals Tinsley underscored that Help at Home does a lot of work up front and tries hard to avoid mid-process price reductions. When issues arise, the biggest recurring problems are: Undisclosed compliance issues uncovered in diligence Caregiver pay or employment missteps that carry tail risk Non-responsiveness and delays from sellers Operational decline once a sale decision is made “Selling your business is a full-time job… businesses that are declining or start to decline once they decide to sell, that sometimes is really hard for us to get over.” He summed it up bluntly: “Declining businesses are tough.” Help at Home will typically look for ways to solve around issues when a seller is reasonable — through structure (escrows, reps and warranties) and a practical view of risk. But if performance slides and information is slow or incomplete, the probability of closing drops quickly. Deal Structure Preferences: Cash Up Front, No Earnouts On structure, Help at Home’s position is clear: Tuck-ins: almost always 100% acquisition of the business Larger transactions: more flexibility on keeping owners involved or structuring payouts Earnouts: essentially off the table “We don’t do earnouts, right? They’re just hard… I find that earnouts, no one’s happy at the end.” That doesn’t mean sellers can’t stay involved in the business — especially in larger transactions — but it does mean Help at Home prefers clean economics at closing rather than long, subjective earnout tails. What Happens After the Sale? Integration and People For many owners, the biggest concern isn’t just price, but what happens to their team and legacy. Help at Home’s integration approach depends on size, market, and performance: Small in-market tuck-ins: often integrated in weeks, with a quick move to the Help at Home brand and centralized back-office functions. Larger or new-state platforms: integration is more gradual; dual branding can remain for a time, and the pace adapts to what’s working locally. Back-office functions like recruiting, billing, and collections are centralized to free up front-line leaders: “The first rule is don’t do any harm.” And on people, Tinsley was explicit: “I don’t have a barn full of good people.” Help at Home is acquiring clients, caregivers, and the teams who support them, not trying to replace them: “The assets that we buy are really clients and caregivers, right? I mean, that is the business.” For employees who want to stay and grow: “The runway here is really long because we’re growing and you can grow within our company.” The Current M&A Environment: Strong, But Different from 2021 From Tinsley’s vantage point, today’s home-based care M&A market is: Stronger than long-term historical norms Clearly below the peak valuations seen during and immediately after COVID “I think buyers have lowered their prices. I think sellers have lowered their expectations, but I still think there’s a gap.” He believes the COVID/post-COVID period may have been a “once in a lifetime” pricing environment for this sector, and that owners waiting for those multiples to return may be disappointed. Uncertainty around policies such as the 80/20 rule and other reimbursement changes is a bigger drag on deal volume than cuts themselves: “It’s not necessarily the cut. If we knew what the cut was… it’s easy for somebody to model that… When things are changing, that uncertainty just creates… it’s hard to pull the trigger.” Advice for Sellers: Preparation That Actually Matters Asked what owners should focus on 8–12 months before going to market, Tinsley cautioned against cosmetic, last-minute changes: “Last minute changes don’t tend to work, right?” Instead, he highlighted a few practical steps: Professional financials – ideally monthly, with clear visibility into revenue, pay rates, bill rates and margin. Clean records – organized client and caregiver files, compliance documents, and contracts ready to share. Integrated past acquisitions – if you’ve bought agencies, get them fully integrated (systems, reporting, processes) and let that stability show up in your numbers. Operational consistency – keep running the business like you’ll own it for years; buyers want to see stability, not a short-term pre-sale push followed by decline. “Being ready to sell and answering those questions is really important. It really speeds up the process.” Looking Ahead: Demand Isn’t Going Anywhere Despite policy shifts and reimbursement debates, Tinsley is confident about the long-term fundamentals of home- and community-based personal care: “My services aren’t going away… the demand for my services, the desire to have it in their home isn’t going away.” Help at Home’s strategy is built around that reality: dense local markets, strong culture, compliant operations, and disciplined acquisitions that can be integrated and grown over time. Final Thoughts Rich Tinsley’s session offered a clear view into how a scaled, strategic buyer in personal care services thinks about value, risk, and partnership. His emphasis on culture, compliance, sustainable economics, and preparation aligns closely with what we see across the broader M&A market in home-based care. Whether you’re actively preparing for a transaction or simply planning for the next 3–5 years, these are the levers buyers are looking at long before they ever submit an LOI. 👉 To watch the recording of the full webinar, visit: https://www.mertztaggart.com/behind-the-curtain Are you contemplating a sale of all or a portion of your healthcare services company? Arrange a confidential discussion with our M&A experts via info@mertztaggart.com.

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. Hospice Enhanced Oversight States (2024) “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.” David Jackson, Founding Partner & CEO, Choice Health at Home 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.

By Cory Mertz, M&AMI, Managing Partner, Mertz Taggart At a Glance Due diligence is the buyer’s detailed review of your business after you sign a letter of intent. Over roughly 60 to 90 days, their team verifies your financials, compliance, and operations before the deal closes. Most of it is predictable, and owners who are organized and prepared tend to move through it faster and hold on to the value they negotiated. By the time you reach due diligence in the M&A process, the hardest decisions are mostly behind you. You have run a process, weighed your offers, and signed a letter of intent with the buyer you chose. What comes next is the buyer’s turn to look closely at the business before the deal becomes final. Due diligence is that close look, the most intensive phase of a sale, and for many owners the least familiar, because selling a business happens once and most of diligence stays out of view until you are in the middle of it. Knowing what to expect, and preparing for it, is most of what makes it go smoothly. When diligence starts, and what the buyer is doing Due diligence begins once you sign the letter of intent, and it runs on an exclusive basis, which means you have agreed to work only with that buyer while it is underway. Diligence is a confirmatory process: during the sale, the buyer formed a view of your business from the materials and conversations you provided, and this is where they verify that view before signing a definitive purchase agreement. That review runs on two tracks: confirming that the business is what you represented, and identifying material liabilities that were not apparent in the materials you provided, particularly exposure with payers and government agencies such as CMS, the IRS, and the Department of Labor. Most reviews run roughly 60 to 90 days, though larger or more complex businesses can take longer. The shared goal is a clean close, with the buyer confident in what they are buying and you holding the terms you agreed to. What buyers actually examine Diligence covers far more than the financials. The buyer’s team reviews the business across several areas at the same time, usually through a secure online data room where you post documents as they are requested. The main areas include: Financial. Validating your reported earnings, anchored by the quality of earnings review covered in the next section. Legal and corporate. Contracts, leases, ownership records, and any past or pending litigation. Regulatory and compliance. Licenses, Medicare and Medicaid provider numbers, accreditation, and billing and HIPAA compliance. This is where healthcare diligence runs deeper than most industries. Operational. How the business runs day to day, including staffing, referral sources, and payer mix. Clinical. In care-delivery businesses, a review of a sample of patient charts, typically 30 to 200 depending on the size of the business. People. Payroll, employee classification, key staff, and employment agreements. These run in parallel rather than one after another, which is why the volume of requests early on can feel heavy, though it eases as you work through it. The quality of earnings review is the center of it Of all the workstreams, the financial review draws the most attention, and at its center is the quality of earnings review, usually called a QoE. In a QoE, the buyer hires a third-party accounting firm to confirm that your reported earnings are accurate and sustainable. The firm works through the detail behind the numbers, transaction by transaction, including your add-backs. Add-backs are expenses you remove from earnings because they will not carry over to the new owner, such as a one-time legal cost or an owner expense the business will no longer have. The QoE tests whether each one holds up, because those adjustments feed directly into the value. If the review supports your earnings, it confirms the basis for the price. If it raises questions, the buyer may revisit the number. Much of how a QoE goes is settled long before it starts. We prepare our clients for these questions before they go to market, so that by the time the buyer’s accountants dig in, there are rarely surprises. → Related: How to Prepare Your Behavioral Health Business for Sale in 2026 It is not only documents: site visits and interviews Diligence is not entirely a paper exercise. At some point the buyer will want to see the business in person and meet the people who run it. Expect one or more site visits, where the buyer assesses the operation firsthand, and interviews with you and sometimes a few key members of your team. These are not interrogations. The buyer is trying to understand how the business actually works and who makes it run, which is part of what they are paying for. This is also where confidentiality gets sensitive, because staff often do not know the business is for sale. A well-run process manages who is told and when, so the people you rely on hear it the right way. The harder challenge is less visible: diligence runs while you are still operating the business, and letting performance slip during it is one of the costlier mistakes an owner can make, because the buyer is watching current results the whole time. How problems surface, and how the agreed price can change Diligence is also where surprises come to light, and where the number you agreed to can move if they do. When the review turns up something material, the buyer may ask to revise the price or the terms. That could be overstated earnings, a compliance gap, or more customer concentration than they expected. Reducing the offer after the LOI is common enough to have a name, re-trading, and it is most likely when something in diligence does not match what the buyer was told. Most re-trades trace back to something that could have been found and fixed earlier. Clean financials, current licenses, organized records, and a management team ready for the questions all reduce the chance of a late price reduction, and most of that work is done before diligence ever starts. Your job during diligence is to respond to requests quickly and accurately, and to keep the business performing. Consistent file naming and timely responses sound minor, but delays slow the deal and can wear down a buyer's confidence. Your attorney handles the purchase agreement and legal risk, your accountant works through the QoE and working capital, and your advisor coordinates across everyone to keep the deal moving A lot of advisors step back once the LOI is signed. We stay closely involved through diligence, because pushing the deal to closing efficiently is a large part of what we are there for. → Related: Overcoming Common Challenges in Home-Based Care M&A Key Takeaways Due diligence begins after you sign the LOI and runs on an exclusive basis, usually about 60 to 90 days. The buyer reviews the business across several areas at once: financial, legal, regulatory and compliance, operational, clinical, and people. The quality of earnings review verifies that your reported earnings are accurate and sustainable, including your add-backs. Expect site visits and interviews, not only document requests, and plan for how confidentiality is handled while you keep the business running. The agreed price can change if diligence turns up material problems, so the preparation you do before diligence is what protects your value. Responsiveness and organization keep the deal moving, and your advisor, attorney, and accountant each carry part of the work. Due diligence rewards preparation more than almost any other part of a sale, and the owners who move through it cleanly are usually the ones who got ready long before a buyer was at the table. Mertz Taggart is a healthcare M&A advisory firm that has represented owners across home health, home care, hospice, behavioral health, and infusion therapy for over twenty years. We prepare our clients before they go to market and stay closely involved through diligence and closing, so the value you negotiated is the value you keep. If you are getting ready to sell, or want to understand what diligence will ask of you before you start, it is worth a confidential conversation. Let’s talk.

Behavioral Health M&A By Kevin Taggart, CM&AP, Managing Partner, Mertz Taggart Published August 2026. Transaction data reflects deals closed between April 1 and June 30, 2026, as tracked by Mertz Taggart. At a Glance Behavioral health M&A slowed in Q2 2026. A total of 27 transactions closed during the quarter — 21 traditional M&A deals and 6 growth deals — making it the lightest quarter for closed traditional volume in the Mertz Taggart data set going back to 2022. Mental health led all sub-sectors with 14 closed deals, followed by autism and I/DD with 6 and addiction treatment with 2. Two new private equity platforms formed, nonprofit and health-system combinations accounted for roughly a third of closed traditional volume, and several of the quarter's largest transactions were announced rather than closed. A total of 27 closed transactions — 21 traditional M&A deals and 6 growth deals — were reported in Q2 2026. Traditional M&A volume declined from 34 closed deals in Q1 2026 and 29 in Q2 2025, making it the lightest quarter for closed behavioral health M&A in our data set going back to 2022. The six growth deals carried a combined disc`losed value of approximately $183.8 million across the six rounds with disclosed terms. Note: Total industry transactions do not necessarily equal the sum of the sub-industries, as many transactions include more than one sub-industry. "Volume was down, but the composition of the quarter is more interesting than the count. Two new private equity platforms formed, one of the largest nonprofit combinations we've seen in years closed, and the sponsor-backed strategics that have driven this market for three years kept buying — just in smaller bites. What we're not seeing is the mid-size auction. Buyers are there; sellers of scale largely sat out the quarter." — Mertz Taggart Managing Partner Kevin Taggart said. Why nonprofit combinations stood out Nonprofit and health-system combinations were unusually prominent, accounting for roughly a third of closed traditional volume. Several were driven by Medicaid economics, with acquired organizations citing scale as the path to absorbing reimbursement shortfalls. It is one quarter, not a trend, but worth watching as state budgets tighten. "Anyone underwriting behavioral health right now is underwriting Medicaid more cautiously than in years past, but we expect this to pass as things eventually quiet down in DC. Buyers with capital are being deliberate — paying up for clean, in-network, growing businesses and being more diligent on everything else. For an owner, that spread is the whole story." — Taggart said. → Related: What Behavioral Health Owners Should Understand Before Comparing Offers Addiction Treatment M&A Two addiction treatment deals closed in Q2 2026, down from 6 in Q1 2026 and 7 in Q2 2025, and the lowest quarterly total in our data set. Substance use disorder deal flow has trailed its 2022 pace for several consecutive quarters as platforms work through integration, payer contracting and, in a few cases, balance sheet repair. MKH Capital Partners forms a new platform with Haven Health Management The most significant addiction treatment transaction of the quarter was MKH Capital Partners' platform acquisition of Haven Health Management, a Palm Springs, Florida-based operator of 22 Joint Commission-accredited mental health and substance use treatment locations across nine states and Puerto Rico with nearly 2,000 employees. Brands include Indiana Center for Recovery, The Haven Detox and The Recovery Team. Terms were undisclosed but described as nine figures. MKH concurrently acquired United Billing Solutions to support in-network billing across Haven's brands, and named Brian Thorn chief executive officer. Advantage Behavioral Health highlights A sizable behavioral health transaction was also announced (not closed) during the quarter: Advantage Behavioral Health agreed to be acquired by QCF/I, Inc. in a transaction financed through a planned $610 million non-rated municipal bond issuance, although the deal had not closed as of quarter-end. Clearview Capital, Advantage’s founders and management were expected to receive approximately $415 million at closing, with the potential for an additional $100 million tied to performance milestones. We classified the transaction within mental health because mental health is Advantage’s primary line of business, although the company also provides substance use disorder services. The announcement is another positive signal that investors remain interested in scaled SUD platforms. Also in the quarter, Abacus Investments-backed Recover Now closed its merger with Widespread Wellness, a Tennessee-based outpatient provider. “Two closings is a low number, and I don’t want to over-read it. SUD is where the gap between good assets and everything else is widest right now. Platforms are still looking, but they’re selective on payer mix and length of stay, and some are still cleaning up what they bought in 2021 and 2022. For a quality operator, there’s very little competing supply. It was also encouraging to see a transaction like Haven close and Advantage Behavioral Health get announced, largely because of the scale of both businesses,” Taggart said. Mental Health M&A Fourteen mental health deals closed in Q2 2026, down from 18 in Q1 2026 and 20 in Q2 2025. The sub-sector continues to account for the majority of behavioral health transaction volume, with activity split between technology-enabled platforms consolidating and a steady base of outpatient psychiatry and community provider combinations. The quarter's largest mental health transactions PsychPlus acquired Koa Health, a multinational digital mental health company, in a combination the buyer describes as the largest technology-enabled mental health platform globally, serving more than six million patients across the U.S., Europe, Australia and Asia-Pacific. PsychPlus operates more than 200 U.S. locations; Koa founder Dr. Oliver Harrison becomes president of PsychPlus. Spring Health closed its acquisition of Alma, the mental health provider marketplace, materially expanding Spring Health's in-network provider supply. The deal was announced in Q1 and closed May 1st. WPS Health Insurance acquired Mavida Health, a women's mental health platform — one of the quarter's few payer-side acquisitions of a virtual provider. Other closed mental health transactions: Thurston Group-backed Arc Health acquired North Carolina Mental Health & Psychiatry Group. Hillandale Advisors-backed Sidekick Therapy Partners acquired Word of Mouth Clinical Associates, a Tennessee pediatric therapy practice. Curio Digital Therapeutics acquired the Nora Mental Health franchise system, adding a national outpatient footprint to its digital platform. Unyte Health acquired Vital Links and Vital Sounds, the developers of Therapeutic Listening. Sweetser acquired Common Ties Mental Health, and Keystone Human Services merged with Mikayla's Voice — both nonprofit combinations. UConn Health assumed operation of the state-run Albert J. Solnit Children's Center in Middletown, Connecticut; Neosho Memorial Regional Medical Center acquired Kansas-based Ashley Clinic; and Xpress Wellness Urgent Care acquired Wichita's Midwest Counseling Services. Mental health deals highlights Several larger mental health transactions were announced but had not closed at quarter end. Clearview Capital agreed to exit Advantage Behavioral Health, a New Jersey-based operator of more than 30 mental health and sober-living facilities in eight states, to nonprofit QCF/I, Inc., financed by a planned $610 million non-rated municipal bond issuance. Clearview and ABH's founders and management are expected to receive roughly $415 million at closing, with up to $100 million more tied to milestones. ABH is projected to generate approximately $170 million of revenue and $78 million of EBITDA this year. Mental health growth capital in Q2 2026 HPS Investment Partners agreed to take majority ownership of Discovery Behavioral Health in exchange for a substantial debt reduction, subject to regulatory approval. Universal Health Services' $835 million acquisition of Talkspace was approved by shareholders May 30 and is expected to close in Q3 2026. On the growth side, mental health accounted for all six of the quarter's rounds. Click Therapeutics raised $50 million in a Series D from Boehringer Ingelheim to commercialize CT-155, a prescription digital therapeutic for schizophrenia symptoms. Tava Health raised a $40 million Series C led by Centana Growth Partners; Instride Health raised $30 million from Echo Health Ventures; Klinic raised $24 million; Zocalo Health raised $22.8 million from EO Ventures; and Vanna Health raised $17 million from Health Velocity Capital. Autism and Intellectual/Developmental Disabilities M&A Six autism and I/DD deals closed in Q2 2026, down from 10 in Q1 2026 and roughly in line with the 7 closed in Q2 2025. New platform formation and nonprofit consolidation drove the quarter. Merakey and I Am Boundless: the quarter's largest behavioral health transaction The largest transaction of the quarter in any behavioral health sub-sector was Merakey's acquisition of I Am Boundless, an Ohio nonprofit serving people with intellectual and developmental disabilities and behavioral health needs. Merakey, a Pennsylvania-based nonprofit operating in 12 states, and Boundless will together generate up to $1 billion in annual revenue, with Boundless keeping its name and leadership. Boundless had grown revenue from $20 million to an expected $200 million through five acquisitions in seven years, and its CEO pointed to Medicaid shortfalls as the reason it sought a larger partner. Cathay Capital launches Ascendia Autism Care Cathay Capital launched Ascendia Autism Care, a new applied behavior analysis platform built around a founding affiliate operating 20 centers across eight states with more than 400 clinicians. Ascendia focuses on early intervention for children ages two to six and plans to grow through de novo expansion and additional clinical partnerships. Additional Q2 autism and I/DD transactions: Gryphon Investors-backed LEARN Behavioral acquired Little Leaves Behavioral Services from FullBloom. Frontline Healthcare Partners-backed JoyBridge Kids acquired A Bridge to Achievement, its first step into adult services. Doma acquired MPA Services, an Ohio I/DD provider. The founders of North Arrow ABA in Michigan converted the practice to 100% employee ownership. "ABA and I/DD are still where the most consistent buyer interest is, and Cathay's launch is a good example — a firm entering around a single high-quality founding group rather than buying a built rollup. The other story is the nonprofit side moving. Merakey and I am Boundless exists because the Medicaid math doesn't work at smaller scale according to I am Boundless, and I expect more of those combinations over the next 18 months." — Taggart said. → Related: How to Prepare Your Behavioral Health Business for Sale in 2026 If you are interested in downloading the PDF version of the Q2 2026 Behavioral Health M&A Report, click the download link below:

By Cory Mertz, M&AMI, Managing Partner, Mertz Taggart At a Glance A behavioral health owner who grew a solo practice into a much larger New York City business shares ten lessons from selling it. Among them: get clear on why you are selling, interview several advisors and compare them side by side, choose a behavioral health specialist you trust, protect confidentiality from the first conversation, and organize your financials long before going to market. No matter where you are in your home-based care journey, it is never too early to ask: what comes next? One of the most common questions owners raise is who, exactly, buys home health, home care, and hospice companies. The answer varies more than most people expect. This article breaks down the buyer universe into its main categories, explains what motivates each type, and gives you enough grounding to recognize which buyers might be relevant to your eventual exit. The Two Buyer Types: Strategic and Financial There are two broad categories of home-based care buyers: strategic buyers and financial buyers. Because their goals differ fundamentally, how they approach a transaction, including what they pay and what they require from a seller, can differ significantly. Strategic buyers tend to dominate the M&A landscape in terms of deal volume. They usually operate in the same or closely connected industry and can realize synergies from an acquisition. Those synergies, whether in the form of cost savings, referral relationships, or value-based care arrangements, represent a real financial benefit, which means they can often support a higher acquisition price than a buyer who cannot capture them. Financial buyers, by contrast, are acquiring with a targeted return on investment and a defined exit horizon in mind. They are not operators in the traditional sense, which means they typically need an existing management team or an operating partner to run the business after close. → Related: Home-Based Care M&A Report Strategic Buyers Strategic buyers in home-based care generally fall into three groups. Public Companies Public companies operate under Wall Street scrutiny and face reporting requirements that influence how they approach acquisitions. The price-to-EBITDA multiple at which their own shares trade can factor into whether and at what price an acquisition makes sense. Examples include Amedisys, Addus, Enhabit, Aveanna, and The Pennant Group. This group has also expanded to include ‘payviders’, the large managed care organizations playing an active role in value-based care. Cigna (Signify), United's Optum Ventures (LHCG), and Humana's Centerwell, along with Gentiva (co-owned with Clayton Dubilier Rice), are examples of that category. Private Equity Portfolio Companies These are companies formed through a private equity fund's initial, or platform, investment in the sector. Their typical growth strategy involves add-on or tuck-in acquisitions around that platform. Their cost of debt, a function of the interest rate environment and their existing leverage, shapes how actively they pursue deals. Examples of PE-backed home-based care portfolio companies include Elara Caring, Help at Home, AccentCare, Care Advantage, and Compassus. Non-PE-Backed Strategic Buyers Every strategic buyer that is neither publicly traded nor backed by a private equity fund falls here. Their acquisition appetite depends on their size and operational sophistication. This category includes for-profit and not-for-profit health systems, such as Trinity Health, as well as larger not-for-profits, which are particularly active in the hospice segment. Financial Buyers Financial buyers are investors, not operators. They acquire with a specific internal rate of return and exit date in mind, though both are subject to change depending on market conditions. To reduce execution risk, they typically incentivize existing management or bring in an industry operating partner by offering equity in the platform. Private Equity Groups Private equity groups raise capital from limited partners, such as pension funds or high net worth individuals, and deploy it through funds that typically run seven to ten years. They acquire stakes in businesses they intend to improve and sell at a profit, with returns shared with their LPs. In home-based care, most PE firms pursue a roll-up strategy. A platform is acquired, then the firm adds smaller companies in new markets over time. The goal is to build a larger, more efficient entity that benefits from economies of scale and increased market share. The underlying concept is multiple expansion: the combined company can sell at a meaningfully higher EBITDA multiple than the individual companies that were acquired. Debt financing is typically used to maximize returns. Active private equity sponsors in home-based care include KKR & Co. Inc., TPG Capital, Webster Equity Partners, Vistria, and Lorient Capital. → Related: What Do Buyers Know That You Don't? Family Offices Family offices manage capital on behalf of one or a small number of high net worth families. That structure gives them more flexibility on holding periods and investment strategy than a fund with a defined life. Like PE firms, they need a platform acquisition to enter the industry. Examples in home-based care include Dorilton Capital, through its investment in Traditions Health, and Kaltroco, which owns New Day Healthcare. Independent Sponsors Independent sponsors, sometimes called fundless sponsors, are individuals or small groups who identify and pursue acquisitions without a committed fund behind them. They are often former investment bankers or private equity professionals with the deal experience to source and execute transactions. They tend to target industries where they have prior expertise. Unlike traditional PE, independent sponsors typically do not raise equity until they have identified a specific target. They work through various capital channels, including private equity firms, family offices, hedge funds, and pension funds. Search Funds The search fund model, which dates to 1984 and has grown in visibility in recent years, involves an MBA graduate, typically from a top business school, who raises capital from alumni and other backers to acquire and operate a profitable private company. Backers may include school alumni, faculty, and established debt partners. The MBA graduate serves as the operator post-close. Key Takeaways Strategic buyers, including public companies, PE-backed platforms, and non-PE operators, account for the majority of home-based care deal volume. Strategic buyers can often pay more because they capture synergies a financial buyer cannot. Private equity typically pursues a roll-up strategy, building value through multiple acquisitions and then selling the combined platform at a higher multiple. Family offices and independent sponsors represent a smaller share of activity but can be flexible and competitive buyers for the right business. The type of buyer matters as much as the price: each brings different motivations, timelines, and expectations post-close. Working with an experienced M&A advisor can help you assess which buyers are realistic for your business and how to run a process that generates competitive tension. Considering Your Options? Understanding the buyer universe is one piece of exit planning. Knowing how to position your business within it, and how to run a process that surfaces the right buyers, requires a different kind of work. Mertz Taggart has advised healthcare services owners for over twenty years, across hundreds of transactions in home health, home care, hospice, and adjacent services. If you are thinking about what comes next, a confidential conversation is a reasonable place to start. Home-Based Care M&A, Selling a Home Care Agency, Home Health Buyers, Private Equity Home Care, Strategic Buyers Healthcare, Home Care Exit Planning, Hospice M&A, Healthcare M&A Advisors, Sell My Home Care Company

At a Glance A behavioral health owner who grew a solo practice into a much larger New York City business shares ten lessons from selling it. Among them: get clear on why you are selling, interview several advisors and compare them side by side, choose a behavioral health specialist you trust, protect confidentiality from the first conversation, and organize your financials long before going to market. For many behavioral health practice owners, the decision to sell does not begin with a neatly defined exit plan. It may start with growth. It may start with fatigue. It may start with an unexpected inquiry from a buyer. Or it may start with a quiet realization that the business has become bigger, more complex, and more stressful than the owner wants to manage alone. That was the case for one clinical psychologist in New York City who recently shared their experience selling a behavioral health practice with Mertz Taggart. The owner had practiced for about 15 years and started as a solo practitioner. Over time the practice grew, and COVID accelerated that growth, since the organization was already comfortable working remotely and in the home. What had once been a manageable practice became a much larger business, with more pressure around cash flow, hiring, firing, and day-to-day management. When the owner grew to over 325 employees, it was time to do something different. "I couldn't see myself continuing to build the business on my own, ” the owner recalled thinking. “I would love to have a partner who was an expert in all the things I was not." That thinking led to a sale process that ultimately closed about a year later. Looking back, the owner described the outcome as financially rewarding, but also more emotional and complex than expected. For other behavioral health owners thinking about a future sale, this experience offers several practical lessons. 1. Know Why You Are Considering a Sale Before interviewing advisors or responding to buyer interest, get honest about your motivations. Are you trying to reduce the day-to-day management load, create financial security, avoid taking on a partner, set the business up for its next stage, or simply learn what the practice might be worth? The answer matters, because selling a behavioral health practice is not only a financial decision. It affects the owner, the employees and clinicians, the patients, the referral relationships, and the future identity of the organization. The owner we spoke with was not chasing a transaction for its own sake. The practice had grown, the responsibilities had become heavier, and selling became a way to create relief, reduce risk, and set up for the future. That clarity helped guide everything that followed. 2. Interview Multiple Advisors, but Compare Them Thoughtfully The owner interviewed five or six M&A advisors before choosing Kevin Taggart and Sandra Zervoudakis with Mertz Taggart. A few factors stood out during those conversations: • Cost structure • Process and communication style • Trust • Expected value • References • Behavioral health experience The owner was especially focused on whether the fee structure was simple and understandable. Some advisors quoted upfront costs or layered percentages that felt complicated, and simplicity mattered because the owner did not want to guess what the process would cost. Trust mattered just as much. New to M&A and selling a company for the first time, the owner wanted someone who could explain the process clearly, set realistic expectations, and feel like the right person to rely on through a high-stakes decision. Their advice to other owners: build a structured way to interview advisors so you can compare them fairly. Ask each of them similar questions, take notes, and understand the differences in process, fees, buyer approach, experience, and communication style. And do not be afraid to ask for references. → Related: Business Broker vs. Healthcare M&A Advisor: What Owners Should Know Before Choosing 3. Behavioral Health Specialization Matters Selling a behavioral health practice is different from selling a general business. The owner felt strongly that industry experience was essential, because behavioral health is a specialized market with its own buyer universe, terminology, risks, and operating dynamics. “I wouldn’t hire a gastroenterologist to examine my heart,” the owner said. In their view, few advisors truly specialize in behavioral health, which made the choice more important. The right advisor needed to understand the field, the buyers, and how to position the business so it made sense to the market. That expertise also matters when comparing buyers. The highest bid is not always the deciding factor. Fit, expectations, structure, and certainty to close all influence whether a buyer is the right choice. → Related: What Behavioral Health Owners Should Understand Before Comparing Offers 4. Confidentiality Is One of the First Fears Owners Face At the beginning of the process, the owner was most worried about people finding out. No one inside the company knew a sale was being considered, and there was real concern about competitors hearing the news, especially in New York City, where the market can feel smaller than it looks. Those fears are common. Owners worry about staff morale, rumors, referral relationships, and whether early information could create instability. It is one reason the process has to be handled carefully, and why owners should be thoughtful about who they involve, when they involve them, and how they eventually communicate a completed transaction internally. The owner noted that strong internal relationships make the announcement easier when the time comes. Weak or purely transactional ones create risk, and losing key people can do more than sting; it can put the deal itself in jeopardy. 5. The Process Is More Stressful Than Most Owners Expect The owner had been told the process would be stressful, and still found it hard to grasp until they were in it. The stakes were high, the experience was unfamiliar, and the owner had to trust an advisor, an attorney, and a buyer while continuing to run the practice. “It’s like giving your child over to strangers and having to trust them,” the owner said. For founder-led businesses, that feeling makes sense. Owners are used to being in control. They built the company, made the decisions, and carried the risk. A sale asks them to share information, wait for feedback, weigh unfamiliar options, and accept that parts of the process sit outside their direct control. The stage after the letter of intent is often the most stressful of all, when negotiations, legal questions, deal structure, and buyer requests arrive at once. This is where strong legal and M&A support matters most. 6. Calm, Honest Guidance Matters One reason the owner chose Kevin Taggart was his demeanor. Compared with other advisors, Kevin did not come across as overly negative or overly optimistic. He was matter of fact, realistic, and steady, and that made a difference. The owner described him as a “calm, stabilizing force” during a process that often felt uncertain. He offered guidance without pressure and made clear that the decisions ultimately belonged to the owner. The owner also valued that Kevin was willing to share his perspective early, before asking for any formal commitment. 7. Get Your Financials and Operations in Order Early One of the owner’s biggest lessons was the value of preparation. They wished they had organized their financials better before starting. Smaller practices often lack large finance or HR teams, which means data requests can fall heavily on the owner or a small internal group, and that becomes time-consuming fast. Preparation is not only about financials. It also means building the business for the future rather than only for today. Hiring, software, processes, and documentation all affect how smoothly a sale runs. Repeatable processes matter, whether it is onboarding, clinical documentation, or another part of the operation, because consistency helps you respond to buyer requests without unnecessary friction. That kind of preparation cannot be done 30 days before going to market. It takes time. → Related: How to Prepare Your Behavioral Health Business for Sale in 2026 8. Be Involved in How Your Story Is Told For a distinctive behavioral health business, the owner believes it is important to stay involved in how the company is presented to buyers. An advisor leads the process, but the owner knows the business best: what makes it different, how it grew, and which parts of the story should not be oversimplified. That does not mean managing the process alone. It means the advisor and owner work together, so the business is positioned accurately and thoughtfully. When a buyer does not understand something, they tend to move past it rather than dig in, so clarity is worth the effort. 9. Understand What You Are Giving Up Selling often means giving up some level of control, and for owners who built a practice from the ground up, that can be hard. The owner advised future sellers to think carefully about whether they are ready for that shift. It’s not enough to ask what the business can fetch. Owners also need to ask: • What do I want my role to look like after a sale? • How much control am I comfortable giving up? • What kind of buyer would I trust with the business? • What financial outcome would make the decision worthwhile? • What would make me walk away? The answers may change over time, but it helps to work through them before you are deep in a process. 10. Build a Network of People You Trust The owner also recommended talking to people beyond a single M&A advisor: other owners who have sold, attorneys, financial advisors, and people with private equity experience. Each conversation helps you understand the process from a different angle. The goal is not to crowd the decision with too many opinions. It’s to become more informed so the process feels less opaque. Deal structure, buyer differences, legal terms, rollover, and expectations can all be confusing the first time through, and having people around you who can explain the moving parts in plain language makes a real difference. A Sale Process Is Not Just a Transaction For this owner, the sale created a financial outcome they never imagined when they first opened the practice. “The deal of a lifetime,” as they described it. The broader lesson is simple. Selling a behavioral health practice is a major professional and personal decision, and it rewards preparation, clarity, trust, and the right advisory team. For owners who are not ready to sell today, the best first step may not be going to market at all. It may be getting educated, organizing your financials, thinking through your goals, and understanding what buyers would care about if the time comes. Mertz Taggart has advised behavioral health owners through the sale of their businesses for over twenty years. If you are starting to think about what’s next, a confidential conversation and an honest look at where your business stands is a good place to begin. Key Takeaways Get clear on why you are selling before you talk to advisors or buyers. Interview several advisors with the same questions, and weigh fees, process, references, and behavioral health experience. Choose a specialist. Behavioral health has its own buyers, terminology, and risks. Protect confidentiality from the first conversation, and invest in the relationships that make an eventual announcement easier. Organize your financials and operations well before going to market. Good preparation takes time, not weeks. The highest offer is not always the best. Weigh fit, structure, and certainty to close, and expect the stretch after the LOI to be the hardest part.

By Bruce Vanderlaan, JD, Mertz Taggart At a Glance Home health, home care, and hospice owners are fielding more cold calls from M&A “brokers” than ever. Many of these outreach efforts follow the same playbook: promise a specific buyer or a high multiple, lock the seller into an agreement, then flip the script. This is the broker bait-and-switch. It’s designed to generate a fee for the broker, not to maximize value for the seller. Before signing anything, owners should understand how this tactic works, what questions to ask, and why a competitive, seller-focused M&A process leads to a better outcome. Why Are So Many Brokers Calling Home Health Agency Owners Right Now? Demand for small- to mid-sized home-based care agencies remains high, even in a volatile M&A market. That demand has attracted a wave of brokers reaching out to agency owners with promises of interested buyers or attractive multiples, all without knowing anything about the business beyond a website. At the very least, anyone approaching you with promises of “interested buyers” or specific multiples should be cautiously received. If they haven’t done any diligence on your company, their promises are not grounded in reality. What Is the Broker Bait-and-Switch, and How Does It Work? The broker bait-and-switch is less a fixed sequence than an opportunistic process. The direction it takes depends on what the broker learns once they get you talking. It typically follows three steps: Step 1: The Bait. A broker contacts you claiming to have an interested buyer, multiple interested buyers, or a buyer willing to pay a steep price for your agency. No details are offered. The goal at this stage is not to share information; it is to get you on a call. Step 2: The Call. Once you agree to talk, the broker listens as much as they pitch. They are gathering information about your situation, your timeline, and how willing you appear to pay a fee. What you share in this conversation shapes what happens next. Step 3: The Switch. Depending on what the broker learns, the approach shifts in one of two directions. If you appear willing to pay a fee, they will ask you to do so, then go out and find a buyer after the fact. If you seem reluctant, they may turn to buyers directly, telling them they have an opportunity and asking whether the buyer will cover the fee instead. In some cases, the broker already has non-exclusive, buy-side arrangements in place with those same buyers, meaning they are positioned to collect from either side. The "specific buyer" from the initial outreach may never have existed. Sellers, and buyers for that matter, are likely to find this sort of process expensive, confusing, burdensome, and unprofessional. It leaves owners dissatisfied and fatigued at the end of a process they will likely go through only once. Essentially, the broker is intent on making a fee, regardless of who pays it. A legitimate M&A advisory firm, by contrast, will put significant effort into maximizing value for the seller. There is a lot of work that goes into going to market the right way, ensuring that the agency is ready for due diligence and that the transaction has a high likelihood of closing. Key distinction: Many of these brokers are “transaction” brokers. They represent the transaction, not you, and not the buyer. A legitimate sell-side M&A advisory firm represents the seller and puts significant effort into maximizing value. Why Is Having Only One “Interested Buyer” Almost Never in a Seller’s Best Interest? To avoid succumbing to this trick, the first thing sellers need to understand is that the pressure is not nearly as high as the broker makes it seem. Finding buyers is the easy part. There are plenty of strategic buyers and PE firms regularly looking for quality home health, home care, and hospice assets. The allure of an “interested buyer” should generally be ignored when no details are given. In fact, having “one” interested buyer is almost never in a seller’s best interest. When an owner is ready to sell, they should expect a transparent and competitive process from the outset. An experienced M&A advisory firm should engage with multiple qualified buyers to drive the best price and terms. That also allows the seller—and not the broker, who may just be looking for a fee via the bait-and-switch—to choose the best buyer. That choice will involve price, cultural alignment, certainty to close, post-closing obligations, and a host of other factors. Without backup offers, buyers are hardly likely to raise their offers or make compromises on other seller wishes. They are also more likely to negotiate on the basis of what is “reasonable” versus what is “market,” determined by a professional, competitive process. → Related: Your Company Might Be Great. That Doesn’t Mean It’s Valuable. What Questions Should Sellers Ask Before Signing a Broker Agreement? Sellers should not enter into vague agreements, no matter how eager they are to negotiate with so-called “interested buyers.” In order to ensure the process goes smoothly, they need to ask the right questions to the broker: 1. Who is the buyer? 2. Did the buyer specifically ask you to contact us? 3. Why is my company strategically interesting to them? 4. How did the buyer determine the price or multiple that you are claiming? 5. Is the buyer paying your fee? A respectable M&A advisor should have no problem answering these questions from the start. If they do, they likely do not have the seller’s best interests in mind. Key Takeaways The broker bait-and-switch uses the promise of a specific buyer to generate urgency and move toward a fee arrangement, regardless of whether a real, committed buyer exists at that stage or which side of the transaction will ultimately pay. Transaction brokers represent the deal, not the seller. A legitimate M&A advisory firm represents the seller and works to maximize value. A single “interested buyer” is almost never in the seller’s best interest. A confidential, competitive process with multiple buyers drives better price and terms. Before signing any agreement, ask the five questions above. If a broker can’t answer them, reevaluate. Selling your agency is likely a once-in-a-lifetime decision. If you’re being pressured, the answer should be “no.” Thinking About Selling Your Home Health, Home Care, or Hospice Agency? This is likely one of the most significant decisions you’ll make as an agency owner—and you only get to do it once. It makes sense to be cautious and informed. Mertz Taggart is a healthcare-focused M&A advisory firm that has completed over 160 transactions in home health, home care, hospice, and behavioral health. If you’re considering a sale and want to understand what your agency is worth, contact us for a confidential conversation.

Home-based care M&A volume stepped down in Q2 2026, with 16 transactions closed during the quarter — down from 27 in Q1 2026 and 29 in Q2 2025. Hospice and home care tied for the lead at 8 closed transactions each, followed by skilled Home Health at 6. Two additional deals were announced but not yet closed as of quarter-end. Two of the quarter’s closings ranked among the largest home-based care transactions on record: General Atlantic’s approximately $3 billion acquisition of TEAM Services Group and Kinderhook Industries’ $1.1 billion take-private of Enhabit. Together they underscore that, even as deal count cooled, large-cap sponsor capital remained firmly committed to scaled home-based care platforms. Cory Mertz, managing partner at Mertz Taggart, noted: “The count came down this quarter, and it’s fair to ask whether the regulatory environment is part of it — the fraud takedowns, the hospice 36-month rule, the new enrollment moratorium and enhanced oversight all make deals more complex to get across the line. But it’s one quarter, and the dollars tell the other side of the story. Sponsors are still writing big checks and, increasingly, looking to return capital to LPs after long hold periods.” Home-Based Care M&A By structure, the quarter comprised six new PE platform investments, four sponsor-backed strategic add-ons, one public-company acquisition, and five post-acute, or independent buyers. New-platform activity outpaced add-ons — a reversal of the add-on-heavy pattern of recent years — as several sponsors established fresh platforms in the sector. Note: Total industry transactions do not necessarily equal the sum of the sub-industries, as many transactions include more than one sub-industry. Home Health M&A Home health saw 6 closed transactions — including two new platform investments, one sponsor-backed add-on, and three other strategic or independent buyers — down from 8 in each of the prior two quarters. The quarter’s headline deal was Kinderhook Industries’ completed take-private of Enhabit, the home health and hospice provider that spun out of Encompass Health in 2022 and spent much of its time as a publicly traded company navigating Medicare home health reimbursement headwinds and investor skepticism. Enhabit shareholders received $13.80 per share in cash — a total enterprise value of roughly $1.1 billion (equity plus roughly $480 million of assumed debt), representing a 10.2x EBITDA multiple on $108 million of EBITDA, a 24% premium to the undisturbed share price and nearly 34% to the 60-day average. Cory Mertz offered this perspective: “The Enhabit deal is a good reminder of why we don’t lead with multiples. Enhabit shareholders received a 10.2x EBITDA, which sounds unremarkable for a billion-dollar, public company. But this was a 24% premium to market and nearly 34% to the 60-day average — significant by any measure.” Among other closings, PruittHealth acquired Georgia Home Health Services, extending its home health presence in South Georgia; Lucent Home Health acquired Chambers Home Health Agency of Northeast Texas, a combined home health and hospice operation; and Renovus Capital Partners-backed Superior Health Holdings added Chant Healthcare, entering Oklahoma across home care, home health and hospice. Heritage Home Health and Hospice and Legacy Hospice formed an Ohio joint venture. Hospice M&A Hospice matched home care at 8 closed transactions — three platform investments, two sponsor-backed add-ons, and three strategic or independent buyers — extending the steady, add-on-heavy consolidation that has defined the segment. Webster Equity Partners-backed Bristol Hospice acquired Hope Hospice & Palliative Care, while Norwest made a platform investment in Ennoble Care, a home-based care provider spanning home care and hospice. 5th Century Partners invested in Capstone Hospice, establishing a new platform, and Stillwater Hospice agreed to take over the hospice operations of Campbell County Memorial Hospital. Home Care M&A Non-medical home care tied for the lead at 8 closed transactions — three platform investments, three sponsor-backed add-ons, one public-company deal, and one independent buyer — powered by the quarter’s largest transaction. General Atlantic acquired TEAM Services Group, a San Diego-based, scaled home-based care services company, from Alpine Investors for a reported purchase price of approximately $3 billion — one of the largest home-based care transactions on record. TEAM’s EBITDA was reported, but the transaction’s EBITDA multiple can’t be reliably calculated: only the purchase price is known, not enterprise value. Elsewhere, Warburg Pincus made a platform investment in non-medical home care provider Cornerstone Caregiving, with financing from Monroe Capital; Addus HomeCare acquired HomeCourt Home Care, marking its entry into Indiana; Searchlight Capital Partners-backed Care Advantage added First Priority Home Care; SIG Partners-backed Pillar Health Group acquired Krista Care; and Feature Healthcare acquired Carepoint. One of the quarter's most significant announced (but not yet closed) transactions was Deacon Associates' agreement to acquire 31 home health and hospice agencies from HCA Healthcare (NYSE: HCA) , with terms undisclosed. The divested assets span eight states and will be folded into Central Pyramid, a Deacon subsidiary; the portfolio includes agencies HCA had picked up through its 2021 acquisition of an 80% stake in Brookdale Senior Living's health care services segment. The deal is expected to close in roughly three months, pending regulatory approval. It stands out as a large health system stepping back from home-based care even as operators like Deacon — in CEO Trey Crabb's words — "double down on home health and hospice." Cory Mertz added: “For owners weighing a process over the next 12 to 24 months, this environment rewards preparation. Diligence around billing and compliance has only intensified — especially in the enhanced-oversight states — and the sellers who invest early in getting their house in order are the ones who hold their value all the way through to close.” If you are interested, you can also download the .PDF version of the Q2 2026 Home-Based Care M&A Report via the following link:

By Cory Mertz, M&AMI, Managing Partner, Mertz Taggart The home-based care M&A market remains active in 2026 — but it's not uniform. For high-quality agencies with strong financials, clean compliance histories, strong management teams, established referral networks, stable census, and a favorable payer mix, buyer demand is real and premium valuations are still attainable — while multiples have come off their 2021 peak, they remain very strong by historical standards. For agencies that don't check enough of the right boxes, premium valuations are much harder to come by: buyers are interested but disciplined, and the path to a strong outcome may require more work. What has changed for everyone is the environment around the transaction itself. A combination of regulatory shifts, intensified fraud enforcement, and operational complexity is making deals harder to structure, take longer to close, and more dependent on experienced guidance to get across the finish line. Understanding these dynamics before going to market is increasingly what separates a smooth process from a difficult one. This article covers the major factors shaping home-based care transactions right now, what they mean for sellers, and how to navigate them. Before getting into the specifics, it's worth seeing how much of this is connected. The enrollment moratorium, the renewed bite of the 36-month rule, the enhanced oversight in high-risk states, and the recent enforcement takedowns are not separate events — they are facets of a single, coordinated federal crackdown on fraud in home health and, most acutely, hospice. Read together rather than as isolated hurdles, they explain both why the deal environment has tightened and why going to market well-prepared matters more than it used to. How Does the CMS Enrollment Moratorium Affect Your Sale? In May 2026, CMS announced a nationwide moratorium on new Medicare enrollments for home health and hospice providers. The moratorium, effective for an initial six-month period, was implemented as part of a broader effort to combat fraud, waste, and abuse in the Medicare program. For sellers, the immediate effect is arguably positive. Buyers who previously had the option to build de novo in a target market — rather than acquire — are now effectively forced into the acquisition lane. That increases buyer competition for existing Medicare-certified providers. What this means for sellers: Your existing Medicare certification has increased strategic value. But expect buyers and their counsel to spend more time on transaction structure and due diligence, so build extra time into your closing timeline. What Is the 36-Month Rule, and Does It Affect Your Sale? One of the most frequently misunderstood obstacles in home health and hospice M&A is the 36-month rule. Under CMS regulations, a Medicare-certified home health agency or hospice that was acquired, changed ownership, or was initially enrolled within the prior 36 months may be subject to restrictions on a subsequent change of ownership. In practical terms, this means that if your agency was acquired, enrolled, or involved in a prior transaction within the last three years, a buyer may not be able to complete a CHOW without triggering additional scrutiny, delays, or — in some cases — the need to re-enroll entirely. The 36-month rule affects de novo agencies, recently acquired agencies, and providers that have undergone structural changes such as mergers or entity reorganizations. It is not always apparent on the surface. A good advisor will surface this before you go to market. When sellers aren’t prepared, it can create real friction in an otherwise clean deal. There are exceptions — for example, when a parent company undergoes an internal restructuring, or when the agency has filed two consecutive years of full cost reports since its last ownership change — but they are narrow and fact-specific. What this means for sellers: Know your agency’s Medicare enrollment history and whether the 36-month window applies before you go to market. An experienced advisor will surface this early — before you're in exclusivity with a buyer and the clock is ticking. How Is the Fraud Crackdown Changing Buyer Diligence? Home-based care has been under increasing government scrutiny, and that trend has accelerated in 2026. CMS, OIG, and the Department of Justice have all signaled increased enforcement focus on home health and hospice billing practices — including documentation practices and length-of-stay patterns in hospice. The scrutiny is most acute in hospice. The same fraud concerns that prompted the enrollment moratorium have produced a coordinated crackdown: CMS has imposed heightened screening on hospices that are newly enrolling or changing ownership in the states it considers highest-risk — Arizona, California, Georgia, Nevada, Ohio, and Texas — and is rolling out a public hospice scoring system to flag providers with concerning utilization, quality, or compliance patterns. On the enforcement side, CMS, OIG, and the Department of Justice have suspended payments to hundreds of suspect providers — including roughly 800 hospices and home health agencies in the Los Angeles area — and continue to prosecute the operators behind sham hospice schemes. For hospice owners, that means buyers and their regulatory counsel will scrutinize eligibility documentation, length-of-stay, and live-discharge patterns especially closely, and a clean, well-documented patient record is now a genuine differentiator. For sellers, the direct impact is in the diligence process. Buyers — particularly those backed by private equity or working with healthcare regulatory counsel — are doing more work on billing compliance than they were two or three years ago. Claim-level review, documentation audits, and outside regulatory counsel are now routine on transactions of any meaningful size. This doesn't mean your agency has a problem. Most well-run providers have nothing to worry about. But it does mean that buyers are spending more time on compliance review, and that any practice that could be perceived as inconsistent with CMS guidance will require explanation and documentation. What this means for sellers: A billing audit before going to market is no longer optional — it's table stakes. Identifying and resolving compliance questions before a buyer finds them puts you in a far stronger negotiating position. Surprises in diligence are deal killers. This is even more critical in the enhanced-oversight states, where hospice providers face the closest scrutiny. How Do State Regulations Affect Your Sale? Beyond federal CMS requirements, state-level regulatory environments vary significantly and are becoming increasingly important in home-based care transactions. Several states have enacted or are enforcing heightened oversight of home health and hospice providers — California in particular has seen significant regulatory activity affecting transactions in that market. State licensure transfers and Certificate of Need (CON) requirements add layers of complexity that vary by geography. Over the past two years, state legislatures have also moved aggressively to insert themselves directly into deal review. At least 14 states — California, Washington, Oregon, New York, Massachusetts, Connecticut, Illinois, Indiana, Colorado, Minnesota, Nevada, Hawaii, New Mexico, and Vermont — now require advance notice to the state Attorney General or a related agency before a private equity, hedge fund, or MSO-affiliated transaction can close, with Rhode Island and Maine adding similar requirements in 2026 and several more states advancing legislation. Some of these laws require notice only; others, like Maine's and California's, give the reviewing agency actual power to approve, condition, or block the deal. That's a meaningful departure from how healthcare deals have historically cleared antitrust review: federal Hart-Scott-Rodino (HSR) clearance is a single, uniform process with one threshold and one timeline, regardless of where the parties operate. The new state layer is the opposite — a patchwork of different thresholds, notice periods, and reviewing powers that stacks on top of HSR rather than replacing it, and often applies even to deals well under the federal size threshold. For multi-state providers, the complexity multiplies. A transaction that is straightforward in one state may involve multiple parallel regulatory processes in another. Indiana is a useful example of how state and federal rules can compound. Under a recent state mandate, home health agencies enrolled in Indiana Medicaid must also be enrolled as Medicare providers to keep receiving Medicaid reimbursement — a requirement effective July 1, 2026, with a final completion deadline of June 30, 2027 for agencies that began the process on time. For agencies that were previously Medicaid-only, enrolling in Medicare starts a fresh 36-month clock — which can make them difficult to sell until that window closes, because a buyer's change of ownership within 36 months of the new Medicare enrollment would keep the provider agreement from conveying. What this means for sellers: Know your state-specific regulatory requirements before going to market, and ensure your advisor knows how to navigate state-specific regulatory requirements. State-level issues that surface late in a transaction can cause delays and force renegotiations. Do 1099 Caregivers Create Risk When Selling? Home care agencies — particularly those using independent contractors for care delivery — have faced increased scrutiny around worker classification. Federal and state regulators have been active in examining whether caregivers classified as independent contractors should be treated as employees, with significant implications for payroll taxes, benefits obligations, and liability exposure. Buyers are well aware of this issue and typically conduct labor compliance reviews as part of diligence. Agencies with a high proportion of 1099 workers will face questions about the structure of those arrangements and whether they are defensible under applicable law. What this means for sellers: If your agency relies on independent contractors, have a clear and documented rationale for that classification. In some cases, transitioning workers to employee status before going to market may be appropriate. Your advisor can help you assess the risk and determine the right approach. What Does This Mean for Owners Considering a Sale? None of the above should be read as a reason not to sell. Demand across home health, hospice, and home care remains strong for well-positioned agencies, and even companies that don't check every box are transacting — it just requires more preparation, more patience, and more experienced guidance. What it does mean is that the path from LOI to close is more complex than it was a few years ago — and that complexity has a cost. Deals that surface compliance issues or regulatory gaps in diligence are more likely to fall apart, take longer to close, or close at a lower price than the owner expected. The owners who are achieving the best outcomes right now are the ones who understand where they stand before they go to market — clean financials, a billing audit behind them, a clear picture of their Medicare enrollment history and compliance status, no unresolved audits, surveys, or other regulatory issues that could hold up a deal, and an advisor who understands how these issues play out in a transaction. If you are considering a sale in the next one to three years, the best time to start that preparation is now. Cory Mertz, M&AMI, is Managing Partner at Mertz Taggart, a sell-side M&A advisory firm specializing in home health, hospice, home care, and behavioral health transactions. Mertz Taggart has closed more than 109 transactions across 35 states since 2014. To discuss a potential sale confidentially, contact Mertz Taggart at mertztaggart.com.

By Cory Mertz, M&AMI, Managing Partner, Mertz Taggart At a Glance A letter of intent, or LOI, sets the framework for selling your business: the price, the deal structure, and an exclusive period to complete the deal. Most of it is not binding, but the exclusivity usually is. Signing it is the moment your negotiating leverage flips, so the terms are worth getting right before you sign, not after. When you sell a healthcare business, one moment shapes much of what follows more than owners tend to expect: the day you sign a letter of intent. By then, you have a serious buyer, a number on the table, and real momentum, and signing can feel like the deal is essentially done. It usually is not, and a few of its terms carry more weight than they first appear. Here is what to understand before you sign one. What a letter of intent actually commits you to A letter of intent, often called an LOI, is the document a buyer and seller sign to lay out the main terms of a deal and a plan to reach closing. It typically covers the price, the broad structure of the deal, the timeline, and the major conditions that have to be met. Most of those terms are not legally binding, just a statement of intent, a framework both sides agree to work from while diligence is conducted and the details are finalized. A few parts of the LOI usually are binding, and one matters more than the rest: exclusivity. When you sign, you generally agree to stop talking to other buyers for a set period, often 60 to 90 days, while this buyer completes their work. Confidentiality is typically binding as well. So the document that can feel non-committal, because the price is not locked, actually does commit you to one thing that is hard to undo, which is taking your business off the market for everyone else. Your leverage is highest the moment before you sign The reason exclusivity matters so much is what it does to your negotiating position. Up to the point you sign, a well-run sale keeps more than one qualified buyer interested, and that competition is what gives you leverage. Buyers who know others are at the table tend to put forward their strongest terms and move with urgency. The moment you grant exclusivity, that dynamic changes. You have committed to one buyer, the others have stepped back, and the pressure that produced a strong offer is gone. This is why the terms in the LOI deserve real attention before you sign rather than after. Anything you would want to negotiate, whether on price, structure, or conditions, is easier to address while you still have alternatives. It also helps to keep the exclusive period as short as is reasonable, with clear milestones and a firm end date, so a buyer cannot let diligence drift while your business sits off the market. → Related: Seller Beware: Going Direct with a Buyer Could Cost You Millions The price in the LOI is not the price you close on The number written into the LOI is a starting point, and the period that follows it is where that number gets tested. After both sides sign, the buyer begins detailed due diligence, a close review of your financials, contracts, compliance, and operations. That review can confirm the offer, or give the buyer reasons to lower it, a practice known in the industry as re-trading, and it is most likely when diligence turns up something the buyer did not expect. The best protection against a re-trade is built before you ever sign. Clean, well-organized financials, documented compliance, and earnings a buyer can verify give a buyer far less room to revise the number downward. It also helps to understand the buyer’s reputation. Some buyers are known for honoring their LOI, and others are known for using diligence to chip away at the number. That history is worth knowing before you take your business off the market for them. Read the deal structure before you sign, not after An LOI does more than name a price. It also sets the structure of the transaction and that structure is hard to renegotiate once you are committed. The LOI sets how the purchase price is paid: how much is guaranteed cash at closing, and how much is tied to what happens later, through pieces like rollover equity, a seller note, holdback, or an earnout. Weighing those pieces against each other is a subject of its own. The point at the LOI stage is simpler, because these terms are far easier to influence before you sign than to define or, worse case, renegotiate afterward. Look closely at how much of the price is guaranteed versus conditional, and treat the conditional portions as possibilities rather than certainties. Earnouts in particular deserve scrutiny, and we generally push back on them and try to keep them out of a deal, or we simply treat them as “icing on the cake”. → Related: Have an Offer to Buy Your Home Care Agency? What to Do Next The buyer behind the LOI decides whether it closes A signed LOI is only as good as the buyer’s ability and intent to finish the deal. The risk here is specific to the LOI. Once you grant exclusivity, a buyer who cannot finish the deal has tied up your no-shop period and your momentum. If the deal then falls apart, you are back at the start, after months spent on a buyer who could not close. So, before you sign, it helps to understand whether the buyer can actually fund and complete the transaction. A buyer with capital in hand tends to move quickly and predictably, while one who still has to raise the money, or who has a habit of renegotiating, brings more risk. A high number is not worth much from a buyer who cannot get to closing. The stretch between the LOI and the closing table is where deals are most often won or lost. It is detailed and demanding, and it is where unexpected problems tend to surface. Many advisors step back once the LOI is signed. Staying closely involved through diligence and closing, keeping the process moving and heading off problems before they become leverage for the buyer, is where advisors earn their keep. Key Takeaways A letter of intent sets the framework for the deal: price, structure, timeline, and an exclusive period. Most of it is not binding, but the exclusivity usually is. Your leverage is highest right before you sign. Once you grant exclusivity, the other buyers step back and the pressure that produced a strong offer is gone. Get the terms right before you sign, not after. Keep the exclusive period as short as is reasonable, with clear milestones and an end date. The price in the LOI can still move. Clean, verifiable financials are the best protection against a buyer lowering the offer during diligence. Read the structure carefully. Separate what is guaranteed cash at closing from what is conditional, such as rollover equity, seller notes, and earnouts. A signed LOI is only as good as the buyer’s ability to close. A buyer who cannot fund the deal can cost you hours of your time, the ability to move forward with another buyer and your momentum. Deciding whether to sign an LOI, and on what terms, is one of the most consequential moments in selling a business, and it is far easier with someone who has been through it many times. Mertz Taggart is a healthcare M&A advisory firm that represents owners through the sale of their businesses, from the first conversation through diligence and closing. We help owners understand what an LOI really commits them to, hold the line on terms, and keep deals moving to a close. If you have an LOI in front of you, or expect one before long, it is worth a confidential conversation before you sign. Let’s talk.

By Kevin Taggart, CM&AP, Managing Partner, Mertz Taggart At a Glance When buyers make offers on a behavioral health business, most owners look first at the multiple. That’s understandable, but it can be misleading. A strong offer depends on more than the headline number. Owners should look closely at how much cash they’ll receive at closing, how much of the price is tied to future conditions, and whether the buyer is truly able to close at the value presented. If you own a strong behavioral health business, buyers are reaching out. Private equity firms, larger operators, and investor groups building platforms in the space are all actively looking, and it is not unusual for more than one to reach out in the same week. At some point, those conversations may turn into real offers. When they do, it’s natural to focus on the multiple. A multiple is simply how many times your normalized cash flow (or Adjusted EBITDA) a buyer is willing to pay. If your business earns $2 million a year and a buyer offers eight times earnings, that suggests a $16 million deal. That shorthand is useful, but it can also be misleading. A multiple doesn’t tell you how much money you’ll receive at close, how much risk is built into the offer, or whether the buyer can execute. Why the multiple is only part of the picture A multiple only matters in relation to the earnings figure behind it. Most buyers start with adjusted EBITDA, which is a measure of normalized earnings before interest, taxes, depreciation, and amortization. But not every buyer calculates adjusted EBITDA the same way. One buyer may use last year’s results. Another may use the most recent few months and annualize them. A third may factor in synergies. That means the same multiple can produce very different results. Two offers that look far apart on paper may be much closer in actual dollars. Two offers that look similar may not be similar at all. For example, one buyer may offer seven times AEBITDA and another may offer five times AEBITDA. At first glance, seven sounds better. But if the seven-times offer is based on last year’s lower earnings, and paid out over time, while the five-times offer is based on the business’s current performance, and paid in cash at closing, the lower multiple may actually produce more value. Before comparing offers, there are many questions worth asking each buyer. Two of the most important: How are you determining adjusted EBITDA? How is the purchase price paid out? Then compare the dollars, not just the multiple. What reaches your account matters more than the headline number The number a buyer quotes is usually the total value of the deal. It is not necessarily the amount you take home at closing, or ever. Several items can reduce the cash you receive at closing. Business debt is typically paid off first. There will likely be a working capital target and subsequent adjustment to account for the cash and short-term assets needed to keep the business operating. A portion of the purchase price is always held in escrow for a period after closing to cover any liabilities that arise from the seller's period of ownership. Other forms of consideration that affect your net proceeds include a seller note or an earnout. Once those items are factored in, two offers with the same headline value can produce very different outcomes. A slightly lower offer with more cash at closing, a cleaner working capital adjustment, and no earnout may be stronger than a higher offer with more conditions attached. The number worth comparing is not only the purchase price. It is what you are likely to receive, when you are likely to receive it, and how much uncertainty sits between the offer and the final outcome. Not every dollar in an offer is guaranteed Every offer includes some combination of guaranteed money and conditional money. Owners should separate the two before deciding which offer is truly stronger. Cash paid at closing is the most certain part of the deal. Other forms of consideration usually depend on what happens later. One common example is rollover equity. Instead of taking the entire purchase price in cash, you reinvest part of your proceeds into the buyer’s larger company and become a part owner. This can be a meaningful opportunity, but its value depends heavily on the buyer. If the buyer is well-run and continues to grow, the rollover may become worth significantly more than the cash you reinvested. If the buyer struggles, that equity may be worth far less.(maybe add, “even worthless”?) The percentage matters, but the company you are rolling into matters just as much. A seller note is another example. This means the buyer pays part of the purchase price over time, with interest, effectively making you a lender until the note is paid off. An earnout goes a step further, tying part of the purchase price to future performance targets. We generally push back on earnouts and try to keep them out of the deal. When they cannot be avoided, owners should treat that portion of the offer as conditional, not guaranteed. A simple way to compare offers is to start with the guaranteed money. Then look at the conditional pieces separately and ask what has to happen for that money to be paid, and what are the chances of it happening? This will usually be in the form of a range. Who is behind the offer affects whether it closes A strong offer only matters if the buyer can complete the transaction. Not every buyer has capital ready. Some buyers, including many larger private equity firms, have committed capital and can fund a transaction directly. Others raise capital deal by deal after agreeing to buy a business. These buyers, often independent sponsors or search funds, may be credible, but the funding process adds time and risk. That difference matters. A buyer who still needs to raise the money may take longer to close. In some cases, the capital may not come together at all. A slightly higher offer from a buyer still raising funds is not the same as a slightly lower offer from a buyer with committed capital, an industry thesis, and a clear path to closing. In a competitive process, certainty has value. The best offer is not always the highest number. It is the offer that gives the owner the strongest combination of value, terms, buyer fit, and likelihood of closing. Every transaction will have challenges before closing. Understanding who the buyer is, how they plan to fund the deal, and how they behave in the process is essential to separating a real offer from a number on paper. → Related: Seller Beware: Going Direct with a Buyer Could Cost You Millions Why the offer you accept can still change before closing The offer you accept is not always the number you close on. After both sides sign a letter of intent, the buyer reviews the business in detail. That process can confirm their valuation assumptions, but it can also cause the buyer to revise the offer. One of the most important parts of that review is the quality of earnings process. A quality of earnings review examines whether the company’s reported earnings are accurate, sustainable, and supported by the financial records. There is judgment involved, especially around add-backs. Add-backs are expenses a seller adds back to profit because they are not expected to continue after the sale. Different reviewers may reach different conclusions about which add-backs are valid and how earnings should be measured. That is why a strong offer is not only about the number presented upfront. It’s also about how well that number can hold up once the buyer performs their quality of earnings. Clean financials, strong compliance, clear documentation, and a strong management team all help protect value. Those strengths are usually built long before an offer arrives. They give buyers confidence and reduce the chances of a late-stage price reduction. When comparing offers, owners should consider how each offer is likely to hold up during diligence. A slightly lower offer that survives the review may be better than a higher offer that gets retraded before closing. → Related: How to Prepare Your Behavioral Health Business for Sale in 2026 Key Takeaways A multiple is only a starting point. It does not tell you what you’ll actually receive. Compare offers based on actual dollars, cash at closing, timing, and certainty. Separate guaranteed money from conditional money, including rollover equity, seller notes, and earnouts. If rollover equity is part of the offer, evaluate the buyer carefully. The company you join matters as much as the percentage you receive. A buyer with committed capital is generally more likely to close than one still raising money. The offer you accept can change during diligence, so clean financials and strong documentation help protect value. The strongest offer is usually the one that balances price, structure, buyer fit, and certainty to close. Comparing offers is difficult to do on your own, especially when each buyer presents value in a different way. It is also one of the most important parts of a well-run sale process. Mertz Taggart is a healthcare M&A advisory firm that represents behavioral health owners through the sale of their businesses. We help owners look beyond the headline number, understand the real value and risk in each offer, and negotiate from a stronger position through a disciplined, competitive process. If you are weighing an offer now, or expect to receive one soon, it’s worth having a confidential conversation before you respond.

By Cory Mertz, M&AMI | Managing Partner, Mertz Taggart At a Glance Healthcare business owners considering a sale or recapitalization will encounter business brokers, M&A advisory firms, and investment banks. Each serves a purpose, but they operate very differently. Brokers typically handle smaller transactions and market companies broadly. M&A advisory firms run structured, competitive processes targeting strategic and financial buyers. Understanding which path fits your situation can make a meaningful difference in your outcome. Not every transaction requires the same type of advisor. That’s the point I think healthcare business owners need to understand before they start comparing firms, fees, or processes. A business broker, an M&A advisory firm, and an investment bank may all help owners sell or recapitalize a company, but they’re not built for the same situations. This isn’t about one being good and the other being bad. Brokers serve an important role in the lower end of the market. For the right type of business, a broker-led process can make sense. But when you’re talking about a sizable healthcare services business, especially one that could attract strategic acquirers or private equity-backed buyers, the process needs to be different. The advisor you choose should match the business you built, the buyer universe you need to reach, and the outcome you’re trying to achieve. You only get to do this once. Brokers, M&A advisors, and investment banks are not the same thing The lines can get blurry because people often use these terms interchangeably. But there are important differences. A business broker typically works on smaller transactions, often owner-operated businesses generally up to $2–3 million in enterprise value, though the range varies. The process is usually listing-driven. The broker prepares basic materials, markets the opportunity broadly, sometimes through listing websites like BizBuySell, and waits for interested buyers to come forward. That model can work well when the buyer universe includes individuals, searchers, or someone looking to buy themselves a career. They call them listings. For us, they’re engagements. It’s a different mindset. An M&A advisory firm typically works with larger, more complex companies, usually $5 million and above in enterprise value, sometimes lower depending on the situation. Instead of listing the business publicly, the advisor identifies a curated group of strategic and financial buyers, prepares a comprehensive data book and offering memorandum, manages confidentiality, runs buyers through a coordinated process, and negotiates from competitive leverage. An investment bank is a more specific designation. Investment banks are registered with the SEC as broker-dealers. They may be involved in debt raises, capital raises, growth equity, Series A, B, or C financing, and other work that requires that registration. M&A advisory firms are not licensed for that kind of work. What they can do — and what Mertz Taggart does — is represent owners in majority-stake M&A transactions, including private equity recapitalizations. In everyday conversation, people sometimes use “investment bank” to describe any firm running a larger M&A process. But technically, not every M&A advisory firm is an investment bank, and that’s an important distinction. For most healthcare business owners, the more practical question isn’t the label. It’s this: what type of process does my business require? A listing is not the same as a competitive process One of the biggest differences between a broker and an M&A advisor is how the business goes to market. For brokers, the company is often treated like a listing, with an asking price. The business may be posted on a website or marketed to a broad audience. Offers come in as they come in. There is no established timeline. The seller reviews them one at a time. If one looks reasonable, the parties may move to a letter of intent or even a purchase agreement quickly. That can be appropriate for some businesses. But a larger healthcare services company is different. You’re not trying to find just any buyer. You’re trying to identify the right buyer, at the right time, under the right conditions, with the right terms. A competitive M&A process brings qualified buyers to the table on the same timeline, with the same information, and with a clear understanding that they’re competing. That structure changes buyer behavior. It creates urgency. It gives you a better view of the market. And it gives your advisor a stronger position when negotiating price and terms. → Related: 6 Considerations When Choosing a Home-Based Care M&A Advisor Not every transaction is an exit Here’s something else worth understanding. When people hear “selling a business,” they usually picture the owner walking away with a check. That happens, but it’s not the only type of transaction. We draw a distinction between an exit and a transaction. An exit means the owner sells everything and walks away. A transaction can also mean selling a majority stake to a financial partner while usually staying on to run the business — same owner, different capital structure. That second scenario is a big one. A lot of owners have grown their companies to a point where they want to take some chips off the table, bring on a partner with resources, and take the business to the next level. That’s not an exit, that’s a recapitalization, that requires a process built for that kind of buyer. This is typically a financial sponsor (private equity firm, family office, independent sponsor), not an individual looking to buy a business. Why does healthcare M&A require specialized experience? Healthcare transactions are not generic business sales. A home health agency, hospice, home care company, behavioral health provider, or infusion business comes with a specific set of factors buyers will evaluate closely: reimbursement risk, referral diversity, clinical documentation, compliance history, quality metrics, payer mix, transition risk, and management depth. Most owners understand their business operationally but may not know how buyers evaluate those same factors in a transaction context. That's where healthcare-specific experience matters. A good advisor isn't just finding a buyer. The advisor should be helping you understand what buyers will focus on before the business is exposed to the market, which issues are likely to surface during diligence, which buyers are credible, which are known for retrading after an LOI is signed, and which are most likely to value the specific strengths of your company. That kind of judgment is different from general M&A experience, and different again from having built and sold a healthcare business yourself, which is the perspective Mertz Taggart's principals bring to every engagement. The stakes around process and buyer selection are real. The wrong buyer can consume months without closing. The wrong process creates unnecessary market exposure, and in healthcare, where agencies operate in tight-knit communities, confidentiality is not a courtesy. It's a strategic requirement. A company surfacing on a listing website creates a fundamentally different dynamic than one introduced confidentially to a pre-qualified buyer list. The right advisor helps reduce surprises Owners often focus on price, and they should. For many founders, the business represents most of their net worth. Getting the best possible outcome matters, but price is only one part of the transaction. A strong M&A process is also designed to reduce late-stage surprises. That means setting expectations early, preparing buyers properly, managing information flow, and keeping pressure on the process from first outreach through close. Some of the most difficult issues in a transaction don’t show up in the first offer. They show up later, during diligence, legal negotiations, financing, regulatory review, or final closing mechanics. That’s when advisor involvement matters most. In a broker-led process, much of the heavy lifting happens before the LOI is signed. In a larger M&A process, the LOI is not the finish line. It’s the beginning of a more demanding phase. Your advisor should still be there, still pushing, still protecting your interests, still managing the buyer toward close. → Related: How to Sell Your Home Care Agency: 3 PE Exit Strategies Questions to ask before choosing an advisor Before hiring anyone, ask direct questions about the process. The answers will tell you a lot about how they work and whether they’re the right fit for your situation. Who is the likely buyer for my business? Will you market the company broadly, or will you build a targeted buyer list? Will my business be publicly listed anywhere? What materials will you prepare before going to market? How do you protect confidentiality? How many buyers will be contacted, and how will they be screened? Do you have relationships with strategic and financial buyers in my sector? What happens after an LOI is signed? Who will be involved during diligence and negotiation? How do you create competition instead of simply fielding interest? Key Takeaways Business brokers handle smaller transactions and market companies broadly through listing sites. M&A advisory firms run targeted, competitive processes with strategic and financial buyers. Not every transaction is an exit. Some owners are bringing on a financial partner while staying involved. That kind of deal requires a process built for institutional buyers, not individuals. Healthcare M&A requires industry-specific expertise around reimbursement, compliance, quality metrics, and buyer behavior. Generalist approaches can leave value on the table. A competitive process changes buyer behavior. It creates urgency, gives you a clearer picture of the market, and strengthens your advisor’s negotiating position. The LOI is not the finish line. The advisor’s role through diligence, legal negotiation, and closing mechanics is where outcomes are protected or lost. Ask direct questions about the process before choosing an advisor. How they go to market tells you more than what they promise. Ready to learn more? If you’re thinking about what’s next for your healthcare business, whether that’s a full exit or bringing on a financial partner, we’re happy to have a confidential conversation. No pressure. No obligation. Just a straightforward discussion about where you are, what your business might be worth, and what your options look like. Most owners wait longer than they should to start these conversations, not because they aren’t thinking about an exit, but because they aren’t sure if the timing is right or whether the business is ready. Those are questions worth working through with an advisor who knows the market, before you’re in the middle of a process. Mertz Taggart has been advising healthcare services owners for nearly two decades. We know this space because we’ve lived in it. Reach out to start a conversation. Legacy Preserved. Value Enhanced.