The Florida-based nonprofit hospice and senior care provider Empath Health has been steadily expanding its footprint as well as its service lines.

The company has pursued de novos, acquisitions and has built new programs from scratch as it works to achieve what Empath calls “full-life care” — a full continuum of services to support seniors and the seriously ill throughout their health care journey.

“The various different ways of growth, whether it’s M&A, de novo, joint ventures, or collaboration — we’ve really done it all,” Fleece said at the CONTINUUM conference in the Washington, D.C. area. “We’ve had success in all categories, and we’ve also had challenges in all categories. I’m not sure that I would favor one over the other.”

Empath Health has grown into one of the largest hospice providers in the nation. In addition, the organization currently provides home health care, palliative care, grief services, Program of All-Inclusive Care for the Elderly (PACE), adult day services, primary care services and more. It also operates 17 affiliates and two philanthropic foundations.

In 2024, Empath completed an affiliation process with Trustbridge, which offers palliative care, hospice care, support services and more. With the affiliation closed, Empath now serves 1 in 5 hospice patients in its home state, the company reported. All told, the organization cares for 5,000 patients daily, employs more than 5,000 staff and 3,000 volunteers.

“We launched that expansion into where we feel like we’ve got our deepest core competencies, which is home-based care,” Fleece said. “Ultimately, that led us to the home health division, and then our complete care division. Soon we will be the largest PACE provider in the state of Florida, with probably about 1,000 participants.”

Service diversification will be crucial to Empath’s long-term sustainability and growth, according to Fleece. To prepare for a changing health care environment, the company is working to develop greater economies of scale and take on risk.

“One element that we sort of are also dancing around a little bit are the economics of this type of strategy through economies of scale, best practices, standardization,” Fleece said at CONTINUUM. “I don’t think anyone in the room is ultimately predicting we’re going to get reimbursed a whole lot more over the next five to ten years. So what are the two ways to mitigate against that? Economies of scale, try to mitigate your administrative costs, back office costs, and try to, frankly, jump into the risk business. There’s the shared savings opportunity, and we want to try to also capture some of the value-based side of the revenue.”