Situation

A middle-market private equity firm invested in a leading provider of in-home physical, occupational, and speech therapy services for geriatric patients. Despite strong market positioning, the company lacked access to almost half of Medicare beneficiaries due to limited participation in Medicare Advantage networks.

The engagement focused on defining the accessible market and developing a strategy to expand managed care access, with the objective of increasing in-network coverage to unlock additional growth within existing service regions.

Approach

A structured prioritization framework was developed to identify the highest-value Medicare Advantage opportunities across the company’s footprint. Geographic markets were assessed based on Medicare Advantage size, penetration, growth, and alignment with the target patient population. Within prioritized geographies, Medicare Advantage organizations were evaluated based on serviceable membership, reimbursement dynamics, and enrollee mix across plan types.

This analysis identified 15 high-priority payer targets for engagement. In parallel, multiple contracting and value creation pathways were defined, including opportunities to enhance positioning within value-based care arrangements and improve performance across key economic levers.

Impact

The engagement expanded the company’s addressable market by enabling greater access to Medicare Advantage beneficiaries and strengthening its positioning with priority payers.