Hello,
I would like to present my healthcare delivery start-up—At Home Nursing Services (AHNS). The aim of AHNS is to reduce the gridlock in hospital emergency departments (ED) and related life-threatening care delays. Our system will reduce hospital and Medicare expenses, while bolstering the health system infrastructure by improving geriatric use of hospital emergency department.
The problem with elderly visits to the ED is they too often result in hospitalization and many of those visits are avoidable. The estimated price of the average ER visit is around $2,200. Annual ED visits cost $80 B, and $8 B are unnecessary visits.
AHNS’ solution to this predicament is to reimagine the traditionally congested ED with an ED/AHNS linkage to eliminate unnecessary and costly hospitalizations.
For example, after an ED physician determines it’s unnecessary to hospitalize a senior, AHNS will treat the senior in the safety of their home with a new wave of digital products, making it easier to receive care via the benefit of telemedicine, and any equipment, medication or other supplies the ED physician believes is needed.
Instead of consuming an ED physician’s time and a hospital bed, AHNS’ disruptive differentiation is our 24-hour staffing of a caregiver (an HHA at our cost and at no expense to the hospital) who waits in the ED to meet the patient and care for them in their home. AHNS’ 24-hour on-call concierge service will reduce both Medicare and hospital costs while providing convenient home care for a senior.
In addition, we have the advantage of establishing a long-term relationship with a senior in the ED with an ED physician’s discharge that authorizes AHNS to provide additional skilled nursing services (RN, PT, OT) rather than going to another healthcare firm (a huge revenue source). Need substantiation of the concept? Consider the success of Luna PT and Dispatch Health, and realize we’ll be the first firm to care for the home health needs of the senior—not Luna or Dispatch. Please contact any ED physician for their reaction to the idea, and how we’ll be market dominant in the ED homecare field!
I am now actively looking for investor financing for our upcoming $950,000 Seed Round. Following are facts to substantiate my passion about this strong start-up: 1) The two founders of AHNS each have 20-years of experience in healthcare and emergency hospitalists, 2) The massive geriatric home care market is expected by Fortune Business Insights to reach $146.61 billion in 2028, and 3) 140% average annual revenue growth during first 5 years and over a 20X return on investment.
Attached is our Business Plan. If after reading the plan you have unanswered questions, or would like to review our financial projections, you can contact me by phone: (747) 235 9628 or by email: mhfruch@icloud.com.
Cordially,
Martin Fruchtman
1. At Home Nursing Services, Inc
The Next Generation of Home Care
Pitch Deck for Seed Round - April 2023
2. Problem: Senior Use of Emergency Departments
The problem with elderly visits to Hospital Emergency Departments
(EDs) is they too often result in hospitalization and many of those
visits are avoidable. The estimated price of the average ER visit is
around $2,200. Annual ED visits cost $80 B, and $8 B are
unnecessary visits.
EDs face the challenge of serving 20 million older adults who use it
each year and do so more often than any other age group. Over 60%
of all older adults hospitalized in the United States enter the hospital
through the ED.
Dr. Robert Pearl, the former CEO of the nation’s largest medical
group, The Permanente Medical Group, wrote, “As ERs swell with
non-emergent patients, those with urgent and life-threatening issues
have to wait longer for evaluation and treatment. This combination—
more ER patients with preventable issues and unnecessary ER
utilization—will invariably drive our nation’s medical expenses
higher.”
Home care is still in the horse and buggy era. It’s a fragmented, niche
industry with a transient labor force. The industry consists of several
national firms, many franchisors selling offices, and countless local
“mom and pop” firms (78% per HCAOA).
Will technology benefit home care? Biofourmis CEO Kuldeep
Singh Rajput said that virtual care can help reduce costs by almost
40% and reduces hospital readmissions by more than 70%.
3. Solutions: The aim of ‘At Home Nursing Services’ is to end ED
boarding of patients, reduce the gridlock in hospital emergency
departments, and related life-threatening care delays. Our system will
reduce hospital and Medicare expenses, while bolstering the health
system infrastructure by improving geriatric use of hospital emergency
department.
AHNS’ solution to this predicament is to reimagine the traditionally
congested ED with an ED/AHNS linkage to eliminate unnecessary
and costly hospitalizations. And importantly, the ED/AHNS
collaboration provides senior-friendly care by staffing an ED patient’s
needs immediately.
AHNS’ competitive differentiation is we staff three 8-hour shifts of
our caregivers in the ED to meet the patient, and we pay our Home
Health Aides (HHA) while they wait for an ED discharge at no
expense to the hospital. AHNS accomplishes the task of better patient
health by extending the walls of care beyond the hospital. And one of
our HHAs is ready 24-hours per day in the ED for a discharge!
As an alternative to consuming an ED physician's time and a hospital
bed, AHNS’ efficient solution reduces both Medicare costs and
hospital expenditures while providing convenient home care for a
senior. To authenticate this, Alivecor’s Dr. Dubey described, “Just by
adding remote patient monitoring, we were able to show real-world
evidence of nearly 56% reduction in emergency room use and then
68% reduction in hospitalization for patients with arrhythmia. That is
powerful.”
**Law Change** - The Centers for Medicare & Medicaid
Services (CMS) announced in April 2019 it would allow non-
skilled in-home supports to be added as a supplemental benefit for
Medicare Advantage (MA) plans in 2019. Only Medicare certified
firms eligible for MA reimbursement.
Strategy: Buy existing Medicare-certified agencies and focus on
neglected in-home support for hypergrowth growth.
4. Market Validation: Overall Home Care Provider Market
The healthcare industry is 19.7% of U. S. economy and is booming.
$110.0 B - Home health care revenue Industry Employment: 1,916,095
The ED/AHNS linkage is a momentous game changer for hospitals as they
navigate unprecedented financial challenges that are causing an increased strain on
an already fragile system. This is a massive market to tap with annual ED visits
costing $80 B, and at least $8 B are unnecessary visits.
The future of EDs is a linkage with AHNS. Plus, we will have the advantage of
establishing a long-term relationship with a senior in the ED, and the physician’s
discharge will usually authorize AHNS to provide additional skilled nursing
services (RN, PT, OT) rather than going to another healthcare firm (a huge revenue
source). Need substantiation of the concept? Consider the success of Luna PT and
Dispatch Health, and realize we’ll be the first firm to care for the home health
needs of the senior—not Luna or Dispatch.
5. Product: Home healthcare and custodial care:
The expenditure for hospital readmissions for people over 65 is not
sustainable for Medicare. The good news is that many readmissions
can be preventable. Pre-discharge linkage to AHNS would establish
a safe discharge with a HHA and a team of related home healthcare
professionals providing personalized care at home. As mentioned
above, this extraordinary innovation is similar to, and based on, the
Acute Care Hospital at Home (ACHaH) program.
The cost of readmitting just one patient can average over $15,000.
And with the median readmission rate at 3.8 million and Medicare
penalizing providers for excessive readmissions, it’s no surprise that
reducing these costly rehospitalizations are becoming more of a
priority in home-based care.
AHNS’ 24-hour delivery model is unprecedented among home
healthcare agencies. The groundbreaking development of a
caregiver’s immediate availability for a patient discharged from an
ED brings a better and more cost-effective solution to the healthcare
market. Our rapid caregiver deployment service model will drive up
AHNS revenues and significantly enhance our competitive position
(note—AHNS pays the HHA while they wait in the ED for
assignment and Medicare pays the HHA and any needed skilled
nursing after the patient is discharged from the hospital).
Importantly, AHNS breaks the funding dilemma for low-income
patients and seniors on a fixed income since payment for our Home
Health Aide service is authorized and paid by Medicare.
From Responsive to Anticipatory – AHNS will have one caregiver
in the hospital ED for rapid discharge. This will be the fastest
continuous service in the industry. Said caregiver will remain at
patients’ home until permanent replacement caregiver is located and
sent. This is a transformative approach.
6. Initial Service Areas:
Phoenix/Maricopa County-4.4 million.
California: Los Angeles County-10 million, Orange County-3.2 million, San Francisco
County-3.3 million, San Diego-3.3 million, Inland Empire/Palm Springs-4.6 million.
Texas: Dallas-2.6 million, Harris County/Houston-4.6 million, San Antonio-1.4 million.
Soon after: Florida, Pennsylvania, Georgia and New York
Concentrating on these major urban areas will cover 50% of market
With Plenty of Opportunities For Future Growth
113%+
65 AND OLDER WORLD POPULATION GROWTH
2019 2050
703M 1.5B
The world’s 703 million people aged 65 and older as of 2019 will more than double to 1.5 billion
by 2050.
HHS results show that 70% of adults who survive to age 65 develop severe Long-Term Services
& Support needs before they die and 48% receive some paid care over their lifetime.
The private caregiver services sector is one of the fastest-growing healthcare industries in the
United States. Demand is driven by over 73 million baby boomers, representing around 25% of
the U.S. population
7. AHNS was founded by seasoned healthcare entrepreneurs with
financial & legal backgrounds.
Only ‘Medicare-certified’ home health agencies officially serve: Medicaid patients,
and they are only agencies allowed for Medicare Advantage Part C patients for in-
home care by home health aides—a recent benefit overlooked by most companies.
90% of seniors plan to remain in their homes as they age. (Source: AARP)
More than 10,000 baby boomers turn 65 every day, and by 2030, 61 million
baby boomers will be aged 66 to 84. (Source: Census)
Home health care revenue in the U.S. has grown to $97 billion.
(Source: Statista)
About 78% of home care providers are ‘mom and pop’ firms that employ
fewer than 50 workers. (Source PHI) and can’t compete with our ED
linkage.
The State of Washington approved the Long-Term Care Trust Act. The new
law requires residents to pay into a long-term care program through an
employee payroll tax. Eligible individuals will have access up to $36,500 in-
home care, and it will begin paying benefits in January 2025. Several states
(CA, IL, HA, and MN) are examining the potential for an LTC social
insurance program. Result: A windfall for home care!
8. Proof of Concept: Hybrid Proposal: Innovation plus ‘Strategic
Rollup’
AHNS Advantage: ED linkage is momentous as it gives us a huge benefit to crush the
competition since we will establish long-term relationship before any other firm.
Dramatic Upside: The Centers for Medicare & Medicaid Services (CMS) announced in
April 2019 it would allow non-skilled in-home supports to be added as a supplemental
benefit for Medicare Advantage (MA) plans in 2019. Few firms have fully capitalized on
this recent rule change.
Great Product: Only MA-certified agencies are able to provide above-mentioned in-home
services. That is why this is the perfect time for a roll-up of existing MA-agencies and
home care agencies. Also, innovating for existing home care companies will cause us to
get access to an enormous user base, an existing infrastructure that we’ll transform to our
modality, and an established team.
Proof of Concept: How investors can test the merits of this business vision for AHNS —
Seth Sternberg (co-founder and CEO of Meebo, which was acquired by Google for a
rumored $100 million in June, 2012) started Honor as a senior care network. $325 million
backed it in equity funding from Andreessen Horowitz, Prosus, et al. Honor ultimately
bought Home Instead, the largest franchise home care enterprise in the world. The
combined Honor/Home Instead firm has $2.1 billion in home care services revenue, up
11.3 percent from the year before.
9. Our Team: Our company is driven by an energetic, talented team of founders and advisers. In
hiring employees, we particularly look for a track record of successful performance.
Martin Fruchtman - CEO (Chief Executive Officer)
20 years experience in home care, home health care & DME markets as CEO of
American Companion & Homecare Services and Unlimited Nurses.
Wilshire Savings & Loan - Member of the Board of Directors
Member of Loan Committee
President of Wilshire Equities
Coast Savings & Loan/NAPICO – Sr. V.P. – Real Estate Syndication. Hutton/Real
Equity Partners. Firm raised $1.4 billion for the acquisition of more than 67,000
housing units with a total purchase price of $2.2 billion dollars.
Shen Yun, MBA – President
COO – Emergency Management firm, 10-years experieince
Chief Compliance Officer – Emergency Medicine Management, 10 years-experience
10. EXECUTIVE SUMMARY
AHNS has been formed to make investments in Medicare-certified home
health agencies with the intent to form linkages with hospitals EDs.
Primarily focused on unskilled home care and skilled nursing
businesses in states with densely populated urban areas
Opportunity to build foundational infrastructure with hospital EDs,
and brand in new markets with innovative ED geriatric linkage giving
us a ‘first-user’ relationship with seniors.
Investment offer strong present cash flow to return capital quickly and
high IRRs
Potential to increase revenue significantly due to digital approach
Due to the pandemic, a substantial share of the senior care market has
shifted from community settings like nursing home and assisted living
facilities to the safer alternative of one-on-one home care.
Internal Growth: Once an acquisition is completed, the firm can
expand from the main district office and establish in adjacent cities
and counties in a ‘hub and spoke model.’ For example, an LA office
would expand to Orange, Riverside, and San Bernardino Counties
without the need for added external acquisitions in area.
Dramatic Upside: The Centers for Medicare & Medicaid Services
(CMS) announced in April 2019 it would allow non-skilled in-home
supports to be added as a supplemental benefit for Medicare
Advantage (MA) plans.
Tech enabled: Digital ads, comprehensive care platform—a
combination of a technology layer, centralized operations and local
leadership.
Opportunity to develop a premier home care & Medicare-certified
home health agency brand
Projected to generate $21 million of revenues and over $2 million of
EBITDA in Year 2 of operations on $1 million investment.
Net investor returns are expected to be over 30x initial investment
during five years period.