Chicago-based CommonSpirit Health has grown into the country's largest Catholic provider of care at home.
It started decades ago with the home healthcare company that eventually became CommonSpirit Health at Home. The care model has evolved dramatically in that time, as more patients grew to demand — and expect — medical treatment in the comfort of their homes, with technological advancements enabling that shift.
Becker's recently sat down with Trisha Crissman, interim president and CEO of CommonSpirit Health at Home, to discuss the metamorphosis of at-home care, not long after her organization established a new joint venture with Fort Wayne, Ind.-based Parkview Health. The interview has been lightly edited and condensed for clarity.
Question: Can you walk me through the history of CommonSpirit Health at Home and how it has evolved to where it is today?
Trisha Crissman: CommonSpirit Health at Home began as American Nursing Care over 40 years ago, through our partnership with the Bethesda Hospital in Cincinnati, and we were providing home health and home infusion and medical transport in and around the tri-state area as our genesis. Then in 1999, American Nursing Care expanded its name to Consolidated Health Services, because we were expanding the number of services and the types of services that we were going to provide.
And home health was primarily focused on nonskilled care at that time. So Consolidated Health Services over basically the next decade was focused on predominantly nonskilled care, home infusion, medical transport, and we added DME [durable medical equipment] through a couple of other acquisitions. But in 2000, joint ventures with health systems became our primary growth strategy, leading to the creation of 11 health system joint ventures in Ohio, Kentucky and Indiana.
One of those early joint ventures was with St. Joseph Hospital in Lexington, Ky., which was owned by Catholic Health Initiatives, or CHI. And that joint venture was so successful that it led CHI to approach us to express their interest in acquiring our organization to become its home-based services chassis for the entire CHI system. That acquisition took place in 2010. And then we became CHI Health at Home, and that acquisition drove expansion across six new states and 35 locations. And we established hospice as another service line for the organization.
We were transitioning all of their locations to our platform over the next five years or so. Then in 2019, Dignity Health in the West and CHI aligned ministries to form CommonSpirit Health, and then we became CommonSpirit Health at Home and then shifted again our focus to transitioning all of those Dignity home health and hospice locations to our platform over the subsequent next three years.
And that brings us to where we find ourselves today — as the largest Catholic care-at-home provider in the country, with 84 locations and soon to be about 15 states, serving about 15,000 patients daily, with skilled home healthcare, hospice, palliative care, home infusion. We have many solution models, including "hospital at home," SNF [skilled nursing facility] at home, and ED [emergency department] diversion solutions.
Q: We wrote recently about CommonSpirit Health at Home's joint venture with Parkview Health. How important are these partnerships to your mission, and do you expect them to accelerate in number?
TC: The new joint venture with Parkview Health in Fort Wayne, Ind., is an exciting addition to the CommonSpirit Health at Home family. We benefit greatly from partnering with strong regional health systems. And Parkview Health was a great example. It's not uncommon for health systems to need to evolve and diversify their portfolio over time to meet the needs of patients that they're serving, especially as care is being transitioned from acute facility-based settings to the home.
Oftentimes, a partnership with the right organization can provide the required scale and focus and expertise and tools and resources, some of which are very expensive, that are vital to managing a successful home health operation and hospice and expanding in nonacute operations.
So it makes sense that regional health systems reach out to providers like CommonSpirit Health at Home. We benefit greatly from our partnerships, and we leverage the perspective and the culture and the best-in-class practices and protocols from each of our joint ventures. We're a stronger, more versatile and well-rounded organization as a result.
Most importantly, and we see this with the new joint venture with Parkview, is that when we partner with health systems, we wind up having really sharp, experienced leaders join our team, which expands our collective acumen and capabilities to be a stronger, more viable and successful organization tomorrow than we are today.
We believe the opportunity to form JVs with health systems will likely continue to grow across the country, and we welcome opportunities to continue to develop our core capability even more into the future. What will be most exciting for us is to leverage our skill set and experience with joint ventures to translate that into building out the ecosystem needed to expand care in the home as it evolves and more care is shifted away from acute settings.
Q: Can you tell me more about the technology that powers CommonSpirit Health at Home, including its EHR and other software platforms?
TC: I will tell you, unabashedly, that we are a pretty sophisticated user of [care-at-home EHR] Homecare Homebase, and we have been for over eight years. Transitioning to Homecare Homebase transformed our organization and continues to.
We've made it a strategic priority to layer on best-in-class, integrated cutting-edge technology and intuitive software to empower the care that we're providing. Forcura is a good example — the healthcare and workflow management platform. And Element5 is another good example of how we're using technology to automate to enhance efficiency and precision and increase capacity with existing resources.
We are looking at factors like scalability and compliance and interoperability and access to data. We're most interested in solutions that can help us be more agile, leaner, build capacity — particularly with clinicians — and move faster.
We've recently partnered with Medalogix for their suite of solutions, which I'm really excited about. And that meets all of those requirements.
And I'm excited about the fact that we can leverage predictive analytics and generative AI to drive better outcomes and increase clinical capacity and improve our overall performance.
Q: What is the biggest challenge to providing healthcare at home nowadays?
TC: There isn't just one. We continue to challenge ourselves around trying to engage a remote workforce. And that evolves over time. We learn a lot about ourselves, and our workforce learns about themselves, being remote.
We also want to inspire young clinicians to consider care at home as their calling. How do we get them interested and attract like-minded individuals to want to work for a mission-driven organization?
And I definitely would say inflationary pressures coupled with reimbursement cuts, not to mention the increasingly difficult dilemma of desiring to care for all people who need our help, but some of them have less-than-desirable insurance. It's a huge challenge for us to continue to accept poor rates and to attempt to negotiate reasonable and fair rates with large, multibillion-dollar health insurance corporations that expect home health providers to subsidize their patients and provide significant needed and valuable services at a loss.
As a care-in-the-home provider that is a part of a larger health system, serving about 150 hospitals nationwide, we also try to be a true partner to take care of patients discharged and reduce the length of stay for acute hospitals. We see the level of acuity of patients being discharged to home care increasing significantly, and we're needing to evolve our skill set and how we care for these very sick people as this level of acuity increases.
Our average home health patient is 75 years old, lives alone, has had two to four hospitalizations in the last two years prior to the admission, has a primary diagnosis of CHF [congestive heart failure] or COPD, and at least 16 other comorbidities. When you put that all together, those are significant medical complexities to manage. And then you layer on the social determinants of health alongside this reality, and it makes the patients we're caring for across the country a significant challenge — and one we expect to continue to become more and more complex as care in the home is expanded and then embraced as the right destination for the continued care of medically complex patients.
It is not the skilled home health of 20 years ago.
Q: Where do you see home-based healthcare going next?
TC: We can definitely expect that it's going to continue to expand as we adjust to the healthcare needs of an aging population, and they're sicker than they've ever been. What will need to happen consecutively is this evolution of care in the home and the ecosystem that will enable services in the home typically accessed by patients in an acute setting. So an ecosystem that can provide things like mobile diagnostic services, medical house calls, personal care, behavioral health.
That'll be vitally important as care-at-home evolves. This is the proverbial jump ball. Providers like CommonSpirit Health at Home don't necessarily need to build it or buy it themselves but create strategic partnerships to build out the ecosystem. Strategic partnerships enable the success of care in the home and its future. And we'll have mutual alignment around performance metrics and a commitment to a vibrant post-acute ecosystem that ensures that care at home is easy to access, easy to understand, and easy to navigate.
That will make providers successful in the future. Most importantly, that's the framework and the safety net that will ensure our highly vulnerable population of increasingly frail and chronically ill patients will have the care they need, when they need it and in the setting of their choice — which undoubtedly, to me, is the safety and comfort of their own home.