Q&A With Virginia Mason Franciscan Health CEO on Hospital-at-Home Pilot

The Puget Sound-area health system follows in the footsteps of its corporate parent, CommonSpirit Health.

The 11-hospital Virginia Mason Franciscan Health system, serving the Puget Sound region of Washington state, recently announced a new collaboration with Contessa Health to operate Home Recovery Care, a care model that brings all the essential elements of hospital care into the comfort and convenience of patients' homes, offering a safe and effective alternative to the traditional inpatient stay.

Home Recovery Care is slated to launch at the health system's St. Joseph Medical Center in Tacoma later this year, aimed at patients with a variety of acute conditions including COVID-19, pneumonia, cellulitis, chronic obstructive pulmonary disease, congestive heart failure, and urinary tract infections. The payer mix at Virginia Mason Franciscan Health is 30% commercial insurance, 50% Medicare and Medicaid, and 20% self-pay/charity care/workers comp/TRICARE.

Ketul J. Patel, MHA, MBA, chief executive officer of Virginia Mason Franciscan Health, spoke with HealthLeaders about the new hospital at home initiative. This conversation has been lightly edited for clarity and brevity.

HealthLeaders: Is this part of the overall hospital-at-home trend?

Ketul Patel: This pandemic has driven us to be a lot more creative in terms of our approach to care. We entered this relationship with Contessa to do exactly that. When you just look at our quality outcomes, our safety scores, we're one of the best in the country, and for us to now be able to increase that level of care closer to where all of us would like to be, which is home, the better for us. And this was an opportunity for us to be able to do that.

HL: What was the timing involved that said, let's do it now?

Patel: Virginia Mason Franciscan Health has had many days that were over 100% occupancy. We want to be able to commit to finding opportunities for patients to stay out of the hospital [and] create capacity for us, so that we can take care of those who are critically in need of an inpatient stay. We decided to launch this now because we've found a partner that we think is strong and has the ability to help us scale all throughout our system.

HL: The technology involved has been evolving over the past few years. How ready is the technology to handle things, maybe even at scale?

Patel: Before 2020, we saw less than 2% of our patients on ambulatory setting virtually. At the height of our different surges, particularly in the beginning, we escalated all the way up to the mid-20s%. We're hovering in the 16%–17% range right now, in terms of virtual care. The technology has caught up to us, frankly.

HL: Why did you select St. Joseph Medical Center in Tacoma to do the initial launch?

Patel: St. Joe's has had the highest level of occupancy in our system for a number of years. It's one of our three tertiary care facilities in our system. It made the most sense for us to be able to do that, given the capacity challenges and some of the opportunities that we have in a tertiary-based hospital.

HL: Other hospital-at-home solutions have implemented their own dedicated internet connections in these cases, due to concerns about reliability of ordinary commercial internet. Do you do that also?

Patel: We have not done that yet. We're going to see if that's a need that we have. Connectivity to the internet goes into decision-making that we have in terms of identifying patients who are the right patients to have in this home recovery system.

HL: What are your goals for usage? What are the general milestones you're looking at?

Patel: I'm a big believer that we go slow to go fast. We need to have a sample size of patients that not only have gotten the right kind of treatment, but they're experiencing the kind of patient experience that we want. They feel safe. They are improving. We see readmissions rates continue to drop. So, we want to start there. Rather than forecasting numbers, in terms of what we want to see, I want to make sure that the pilot shows legitimacy around patient care, patient satisfaction, and impacting some of the metrics that we've talked about, which is slowing down readmission rates, and it's improving patient care.

HL: There are so many technologies and telehealth offerings these days. How did you narrow the selection down to Contessa?

Patel: It was a bigger question. One is, should we build it on our own? Or do we partner with a company like Contessa? So obviously, the first decision we made is we want to look for a partner. We've had history with Contessa in other parts of our system at CommonSpirit Health. And so that was, in many ways, a proof of concept for us. The biggest issue for me, though, is that we want to make sure that any partner that we have is a good partner for us in terms of our values, in terms of our focus. Our brand is so strong in terms of clinical outcomes and quality and safety, we want to ensure that the partnership that we're in is going to continue to help us elevate our performance for our patients.

HL: Does this in any way represent an alternative to building more hospital beds?

Patel: Well, I would assume that if this continues to proliferate, we all talk about moving into the value-based care segment. In the Pacific Northwest, we're still predominately fee-for-service. And we feel strongly at Virginia Mason Franciscan Health that we need to move patients outside of the hospital. It's models like this that will help us go certainly into that journey, have a little lower total cost of care for our patients in our communities, [and] be less reliant on inpatient stays on a day-to-day basis.

HL: How do you roll this out from a staff and culture point of view?

Patel: When we go through the hiring process, we want to make sure that the culture that we not only have but that Contessa has, our partnership has, is seen through the staff when they provide that level of care.

HL: So there are going to be dedicated staff, some of which are yet to be hired, that will help implement this?

Patel: Yes, so we'll have nursing staff that are going to be embedded as part of this relationship with Contessa. We're going to be using our existing physicians that are part of Virginia Mason Franciscan Health to oversee, from a physician perspective, the level of care. They also are going to have other responsibilities, but at the same time, when you're dealing with this level of care, our physicians are skilled to be able to do that. The clinical staff that are going to be in and out of homes are going to be important for us, too.

HL: Can you be more specific about the implementation timetable?

Patel: Well, the gating issue for us right now, much like anywhere else in the country, is staffing. When we have a core staff, we're going to be ready to go. In the next few months, we'll be launching this for sure.

HL: Are you at all inspired or challenged by efforts you've seen elsewhere? What's your interpretation of how it's been going elsewhere?

Patel: We've obviously done our homework. And there's nowhere else better to look than our own family, within CommonSpirit. That was a good proof of concept for us.

HL: You mentioned being predominantly fee-for-service. To what degree can this help you move toward more value-based care?

Patel: All of us feel obligated that we need to do that. And again, it's not about, as you said, increasing our bed capacity, even though we do need that in the Pacific Northwest. We have to invest in the overall continuum of care. And this to me is part of that continuum of care. It's an obligation, not just an idea. It's an obligation for us to move into value-based care. And obviously, initiatives like this are going to drive us to be able to do that.

I am proud of our entire team. We all have staff members that are incredibly fatigued but working hard. I love to see that every single day when I'm rounding.