It might be helpful just to start by giving a brief overview of BrightSpring for those that are a little bit more unfamiliar with the organization, the strengths of your provider and pharmacy segment, and just in general how you're meeting all the needs of the polychronic population today.
Sure. Thanks, Whit. As far as we're not there in person, it's never fun getting on a plane, waiting around, and getting off a plane. Thanks for accommodating. Yeah, look, BrightSpring today is, I think, a very unique and dynamic platform within health services. We're touching about 400,000 people every day across the U.S. I think that helps give a sense of our scope and our impact. We are doing that with services more focused on home and community settings for seniors and specialty populations. We believe that to be something that has an incredibly strong value proposition, delivering very high-quality services where people are in their home and community in a more economical way. Our business cuts across pharmacy services, provider services, and our home-based primary care. On the pharmacy side, it's really three closed-door pharmacy operations.
Number one, it's our specialty pharmacy business focused on oncology, where we go to the patient in their home and support them with a set of white-glove wraparound services. Number two, it's our home infusion business, where, again, we go to the patient where they are with infusible therapies. Number three, our home and community pharmacy, where we go to a myriad of settings in the community or at home 24/7 in all 50 states. We can be anywhere within three hours, whether that's an assisted living facility, a skilled nursing facility, somebody at home on hospice, somebody in a group home with behavioral needs, somebody at home with home health, etc. Scale is a defining characteristic of our pharmacy business. We'll do over 40 million scripts a year.
I think that makes us in the top 10 in the U.S. from a pharmacy perspective, just trailing the big retailers and the big PBM mail order houses. We have a closed-door white-glove model where we customize services for people where they are. Scale is incredibly important in that industry. On the provider side, it's a very similar set of populations where we go to them with home health, rehab, hospice, and personal care services. Our third pillar has been building out home-based primary care, really to weave all of our services together and to allow us to lean into value-based care to leverage the incredibly strong quality outcomes and value that we're driving in the organization. We've got a nine-year track record of about 15% or more CAGR on revenue and adjusted EBITDA. We see that growth rate exceeding 20% this year.
You recently announced the sale of the community and living business. Do you want to maybe spend a second talking about that transaction, the strategic rationale behind it, and maybe the deployment of the capital proceeds as well?
Sure. Community living business was really the heritage and foundation of the organization going back 50 years ago. That's where we take care of individuals with intellectual and developmental disabilities, either in a group home setting or in their own home in a host home model. It's probably, Whit, the greatest ROI I've seen in healthcare. We literally save the system and states billions of dollars a year by allowing these very acute individuals to be in their homes instead of in an institution for their life. We have invested heavily in that business over the years to achieve service levels and outcomes that we are extremely proud of. The mission in that business is one like I've never seen before, taking care of this population of individuals.
I would say, as you just look at our organization, as we continue to try to focus strategically as much as possible, that population, that patient set, if you will, is a little bit more tangential. As we just focus more and more on seniors and certain specialty populations with really skilled clinical services, that's where we continue to trend more and more in the future. We were excited with Sevita to find a partner who we believe will continue to run the business in a very high-quality way. We have a lot of respect for that organization. We believe that will be a seamless transition. After the fact, we will use the proceeds largely to pay down debt, to continue to delever, to move towards our three-times leverage target in the near future.
By the end of this year, or certainly next year, we would expect and hope we might leave a little of that capital on the balance sheet for our typical tuck-in M&A at very attractive and accretive acquisitions. That is the game plan.
Got it. Maybe just turning to the pharmacy business for a second. I mean, specialty certainly has been a major growth driver and certainly well aware of a lot of the tailwinds behind that business. But you guys continue to have tremendous momentum with your—did we lose you, Jon?
Can you see us?
Yeah, I can see you. Can he hear me? Jon, can you hear me?
I can hear you.
Okay. Sorry. Jen just ran out of the room. I thought maybe you had some technical difficulties. Just looking at the momentum that you're having with LDD wins in the market, one, do you think you're taking share? How do you think you're doing this? How sustainable do you feel about the growth within the business?
Yeah, thanks, Whit. You did black out there for a second, but I heard the question. Now, look, across our pharmacy business, we continue to try to drive quality and volume and relationships with our customer base. Nowhere really is that more evident than in our specialty oncology business. It goes by the name of Onco360. And for some of the therapies that we serve that are not oncology, that's CareMed. By the way, we just received a 198 net promoter score in our most recent surveys from our patients. So really, that business is a three by three. First of all, the business has been underpinned by quality, which drives, number two, very strong relationships with manufacturers. That allows us to service their therapies and their drugs in more limited distribution drug networks. Cancer is obviously a very serious condition and a white-glove therapy.
Manufacturers really care deeply about their pharmacy partners. We're privileged and honored to be able to work with them in either exclusive situations or what's called ultra-narrow situations, where only one or a few pharmacies will support that drug nationally. You have the quality that supports the manufacturing relationships, access to the drug. Third, we've heavily invested in clinical liaisons to advocate and educate in thousands of prescriber offices every day to pull through scripts. That really is the underpinnings and our three critical success factors. From there, the three revenue drivers are brand LDDs. These are the drugs that come to market in limited distribution drug networks. Our history has been winning about 12 of those a year, a very steady supply of innovative drugs coming from biotech and the manufacturers to the market in the oncology space.
The data says about $90 billion of new oncology drugs are coming to the market over the next seven years. We continue to win a lion's share of those in these limited or exclusive networks. Number two, beyond the brand LDD drugs, there are generics. Starting several years ago, some of the big brands historically started reaching their patent cliff and rolling and converting into generics. As you look forward for the next five years, there are about 10 very significant brands that will also convert to generics. Our team is very focused on driving generic utilization for the benefit of everybody in the industry. Generics, to be very clear, in the oncology world work very differently from retail. This is not Lipitor. Nothing changes about a generic overnight other than your supplier and some of the reimbursement structure.
Everything about those drugs, the way their service is supported in the competitive landscape, remains the same given the very high need and white-glove services that support those manufacturers and those patients. Third, in addition to brands and generics, which keep rolling out, we are building out a fee-for-service business consistently over the past five years. These are data services back to manufacturers. These are clinical hubs programs that we provide for manufacturers. In each one of those three areas, it is doing extremely well. As you look at the pipeline on the brand side that I mentioned earlier from an innovation perspective, the drugs at the FDA, and if you look at what's expected on the generic side over the next five years, we certainly expect the momentum to continue there.
Again, it's been underpinned by the quality that we've built over the years and the trust we've earned from the manufacturing partners.
Shifting to the infusion business, that business did not really grow terribly much in 2024. You seem pretty optimistic that you are at a position now to really scale and maybe double the size of that business. Just when you look to grow infusion, how do you think about what the right locations are when you look at some of the other businesses that you have right now?
Yeah, we're in about 30 markets on infusion. I mean, that's a sizable business for us of about $700 million in revenue. We think it has a lot more potential. We've spent the last 12 to 18 months, really given the growth in the rest of the organization, we're always trying to invest in the future. We took the last year to continue to make investments in that business while a lot of the other businesses have been performing extremely well so that infusion could be a growth leader for this company going forward. What we've tried to do in that space is streamline our operations with best practices and consistency across all of those 30 markets as best possible, being very careful about what's centralized, what remains local. That's a key to infusion as well, and being very focused on acute and chronic specialties.
What you've seen in the infusion world is both acute therapies and chronic therapies. Operationally, those actually can function pretty independently. They have very different customer and patient requirements. You have to be very adept if you are trying to scale in both of those end markets, which we are. We think offering the acute and the chronic therapies makes you more relevant with patients. It just increases overall market size. As we've made investments in revenue cycle, in operations, and as we've put an entirely new management team in that business in the next year, we have high aspirations at this point going forward. We are seeing on the specialty side of our business turnaround times now of around 10 days, which would be best in class in the industry.
We are optimistic that we can leverage those service levels to drive more growth on the specialty and chronic side. That business is budgeted to certainly grow at the 20% or more level as an organization this year. If we are able to execute on that, I think it will make us really optimistic about the years to come thereafter.
When you say 20%, is that for the full pharmacy segment?
That would be for infusion.
Just infusion. Okay. You referenced a number of initiatives operationally you have around infusion. When I think about the broader pharmacy segment, I mean, you've talked on the call about 100 different things that you're sort of doing at the enterprise level. How do you think about how that might impact the margin profile of the pharmacy segment over the next two or three years?
Yeah, certainly what we try to do with the organization is focus on markets that we think are attractive for the long term. Our specialty oncology, the infusion industry, and these home and community markets, they will continue to all experience very solid growth where we will continue to try to drive market share where we largely have historically. In pharmacy, as I mentioned before, volume is critically important in terms of your reimbursement relationships with payers, in terms of the ability to buy supply from your manufacturing partners. Those 100 or so projects, those were really lean projects across the breadth of the enterprise where we're constantly looking at efficiency and more and more automation opportunities.
Within pharmacy, a lot of these initiatives that we've taken on certainly are leading towards some of our EBITDA performance in the last, well, it's really been the last nine years, but in last year, 2024, and this year in 2025, a lot of those efforts are continuing to drive performance for the organization. However, importantly, we're really balanced in terms of what we do with greater efficiency and scale in the organization. We really invest in our people significantly. We invest a lot of those dollars back to continue to invest in recruiting, to continue to invest in sales personnel, to continue to invest in quality and compliance team members, and then IT as well. We really take a balanced approach again, trying to succeed today, but also continue to lay the foundation for further growth in the future.
I would say in our specialty oncology business, we've been effective at driving leverage in that organization as it's continued to scale. As we've made more investments in infusion and home and community pharmacy, we are really expecting this year to see some of that come back to us in cost per script, OpEx per script. I think we've put ourselves in a good position to do that this year with a lot of our efforts over the past several years and particularly last year.
Yeah. Maybe just for a minute on the home and community-based pharmacy, the former PharMerica. You've always referred to it, John, at least to me, as being unrecognizable versus I think how many people in this audience may remember that organization. Just maybe remind us what has changed about that asset, the mix, the growth, and how did it perform in 2024 versus your expectations?
Yeah, if you probably look back, Whit, to about 10 years ago, PharMerica, the brand, used to be a public company. That was primarily a SNF pharmacy business. We like the skilled nursing end market. There's a huge need there. We think with our service levels and our scale, we do that better than anybody. That is a stable and attractive market for us that we would be focused on. It's just that there's a lot of other attractive markets in the home and community closed-door pharmacy world. If you look at the business of PharmAerica going back a decade, there's probably about 7% or 8% of that business 10 years ago in terms of our EBITDA contribution in our company today.
That just really gives you a sense of how explosive our growth has been in so many other end markets in the oncology space and infusion, and then in all the other markets of home and community like senior living, like behavioral, like hospice pharmacy, where we have a leading franchise there. Just a lot of diversification across attractive closed-door pharmacy markets over the past decade, I would say in particular over the past three, four, five years. Home and community itself, being an amalgamation of those various end markets today, did perform in line with our expectations last year and showed solid growth.
Okay. When you look at specialty and infusion, I just want to come back to this for a second. We spent a lot of time talking about the growth opportunities. What are the biggest risks or the blind spots that you see within that business? Is it risk around how PBMs may react, or what would be the challenge that could surprise you that you're paying attention to?
Yeah, I mean, look, we're always trying to think several years ahead in terms of our growth, in terms of our strategy and where we focus. We're always trying to ensure that the company is as enduring and stable as possible. We take a lot of pride in that. I think you see some of that reflected in the past decade's worth of a 15% plus revenue and EBITDA CAGR. That's what we like about the complementary diversification that we have at the organization across our service lines where we're serving similar settings and similar patients. We think that scale and we think that diversification really insulates you from a lot of overly impactful items should anything negative ever come up. It's the real world. Things happen. We like the platform that we've put together, given the scale and the complementary diversification.
We are always thinking about different ways to leverage our capabilities to serve more individuals with the value that we can. Specifically, as you look at the healthcare industry, I would just say reimbursement rates, integrity, and stability of those are always first and foremost. I think with our quality track record and our scale and just the way that we try to partner so closely with payers and stakeholders across the system and do everything we can to take great care of their members, I think we are able to cultivate differentiated and great and very trusting relationships and necessary relationships with everybody across the value chain. We just try to be the best partner possible to everybody across the value chain through our service levels and through our quality and the impact we drive and the value of our services.
I think if you look at what we do outside of how we specifically do it, the value of these services, whether it's oncology pharmacy, whether it's infusion, whether it's home health, these are things that are the solutions in healthcare to potentially taming healthcare inflation years and years down the road. What we do lowers costs and improves outcomes. We have always historically seen a tremendous amount of bipartisan support for that. We just continue to educate and advocate for our services as best possible so everybody clearly understands the ROI and the value of what we do.
Yeah. Maybe to shift to the provider segment, it might be just helpful to rank the growth with each of the individual sub-businesses within the provider segment and which one is driving the most contribution today.
Yeah, home health and hospice, those have been well-performing businesses for us the past several years, certainly into the double digits from a growth perspective. We're excited about both of those businesses going forward. Hospice has a tremendous value proposition. 99% family and patient satisfaction dramatically reduces costs in the later days of an individual's life. We've got a very sizable platform there that we will continue to grow as much as we can to bring more hospice to as many people as deserved as possible. Home health is a smaller part of our home health and hospice today. We believe a nice time to be growing into this industry. There's been a little bit of acquisition activity in recent years. We think we're getting to the precipice where reimbursement rates should and really have to turn around.
What you're seeing in home health is some demand-supply imbalance where demand is outstripping supply. We really need to get back to the days of the steady 2%-4% rate increases for the benefit of the industry and so that more people can receive the benefit of home health. I think 40% of the people out there who are referred to home health don't get it. That's a little bit of a travesty just given how home health absolutely directly improves your mortality rate and reduces costs. We're hearing a lot of really positive things out of D.C. in terms of support for that industry. As we get into fiscal 2026 or 2027 at the federal level, getting a lot of support there. We're working with payers a little bit more creatively. We love to do that.
They are really leaning in, trying to figure out how to make sure their members get home health utilization, which is fantastic. Some of these contracts could have quality modifiers attached to them, which is absolutely the right thing to do. We're pleased and honored that some of the payers are talking to us. I think that's a reflection of their perception of our quality. You have seen our star ratings go up dramatically over the past several years from where we have acquired assets to now being at about 85% four-star or greater. We are optimistic about home health.
We think this is the right time to go from a decent-sized presence in about 10 or 12 states, but really the capability to scale that and take advantage of maybe some good timing in the market here over the next five years in an industry that has a very clear value proposition where clearly more and more people need access to these services. Home health and hospice for us, we will continue to view as a double-digit growth business. That's certainly our expectation. Rehab, where it's a more neuro rehab focus, a more commercial and workers' comp payer, taking care of individuals who've had a very significant neuro or spinal cord injury, intensive rehab therapy, either in day programs, transitional care settings, or in an individual's home. That business is clinically outstanding. We've continued to drive well into the double digits growth in rehab.
We are expanding that business further and further in more homes and more outpatient settings. We would expect that growth to continue. For us, personal care is a steadier business. That is about 60% Medicaid, but also about 40% private pay, VA, commercial, and other payer sources. That is just a steadier business, great cash flow, where we operate that business exceedingly well, extremely reliable business that helps fund other investments in the organization. Home health, hospice, rehab, those have both been mid-teen sort of growers for us. That certainly will be our long-term expectation for them. I would view personal care as being more steady.
Yeah. I mean, if I could see the organic earnings growth of home health, are you growing that? I mean, it's well documented, some of the challenges that others within the industry are having right now. We've got MA issues, mixed shift, obviously the behavioral adjustments. I mean, is that all through acquisition, or are you growing organically, and how are you able to do that?
Yeah, for us, it's been 90% organic. It is very much mostly an organic story. I mean, we do think that's a market that we do focus on for tuck-in acquisitions. We've done some of those. Just to give you a flavor for it, buying a small operation that might be break-even or a couple hundred thousand of EBITDA for a two to three to four times multiple, and three years later, we would expect three times greater EBITDA. That's how we approach tuck-ins in those markets. There are hundreds of those types of opportunities out there. We think tuck-in strategy in that space makes sense to accelerate in the future with really attractive acquisitions backed by the growth that we're able to drive in those operations after we get a hold of them and operate them better.
No, it has been a focus on clinical liaisons, educating and reaching out in the market, forming great relationships with the referral sources to drive admissions, to drive census. We have been really focused on operational consistency and standardization within the organization. We have been deploying a lot of technologies. We could talk for 30 minutes about the technologies we have deployed in that industry, whether it is being on a best-in-class EMR, whether it is having technologies that give you forewarning about deterioration in patient conditions so you can be more proactive, risk stratifying our patient base, centralizing intake, et cetera, et cetera, automating pieces of the onboarding process too. We have really looked to deploy technology and best practices through that business. Over the last couple of years, we brought in some great leaders as well.
We're excited just to continue to try to operate that business as well as we can within the industry.
Yeah. Maybe just spend a second on some of the primary care initiatives that you have underway. You acquired last year, I believe, an I-SNP plan. There is sort of an incubator going on within BrightSpring, as I like to think about it, in the context of value-based care. It is not driving a considerable amount of economics today, but certainly, you have got this constellation of all these solutions that kind of come together in a very unique way. Maybe just a brief update as to kind of what you are developing currently.
Yeah, I think that's accurate. I mean, that's a third leg of our stool today, along with pharmacy and provider services. I mean, with the reality, and this is what providers have been chasing for 15, 20 years, the reality is that with our high ROI, high-quality community-based services, the benefit of a lot of our services economically is all innerring to other people, right? If we're keeping people out of the hospital at a high rate, we're not seeing the benefit of that in a fee-for-service world. It's all around how not only can we continue to drive even better quality and more integrated care, but ultimately, how do you have a fair seat at the table for the benefit that you're driving throughout the value chain? We thought building out primary care, but think house calls, home-based primary care.
These are NPs and doctors going into assisted living communities, going into skilled nursing facilities, going into people's homes. They are the doctor, the NP coming to you. That produces a black-and-white superior clinical result. I mean, it is common sense. If you go to somebody who is a chronic, highly acute individual, where they are in a more proactive way, you step in front of things naturally all the time. That is what we see in our business. It drives a 50% reduction in hospitalization, just outstanding results typically. Our approach to that, and again, we never lost money on this. We've just been slowly but surely building it out. We're up to about, call it 16,000 or so patients. That is substantial. In our mind, that is still really small.
As we transition from fee-for-service to different payment models, we're doing that in a very, I think, risk-averse and controlled way. First off, last year was the first year we were participating in an ACO. That's where you get shared savings on Medicare patients that are attributed to you in the communities and at the homes where we serve them. We won't see our first payment from shared savings for last year until this October. It's nine months in arrears. We've been really conservative about booking any shared savings and accruing that, although we're seeing cost savings of about 12%-15% with superior quality outcomes on those populations versus the benchmark. We're very optimistic we will get shared savings on that population going forward. The other side of that is, in addition to straight Medicare, we acquired a small institutional special needs plan.
It's in two states. You are a managed care plan. And it's a business that had five years of history with very steady MLRs. And it just serves a couple thousand patients. Over the next 5 to 10 years, we will try to go into more and more states, ultimately, hopefully in 20 states, where for individuals who are long-term residents in assisted living and skilled nursing, we can be the physician as well as the managed care provider with a very intimate and highly proximal level of care for them where they are. Those are the two strategies that we would control and own with our own value-based care payment methodologies and capabilities, if you will. There is a third piece of that, which is taking that value proposition to other third-party payers and serving their highest-risk members in their homes in the community.
We've been talking to multiple payers for the past year or so about that. It can be a long journey to execute on those sort of agreements. I think this year, we will certainly have one, if not two agreements with payers to go target their highest-risk members in the community with a much better solution for them where they are. That would look like something like a PMPM model or a shared savings component. Down the road, that could ultimately convert into a full-risk model when you get several years of performance data. That's our approach to value-based care and primary care in our organization. Again, we're leveraging the access to the 500,000 people a year that we will touch directly through our services who can more and more in the future roll onto our home-based primary care as well.
All right. With that, I think we are just out of time. It sounds we've got some positive developments we'll look out for over the next year. John, Jim, good to see you. We'll talk soon.
Yeah, thanks, Whit. Thanks for accommodating the video today. Nice seeing you.
Thank you.