The economic and operational climate continues to favor big players and industry consolidation this year. As a result, top providers to watch in 2025 are those chains planning to tap into scale for efficiencies, as well as those leveraging technology and value-based care to thrive.

It’s worth noting that operational pressures, including a shortage of workers, and a tough economic environment with rising inflation and high interest rates, led to nursing home closures last year. Many smaller nursing homes simply failed to stay afloat, unable to reap the benefits that came to those with size. And so, these closures present opportunities for those wanting to grow.

Moreover, many of the companies on our list are expanding through acquisitions and partnerships, capitalizing on opportunities despite market turbulence. Notably, the staffing challenges that had hindered growth in 2024 are now showing signs of easing, allowing providers, who had previously been cautious, to shift toward more aggressive expansion plans. These companies are also successful in reducing expensive agency labor, a trend which has a side benefit of improving quality of care.

As a result, while industry stalwarts resume their growth strategies after holding back in previous years, many newcomers to the scene are relying on regional growth and the facility cluster model to gain strength. But this is not to say that scale solves all problems; one of the largest providers in the sector is a company to watch in 2025 given the uncertainty that surrounds it at the moment and question marks over how quickly it will get back to an aggressive growth push.

PruittHealth

As PruittHealth faced havoc created by the Florida hurricanes last fall, its plans to deepen its footprint rested not only on the company’s long-term strategy but a resilience that stems from an ability to continually adapt to operational pressure. As CEO Neil L. Pruitt put it to SNN, “There will always be a pandemic, there will always be a storm, there will always be a new government program that we have to react to.”

The way in which PruittHealth has continued its plans in the face of adversity makes it a top provider to watch in 2025.

The company is committed to expansion, with significant investments in new facilities and upgrades. PruittHealth opened two new state-of-the-art centers in 2024 and is investing $50 million in its existing properties to bring them up to modern standards. In addition, the company is undertaking a $385 million project in Raleigh, North Carolina, to develop a comprehensive care and retirement community, blending health care expertise with top-tier hospitality.

PruittHealth is also focusing on reducing operational costs and improving care delivery. The company’s Medicare Advantage program, PruittHealth Premier, is a key initiative aimed at decreasing readmissions and improving patient outcomes by providing better coverage and support within its facilities. It aims to enroll 70% of eligible patients in this program, which will drive efficiency and enhance staff retention.

The company’s innovative strategies extend to workforce development, where it has reduced turnover by half through programs like Pruitt University and career advancement opportunities for CNAs. Additionally, PruittHealth is tackling challenges related to Medicare Advantage through a partnership with Accenture, using AI to streamline documentation and reduce administrative burdens, ultimately improving financial efficiency.

With plans for continued expansion across Tennessee, North Carolina, South Carolina, and Georgia, alongside a strong focus on technology and workforce training, PruittHealth is well-positioned for significant growth in 2025.

Covenant Living Communities

Covenant Living Communities has earned a spot on the list due to creative approaches to managing its facilities across multiple state lines. Its centralized intake model has eased contract negotiations, created efficiencies in revenue cycle management and helped overcome reimbursement challenges emerging from the growth of managed care.

The Illinois-based non-profit provider has an extensive network of 20 long-term care communities, including those featuring skilled nursing, spread across 11 states. The organization’s diverse footprint presents a complicating factor in the midst of this rise in managed care.

And given that Covenant has more residents overall using managed care than traditional Medicare, particularly in Florida and Minnesota, the varying requirements from different health insurers across the country presents hurdles. This is especially true when it comes to changing admission, referral, and authorization processes.

To address these challenges, Covenant’s centralized intake model streamlines admissions across its communities. A team of specialists handles eligibility verification, authorizations, and data entry, ensuring consistency across diverse health plans. The model also includes tools like a “managed care cheat sheet,” which helps staff navigate complex insurance contracts, ensure compliance with insurers’ documentation and avoid coding errors in claim submissions, minimizing denials.

Moreover, Covenant utilizes electronic billing systems and automated data entry to improve accuracy and cash flow, minimizing manual processes.

Technology is also a key feature for revenue cycle management at Covenant, with executives emphasizing the use of electronic billing systems, clearinghouses, and automated data entry to enhance accuracy and efficiency.

Covenant’s system prevents missing out on reimbursement and minimizes audit risks by ensuring that all ancillary charges and services are accurately captured and billed, according to Lauren Kublank, director of intake and admissions at Covenant.

Reimbursement rates and terms vary widely across regions too, so Covenant has relied on external help to renegotiate contracts and increase reimbursement rates. The organization also emphasizes the use of electronic remittance advice systems and keeping track of relevant contract details to avoid denials and ensure timely payments.

And while Medicare Part B coverage remains an ongoing issue, particularly with certain insurance providers, it is a growing area that has added to revenue.

PACS Group

Last year was a fast and furious one for nursing home giant PACS Group. The company debuted on Wall Street, expanded its footprint substantially, and then the good news came to a crashing halt in November. A federal investigation into its referral and reimbursement practices on the heels of allegations of fraud made by Hindenburg Research has put a pause on PACS’ earnings releases. PACS also stated it is conducting its own internal investigation. In the aftermath of the news, and when PACS failed to give guidance and share fourth quarter results, it was dropped from coverage by some equity investment analysts.

Clearly, this ongoing situation makes PACS a provider to watch in 2025. But not all is doom and gloom for the provider, and if a resolution comes, expect to see the company continue on its push for growth. The Farmington, Utah-based company is one of the largest skilled nursing providers with more than 200 nursing facilities across nine states and serving over 20,000 patients daily. And it has only grown, with CareTrust deepening its partnership with PACS in 2024.

“As we continue to grow, we intend to explore additional purchases of real-estate assets through purchase options or right-of-first refusals in existing leases, as well as acquisitions and de novo construction of purpose-built facilities,” the company shared before all the trouble began related to its alleged billing practices.

At the time, PACS executives touted its success in transforming “under-performing” facilities into those with high Star ratings, saying that the average 5-Star Quality rating of its “mature” facilities stood at 4.2 at year end, with an average occupancy rate of 93%. These metrics exceed the average 5-Star rating and occupancy levels for “New” facilities in the sector of 3.9 and 87%, respectively.

And while PACS has failed to share any updates to the investigation, its operating partner, CareTrust, shared confidence over performance of PACS-run facilities in its portfolio.

CareTrust CEO Dave Sedgwick said he isn’t worried about the PACS situation’s impact on his own company.

“We don’t have a worst case scenario that we’re concerned about right now. We think that they’re going to be just fine,” Sedgwick said.

Journey

As a startup that is focused on the regional cluster model, as well as its ability to effectively tackle staffing challenges, Journey is a top provider to watch in 2025.

Based in Indiana, Journey has experienced impressive growth since its launch, expanding to 22 facilities across six states within a year. Led by industry veteran Bernie McGuinness, the company aims to build a regional cluster model similar to larger operators like Ensign Group. This model focuses on efficiency, shared staffing, and alignment with state Medicaid systems to maximize reimbursement and care quality.

“We’re trying to build out regions in which we can have efficiency and shared staffing resources, relationships with managed care organizations, really become experts at state-operated Medicaid systems, [and] understand the reimbursement in these states, understand rehabilitation services, vendor alignment, you name it,” McGuinness told Skilled Nursing News recently.

Georgia has been a large growth market for Journey, with nine facilities throughout the state. Also, the operator has added six locations in Kentucky.

“Those are our two largest regional cluster markets. You can get to eight of the nine facilities in Georgia within about 90 minutes of each other. So we’ve got a lot of shared staff, shared referral sources, managed care organizations, vendor relationships that we can maximize,” McGuinness explained, emphasizing the success of the facility cluster model.

The pace of the expansion will likely be slower, especially in the first half of 2025, as Journey looks to stabilize its 2024 acquisitions. That said, the overall growth outlook remains positive for 2026, with continued regional expansion, a strong commitment to quality care, and strategic investments in both staffing and infrastructure.

“We’ll be active and looking at the right opportunities to continue to fill out our regional cluster model and bring efficiencies and value add-ons to the Journey family. But we’re going to focus on the basics right now: staffing, workforce development, quality,” McGuinness said.

The company plans to capitalize on its regional model and expand further, while navigating the challenges of regulatory compliance and financial pressures in the skilled nursing space.

 “A lot of our initial facilities are heavy regulatory lifts, [with a focus needed on] quality outcomes. We need to change reputations, change culture, have some better survey compliance, and then put some investment back into the facilities,” McGuinness said.

Moreover, at a time when many in the SNF world are still grappling with agency labor, Journey has rapidly reduced it, chalking it up to company culture, which in turn has also played a huge role in bedside care.

“Twenty of our 22 buildings used at least 30% agency at the time of acquisition, and as of today, we have one facility currently in agency usage that will be out by the end of the month. Journey should be agency free by the end of the first quarter,” McGuinness said.

ArchCare

With its ongoing investments in specialized care, partnerships, and value-based models, ArchCare is positioning itself as a leader in evolving nursing home care, making it a provider to watch in the coming years.

ArchCare is a continuing care retirement community (CCRC) of the Archdiocese of New York and operates nursing homes in six locations in the state. It has more than 2,000 patients and residents in its programs across the health care continuum, including a PACE program, adult day care, long-term skilled nursing care, short-term rehabilitation, home care, assisted living, hospice, and an acute care specialty hospital. It is one of the largest Catholic health care systems based out of New York.

ArchCare has a significant advantage in its integrated care model, as it operates both a home health agency and a hospital, allowing seamless care coordination within the system. This has led to successful partnerships, such as with Calvary Hospital and the Hospital for Special Surgery (HSS).

Part of ArchCare’s success lies in making the transition in care more seamless for patients, according to Dr. Taimur Mirza, chief medical officer for ArchCare. The company also focused on moving certain subsets of patients from the hospital to the nursing home. This is especially true for those who are Medicare Advantage beneficiaries, he said.

ArchCare’s focus on specialized post-acute care is evident in its partnerships with Memorial Sloan Kettering Cancer Center (MSK). An ArchCare skilled nursing facility provides dedicated care for cancer patients with complex needs, supported by MSK specialists. This model aims to alleviate hospital burdens by offering in-house services like dialysis, radiology, and vent units, turning nursing homes into extensions of hospitals for more intensive care.

The organization also participates in innovative CMS programs like GUIDE and TEAM. The GUIDE program focuses on enhancing dementia care through caregiver support and care coordination, while TEAM is a bundled payment program, which ArchCare has piloted in collaboration with HSS for orthopedic patients. These programs aim to reduce readmissions and improve patient outcomes, with ArchCare achieving high patient satisfaction and low readmission rates – key goals that skilled nursing providers will be pursuing throughout 2025 and beyond.