How BrightSpring Health Achieved a 48% Drop in Hospitalizations

Over the past few years, home care has gained more of a foothold in the larger health care continuum. One company, BrightSpring Health Services, exemplifies this evolution in the role of home care.

Based in Louisville, Kentucky, BrightSpring provides a diverse array of home and community-based services. It serves more than 350,000 patients across 50 states.

Last year, BrightSpring was acquired by global investment firm KKR — an affiliate of Walgreens Boots Alliance Inc. (Nasdaq: WBA). As part of the deal, the company merged with pharmacy giant PharMerica.

Above all, home care is primarily associated with helping seniors handle their activities of daily living.

While these services are largely non-medical, it’s important for providers to be strategic about the care they provide and take health conditions into consideration, Sherry Pemberton, vice president of sales for BrightSpring, said Thursday during a presentation at the HCAOA 2020 Virtual Leadership Conference.

“We have to think differently,” Pemberton said. “What is their health condition? How do I take care of a medically complex person from a non-medical approach? How does that look with the services that my agency provides? How do I make sure that they are not having issues from their medical condition based on the non-medical services that I’m providing?”

For BrightSpring, there are specific models of care that help the company keep seniors out of the hospital. This means managing for medical “red flags”, implementing frequent check-ins and building relationships with the clients and family.

“As an agency, the services we provide to those clients need to be more than just our caregivers going into that home and fulfilling a checklist of items that we tell them they need to have,” Pemberton said.

One way BrightSpring accomplishes this is by educating its caregivers on what signs and symptoms to look for.

When caring for someone with pneumonia, for example, a caregiver should take notice of things, such as shortness of breath, fever, chills, headaches and confusion, according to Pemberton.

“I go into the home as a caregiver to provide that homemaking or that bath visit and if these are things that I notice that’s when it’s important to make a call to a supervisor and say, ‘I noticed Miss Smith not feeling well today … we might want to call her family,’” she said. “By calling their family and providing that intervention as a supervisor … we’re getting that doctor involved earlier [rather] than waiting so far along into her pneumonia that she ends up in the hospital.”

Along with pneumonia, BrightSpring has also established care models for when a client has diabetes or chronic obstructive pulmonary disease (COPD). Medication reminders are also a part of the company’s care model.

This approach allows BrightSpring to gather data on the company’s outcomes, creating a value proposition that speaks to the impact of their strategy.

As a result of BrightSpring’s models of care, the company saw a 48% drop in hospitalizations in three of its branches. The company also had 107 extrapolated hospital diversions per year that were worth up to $1.14 million in payer cost avoidance.

Ultimately, these outcomes and data are appealing to payers, according to Pemberton.

“That’s non-medical, that wasn’t home health,” she said. “If I go to a payer with that kind of data, they’re going to think it’s a cheaper cost to have somebody in the home.”

On its end, BrightSpring has already begun to attract attention from payers.

“One of the payers that normally would not even look at us because we’re non-medical saw value in adding the non-medical piece based on the study that we had,” Pemberton said.

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BrightSpring CEO: COVID-19 Has Reinforced the Importance of Patient Access

There has been no such thing as conventional wisdom during the COVID-19 crisis. Theories on best practices and safety measures have evolved endlessly since March.

For Louisville, Kentucky-based BrightSpring Health Services, a company that has been transparent about its road bumps and triumphs on its COVID-19 journey, one of its key takeaways has been how important access to patients is.

Early on in the COVID-19 pandemic, for example, the concept of social distancing may have gone too far. As seniors were blocked from contact with home health aides, caregivers and health workers outside of institutional settings — either due to their choice or someone else’s — their collective health took a toll.

“I think the whole situation was just an incredible reminder and reinforcement for how critical it is to be able to get to people,” Jon Rousseau, the president and CEO of BrightSpring, said last month at the Home Health Care News FUTURE conference. “And that connectivity — [or lack thereof] — was really spotlighted at a time like this.”

BrightSpring Health Services — formerly known as ResCare — is a provider of comprehensive home- and community-based health services. It provides a wide range of services across a variety of settings, caring for tens of thousands of individuals in 49 states. Among its offerings, the company provides home health, hospice, behavioral health, non-medical home care, pharmacy services and more.

In the first quarter of 2019, global investment firm KKR — an affiliate of Walgreens Boots Alliance Inc. (Nasdaq: WBA) — acquired BrightSpring for $1.32 billion. As part of the deal, BrightSpring also merged with PharMerica Corporation.

“There are millions of people out there, whether they have behavioral conditions or whether they’re seniors, whose lifeline, day to day, is [our] people coming into their home.” Rousseau said.

BrightSpring also provides its services to patients in skilled nursing facilities (SNFs), senior living communities and hospitals.

When BrightSpring was increasingly cut off from its clients, the company’s hospitalization rates ticked up, Rousseau said. A lack of access makes those kinds of unfortunate trends a near certainty when a company is dealing with complex senior populations.

The lack of access needed to be mitigated, so BrightSpring took action to try to get to its patients in the safest manner possible to keep them healthy.

Considering how large the provider’s footprint is, it had to adjust to different requirements from its hospital, senior living, and SNF partners across the country.

“It really varied by geography and what kind of entity the [partner] was. Whether it was skilled nursing facilities or senior living facilities, they had very specific requirements and needs for you to enter their buildings,” Rousseau said. “And you had to comply with that, and you had to go out of your way to make them comfortable to help them be successful.”

On its end, BrightSpring has been open about its COVID-19 plans before many companies had even finalized theirs.

In the spring, the company published a detailed account of its COVID-19 strategy and mitigation approach in the academic journal Home Health Care Management & Practice. It focused on BrightSpring’s own battle dealing with 67 COVID-19-positive patients in the first 100 days of the pandemic in the U.S.

The company asked strategic questions to its partners on what it could do to help: What were their specific needs? How could BrightSpring help manage some of its most current, pressing challenges? What could BrightSpring do to keep its partners confident in its own abilities to keep patients safe?

“These are times where we try to go above and beyond as a partner,” Rousseau said. “In times like this, there are opportunities to try to shine for your partners. That’s a sector of the health care value chain that we’ve tried to be very focused on. Even as our whole company shifts much more to the home, there’s always going to be a critically important role for skilled nursing facilities and in other institutional settings.”

Increasing access also meant bolstering its telehealth capabilities to find any way to reach its patients, whether it was through a more sophisticated platform or simply through FaceTime on an iPhone or an iPad.

BrightSpring is hoping to get more help from the Centers for Medicare & Medicaid Services (CMS) as it relates to remote care moving forward. It also hopes that the government will respond to home-based care advocates’ pleas to shine a greater light on the need for these home-based services right now, especially given the staffing issues facing the industry at large.

“It’s a good time to advocate for the incredible value that our services provide and the wonderful work that our caregivers do to make sure that reimbursement rates are fair, and they continue to increase with cost of living,” Rousseau said.

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