How CommonSpirit Is Using AI to Support Holistic Patient Care

October 20, 2020 – At CommonSpirit Health, an episode of care doesn’t simply start and end with administering a treatment or intervention. The organization, which was created in 2019 out of the alignment between Catholic Health Initiatives and Dignity Health, instead strives for holistic patient care.

That’s because patient health and wellness rarely exist in a vacuum. Health is not just the sum of interventions administered during a single care encounter, but rather it includes the overall experience of care and the factors patients see outside the four walls of the hospital.

To that end, the Catholic health giant is expanding its strategy to use patient engagement technologies to provide that holistic care. Building on a four-year-old relationship, CommonSpirit Health recently announced it would tap Docent Health for text-based patient outreach and care coordination.

“It initially started out as a pilot in one of our markets that had a pretty significant amount of patients with Medicaid as well as Medicare, and was really looking at how we help patients navigate through different clinical episodes of care,” Alisahah Cole, MD, the system vice president of population health and innovation policy at CommonSpirit, told PatientEngagementHIT.

“If someone was coming in for a right knee replacement or somebody was pregnant and having a baby those are considered episodes of care. So how do we help patients navigate through not just our own healthcare system, but also through all of the resources that they may need in order to have a successful clinical outcome?”

READ MORE: Care Coordination Lagging in US Primary Care, Community Health

The tool uses patient data and artificial intelligence (AI) to predict patient care needs, refer patients to services within care pathways, and then coordinate that care. Patient navigators also help guide patients to different community resources and prepare patients for different elements of their care.

During the pilot phase of the program, Cole said the technology had a significant impact on care outcomes for both maternity and orthopedic surgery patients.

New mothers saw their average length of stay drop from 2.46 to 2.29 days, a 10 percent decrease. Neonates in the Medicaid population likewise saw their length of stay go down, from 6.13 days to 4.3. The program also yielded a 37 percent decrease in pre-term births among the Medicaid population.

Patients getting orthopedic surgery likewise saw improvements in outcomes. Average length of stay went down from 3.5 days to 1.93, a 45 percent decrease, while the 30-day readmission rate went down 71 percent, from a 3.5 percent readmission rate to 1 percent.

“We saw this data and these clinical outcomes, and then on top of that, we were getting good patient reviews of the program. We were getting a good employee satisfaction score and reviews about the program,” Cole recalled.

READ MORE: Patient Outreach Tech Can Support Care Coordination, Transitions

“The question became, why wouldn’t we offer this service to all of our patients who are coming in to have a baby or to have a total knee replacement? And that’s really how the decision was made to expand that partnership and that relationship across our enterprise.”

This type of platform really made sense considering the type of holistic care CommonSpirit wanted to deliver and its target population of traditionally underserved patients. Basing the platform in text messages, for example, is important for making sure the program is accessible for low-income or under-resourced patients.

“The majority of people now have some kind of phone, whether it’s a smartphone or other device, and the majority at least has texting capabilities,” Cole pointed out. “However, not everyone has the ability to download apps and access apps, et cetera.”

Cole is right. As of February 2019, Pew Research Center reported 96 percent of Americans had a cell phone, and 81 percent had a smartphone. While some reports show that there are few, if any, people who don’t have data on their smartphones, there is still that 15 percentage-point gap of people who have a cellphone—not a smartphone—who might not have a data plan.

And without that data plan or a smartphone, app-based patient engagement interventions simply won’t work. In order to make CommonSpirit’s program operate smoothly and work for its traditionally underserved populations, it was important that they not make downloading an app or having connection to internet data a requirement.

READ MORE: Education, Clear Healthcare Navigation Next Steps in Patient Care

The AI and text-based tool also lets CommonSpirit do some work around the social determinants of health, a longstanding priority for the health system, but even more so now during the COVID-19 pandemic.

“One of the things we’ve added is screening around social determinants,” Cole noted. “That was one of the things that kept coming up in the pilot, that people were stating they need help with transportation or they needed help with food or they needed help with housing.”

Like other providers have found, the outbreak of the novel coronavirus has added some urgency to those community health needs. The hits to the economy, shelter-in-place orders, and general fear of going out into public spaces has made these social needs more salient.

“Again, it’s really about advocating for the patient and being able to connect them to any resources that they may need, whether that was a healthcare resource or work community report,” Cole said.

This program expansion will foremost seek to scale the AI and text-based intervention to CommonSpirit’s entire maternity and orthopedic surgery patient populations, spanning 11 states and more than 60 of the system’s care facilities.

It also aims to look at the bigger picture of nationwide health disparities, Cole said. The nation’s other epidemic, Black maternal mortality, is a crisis that Cole hopes this platform will help address.

“With this wave we’re being really, really intentional and focusing on how we make sure that we are engaging our African American moms, make sure they’re aware of the program and they’re connected, make sure that we’re advocating and getting them connected to resources and to additional levels of care if need be,” she said.

“Ultimately, our goal at CommonSpirit would be to eliminate that disparity,” Cole continued. “I tell people, ‘Yes that’s a bold statement to make.’ But we have everything that we need to make that disparity go away, we just have to be really intentional and strategic about it and make sure we’re capturing the data.”

This program is just the first step in CommonSpirit’s journey to address patient care needs and provide holistic health, Cole acknowledged. Maternity and orthopedic patients represent just two types of episodes of care, and ultimately CommonSpirit wants to roll out this type of programming among numerous other care types.

Central to that goal will be having the right kind of data to strategically implement programming and target patients. Like Cole said, it’s a bold goal to make, but healthcare is increasingly creating the right tools to accomplish it.