Why Home? Why Now?

In the first episode of At Home, At Scale™, hosts Pippa Shulman and Erin Bartley explore what complex care at home really means, why it matters now, and what it takes to make it work at scale.

Drawing on their perspectives as a physician and an operator, Pippa and Erin discuss how delivering complex care beyond hospital walls requires more than simply relocating care—it requires rethinking the systems around it. From clinical care and technology to workforce, logistics and operations, they explore what health systems need to consider as they work to make complex care at home a scalable part of healthcare delivery.

The information discussed in this podcast is intended for general informational purposes only and does not constitute medical, health, legal, financial, tax, investment, or business advice. Listeners should consult qualified professionals regarding their specific circumstances before making any decisions.

Transcript

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SPEAKER_01 0:00

Every day I get to hear patient stories and to see what it does for patients and families to be able to stay in their homes, to look out the window at the view that's important to them is a gift that enriches me and encourages me to keep going until we really can make this as accessible as possible.

SPEAKER_00 0:16

It's an awakening to what's possible. And it's hard to imagine an experience for any patient that doesn't at least give them the opportunity for this type of experience.

SPEAKER_01 0:46

But maybe the next chapter isn't about building more hospitals. Maybe it's about building better systems around people's lives.

SPEAKER_00 0:54

Today we can deliver levels of care in the home that seemed impossible just a few years ago. The question isn't whether we can, it's how we make it work at scale for every patient, every clinician, every health system, and every community. That's what this podcast is about. I'm Dr. Pippa Schulman, and I'm Erin Bartley. Welcome to At Home at Scale. We've spent the better part of the last decade together helping health systems rethink where and how complex care can be delivered. We've been thinking about this podcast for a little while, admittedly, debating does healthcare really need another podcast? But we decided to take the plunge because everywhere we go, we keep getting asked the same question from health system executives, from payers, from policymakers, regulators, investors, even patients and families. If this really works, this is really better care, then why isn't everyone doing it?

SPEAKER_01 2:00

That is indeed a good question. And we've learned together that delivering complex care at home isn't simply about moving hospital care into someone's living room or about a bunch of equipment. It's about truly redesigning health care, operations, technology, payment, clinical models, workforce, leadership, and honestly, perhaps most importantly, how we think about patients. We've spent years looking at this challenge from different angles. I'm a physician. And so I naturally began with the patient and their caregiver, if they even have one. What does better care actually look like? And how should medicine and healthcare evolve? How do we build a healthcare system that's actually worthy of the people that it serves?

SPEAKER_00 2:50

And I'm an operator. I tend to think about the systems and the process first. So always contemplating how do we make this work every day for every single patient? How do we scale this? What does it cost? Can't help but thinking about that as well. And so we we have learned so much coming at this from different angles. But I think about the last 10 years, the hundreds of thousands of patients we've had the privilege of getting to support through the work that we've done, and the many other people that we know who are leading this charge and how much there is to learn from that. And that conversation isn't really happening anywhere else. I agree.

SPEAKER_01 3:30

And it's what it's our perspectives, the difference in our perspectives that I think makes this conversation interesting. And this podcast is where our conversations with others are going to continue. So every few weeks, we're going to sit down with leaders who are helping to shape the future of care and care in the home, health system executives, other clinicians, innovators, policymakers, payers, technologists. It's to explore what's working and also what isn't, because that's how we can all learn together.

SPEAKER_00 4:01

Cited for what the path is ahead. Before we start bringing other guests into the conversation, though, we wanted to start with one simple question. What is complex care in the home and why does it matter now? So that is what we're going to explore today. However, before we get to that, Pippa, I want our listeners to get to know you and your story a little bit. You've spent the last 20 years as a clinician providing amazing care to patients. And for more than 10 years, you've been exclusively focused on home-based care in one form or another. What made you first realize that care could be different?

SPEAKER_01 4:44

I love that question. And I was fortunate enough that I had exposure to house calls, good old-fashioned house calls back in medical school. I went to medical school in Maine and we had a wonderful curriculum where we could go sit in patients' living rooms and talk to them there. And then I had the good fortune of going to a residency program where we actually, in addition to our panel of primary care patients in the clinic, we had a panel of home care patients that we took care of and saw them every few months in their in their homes. And it was that difference, that contrast that really highlighted for me this difference. And it was one of my primary care patients who I originally cared for in the clinic that really opened the door for me to rethink healthcare. She had come in one day for a hospital follow-up and was sitting on the exam table. I think everyone knows what an exam table in a clinic looks like. And this person weighed, I don't know, 80 pounds. She was tiny, tiny, tiny. Her husband was sitting in the corner. The room was set up very badly for a patient care visit. And I storm in and I, how you doing? And I can tell like something's wrong here. And I had taken care of her in the hospital. This was probably her sixth hospitalization that year. Um, and she looked terrible and unhappy. And her husband looked mad as heck at me. And and I I have permission to tell this story. This happened many, many years ago. And she said, I am so tired of coming here. This is so hard for me. I have to get up and get dressed, and it takes everything out of me. And then I sleep for two days. And, you know, as a result of her medical condition, she had very serious lung disease and heart disease. That just her coming to have this visit with me took everything out of her. And I thought, oh God, like I did this. And her husband was so mad that she was so upset. And I realized, like, I I could go see you at home. I don't have to bring you in here. And in fact, we could probably do some of your hospitalizations at home. And I it just really rocked my world. And it was the first time I saw that I was in some ways harming people by trying to help them. And all of a sudden, I couldn't not see that in the hospital over and over and over again.

SPEAKER_00 7:02

So it clearly started so early for you with having this experience of patients in the home. When did you realize that we could drive up the acuity of what could be done in the home? So this patient clearly had such an impact on you. What drove you to see and start to focus on, you know, bringing higher levels of complex care into the home?

SPEAKER_01 7:25

You know, that was fairly early in my career as well. I was helping to run a program that was doing what we called IHB, intensive home-based care, was primary care and post-acute care for very complex seniors in their home. And we often, like many clinical teams do, would care for these patients when they had acute exacerbation of their chronic disease in their home without sending them to the hospital. But we did it a little bit seated the pants, right? We would be taking medicines off the floors of the clinics. And hospital home is not a new idea. France started doing this in the 60s and before. And obviously you can think about the distant past. But how do we how can you make this look like the hospital? And now we have some, there's monitors, there's there's ways to deliver the care differently. What would change this a little bit? And so I just started thinking if we added just a little bit more, if I could talk to my patients any time of day or night, if they could talk to me any time of day or night, uh, if I could have eyes and ears on them, if if I could monitor them a little differently, that's really what started us saying we could we could manage acuity differently and making sure that when we put devices in the home, we were getting clinically actionable information from them. We knew we could do this. And we also started with one patient. We didn't start with a hundred patients, right? Let's see if we can do this with one. I'm I'm sure we can. And then we you test and test and test and prove you can do it.

SPEAKER_00 8:51

You and I both have learned that this work is hard and still building so much momentum. What has driven you to devote so much of your career to this space?

SPEAKER_01 9:03

Well, I talk a lot about my patients, but this also comes from personal experience. And I think many people and especially many physicians, nurses, and other clinicians have a personal experience. And both of my parents experienced care in the home. And I was fortunate enough to be able to do that. Really, this came about because of my mom. The same time that I was having this epiphany with my patient that I told you about, my mom was also sick. She had had a long hospitalization at her diagnosis. And when we brought her home, it was May, uh, and the tree outside the window was blooming. And she said, I never want to go back to the hospital again. And it wasn't because she didn't want treatment. Uh, she very much did. But I said, Well, I can make that happen. And we did that. And I, it's the desire to make that happen for every family, if that is what they want, and the ability to spread that as far across the country as we can. And then to see the results of that. Every day I get to hear patient stories or I get to see it myself and to see what it does for patients and families to be able to stay in their homes, to stay in the familiar surroundings, to be with loved ones, to be with pets, to look out the window at the view that's important to them rather than a strange place is a gift that enriches me and encourages me to keep going until we really can make this as accessible as possible.

SPEAKER_00 10:24

Yeah, I think about it like once you're you see this, it's an awakening. I mean, it's an awakening to what's possible. And it's hard to imagine an experience for your family member, your friend, but really any patient that doesn't at least give them the opportunity for this type of experience. Oh, 100%.

SPEAKER_01 10:46

Now listen, it's time for people to get to know you. I've been talking for a long time. You've had such an extraordinary career, and you've spent most of it in healthcare trying to improve efficiency and operations. You are a builder of systems and you have kind of a different journey into this home-based side of care. What drew you into this space?

SPEAKER_00 11:08

Well, yes, I spent about 18 years, the first half of my career, in consulting, always in healthcare. I was always working with health systems to help them improve their processes, to improve more access to care. Again, always thinking about process and systems and how do we make things better. And I always loved the work that I did, and it felt really meaningful getting the chance to help these health systems and hospitals, you know, really drive improvements within their organizations. I remember first discovering hospital home. I think it was about late 2018, when I was researching what were innovative ways that we could help health systems drive better patient experience, you know, really hit on value. And that's when I first discovered hospital home. Again, I know it had been around for a long time, but I had never personally heard of it or seen it. But it wasn't until about six months later when, admittedly, at Medically Home kind of came into my life in a deeper way where I had the chance to really understand what it was. I met you and a few others leading what this space looked like here in the United States. And I mean, I'll I'll never forget when I just hearing the first patient stories and hearing the impact that not only had on patients and their trajectory, but also on their families and the experience that they have. And around that same time, I'm so blessed to have all four of my grandparents live into their 90s. And my grandmother in particular really suffered the last couple of years of her life being in and out of the hospital and contrasting her experience, seeing her experience delirium in the hospital. I never seen anything like that. I didn't think she'd come out and have her right mind when she got back into the home. And yet she did, but she had to suffer through that when she was in the hospital. And so that was my awakening. This is what it looks like. And yet there's this other experience that people can have. And I just felt such a passion for making that available everywhere and bringing the skills that I have, the process and the building skills to think about how do we really scale this in a different way?

SPEAKER_01 13:23

That's a powerful story and scary for family members. And seeing that contrast, what surprised you most about delivering care outside of hospital walls?

SPEAKER_00 13:35

Well, I think first and foremost, like how impactful it can be, not just because of the experience, but you've taught me so much about what you actually learn about a patient and how you can help them and really tailor their care plan to the practical things that they experience in their life, whether that's sort of the medication plan and the barriers that are facing them when their hospitalization is done, or other things about their family circumstance. The deeper way that you see that and how impactful that is to the care. That was really surprising to me. I mean, again, once you know it, it makes so much sense, but I don't think I appreciated that. I expected there would be challenges with how do you make this happen? You got people driving around in cars, we've got to make that efficient. How do we make that efficient? I expected those to be some of the challenges, but some of the benefits were even unexpected.

SPEAKER_01 14:32

You know, when did you have that realization, I guess, that, you know, operations, which I think people think about as maybe a cold field, but could actually improve patient outcomes. This is just as mission-driven as the practice of medicine in many ways. When did you have that realization?

SPEAKER_00 14:48

I would say all the work I always did because it touched patients, whether directly or not, I've always viewed operations as very patient-centered. But being able to do that in a different and deeper way through this work because it feels so much more personal. Because what this care is, is it's designed around the patient, as opposed to being designed to explicitly make the care efficient. Because let's face it, towers and medical campuses were created to create efficiency. So the interesting challenge to me was how do you really, on this personal level to give patients this experience, how do you really rethink that challenge and create still create efficiency, but doing so in a way that makes this opportunity available to patients?

SPEAKER_01 15:39

Oh, 100%. I mean, the other problem is, you know, the towers and medical campuses and the lobbies of those were also created to raise money for medical campuses. So ask yourself that. It's so interesting. We arrived here really from completely different directions, but somehow ended up in the same place. Maybe not somehow. We ended up in the same place. And it's this fundamental idea that drives me, I know, and you as well, that healthcare just has to meet people where they are.

SPEAKER_00 16:07

That's the it. Absolutely. That's the it. Well, let's dive into the meat of our topic today. I think there's a myth that people often think about when it comes to care in the home, and that it is simply taking the patient, moving the hospital bed into the home. And you and I both know that that is not true. So describe for us what is complex care in the home. What do we actually mean by that?

SPEAKER_01 16:39

You know, I think when people hear care at home, hospital at home, ER at home, whatever, they they often picture a nurse coming by after surgery or someone, you know, receiving physical therapy in their living room, which is an important part of healthcare and has been an important part of healthcare for decades, but that's not really what we're talking about here. Complex care at home is about bringing the capabilities of the healthcare system and really the acute care system, the hospital, to the patient rather than bringing the patient to the hospital. You know, today we can care for people at home who not long ago would have automatically had to go to a floor in a Brickson Mount Moor hospital. And so that includes patients with congestive heart failure, exacerbation, pneumonia, uh, COPD, serious infections who need um intravenous IV antibiotic therapy, and lots and lots of other conditions that, again, would have required hospitalizations. They have people coming to their home, clinicians, virtual physicians, nurses, uh, monitoring them around the clock. There are sophisticated diagnostics in the home, medications, remote monitoring, and a whole logistics network that operates behind the scenes to care for these patients. And what's amazing about this is it's not just the location that makes it different. It's the level of care. This is not about an, you know, can we send someone home from the hospital a day or two earlier? You know, I think decades ago, that was really a big push from hospital systems. Can we reduce length of stay? This is really a new question. Does this person need to be in a bricks and mortar facility at all? And the really exciting part for us and for me is that the home isn't just a substitute for the hospital. It's often a better place to understand a person's life. And you've you've noticed this. When we are in the home, we can see what's in their refrigerator, we can see whether they get up the stairs, I can see if they have pictures on their walls, I can see if they're alone, who helps them or doesn't help them. You can see their medications and how they store them and what they're actually taking. And you can understand like the context of their health and their lives and not just their disease, which unfortunately is so often how we see people in a hospital. So, you know, when I see complex care at home, I don't think of it as moving just healthcare out of the hospital. I really think of it as redesigning this system around the patient. And that's the wonderful part. So instead of me, you know, looming over a bed at night or early, early in the morning, and there's a person there with a gown, you know, we become a guest in their home and really providing something completely different to this person.

SPEAKER_00 19:33

Yeah. I think the other thing that's been so interesting is, you know, you and I both spent a lot of time on hospital home, but complex care in home has really come to mean, I think, more than that. Over time, we continue to see other ways that, you know, this is materializing, whether that's avoiding an ER visit through some kind of ER alternative care. We're increasingly seeing more into the oncology space. People are at who are at a really vulnerable time in their lives, whether that's pretreatment labs and you know, other supportive needs for these patients during that time, or you know, other types of things, even moving into chemotherapy in the home. There's there's just ways that this is expanding, continuing to challenge the type of care that can be provided into the home and meet people where they are, that I think is really interesting and exciting. And, you know, you and some of our other physician colleagues that we get to work with have often talked about like there's different ways to think about complexity. One of those things is acuity, right? The actual clinical need of the patient. But talk about some of the other things that you see as the complexity of patients that you know really causes us to need to meet them where they are.

SPEAKER_01 20:52

Oh, I'm glad we're going to talk about this because I think this is so important and where the home really has such an advantage over the hospital. You know, humans are a whole mix of different things. And so complexity can be your family system environment or your lack of family. So isolation can cause complexity. We think about a whole myriad of social determinants of health. And so patients who don't have resources, that is a form of complexity where we need to be able to deliver health care in their environment, whether or not that's a permanent home for them. We can care for unhoused patients and we still call that hospital at home. It's just not their home. Patients who struggle with substance use disorder, they're incredibly complex and they deserve care that's just as comprehensive and wraparound as everybody else. And we can kind of go on and on and on. And there are many, many groups of patients who over time have developed a distrust or mistrust of the healthcare system because it isn't serving them well. And when we can move that care out of the bricks and mortar system and kind of bring it back and put the patient at the center. We can actually reset the trust equation and start working with patients really, really differently. And that's where I get very, very excited. And being able to address complexity in that way helps us actually provide better health care. And so, you know, we've done things with temporary sites of care, we've done things with new care models, we've done things with populations that people said couldn't receive care in the home, but it it really does offer a flexibility and an opportunity to just rethink how we deliver this.

SPEAKER_00 22:33

Yeah, you mentioned unhoused populations, and it reminds me of one of the most impactful patient ride-alongs that I ever went on for a mother who was living in a shelter and had three young children and who had a very serious infection that required IV antibiotics and other things that you know needed her to be in the hospital. And I just kept imagining what would this woman have done if she had to be in the hospital with these three young children? You and I are both moms. And that was just so powerful to me. And truly, as you noted, an example of the kinds of complex situations that patients find themselves in, and all the more important for us to find the ways to meet them where they are. Thinking a little bit about ride-alongs, I think we should talk about, you know, the things that we've learned that there's the complexity of the patients, but how do we actually deliver this care? Because there's a number of aspects that make it, you know, a challenge to figure out how do we scale this, how do we make it efficient, knowing that towers and medical complexes were really built for efficiency. So let's talk a little bit more about that. Share a few of your thoughts on the aspects that you see, you know, that are what we've learned, what still has to be solved as we go forward with this.

SPEAKER_01 24:03

You realize as a clinician how narrow a view you have of the world, because often you walk into a room and everything you need is right there. And then in the home, it's just not. And so, so much of the way we would solve these problems at the beginning of our work is we would just, you know, bring it there. So, for instance, think about the issue of just general medical supplies, you know, gauze and tubing and catheter supplies, things like that. In a hospital, there's a supply closet. And in fact, there's cupboards in and outside of every patient's room that have basic supplies. Well, we you don't have that in the home. And so in the beginning, we created this idea of the patient supply box and we absolutely over-stuffed this thing full of supplies. And we tried to make it interesting and clamshell it and individually package things so we wouldn't waste and we could reuse and such. But we really we've realized over the intervening 10 years, like we can adapt that and customize that solution. So we're not, we don't have to bring everything all at once, right? I think, you know, you learn this as a parent. You don't have to bring every toy to the beach or on an outing, right? Just what you need. And so it's very similar, right? This is these are the lessons that we learn over time. We can actually trim down the supplies we need, outfit our uh the the vehicles that our teams are bringing to the homes so that they have what they need and set those up in a way that are is more efficient. But but that's just a great example of all the things we had to think through, just to think through gauze and how that would get there. And that came out of an experience where at the beginning we were using a home care team to do this work, and they just don't generally carry IV supplies around unless they're specifically asked. And we were like, well, you know, hospitalized patients need IVs, gotta have IV supplies, right? So you can see how how stepwise this starts to evolve. Um, and we have lessons like this for every piece of it. I mean, think about technology. You don't need every bit of monitoring everything. Technology enables but doesn't replace the care. I think we've learned a ton about how do we know how many patients we can care for. Talk about that, because that's something that we we are learning from every single day.

SPEAKER_00 26:15

I was also going to build on your example of, you know, really what you're talking about is how we have to equip people differently for this, right? So you can't just grab something out of the supply closet. We're trying to be thoughtful of not wasting, but also making sure that what is needed is there and is with every care team member. And so this aspect of equipping, I think over time, what you pull back on, we that we did too much in the early days, but then what you need to add and things like point of care lab testing as an example of equipping the care team members. There's other examples like that of just making sure they have what they need, just the right amount, not too much. That is a key part of the learnings that we've really driven. I also think about there's windshield time, right? That's a practical factor when we're coming to meet somebody where they are. And you know, so this becomes kind of a how do you make an efficient and effective workforce challenge? And so, you know, really maximizing the time for every single one of those care team members, you know, routing the most efficient route, who I'm seeing versus who you're seeing, those aspects we've learned are so, so critical. So equipping them, making the team efficient so that they can focus on what they do best, you know, which is interacting with the patient and giving them great care while they're there. The other thing I find so interesting about this, perhaps even different than other kinds of home-based care that have existed previously, or virtual care that is becoming more and more prevalent. This is a combination. And so the mixture between the virtual team and the in-home team and how they support each other, how that interplays, how it doesn't overlap. So again, everybody's efficient and working to top of license. That's been one of the really interesting things and observations I have about like what makes this different. You know, we want to make the providers as much as possible virtual to see as many patients arm them with effector arms personally in the home who were really well skilled to be able to provide this care in the home. So I'm curious because you've treated patients yourself in this model where you're the virtual team. Like, talk a little bit about how that interaction has, you know, worked for you and what you've learned through it.

SPEAKER_01 28:48

I think people often think you can't develop a patient-physician relationship virtually or that care cannot be as effective virtually. And I just have to say that's fundamentally not true. You just have to set up the right conditions and you have to train people. And it's about training the person doing the virtual visit to do it properly. It also helps that you build the relationship over time. And we are able to do some of the first visits with someone in the home with the patient so that I have hands in the home that can help me with early exam and get to know that patient. I don't need them every time, but knowing that there are times when I will have someone in the home to help me and times when I won't is is incredibly helpful. We do, you know, I had to learn how to do this though. And we learned how to train people how to do this. How do you look into the camera and not away from the camera? How do you, you know, ask questions of the team? How should our technology in the home be set up so that patients and their families can effectively use it? How do you use translation systems so that even a virtual visit can be effective with medical translation? How can you bring family members in? There are many ways that a virtual visit can be really advantageous. People can listen in from a distance, you can reduce others' family time, and we can have more time because of that. And so knowing what you can do better and taking the opportunity to take a little time and notice, you know, oh, tell me about the picture that's on the wall behind you, and getting the patient to open up about that if they're feeling well enough to do so is really, really helpful. And then teaching our clinicians how to do an effective exam at a distance is really, really important. And then we equip them with technology when appropriate to be able to get the information they need, whether it's about vital signs, whether it's about clinical data like um lab results or ongoing biometric data that came over time from more remote monitoring. If we give them good data and they can get good visual information, you will be able to make great clinical decisions. And you can talk to the patient. The patient's always the most important one. So that's it's that combination of things, but but it's it takes time to know how to do that. And then we and we train the teams right and we keep revisiting that and making sure that they they know what they're doing and they do.

SPEAKER_00 31:19

You you hit on technology in a couple of different ways. To me, that is what has created an even greater unlock for complex care in the home than what we saw, you know, even five years ago, because of this, you know, there's information, right? You've got the patient, you've got the field in home care teams, you've got a virtual team. And that's a group that's all working together and has to stay highly interconnected with information, with status, with, you know, again, coming together when you need to, but not overlapping each other in order to create efficiency. And I think the kind of technology, you know, remote monitoring, of course, such an important part of that to keep everybody connected, the connectivity, you know, from the patient in the home to their virtual care team. But the other aspects that really drive communication efficiency between those teams, more on the logistics side, I think, is what has been, you know, so interesting to come along, you know, and and will continue to drive the real efficiency and next level of scale in this space.

SPEAKER_01 32:29

Oh, absolutely. The technology not making it easier, no one's gonna use it. And if people can't trust the technology, then you're you're wasting time, frankly.

SPEAKER_00 32:38

Yeah. So you and I both have the benefit of getting to work with a lot of health systems and leaders. What do you think often surprises them in this journey of complex care in the home, where they start from a mindset, and then let's say a year in, you know, where it really moves to?

SPEAKER_01 33:00

I think often people are surprised at the acuity of patients we can take care of in the home. People believe in hospital home now. They they believe it's a thing, but they are surprised at the acuity. I think people are still surprised as well at the connection that the teams can build with patients. And those are really delightful surprises, frankly, and and ones that are actually easy to overcome and usually overcome the first time that they admit a patient often. It's just it's wonderful to hear the early patient stories from these programs and and you kind of make evangelists out of them all, which is great, including the patients and their families.

SPEAKER_00 33:42

Yeah. I would just add too, you know, we've talked about the awakenings. You had it very early. I had it a little bit midway through my career. And helping people to understand and see that, because until you've directly experienced it, there is still a lot of change. And, you know, getting others, whether it's the patients and families themselves, whether it's specialists within the health system, you know to really understand what's possible, what can be done. Again, whether it's hospital at home or whether it's let me avoid an ER, you know, visit for these patients, or all the oncology examples that we've talked about, to some degree, there's sometimes this, if we build it, they will come mentality. But you and I have both learned along the way. Um, and I think a lot of our partners and health system leaders that we've gotten to work with have also learned along the way, you know, you've really got to treat this as a, I'm gonna get everybody in my organization on board. And I need to help them see the benefits because they're busy in their day-to-day, their processes work how they work. And it's gotta fit to those. It's gotta fit within the existing processes and flows within the health system. Otherwise, folks won't use it. You'll be working through an uphill battle. And so I think when I think about those surprises and the lessons learned, it's like addressing that early and often and continuing to do that until it's the norm. And we both know this is still very far from the norm.

SPEAKER_01 35:18

We definitely see, though, that health systems that make a commitment that this is part of their normal course of business, that this is, you know, we sometimes call it the default pathway, that patients in our system they go to three north or they go home, right? That that is, those are equal options in their minds. The systems that are able to make that cognitive leap, that are able to really believe that, you know, tip to tail, that the when the ED doc says you're sick enough to be in the hospital, and fortunately for you, for your condition, the hospital can come to your home, they are the ones that are able to make the most gains. And we talk about culture change so much when we talk about our the implementation process. That is the most important part. And that is when I know you're going to be successful faster than others, is if it's you adopt that early and often, as they say.

SPEAKER_00 36:11

Well, yeah. And so there's the change aspect of it too. But going back to my roots of process, you know, what you were describing with the default pathway, I mean, that's an example of the process that has to accompany the change and education. Because if it's always easier to go, you know, left, then nobody will ever go right. And it's like you've got to start to flip those directions and be really clear with who are the patients where this is actually better for them than going up to floor three. Agreed. I love that. So we're gonna end every episode with two questions for our guests. So I'm gonna I'm gonna ask those to you, Pippa. What is one thing listeners can take back to their organizations tomorrow? Tomorrow.

SPEAKER_01 37:03

If I could leave people with one idea, it's this start with your patient, not with the program. And that sounds very, it might sound obvious or too simple, but so often we ask, how do we build a hospital at home program or how do we build X program? And I think the better question is which patients are we failing to serve today because the hospital is our only answer? And when you start with that patient journey, you begin to see the opportunity. And you really begin to see the opportunity everywhere. You know, maybe it's the older adult we keep talking about, older adult with heart failure who would recover better at home where the outcomes might be better for them. Maybe it's someone on the floor who's been waiting for a skilled nursing bed that you have a different option for. Maybe it's your patient population who keeps bouncing back to the emergency department because there isn't the right support system around them. You don't have to transform the entire thing overnight, but pick one population and often starts with a key patient story. You know, solve one of those and measure those outcomes and learn from that and build from there. You know, I think often innovation doesn't start with this grand strategy. It starts by asking a really simple question. If we were designing this today, would we build it this way? And usually the answer is no. And so build it differently. That's what I think.

SPEAKER_00 38:30

Well, I love that. You know, I would say to anybody who is inspired at all by this conversation has been thinking about how I can bring more patient-centered care to my patients in my organization. I would say seek to learn more. There are so many resources available. There's so many studies that have been done on certainly hospital at home, but other forms of complex care in the home that really demonstrate the powerful impact that it is. There's organizations out there who are, you know, helping organizations build these types of programs. There's users' groups, there's just various places that you can go to learn more, educate yourself, and be able to, you know, continue to build that groundswell and build more support within your organization for how you can drive this kind of care forward. All right, Pippa, final question. What gives you hope? What gets you really excited for the path ahead for this space?

SPEAKER_01 39:33

Well, what gives me hope is something we've touched on a little bit, and you just touched on it too. It's the fact that we have moved beyond debating whether this kind of care in the home is possible. When I first started doing this work over a decade ago, many people thought it sounded interesting, but was probably unrealistic. And today we're just having different conversations. We're talking about evidence, we're talking about implementation and workforce models and reimbursement and technology and logistics and scale. And that is progress. And it's so exciting. And what gives me really most hope in that conversation isn't even like the new fingled fun technology or the policy. It's the people involved. Because I continue to meet, you know, clinicians and health system leaders and paramedics and nurses and caregivers and patients themselves who really truly believe that the healthcare system can be better than it is today and who are willing to join us and build this. You know, healthcare has never lacked for talented people. Sometimes it certainly lacked for permission to think differently. And I think we're entering a period, our hope, where that permission is somewhat growing. We have the evidence, we have the technology, or it's coming, and we have really incredible people who are doing this work every day. And so to me, it's about do we have the courage and the will to scale what we know works? So that's where my hope comes from.

SPEAKER_00 40:58

I love that. And for me, it's also about the people and the continued excitement and passion that we see with everybody that we get the privilege to interact with across the industry in this space. There's so many incredible minds who are passionate about this, like you and I are, and who are driving this forward for their organizations. We've got to keep working on the process. We've got to keep moving the roadblocks out of the way, whether that's reimbursement structures or process systems within the walls of healthcare that are still keeping that opening down. But there's more and more people who are focused on that and more and more tools and solutions who can really help people drive through those barriers and opportunity. And so, from my view, we're still only scratching the surface. The opportunity is huge here, and yet it's building. And I can't wait to continue to see what drives forward in the next year, but really over the next five years in this space.

SPEAKER_01 42:06

Well, I'm excited. And I hope all of you are excited too. Thank you so much for spending time with us. If there's one other thing we hope you take away today, it's that complex care in the home isn't simply another service line or care model. It's part of a much larger transformation in healthcare. And we are so excited to explore that journey together.

SPEAKER_00 42:27

And in future episodes, you can expect interviews with experts in the field, more mythbusters conversation of things that aren't the actual truth, but everybody thinks are the truth, segments like what's happening in the field and what's trending in the industry. So we're really excited to open this conversation and continue it with you. And we're excited on our next episode, we'll have the benefit of Max Mancini, who is the chief technology and information officer at Dispatch Health, where we'll really be examining the role of technology and how it really drives scale, how it should be invisible and behind the scenes and really serving the clinical teams in this model. So we're excited for that conversation with him.

SPEAKER_01 43:14

If you enjoyed today's conversation, we would love for you to follow the podcast and share it with someone else who's passionate about improving health care.

SPEAKER_00 43:24

And we would genuinely love to hear from you your feedback, your thoughts, your topic ideas. If you have any of those, please send them to us at podcast at dispatchhealth.com.

SPEAKER_01 43:36

Until next time, keep building better care.

SPEAKER_00 43:40

At home, at scale.