A full competitive and ecosystem analysis of the US home-based care market — the agencies, the software systems running every shift, the background-check vendors already embedded, and where Allied Screening should invest to win the next 5,000 agency logos.
AxisCare lists Allied Screening as its primary background-check integration. That's a defensible ~2,500+ agency beachhead in non-medical home care and a proof-point Allied can productize for every other platform conversation.
Axxess (9,000+ orgs, 3M patients) and Homecare Homebase (~44% of Medicare home-health agencies) have no publicly announced BGC integration partner. Winning either is a category-defining deal.
HHAeXchange's Partner Connect shows Sapphire as the named BGC vendor. Medicaid home-care is currently a competitive loss; displacing Sapphire or carving out a state-registry niche is the only path in.
34% annual aide turnover + OIG LEIE monthly screening + biennial/5-year state recertifications = a subscription business, not a transactional one. Continuous monitoring is the growth lever.
UnitedHealth/Optum now owns LHC Group + Amedisys. Humana owns CenterWell. Four buyers could represent 30%+ of Medicare home-health volume within 24 months — enterprise wins compound faster than ever.
Agencies increasingly buy BGC through their EMR. Every month without embedded integrations in HCHB, Axxess, WellSky, MatrixCare, and KanTime is a month agencies default to whichever vendor is one-click away.
At an average blended check price of $35–65 per completed screen (mix of basic + enhanced healthcare + continuous monitoring subscription), a 450–700K annual check volume yields a $15–45M serviceable revenue opportunity in home-based care alone — before factoring in credential monitoring, drug testing, and I-9/EVV adjacencies.
| Provider | Segment | 2025 Revenue | Ownership | Scale | Notes |
|---|---|---|---|---|---|
| UnitedHealth / Optum (LHC Group + Amedisys) | HH HOS | $10B+ combined | Public · UNH | Integrated | Closed $3.3B Amedisys deal Aug 2025; LHC acq. Feb 2023. Largest single buyer in post-acute. |
| Humana / CenterWell | HH HOS HC | $3B+ est. | Public · HUM | Vertically integrated | Former Kindred at Home; ~350 locations; integrated with Humana Medicare Advantage. |
| Aveanna Healthcare | HH HC | $2.43B | Public · AVAH | Private duty heavy | 82% private duty; pediatric focus; +27% YoY Q4 2025. |
| BAYADA Home Health Care | HH HC HOS | ~$1.6B | Nonprofit | 370+ locations | Largest independent nonprofit; wide geographic footprint. |
| Addus HomeCare | HH HC | $1.42B | Public · ADUS | 107K consumers | Dual-eligible focus; 262 offices across 23 states. |
| Enhabit (spun from Encompass) | HH HOS | ~$1.04B | Public · EHAB | ~350 locations | Activist pressure; potential acquisition target. |
| Home Instead (Honor) | HC | ~$2B (network) | Private (Honor) | ~1,200 franchises | World's largest senior home care network; Honor acquired 2021. |
| Visiting Angels | HC | ~$700M (network) | Private franchise | 600+ franchises | Non-medical; strong brand recognition. |
| Right at Home | HC | Private | Private franchise | 500+ franchises | Non-medical; international presence. |
| Interim HealthCare | HC HH | Private | Private franchise | 300+ franchises | Skilled + non-skilled mixed model. |
| AccentCare | HH HOS HC | Private | PE-backed (Advent) | 250+ locations | Broad post-acute footprint. |
| VITAS Healthcare (Chemed) | HOS | ~$1.6B | Public · CHE | Largest dedicated hospice | Q1 2025 revenue $407M; 19,000+ patients daily. |
| Compassus | HOS HH | ~$1.2B est. | JV · Providence/OMERS | 200+ locations | Ascension/Providence JV announced 2024. |
| Gentiva Health Services | HOS | ~$1.1B | Clayton, Dubilier & Rice | Hospice focused post Humana spin | Carved out of Kindred by Humana; pure-play hospice. |
| Traditions Health | HOS HH | ~$400M est. | PE-backed | 150+ locations | Fast-growing Southern US hospice. |
| Seasons Hospice (AccentCare) | HOS | Part of AccentCare | Private | Multi-state | Consolidated into AccentCare hospice division. |
| Brookdale (home health segment) | HH HOS | Segment of BKD | Public · BKD | Senior-living integrated | Small vs. pure-plays but captive referrals. |
| Amedisys Hospice (now Optum) | HOS | ~$800M (Hospice segment) | Public · UNH | Part of UNH | Q2 2025 hospice revenue $215M pre-close. |
| Platform | Segments | Install Base | Ownership | BGC Partner | Allied Status |
|---|---|---|---|---|---|
| Homecare Homebase (HCHB) | HH HOS | ~44% of Medicare HH agencies · 300K clinicians | Hearst Health | None announced | WHITESPACE · Priority #1 |
| Axxess | HH HOS HC | 9,000+ orgs · 3M patients | Independent (Dallas) | None announced | WHITESPACE · Priority #2 |
| WellSky (Kinnser · ClearCare) | HH HOS HC | 10,000+ sites · 99% retention | TPG + Leonard Green | Ecosystem partners, no primary | WHITESPACE · Priority #3 |
| MatrixCare | HH HOS LTC | 15,000+ providers | ResMed ($750M acq.) | No named primary | Open · courting required |
| AxisCare | HC | ~2,500+ agencies · G2 #1 | Private (VC-backed) | Allied Screening | WON · primary partner |
| HHAeXchange | HC Medicaid | 1.6M caregivers · Medicaid focus | Private | Sapphire (Partner Connect) | LOCKED · displace or niche |
| KanTime | HH HOS Pediatric | 912K patients · 210K users · $12.9B claims | Private | None announced | Open · fast-growing |
| Netsmart (myUnity) | HH HOS HC | Top vendor per Black Book | Bain + GI Partners | None publicly named | Open · enterprise-facing |
| Alora Health | HH HOS HC | Hundreds of agencies · 95% CSAT | Independent | None announced | Open · AI launch 2025 |
| Brightree | HH HME HOS | 3,000 post-acute · 68K users · 40M claims/yr | ResMed ($800M acq.) | None named | Open · HME + HH overlap |
| Forcura | HH HOS | 776+ customers · KLAS best-in-class | Independent | None named | Open · workflow add-on |
| CareVoyant | HH HC | Mid-large agencies | Independent | None named | Open · niche enterprise |
| Complia Health / Igea | HH HOS | Varying | Careficient (2020) | None named | Open · smaller footprint |
| PointClickCare | LTC HH | LTC-dominant; HH expansion | Private | None for HH specifically | Open · if HH scales |
Non-medical home care platform, G2 #1-rated in 2025, ~2,500+ agencies. The Integration Marketplace lists Allied Screening on a dedicated page — a signal that Allied is the default recommendation for AxisCare's new customers.
Ship a co-branded onboarding flow and continuous-monitoring subscription inside AxisCare. Every new AxisCare logo should default to Allied without a sales call.
Cloud-based home health + hospice + home care platform with a public "Interoperability Partners" program. No background-check vendor is publicly named. This is the single largest platform opportunity for Allied outside the ones already locked.
Pitch a preferred-partner agreement with revenue share + embedded UI. Frame around Axxess's mission to simplify compliance — OIG LEIE monthly + state registry checks are Axxess's current gap, not just a BGC add-on.
Where they win: large health systems and hospital-owned home health segments.
Where they win: hospital credentialing, physician groups, enterprise SNF chains.
Where Allied lives. Owning this tier = owning the non-medical HC category.
Allied's natural battleground is Tier 3 — where a BGC vendor wins or loses based on software integrations, speed of turnaround, and familiarity with state aide registries. Tier 1 competes on procurement and RFPs; Tier 2 on credentialing. Allied's wedge is platform-embedded, home-care-fluent screening with continuous OIG/LEIE monitoring bundled-in.
List of Excluded Individuals and Entities, updated monthly. Every Medicare/Medicaid-billing provider must screen all employees against it. Non-compliance carries $20,000 civil monetary penalty per item billed. Makes continuous monitoring a standard-of-care offering, not a nice-to-have.
System for Award Management debarment list. Screening required for federally funded providers; typically bundled with LEIE monitoring by sophisticated BGC vendors.
Every state with certified nurse-aide or home-health-aide programs maintains a registry of abuse/neglect findings. Screening rules vary wildly — NJ FBI fingerprint biennial, WA biennial state check, MD 5-year, MA annual CEUs. Breadth of registry coverage is a defensible moat.
All state Medicaid programs required to implement Electronic Visit Verification — PCS completed, HHCS hard-launching through 2026 (NC Oct 2025, MI Jan 2026). EVV platforms tie identity + schedule + visit together — background-check integrations often live alongside.
Point-in-time checks are becoming table stakes. New state rules (CA, NY, FL) now require "ongoing" monitoring, and sophisticated agencies are procuring continuous monitoring voluntarily to reduce CMS audit exposure. ARR per worker $20–40/yr at industry pricing.
Accreditation bodies for home health and hospice require documented screening policies, sanction checks, and license verification. Agencies pursuing accreditation are active BGC buyers — a known demand signal.
Ship a bundled monthly plan inside AxisCare: new-hire check + OIG LEIE monthly + state aide-registry monitoring + EVV identity. Co-brand the onboarding flow. The goal is zero reason for any AxisCare customer to price-shop Allied.
Pitch a preferred-partner agreement with revenue share + embedded UI. Axxess has no named BGC partner — a 12-month exclusive window here is more valuable than a dozen mid-market logos. Emphasize OIG monthly + state registry gap they currently have no answer for.
Homecare Homebase powers ~44% of Medicare home-health agencies. Enterprise integration is a longer cycle (12–18 months) but the single biggest TAM unlock Allied can make. Start with a named pilot at a large HCHB customer (BAYADA, Aveanna, Enhabit).
Ship out-of-the-box integrations with KanTime, Alora, Forcura, CareVoyant, MatrixCare, and Brightree. None have a locked BGC partner. Goal: 6 new platform partnerships live within 6 months — each unlocks 100–5,000 agencies.
HHAeXchange is locked, but Medicaid home-care has massive state-level variation Sapphire doesn't serve uniformly. Carve out 3–5 state-specific packages (TX, FL, PA, NY, CA) that Sapphire can't easily match, and pitch them to HHAeXchange as a secondary partner.
Reposition from "background checks" to "hiring + compliance operating system for home-based care." Monthly LEIE + state registry + exclusion list + license monitoring = an ARR product, not a per-check product. Pricing: $20–40 per worker per year; attaches to ~3.2M workers.
Allied wins home-based care by becoming the default, embedded compliance layer inside every agency-management platform — starting with the AxisCare moat, attacking Axxess, then HCHB, then everything else in parallel. Transactional checks become a subscription. Background checks become a platform play.