How April Anthony Made A $700 Million Fortune In One Of The Toughest Corners Of U.S….

Anthony built her home healthcare empire during an industry slump that wiped out nearly a third of her competitors. Now she’s facing her biggest challenge yet with Covid-19.  

^“I spend my drive to the office praying,” says April Anthony, her voice breaking. The CEO of the fastest-growing division of publicly traded Encompass Health, she runs the country’s fourth-largest Medicare-approved provider of home healthcare. 

Since coronavirus was declared a global pandemic in early March, she’s been working overtime from her office on the 13^th floor of a Dallas high rise to keep her 8,000-plus nurses and therapists safe from Covid-19. She’s also responsible for 40,000 high-risk patients. Most are elderly and many are dying or chronically ill. She fought to secure protective gear and devised a system to monitor Encompass’s clinicians, who take their temperature daily and self-screen using a CDC questionnaire. She is offering telehealth visits for the first time even though Medicare doesn’t reimburse for those appointments. Beyond the immediate health risks to her staff and patients, the coronavirus has wreaked havoc on her business, knocking visits down by as much as 30% in mid-April. 

Throughout her career, Anthony, 53, has beat the odds in one of the most difficult corners of U.S. healthcare. In December 1997, she was fired while giving birth. In the nineties, when caps on Medicare reimbursements and burdensome regulatory changes wiped out nearly a third of home care providers, she acquired more than a dozen failing agencies and established her first company, Encompass Home Health & Hospice. She amassed her $700 million fortune by gradually selling stakes in Encompass and a lucrative software business she’d spun out of it. 

Nothing prepared her for Covid-19, but her experience, determination and Christian faith help her cope on the darkest days. Now with many states reopening, and elective procedures such as hip replacements restarting, patient visits are nearly back to pre-Covid levels. While she acknowledges a resurgence of the virus could change everything again, she sees home care as a safer — and cheaper — alternative to nursing homes ravaged by the pandemic. “We can care for patients in their home where their only exposure is to their family and their individual caregiver who comes in with a fresh set of PPE every time,” she says. Medicare-reimbursed home visits cost nine times less than the average daily nursing home fee.   

U.S. Spending On Home Health vs. Nursing Homes

Anthony did not set out to be a home healthcare mogul. Growing up in the Houston suburb of Kingwood, she imagined she’d lead a quiet, traditional life. The daughter of an accountant and a homemaker, she went to church three times a week with her family. “I thought I was going to be a stay-at-home mom,” she says. “I’d just get a job for a year or two first.” In 1991 she married her college classmate, Mark Anthony, who was beginning a career as a stockbroker.

The following year, she took a job that changed her life. Through her brother, whose business partner owned the company, she got a controller post at a Fort Worth home health agency with a subsidiary, Liberty Health Services, that had run up losses of $150,000 and was on the verge of shutting down. A new agency with some 25 employees, it serviced 50 home-bound patients in the greater Fort Worth area. It had gotten caught in a maze of government bureaucracy that delayed its Medicare payments.

At her boss’s request, she tried to find an acquirer, but after a dozen meetings, she came up empty. “I don’t like to lose,” she says. She made a rash proposal: if she could reverse the losses within seven months, her boss should make her the company’s new owner. He agreed and she got a $150,000 line of credit with her father-in-law as the guarantor.

^{April Anthony at home in Highland Park, Texas. Photo by Jeff Wilson for Forbes}

Within a year, she’d turned the losses into profits, paid back what she’d borrowed and squeezed out a $10,000 salary for herself. Her strategy: fire all but two office staffers and handle most of the accounting and administrative work herself. 

She went on home visits with her health aides so she could talk convincingly with doctors about how Liberty cared for patients with chronic heart and lung conditions. She was able to bring Liberty’s cost of treatment 25% below what Medicare would reimburse. To raise operating capital, in 1993 she sold an 85% stake to Dallas investor Mark O’Brien.

After her first child, a daughter, was born in 1995, she set up a nursery next to her office with a full-time nanny. In 1996, Liberty’s revenue hit $32 million. At the end of the year, Home Health Corporation of America (HHCA) bought Liberty for $40 million in stock and cash. Anthony joined the parent company as a vice president for the southwest region. 

It was a terrible fit. In a meeting at HHCA’s King of Prussia headquarters, she recalls, “all these guys were just f-bombing all over the place. On top of just being crude, everything they’re saying is just so opposite of the way we had run our business.” In the meeting, she says she learned that HHCA overpaid to rent office space in assisted living facilities and hired patient care coordinators to work in doctors’ offices, effectively giving kickbacks for patient referrals.

When she refused to follow suit, concerned about potentially violating Medicare law, she says she became an “outsider” in the company. Less than a year later, while she was giving birth to her second child by scheduled C-section at a Dallas hospital, her bosses sent a termination letter to her home fax machine. 

“It turned out to be the best day of my career,” she says. Seven months later, HHCA began downsizing. It closed its Texas operations and later filed for bankruptcy. A subsequent criminal investigation found that HHCA had violated federal anti-kickback law. (HHCA settled in 2005.) Anthony filed a wrongful discharge claim with the EEOC and settled with HHCA, which paid out her contract. (HHCA liquidated in 2010.)

“I had no business owning a business at 25. But I knew from that time forward that this is what God was calling for me.”

HHCA’s implosion voided her non-compete agreement, and drawing on the $3 million in cash she’d made when she sold Liberty, she went on a buying spree. She acquired 17 struggling home healthcare providers for less than $500,000. The deals launched the company, Encompass Home Health & Hospice, where she built her fortune. 

To help manage the government red tape that was decimating the industry, she hired a team to develop medical records software. The project drained $2.5 million from Encompass’s cash reserves and in 2001, she spun it out as Homecare Homebase. 

At the start, the software company kept losing money but Anthony held on. “I was so bullheaded, I refused to fail,” she says. She finally scored a $4 million contract to sell her source code to healthcare giant Gentiva in 2006. The deal attracted customers and Homecare Homebase became cash-flow positive in 2007. 

In 2011, she and her husband sold a 40% stake in Homecare Homebase to private investors at a $150 million valuation. She now calls that sale her worst deal ever. “I should have held on,” she says. Two years later, Hearst bought out those investors and most of the Anthonys’ stake at a $625 million valuation. Homecare Homebase was worth $2 billion when she sold the last of her stake to Hearst healthcare group in early 2020. She still made $422 million after tax from the sales.   

“She created the most efficient software because she was the most efficient operator,” says Paul Kusserow, CEO of one of her main competitors, Baton Rouge-based home healthcare provider Amedisys. “She split her companies, spun them out and hit a double,” he says.

Meanwhile, Encompass, the home healthcare business that she continued to run, was thriving and attracting its own suitors. In 2004 she started selling off chunks to private equity firms, including a 67% stake to Chicago-based Cressey & Company at a valuation of $280 million. 

She says that by 2014 some 45 buyers were clamoring to acquire stakes in Encompass, including publicly-traded HealthSouth, which wanted to make Encompass a subsidiary. But she was reluctant to sell the whole company after getting burned by HHCA. 

While she was concerned that HealthSouth’s reputation had been battered more than a decade earlier by a massive accounting scandal, its 21% market share in the inpatient rehab industry offered a great patient referral network. She accepted HealthSouth’s offer in late 2014. (The parent company changed its name to Encompass Health in 2018.)

For nearly two decades, Anthony served as CEO of two demanding companies, while raising three children (the youngest was born in 2000). This January, she left the software job, thinking she might finally get to work less. With her children out of the nest, she spent weekends golfing (she has an 8 handicap) and zipping around Dallas in her three sports cars, including a new deep plum-colored Bentley, a black 2018 Rolls-Royce Wraith and a white 2016 McLaren 650S.

^{Before Covid: Anthony with her McLaren 650S, shot in January 2020. Photo by Jeff Wilson for Forbes}

The pandemic changed everything. Since March she hasn’t driven much farther than the six minutes to the office, her time to gather her thoughts and connect with God, she says. Faith is a defining theme in her life. Though Texas is reopening, she and her family are still taking precautions and worshipping at home, attending virtual Sunday services given by Preston Road Church of Christ in Dallas. She and her husband have donated $57 million to their alma mater, Abilene Christian University. At new employee orientations, which happen 40 times a year, she repeats a proverb that she says has guided her life: “God does not call the equipped, he equips the called.” 

“I had no business owning a business at 25,” she says. “But I knew from that time forward that this is what God was calling for me.”

What is God calling for her next? Her competitor Kusserow says it’s time for her to start another company. “There would be a line around the block of people who would give her money,” he says.

Her current priority is making sure Encompass weathers the storm, but she has been contemplating founding a care-management company that both helps elderly patients before they fall ill and delivers affordable, compassionate palliative care. “People get sick, they go to the hospital, spend a ton of money, they go to home health, spend some more money, they get no care for a while and then they get sick again,” she says. “Patients at the end of life are spending so much money on chronic conditions and no one’s really sat down and asked, ‘What do you want?’”

The Covid-19 crisis has renewed her determination to help people find a more humane way to die. One Encompass hospice patient, locked down in a nursing home, was unable to see her husband, who was suffering from congestive heart failure. Encompass made it possible for the wife to come home so the couple could get hospice care and die together, surrounded by their children. “Life is going on, death is going on, unrelated to Covid,” she says, her voice breaking a second time. “How can we turn an awful death into a good death?”