Angels in Your Home LLC has prospered in a tough business. Over the past four years, the home care provider has grown from 35 to more than 1,000 workers.
The privately owned, for-profit agency’s success, said President Andrew Wegman, is due to “our ability to treat the business like a family. We’re family owned, and I work with three brothers.”
Angels in Your Home started as a tiny adjunct of the Wegman family’s Hilton East Assisted Living LLC, a privately owned, 205-bed for-profit facility in western Monroe County. Headed by Wegman’s father, David Wegman, Hilton East ranked as the largest facility of its type on the Rochester Business Journal’s 2015 list of assistive living communities.
Spurred by what the Wegman family saw as a growing need for home-care services, Angels in Your Home moved into the general home care market in 2012. The family’s assessment of the market was accurate.
With its office relocated from Hilton East to quarters on Lake Avenue, Angels has seen explosive growth over the past three years. In each of the past two years, its revenues have seen increases topping 90 percent.
Like other U.S. health care providers, Angels’ revenues largely are determined by a rate structure set by third-party payers. And for the home care market, rates are determined by government agencies for the most part. The payer is Medicaid in the segment in which Angels in Your Home does almost all of its business—New York’s Consumer Directed Personal Assistance Program.
“We probably do 90 percent of our business in CDPAP,” Wegman said.
A government insurance program aimed at the poor, Medicaid is funded jointly by states and the federal government. States cover approximately half of Medicaid’s costs. Following federal guidelines laid down by the federal Center for Medicare and Medicaid Services, each state designs and administers its own Medicaid program.
In New York, Medicaid pays less than the cost of care, say many providers. For home care, Medicaid pays close-to-the-bone reimbursements that make for razor-thin margins, said Michael Wegman, Angels in Your Home’s chief financial officer.
State Department of Health auditors keep a close eye on CDPAP home care providers throughout the year, making sure services are delivered efficiently without letting quality standards slip. If an agency is well run, the Health Department and the Department of Financial Services, which jointly oversee the state’s Medicaid program, set favorable rates for it but leave scant room for error. Angels in Your Home so far has stayed profitable, Michael Wegman said.
CDPAP clients are chronically ill or disabled individuals who need home aid and nursing assistance on a continuing basis.
The consumer-directed part of the program puts home care clients in charge of hiring and training their own aides. Clients can choose family members or friends or hire an aide provided by an agency such as Angels in Your Home. In either case, the agency administers the case as the payee of Medicaid reimbursements and payer of aides’ salaries.
A relative latecomer to the local CDPAP market, Angels in Your Home pulled even with and surpassed more established local competitors. Maxim Healthcare Services Inc.’s staffing showed 60 percent growth from 550 to 880 people over a two-year period. During the same span, Angels in Your Home’s employment growth topped 1,000 percent.
Andrew Wegman largely attributes his agency’s rapid and sustained growth to the family’s 2012 decision to pay aides a then above-market rate of $11 an hour. The relatively high pay fostered employee loyalty, which in turn has helped foster client satisfaction by ensuring care continuity, he said.
Wegman sees plenty of room for continued growth. The market for CDPAP services is growing and will continue to expand, he believes. That is partly because, under a Medicaid reform program begun in 2012, New York intends to shift much of the state’s long-term care from institutional settings to home care.
The reform effort largely dovetails with a growing consumer preference, Wegman believes. Most of those who need long-term care overwhelmingly prefer getting help in their own homes to nursing homes or hospital care.
Licensed in nine counties, Angels in Your Home provides services in four. The agency could also grow by moving into new territories, Wegman said. But the family is cautious. Such expansion would require added infrastructure, satellite offices and supervisory personnel.
#5 Angels in Your Home LLC
Full-service home care agency
2016 ranking: 5
Top executive: David Wegman, CEO
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