2026 Clinical Services into Senior Living Facilities Market Update: Consolidation Wave Accelerates

Primary care and specialty services provided into a senior living and skilled nursing setting continue to attract significant investment from both private equity and strategic acquirors. An aging population, industry fragmentation, modest capital expenditure requirements, benefits of economies of scale, recurring revenue streams and service line expansion opportunities continue to drive buyers to aggressively pursue SNFist and specialty clinical practices servicing SNFs.

Facility residents are among the highest-cost patients in the healthcare system, with a significant portion of spending driven by emergency department visits and hospital admissions that can often be avoided through more effective on-site care. As payors increasingly reward providers that reduce these costly interventions, the services delivered within these facilities have become increasingly critical to improving outcomes and lowering overall healthcare costs.

There are 14,742 CMS-certified nursing facilities in the United States housing roughly 1.24 million residents, before accounting for assisted living, memory care, and other senior living communities. ¹  Many of these facilities rely on third-party clinicians for primary care and specialist coverage, often through a fragmented network of community practices that provide services on a part-time basis. This reliance on outsourced, episodic coverage creates a significant opportunity for scaled providers to consolidate and professionalize care delivery.

Patient acuity has also increased across assisted living facilities (ALFs) and independent living facilities (ILFs), as these settings are increasingly caring for individuals with more complex clinical needs. As a result, services that were historically delivered in skilled nursing facilities (SNFs) are now being provided in ALFs and ILFs, creating a meaningful growth opportunity for the contracted clinical service groups.

Senior living contracted care is increasingly attracting interest from healthcare private equity firms and strategic acquirors because it combines stable, recurring facility-based revenue opportunities to create additional value through value-based care.

The value-based case is straightforward. Facility residents are medically complex, yet their care has historically been fragmented and reactive, allowing manageable conditions to escalate into emergency department visits that lead to hospital admissions. A meaningful share of those events are preventable, and they account for a disproportionate share of this population’s total cost of care. By embedding clinicians in facilities and managing residents proactively, providers can move toward shared-savings and risk-based arrangements that reward better outcomes and lower costs. This opportunity is a key driver of buyer interest in senior living contracted care and an increasingly important component of the growth strategies pursued by PE-backed platforms such as HealthDrive and Curana Health.

The supply-demand imbalance is structural and widening. Facility operators often lack the infrastructure to employ physicians and specialists directly, while community-based practices rarely have the capacity or the economics to round in facilities consistently. The result is a growing reliance on dedicated providers servicing the long-term care setting to manage operational complexity, maintain continuity of coverage, and deliver care at a predictable and efficient cost to the facility.

For independent operators, this creates a specific strategic tension. Demand for their services has never been stronger but at the same time, the cost and complexity of staying independent at scale is rising. Managing clinician recruitment, credentialing, payer contracting, regulatory compliance, facility relationships, and the data and care-management infrastructure required to participate in value-based arrangements across dozens of facility contracts requires a level of back-office investment that increasingly favors well-capitalized platforms.

To further support these observations, PGP had the opportunity to interview Rocco Coniglio, Co-Founder and former CEO of Psych360, a business PGP previously advised in connection with a private equity transaction. Coniglio currently serves as President and CEO of Senior Care Therapy, a Madison River Capital-backed provider of clinical services to the senior living and long-term care market.

Discussing the factors driving private equity interest in these clinical services platforms, Coniglio noted, “Investor interest in clinical services within senior living and long-term care is being driven by durable demand and increasingly complex resident needs. Delivering care where residents live creates an opportunity to improve access, strengthen coordination, and help reduce avoidable hospitalizations.”

Coniglio also highlighted the sector’s fragmentation and the opportunity for scaled platforms to create value, adding, “The clinical services market remains highly fragmented, which creates meaningful opportunities for organizations that can build scale through recruiting, technology, revenue-cycle management, and strong clinical infrastructure. The most compelling platforms are those that translate those capabilities into measurable outcomes and sustainable growth.”

Skilled Nursing Facilities face increasing pressure to maintain and improve quality ratings, which can have a direct impact on reputation, referral activity, regulatory scrutiny, and overall competitiveness in the market. Many of the measures that influence those ratings are tied to the quality and consistency of care delivered within the facility.
Consistent on-site clinical coverage allows providers to identify changes in residents’ conditions earlier, manage chronic conditions more closely, improve medication oversight, and address issues before they escalate to an emergency department visit or hospital admission. These efforts can help reduce avoidable utilization while supporting improved clinical outcomes and stronger quality performance.

For companies that provide behavioral health services, medication management is especially important. CMS quality measures include antipsychotic use among long-stay residents, reinforcing the importance of appropriate prescribing and ongoing oversight. Physicians and other prescribing clinicians play an important role in reviewing medication regimens, documenting clinical indications, and supporting gradual dose reduction (GDR) when clinically appropriate.

The value proposition of primary care and specialty clinical services provided in Skilled Nursing Facilities (SNFs) extends well beyond basic clinical coverage. SNF clinical groups can create significant value by improving resident outcomes and supporting regulatory compliance. They can also help reduce avoidable hospitalizations and unnecessary healthcare utilization. In addition, these groups can play an important role in helping skilled nursing facilities improve or maintain quality ratings.
As a result, high-performing clinical service organizations can become highly valuable strategic partners to skilled nursing facility operators, referral sources, and payors. SNF clinical groups that can demonstrate improved quality scores, better patient outcomes, and lower hospital admissions can further differentiate themselves and be highly attractive to strategic acquirers and private equity investors.

Buyers in primary care and specialty services provided in SNFs are looking for the following to pay a premium valuation:

• Scale and Retention: A large and diversified facility base, long-standing customer relationships, and limited contract attrition.
• Demonstrated Value Proposition: The ability to show, with data, improved clinical outcomes, reduced hospital admission, and strengthened facility quality performance.
• Clinical Model: Consistent facility-based coverage, strong provider productivity, efficient scheduling, and the ability to add services across the existing customer base.
• Compliance and Infrastructure: Strong processes around documentation, coding, credentialing, billing, and clinical oversight.
• Payor Opportunity: Participation in value-based care, shared-savings programs, and other reimbursement models that reward better outcomes and lower total cost of care.
• Growth: A repeatable model for adding new facilities, providers, geography, and specialty services without requiring significant additional capital.

Reflecting on the characteristics that differentiate high-quality clinical services platforms and the attributes that can support a premium valuation, Coniglio noted, “Strong clinical quality, durable facility relationships, a stable provider workforce, and disciplined operational performance are the foundations of a high-quality clinical services platform. When those fundamentals are supported by reliable collections, sound compliance, and a credible path to growth, they can support a premium valuation.”

Based on PGP’s transaction experience in the sector, businesses that exhibit the characteristics outlined above and generate more than $3 million of EBITDA may be positioned to achieve valuation multiples in the low double digits. Platforms approaching $10 million of EBITDA may command low-to-mid teens multiples, depending on factors such as growth, earnings quality, scale, market position, and buyer demand. This level of valuation support has helped make the sector one of the more actively pursued areas within healthcare services.

SNFs rely on a broad range of clinical services, and a provider’s service mix can significantly influence which strategic buyers are most likely to pursue an acquisition. Key service lines include:

• Primary Care / Internal Medicine: Routine medical management, chronic disease management, medication oversight, acute issue evaluation, care coordination, and hospital avoidance. The primary care provider will also act as the Medical Director in the facility in some instances.
• Behavioral Health / Psychiatry / Therapy: Management of depression, anxiety, dementia related behaviors, psychotropic medications, and support for antipsychotic reduction and GDR programs.
• Wound Care: Evaluation and treatment of pressure ulcers, diabetic wounds, post-surgical wounds, and other skin conditions.
• Podiatry: Routine foot and nail care, diabetic foot management, ulcer prevention, and treatment of mobility related foot issues.
• Rehabilitation Services: Physical therapy, occupational therapy, and speech therapy, particularly for senior living residents recovering from hospitalization, surgery, stroke, or injury.
• Other Common Specialties: Cardiology, pulmonology, infectious disease, nephrology, neurology, dermatology, optometry, dentistry, and palliative or hospice care, depending on resident acuity and facility size.

Several of these specialties, particularly behavioral health, operate under nurse practitioner-led models, with NPs delivering much of the on-site care and physicians providing clinical oversight as appropriate. The structure of these models can vary significantly by state, given differences in regulations governing nurse practitioner scope of practice, prescribing authority, and physician supervision or collaboration requirements.

The buyer universe for post-acute contracted care providers is broad and becoming increasingly competitive. Understanding each buyer’s growth strategy and partnership approach directly affects deal structure, rollover equity mechanics, governance terms, and the likelihood of a premium valuation outcome.

Strategic Platforms (Backed by Private Equity)

There are several types of strategic platforms operating across the clinical services market serving Skilled Nursing Facilities (SNFs) and the broader post-acute care sector. These include primary care-focused groups, often referred to as “SNFists.” Some of the most active SNFist private equity backed platforms include:

There are also private equity-backed, single-specialty platforms focused on areas such as behavioral health, podiatry, dentistry, and other clinical specialties serving Skilled Nursing Facilities (SNFs) and the broader post-acute care market. The most active groups are as follows:

The market also includes larger multi-specialty national platforms that provide a broader range of clinical services across SNFs, long-term care facilities, and senior living communities. HealthDrive, backed by Cressey & Company, is one example, offering services across primary care, podiatry, vision, dental, behavioral health, and audiology. Curana Health, backed by NEA, has built a scaled platform combining on-site primary care, value-based care programs, and Medicare Advantage offerings for senior living and skilled nursing communities.

These scaled platforms continue to pursue growth through geographic expansion, new service lines, strategic partnerships, and acquisitions, creating an active buyer universe for high-quality clinical services businesses serving SNFs and post-acute care facilities.

Healthcare Private Equity Buyers

PGP has interfaced with a broad range of private equity buyers, many of which are actively prioritizing opportunities to acquire clinical services platforms serving Skilled Nursing Facilities (SNFs) and the broader post-acute care market.

Despite the presence of more than 25 existing platforms in the sector, private equity interest remains strong. Buyers continue to pursue new platform investments and are willing to pay competitive valuation multiples for high-quality businesses with attractive growth, scale, and market positioning.

Post-Acute and Long-Term Care Operators

While PGP has observed relatively limited acquisition activity in clinical service companies from scaled facility operators, a select group of larger organizations managing skilled nursing, assisted living, and senior living facilities are increasingly evaluating opportunities to acquire the clinical providers that already serve their communities. These transactions can allow operators to capture additional clinical margin, strengthen care coordination, and gain greater control over the delivery of healthcare services within their facilities.

Payors and Risk-Bearing Entities

Medicare Advantage plans, Institutional Special Needs Plan (I-SNP) operators, and Accountable Care Organizations (ACOs) are increasingly relying on facility-based medical groups to help manage total cost of care, improve clinical outcomes, and coordinate care across post-acute settings.

The table below highlights select transactions involving companies that provide clinical services to nursing homes and long-term care setting. PGP has significant experience in the sector and is currently advising several companies as they are looking to explore their options across the market. A recent example is Psych360’s partnership with MindCare, for which PGP served as the exclusive transaction advisor to Psych360.

Given PGP’s broader focus on healthcare services, the firm also has longstanding relationships with many of the strategic and private equity buyers that actively invest in provider-based businesses. Many of these buyers have shown increasing interest in outsourced clinical service models that deliver care into SNFs and the broader post-acute settings.

PGP believes that primary care and specialty groups serving senior living facilities are among the most attractive healthcare services businesses for owners considering a sale. Strong buyer interest from both private equity firms and strategic acquirers continues to drive a competitive market for high quality outsourced clinical service businesses focused on senior living settings.

Independent operators have an opportunity to achieve double-digit EBITDA multiples and platform-level valuations, reflecting the appeal of recurring facility-based revenue, essential clinical services, and growing reliance on outsourced care delivery. Looking ahead, PGP expects the next 12 to 24 months to bring increased secondary buyout activity across private equity-backed outsourced clinical platforms, which should further accelerate consolidation and alter the competitive landscape. At the same time, the challenges of remaining independent continue to grow, driven by rising clinician compensation, recruiting pressure, increasing compliance requirements, and the investment needed to compete effectively in value-based care.