This article is part of the HHCN+ membership
Earlier this week, Elara Caring announced strategic investments from two publicly traded companies: Ares Private Equity Group (NYSE:ARES) and DaVita (NYSE:DVA).
This, of course, fuels my imagination as to what we will see from Elara Caring now that it is operating with new support. But the details of the investment have far wider relevance than Elara Caring alone.
One of our investors, DaVita, is a healthcare provider specializing in kidney care. Private equity-backed deals are common across the home care industry, but this category of investors stands out. This represents a new high water mark in a trend that has been growing across the home care industry and will help shape its future.
As the focus of care increasingly shifts to the home, services such as home dialysis are becoming increasingly attractive to payers and a more viable option for patients, but only 14% of patients receiving dialysis will have access to home options by 2024.
Home health care providers are a key factor in how that rate rises. Our agreement with Elara Caring is proof of that and heralds a new era in home dialysis.
In this week's HHCN+ Update, we share key takeaways from our transaction with Elara Caring and insights into the home dialysis market, including:
What this deal means for Elara Caring Opportunities for home health providers What it means for disease-specific care
Elara Caring Vision
Elara Caring CEO Ananth Mohan previously told HHCN that the company is bullish on acquisitions as a means of growth.
“I think there will be more and more (M&A) in our company's future,” Mohan said in July 2025 after being promoted from chief operating officer to chief executive officer. “There will be a lot of smaller agencies that would benefit from joining our platform, so we think there is an opportunity.”
It's certain that it will go into hyperdrive “increasingly” with the Ares/Davita deal. In a release about the deal, Elara Caring said the investment leverages Ares' experience in growing healthcare businesses and DaVita's experience in value-based care to support the company's next phase of growth. The company also said each organization will work to develop new care models and clinical programs.
Therefore, a multi-pronged strategy that includes clinical and reimbursement components as well as growth through M&A will soon be launched.
But I'll be keeping an eye on the company's kidney disease-focused home care mode with particular interest.
The agreement included plans to leverage Elara Caring's clinical capabilities and DaVita's kidney disease expertise to create such a model. This program aims to reduce hospitalizations and reduce total treatment costs.
“Through our integrated care program, we have seen meaningful differences in patient outcomes that are closely related to the quality of home support patients receive,” Steve Phillips, DaVita's chief strategy officer, said in a statement. “By enhancing access to Elara Caring's superior services, more patients can remain stable at home, avoid unnecessary hospitalizations, and ultimately experience a better quality of life.”
To me, DaVita's role in this investment formalizes the growing trend of home health providers partnering with kidney care companies. While the trend of expanding the home dialysis market is not new, the agreement with Elara Caring solidifies that home health care providers will play a role in this wave of the future.
The momentum of home dialysis
Major companies have already entered the home dialysis market. CVS (NYSE: CVS) began clinical trials of its home hemodialysis system in 2019. Research on this system continued until 2025.
There is also support at the federal level for innovation in kidney care. In 2019, during the first Trump administration, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) proposed a series of new payment models for certain kidney-related diseases that experts said would accelerate the adoption of home dialysis.
Home dialysis is also attracting attention from members of Congress. In 2024, a bipartisan group of members of Congress introduced the Improving Home Dialysis Access Act in the U.S. House of Representatives. This aptly named legislation would provide homebound patients with trained, professional staff to ensure they understand the availability of home dialysis.
“People with end-stage renal disease often face difficult decisions when choosing where to receive dialysis services,” Rep. Mariannette Miller-Meeks (R-Iowa), one of the bill's sponsors, said in a statement in 2024. “In rural areas, some patients must sacrifice full-time jobs and family time to travel hours back and forth to dialysis centers to receive the life-sustaining care they need. Home dialysis is a great tool that allows patients to become the center of their own care, and Congress should work to ensure that patients who choose this option have the training they need to safely dialyze at home.”
Investors are also showing interest in home kidney care. Somatus, a value-based, home-centric primary care management provider for kidney and heart disease patients, has raised more than $500 million. The company boasts that its National Health Program's home dialysis initiation rate is 48% higher than the national standard. Monogram Health, a value-based home health services company for patients with multiple chronic conditions, including kidney disease, has raised a total of $542 million, according to Tracxn.
Importantly, there is scope to develop home care partnerships with these well-funded professional care providers.
“We need clinically integrated partnerships with home health companies,” Monogram Health CEO Mike Euchlin previously told HHCN. “For example, people with end-stage chronic kidney disease have a wound at any given time. About 10 percent of the population has an active wound at any given time. They need an effective home health company to provide care for that wound. They need a skilled nurse to come to their home and provide immediate care.”
Elara Caring's move into this field shows that now is the time to tackle home dialysis. Elara shows how partnering with a leading dialysis provider like DaVita can help home health companies establish an early presence in the home dialysis market while diversifying their partnership and payer mix. More broadly, kidney-focused collaborations offer a path for home health providers to create differentiated value beyond their traditional service lines and carve new paths for long-term growth as care continues to shift to the home.
But with that said, details are so far scant as to what the future holds for Elara Caring and Davita. The deal announcement did not include terms such as how much money Ares and DaVita would invest in Elara Caring, and I have not spoken to Elara management since the announcement. And there are elements of this agreement that require further consideration.
For example, as home kidney care accelerates, DaVita's scale makes the deal with Elara Caring exciting, as it shows how serious major companies are taking home care partnerships. While Elara Caring is a large national provider, DaVita's large number of outpatient dialysis centers (more than 2,500) suggests room for further home care collaboration. Needless to say, the deal with Elara Caring could spur the evolution of home health strategies by other players in the kidney care space, such as Fresenius.
Meanwhile, the size of DaVita and Fresenius is already fueling antitrust concerns, with the Federal Trade Commission investigating noncompete clauses in the companies' physician contracts. The investigation began under the Biden administration. While the Trump administration has taken a more accommodating stance on antitrust laws in some cases, the Elara Caring deal is just another sign that the push and pull of health care integration is a powerful force shaping home health care.
Two major providers, LHC Group and Amedisys, are now part of the giant UnitedHealth Group, but only after an antitrust lawsuit related to the Amedisys deal was resolved. Now, another major home health company has financial ties to a home dialysis giant that also faces antitrust scrutiny. And that comes as federal lawmakers have begun to more actively oppose health insurance integration, including by introducing legislation to dismantle “health care providers.”
While I don't think it's unlikely that the Feds will try to block this deal or that a future administration will try to break up DaVita's partnership with Elara Caring, I think the details of the companies' partnership will provide another test of how well the combination will work. They hope their approach improves patient care, lowers costs, and answers skeptics who fear that health care consolidation is primarily a vehicle for increasing profits and market domination for health care providers.
