Company: Accurate Home Care
Year Founded: 2002
Annual Revenue (2013): $48.3 million
Employees: 4,000 (full and part time)
Category: Health Care and Biotechnology
What It Does: Provides personal care and extended hour nursing for adults and children, as well as respite care, skilled nursing care, mental health care for children, and therapies.
Amy Nelson learns fast. That’s a good thing: She’s been running her own business since she was 18.
After a couple of home care jobs in high school, Nelson changed her plan to become a nurse and instead majored in health care management, later earning a master’s degree in business administration. On that foundation she built Accurate Home Care into a business with 1,500 clients across Minnesota, Illinois and Iowa. Nelson says that she’s done that by providing skilled, reliable caregivers in an industry where the jobs aren’t always the workers’ first choice.
“Traditionally, when people think about home care they think about the elderly, Medicare population,” Nelson says. “What we do are cradle-to-grave services.”
Early on, gaining credibility in the industry was a challenge. But Nelson perservered. “I heard a lot of no’s but doctors and people making referrals were intrigued that I was a newbie and willing to try new things,” she says. “I learned not to give up.”
Accurate Home Care provides personal care and extended hour nursing for adults and children, as well as respite care, skilled nursing care, mental health care for children, and therapies. About 60 percent of the company’s clients are under age 18. Last year the company added Medicare-funded services, which continue as long as the recipient’s condition is improving.
Other clients, supported through funding sources that include Medicare, Medicaid and private insurance, will probably need care for the rest of their lives. Terri Dock’s son, Jacob Brown, is one of the clients who will always need care. After her son was paralyzed in a diving accident 11 years ago, the Inver Grove Heights resident used several different home health care agencies.
“Because Jacob is paralyzed from the neck down and on a ventilator, the nurses who care for him need complex skills,” Dock says. “It was hard to get those people with other agencies. That’s why we went with Amy. We haven’t gone more than a day or two without assistance.”
Nelson acknowledges that finding good hires is a challenge. “The employee turnover in home health care averages 50 percent,” she notes. “We average 30 percent.”
The reasons lie partly in cultural ideas about job desirability. “In nursing school, they teach you that the hospital is the place to be, and if you can’t get a job anywhere else, you go into home health care,” Nelson says. “Part of my mission has been building a quality provider, so that employees want to come here.”
To attract qualified, dedicated professionals, Nelson has offered health insurance as an employee benefit in the past. Ironically, the Affordable Care Act (ACA) has raised the cost of employee benefits for Nelson, even as it’s allowed the company to sell services to newly insured clients.
“I’m happy with the ACA in many ways, but on the employer side, the cost of benefits doesn’t help at all,” she says. Accurate Home Care dropped coverage for 2014 because premiums were so high, but will start offering the benefit again in 2015, both as a way of attracting quality employees and because “we can’t afford the fines,” Nelson says. “We’re taking a year off so that insurance companies will rate us without claims data,” which will probably mean lower premiums.
Nelson owns 36 percent of her company. She sold another 37 percent to private equity investors in 2007 to buy out her ex-husband as part of a divorce settlement. Her managerial staff owns stock as well.
Much of Accurate Home Care’s growth has come from an expanding client base, but acquisitions have also fueled expansion. The company bought A+ Health Care in Moline, Ill., as a way to move into Iowa and Illinois, and funded that deal in part with equity.
Some home health care companies don’t want to do business under the ACA, which has created a buyer’s market in the industry. Nelson thinks that this is an opportunity for her company, which will probably buy more businesses this year. “I have three on my desk right now,” she says. “ If Nelson picks right, she’ll have to learn how to run a big company. “I think we can reach $300 million in net annual revenue,” Nelson says. “Then we’ll decide if we want to go public or stay private.”