How CommonSpirit Health at Home Launched a 27-Market Telehealth Program in 2 Weeks

For the home health industry, 2020 was the year agencies unquestionably embraced telehealth. Amid the COVID-19 emergency, virtual visits have become a key tool utilized in the delivery of care.

One company, CommonSpirit Health at Home, has long recognized the value of telehealth.

Prior to the COVID-19 emergency, CommonSpirit Health at Home had plans to roll out a major telehealth pilot. The public health emergency kicked those plans into high gear, pushing the organization to implement telehealth much sooner.

To learn more, Home Health Care News sat down with Trisha Crissman, COO of CommonSpirit Health at Home’s home care and hospice division, for a recent Disrupt episode. Highlights from the conversation are below, edited for length and clarity.

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HHCN: For our listeners who aren’t familiar with CommonSpirit Health at Home, tell us a little bit about the company.

Crissman: CommonSpirit Health at Home has been providing home-based health care for over 40 years through specialized home care, home infusion, hospice and medical transportation services across the country. We’re headquartered in Milford, Ohio, and we’re currently comprised of 70 locations across 13 states and nearly 3,000 employees.

In February 2019, CHI Health at Home transitioned to what we call now CommonSpirit Health at Home, as our two larger parent organizations aligned our ministries to form CommonSpirit Health. As a result of Catholic Health Initiatives and Dignity Health aligning, CommonSpirit Health became the largest nonprofit health care system in the country.

It currently operates more than 700 care sites in 142 hospitals across the country. The combined system has about 150,000 employees, and 25,000 physicians and advanced practice clinicians.

For most home-based care companies, the COVID-19 emergency has become the new normal, so to speak. What is CommonSpirit Health at Home experiencing on the ground, now almost 10 months in?

Patients and families have a heightened — and new — level of expectations for care in their home or their place of residence. We’re really seeing that they have become more accustomed to the role that technology plays in their care, which is refreshing. We’re seeing patients become more involved in their health and safety, and becoming more involved in opportunities to collaborate in their plan of care with providers. I think we’ll see this for quite a long time to come still, but we’re still having a difficult time and experiencing challenges related to accessing patients in congregate living environments.

I would also add that our clinicians are increasingly becoming more comfortable with the use of technology as well, understanding that remote patient monitoring and telehealth visits are powerful tools that can help keep our patients and our employees safe.

I’m really proud of the way that our teams have continued to say “yes” to their calling in this kind of new normal state. I think we’ve gotten beyond a place where we think it’s going to go back to normal. I think we’re kind of resolved that this is a new way of existing, and we’re continuing to lean into what’s happening across our country.

I’d also lastly add, in this new normal, our operators and our clinical leaders are responding more quickly to the day-to-day needs and requirements of the business.

What kind of results have you seen related to your telehealth efforts?

I would start off by saying that our rollout of telehealth solutions was incredibly rapid, but the preparation for it was really long. We’ve known all along, as an organization, that telehealth would be an important offering for the future. Our plan was to walk slowly into telehealth, with a plan to implement over the course of 18 months across all of our locations.

We were planning to do a pilot, work out the kinks over five months — and then COVID hit. So remarkably, my team did a phenomenal job responding. We altered our plan, skipped the pilot completely, and rolled out in 27 markets in literally two weeks.

Throughout this process, we’ve expanded our original inclusion criteria to allow for patients that did not want to have clinicians in their home due to COVID concerns. We’ve seen that we’ve had a really strong adoption of remote patient monitoring by both staff and patients. It’s taken us a little bit longer to adapt to the use of virtual visits. So we did spend a lot of time helping clinicians get comfortable with remote visits. We’re prepared for its kind of increased use as we see this resurgence.

Today, I would share that we’ve done over 3,700 virtual visits and have had 2,700 patients on remote patient monitoring since the beginning of the pandemic. This is just a little bit under a quarter of our overall home health census. From an outcomes standpoint, we’ve been able to decrease our in-person nursing visits and increase capacity to care for other patients — which is an outstanding byproduct.

Outcomes for our remote patient monitoring patients are better than those without remote patient monitoring, even though those patients have a higher acuity level, which is interesting to know. Related to patient satisfaction scores, our telehealth patients are 43% happier than those without telehealth. There’s some sort of ability to feel like you’re in control of your care and your environment.

We are constantly talking about this idea of the “cost of COVID-19.” What would you say has been the 2020 impact of the public health emergency on CommonSpirit Health at Home?

I would say the biggest impact that we have seen, of course, is our lost volume, particularly due to hospitals suspending elective surgeries back in the spring. The biggest impact was in states that did a statewide shutdown. In the states that did county-based shutdowns — for example in the Midwest, like Iowa and Nebraska — we didn’t see a significant impact in volumes as we did in other locations.

From a cost standpoint, we’ve seen increased spending for personal protective equipment (PPE), hazard pay, furloughs, lost productivity and costs due to workers being in quarantine.

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Disrupt Podcast #39: Trisha Crissman of CommonSpirit Health at Home

The 39th episode of our podcast, Disrupt, is now available!

Formerly CHI Health at Home, CommonSpirit Health at Home is a Milford, Ohio-based health care organization that provides home care, home infusion, home respiratory care, hospice and medical transportation services.

As with most home health providers, COVID-19 has become the “new normal” for CommonSpirit. Throughout the public health emergency, the company has implemented a number of measures to address COVID-19 including — most notably — the expansion of its virtual monitoring capabilities.

For this episode of Disrupt, HHCN caught up with CommonSpirit’s Trisha Crissman, vice president and COO of the company’s home care and hospice division, to hear firsthand about its on-the-ground experience with COVID-19. During the conversation, Crissman also touched on how the company is tackling flu season.

Listen to this episode of Disrupt to learn about:

— The financial impact of COVID-19
— Lessons from the public health emergency
— CommonSpirit’s 2021 goals
— And more!

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‘The Pandemic Is Far from Over’: Top Concerns for the Home Health Industry This Fall

The home health industry entered the eighth month of the COVID-19 pandemic this October. While most have adapted to a “new normal,” the public health emergency — and a possible second wave — understandably remains the biggest concern for many operators across the country.

As of Oct. 1, there had been more than 7 million COVID-19 cases in the U.S. with more than 200,000 deaths, according to federal statistics. A forecasting model created by the Institute for Health Metrics and Evaluation at the University of Washington estimates that there will be 371,509 COVID-19 deaths by January 2021.

To get a better understanding of what home health operators are up against this fall, Home Health Care News asked several CEOs and C-suite executives about their biggest concerns — and their plans for addressing them. In addition to the COVID-19 virus, respondents also touched on staffing challenges, consolidation and more.

Here are the top concerns of seven home health leaders as the industry heads into 2020’s final months.

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The biggest concern that we have is what will happen with COVID-19. We have seen a surge happen as young adults return to college and then spread this into the community. Will that negatively impact our senior populations or reduce the referrals we are seeing from some doctors who have resumed elective surgeries? We are working with doctors’ offices that we regularly get referrals from to discover their plans and plan how we can work together to mitigate the impact for both the agency and for the doctor.

Other referral sources like assisted living facilities have stayed on stringent lockdowns, and we see that continuing throughout the duration of the crisis. The concern here is for access to caregivers and the ability of staff to be able to go in and do their job appropriately to make sure that these seniors are not left behind as a result of the ongoing surge that we expect to continue for several months.

We are mitigating this by working with facilities to reduce exposure potential by assigning specific staff just to that facility, running daily ongoing COVID checks and possibly utilizing some of the testing capacity that we expect to see from the federal government for rapid tests. We also have a standing relationship with local testing facilities to get staff in and tested immediately if needed, so that we can do immediate checks and short-term quarantines. We then utilize backup staff who have office positions as a stopgap until the all clear notice is given.

— Beau Sorensen, chief operating officer at First Choice Home Health & Hospice

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The remainder of the year will be focused on a series of concerns including the need to increase provider support through the Provider Relief Fund, addressing Medicaid support shortfalls, securing support for telehealth reimbursement, and bolstering anticipated needs for PPE and staff testing.

Each of these items can be addressed through the ongoing stimulus legislation efforts or through Congressional action post-election. We have taken steps to cover both opportunities with targeted legislation on telehealth and Medicaid, along with broad supports in health care overall for the Provider Relief Fund, Medicaid, PPE and testing as part of the stimulus packages.

Given the extent of needs in the home care and hospice community, no one single focus is sufficient.

— William A. Dombi, president of the National Association for Home Care & Hospice (NAHC)

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My biggest concern going into the fall is a COVID-19 resurgence coupled with what could be a tough flu season. This puts our staff at greater risk and could have a terrible impact on the elderly and at risk populations.

How do we address this? By working to get 100% of our clinicians vaccinated against influenza, ensuring we have adequate PPE and keeping our staff up-to-date on how to avoid community-based infection while both on or off the job. The health of our staff is our highest priority, and we have to double down on what kept them safe in the early days of COVID.

The pandemic is far from over, and I fear that the fall could be far worse than the spring if we don’t continue to take real action to keep health care workers safe.

— Brent Korte, chief home care officer at EvergreenHealth Home Care

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As we move into fall, amidst this next phase of the pandemic or otherwise, our biggest concern remains caring for all patients with a range of health care needs: from high-acuity medical care to personalized non-medical support.

This means caring for the widest range of those who need our help, including pediatric patients with complex medical needs at home or in school while parents sort out virtual/hybrid learning models. It means setting up seniors with home aides to assist with meals and other chores. We’re also providing clinically based COVID-19 testing and screening services to ensure healthy work, learning and retail environments.

Our aim is that patients with milder COVID symptoms can transition home with the same high-quality care, while freeing up hospitals to support more intensive cases of COVID-19. To do this, we continue to fight the other battle, the caregiver shortage. To care for our patients, we search for and welcome the caregivers who want to give back, support their communities and make a difference in a job that is recession-proof and can change lives. Currently, those candidates could be from the many left jobless by the pandemic, including those from the hospitality, travel and restaurant industries.

Our challenge to meet patients where they are means being there to combat feelings of social isolation, especially as we approach the fall and winter seasons. By caring for our patients’ minds, bodies and spirit through our “Home Life Enrichment” standard-of-care, we can keep them healthy and safe but also connected to their loved ones and the world around them via in-person or telehealth interactions. For those facing end-of-life, meeting patients and their families with the support and comfort care of hospice in their final days and moments is what makes our team different.

— Jennifer Sheets, president and CEO of Interim HealthCare

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What are the top concerns for our home health agency this fall? Is it our star rating? Our patient satisfaction? Maintaining a low re-hospitalization rate? Is it delivering on value or ensuring compliance? Surveys? Staffing? The Patient-Driven Groupings Model (PDGM)? The Review Choice Demonstration (RCD)? Audits, payers, costs, technology or hospital narrow networks? COVID-19?

These are all yesterday’s concerns. Today’s top concern is how hospital systems and the U.S. Centers for Medicare & Medicaid Services (CMS) want the small home health agencies to close. This is good for the large providers that have exclusivity and control a majority of the Medicare revenue, but bad for small providers, which are the great majority of agencies in America. We don’t have a seat at the table regardless of cost, quality or patient’s choice.

The second concern is the volume increase of “low pay,” “slow pay” and “no pay” high case-mix patients who are having issues accessing care. Agencies are going to have to be providing their referral sources with 5-star care. If an agency has a bad referral source, it’s safe to assume they are another agency’s good one. If agencies keep taking bad referral sources hoping that they will turn into good ones, it will most likely accelerate an agency’s closure. Agencies must be continuously looking for partnership opportunities with referral sources that want value — or get an exit strategy.

— Peter Miska, president of Phoenix Home Care LLC

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The biggest concern — and opportunity — we have as an organization is the continued uncertainty, unrest and anxiety facing our communities, our patients, their families and our front-line “heroes” in the field. Adding fuel to “COVID-fatigue” is the unknown impact of the flu season aligning with a possible resurgence of the coronavirus. That requires us to remain vigilant in our support and messaging. We’ll continue to build upon what we have learned so far.

Over the last seven months, we have successfully navigated through the varying challenges of the pandemic to keep our patients, employees and communities safe. The result of this focus led to the implementation of new tools, technology and strong processes that have elevated home health in the continuum of care. We are reaching more patients, more families and serving our communities in different ways than we have in the past, putting us in a strong position to weather additional challenges as they come.

In response to the pandemic, we implemented innovative technology strategies and solutions to assist in keeping everyone as safe and connected as possible. As the flu and COVID-19 collide, we will continue leveraging our technology-based solutions such as remote patient monitoring, virtual visits and medication management delivery to enhance our care plans while supporting infection control measures and social distancing to minimize risk for our caregivers.

Regular COVID-19 training and flu education ensures a consistent approach to proven methodologies that have been implemented to protect our greatest resource – our staff – so they can do their best work for our patients.

We have used and will continue to use analytics to help make data-driven decisions during the pandemic. We have refined processes and implemented changes based on our learnings to ensure the safety of all. We have focused equal effort into providing tools and resources to our front-line caregivers to ensure they are safe, engaged, supported and have what it takes to be resilient in hard times.

— Dan Dietz, president and CEO of CommonSpirit Health at Home

* * *

Trinity Health At Home has seen an increase in home care visits at faster rates than expected this quarter. As patients across our nation continue to seek equal access to health care, the need for home care services continues to climb. As home care providers, we must continue monitoring and improving our processes to ensure current and future patients have access to care. At the start of the pandemic, we adapted quickly across our home health agencies to meet patient needs under new circumstances. Our innovation will continue in the brighter days ahead.

Though we have all adapted to COVID-19, we must continue to take our COVID-19 response and processes very seriously. At Trinity Health At Home, the safety and well-being of our patients and colleagues remain our priority moving forward. Right now, support for our devoted nurses and clinicians is of utmost importance. We are securing additional supplies of PPE, ensuring the safety of staff on home visits and encouraging self-care to limit the stress and uncertainty of our new normal. By keeping our colleagues healthy and engaged, we can ensure proper staffing levels to guarantee high-quality home care and expand access to care within our communities.

— Mark McPherson, president and CEO of Trinity Health At Home

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