Colleen Hole, BSN, MHA, FACHE – Hospital at Home Update

In this episode of the Move to Value Podcast we catch up with Colleen Hole, Vice President of Clinical Integration in Population Health at Atrium Health to learn about the new partnership with the retailer Best Buy, the impact of the merger of Atrium Health and Advocate Aurora Health on the Hospital at Home program and Colleen’s experience as a presenter at the global Hospital at Home Congress held in Barcelona Spain.

You know, the last time we talked, we talked about the Hospital at Home program, and you gave some great information. A back story. And so, how’s it going? Is it still a benefit to the community? Is it still being used in the ways that it’s supposed to be? I mean, how is it? How are things transpiring?

I would say we’re continuing to gain momentum in the program. So, as we talked about several weeks ago, it was born out of the COVID crisis if you will. For that, I am grateful for the pandemic because in most large somewhat risk averse organizations these things don’t happen very easily. You tend to meet and meet and meet and then finally maybe put together a proforma and do a small pilot. We bypassed all of that. We did a big pilot, um, out of necessity. So, what we’re doing now really is pivoting from COVID, which is now less than 10% of our patients, to other diagnoses which I think I mentioned last time: heart failure, COPD, various infections, but then going into oncology, neurology, surgical trauma. Other patient categories that even some established programs I think are not pursuing. Bottom line is we’ve not been diagnosis specific in this program. We’ve been more general clinical eligibility first, by clinical condition, and then what diagnosis fit in it. And then obviously once we’ve got a clinical clearance, you got to look at the social determinant of health and all social determinants of health and all those other factors that play into whether the patient would be successful.

But no, it’s going great. We have every intention to scale as far as we need to scale to continue to decompress our hospitals. And, your point, it is making a difference in the community. We get a lot of letters and feedback from patients that say please don’t ever make me go back to the hospital, I was so much more comfortable here, I feel safe here, I got to be with my dog. You know, that sounds small but it’s not small. So again, as we find our population aging with more and more chronic conditions in their senior years, hospitals can be pretty risky places for those patients who are often disoriented, tend to fall at a higher rate, they’re at risk for infections, they don’t typically eat as well, sleep as well, and they don’t move. They tend to stay in their bed with the door shut. Who wants to go down the hall in a hospital gown? So, all of these reasons in most cases make the home a better place for healing.

So, we got some big news that hit the media about the partnership with Best Buy and Advocate Health Atrium. How did this come about and how does it work? It’s fascinating.

Two very large health systems coming together to be one. And looking for the synergies that happen when you do that. Now there are naysayers out there that say stop the madness, health systems shouldn’t be merging. They are in Milwaukee, Chicago Illinois market. We’re down here in the South, in North Carolina, South Carolina, Georgia, and a tad bit of Alabama. So, we’re not in, you know, competing overlapping markets. They’re almost identical in size.

So let me back up a tad. Advocate and Aurora merged four years ago to become Advocate Aurora. Now that has merged with Atrium Health. So, the national name is Advocate Health, but each market will retain their brand that is known in that community. So, we’re still Atrium Health. What I’ve been involved in is just integration work around nursing. So, how do we align nursing around standards both structurally and clinically? How do we align some of this space that huddle lives in, which is this space between brick-and-mortar hospitals and clinics, this home-based care space. So, we’re doing some work around what do they have, what do we have, what can we learn from each other. So, a lot of it right now is what we’re calling discovery. We’re just learning oh you all do it like that. For example, they don’t really have a hospital at home program. They did a little bit of that at the peak of COVID. saw a few patients in their home, but not much. So, they’re real interested in figuring out what we’re doing down here. But the different markets matter because in the South we’re still largely fee-for-service, not a lot of value-based care yet. You and I would love to see that get driven forward. Up there they’re further down the value-based their contracting and care models.

There are really two reasons to hospital home broadly. One is you’ve got a capacity issue, which is our driving force here. They have value-based care and not so much of a capacity problem. So, their reasons for doing it would be different but all being involved and evaluate does this make sense for you all and how could we stand that up. So, the Advocate Aurora thing was cooking, I don’t know how long ahead, far way, before I knew about it. But that it’s a thing. Separate from that is our partnership with Best Buy. So, Best Buy five or six years ago said you know we’re really good at tech, we’re really good at logistics, what else would we want to lean into. Is it communications? They had five or six things health being one of them. And they felt like, you know what, we’d like to get into the business of health. So, they created Best Buy Health and started looking for partners to operationalize some of their skills.

So, they’ve got as I mentioned logistics and technology, we’ve got know-how from a clinical and operational perspective. So, what could we partner on and focus really in this home-based care space? And there’s a lot in there, it’s not just hospital at home. It’s home health, it’s virtual, you know, initiatives that we take care of people managing their blood pressure at home or their heart failure. So, that’s really what it’s about. We’re going to work on some things together and the media kind of grabbed ahold of the Geek Squad thing which is one of them. They’ve done Geek Squad for two decades. They’re looking at a Health Geek Squad. So, helping people manage health-related technology in their home. That’s probably the clearest, easiest one that we’re talking about working together on. What it looks like past the product development I have no idea, but that that’s really what it’s about. Everybody wants to get into the home-based care space knowing the cost of brick and mortars is too high, we’ve got access issues, we’ve got health equity issues, we’ve got rural health specific access issues. This stuff actually addresses all of that.

Has it been operationalized, or is it still in more of the strategy planning development stage?

It’s really still in the strategy development planning stage. We’re just beginning to meet to figure out what makes sense to do together. So, I know I sound vague but there’s truly not a lot of definition yet to it. We just think there’s stuff that we could marry up that they’re good at and we’re good at to create something that really advances health. And we’re not the only people in the country trying to do this kind of work. I think everybody agrees current health system structures they’re just not work for the long haul. And I really heard it in Barcelona. They’ve got more of a national view of health far more than we do and it isn’t saying we need socialized medicine, I’m not going to get into any of that, but they really do look at the whole of it. And we still are built around how we fund healthcare. We build stuff that is billable versus what the patient actually needs to live their best life. And that’s why I’m such a big fan of Hospital at Home. It is not a physician-centric model, it is not a facility-centric model, it’s not a payment-centric model, it’s a patient-centric model. Yay.

You mentioned Barcelona. So, just for reference, you recently were in Barcelona for the World Hospital at Home Congress, and you mentioned that it was quite an honor. And I can think of no one more deserving. Did you hear any other really off the wall, creative ideas about what’s happening outside of our borders that people are doing in this space that maybe we should pay attention to?

Um, I didn’t hear anything like, I never would have thought that, oh my goodness. But they’re further along in some of the things. But not as far along as in others, particularly around tech. You know, I think, we’re ahead of them with tech enablement. Like since I’ve talked with you, we’ve implemented our remote patient monitoring. So that allows us to have 24/7 visibility, audio, video connection to our patients. That’s awesome. In the countries that are doing it well, Spain, for example, it’s just become the way they take care of people. We’re still far more tentative about it. You know, Doctor Bruce Left started this at Hopkins 20 plus years ago aimed at seniors who he knew, as a geriatrician, didn’t do well in hospitals. But his program is still pretty small. I believe the potential is gigantic and other countries have really scaled a whole lot better than we have. They are starting in Spain, a master’s degree program in hospital at home which I thought was cool. We could sure do that with our Wake Forest academic arm. I would love to see that. But, yeah, nothing revolutionary really.

The type of patients was seemingly similar across all the countries that I saw. The only thing that kind of shocked me was Israel. Where we are very careful about patient selection and making sure that it’s for all, but yet that the home environment is safe enough to do this kind of care. It’s become such a way of doing things that they don’t screen for that as much. They talked of case studies where a patient lives alone and decreased mobility and no one there to help with food and meds and that’s one of their patients. We wouldn’t do that. Like we would not leave the patient without someone in the home to help them if they were that fragile. But they have to because they have no beds.

So, when I hear you say that, so from a technology standpoint we seem to be ahead but an implementation standpoint where, eh, middle of the pack.

Yeah. They’ve been at it, not all, but many have been out a lot longer than we have. Like decades, 30 years.

So, now that we’ve had this partnership unfold with Best Buy, which is I guess known for tech. I mean for nothing else they sell it right. But they’ve got the Geek Squad. They fix my parents’ computers time and time again. Do you see this as a really good opportunity for, of course it is a good opportunity to serve the patient, but really the things I think about is our underserved population. Folks with some economic, social determinant issues, health equity. How do you see, you know, something that’s a technology barrier from a cost standpoint being implemented to serve this patient population that could really benefit from the service?

So, when you look at social determinant issues the digital divide is the thing. And you know there’s a federal movement to try to address this with policy and infrastructure. But, um, that actually did come up a good bit in Spain. So, we’ve implemented a product called Current Health. That is our remote patient monitoring product. It’s actually owned by Best Buy Health, but it carries the connectivity in the device. So, we actually said before we implemented remote patient monitoring, we’re going to do it for all but we’re not doing it at all. And so, we didn’t want the haves and the have nots to experience this differently. So, rarely we still can’t get a connection, we can resort to a phone, you know, in other words it’s not a deal breaker no matter what. And there are connectivity issues urban and rural. It’s both. Some of it is just the towers aren’t there, others the patient doesn’t have the means to have it. But we did not want that to be a barrier for them to receive care.

So, that interestingly ,I was on a call with some folks from Mexico last week who thought I should come and help them build a Hospital at Home program in Mexico, but they were talking about the mountains in parts of South America and how that stops, you know, this is not my expertise, but signals get broken in the mountains and how would we mitigate that. And I’m like whoa, it’s interesting, different parts of the world they’ve not built the infrastructure we have in America. And so, that’s part of the tech problem. You know, any companies are going to sell it to them, but it won’t work if they don’t have, you know, the infrastructure in the country.

This sounds like an amazing opportunity for cost savings in patient care, which is one of the aims of value-based care. Do you see more initiatives of serving patients where there are on the horizon?

Yeah, I mean not so novel really, but just technology, virtual care, all of that I think partly empowers patients to direct their own care a little bit. Because in addition to our health systems being built around payment and largely physicians, it’s paternalistic. We set it up with we know what you need and you’re going to do what we say when we say and where we say to do it and if you want our help, you’re going to come to us. And that’s how we built it. This flips all of that on its head and by helping the patient with some technology, you empower them to actually self-manage, which does 100 million things, not the least of which is you get far better compliance and far better outcomes when the patient actually one understands and two says I can do this. So, that’s what I love about the technology.

We’ve also shaken the paradigm of well it won’t work for older people, that’s intimidating to them. We haven’t found that to be true at all. It’s actually been fun to see older patients go oh I don’t like computers, but this is really cool. So, you know, I think it doesn’t replace the care, but it can certainly enable it and allow you to take care of a lot more people. So, you could monitor hundreds of patients because you get a feed from their wearable device and be able to see 24/7 real time who might be in trouble, who needs a phone call, who needs a visit by a community paramedic. You can just be more efficient with how you deploy your resources, which lowers the cost.

Thank you, Colleen, for joining us today on the Move to Value Podcast.

Thank you. It’s been my pleasure.