Last week, several large, publicly traded home-based care providers took the stage at the 2026 Jefferies Healthcare Services and Technology Conference, offering a back-to-back look at how the industry’s biggest operators are thinking about growth heading into 2027.

Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH), Addus HomeCare Corp. (Nasdaq: ADUS) and the Pennant Group Inc. (Nasdaq: PNTG) were among the presenters. 

A theme quickly emerged across the conversations: With reimbursement rates stabilizing but not necessarily accelerating, these companies are increasingly looking inward — to staffing, technology and leadership — to unlock growth that does not depend on winning a new referral or landing a new client.

In this week’s exclusive, members-only HHCN+ Update, I synthesize these presentations, offering analysis and key takeaways, including:

— How Aveanna is filling authorized hours through wage increases

— How Addus is taking a tech-driven approach to improving fill rates

— How Pennant is focusing on a foundation of strong leadership

New rate hike, better wages

I often discuss referral strategies and client acquisition trends with providers. Those conversations are predicated on the idea of getting new hours, new clients, new patients. So during the Jefferies presentations, I was interested to learn more about the providers’ approach to growth through another avenue: filling already-authorized hours.

The top-line news from the Aveanna presentation, at least to me, was the new tailwind for the company’s California business. Aveanna CEO Jeff Shaner has previously talked to me about how the company’s California operations have suffered from a seven-year-long rate-increase drought.

“The wage dynamics are completely out of balance with the rate,” Shaner said last December. “That won’t change until we can get California to do a significant investment in home-based nursing.”

Aveanna is an Atlanta-based provider of pediatric and adult home health, home care and medical solutions services, operating in 32 states.

At Jefferies, Shaner said that a Medicaid rate increase, slated to go into effect on Jan. 1, 2027, means that all 32 states in which the company operates now have had meaningful rate increases. The rate hike will lead to hundreds of families able to receive care in their homes, rather than in hospitals, the CEO said.

While celebrating the California news, Aveanna leadership also addressed how the company can continue to grow once that tailwind fades.

“That was a nice step for us, but going forward, it’s not going to be the chunky 20% increase, 30% increase,” said Aveanna CFO Matt Buckhalter. “It’s going to be 7,10 states a year that are 4%, 7%, 8%, 10%, and every once in a while you have one that comes out of left field, as we did with Wisconsin this year. [A] 38% increase that came out of nowhere. Those are great, but now we’ve gotten to a place where we can just compete consistently.”

With more sustainable rates, but without reason to anticipate another one of those “chunky” increases anytime soon, Aveanna must grow in a different way. That’s where filling already-authorized hours comes in.

Speaking about California, Shaner said that his very first priority in the state will be to improve the company’s fill rate within the state.

“We’ve dropped almost down to roughly 50% of our hours actually being staffed that were authorized,” he said. “That’s very, very low for us. So the opportunity to get those nurses that are currently working paid a higher wage, even before the rate increase goes into place, is our goal and our focus for Q4. We’ll then start applying new wage rates and recruiting and starting in January to really try to pull through new patients.”  

The rate increase allows the company to raise caregiver wages; higher wages draw new nurses; and additional nurses mean a higher fill rate. In other words, without landing a single new patient, Aveanna is positioning itself for meaningful growth simply by better serving the demand it already has on the books — a reminder that in a heavily regulated, staffing-constrained industry, capacity can be as valuable a growth lever as census. 

Technology for the fill rate win

Addus is taking another approach to increasing fill rates, one that relies on taps on a caregiver’s phone.

To take better advantage of authorized hours, the company’s leadership has bet on a caregiver app called Addus Connect, as well as other measures to improve conditions for frontline workers. I’ve written about this app before; it allows caregivers to view information like upcoming shifts and completed hours. CEO Dirk Allison has already touted slightly reduced turnover that he credits to the app.

The app also lets the provider use all its authorized hours, company leadership said at Jefferies. This is especially crucial in a rate environment that is unlikely to change meaningfully, according to Addus CFO Brian Poff.

“There’s probably not going to be a lot of impact in increasing the total rate,” Poff said. “It’s really going to be [an] increase in hours … I wouldn’t really think of it as a margin expansion opportunity, but more so just about volume potential opportunities.” 

Illinois-based Addus provides primarily personal home care as well as home health and hospice services.

In Illinois, Addus’ fill rate is currently in the upper 80%, Poff said, thanks to the caregiver app. The company next rolled the app out in Texas, and has since seen fill rate improvement there, as well.

“So I think you know our hope and our, I guess, anticipation is that as we roll this out in more states, we become more efficient,” he said. “Can we get our consolidated 84%, 85% … up into that upper 80% range?”

Taken together, these two companies illustrate two distinct paths to the same destination. Aveanna is approaching its fill-rate problem with wage increases made possible by a meaningful rate bump, while Addus is tackling the same problem through technology. Neither approach requires winning a new referral source or a new client — a notable contrast to how growth conversations in this space usually unfold.

The role of leadership

Pennant did not use the same terminology as Addus and Aveanna. The concept of “authorized hours” is a Medicaid term. But Pennant leadership did directly support the core underlying principle at play for Aveanna and Addus: growth is not constrained by a lack of patient demand.

Leadership framed the company’s staffing and clinical-capacity constraints not as a limitation, but as a solvable problem — one rooted in culture rather than reimbursement.

“We are a leadership company first,” said Pennant CEO Brent Guerisoli. “The reason for that is we fundamentally believe [that] if we have the right leaders in place in our local operations, they’re going to create an environment where employees want to work, and by extension, we’ll have opportunities to serve the communities in a greater way.”

Eagle, Idaho-based Pennant provides home health, hospice, senior living and home care services.

I was glad Guerisoli raised the company’s underlying approach to improving staffing. It’s easy to say that the key to solving a recruitment or retention problem is becoming an employer of choice. But his framing — that the company’s entire growth thesis starts with leadership, not with a specific tactic or technology — offers other providers a useful note to reflect on: whether their leadership is fostering the kind of environment people want to work within, whether leaders need additional support, or whether new leaders are needed.

As always, the takeaways from what these large providers discuss often serve as important tips or thought exercises for providers of a variety of sizes and services. To underscore what I heard from these panels: when rates or other important elements appear static, the real growth opportunity lies in unlocking capacity that’s already sitting on the table — capacity constrained by staffing and clinical bandwidth, rather than a lack of patient demand.