This article was originally published on Home Health Care News on March 27, 2020.
With a background in accounting rather than home care, BrightStar Care founder and CEO Shelly Sun has embodied changemaking from the inception of her company, which today is a franchiser of in-home care services spanning more than 340 locations in the U.S. with several lines of business.
Having launched the Illinois-based company in 2002, BrightStar Care quickly ramped up to become a franchised model starting in 2005. Since then, Sun has led the company’s growth efforts to include a medical staffing business and BrightStar Senior Living & Memory Care communities.
Rather than shy away from change, Sun says she runs toward it. From embracing technology when other industry players have resisted it, to investing in an online fulfillment platform for PPE, Sun and BrightStar Care are transforming the in-home care industry one change at a time.
HHCN: You founded BrightStar Care in 2002. How has your company changed since then?
Sun: Well, when I first started, for maybe the first 18 months, everything was manual. Our calendars were tracked on a big whiteboard. Payroll and billing was in QuickBooks. But we recognized our desire to scale and came up with a plan to open locations across the country. For that to happen, we knew we needed technology platforms that would allow us to scale, something that streamlined scheduling and allowed us to track key performance indicators by location.
And by indicators, I’m not just talking about the ones that were financial in nature. We also wanted to track customer, employee and clinical dimensions as well. So we launched our first technology platform mid-2004. Every franchise location we’ve ever opened has been on that technology platform, which has been really key to being able to gather and disseminate our best practices.
That’s one way we’ve changed. Compared to 2002, we also now see a changing environment in terms of reimbursement for care, in addition to a focus on improving outcomes for the consumer. The technology part is intertwined with that, as we’ve been really focused on leveraging our technology to drive our high-quality services. So much of that is measuring data to differentiate what we are able to do — and to align what’s important to payers around the capabilities that we have.
Can you dive into that reimbursement angle a bit further?
We also now serve a large workers comp adult population as well as care for families with high-touch pediatric care needs. We specialize in infusion and case management for our families in many large insurers. So we’ve also broadened who our client is and who we ultimately care for compared to when we first started two decades ago.
As we think about companies looking at the Patient-Driven Groupings Model (PDGM) and how that’s going to impact the home health care industry, with Medicare rates being lower for community-based referrals than with hospital-based referrals, that’s going to change things for BrightStar Care. Home health agencies are gladly going to take both types of referrals if they had an abundance of labor, but none of us do.
So the change in reimbursement under PDGM — plus the ongoing labor shortage — is going to steer home health agencies to where reimbursement is higher. What’s that mean for us? It means we’re really focusing on those community-based referrals. We’re looking at different community-based partnerships and alliances. We’re looking at increasing our spend in the community with TV, social and digital to access those consumers.
That’s how BrightStar Care has changed, and is changing.
Since you’ve gotten into the senior care space, how have you seen in-home care for seniors change, more broadly?
When I was looking for care for my grandmother years ago, there really wasn’t one-stop shopping. You weren’t able to hire an agency that provides a range of nonmedical and medical services. That’s one of the reasons we launched BrightStar Care. We wanted to fill a need for that higher standard of care, that full continuum of care.
At our organization, a registered nurse (RN) oversees every single plan of care. So we as providers have evolved over the years.
BrightStar Care specifically doesn’t just have a registered nurse and personalized approach to every single client. We also make sure that all of our locations from coast to coast are all Joint Commission-accredited. We’ve been doing that since 2008.
Has that focus on quality helped with the coronavirus?
Everybody’s going through coronavirus. Being Joint Commission-accredited gave us a good starting point. We didn’t have to figure out how to make sure there was good hand hygiene at our organization. It’s been part of our orientation with every single caregiver for a decade. That really helped us to be able to build off a strong safety program and take it to the next level.
Another one of the ways that BrightStar Care has been changing is the BrightStar Senior Living model. Why did you decide to launch that?
We have an intention to meet customers where they need us to be. We had families whose loved ones were reaching a certain stage of higher acuity or dementia. We had more families determine it was holistically better to look at a community setting for their loved ones. It was all about trying to meet our customers where they were and where their journey was taking them.
And we really, you know, imagined not moving from the home to an institution for them, but moving from home to more of a bed-and-breakfast experience that comes with great personalized care services. We don’t use “the F word,” so to speak — “facility.” We built our BrightStar Care home care model around safety, service and a personalized approach to care. We’re doing the same when building our BrightStar Care senior living and memory care communities.
What does that model currently look like in terms of locations? And what’s in store for the rest of 2020?
We have two communities open in the Madison, Wisconsin, area. We have a third in Fort Wayne, Indiana, and one that’s set to open in [summer 2020] in Mason, Ohio. We hope to open two new constructions by the first or second quarter of 2021. And after that, the company’s goal is to open two to three locations per year over the next two to three years. Then we want to scale construction to five new communities per year after that.
It is a much larger capital investment, but the synergy between our two brands — home care and senior living — is very strong.
As the leader of BrightStar Care, do you consider yourself somebody who runs toward change or somebody who tries to avoid it?
I say I run toward change. It’s something I’ve absolutely had to embrace during my career. Speaking as someone who was an accountant who then started her own business, I had to be comfortable with change personally. Today, in the industry that I’ve chosen to be a part of, health care is changing rapidly, too. We want to be on the precipice of leading that change. And I think BrightStar Care has a history of demonstrating that. You could point to our early investments in technology or our alignment with the Joint Commission, for example.
Of course, we’ve also had to change and make adjustments through the COVID-19 pandemic. We were one of the first in-home care brands to have technology helping our caregivers certify that they are symptom-free before going into the home and potentially exposing a client. We then quickly rolled out client-screening questions as well. We readied our franchisees for voluntarily paying for paid sick leave as part of Families First Coronavirus Response Act (FFCRA), even though the industry ended up with an exemption status.
I think change is really only possible if everyone can see the “why.” There has to be transparency and consistency with what change you’re embarking on. Remember, as soon as you get tired of hearing the “why” behind the change yourself, some of your stakeholders are still probably hearing it for the first time. You need to make sure you’re saying what needs to happen, and why, over and over and over again.
What’s one changemaking effort that stands out to you as one you’re really, really proud of?
I’m going to cheat and do two, because one is about the industry as a whole and one is about BrightStar Care.
At the end of the day, we want to play our part in helping our consumers. The U.S. health care system is better served having more people stay home. So the first changemaking effort is recently leaning into advocacy and taking an important part in mobilizing the industry to ensure home care and assisted living are part of the definition of “health care.” I’m talking about the health care workers exemption granted by the labor secretary related to FFCRA. That’s when I knew having a workforce was critical to keeping vulnerable seniors at home and keeping them from overtaxing the hospital system.
But just because we got the exemption doesn’t mean we’re not doing the right things as a brand. We’re still tracking sick pay, paying sick pay and looking for government reimbursement for that. Just because we do have an exemption doesn’t mean we’re using that to not live our core values. But that was an important thing for the industry.
What we’ve done at BrightStar Care that I am the most proud of is that we built out an entire PPE online ordering and fulfillment capability. We’ve invested over $2 million in PPE, housed in secure, temperature-controlled inventory locations. We want our franchisees focused on providing care. We try to help them on any of the things we can take off their plate. We have ordered N95s so our franchisees’ workers are safe.
As part of our response, we also launched a respirator program. That obviously took lots and lots of hours and investment. And to help those who are raising their hands to take care of symptomatic or COVID-19-positive patients, we’ve also invested in training to avoid risks associated with using a respirator mask, especially for individuals with asthma, difficulty breathing or claustrophobia.
What’s an example of a changemaking effort that didn’t go so well?
It’s a hard question because I don’t really focus on the negative. I believe every action that we learn from is still an opportunity to be better the next time. But we certainly have had changemaking efforts where we’ve tried to implement third-party technology solutions. Or changemaking efforts where we’ve built rather than buy add-ons such as CRM over the years.
Sometimes there’s a learning curve. We’ve stumbled over the years in terms of CRM tool selection, doing it from the corporate office, if you will, versus engaging our franchisees and engaging our franchisees’ salespeople. It has probably been five or six years, though, since we had one of those missteps.
And again, the key is to learn from it and do better next time.
What are the key ingredients of successful change?
Is there something other than getting the buy-in from your team? I think that’s a large part of it. But I would say successful change takes really open communication and transparency, plus a willingness to collaborate across a large spectrum of stakeholders. And then you have to evolve rapidly based upon input.
What’s the hardest aspect of change, in your opinion?
I don’t know if it’s the hardest aspect, but having a clear, visible plan is one of the things most essential for success for planning for change. But it takes a lot of work to communicate that plan fully. You need to focus on all types of communication: in-person meetings, video meetings, email messages, regional meetings, townhall events, newsletters — and across all the impacted stakeholders.
What’s next for BrightStar Care? How else might we see change happening moving forward?
We will continue to look for opportunities to provide clients the highest quality care. I think if we look forward, we’re looking for growth. In the short term, we plan to continue to expand our existing brands: BrightStar Care and BrightStar Senior Living.
In the next 10 years, I predict that BrightStar’s family of brands will be serving 250,000 families per year. Right now, we serve about 20,000 unique families per week and about 100,000 per year.