The New Normal: Day in the Life of BrightSpring’s Home Health Leader Amid COVID-19

In a normal week, Rexanne Domico — president of home health care and rehabilitation at BrightSpring Health Services — might be back and forth between Charlotte, North Carolina, where she lives, and Louisville, Kentucky, where her company is headquartered.

Or maybe she’d be hopping around the South, visiting BrightSpring’s newest locations, which the home- and community-based care provider gained as a result of its March 1 acquisition of Advanced Home Care.

But amid the COVID-19 emergency, Domico’s days are anything but normal. In fact, she hasn’t traveled in weeks — since March 10, to be precise, when she went to Nashville for some business in the market.

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“[I was] thinking that I could get in and out … before things got really complicated,” Domico told Home Health Care News. “But my travel time there was almost useless because it ended up turning into me having to sit in a room and firefight around what was starting to happen with COVID. … [From there,] it became very constant, every part of our day.”

Since then, her schedule has been packed with all things coronavirus, all the time. On top of that, her to-do list is longer than ever — which is saying something, considering how busy BrightSpring has been in the past year and a half or so.

In August 2018, the company rebranded, changing its name from ResCare to the one it holds today.

Then, in March of last year, BrightSpring was acquired by global investment firm KKR and an affiliate of Walgreens Boots Alliance Inc. (Nasdaq: WBA) for $1.32 billion. As part of the deal, BrightSpring merged with PharMerica Corporation.

All the while, the provider continued to do mergers and acquisitions of its own. BrightSpring cares for tens of thousands of patients per day across 49 states, with a total of 11 service lines. That includes home health, which BrightSpring offers in six states.

Domico oversees those operations and a total of four business lines, which in the new COVID-19 climate means early mornings, late nights and entire afternoons spent trying to procure personal protective equipment (PPE).

She gave HHCN an hour-by-hour account of a recent day in her life.

Monday, April 6

Domico’s mornings usually start around 5 a.m., with her work days kicking off shortly after. Such was the case on Monday, April 6.

First thing’s first: Every day, she checks to make sure nothing major has happened overnight that needs her immediate attention. Then she’s out the door.

“On my way into work every morning, I call a person that I either work with currently and haven’t talked to in the last couple of days or someone from a competitive organization that I know or have worked with,” she said. “[The goal is to] stay as up-to-date and current with what’s going on as possible — and to touch as many employees as possible.”

By 7:15 a.m. or shortly thereafter, Domico’s in her office. While many home-based care organizations have chosen to move to an entirely remote corporate and leadership structure amid COVID-19, BrightSpring has taken a different approach.

That means a combination of staggered start times and reduced scheduling, as well as having some leaders come in on different days.

“We’re trying to keep our offices open, even if it’s on a reduced schedule,” Domico said. “We just find that in certain cases, every single thing can’t be done from home.”

The reasoning behind the decision is that BrightSpring’s offices, in many cases, have become mini-distribution centers, where PPE is delivered and then picked up by caregivers. But, ultimately, office logistical decisions vary by market and are up to the local leaders in those geographies — folks Domico is trying to check in with regularly.

As one could probably deduce from Domico’s early morning calls, communication has been a key part of BrightSpring’s coronavirus response.

Early on, the organization set up Microsoft Teams channels to allow leaders to seamlessly communicate updates with those in the field and across the organization. It works like a bulletin board, giving employees “one source of truth” for best practices and procedural changes. Leaders have also worked with their IT teams to blast out messages to caregivers.

In that same vein, Domico spends large swaths of time wrapped up on conference calls, on top of her regular duties. In fact, her days are somewhat dominated by them. She flipped through her April 6 schedule and rattled off the full list.

“I had one, two, three, four [calls],” she counted, trailing off before settling on the final number. “[On April 6,] I had nine conference calls.”

Topics for those usually run the gamut. First, on April 6, it was telehealth and all the logistical complexities that come with it. While BrightSpring has always had a telehealth component, COVID-19 has prompted the company to look into how to best expand those capabilities.

“We’re exploring whether picking up the phone and talking to a patient is enough and whether we should be bringing some of those calls into our call center and having clinicians actually managing that,” Domico said. “Then also, do we need technology in the home to support telehealth?”

BrightSpring’s aim is to do what’s best for patients, even if it’s not always best for the company’s bottom line. That means offering necessary telehealth services to home health patients, even though the Centers for Medicare & Medicaid Services (CMS) won’t pay for them.

As a large PE-backed provider, the organization is in a good place to do that; but other providers aren’t so lucky.

“We would like to think that CMS will recognize the opportunity to increase reimbursement around telehealth or to provide reimbursement around telehealth,” Domico said. “We think that this crisis has certainly shined a light on the need for telehealth and the need for providers to have some reimbursement in that area so that we can better take care of people.”

Next up on the call log was troubleshooting background checks. Namely, how can BrightSpring hire new caregivers in states where courts and fingerprinting establishments are closed? It’s something they’re figuring out.

While elective surgeries are down, the company is preparing for an onslaught of coronavirus cases, Domico told HHCN during the early April conversation.

“I am having regular … check-in calls with our hospital partners, just to make sure that we are prepared for what they need,” she said. “They are talking to us about what they are seeing and forecasting — and what they believe that their needs are going to be.”

An executive committee meeting call came next, followed by a new site planning check in to determine whether or not to proceed with opening new rehab facilities that were planned pre-coronavirus. Then, an integration call with Advanced Home Care.

By that point, Domico was well into the afternoon.

“Talk about interesting — to do an acquisition on March 1 — then be full out dealing with COVID-19 by March 6,” she said.

Call No. 6 was a check in with the new acquisition’s leadership team. By the time that finished, the clock read 4 p.m. — time for Domico’s daily standup with her direct reports and other key members of BrightSpring’s leadership team.

Like always, the call centered around COVID-19 cases and concerns, as well as considerations for employees. Every day, the team goes over new positive COVID-19 cases and how to adapt.

The team keeps track of cases in a database, which includes information on both patients and employees. The database helps BrightSpring keep track of individuals who have tested positive and those who are presumed-positive; it also helps the company keep track of untested individuals who are showing symptoms.

“We go through that list, … [and] I’m determining whether I need to check on any one group or any one individual — it might be an employee,” Domico said.

At the time of the interview, Domico noted a total of about 15 cases across her divisions, whether those be patient or employee cases, but said BrightSpring was prepared to take on more as needed to help free up the beds of hospital partners.

In general, data has been key to guiding Domico’s decision-making across the four arms of business she oversees. She uses the information, along with projections, to inform what will be best for BrightSpring in the days and months to come. But because the landscape is quickly changing, there’s also a lot of contingency planning.

“I am looking at my metrics differently, understanding how we impact and improve them in this environment,” she said. “Do I need to do something about shifting resources or shifting cost? Do I need to have more people looking at a certain issue before it becomes a larger issue? There’s just a lot of room for new logistics that come in.”

One of those logistics is PPE, which is usually a pervasive part of Domico’s day-to-day, making its way into many of her conversations. She estimates that two to three hours of her afternoons are typically spent on PPE management.

In fact, after a 5 p.m. COVID-19 executive call, still on April 6, Domico spent her last conference call of the day discussing PPE needs across her markets.

BrightSpring quickly went through the PPE it had on hand at its facilities when the coronavirus first broke out, with leaders realizing they would need to shore up a lot more. In response, they set up a central PPE supply center in Kentucky, where emergency kits are assembled and then sent across the country to locations with positive patients.

BrightSpring aims to equip every caregiver with masks and gloves for a home visit. For COVID-19 positive patients, that’s not enough and more supplies are required. But getting adequate amounts of PPE is a challenge for any provider, BrightSpring included.

“My biggest surprise has been how difficult it would be to get PPE into the hands of the people who need it,” Domico said.

Every day, she and BrightSpring’s purchasing experts check in with vendors and other sources to make sure they’ll be able to get the PPE they need to keep caregivers safe. It’s a team effort, with assists even coming from outside the organization.

“We also got very busy contacting our local distilleries,” Domico said. “I have put family members to work going to pick up hand sanitizer from our local distilleries, and we’ve been driving and distributing it very quickly in the Carolinas and as far as Georgia. We have co-workers doing the same things in Kentucky, the Midwest and other areas so that we can get … our staff the things that they really need to feel comfortable continuing to do their jobs.”

PPE remains a struggle for BrightSpring.

Back on April 6, by the time Domico is wrapping up, it is about 8 p.m.

“So I go home and try to eat something,” she said. “Take a walk, so that I can breathe and have a little bit of mental health, then go to bed and start all over again.

And for as long as the COVID-19 crisis persists, that’s Domico’s new normal.