Just a few weeks after "retiring" as founding CEO of Providence Service Corp. last November, Fletcher McCusker handed his wife a five-page document, and it wasn't a vacation brochure.

It was a business plan.

"She looked at it and said, "What took you so long?" McCusker recalled.

Now, after starting Providence in 1997 and watching it grow to a half-billion-dollar behavioral services provider, McCusker is back in the home-based health care business with a new company, Sinfonía HealthCare Corp.

And McCusker can also pursue his other passion: boosting economic development.

McCusker, who is chairman of the Rio Nuevo downtown development district, moved Sinfonía into new, old digs at 1 E. Toole Ave., a former produce warehouse. Along with owner Peach Properties he has turned it into a hip, open office space split with a new, collaborative workspace, the Toole Avenue Hive.

It's the second downtown rehab project for McCusker and Peach. McCusker spearheaded Providence's 2010 move into the historical Scott Building at 64 E. Broadway, where it still resides.

McCusker retired from Providence in November, officially to pursue other interests, but he acknowledged that differences with the company's board had much to do with the separation.

The board of the roughly half-billion-dollar company was too focused on short-term gains, McCusker said, while he had advocated to diversify into new markets. Providence provides home-based behavioral health and non-emergency transportation.

After he left Providence in mid-November with Chief Financial Officer Michael Deitch, McCusker dusted off his idea to form a company offering an array of home-based health services, such as therapy and medical equipment, all under one roof.

Restless over the Thanksgiving weekend, McCusker sat down and started with the company name, which means "symphony" in Spanish; he wrote the business plan overnight before presenting it to his wife, Liz, as an alternative to their tentative plan to retire to their home in Laguna Beach, Calif.

"She said, 'This is what you do, you should do this,' " he recalled.

As word spread, McCusker said, he got a call from Robert Sarver, Phoenix Suns owner and chairman of Western Alliance Bancorp, offering lending help. He was offered a $10 million credit line from Alliance Bank of Arizona, and other lenders stepped up to form a $25 million kitty for acquisitions to start the company.

In April, Sinfonía agreed to purchase a 49 percent interest in Tucson-based Assurance Home Care and Assurance Caregivers. The company subsequently acquired Serenity Hospice, a local home-based hospice care service; and AirVida, a Tucson-based oxygen and sleep-therapy company.

With those pieces in place, McCusker said, Sinfonía can offer a "continuum" of services designed to keep people at home: skilled nursing; companion care; occupational, physical and speech therapy; oxygen and other home medical equipment; and hospice care.

"Health care is a very fragmented business - it's vertical. You're a hospice - you're a hospice only. You're a home-health nursing agency - you only do nursing," he said. "None of them combine all the home health-care products under a single roof, so that became our business plan."

So far, the concept has been well-received by insurers, hospital discharge planners and physicians, McCusker said.

Interest should only increase under the federal health-care reform law, which favors home care as long as possible, he said.

"The driver for all this is the Affordable Care Act. Under the new rules, as you and I age, they can't just stick us in a nursing home. You're going to have to demonstrate that home health care was unsuccessful," McCusker said, adding that some 45 million people are expected to be eligible for such services in 2014.

McCusker said Sinfonía's plan is to grow locally first.

"If we can pull this off to where it becomes the preferred model, then we'll replicate it. We'll go to another community, another state," he said.

McCusker said he's had no trouble attracting talent to add to the 50 employees inherited in the acquisitions. Providence alum Deitch is Sinfonía's CFO and helped launch the company, and former Providence information technology chief Jeffrey Pochily is chief information officer. Sinfonía has kept executives of the acquired companies, and recruited others.

Sheri Bracamonte, a speech therapist and an old family friend of McCusker's, ran her own therapy firm for six years and was set to take a new job when McCusker called.

"I was used to getting up and doing my own thing for 14 years," said Bracamonte, now director of rehabilitation services for Sinfonía.

fostering innovation

The Toole Avenue Hive is no small part of McCusker's vision for Sinfonía, and for downtown.

The Hive occupies half of the open space of the former produce warehouse, divided by a glass wall framed in welded steel.

The co-workspace has formed a link with the University of Arizona's Eller College of Management to provide space for budding students in Eller's top-rated entrepreneurship program, the McGuire Center for Entrepreneurship. Three student-run companies are expected to arrive in August.

The Hive is part of the emerging Downtown Innovation District, which also includes Gangplank Tucson, a nonprofit co-workspace in the old Pioneer Building; Maker House, an artisan-focused collaborative space opening in September in the historic Bates Mansion; and Xerocraft Hackerspace, a tech-oriented nonprofit work space, which will soon move into the Steinfeld Warehouse.

Startup Tucson, a nonprofit, tech-oriented startup business group based at Gangplank, has already set up an office at the Toole Avenue Hive.

The head of Eller's McGuire Center said the Hive will become a nexus for innovation and business.

"Every community with a great university needs a great business environment with a vibrant entrepreneurial spirit of innovation," Bob Lusch, executive director of the McGuire Center, said in an email, calling the Hive "a keystone species in the Tucson innovation ecosystem."

"Under the new rules, ... they can't just stick us in a nursing home. You're going to have to demonstrate home health care was unsuccessful."

Fletcher McCusker, founder and CEO of Sinfonía

Contact Assistant Business Editor David Wichner at dwichner@azstarnet.com or 573-4181.