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today on This Week Health.

The role of the doctor and nurse in the future in the home health domain will be different than it is in the hospital domain.

one of the most frequent things we hear from, nothing in physician staff is that when they're on the hospital floor and they've got a waiting list, that's, four pages long.

They can't spend much time with individual patients.

Now they're getting to going at the home and spend an hour with the patient and more holistically, assess them and look at their whole lived environment.

Welcome to TownHall. A show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.

 Hello. Again, this is Brett Oliver chief medical information officer for Baptist health in Kentucky in Indiana. And I am really excited to have a friend and colleague on today. Chris McCann, who is the CEO and co-founder of current health. Welcome Chris.

Thanks Brett. I'm really, really excited to be here.

Thanks for the invite.

Absolutely. Well, before we get into kind of some of the technical questions that I wanted to ask you, I think your backstory is kind of unique and I'd like, if you just share quickly how did you get into home care business, the RPM business and just, what's your backstory.

For sure. So, I'm clearly not an American. I know it's hard to tell with this accent, but I'm originally from Scotland. I actually started out in a completely different space. I, I did a degree in computer science and then afterwards decided to go to medical school. I, I wanted to be a physician and I loved medical school.

I loved training to be a physician. It was one of the happiest places of my life. And then a couple of things happened as I was training. The first one was actually my own grandmother. She was like many elderly patients that our healthcare system cares for every single day. She had multiple comorbidities, she had dementia, she had heart failure.

She had C O P D. She was recurrent admitted to hospital for things. I felt could and should have been managed in a home based setting. I think simultaneously being a med student, you see the structural and this is as much true in the UK. As, as the us, you see the structural financial clinical reasons, why is really difficult to care for someone.

Like my grandmother at home. And I started current health to try and solve all of those gaps and help healthcare institutions to our care at home, to any population, population like my grandmother really cure subacute population, but help them follow all of those gaps into level safe and effective care into the, the.

I also thought it was interesting in your story as current continued to go to move along and you continued to defer. Medical school, they finally got a point where they were like you gotta come back or forget it.

Uh,

Finally, yes. I mean, the, my medical school in, Dundee, which is just north of Edinburg, they were incredible, really, really supportive of what was trying to do.

But eventually after like three years, it was are you coming back or not? And at that point we were starting to do really well. And I was really excited by the business we were building and where we were going and decided that I was gonna make the shift and just focus on, current health.

And I'm really, really glad that it's been an incredible John. Oh,

awesome. Awesome. I appreciate you sharing that. So, as, as I mentioned, we've known each other for four or five years now. Well, since before the pandemic, for sure. And in that time, I think you've had a pretty unique vantage point.

What do you think the biggest changes that you've seen in the industry from the standpoint of technology being leveraged at home? To provide care?

Yeah. So when we started, this has gone right back to like 2015. We knew the home was where we wanted to go, but we didn't think the market.

Was ready yet. So we actually wanted to start on the inpatient site. We thought if we could improve the collection of biometric data from patients on the general floor and free up the RNs from that task, then we could help get patients home faster. And then we thought the next evolution would be, we could follow them home and our

post. use case and to a certain extent, that's what happened. But actually what we found is we went into 20 16, 20 17, 20 18 that health systems were much more quickly moving to that destination of how do we move more care into the home, but it was still largely. I think theoretical, I think it was still very centered around what might be called traditional home care or post-acute it was less, how do we take.

Traditional facility based care and move it into the home that wasn't really happening yet. The UK was doing more because the UK has, despite the fire hospital at home was really coined in the us. The UK has had a more mature model for hospital at home. Certainly at that point, so we were doing more in the UK, around hospital at home, and then I.

And this is gonna sound like, I'm just saying this, cuz I'm doing it with you. Then we met you and you were actually the very, very, very fast person and Baptist was the fast health system to buy current health. And it happened just before the pandemic. Although we had been piloting together.

Before anyone knew what COVID was and the combination of you and Baptist partnering with us and the pandemic. So the referenceability of saying, well, some health system is using and the, pandemic happening just completely changed the space suddenly. Every hospital wanted to decompress and identify a means to, maintain or protect capacity.

And suddenly everyone wanted to deliver more care. Into the home and that accelerated in my view, a strategic shift that was happening in executive's heads. By 10 years, if I remember when you and I were at ATA, you said to me, we have to evolve about to tell from just seeing ourselves as. Traditional bricks and mortar facilities.

I'm slightly paraphrasing what, what you said, but traditional bricks and mortar facilities to like a network of how we deliver care into the whole community and our into people's homes and that strategic shift that I think happened very quickly through 2020 as there was suddenly this institutional imperative to deliver more care at home.

I think as COVID has, hopefully subsid. That has slowed again, but I think what hasn't changed is one consumer demand for care at home. I think a lot of patients, consumers are recognizing that it's easier and more efficient to get care at home rather than have to come into hospital, have to come into the primary care clinic and they want that to continue.

And I think, secondly, the hospitals recognize that for their own growth. Care at home is really promising way to expand. And that shift is still, continuing today.

When I think too, during the pandemic, one of the more important things, at least in our organization was. Proving out that it could work.

Yeah. Even something as simple as a video visit, having a colleague say, oh, that'll never work. Well that was the only option they had. So they tried it and said, wow that was okay, so now we have to take it from that emergency setting and make it a little bit more, commonplace.

And as we talked a little bit before we got started with the podcast, I. think Data tends to move the physicians and the frontline folks more than anything. And so at least that's the approach we're, taking at this.

point

I mean, I think you're absolutely right. I mean, if we just look at hospital at home or acute care at home, one of the most frequent objections we see is, how can the patient be safer in their own home than when they're 10 feet from the nursing station?

I can't put my hands on them when they're at home. I can't see them when they're at home. I can't walk to the bed and look at them. So how can they be safer? And actually the data fairly consistently from our partners in hospital at home shows, they aren't actually. As safe in the home, they're safer in the home.

They aren't suffering hospital, acquired infections, actually rates of falls are less than they are inside the hospital. And the patient satisfaction is even higher. The other thing I find really interesting is that patients who were traditionally hard to get into the hospital, patients who were disengaged with health, maybe they were like agoraphobic and, they were nervous of, or at fear of, healthcare in general.

Suddenly they're able to get service they couldn't have had before. So it's not just making them safer. It's making also more accessible.

Yeah. I hadn't thought about the accessibility piece. You think about safer, like just deliriums have to be lower when you're in a familiar environment. You know how your bedroom is laid out in the middle of the night, when you have to get up all those kinds of things.

I certainly understand the nursing perspective that you articulated, but I think the data bears it out when you really, think about it in detail. So, a lot of people throw around hospital at home. It's almost like AI, sort of a buzzword. You guys at current health have been involved in true hospital and homework.

What have you learned? This is probably the question I wanna know the most. What have you learned that other organizations should know about, like, were the parts that were easier than you thought parts that were more difficult, biggest surprise, anything along those lines?

So I think the first thing is that It can't be a side project for the institution.

Like this is as complicated as standing up an entirely new hospital that, it has to be an institutional priority and it has to be a priority across lots of different teams, the physician team, the nursing team, the it team, it requires people at all different levels and in all different departments to truly make.

model work and it needs that like executive buy-in to really in my experience make it work. The second thing I think is that there's still a lot of concern about things like, and I touched on the safety will patients of connectivity, will they be able to reach out to their physician?

Technical challenges are real. And especially in the populations that most need this service, they're less likely to have momentum net. They're less likely to have even good cellular signal. And these challenges are real. And rather than trying to say, they're not real. And that. Technology can just solve all of this, which it can't.

These are, there, there are, you there are real problems that can't just be wiped away. What I also think we have to say is that the role of the doctor and nurse in the future in the home health domain will be different than it is in the hospital domain. the nursing doctor of the future that is in the home is going to have a broader role than just what they do in the hospital.

They're gonna have to be responsible for, some of the things than they might be in the hospital. They're gonna get to spend a lot more time with the patient than perhaps they can in the hospital. One, one of the most frequent things we hear from nothing in physician staff is that when they're on the hospital floor and they're getting paged through multiple different people, and they've got a waiting list, that's, four pages long.

They can't spend much time with individual patients. Now they're getting to going at the home and spend an hour with the patient and more holistically, assess them and look at their whole lived environment. But they're also having to do a lot of things. So I, I think my second learning is we can't just say, Hey, the ed physician, the ed nurse, that's the role in hospital at home.

It's not, it's a different role in hospital at home. The third thing I'd say is it takes. A village of people working together to make it work. There's lots of partners involved. Those technology like ours, those clinical buyin, you know, volume is one of the hardest challenges in hospital home getting patients into the programs.

And that means getting the ER physicians, the floor physicians, the nurses all aligned to are going to do this and bringing everyone on that John Lane. Again, that's why I say this. Isn't. This can't just be a side project. This needs to be like an institutional priority that we all want to do this, that we seek here at home at our strategic direction that we want take the health system in 📍

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  Those organizations that you're engaged with or that you know about that are doing true hospital home.

Do you see them starting? From the emergency department in terms of shifting those patients home, do you see them feeling more comfortable once they've been admitted and stabilized? Okay. Now we'll let you go home a little early or a combination of both is where do people tend to start?

So this is a generalization, but I think a lot of people start thinking about the ed and then find it's easier to admit from the floor. And I think by and large, we've seen a shift in most of our partners in that model where they, all start ed focused and then move more, floor focused.

and I guess my hunch would be as we get more data on the safety and efficacy and outcomes from these programs that you'll probably start to see that shift back again. I also think part of it is that the current CMS waiver requires. Admission to hospital at home from the physical facility,, they physically have to be in the ER or the floor.

I do think that's something that in the future, it would be prudent to revisit as we get more safety data. My. Suspicion would be. And I think this is backed up by the data that once, they come into the ER, once they come into to the hospital, the natural bias, because that's been our behavior for the last 50 years is we're just gonna admit them.

Whereas actually, maybe if we can review and assess in the home fast, perhaps that can enable us to send less people into the, ER and the in. Facility again to make that viable is gonna have to mean we revisit that financial model and the requirements that CMS have put on it.

Well, that's a great point.

That's a great point. Money makes the world go around. We have to have to deploy the game there, but yeah, that makes a lot of sense. Unknown patient. Why would you wanna drag into the ER, if you can admit them, get the similar level of care at home with these organizations what are some of the most common clinical use cases like.

feel like I've heard some or just like any and all patients, whereas it seems like most start with a prescribed number of diagnoses. Curious what you've seen.

Yeah. I think we would always recommend starting from a set of specific diagnoses. I've seen some organizations who kind of leave it to.

The clinical judgment of the physicians and nurses. And I, think that clinical judgment always has to be part of it, but I think rather than just setting it out as if you think this patient is a candidate for hospital at home, based on. No specific objective criteria. I think that's less successful in saying, Hey, this is the list of diagnoses that we believe could be tractable to hospital at home.

We see. Wide range of diagnoses within that. I mean, we do a lot in postoperative, everything from prosec Tommies to hysterectomies, to, even as far as things like cabbage, to We do quite a bit in oncology around things like car T and chemotherapy and, related complications.

And then a lot in infection, know, things like C P D Py, nephritis still today. See a lot of COVID. I mean, I think. Today, something like 10, 15, 20% of our populations are still complications from COVID 19. So, that's still a background impact on, healthcare institutions. I would say that while those generalities there is.

Institution little specific differences in the diagnoses they go for based on their local populations. I think over time, we'll probably coalesce CMS as a suggested criteria right now. But I think over time, industry as a whole coalesce on a certain set of diagnoses that we think are most appropriate for care home.

That makes sense too. And then, just like some of our facilities are known for certain things. Whereas, they're not like we don't do transplant. I know it's an extreme case, but it's like, that's what we're know for. So I'm sure there'll be some of that variability between organizations.

Where do you see the biggest opportunities right now for organizations? Should they all just go out at least go out and get the waiver? Even if they're not ready to, move on hospital at home or what, what are your thoughts?

I think firstly I don't think organizations should run out and get the waiver unless they're ready to make the institutional commitment to build and run hospital at home.

And also think about how they're gonna run hospital at home in an environment where the waiver doesn't exist. That public health emergency was just extended. It's possibly the last time it will be extended. We don't know yet There's legislation in. Congress right now to extend the, acute care at home waiver for another couple of years, but there's no guarantee as to whether that will happen or not.

And it, to me, that's one of the most important things that does need to happen. We need to see that waiver extended I, think strategically for organizations, I would say that clearly I have a bias because I'm in this space, but the vast majority of organizations that I meet with all will say that they have a strategic priority around growing how they deliver care into the home and doing so across current disease management and more traditional facility level care, moving that into the home and it's.

To me, it's not binary. It's not, do we do care at home or do we do care in the hospital? There's always gonna be patients who need to be treated in an inpatient facility. That's never going to change the question is, is there a percentage of care right now that could be delivered either chronically or acutely in the home based setting?

And I think the data over the last two years have shown clearly that's true. So for me, the organizations who are going to. Grow and be really successful over the next five years are those that are going to embrace that strategic shift, that more of their local populations are gonna want care at home.

And that is where growth is gonna come from over the next five years is what consumers will want. I actually think it's what the staff will start to want over the next five. years And they need to start embracing that now and not just wait for. The acute care at home waiver to become permanent law. I think that by the time that happens, I think this is too late.

I agree. As, as you dig into this true hospital home and you peel back the layers of the onion and you recognize the complexities and what it really takes to make happen you've gotta start early. My fear has always been, we go back to the money situation. Payers, the government continue to cut back on what they cover for certain DRGs, because they know, people are doing this at home, they can do it cheaper.

And then all of a sudden you're forced. You're like, I can't even take care of this basic bread and butter admission because they're not paying me enough because everybody else has transitioned those patients to the ambulatory or outpatient hospital home setting.

I think that that's totally valid.

And, we hear that concern and talk about that concern a lot. I think that one part of that is articulating strongly. when a patient is cared for at home, it, it is not just that we can take the, fixed cost of the hospital and no longer need to spend that money.

There's actually a load, more stuff that can be done in the home. For the patient, because we don't have to spend that money on the fixed cost of the hospital. There's a load more resources that can be taken into the home that we couldn't otherwise deploy. So I think we need to make a strong articulation and many organizations are doing this right now that actually within that DLG, there's lots of things that we can do in the home that we couldn't do in the hospital.

Maybe we can put more home care nursing in. Maybe we can give them more. home health aid into the home to help them with mobility and so on. there's lots more that can be done in the home with that through DLG payment that can be done in the hospital. And we need to strongly articulate that first point, the second point is that.

I think a lot of the panel are really willing to collaborate on this. And some of this is about the whole industry coming together and having open conversations about how we create these models in a way that improves care for patients. And doesn't drive up cost over the next five years because we're already, Spending such a colossal sum of money on healthcare, needs to be some way to also make it sustainable.

No, I love your thought though, that without the fixed costs, that you have bricks and mortar, that you can actually offer more services. Yeah. It's not just that's a really important point. It's not just enhancing that margin by keeping them at home. Exactly. I think we all, as providers, we all got.

With telehealth, video visits, things like that. We had some glimpses into homes, like it was almost analogous to the old home visit. You could see, Hey, why don't you show me what's in your refrigerator? Hey, what's, you've got seven cords running between you and the kitchen, can, you're gonna trip and fall on that.

All those kinds of things that, know, you really get a glimpse of when you get to be in someone's home. And I think there. While that's not very objective what I just said. It's something that I think could be objectified and, bring some data to, because that may be why they're safer after an a.

A hundred percent. I completely agree. And that, I guess the ability to do more holistic assessment is one of the key things I think there is in this model to see everything, not just the narrow thing that you see when someone comes into the inpatient facility,

the education of patients has to be better at.

The receptivity, you know, I always have problems with patients getting educated when they're acutely ill, like, but you're just not gonna, grasp all that at one time. But the fact that you're in your home, someone very easily can take notes for you. Can, whatever it might be, even record something that someone's saying.

I think that's an area that we don't talk enough.

One of the most powerful stories that I've seen from this came from relatively senior RN that works for one of our partners and she's in a long career in nursing. And she talked about the fact that over the pandemic, know, she walked in like a field hospital.

Was under incredible pressure and, came out of it really bumped out and depressed and not sure that she wanted to be part of the nursing profession anymore. And then she started working in hospital at home and suddenly in her world, she was able to deliver the kind of care that she's wanted to do for her whole career and not being able to,

I fill out with a patient in the home, talking to them, getting to know them, educating them discussing their health rather than what happens in the hospital where, she gets a couple of minutes, then she gets pulled off to do something else. Yeah. And. I just thought that was really powerful on both sides.

Like the patient, what an incredible experience for them, that they're getting proper one to one attention really focused on their health and what would that do for long term outcomes? And then secondly, at a time when we're losing physicians and nurses, what a profound story for the nurse involved you know, she's still in the profession, she's engaged with the profession.

She wants to be here and. Finally delivering what she sees is really high quality care. I just, think that's super powerful to linking it to your point on education and what she was able to do there, but it's, even bigger.

Yeah. I think that's a wonderful place to, call it quits here today, Chris, that's what a great story to, improve patient care improve burnout all in one, story, but I think you're right.

And I think We undersell the educational piece. I've seen some just straight up remote patient monitoring data where the patient engagement with the monitoring was okay. But they had these phenomenal results. And part of my brain is saying it's all about giving the patient the attention and that education piece.

Yeah. The monitoring was important. But and I don't know what proportion is that attention in education and focus and increased touch points. But somehow I think we hand them a, PDF of 20 pages on their congestive heart failure. I discharge and expect somehow that's gonna make behavior change.

And I mean, it just doesn't. So

I completely agree with you completely.

Well, Chris, thank you so much. I know you're a busy guy. I really appreciate you taking time and talking with us. I sure learned a lot and hopefully our listeners did too.

Honestly. Thank you for the invite and for all your support and partnership over the last few years, Brett, it's been amazing working with

it's a pleasure.

Thanks Chris.

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