The traditional hospital model is struggling to meet growing healthcare demands and evolving patient expectations. Healthcare everywhere—a paradigm shift towards distributed care, hospital-at-home programs, and innovative delivery models—offers a solution to these challenges. This keynote will explore how forward-thinking healthcare leaders are reimagining care delivery, breaking down walls, and leveraging technology to extend high-quality care beyond traditional settings, ultimately improving access, outcomes, and patient satisfaction.
• Implement strategies to transform your organization into a "borderless hospital," expanding your reach and impact
• Leverage emerging technologies to create seamless, patient-centric care experiences across diverse settings
• Develop a roadmap for integrating hospital-at-home and other distributed care models into your existing operations
• Identify key performance indicators to measure and demonstrate the value of healthcare everywhere initiatives
Rasu B. Shrestha, MD, MBA, EVP, Chief Innovation & Commercialization Officer, Advocate Health
Shahid Shah, Chairman of the Board, Netspective Foundation
Welcome 0:01 Welcome to Digital Health talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't. As we focus on the innovations that deliver. Join Megan Antonelli, Janae sharp and Shahid Shah for a weekly no BS, deep dive on what's really making an impact in healthcare.
Rasu Shrestha 0:29 For those of you have not met yet, razu Shrestha, I'm a radiologist by background, trained in informatics and business, and I've been doing this for the last 2530, years, really leading health system transformation and innovation and innovation and strategy. I'm currently the chief innovation and commercialization officer for advocate health. Advocate health is really the merger of atrium health in the southeast and advocate Aurora healthcare in the Midwest. I joined advocate when it was still atrium six years ago as the chief strategy and transformation officer, some of you remember this, Becky, hi there in town, and at that point, we're a $6 billion annual revenue health system, sizable, right? But the impact 2025, strategic plan that I had the privilege of authoring and working with the team to build, which really led to some of the things that we'll talk about today, mandated for growth, right? And it really was about growth, not just for the sake of growth, but growth for the sake of influence and scale, right? And so we've since grown from 6 billion to now 34 billion in the last five years or so, and one of the largest health systems in the country, but really excited to talk about this topic of borderless hospitals and culture change and everything else that comes with so real pleasure to be here.
Shahid Shah 1:50 No, it's actually fantastic, because so many of you in the audience will have detailed questions before going to atrium. Ras was at UPMC right, also heading the innovation department. And what he did a lot there was working with people who just started with an idea, and going through actual user centered design, understanding how to code, building the systems and then launching them within UPMC. So from all the way from UPMC and his prior work, plus the work that goes on at where he's doing it, at Advocate now is details matter, the strategy that you're going to go with, which is, let's start with that strategy, that growth strategy, we know the in general, the idea of big box healthcare, where you drive everybody to this big box in the In the center of town or wherever it might be, is long gone. That's not going to happen in as growth anymore. You've pioneered this concept of this borderless hospital. Let's jump into that. You know, matter, what does borderless hospital meet mean to you guys, and what are the challenges of getting to a borderless hospital? Yeah.
Rasu Shrestha 2:59 So what's really interesting is in how innovation really takes shape, and the fact that we've just lived through a pandemic shouldn't be taken lightly. It was March of 2020, when you know the pandemic, right in the midst of the pandemic, we said, All right, instead of really looking we're looking at New York City at that point, right? And all of how we were reacting as the pandemic was spreading in the United States and and we're contemplating building, you know, pop up hospitals and tents in the Bank of America Stadium in Charlotte. Right? Charlotte is where atrium health advocate health is headquartered, and at that point we pivoted, and we said, look, we've got this amazing virtual care network that we've set up, we've got this amazing Paramedicine program that we've set up. We've got all of these different elements as it relates to mobile medicine and the program around mobile medicine that we've set up. How about if we're able to pivot rapidly and set up this hospital home program. So really, within two weeks of us coming together as a team coming up with that idea, right, you were able to launch this hospital home program and target COVID positive and COVID presumptive patients and immediately decompress our ICUs and our EDS. And you know how things were at that point, right? Our hospitals were shut down $150 million worth of losses every month. Because, you know, the core bread and butter of the health system, the bricks and mortar facilities were completely shut down at that point. Second month 150 the third month, 150 million. Right? So at that point, March of 2020, we turned on our hospital home program, primarily so that we could decompress our ICUs and Ed facilities and treat our COVID positive and COVID patients. Fast forward to today. We're treating over 150 different conditions in the comfort of these patients. Homes, and this is now a legit program where, in fact, it is the largest hospital home program in the country. And, you know, I remember way back when, six years ago, when we're when I from, from Pittsburgh, and one of the things that we started putting together as part of impact 2025 was what we call our Connected Care everywhere strategy, right? And the idea behind that was, we said, you know, the next 100 bed hospital really should be these 100 homes in this neighborhood, and then this is the next 100 bed hospital and this, right? So we're really starting to think creatively in terms of what is connected care everywhere really look like and and today, I'm really proud to say that we, this month, celebrate 14,000 patients having gone through our hospital home program. Right the scale and the magnitude of how we've been able to grow this across advocate health, and I'll talk about how we're thinking even more broadly. Beyond that, is this tremendous so that, in essence, is the way that we're thinking. We borderless. Hospitals look, bricks and mortar. Facilities aren't going to go away. We're human beings. I'm a radiologist. Folks are going to need scans. We're going to need procedures. We might need chemotherapy. Bricks and mortar, hospitals are not going to go away. The vision that we have is that as we think about borderless hospitals, Home is where the health is right, and if we're able to really address some of the key needs and the wants and desires and really up the experiences for our patients has been amazing dialog this morning already in terms of patients and putting patients in the center of our design and our innovation thesis. What we're about is really broadening that thesis from patient centered care to person centered care, and I think that's really important. We still have the patient in the center of our care, but we're now broadening that thesis to more of a person centered approach to care, and we think that's really critical, right? So borderless hospitals is about moving from patient centered to person centered care. It is about moving from bricks and mortar to clicks and mortar, if you can, if you can, contemplate that. And it is also about really moving from episodic care, which is what healthcare has been about for centuries at a time, right? Well before EMR, as well before Gen AI, it's been about episodic care to now always on pervasive, continuous care, which is what it should be, right? So really excited about the program that we've set up and and the and the embrace that we're starting to see, but it's not been without any struggles.
Shahid Shah 7:44 No, I think you know, a lot of the struggles that you guys have, you've been able to strategically mine those and figure them out and help your executive leadership team weave them through the challenge that I've seen in other organizations trying to do these borderless and remote First, however you'd like to call it. Is that executive leadership teams know how to buy a building staff it put people in one place, train for it, etc. But have you do so COVID forced you to think about this. But unlike most other places, you didn't say, Oh, COVID is done. Let's go back. You said, Oh, wait, how do we expand? So talk about the three things, which is, when you are trying to go to the 100 bed hospital in the community, how do you have to think about this from a financial logistics point of view, it's not just about having the money. You have the money, but how do you spend it in those 100 beds in the community, rather than here? So that's financial logistics. Is number one. The second part of them is just the human logistics, like the workforce has to operate now. They've they've never operated in this environment before, but they have to now and then. The third thing, I think the patients are probably happy, but they're also surprised, right? Like, I didn't realize that if I needed this one piece of thing that not having a nurse down the hall means that my care might take longer. So you got financial workforce and then patient, unexpected activities. How does that look in the border? What's really
Rasu Shrestha 9:14 What's really interesting is we started this because there was a need, right? Our our hospital beds were filled, right? The ICUs, the EDS that were completely filled and we needed to decompress and and we saw very quickly that beyond COVID and COVID presumptive patients were able to grow this to now this over 150 different conditions. From a financial perspective, what's really interesting was what was unexpected out of all of this. We're seeing that in compared to the same acuity of cases that we're treating in the bricks and mortar facilities. And we still have tons of bricks and mortar facilities, the cost of care is 25% less. So it's actually cheaper for the same conditions for the patient. To be treated in the comfort of their home. What's also interesting from that ROI the financial perspective is the quality of care is on par, if not better. The outcomes are actually better in the hospital at Home program than in the bricks and mortar facilities.
Shahid Shah 10:19 You didn't know that before. We did not know. How did you get them to agree to spend the money in that way we
Rasu Shrestha 10:26 needed? Like I said, this is this came as a result of the need that we had, right? We were tracking as an academic learning health system. We were tracking to each of these metrics as we were, as we were going live with this program, and then growing the program across the board and seeing that the cost of care is dramatically less has been quite uncanny. What's also interesting, however, is this was new. We were pioneering this, and there are other health system that were also trying to your point earlier. What's what's really interesting is that we were not getting reimbursed for this. Yeah, right. So from a financial perspective, the first part of your question, we were actually not in were actually not getting reimbursed for this. So for us, it was really as a result of knowing that this was the right thing to do at that moment in time, and then starting to see some of these benefits right in terms of this being actually financially cheaper for the patient, as well as the experience scores being 10 percentage points higher than bricks and mortar facilities. It's just quite remarkable. So we're not getting reimbursed. What we did start to do, however, is we started to work with some of the payers, and we started to really talk about their members and our patients, right? And really figure out the payer and the provider dynamics in all of this, and the payers started to see the rationale around the hospital at Home program as well. So it wasn't it wasn't easy, but Medicare, Medicaid, and we've been trying to push towards the commercial payer population as well. What was also interesting from a financial perspective, was the education that we needed to provide to CMS, right? So again, we're in the midst of the pandemic, right here. We are turning this innovative program on, really, within two weeks of us saying, Hey, how about this? Right? But the reform as it relates to payment reform, was lagging behind, but we did a lot of work, working directly with our government affairs team, actually going to DC, educating Congress on the specifics of why this program actually makes sense, and why CMS should reimburse in health systems like us. And as a result of that, we're able to get CMS to pass the CMS waiver. So big success there. The CMS waiver ended last year and was extended to March of 2025, so really kicking the can down the road a little bit, we're hoping that it'll get extended by another five years. It is a bipartisan supported mandate. There is a lot of support, a lot of evidence, a lot of data around this as well. So we're hoping that we'll get extended. So from a financial perspective, it's been a struggle, right? Because change is hard. Healthcare is not used to change, right? We like status quo, as we've established in the prior dialog. The second part of your question was really around workforce, and I think it's a really interesting question there. You know, for us, as we started putting this program together, we're bringing together paramedics, we're bringing together EMT folks, we're bringing together nurses and physicians, social workers and the care team that is really around the patient as well, really as one team focused on that patient that we're treating in the comfort of their home.
Rasu Shrestha 14:08 What's really interesting, as I've been doing these ride ride alongs with our hospital at home teams is talking to the paramount right as we're going in and rounding on these patients twice a day. So we're doing this. But much like what happens motor facility,
Shahid Shah 14:24 they're not nurses going out there, you're just talking so all alongside
Rasu Shrestha 14:27 nurses, virtual care managers and others as needed for the care that we're providing to these patients, we're actually rounding on these patients twice a day and talking to these paramedics, talking to these nurses, what I'm starting to see, what we're starting to see is a level of satisfaction in their jobs that they've never had before. Nice, you know, they tell me they're Dr Shrestha. Look, we used to drive ambulances back and forth, not knowing you know what's going to happen to this patient. And now, with continuity rounding on these patients twice a day for the duration of how long they're admitted. Into the hospital home program. It could be a five day admission, a four day admission, a two week admission, depending on the severity of the cases and such, but there's continuity. That level of satisfaction that they have is is quite tremendous. And then from from a from a job perspective as well, really starting to see how technology is coming to the human element of providing care in the comfort of the home. That's the other element of this as well, right? So, in addition to us rounding on these patients twice a day, they are being monitored 24/7, right? So remote patient monitoring, these devices, these sensors that we're leaving at home, there is round the clock monitoring. There is instant on virtual care that's available to these patients so that they can talk to any of the care teams at any given point in time. So that level of satisfaction has really gone up through the roof as well. The third part of the question was around the patient. We think that's really critical, right? So when you look at the home, I you know, whether it's for me, you or anyone in this in this audience here, the home is a really personal space. It is your private space. And what we're doing is we're inviting now care providers and others into the privacy of your home. And there was a lot of unknown in all of this, right? And as far as the patients are concerned, what they're seeing now, however, is for them to be in the comfort of their homes and not in a sterile environment that is the hospital, right? So imagine this patient that is confused, that is navigating perhaps one of the most challenging times in their in their lives, right? But also at the same time, in a completely different environment, in the ICUs, all of the the whizz bangerry around them, all the beeps, the sterile environments and all of that, versus them being in this comfort of their home, right? It is a completely different experience altogether, and what we're starting to see right now is that patients are actually asking for this. They are demanding this. We had a AHRQ supported, grant funded effort where we actually sat down and interviewed patient and talked to the patients about the program that we're putting in place, and what they told us, what we found was that patients were actually asking for this, as opposed to us recommending a hospital at home option for patients who would be admitted into an ICU bed. They're coming to us and saying, Hey, my mom's elderly, there's dementia, there's confusion. Could we sign her up for this hospital at Home program? Does she qualify? Right? So there are algorithms and others we have embedded into our EHR that automatically make these recommendations. But patients are coming to us and asking for this just because the satisfaction level is now through the roof.
Shahid Shah 17:56 How far up the Unity do you guys go? So
Rasu Shrestha 17:59 this is, this is akin to us treating patients in in busy ICU, really, all the way up, guys, all the way, all the way up. It's a, we've got patients with multiple comorbidities that we're treating at home. We're, we're infusing, you know, broad spectrum antibiotics at home. We are even working right now in heart T cell therapy at home. Really, absolutely, wow. And it's really interesting how, as a result of us being able to really mandate a strict regimen in treating this like a hospital bed, right? So all of the things around CMS and JCO and the quality metrics and all of that, we're mandated to really treat this as a hospital bed, right? So we're admitting a patient to the hospital bed, and after a period of four days or five days a week, or however long, we're discharging the patient. And they could go over to our transitionary care. It could be a health at Home program. It could be a virtual care program, but we're discharging a patient. So all of the different elements of managing a hospital bed were doing that in the comfort of their homes. Yeah. I mean,
Shahid Shah 19:04 I've heard a lot of people call health at home by just doing everybody sub acute, right? Yeah, less than I say, but that's very fascinating, all
Question 19:12 right. Well, first off, congratulations, rasu, on all the success of the hospital at home. Super exciting stuff. I'm a caregiver for my grandma, and she has to be admitted every now and then, and I'm sure we would love to have her be able to get the care she needs in the comfort of our home. So really hits home here. My question is a multi part related to the technology required. So as this was a need that was emerging in COVID, how, what was the state of technology and helping facilitate the programs that you were, you know, putting in place. And then what innovation have you seen along the way to further facilitate and what are you most excited about in the future, whether that's AI based or not really curious. Thank
Rasu Shrestha 19:53 you for that question. So look, our core belief in continuing to push forward with the hospital. Home and now the health at Home program, because the hospital Home Program is one element of it. It's the acute care elements that we have in hospital beds and ICUs and such. And to your earlier point where you're really growing this to chronically ill patients who get discharged from the hospitals, and we're now monitoring those patients, the congestive heart failure COPD patients, right? We're monitoring those patients and making sure that they don't fall back into that circle of illness, that they retain themselves in that circle of wellness, all the way to the worried well, folks like you and I and all of us in this room as well. So in that continuum, the technology really is different for different use cases, across the board, the hospital at Home program that we had, we had, like I said earlier, some of the core elements of the virtual care programs, the remote patient monitoring capabilities and such as well. What we found was, as we continued to scale this program across the greater Charlotte area, now really across advocate we needed to do this quickly. We know what we're good at, right? We're good at caring for our patients. We're good at really care elements, the care team elements, really looking at these acutely ill conditions that need to be now innovatively cared for at home. And what we decided to do is we said, Let's partner, and we partnered with Best Buy health. It's about three years ago, was when we partnered with Best Buy health. And as some of you might know, Best Buy health is now actually coming into healthcare, right? So they're not just about selling flat screen TVs, Wi Fi routers. With the Geek Squad coming to your home, we are training the Geek Squad to become a Health Tech Squad, so much like our paramedics that have been going to the home, we are training the Geek Squad to go in and look for Fall risks. Look for is there healthy food at home? Is there a fridge in the home? Is there a gun that is unlocked in the home? Is there domestic violence in the home? The social determinants of health care that really determine the 80% of the health outcomes we are now head on, going in and working with Best Buy health to really take that into account as well. So the technology element continues to evolve. Remote patient monitoring is a is a no brainer, right? So that that is a requirement the sensors and the types of sensors and devices depending, again, on the acuity the different conditions and cases. Now we're talking about clinical trials at home, right? And that's, that's another different, you know, set of opportunities from a technology perspective. You know, imagine working with pharma, and we are working with J and J and Best Buy health and advocate health in really looking at clinical trials at home, and that brings together different elements of technology as well. Ai obviously factors into this. We are feverishly working together in creating, we're calling the care traffic control center, right as I painted the picture earlier of Connected Care everywhere. You know, health systems really saying, all right, bricks and mortars will not go away, but care needs to happen everywhere. I believe that hospitals will really start becoming more like care. Traffic Control Centers. We'll have hospitals, you know, continue to treat patients when they need care in the bricks and mortar facilities or or procedures, or our scans or other other things, but they're also then become centers who will be monitoring the communities that the hospital is a part of, and continuing to then look at that inflow and outflow of patients throughout that continuing care experience? Yeah,
Shahid Shah 23:42 what I love about the answer here is that they're not waiting to have every problem solved before taking care of the patient, right? That's what other crazy people do. Is we don't have this technology, we don't have that technology, so let's not do it. But we have to do the hard part to get the patient to experience what they care most about. And that's what I love about this. Is decision making. Go making. Go ahead back then
Question 24:04 my question to you has to be a challenging one, so it can't be just an easy, you know, softball. So what are your I was going to say top three, but top two resourcing issues because scheduled events, you can schedule them, get the patient or the resource to the to the house and deal with it. And the most emergencies, you can put them into an ambulance and send them back to where they need to what is your middle ground? Top Two resourcing challenges for ICU at home,
Rasu Shrestha 24:30 there are a lot of challenges, you know, for us, these challenges specifically around the hospital Home Program, also specific to the geographies that we're trying to turn these programs on in. So in the Greater Charlotte area, it's a different environment than, say, the Greater Chicago area, than say in Macon, Georgia or Milwaukee, Wisconsin, right? So we're across the southeast and the Midwest the greater Charlotte. Area is one of the fastest growing areas in the country. You've got 134 people moving into Charlotte every day. You can't build hospitals fast enough. So even without CMS reimbursing or payers reimbursing for the programs, the truth of the matter, and don't tell this through CMS folks, is that it made sense from an ROI perspective, because we were able to capture these patients and treat these patients in these facilities that we were now growing as a result of the hospital home program. The challenge there was really looking at areas like the Greater Chicago area, where there isn't that much growth actually happening. And so for us, we really had to look at more of a capitative model in those in those geographies. And then similarly, when you're looking at areas like in Macon, Georgia, where we're also growing the program, the challenge also then becomes, all right, we don't have the mobile medicine programs as as proliferated, as we do say, in the Greater Charlotte area. So there are lots of challenges across the board, and that's part of the reason why we're partnering with a best buy health, right? Best Buy health, Best Buy has over 1000 storefronts across the country. They've got multiple distribution centers and warehouses. So you think about these devices and the technologies and the questions you're asking earlier, as well the omni channel elements, warehousing elements current and the staffing that they can do, and the staffing elements and the current health components of where, you know, the cleaning and the RE kitting we were doing, all of that my team, working with the IT team, with the nursing team and others, were sitting down and re kitting these devices as we're discharging the patients and readmit admitting patient, newer patients into into our facility. So we had a lot of challenges in really scaling the program across the board, but we're now at a point where we found our rhythm, right? We found what we are good at doing and what our partners are good at doing. And we're at a point where we have an average daily census of 100 today, and we have signed off internally on an investment where we're 4x ing, the size of what is already the largest hospital home program in the next two years. So two years from now, it'll be 400 average daily census in our hospital home program, just in the Greater Charlotte area. And we're also growing in, like I said, everywhere from Macon, Georgia to Milwaukee, Wisconsin.
Shahid Shah 27:34 I love it. And so we're out of time. I just enjoyed this conversation, because we whenever we talk, you're always doing 10 new things. So I just love that.
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