The economic and operational landscape continues to favour larger entities and industry consolidation this year. Consequently, the key providers to monitor in 2025 are those leveraging their scale for efficiency, as well as those embracing technology and value-based care to ensure sustained success.
It is worth noting that operational challenges, including workforce shortages and an unfavourable economic climate with rising inflation and high interest rates, led to multiple nursing home closures last year. Many smaller providers were unable to survive, lacking the advantages of scale that benefitted larger organisations. These closures, however, have created opportunities for expansion-minded providers.
Several companies on this list are pursuing growth through acquisitions and strategic partnerships, capitalising on opportunities despite market volatility. Encouragingly, staffing shortages that previously hindered expansion in 2024 are now beginning to ease, allowing providers who were previously hesitant to resume aggressive expansion strategies. Furthermore, these providers have been successful in reducing their reliance on costly agency staff, a trend which also contributes to improvements in the quality of care.
As a result, while established industry players are resuming their growth trajectories after periods of cautious restraint, newer entrants are adopting regional growth and cluster-based facility models to strengthen their positions. However, scale alone does not resolve all challenges. One of the sector’s largest providers remains under scrutiny in 2025 due to ongoing uncertainties surrounding its future direction and how soon it will return to rapid expansion.
PruittHealth
PruittHealth faced significant disruption from the Florida hurricanes last autumn, yet its expansion plans remain firmly rooted in its long-term strategy and a resilience forged through an ability to continually adapt to operational pressures. As CEO Neil L. Pruitt stated, “There will always be a pandemic, there will always be a storm, there will always be a new government programme that we have to react to.”
The company’s ability to persist with its growth plans despite adversity makes it a key provider to watch in 2025.
PruittHealth remains committed to expansion, investing heavily in new facilities and upgrading existing ones. In 2024, the company opened two state-of-the-art centres and allocated $50 million to modernise its current properties. Additionally, a $385 million project is underway in Raleigh, North Carolina, to develop a comprehensive care and retirement community that combines healthcare excellence with high-end hospitality.
A central focus for PruittHealth is cost reduction and improved care delivery. The company’s Medicare Advantage initiative, PruittHealth Premier, aims to reduce hospital readmissions and enhance patient outcomes by providing more comprehensive coverage and support within its facilities. The goal is to enrol 70% of eligible patients, driving both operational efficiency and improved staff retention.
Furthering its innovative approach, PruittHealth has significantly reduced workforce turnover through Pruitt University and career progression opportunities for Certified Nursing Assistants (CNAs). Moreover, a partnership with Accenture aims to streamline documentation processes via artificial intelligence, reducing administrative burdens and improving financial sustainability.
With expansion plans across Tennessee, North Carolina, South Carolina, and Georgia, along with a strong focus on technological advancements and workforce development, PruittHealth is well-positioned for significant growth in 2025.
Covenant Living Communities
Covenant Living Communities has secured its place on the list due to its innovative approach to managing operations across multiple states. Its centralised intake model has facilitated contract negotiations, enhanced revenue cycle management, and alleviated reimbursement challenges associated with the growth of managed care.
Based in Illinois, the non-profit provider operates an extensive network of 20 long-term care communities, including skilled nursing facilities, across 11 states. However, the organisation’s broad geographical footprint presents challenges amidst the rise of managed care.
Given that Covenant has more residents using managed care than traditional Medicare—particularly in Florida and Minnesota—the diverse requirements from insurers create hurdles, particularly in terms of admissions, referrals, and authorisations.
To mitigate these issues, Covenant’s centralised intake model streamlines admissions across all communities. A dedicated team manages eligibility verification, authorisations, and data entry, ensuring uniformity across various health plans. This system also incorporates a “managed care cheat sheet” to assist staff in navigating complex insurance contracts, maintaining compliance with insurers’ documentation requirements, and minimising claim submission errors to reduce denials.
Covenant has further optimised its revenue cycle management through electronic billing systems and automated data entry, enhancing accuracy and cash flow while minimising manual processes.
Additionally, Covenant employs external consultants to renegotiate contracts and boost reimbursement rates, given the considerable regional variations in rates and terms. The organisation also utilises electronic remittance advice systems to track contract details, preventing denials and ensuring prompt payments.
Despite ongoing challenges with Medicare Part B coverage—particularly with specific insurers—this remains a growing revenue stream.
PACS Group
PACS Group experienced a tumultuous year in 2024. The company’s successful Wall Street debut and significant expansion were overshadowed by allegations of fraud and a subsequent federal investigation into its referral and reimbursement practices. Following these allegations, the company paused its earnings releases, and several equity analysts withdrew their coverage. PACS has since launched its own internal investigation.
This ongoing situation places PACS Group firmly among the providers to watch in 2025. However, should the investigation reach a resolution, the company could well resume its rapid expansion.
Based in Farmington, Utah, PACS Group operates over 200 skilled nursing facilities across nine states, catering to more than 20,000 patients daily. Despite the controversy, the company has continued growing, strengthening its partnership with CareTrust in 2024.
Before the allegations surfaced, PACS executives highlighted their success in turning underperforming facilities into high-rated ones, claiming that their mature facilities had an average 5-Star Quality rating of 4.2 by year-end, with an occupancy rate of 93%. These figures significantly exceed the sector averages of 3.9 and 87%, respectively.
Although PACS has yet to release any updates on the investigation, its operating partner, CareTrust, has expressed confidence in the performance of PACS-managed facilities within its portfolio.
Looking Ahead
The skilled nursing industry is entering a transformative phase, where adaptability, financial strength, and innovation will determine which providers thrive. While large-scale operators gain momentum through consolidation, regional players are using innovative models to carve out their space. In an era of economic uncertainty and regulatory scrutiny, those that successfully balance growth with compliance and efficiency will be the ones to watch in 2025.
The skilled nursing industry has been navigating unprecedented challenges, including post-pandemic workforce shortages, evolving reimbursement models, and regulatory changes. The increasing prevalence of value-based care and Medicare Advantage plans has made financial sustainability a critical factor for long-term success. Furthermore, technology-driven care models and AI-powered operational efficiencies are becoming integral in enhancing patient outcomes and streamlining administrative processes.
As the industry moves forward, the interplay between policy changes, technological advancements, and strategic consolidation will continue to shape the sector’s future. Industry observers will be closely watching these key players as they adapt to the shifting landscape in 2025.