Why CommonSpirit Health at Home Has An Edge In Moving Care Upstream

Home-based care has spent years talking about moving care upstream. This involves identifying patients who qualify for additional support before an acute exacerbation. But turning that ambition into routine practice has not been straightforward.

That was a central theme from my recent HHCN+ TALKS conversation with Trisha Crissman, president and CEO of CommonSpirit Health at Home.

I see CommonSpirit Health at Home as uniquely positioned to be a forerunner in moving care upstream, because of its position of part of a health system and its existing partnerships.

What also caught my ear was how the agency has responded to a tougher backdrop for expansion.

With federal enrollment moratoria putting parts of the organization’s de novo growth strategy on hold, Health at Home has had to rethink how it expands. But as Crissman noted, the organization’s financial targets haven’t budged.

To achieve those goals, Health at Home is focusing on two connected priorities: reaching patients earlier through primary and specialty care clinics and using tools like ambient scribing and AI referral management to expand capacity within its existing workforce.

In this week’s exclusive, members-only HHCN+ Update, I unpack CommonSpirit Health at Home’s strategy, offering analysis and key takeaways, including:

— Why health system integration and JV relationships give the agency an edge in moving care upstream
— How AI-driven efficiency fits into a growth plan constrained by enrollment moratoria
— The adoption hurdles providers face when rolling out ambient tech to the front lines

Moving care upstream

One of Crissman’s top priorities for CommonSpirit Health at Home is moving care upstream, aligning with physician enterprises across the broader CommonSpirit Health system.

In Crissman’s words:

“[This involves] establishing proactive early identification of eligibility and transition pathways into home health, hospice, palliative care and doing that upstream in specialty clinics with primary care providers,” she said.

CommonSpirit Health at Home is especially well-positioned to do just that. It’s part of a larger health system and has 15 joint ventures with regional hospital systems, giving it relationships to build on as it looks to move care upstream.

It already has hospital partners with a stake in what happens to patients outside their walls. The opportunity now is to make home-based care a more intentional part of those patients’ care plans — before another hospitalization, not just after one.

That’s where Crissman’s focus on primary care and specialty clinics gets interesting. Those settings offer a chance to identify patients who may qualify for home health, hospice or palliative care, and start those conversations when patients and families have some breathing room. A referral doesn’t have to begin with a discharge planner trying to figure out what comes next.

Of course, being part of the same health system doesn’t mean those connections happen automatically. Crissman acknowledged that Health at Home still has to push for inclusion in value-based care contracts and educate internal stakeholders about what it brings to the table. Even when the relationships exist, somebody still has to connect the dots.

But CommonSpirit Health at Home has a foundation that a standalone provider would have to work much harder to assemble.

As Crissman acknowledged, the home-based care industry has not always succeeded in moving care upstream, despite its best intentions. She pointed to AI integrated into electronic health records as a way to flag changes in patients’ conditions that might otherwise go unnoticed, helping clinicians identify potential needs sooner.

An earlier warning is only useful if somebody can act on it. A flag in an EHR isn’t the same as a conversation with a patient, much less an admission to care.

That’s why I think Health at Home could be a forerunner here. The potential advantage isn’t just access to new tools. It’s having those tools alongside the health system and JV relationships needed to turn an earlier warning into earlier care.

Reconceptualizing growth strategies

Crissman said that CMS’ moratoria on new home health and hospice enrollment didn’t change her goals for growth, but it did force a strategic shift.

The financial expectations stayed the same, but one of the growth levers was cut off.

I’ve written about the home health moratorium’s impact to growth potential for agencies. What stood out in my conversation with Crissman was how plainly she put the other side of that equation: The budgets weren’t changing to accommodate it.

“The numbers don’t really change,” Crissman said. “The budgets have been set.”

A pivot was necessary. For Health at Home, part of that pivot means finding ways to serve more patients with its existing workforce.

Once again, the answer includes technology. Crissman expects ambient scribing and referral management AI to reduce administrative complexity and increase capacity, supporting the organization’s financial goals.

There are two pieces I’ll be watching as that strategy takes shape. The first is adoption. HHCN Senior Reporter MK Manoylov recently wrote about change management with AI tools, including results from a survey we ran asking industry insiders how they implement and train staff on new tools.

Crissman said adoption of ambient scribing had been slower than she expected, and Health at Home is working with superusers to help hesitant clinicians get comfortable with it.

That approach surfaced in Manoylov’s reporting, too. Tribute Home Care worked directly with leaders before building AI tools, according to Galip Gencer, director of strategic planning and project management. The company also involved workers from each department in the process.

Designating change champions or super users was a common answer among survey respondents.

So this tension can likely be overcome. People can be resistant to change, but if a company demonstrates the value of a new tool using methods like super-users, workers are likely to see the benefits for their own workloads.  

The other tension involves the benefit Crissman seemed most passionate about: giving clinicians more room to connect with patients.

She painted a picture of interactions hindered by clinicians documenting on tablets throughout visits. Ambient scribing could help remove that barrier. More eye contact. Less attention divided between a patient and a screen.

What I find compelling is that Crissman isn’t describing efficiency as an end in itself. She’s connecting less administrative work to a better experience for clinicians and patients alike. The goal is to make room for more care by reducing the work that gets in its way.

That also gives Health at Home more than one way to evaluate whether the technology is working. Increased capacity matters, but so does whether clinicians feel more present during visits and have less documentation hanging over them afterward.

Crissman offered an early, anecdotal example: a clinician who finished documentation in time to attend her son’s baseball game. That’s a different kind of return on investment, but one that could matter for the attraction and retention goals Crissman also outlined.

That’s the piece I’ll be watching. Greater capacity, a better workday and more personal care are all part of the promise here. Crissman’s strategy makes the case that reducing administrative burden can help support all three.

I’ll be excited to catch up with Crissman and hear whether the company’s new technology is delivering across those goals.