This company scaled up its impact as a champion of people with disabilities while growing to $300 million in revenue

By Verne Harnish

John Carmichael learned the importance of giving people with disabilities a voice in their own care from his brother Ben, who has developmental disabilities. When living in a group home didn’t suit Ben, their parents set up a house for him and let him choose a support provider to assist him. “He blossomed, made friends and was busy,” says Carmichael. 

That experience made a lasting impression. Today, Carmichael is CEO of GT Independence, a family-owned financial management company in Sturgis, Michigan, that helps people with disabilities live in their own homes while receiving the care they need. The company, which is contracted by state Medicaid agencies, helps people employ their own in-home caregivers by providing payroll and administrative services. 

In 2015, Carmichael took over GT Independence, founded in 2004, after serving as chief operating officer since 2005. He saw an opportunity to turn around the company, which was struggling with high turnover, low customer satisfaction and stalled growth. 

On one of his first days at his new office, Carmichael spied a copy of Scaling Up: Rockefeller Habits 2.0 on his bookshelf and began reading. By applying the strategies in the book, he and his leadership team built the company to $300 million in revenue and 300 employees around the country. Along the way, they have helped more than 25,000 customers live life in their own homes—and the company has become such a popular employer that it keeps a waitlist of job candidates. “It’s a company everyone is trying to get into,” says Carmichael

Getting the right people in the right seats

When Carmichael took over GT Independence, it was hard to operate the company efficiently. Employees’ responsibilities overlapped in some functional areas while other critical tasks went undone, because no was assigned to them. For instance, the company’s marketing director was doubling as the head of innovation and R&D—and had developed an industry-leading software—but the company lacked the personnel to handle marketing work that was piling up.

To get a comprehensive overview of where the redundancies were—and what gaps needed to be addressed—Carmichael and his leadership team completed the Function Accountability Chart (FACe) and Process Accountability Chart (PACe) from Scaling Up. In doing so, they defined the five operational areas of the business and assigned senior people to run each of them. After completing the chart, Carmichael created a “chief relationship officer” who oversaw a national director of business development, a director of strategic innovation (the former marketing director) and a new director of marketing. 

Completing the FACe and PACe helped Carmichael make key decisions about other departments, as well. For instance, within HR, GT Independence created both a director of personnel, who oversees employee benefits, and a director of talent, who is in charge of recruiting and career development. That includes promoting the company’s employer brand to current and potential hires. 

“The work we do is really important, and our story is really important to the work we do,” says Carmichael. “We find it incredibly important for everyone who works with us to share in that story.”

Keeping the team aligned

As they adopted the Scaling Up performance platform, Carmichael and his leadership team began holding 15-minute daily huddles and weekly team meetings to make sure everyone was on the same page. 

The leadership team defined five core values that were truly important to the company’s mission of giving people with disabilities “self-determination” in their care: Integrity, professionalism, community, excellence and respect. 

These core values, in turn, tie into the company’s brand promise: “We bring our values to the table.” That means Carmichael has empowered his team to fight for them. 

“If we are getting pressure from a Medicaid program that would violate an individual’s right to self-determination, we push back and get people paid,” says Carmichael.

GT Independence has placed a strong emphasis on metrics to track everyone’s progress on measures that support its core values, such as reducing falls reported by people who are elderly. The company tracks these in a dashboard in the Microsoft Teams app, visible to all employees. 

Carmichael and his team are holding their own feet to the fire, making sure they show care to the caregivers they employ. The metrics track the company’s performance on measures like how quickly and accurately it processes their paychecks. Carmichael is well aware of how challenging caregiving work can be.

Building a strong culture 

To celebrate its culture, GT Independence holds an annual event called GT Week, a weeklong offsite for the whole company in Sturgis, Michigan—where Carmichael was Mayor from 2007 to 2011.

GT Week has become so large that local merchants began offering discounts and deals to attendees, and the hotel staff are on a first name basis with some of the employees who come every year. “People plan for it all year,” says Carmichael.

Throughout the year, the GT Weekly Newsletter helps Carmichael keep in touch with his far-flung employees. One recent edition highlighted the availability of a “Success Coach” for team members who want to develop their skills and advance. 

“I think our success from a culture standpoint is our commitment to self-determination,” says Carmichael. “We allow people to choose their own path. People appreciate the freedom and flexibility they have, and the level of trust we place. Everyone feels connected and free to do their best work.”

Currently, the company is using the newsletter to reach out to the team for a diversity and inclusion survey. Carmichael issued a formal statement on the company’s diversity and inclusion policy earlier this year and held an all-hands meeting to discuss it. 

All of the company’s work to build a strong culture has been paying off. GT Independence received a National Best and Brightest Companies to Work for Award in 2019 and 2020.

Meanwhile, in a 2020 Gallup Engagement Survey of 335 employees, in which 88% participated, GT Independence found that the team gave the company a score of 4.36 out five on engagement, performing better than 72% of companies. “The rep from Gallup said, ‘I don’t know what to tell you to work on,’” recalls Carmichael. 

Accelerating cash flow 

Although GT Independence was profitable before Carmichael read Scaling Up, it often experienced cash flow constraints. That changed after his team made a series of process improvements to manage the cash conversion cycle. For instance, they learned customers’ disbursement schedules and reoriented the company’s payroll cycles to optimize cash flow. They also identified common causes of claim rejections and standardized their responses to those causes. 

Better cash flow has been helpful as GT Independence works toward its strategic goal of serving 100,000 clients by 2029. The company is responding to heightened interest in the at-home care, sparked in part by high mortality rates nursing home residents have suffered during the COVID-19 pandemic. “There’s been tremendous growth,” says Carmichael. He’s determined to keep scaling, so more people with disabilities can experience the freedom his brother Ben lives with.