(upbeat music) - Welcome to "At Issue."

I'm H. Wayne Wilson.

Thank you for joining us.

We're very familiar with the concept of, you recover better on health issues when you're at home.

But the question then becomes, how do you do that best when we're all used to, best care would be in the hospital?

Well, one answer is what is called OSF, OnCall Digital Hospital.

Digital Hospital.

And to have a conversation about that, we're joined by Jennifer Junis.

Jennifer is the Senior Vice President, Digital Health, OSF OnCall, thank you for being with us.

- Thanks for having me.

- Explain OSF OnCall Digital Hospital.

I mean, when we go to the hospital for surgery, at ER, whatever the case may be, in the back of our mind there's that, I may be going into the hospital.

You mean I can get service at home?

The equivalent service?

- Correct.

So this is a new program that we have started that if you meet criteria to be cared for acutely in your home, instead of being admitted into the hospital, or staying longer in the hospital, you can go home and receive those same services in your home.

- So you might be admitted to the hospital for a couple of days, instead of a week, depending on what kind of conditions?

- So there is a list of 26 diagnosis codes that qualify for our digital hospital.

So some examples are congestive heart failure, sepsis, COPD, things that you would traditionally be admitted into a hospital for, we can take you to your home and monitor you from our command center, and come into your home, and care for you in that acute phase in your home.

- Who qualifies?

I mean, is your age, where you live, et cetera?

- So I think of it as a big funnel.

So there is insurance plans and Medicare that support this program.

So first we wanna make sure that it's covered by your insurance or by Medicare for you.

And then there's a list of diagnoses.

And then we make sure that it's a good fit for you.

What's your home environment like?

Social environment, and that's a screening process.

And then we offer it to you.

- How old do you have to be?

- We do adults.

So we do not do this program for pediatrics at this point.

- And is there a location, I mean, where is this is, this is Peoria right now?

- Yep, so right now our command center is here in Peoria.

And so our radius is a 35-mile radius from the center of Peoria.

And then in October we'll be launching in Rockford, so a 35 mile radius around our hospital, St. Anthony's Medical Center in Rockford.

- Does the patient have the option of saying, I would feel more comfortable being in the hospital?

- Yeah, of course, it's always patient choice.

We just wanna make sure our patients have a good understanding of what it is so they can make that informed choice.

And we really find that most patients, if they meet all of the criteria, and after they have met with our advanced practice provider, is the one that is in the ER or in the hospital talking to them, most patients really wanna do this.

- Most would be defined as 51%, or are we talking 9 out of 10?

- Well, you know, we are monitoring those percentages and they continue to increase as we do more like this and get the word out, and there's more word of mouth.

We've cared for over 200 patients now, so those patients are starting to tell their friends and neighbors about this program as well.

And that acceptance rate is continuing to climb.

Right now we're at about a 60%, but continuing to work on that.

- So let's get into the guts of the program in terms of, what kinds of services can you provide to a patient who is at home?

- So we are required by regulation, to be able to provide all the same services that you can get in a hospital.

So you can, we provide you with meals if you want our meals, we provide you with all of the level of care and monitoring that you would receive in the bricks and mortar hospital.

Your medication is provided as well.

So all of those same services we have to meet those same requirements.

- Is in-home visits?

- In-home visits, yep.

So by the clinicians, so by our nurses, by therapies, by our providers, provide those in-home visits.

- But the most important thing is, the patient wants to know if you're in the hospital, there's a nurse right there, or a physician, what have you.

Do you monitor these patients?

- Yep, so same thing, so there is a nurse, a physician available to our patients 24/7 via a virtual camera.

So they have a tablet, they have a phone, they can push a button, we give them multiple ways to contact our command center, and they are immediately connected with our staff.

- So you can see them visually?

- Yep, we can see them visually.

- And you can monitor them in terms of the vitals?

- Vital signs, yes.

- So what happens when a patient has an emergency at home?

In the hospital, we know what happens.

How do you respond to an emergency?

- Yeah, so that's another regulatory requirement.

We have to be able to rapidly respond to patients that need emergency level care.

So that is, we work with our local EMS and we activate 911 if our provider feels that is the right level of emergency care that needs to be given at the time, or we can send our team out to handle that in the home.

- So let's talk, you've mentioned regulatory several times.

Who's regulatory?

I mean, what regulations do you have to meet, and who sets those standards?

- Yeah, so CMS really is the one that has- - And for the audience's benefit, Central Management Services, is that CMS?

- Center of Medicare Services?

- Oh, I'm sorry.

- Yes.

- Okay, they're different CMS.

- Yes, so they really have regulated, and then we have Illinois, Illinois Department of Public Health also has adopted CMS's same regulatory requirements.

So, which is what usually happens in this case.

And then for private commercial insurers, they really want that same regulatory environment as well.

- So let's go back to the origins.

I wanna talk a little bit in a moment about, you seem to be leading the way here in Illinois.

You're, I don't want to use the word pilot, but you're out front on this program, this is new.

But its origins go back five, six years?

- Yeah, so really about two years before Covid, we had a hospitalist at St. Francis Medical Center that brought this forward in an innovation challenge.

So we do innovation challenges, ask our frontline caregivers to come up with new ways to deliver care to our patients, that could improve the outcomes for our patients.

And so he had brought this forward, he had seen it in other parts of the United States, had been following hospital at home programs, which were just a few at the time, and thought it would be a good solution for OSF healthcare, especially at St. Francis Medical Center, where we do have capacity constraints at times.

And so we took that then into a lab at Jump Innovation and Simulation Center.

And that team was really working kind of, in addition to their day jobs, but we're working on this pilot of launching a hospital at home program for OSF.

And then Covid-19 pandemic started to hit us, and especially our facility in Evergreen Park.

So a little company in Marion Evergreen Park in the Chicago land area were seeing an increased number of Covid patients coming to their hospital.

And so really asked us to bring this program out of the pilots, out of the lab, and take care of Covid patients in their home.

So we learned a lot, we took care of over 200 patients during that time, not just in the Evergreen Park area, but then across our system.

And we learned a lot about how to care for acutely ill patients in their homes.

- So post Covid, if there was such a thing as post Covid, you went back to that original plan and said, we need to do this on a regular basis?

- Yeah, so about mid pandemic is when CMS acknowledged that a lot of care in the home was happening.

And so said, we're gonna put some waiver requirements around acute hospital at home programs.

So that allowed us to then say, okay, we wanna make sure we're building this from a strategy standpoint, we're building this for the long haul, and that we can take care of patients other than Covid patients.

We wanted to expand that diagnoses code level to the broader population.

And so that's really, it took us about six to nine months to build our electronic health record out, to make sure that we were hiring the team that would focus on this every day, and care for these patients, that we were training we were simulating, and that we were ready to relaunch this program.

- You've mentioned several hundred patients have gone through the program so far.

What's the experience been in terms of, are you meeting, you had goals in mind?

- Correct.

- Are you meeting those goals from the patient's perspective?

- Yeah, so we have quality metrics that we are far outperforming.

So we measure our readmission rates, compare those to national benchmarks, as well as our own internal benchmarks, our falls, infection rates, pressure ulcers rate, all of the quality indicators that we measure in our hospitals, as well as then a patient experience score.

So nine out of 10 patients in this program would highly recommend it to others.

So we're really proud of the results that we're getting so far.

- What is the response of staff?

Because, this is new workflow.

Has the staff, have they been pushed or are they saying, no, we'd like to participate?

- Yeah, so we actually hired into this program, so we feel like we've got the right talent and the right fit.

And several of them work in other settings, and this also allows them to work in other settings.

So if you think about our nurses, even in within this program, they work in the command center a shift, and then they're out in the field for a shift.

So it gives them both sides of the care delivery.

Our hospitalists, many of them are also adult hospitalists at St. Francis' Medical Center, but they also then are able to work in the command center and see patients in the digital hospital virtually for a shift.

- You have been in, prior to your current position, been a chief nursing officer at a couple different medical centers.

When you took this on, what change have you seen?

Because a chief nursing officer, you're focused on the hospital, and making sure nurses are there.

What kind of, what's the change in atmosphere?

- Well, when I was a chief nursing officer, I worked in rural communities, and so I was always looking for innovative ways to care for patients, because of a lack of resources in those rural communities.

And then when I was a hospital president, that really accelerated my passion towards making sure that the communities that our sisters were called to serve really had the right level of care for patients.

And so this was a natural evolution for me to be in this role when the chief strategy officer, Michelle Conger put structure around Digital Health.

It was that we were gonna wake up every single day redesigning care, and actually providing that care to patients.

So I feel like this was a natural evolution for me to use that innovative spirit, but also that operational background of running hospitals in our rural communities.

- The change in atmosphere, is the word I'm using, are there people saying, staff, I'm talking about staff saying, I want this experience because it's varied, and I feel like I'm helping the patient just like I'm helping them in the hospital?

- Yeah, so we know we have a national nursing shortage, so we're not immune to that here in Peoria.

So I feel like once the nurses understood what the program was, then we've been able to really hire to those roles.

Same thing with our hospitalists.

We actually are full of, for our hospitalist shifts, the hospitalists were really interested in doing something like this as well as then our nurse practitioners, our APPs.

This has been a great learning opportunity for them, because it's not inpatient, it's not outpatient, it's a completely new care delivery model.

- At the top of the show, I said we are pretty sure that patients recover better when they're in their natural environment, which would be home.

Is that the case?

Are there numbers to show that yes, I'm recovering more quickly, et cetera, because I'm at home?

- Yeah, so we mind our length of stay.

So that was one of our key metrics when we launched this program to really look at the length of stay for comparable diagnoses.

So we take a comparable patient, and a comparable diagnoses, and then we can crosswalk that and compare that to a patient that spent time in the bricks and mortar hospital, versus those patients that spent time in the digital hospital.

And we're seeing that about a day and a half to two days lower.

- You mentioned some of the examples of some patients who would qualify of the 26 different disciplines.

Is surgery included in that?

- Yeah, so we have been working with our surgeons, as well as our oncologists, as we start to think about the new cancer center that's opening here in Peoria, and what that will look like as we could work with them to really talk about, talk to their patients about that hospital at home prior to them coming in for their surgery or coming in for their cancer treatment.

So we're just starting to expand into those two service line disciplines.

- Are you confident that this digital on-call service at home is really as good as hospital care?

- Yes, 100%.

- Why do you say that?

And we've talked a little bit about various things, but, there's, you know traditionally people say, well, the hospital, the doctor, the nurse, they're all right there.

How can you say I'm 100% confident that this is just as good as being at OSF or St. Anthony's in Rockford, et cetera?

- I think it's three things, right?

So I always talk about technology, people, and process.

So first I think the technology continues to evolve, and the technology is incredible of what we can do today versus what we could even do a year or two years ago.

That technology is rapidly increasing, and gives us the opportunity to really provide this level of care in the home.

And then it's about the people.

It is about the clinicians and the pride that they take in their work, and that their diligence around continuing to design, improve and create this program.

And then it's the processes.

So I know I talked a lot about regulatory in the beginning, and a lot of times we see regulatory maybe in a negative light, but in this case regulatory is a very positive thing to be able to have those regulatory requirements, where we report all of our data to CMS as they collect this data across the nation, and even out outside of the nation to really look at the outcomes that are being provided in hospital at home level care.

- I wanna talk about that we're regulatory again, but take it a little different direction, is there legislation either on the federal or the state level that's needed long-term to make in-home care viable?

- There is.

So we have been a part of a lot of advocacy efforts.

And really those advocacy efforts are about helping our legislators understand what hospital at home is.

It is a concept that really takes some learning, and it takes some visualization of what it is.

We recently had the Jump 10 year anniversary and we set up a hospital at home environment, and had key stakeholders coming through to really actually see it, see what care kinda that noisy, interrupted care in the hospital looks like, versus this is the care at home, and see the technology, and see our command center and what our command center staff sees in the home.

And so I feel like a lot of the advocacy has been just helping everyone at a federal and state level understand the level of care that can be provided in the home.

- You mentioned earlier, I wanna make sure I understand that well, to make sure that this is the equivalent of in-hospital care, you're monitoring vitals, there's in-home visits, et cetera, but you set a camera.

- Mm-hmm.

- Where's the camera?

How do you, I mean, as a patient, they still could move around, they might go to the bathroom, they might fix lunch.

- Yep - How's that work?

- Yeah, so there's a tablet that the patient can decide where they would like it.

But there is a tablet, there's a phone, there's also a button either on a bracelet or a necklace.

And so our command center can be reached, if they're up and mobile, they can just push that button and get an audio if they're not in front of the camera, or if they're in front of the camera, they can just push the tablet, or they can just pick up the phone.

So we make it super simple.

We know we're all familiar with that easy button.

We really do make it an easy button for the patients.

I was really fortunate when we were getting ready to launch, I was one of the simulated patients.

So I started at the Jump innovation center in an "ER room."

And I was taken by ambulance to my home, and then all of the equipment was set up in my home, I had to warn my neighbors when they showed, when the ambulance was showing up at my house.

But I was able to see all of the equipment from the patient side.

- I wanna talk about stress for a moment, both from the patient's perspective and the staff perspective, is there any change in the stress level, first for patients, then for staff?

- Yeah, so one of the things that resonates with me is one of our very first patients, I remember our hospitalist, I was rounding with him and I said, how's our patient doing?

And he said, oh, this is kind of a funny story, because this would never happen in the hospital.

He said, we went to do his virtual visit this morning, and it was scheduled for 8:00 AM, but we were going to talk with him and he overslept.

And so you think about the interruptions in a hospital setting, so you think about rest and being able to heal.

We know the body needs rest to be able to heal.

So think about that calming environment in home versus a hospital setting.

So that was one example of that.

And then from the staff level, I do think there's been a certain amount of stress, just being a part of something new.

It's a lot of change, it's a lot of change management of just helping our internal stakeholders at OSF understand what the program is, much less helping our communities understand what it is, but they're really proud of the outcomes we're starting to see, and that really fuels them to continue this work.

- You had mentioned that you had worked in rural settings, medical centers that were in rural settings.

And we know that there's a 35-mile radius for Peoria, and soon a 35-mile radius for Rockford.

But where this really could make a difference is in those rural areas.

Well do you see this expanding so that a patient who is in a remote town, not close to any urban center could benefit from this?

- That is really our next step.

That is our next challenge from an innovation standpoint, really trying to figure out how we do more of that in-person in those rural communities.

The command center, and the monitoring and the technology and the processes, all of that is very easily doable no matter where the patient's at.

It is providing that rapid response and that in-home, in person care, that's such a challenge in the rural environment.

And to keep that at a low cost, right?

I mean, so we could certainly do it at a higher cost, but we wanna make sure that we're designing care delivery models that are lowering the cost of healthcare.

- And that might lead into this question of, what's snags have you bumped into?

Is there something that you didn't expect, and said oh gee whiz?

- Yeah, I think the logistics of just having a mobile staff of getting out into patients' homes, that's been a little bit of a challenge we're still trying to refine that technology.

So when you think about technology that tells you, depending on where patient's homes are, which route you should take, to make it most efficient and time managed, those are the things that I feel like we've learned a lot about.

We've also learned a lot about how to approach a patient about this program.

And we continue to learn on that journey to help them understand what the program is so that we can get a higher acceptance rate.

- And it seems to me there has to be improved communication within the medical center because of this patient needs meals, you need to send meals at this time, et cetera.

- Yeah, so we actually use some contracted services and some we contract with our own health system to provide those services.

So for the meals here in Peoria, our St. Francis Medical Center cafeteria does a great job.

So they actually, we have a courier that takes the meals out.

- And our half hour is up.

- That went fast.

- We thank you Jennifer Junis, who is the director, senior VP, of Digital Health, OSF OnCall.

Thank you for being with us on "At Issue."

- Thank You.

- And we thank you for joining us.

We'll be back next time with another edition of "At Issue."

We'll see you then.

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