CommonSpirit: Technology in Service to the Vulnerable


Bill Russell / Dr. Alisahah Cole / Royal Tuthill

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October 21, 2020: Today’s focus is on caring for the vulnerable. CommonSpirit and Docent Health’s program to help underserved communities will have you at hello. Are we talking about client-facing technology? Are we putting something on a phone? Are we talking about technology that’s connecting housing, transportation and education needs? Dr. Alisahah Cole from CommonSpirit and Royal Tuthill from Docent Health join us to explain their “air traffic control” virtual care program which helps vulnerable patients navigate the best opportunities to receive the finest care possible. In the words of Dignity Health’s hello humankindness campaign “Aim for nothing less than to inspire change in health care that leads to more empathy, listening, and respect.” 

Key Points:

  • CommonSpiritt and Docent Health are expanding their virtual care navigator program to build on the program’s success in improving health outcomes for maternity and orthopedic patients [00:09:01] 
  • CommonSpirit Health Closes Care Gaps with Personalized, Community-Based Care Navigation in Partnership with Docent Health
  • The program’s technology enables the scaling of teams, care managers, social workers and community health workers [00:13:15] 
  • AI capabilities help scale communications to understand when it’s appropriate for a human to intervene [00:16:15]
  • How do we make sure we don’t put any additional burdens on our frontline clinical staff? [00:18:55] 
  • Excellent results including decreasing the length of stay and decreasing readmission [00:19:30] 

CommonSpirit: Technology in Service to the Vulnerable

Episode 318: Transcript -October 21, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

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[00:02:30] [00:02:30] Welcome this week in health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, former healthcare CIO, coach consultant, and creator of this week in health IT a set of podcasts, videos and collaboration events dedicated to developing the next generation of health leaders.

[00:02:45] Speaking of developing the next generation of healthcare leaders, we want to thank Sirius for supporting our mission and the mission of our show. Their weekly support of the show this year has allowed us to expand and develop our services to the community. All right today, [00:03:00] we are excited to have Dr. Alisahah Cole with Common Spirit  VP of Population, Health Innovation and Policy and Royal Tuthill with Docent Health. He’s the Co-Founder and President of the organization. Join us. Welcome. Welcome to the show. the two of you. 

[00:03:17] Alisahah Cole: [00:03:17] Thank you. We’re excited to be here. 

[00:03:19] Royal Tuthill: [00:03:19] Thanks Bill

[00:03:19] Bill Russell: [00:03:19] That’s pretty, it’s pretty smooth for me. Welcome. The two of you, Dr. Alisahah Cole you’re recently married. That’s probably the most exciting thing going on 

[00:03:31] [00:03:30] Alisahah Cole: [00:03:31] Just this weekend. 

[00:03:32] Bill Russell: [00:03:32] Congratulations. That’s really exciting but that’s not what we’re going to talk about, although I’m sure it would make a great, a great story. We’re going to talk about the expansion of a program that you guys are doing  in these communities. So let’s just jump right into it. Cause I think this is a really exciting announcement. So Alisahah, before we go there, give us a little background on CommonSpirit for those people who aren’t familiar. 

[00:03:55] Alisahah Cole: [00:03:55] Yes. Thank you, bill. so I definitely would love to just, give a little bit of [00:04:00] background around CommonSpirit as a lot of people still don’t know us as common spirit. so this was a, a health system that came together and February of 2019, through the alignment of Catholic health initiatives and Dignity Health. So with those two organizations, strategically, we actually became one of the largest healthcare systems in the country.

[00:04:23]As far as a nonprofit healthcare system  We have over 150,000 employees. [00:04:30] We employ over 25,000 physicians and advanced practice care providers. We have over 137 hospitals and we are in 21 States. so serving almost half the country, and again with a focus on caring for the vulnerable. So this is, it’s such an amazing organization. and thank you for giving me an opportunity to just share a little bit about it. 

[00:04:53] Bill Russell: [00:04:53] Yeah, and this is such a great program. Why don’t you just move straight into the program that you guys are  [00:05:00] expanding. And, the, I’m very familiar with CommonSpirit with, and with Dignity, having been in the California markets and work with some health systems in Colorado as well.

[00:05:11] But you guys literally are across the country. But you are strategically located in some communities that are really underserved. And these are people that have challenges in terms of, keeping up with their care programs and identifying the best really matching the best [00:05:30] opportunities to receive the best care. So talk a little bit about the partnership with dos and what you guys are doing. 

[00:05:36] Alisahah Cole: [00:05:36] Yes. and I’ll definitely hand it over to Royal as well, to talk a little bit more about, the great work that Docent has been doing and the program that they’ve put together. So I joined CommonSpirit a few months ago as the new system Vice President for population health, innovation and policy, in that role had the amazing opportunity to learn more about Docent and initially become the [00:06:00] medical director for that program and our partnership with them. So I’m a practicing family medicine, doctor.

[00:06:07]I come from the academic side. So I’m one of those old holdouts that was still doing inpatient medicine, as well as outpatient medicine and still providing maternity care. And again when I heard about this amazing program and what they were doing, particularly in the space of maternity care, I was extremely excited.

[00:06:24] So our partnership with Docent really focuses on. Helping our [00:06:30] patients navigate through certain episodes of care. And so again specifically looking at the maternity care journey, as well as the orthopedic journey, and we found in our initial pilot, Oh, was that we saw some significant, health outcomes, that, it was, maybe a little bit surprising to some, but not, not all.

[00:06:52]And some of those health outcomes, given the population that we serve, as you mentioned, we serve a very large Medicare and [00:07:00] Medicaid population. One of the largest providers of Medicaid in the country actually. And what we saw was still these significant outcomes, even in the Medicaid and Medicare population, which often are a little bit more challenging to help them navigate through their care.

[00:07:17] So we saw about a 37% reduction in pre-term births, in that population, we saw pretty significant reduction, about 70% in readmissions. And we also saw [00:07:30] pretty significant reduction in length of stay for both our maternity care patients and our orthopedic patients, which meant that we were able to get patients home sooner, rehabbing and healing in their environment, which oftentimes is better than being in a hospital setting.

[00:07:48]Some pretty significant outcomes that we saw in clinical outcomes. And because of that, one of the things I have said about healthcare is, there are times when we have evidence based [00:08:00] practices. We know there are things that work. But for some reason, we don’t standardize that across our systems. And so here was a program that we saw pretty significant outcomes. And, so we said, wait a minute. Why shouldn’t every patient that we serve in this space have the ability to access this amazing program. And so that’s what we, launched into now, the second wave, if you will, to really expand this amazing program across, across all of our facilities.

[00:08:30] [00:08:30] So Royal, you want to talk a little bit more in detail about Docent, but I did want to just acknowledge, that, we saw those significant patient outcomes and utilization outcomes and it made it really easy for us to say this is something that we need to expand across our system. 

[00:08:46] Bill Russell: [00:08:46] Fantastic. Royal give us an idea of the program that you guys are scaling up now and that you’re expanding, but give us an idea of what’s the challenge that you’re solving and what you guys have been able to do. 

[00:09:01] [00:09:00] Royal Tuthill: [00:09:01] Yeah. So probably two, two aspects that it, one is what we built in the past, and then what we’re working on expanding off of from there. And it’s been an amazing journey to work with CommonSpirit, originally dignity and now common spirit and obviously great leaders like, Dr. Cole, who are very committed to this work. And where Docent started, we’ve been around since 2016 and we’ve been working closely with dignity is one of our anchor partners, as we started engaging communities and a lot of the communities to, to your [00:09:30] point that we were working with at Dignity Health originally . High Medicaid populations. We had really hard to engage communities. A number of areas we were working in had, undocumented workers, we had English, high English as a second language. We had a large indigenous community and so pretty quickly we realized if we were going to be able to have an impact, we needed to be able to connect to the communities in a more culturally appropriate way and so a core part of the docent program is [00:10:00] technology that helps scale community-based navigators.

[00:10:03] And so we hire navigators from the community. We enable these programs with technology that we can go more into but there’s a really key part to making sure that we could connect to the patients. We could get them engaged in their healthcare. We could provide that longitudinal support, both in the community and as they get ready to go into the hospital and back home. Really a key driver for the program is making sure that we had [00:10:30] communities that were supported by people in the community and working really closely with the healthcare system and partners like the in CommonSpirit to help ensure that they were on the best track to good health care and outcomes. So that’s a core tenant of docent from the beginning. And, it was a key driver in a lot of the results that Dr. Cole just highlighted. and as we’ve been expanding out this program and looking forward to the future, a big focus for us is how do we continue to replicate the results at scale?

[00:10:59] How do we [00:11:00] standardize some of the best practices? And then also a big focus for us over the course of the spring and the movement around social justice, and more attention to social determinants of health and racial disparities has been, how can we make sure that no communities are getting left behind as we deploy these programs and really being thoughtful about this model that we’ve started to build?

[00:11:21] How do we ensure that we can replicate that in other communities and a very specific focus on African American mothers and infant and child and [00:11:30] maternal mortality, is a key focus within those programs. And so we’re, really privileged to be able to work with one of the largest providers in the country with our mission. 

[00:11:41] Bill Russell: [00:11:41] So let me change this up a little bit. I’m a former CIO for a large health system -and we had similar populations to the population that you’re talking about. So I would have changed this out up as, okay you had me at hello, I’m interested, but now I need to understand it further. So are we [00:12:00] talking about client-facing technology? Are we putting something on a phone? Are we talking about technology that we’re putting in front of care navigators that’s connecting the housing, transportation, education needs, and those kinds of things. What are we talking about? 

[00:12:14] Royal Tuthill: [00:12:14] Yeah, let me explain the technology a little bit on the patient facing side. There’s no apps to download. There’s no portals, there’s no websites or logins to remember. It’s texts. It’s primarily a text messaging based program and a phone. And we have web surveys as well, but it’s [00:12:30] primarily a text based program and we do, automated push campaigns. bi-directional AI communications and then two way communication as well for navigators and for care teams.

[00:12:41]So on the patient facing side, and this has been hugely important to the hard to engage communities that it’s leveraging the tools that they have in their pocket today and works for at risk and vulnerable populations. It also works really well for commercial insured patients. And that’s been a key part of the program to getting really high engagement rates so [00:13:00] that we can connect with patients early.

[00:13:01] We can get more frequent data points. We can build connectivity, you can understand who they are and then we also have the navigators and so some of our partners will work with outsource navigators from Docent. Some of our partners just licensed the technology to scale their teams, their care managers, social workers, community health workers but the technology platform then is really designed to integrate data sources from the EMR, from the practice management system, [00:13:30] each tap spilling to get a holistic profile of who that patient is as a person and then workflow tools that we cue off of that will then surface activities up into a care management platform for the navigators to use, or then triggers messages directly out to the patient.

[00:13:46] And so there’s a really coordinated program, it’s built to longitudinally guide a patient through that journey. And we’re surfacing up the right information at the right time to keep them engaged and on the track. And if we learn more about them, as we capture social [00:14:00] determinants of health, as we capture personal preferences, We can, then we have a mapping of what the resources are and that could be community resources or hospital resources or clinical resources or collapsed the download.

[00:14:13] We can make the connection and it’s between the patient attributes and the attributes of those programs to know what are the next best steps or what are the next best, resources to get those individuals connected to. 

[00:14:24] Bill Russell: [00:14:24] Yeah. You know what I love about it. As a technologist, we have people on the show they’re constantly talking about AI. [00:14:30] They’re constantly talking about really cool smartphone apps and navigation that, but one of the principles you dropped there, which I think is so important is a technology. The best technology is the technology that people can use. And you looked at the communities that you serve and you’re like, you know what? Texting is a way that they, that you can really get to a majority of that population and interact with them pretty easily. It’s is that the principal that really you, you looked at and designed around? 

[00:14:57] Royal Tuthill: [00:14:57] Yeah, absolutely. We made a strategic decision not to build an [00:15:00] app a number of years ago. And I think especially now during the pandemic and COVID-19, we’ve seen a lot of our partners look to us and really lean in to using text messaging because it’s so much easier to drive engagement. And there’s certain things that you can’t communicate over SMS. It wouldn’t be clinically appropriate, but you can use that as a channel for engagement to then connect them to other services. And so it’s been a really important part of that arsenal to drive connectivity and engagement and more frequent points of connection [00:15:30] over time. 

[00:15:30]Bill Russell: [00:15:30] But just because it’s text-based doesn’t mean it’s not high tech. You’re talking about artificial intelligence to get a whole person profile and then map the right services to those individuals. So you’re using a lot of data bringing that data together. and really making decisions around what’s the best nudge to help people to make the right choices. Is that? 

[00:15:53] Royal Tuthill: [00:15:53] Yeah. Yeah. So a big part of this is getting the data together to understand what’s going on and having [00:16:00] this air traffic control system for patients. So you can see where they are as they navigate the system and then a rules engine off of that. So we can then trigger what are the right messages? So the patients at the right time, and then AI capable abilities to help scale some of those communications understanding when it’s appropriate for a human to actually intervene and drive engagement when appropriate, what are the right resources to be connecting and pushing through that channel? So there’s a lot of sophisticated tech to your point underneath text messaging is funny, [00:16:30] feels like the new killer app these days. but in order to make it effective, it does require a lot of sophistication underneath. 

[00:16:36] Alisahah Cole: [00:16:36] Yeah. And one of the things I would add is that this not only is it, messaging, to the patients, but also to the care team. And sending those triggers to the care team, not only allowing or encouraging the patient to advocate for themselves, but for the care team to also advocate for the patient. I think if you look at some of the reasons that these disparities exist, [00:17:00] particularly in the African-American mom and baby disparities from a mortality and morbidity standpoint, oftentimes it’s a navigation issue. How do patients get to the right care at the right time? how do they know which resources to access? and, and yeah, how are they supported in getting to those resources? And so that’s one of the great things about Docent that we love does that. [00:17:30] It also not only again, encourages the patient to advocate for themselves, but in a sense, provided advocates through the docents and through the rest of the care team to advocate for the patient and their family.

[00:17:42] Royal Tuthill: [00:17:42] Yeah. Just to add on to that, it’s been great having a clinician as a partner in Dr. Cole and us really thinking through how do we make sure that great information that we capture about a patient- fears and concerns, social needs, barriers to care – how do we make sure that it doesn’t get isolated with the [00:18:00] navigators, but we can share that with the care teams as well. And so we’re giving them more scale. They have that information as they go to engage the patients, as opposed to spending time to try to collect that information. so I think that’s a key part of the partnership going forward is how can we democratize some of that information that we’re capturing from the patients.

[00:18:18] Bill Russell: [00:18:18] Yeah. 

[00:18:18] Alisahah Cole: [00:18:18] And really add as a tool to the frontline care providers. I think that’s one of the things I often hear from my colleagues, my physician colleagues, okay, are you asking me to do one [00:18:30] more thing? I don’t even like the EMR and now you want to bring another. technology, to me. And so this really does not add any additional work on the providers. the way the technical  is set up, but gives them more information that, again, they can choose to use, in order to take better care of their patients. But that was one of the keys things that we did want to make sure as even we were gathering the data, how do we make sure we don’t put any additional burden on our frontline clinical [00:19:00] staff?

[00:19:00] Bill Russell: [00:19:00] You read my mind. That is the question I was gonna ask you. Wasn’t there before I got there. So, Dr. Cole, I’ll give you the last word on this because I want to, let’s fast forward two years from now, and we’re having this meeting. What would be really phenomenal outcomes. What do you hope to accomplish in the next couple of years with this program? 

[00:19:22] Alisahah Cole: [00:19:22] Yeah, that’s a great question, Bill. Thank you. I think of course we would want to continue to see some of the significant outcomes that we’ve seen [00:19:30] already in regards to decreasing the length of stay for our patients. decreasing the readmission rates, for our patients, expanding this beyond just the maternity care episode or the orthopedic episode, but, do we see benefits in a congestive heart failure episode or in a CLPD episode? Sepsis. There are so many different, potential opportunities, for this program. Of course, I think what I’m excited about as we have now started to [00:20:00] really focus intentionally on these healthcare disparities in the maternal child space, again, specifically to African American women. My goal would be we eliminate those disparities in our system. There is I feel no reason that we can’t do that. if we’re being very strategic about this work, if we’re being very intentional about this work and quite frankly, if we’re checking and monitoring the data. Yeah. And so that, I think ultimately, we at [00:20:30] CommonSpirit and the Docent team would like to be able to say that we eliminated that, that infant maternal mortality and morbidity disparity that exists in African American women and children. Big, huge statement that I know might scares some people, but someone has to make it and someone has to commit to doing it. 

[00:20:48] Bill Russell: [00:20:48] And I love the work that CommonSpirit’s doing, I love your every time I get a chance to listen to your CEO, I’m inspired that  I love the campaign. I think it’s still your campaign, the “hello, human kindness” is that, [00:21:00] that was really powerful when they rolled that out in Southern California, people were talking about it. It’s yeah. I love the work that you guys are doing and Royal. Thanks. Thanks for the you know text! Text is the new killer app. Is that what I heard you say? 

[00:21:14] Royal Tuthill: [00:21:14] That’s right. 

[00:21:16] Bill Russell: [00:21:16] I t is great to use the technology in a way that people can interact with it and it can have an outcome. So I really appreciate this announcement and I appreciate you guys coming on the show. 

[00:21:26] Alisahah Cole: [00:21:26] Thank you. 

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