Compassus: Private equity’s joint venture playbook
July 29, 2026
Private equity’s expansion into healthcare is increasingly happening through joint ventures with nonprofit health systems rather than traditional acquisitions. Our recent report, Private equity’s joint venture takeover of nonprofit healthcare, examines this growing ownership model and the questions it raises for patients, healthcare workers, and regulators.
One of the clearest examples is the partnership between Providence and Compassus. The case illustrates how nonprofit-private equity joint ventures are structured, why health systems pursue them, and the concerns they can raise for workers and communities.
Compassus is a for-profit company that provides in-home hospice care, palliative care, and infusion services in 33 states.[1] Around 10,000 staff members provide care across more than 300 locations in “partnership with health systems and long-term care partners.”[2] Compassus is jointly owned by private equity firm TowerBrook Capital Partners and faith-based health system Ascension Health.[3]
Compassus has had several ownership changes since its founding in 2006.[4] Initially, Compassus operated as Cloverleaf Partners Healthcare Services, Inc. (CLP), a hospice company.[5] That year, CLP “entered into multiple transactions to build a chain of hospice and palliative care providers.”[6] CLP first acquired RTA Hospice & Palliative care, a provider based in Arizona.[7] Also in 2006, CLP acquired Community Hospices of America, Inc., formerly known as Wellspring HospiceCare.[8] The capital for these acquisitions primarily came from the private equity firm Thomas Cressey Equity Partners (now Cressey & Company).[9] In 2009, CLP became Hospice Compassus and in 2014, the company was sold to Formation Capital and Audax Group, two other private equity firms.[10] Compassus was then sold again to its current owners, Ascension and TowerBrook, for approximately $1 billion.[11]
Compassus’ ownership history[12]
Private equity and hospice care
In the 2010s and 2020s private equity firms have actively acquired hospice agencies, drawn to the prospect of consistent Medicare payments and the opportunity for consolidation.[13] As Eileen Appelbaum and Emma Curchin wrote in their 2023 report on the role of private equity in hospice care, “patient care suffers when profit and the maximization of returns to company shareholders is introduced into health care. The effects on patient care may be especially pernicious when private equity firms buy up health care providers.”[14] In addition to patient-harming cost cutting, Appelbaum and Curchin outline examples of fraud that drive up Medicaid costs.[15] Their research found that some for-profit providers not only increase profits by focusing on enrolling patients who are more likely to live longer and require less expensive care, but also commit fraud by recruiting patients who are not terminally ill and therefore ineligible for hospice care in order to collect per diem payments without having to provide extensive care to them.[16]
Joint ventures
Compassus has entered into several joint ventures with not-for-profit health systems and providers, including Ascension, Bon Secours Mercy Health and OhioHealth.[17] The company’s joint ventures have been co-branded with each company’s name, and each has a board of directors with an equal number of representatives from each entity.[18]
Simplified organizational chart[19]
Ascension
Ascension At Home was formed in 2014 as a joint venture between Ascension and Evolution Health, a division of Envision Healthcare.[20] The venture was formed “to provide non-acute care services including home and hospice care and infusion therapy.”[21] In 2020, shortly after the Ascension and Towerbrook Capital acquisition, Compassus became the managing partner of Ascension at Home.[22] In 2023, the joint venture expanded to include Ascension Saint Thomas, to provide hospice services in central Tennessee.[23]
Coverage of the partnership with Ascension Saint Thomas in Hospice News offered the analysis that “The partnership represents a growing trend of hospital and health system collaborations and joint ventures with home-based care companies as more services move into the home setting.”[25] Ascension’s website described the partnership as demonstrating “how hospitals can integrate home-based care to deliver a more cohesive experience for patients and their families.”[26]
Bon Secours Mercy Health
Bon Secours and Mercy Health (BSHM) merged in 2018 to create “one of the largest health systems in the country spanning seven states in the eastern half of the U.S.”[27] In May 2024, Bon Secours Mercy Health and Compassus finalized a joint venture partnership under which Compassus would manage operations for ten home health agencies and 11 hospice operations.[28]
The partnership was a 50/50 joint venture.[29] Under the agreement, “BSHM will maintain ownership of its existing hospice house real estate assets in specific locations while Compassus will manage the operations.”[30] BSHM said it would work with Compassus to transfer employment for its staff to Compassus.[31] “Under the joint venture, the team will continue to provide spiritually grounded care and will operate in accordance with Ethical and Religious Directives.”[32]
OhioHealth
OhioHealth is a “not-for-profit charitable healthcare outreach of the United Methodist Church,” providing care in Ohio.[33] In September 2024, OhioHealth and Compassus formed a joint venture in which Compassus acquired an ownership interest in three hospice locations and four home health locations formerly led by OhioHealth.[34] Two OhioHealth locations — Kobacker House in Columbus and the Athens hospice services — were excluded from the partnership.[35] Compassus will manage operations, w
Providence
Providence is a national, not-for-profit Catholic health system with 51 hospitals, more than 1,100 physician clinics, senior services, supportive housing, and other health services.[39] The health system and partners have more than 129,000 staff across seven states – Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington.[40] Providence and Compassus announced a joint venture in 2024 in which Compassus would assume management of Providence’s home health and palliative care locations across several states in a staged roll-out.[41] Compassus would acquire 50% of the membership interests of Providence’s home health and home-based hospice operations in Alaska, Texas, Washington, Oregon, and California.[42]
Compassus initially took over management of care locations in Alaska, Texas, and Washington in March 2024.[43] In October 2025, the joint venture launched in California.[44] The joint venture was approved with conditions by the Oregon Health Authority on May 15, 2026.[45] Th
On its website, Compassus said, “The joint venture leverages Compassus’ proven expertise in home-based care delivery, operational excellence and advanced technology. It positions both organizations to meet the growing demand for home health and hospice services while addressing challenges such as rising health care costs and workforce shortages.”[48]
In an article for Home Health Care News, reporter Morgan Gonzales described the strategy behind the Compassus and Providence joint venture:
“The joint venture between Compassus and not-for-profit health system Providence is set to expand through two key growth tactics. The organizations are seeking to expand the joint venture’s census of patients coming from the Providence ecosystem while extending its community-based referral sources…For the first pillar, the joint venture aims to expand through multiple sources within Providence, including case management, discharge planning, hospital-based clinicians and Providence’s ambulatory environment. This part of the growth strategy requires close integration and collaboration with case management and other elements of acute care…Its second growth strategy looks outside of the Providence ecosystem for referrals, whether from long-term care facilities, skilled nursing facilities or physicians working directly with patients.”[49]
Providence and Compassus in Oregon
The Oregon Health Authority completed a comprehensive review of the Providence and Compassus joint venture on May 15, 2026, approving the transaction with conditions.[50] The Oregon Nurses Association raised concerns through the transaction review, citing issues around employment and working conditions, care costs, and patient access.[51]
The preliminary review of the joint venture described the rationale for the transaction:
“In the notice, the entities state that while home-based care is a critical community need and helps to alleviate hospital capacity limitations, these services fall outside the ‘core focus’ for Providence and most other health systems. Providence is finding it ‘increasingly challenging’ to manage these services and maintain high quality standards in the face of a ‘rapidly advancing and increasingly competitive industry.’ Independently transforming its home health and home-based hospice services to meet these challenges would be very costly with ‘highly uncertain’ results.”[52]
Providence stated that it has reported operating losses in recent years, though it had improved its margin from -6.4% in 2022 to -2.1% in 2024.[53] Providence said that higher reimbursement rates and less contract labor spending allowed for this operational improvement, though it claimed that state regulations, strikes, and lower Medicaid reimbursements made further improvements difficult.[54] To help address operating losses, Providence launched a reorganization in 2022, selling laboratory assets in Oregon, primary care clinics in Vancouver, and assisted living and skilled nursing facilities.[55]
Analysis in the Preliminary Review Report found that “Providence was the largest provider of home health and hospice services in Oregon as of 2023.”[56] In home health care in particular, Providence is an especially important player, “accounting for 25% of statewide home health episodes in 2023.”[57] Research cited in the Preliminary Review Report suggested that “PE ownership could significantly impact care delivery.”[58] The report grouped public comments about the transaction into four main categories of concern: access to care, quality of clinical care, cost, and equity.[59]
The Oregon Nurses Association issued a statement in opposition to the joint venture. It says, in part:
“By outsourcing their homecare programs to private equity, Providence is selling out their patients and employees and once again proving they care more about their own bottom line than the communities they are supposed to serve. This move will potentially leave underserved populations in Oregon without critical support. It may be financially profitable for Providence and Compassus, but it is morally bankrupt.”[60]
An article for the Washington State Nurses Association noted that “Nurses at PVNA fear that Compassus will, over time, increase patient loads – a common strategy for private equity-owned health care to bring in greater returns for investors. And less time with patients could negatively impact the care nurses are able to provide.”[61] Kathleen Thompson, chair of the Washington State Nurses Association’s local unit at Providence Visiting Nurses Association, said, “When you look at the kind of cuts private equity organizations have made at other facilities, you can’t help but worry about the quality of care. We care deeply about providing the best possible care to people in their homes. Often that includes spending time to make sure the patient understands what they need to do and listening to their concerns. If we’re pushed to take care of more patients more quickly, that wouldn’t be good for us as nurses or, most importantly, to the patients we serve.”[62] The Washington State Nurses Association stated that, while Providence has said that all current nurses will keep their jobs, Providence has also indicated that Compassus plans significant changes to nurses’ benefits, including lost accumulated sick time, and that “Compassus does not intend to cover nurses under Providence’s health insurance plan, pension plan and tuition reimbursement program Providence currently provides.”[63]
[1] “Providence and Compassus Finalize Second Phase of Joint Venture for Home-Based Care Services in California,” Media release, Oct 1, 2025, https://blog.providence.org/national-news/providence-and-compassus-finalize-second-phase-of-joint-venture-for-home-based-care-services-in-california.
[2] “Providence and Compassus Finalize Second Phase of Joint Venture for Home-Based Care Services in California.”
[3] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus (2025), https://www.oregon.gov/oha/HPA/HP/HCMOPageDocs/043-Preliminary-Report.pdf. Pg. 10
[4] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 10
[5] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 10
[6] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 10
[7] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 10
[8] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 10
[9] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 10
[10] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 11
[11] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 11
[12] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 11
[13]“Preying on the Dying: Private Equity Gets Rich in Hospice Care,” CEPR, April 25, 2023, https://cepr.net/publications/preying-on-the-dying-private-equity-gets-rich-in-hospice-care/.
[17] “Providence and Compassus Announce Joint Venture for Home-Based Care Services.”
[18] “Why More Hospital Systems Are Teaming with Home Health Companies,” accessed May 8, 2026, http://www.modernhealthcare.com/post-acute-care/mh-bayada-compassus-hospital-home-health-partnerships/.
[19] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 10
[20] “History & Sponsorship,” accessed May 8, 2026, https://about.ascension.org/about-us/history-sponsorship.
[21] “History & Sponsorship.”
[22] Jim Parker, “Compassus Expands Services, Footprint Via Ascension Saint Thomas Partnership,” Hospice News, October 20, 2023, https://hospicenews.com/2023/10/20/compassus-expands-services-footprint-via-ascension-saint-thomas-partnership/.
[23] Parker, “Compassus Expands Services, Footprint Via Ascension Saint Thomas Partnership.”
[24] “Compassus and Ascension Expand Tennessee Home Health Partnership,” accessed May 7, 2026, https://about.ascension.org/news/2024/01/compassus-and-ascension-expand-tennessee-home-health-partnership.
[25] Parker, “Compassus Expands Services, Footprint Via Ascension Saint Thomas Partnership.”
[26] “Compassus and Ascension Expand Tennessee Home Health Partnership,” accessed May 7, 2026, https://about.ascension.org/news/2024/01/compassus-and-ascension-expand-tennessee-home-health-partnership.
[27] “Bon Secours and Mercy Health Announce Intent to Merge | Bon Secours,” accessed May 7, 2026, https://www.bonsecours.com/about-us/news/ministry/2018/bon-secours-health-system-and-mercy-health-announce-intent-to-merge.
[28] Bon Secours Mercy Health, “Bon Secours Mercy Health and Compassus Finalize Hospice and Home Health Partnership,” Bon Secours Mercy Health, May 7, 2024, https://bsmhealth.org/bon-secours-mercy-health-and-compassus-finalize-hospice-and-home-health-partnership/.
[29] “Bon Secours Mercy Health and Compassus Announce Partnership for Home Care and Hospice,” Compassus, n.d., accessed May 6, 2026, https://www.compassus.com/news_items/bon-secours-mercy-health-and-compassus-announce-partnership-for-home-care-and-hospice/.
[30] “Bon Secours Mercy Health and Compassus Announce Partnership for Home Care and Hospice.”
[31] “Bon Secours Mercy Health and Compassus Announce Partnership for Home Care and Hospice.”
[32] “Bon Secours Mercy Health and Compassus Announce Partnership for Home Care and Hospice.”
[33] “OhioHealth and Compassus Finalize Partnership for Home Health and Hospice,” OhioHealth and Compassus Finalize Partnership for Home Health and Hospice, accessed May 8, 2026, https://newsroom.ohiohealth.com/ohiohealth-and-compassus-finalize-partnership-for-home-health-and-hospice/.
[34] OhioHealth Compassus Final. Partnersh. Home Health Hosp., “OhioHealth and Compassus Finalize Partnership for Home Health and Hospice.”
[35] OhioHealth Compassus Final. Partnersh. Home Health Hosp., “OhioHealth and Compassus Finalize Partnership for Home Health and Hospice.”
[36] OhioHealth Compassus Final. Partnersh. Home Health Hosp., “OhioHealth and Compassus Finalize Partnership for Home Health and Hospice.”
[37] “Why More Hospital Systems Are Teaming with Home Health Companies.”
[38] “Why More Hospital Systems Are Teaming with Home Health Companies.”
[39] “Providence and Compassus Finalize Second Phase of Joint Venture for Home-Based Care Services in California.”
[40] “Providence and Compassus Finalize Second Phase of Joint Venture for Home-Based Care Services in California.”
[41] “Providence and Compassus Finalize Second Phase of Joint Venture for Home-Based Care Services in California.”
[42] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 3
[43] “Providence and Compassus Finalize Second Phase of Joint Venture for Home-Based Care Services in California.”
[44] “Providence and Compassus Finalize Second Phase of Joint Venture for Home-Based Care Services in California.”
[45]Oregon Health Authority, “Executive Summary, Comprehensive Review: 043 Providence-Compassus.”
[46] Muoio, David, “Providence, Compassus’ home-based care joint venture launches in California,” Fierce Healthcare, Oct 3, 2025, https://www.fiercehealthcare.com/providers/providence-compassus-home-based-care-joint-venture-launches-california.
[47] Muoio, David, “Providence, Compassus’ home-based care joint venture launches in California,” Fierce Healthcare, Oct 3, 2025, https://www.fiercehealthcare.com/providers/providence-compassus-home-based-care-joint-venture-launches-california.
[48] “Providence and Compassus Finalize Joint Venture for Home-Based Care Services in Alaska, Texas and Washington,” Compassus, n.d., accessed May 6, 2026, https://www.compassus.com/news_items/providence-and-compassus-finalize-joint-venture-for-home-based-care-services-in-alaska-texas-and-washington/.
[49] Morgan Gonzales, “Inside Compassus’ 2-Pronged Plan To Expand Providence Joint Venture,” Home Health Care News, November 12, 2025, https://homehealthcarenews.com/2025/11/inside-compassuss-2-pronged-plan-to-expand-providence-joint-venture/.
[50]Oregon Health Authority, “Executive Summary, Comprehensive Review: 043 Providence-Compassus.”
[51] Holly Vossel, “Compassus, Providence Home-Based Care JV Grows Into California, Oregon,” Hospice News, October 9, 2025, https://hospicenews.com/2025/10/09/compassus-providence-home-based-care-jv-grows-into-california-oregon/.
[52] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 13
[53] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 13-14
[54] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 13-14
[55] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 13-14
[56] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 18
[57] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 18
[58] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 18
[59] Oregon Health Authority, Preliminary Review Report: 043 Providence – Compassus. Pg. 20-21
[60] “ONA Statement on Providence’s Joint Venture with Compassus – Oregon Nurses Association,” accessed May 9, 2026, https://www.oregonrn.org/page/providencejointventure.
[61] “Providence Home Health Nurses Concerned about Takeover by Private…,” WSNA, accessed May 7, 2026, https://www.wsna.org/news/2025/providence-home-health-nurses-concerned-about-takeover-by-private-equity-backed-compassus.
[62] WSNA, “Providence Home Health Nurses Concerned about Takeover by Private….”
[63] WSNA, “Providence Home Health Nurses Concerned about Takeover by Private….”
