Since joining BrightSpring Health Services in the fourth quarter of 2016, CEO and President Jon Rousseau has helped lead a massive transformation of the Louisville, Kentucky-based home- and community-based health services provider.
In August 2018, for example, Rousseau implemented a brand-revitalization consistent with an updated business strategy, with BrightSpring officially moving away from its former corporate “ResCare” name, which had been used for parts of five decades. Rousseau then maneuvered his company through an even bigger change in March 2019, when BrightSpring was acquired by global investment firm KKR and an affiliate of Walgreens Boots Alliance Inc. (Nasdaq: WBA) for $1.32 billion.
Under the deal, BrightSpring merged with pharmacy giant PharMerica. Today, the combined Pharmacy and provider-services enterprise and its affiliates operate across all 50 states, delivering a variety of services to more than 350,000 clients and patients daily.
As a changemaker focused on quality, growth and people, Rousseau plans to continue BrightSpring’s evolution while further refining its three-pronged strategy focused on pharmacy, non-clinical home care and highly clinical intermittent home health care services, all with a care management overlay to enable integrated care.
HHCN: How is BrightSpring trying to change how we care for vulnerable populations, including older adults, the chronically ill and individuals with intellectual or developmental disabilities (I/DD), among others?
Rousseau: These are certainly growing populations in our society with complex and specialized needs. They’re people that often have the highest level of needs and account for the highest costs in health care. How we take care of them is important to everybody — not only from an outcomes and personalization perspective, but also from a cost perspective. There are certainly ways to keep building on the care for acute, later stage, highly complex or chronic-condition individuals in a way that improves their quality of life — and lowers costs. The good news is that the right care — and better care — should lead to lower costs and greater client and patient satisfaction. We’re very focused on that.
We certainly have a unique platform, and we’re hopeful that it will be beneficial in the future. Our platform is centered around offering multiple essential services that we think are all required to optimally and holistically treat an individual with high needs, somebody with significant acute and/or chronic needs. We focus on three elements.
No. 1 is pharmacy services, the daily medication management component.
No. 2 is the non-clinical day-to-day caregiving components that revolve around social determinants of health.
No. 3 is clinical services provided on a more intermittent basis when required.
For us, those are the three legs of the stool, if you will. All with physician and/or clinician led care management capabilities that drive integrated care across these services, within innovative outcomes and value-based approaches.
With complex populations, if the medication therapy side is not under control or if there are day-to-day issues in the home environment — whether dietary issues, fall hazards, transportation barriers or grooming and bathing challenges — things can quickly spiral. And certainly things that are more clinical in nature — complications from COPD or heart disease, for example — can cause somebody to have to leave their home or current setting and go into a hospital and institutional setting.
So we’re focused on those three key areas because we see them all as risk factors. We actually see in many data sources, the majority of the time, when people run into health exacerbations, it’s because of issues related to medication difficulties and personal care or social determinants of health.
You talk about three legs of the stool, but BrightSpring is far more expansive than just three services.
Yes, within our three core areas, there are multiple service lines in each one. For example, in pharmacy, we have six different service lines. We serve the long-term care setting. We serve senior living communities. We serve individuals with intellectual and developmental disabilities, which is the behavioral health setting. We have a home infusion business, and we have a specialty pharmacy that provides critical and life-saving therapeutics, primarily for people with oncology needs. So within that pharmacy capability set, we have several different services across settings and populations.
Meanwhile, on the clinical side, we have both home health and hospice, including in, some cases, pediatric nursing services. We also offer rehab, with a highly clinical and phenomenal neurotherapies business called Rehab Without Walls. That’s life-changing therapy for people who’ve experienced ABI (acquired brain injury), TBI (traumatic brain injury) or stroke, which greatly improves the independence and trajectory of those we serve and completely changes the cost curve.
Then in the personal care area, our services can range from caring for seniors to behavioral health populations, including clinics for children and youth with autism spectrum disorder. And within the personal care arena, too, you have different client/patient populations and also payer sources. There’s Medicaid. There’s private pay. There’s VA. There’s commercial and managed care.
You joined BrightSpring in late 2016. How has BrightSpring changed over that time?
I’d say we’ve evolved and built on our historical capabilities in a few main ways.
First, we’ve had a strategic focus on the service lines in which we want to participate and grow, and which are complementary to optimize care. We’ve focused on building out more of a clinical capability set, whether that be through pharmacy, through home health and hospice, or through rehab. Many people don’t appreciate how even behavioral and I/DD populations have very significant medication and medical needs.
So, we’ve focused on further expanding clinical capabilities that are complementary and better enable integrated care. We believe one of our strengths in healthcare is not only scale to support required investments, but also diversification. We’ve pursued this with a real focus and purpose. We refer to our business mix as “complementary diversification,” because our various services all fit together to address what every one of our clients and patients potentially needs. Almost every one of our clients and patients, at some point, will need the pharmacy, non-clinical offerings and clinical services that we provide, in order to be best supported and to achieve the highest quality of life.
Secondly, we have heavily invested in our infrastructure components and capabilities, whether that be through people, processes or technology to support our caregivers, clinicians and operations teams. We’ve focused on building out a lot of the core infrastructure in the company through our systems and through continued advancements in our people.
And then lastly, we’ve tried to build on the history and legacy of quality within the organization. If you look at some of our quality statistics, we stand out in many areas. For example, in pharmacy, we have 99.998% order accuracy, 99.6% order completeness and 97.4% on-time delivery, all of which are very rare and almost unheard of in the pharmacy world. These are terrific service delivery statistics in our pharmacy business. We also drive a very material level of cost reduction and cost containment for all of our pharmacy customers by focusing on our formulary management, generic dispensing rates, therapeutic interchanges, split billing, quantity limit program, etc.
If you look on the home health side, our Home Health Compare star ratings are above the national average. We’re at 4 or higher, on average, and they keep trending upward. We exceed national averages on our discharge-to-community rates. We have positive value-based purchasing incentives and scores where we’re in Home Health Value-Based Purchasing Model (HHVBPM) states.
On the hospice side, our HIS (Hospice Information Set) composite score significantly exceeds the national average. Our HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), our overall rating of care, significantly exceeds the national average, as does our HIS Admission measures. So for all of the main metrics in home health and hospice, we exceed national averages handily, and are continuing to reduce hospitalization rates. That’s really satisfying to us. Of note, we’ve improved all of those quality measures at and after any acquisition that we’ve completed.
And if you look at our behavioral population, one of the metrics that can be extremely important is days spent at home. We’re trying to emphasize this critical and telling metric among the industry and to payer sources in the future. Ultimately, it’s days at home that can capture quality of life outcomes and costs for anyone in the health care system.
This is a compelling statistic in our behavioral business, where we are taking care of over 17,000 individuals with intellectual and developmental disabilities, or autism. These are not only people with I/DD, but they are also very medically complex, typically on eight or nine or more medications, with many I/DD clients resembling complex senior patients from a medical perspective.
Nevertheless, the average number of days spent at home for our I/DD population is over 360 days a year. You have a very high needs population, and we’re achieving annual days-at-home of over 360, keeping this highly complex population at home nearly all year. That’s a powerful statistic.
So, to summarize, we’ve tried to focus on quality as much as possible, in addition to strategy and infrastructure capabilities. We’ve continued to invest in quality — in both people and systems — and we continue to try to improve upon already very high client and patient satisfaction scores across each service line.
We’ve talked a lot about how BrightSpring has changed over the years. Now, looking at the U.S. health care system overall, that’s going through massive change, whether we’re talking about the shift toward home or the move toward value-based care. How do you see BrightSpring fitting into all that?
I think that’s one of the things we’re most excited about: how we fit into the future of health care. Our value proposition is entirely consistent with today’s health care mega trends. Look at the cost savings and outcomes our industries achieve — not just us, but our compatriot companies in the industries we participate in. The results that pharmacy and home care providers drive for other stakeholders in the health care system, whether you’re a patient or a payer, are very material.
I was at an industry conference at the start of 2020. Everybody was talking about the greater and continuing appreciation among payers out there, in terms of the outcomes that we are able to achieve in our community settings. The growth in demand is just so large. We have to continue to innovate and provide care in the most logical settings that we can, with individualized care plans. There are certainly always going to be many, many people who need to be in institutional settings for some period of time. You obviously can’t do everything in the home or transitional care setting, and different people require different services and settings based upon their circumstances. We need to partner to ensure coordination and good transitions of care where it makes sense.
We can also keep progressing in care management services to better care for somebody in the community or home more holistically and in a more connected way. That ties closely into technology and being able to connect with and track people in the home. There’s going to be 25 million to 30 million more seniors over the age of 65 in our country over the next 15 years. That is a huge increase. The value proposition of the services that we provide in our core industries is going to be very important.
Changemakers is all about change and reflecting back on your changemaking efforts. What are some specific change-centric efforts you’re particularly proud of?
The PharMerica combination has been a really satisfying experience to go through, both personally and professionally. It’s such a great organization. PharMerica’s service and quality performance are absolutely top notch. And I would say the success we’ve had in the integration is largely a product of making sure we have great people. We have a special culture at BrightSpring. We have something called our LEGACY culture. That stands for our core values of “leadership,” “environment,” “get going,” “attitude,” “communication,” and “you” being an example.
We have amazing and committed people, who enjoy making an impact and helping people live their best life. At the same time, we’ve tried to infuse the organization with additional talent when appropriate. It’s incredible what happens when you have great people in the right roles. We have a simple tagline internally of “work smart, do good … and make an impact.”
Another Changemaking effort I’m proud of is doubling down on our core strategy. You can spend a lot of time thinking and talking about strategy. We try to make that a pretty efficient process so we can spend the vast majority of our time trying to be people who execute and get things done. We laid out a strategy focused on scale, complementary diversification and integrated care, layering on more clinical capabilities. And we’ve been focused on living that out and trying to execute on that strategy over time. I’d say we’re still in the third inning of it. We’ve got a good five to 10 years here of a runway to continue to execute on that strategy, building out our capabilities across all target geographies.
The last area when it comes to changemaking would be our operational processes. Regardless of what industry a company is hypothetically in — whether it’s health care services, health care technology, medical devices, the financial industry or the tire-making industry — we want to be a company that does things really well from a process perspective. So having a focus on process efficiency and continuous improvement is something that’s been huge here.
We live in a world where there are always challenges — and in our industries, regular reimbursement challenges. There are regular regulatory changes and challenges. Sometimes, honestly, it’s frustrating to know that you deliver really great quality outcomes at a much lower cost, but you still face pressure on reimbursement. All the while, you’re trying to drive pay increases for your employees every year and trying to invest in technology — and in a lot of other areas. The reality is that our company has to continue to grow and broaden its impact, reaching more people who need services, so clients and patients in need don’t fall through the cracks. We have to do that through offering great outcomes. And, in turn, we have to do that through being really efficient — working smart.
We look at every department in the organization, whether field operations or internally in IT, finance, HR or any other corporate function. We have a PMO (project management organization) center of excellence, where we very deliberately and intentionally go around the whole company seeking out process-efficiency opportunities, whether those are just lean process changes or something enabled by new technology systems.
What’s a changemaking effort that didn’t go so well?
Certainly, not everything goes to plan. One of the things I’ve learned over time is that there’s only so much an organization can digest. You have to be thoughtful about how you cadence things out in an organization. There have been one or two situations where, for example, a system conversion didn’t go perfectly, so you go back and fix it right away and try to understand what you learned for the future.
There are a lot of things we’re excited about. We have a lot of responsibilities and things to figure out in an ever-changing environment, but also a lot of opportunities. But sometimes you have to sit back and really force yourself to ask, “What can the organization do? And what can people accomplish and digest in a given period of time?” Some of the learnings from the past have revolved around ensuring that we’re being a little bit more thoughtful and patient in terms of rolling things out.
You were named CEO of the year at Business Transformation & Operational Excellence World Summit in 2019. How did that experience change how you see yourself as a CEO and as the person leading BrightSpring into the future?
Any award that any one of our teammates at the company would receive is an honor for the company. It’s a reflection of the company and of all of our employees. For me, that particular event was a nice opportunity to be around an interesting group of people and see all the innovative and cool stuff companies are doing. It’s motivating.
Experiences like that, they also make you sort of step back and reflect — how fundamentally as leaders, it’s our job to make sure everybody else is in a good position to succeed and do well. If you focus on other people on how to make them successful, if you don’t care who gets the credit, usually good results follow. And these types of recognition make you want to live up to it — to continue to try to be as organized as possible, to build as much rhythm into the organization as possible, to come through for those that rely on us.
Do you think you personally thrive on change?
I enjoy change a great deal. By my nature, I’m always interested in thinking about how we can do things in new and better ways. What I’ve also learned over time is that there is a successful level of change that you can inject into an organization as a product of time. I think you just have to be very focused on managing change and not disrupting things too fast. You need dedicated resources to drive innovation. The key question being: How do you drive innovation through a company yet, at the same time, not break things? That’s something that personally I’ve thought about a lot.
BrightSpring, formerly ResCare, has obviously been around for a long time. Adding connections to KKR and Walgreens Boots Alliance must give you guys a whole different dimension. How has that changed things?
It’s been seamless.
First of all, they’re great people as individuals. They’re also just very smart people, as you would imagine. Perhaps most important, we all share a focus on quality and culture. I think that’s the starting point for everything. And as long as you’re aligned on core fundamentals like quality and people, everything else tends to take care of itself.
How do you see BrightSpring continuing to change moving forward?
We have to continue to execute on our unique platform and continue to build out our integrated care service capabilities in target geographies. As importantly, we’re focused on overlaying a care management and a physician component to those three legs of the stool. We really believe in the value of physicians working in partnership with nurses and therapists and other caregivers, as leaders in value-based care.
Apart from that, hopefully, we’re going to have logical regulatory support that’s going to make the delivery of outcomes and cost enhancing care as efficient and easy as possible. A component of that is being able to use and leverage technology as much as we can, and we’ll continue to try to educate and advocate in these areas.
And, we’re excited about data solutions into the future. That’s been something many companies have been focused on, and it’s another area where there are benefits of scale — being able to invest in proper technology and proper quality and compliance oversight in an organization. It takes a tremendous amount of resources and coordination, but we’re focused on trying to have the right technology systems and accompanying data and information in all of our businesses in order to provide the best level of services in a well-managed way.