COVID-19 means taking a ‘hard look’ at strategic planning

With care sites across Washington state, CHI Franciscan has been on the front lines of contending with COVID-19 since the virus first reached the U.S. early this year. CHI Franciscan, which recently announced a merger with Virginia Mason Health System, has learned a lot and had the benefit of tapping into a year-old mission control center that relies heavily on artificial intelligence to help drive decisionmaking. And as part of CommonSpirit Health, CHI Franciscan has been able to share best practices across a large national network. Ketul Patel, CEO of CHI Franciscan and president of the Pacific Northwest division of CommonSpirit, spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: You opened a mission control center about a year ago, long before the pandemic hit. Can you talk a little about how you’re using it now?

Patel: It’s a fascinating story. Just going back a year ago, life for all of us was so different. We were planning to use a mission control (center) to help us manage our occupancy. The Franciscan system, which has over 1,300 beds, was truly struggling because our occupancy continued to be at record highs. Two of our campuses were consistently over 100%. We provide great patient care, but it’s not the best experience that we want for our patients. So we partnered with GE Healthcare to be one of only five systems around the country to set up mission control. One of the primary reasons for that at the time, was to manage flow and capacity and truly predict how that flow, based on historical knowledge, is going to help us plan for the future when it came to not only bed capacity, but also staffing.

Who would’ve thought, after all this time, that we would be ramping up for what’s happened with the pandemic. Seattle became the first hot spot in the country. We actually stood up our mission control and our command center in preparation for all this in January, knowing what was happening in China, assuming that at some point it was going to come here.

So we had a couple of months to plan, but when we saw our first case, which happened to be on Feb. 29, nobody was ready for that. And as we all know now, there was so much misinformation. Guidance continued to evolve with the (Centers for Disease Control and Prevention) and other parts of the country were certainly getting the kind of fear that we were starting to see. So it was an opportunity for us, having had a few months of the mission control center up and running, to put this into practice in different ways.

I’ll give you two specific examples. Early on, one of our campuses, St. Anne Hospital, which is in the shadows of Seattle, started seeing patients from the nursing home in Kirkland that was at the epicenter of what was going on. And from that, we started to see spikes.

St. Anne, historically, has had quite a number of beds available. We started to see record highs of occupancy on that campus and it allowed us to start looking at other parts of our system to see where could we potentially take care of patients if the surge continued.

It also allowed us to bond further as a regional system in Tacoma. It allowed us to communicate exponentially, where, historically, we relied on a lot of phone calls. Now, everybody had things at their fingertips all throughout Franciscan at the same time.

MH: How are you using the lessons you learned from the early stages of the spike to further develop use of artificial intelligence?

Patel: As we started to see spikes, the biggest issue—and it certainly has been around the country—has been testing. A few other points to share: We have over 200 medical clinics around the Puget Sound region. We saw about 28,000 visits per week. Before COVID started … we were seeing 1% of those 28,000 patients in a virtual setting. That has now increased exponentially to where about 15% to 20% of our cases are virtual. We’re going to continue to see that move on.

One of the things we’re looking at now coming out of this is whether we’ll continue to need all the 200-plus clinic sites because we’re starting to see that as our consumers and patients have had the opportunity to have virtual visits, they’re getting more accustomed to it.

MH: You recently opened a new family medical clinic. The plans for building that started pre-COVID, but how does that factor into the equation?

Patel: Franciscan and certainly the Pacific Northwest division of CommonSpirit were growing. We had a lot of strategic priorities built around growth.

We have five regions within the Pacific Northwest, three in the state of Washington and two in Oregon. Our three locations in Washington—one is in the South King region, which is in the shadows of Seattle; the second is in Pierce County, which includes Tacoma; and last is Kitsap and the Olympic Peninsula. That’s where we are not only opening our family medical practice clinic, but we’re also expanding our Silverdale location with about a $500 million project … that’s truly spectacular.

Every patient room has views of the Olympic Mountains. These are projects that we’ve had ongoing for the last couple of years.

The one you talked about we actually kicked off in 2017 with a family medicine residency program. We’ll be graduating our first residents in 2021. So it’s an exciting time for us.

MH: How do you think about evaluating your strategic plan while there’s still so much uncertainty around what the remainder of this year is going to look like, both from the pandemic and financially?

Patel: So much of what we were doing in the Pacific Northwest was driven around inpatient strategy. We needed beds. The population in this community was growing, and growing significantly. With this pandemic, everything has changed. I touched on virtual and virtual capacity, but certainly the population growth is something we have to keep an eye on. Seattle was one of the fastest-growing cities in the country just before COVID hit us. We have to take a very hard pause, which we’re all doing. It helps us being part of CommonSpirit because many independent hospitals are struggling, but they’re struggling on their own. Whereas one of the benefits for us and when we look at CommonSpirit as whole, the pandemic spread around the country and also spread around CommonSpirit. When markets around CommonSpirit were spiking, there were other markets, like Nebraska, that had not seen the pandemic hit.

It allows us to be sustainable for a very long time. Even though we’ve been hit very hard through the pandemic, we have a very good forecast for the future. And we’re taking a hard pause in terms of our strategy.

Some of the plans that we had in place—particularly at Franciscan for projects to expand St. Joseph Medical Center and St. Francis Medical Center—are going to be put on hold. We’re going to take a hard look to see, “Do we now need to do a lot more virtual? Do we need to do a lot more in an ambulatory setting with a lot smaller footprint?” Those are the types of things we’re going to look at right now.

MH: What kind of lessons are you sharing with your colleagues in Arizona and Texas and elsewhere across the CommonSpirit network who are now being hit hard with a surge?

Patel: This is, again, the benefit of being part of a national system that covers the number of states that we do. One of the first things (CommonSpirit Chief Operating Officer) Marvin O’Quinn did … through March, April, May and June was have two calls per week with all of the division presidents. And part of those calls was to talk about what’s happening within each of our divisions, share some of the practices that we have learned, talk about needs in terms of supplies and certainly testing. And because of the fact that we do have scale, it gives him the opportunity to say, “We have Arizona spiking, we have Texas spiking, we have L.A. spiking.” Which is actually what’s happening now, and should we now redirect some of the testing that we need into those markets?”

CommonSpirit, at the time when the pandemic started, was less than a year old. And this has driven us to mature as a health system. Lloyd Dean, who’s now our single CEO, has just been tremendous in his strength of making sure that we have the resources we need.

One of the singular lessons we have learned is that communication is absolutely key. We found that here within Franciscan, and even more so, being part of the CommonSpirit family. I used to get calls daily from my colleagues in Texas and L.A. as we were starting to surge, to just find out what we’re doing, how we’re dealing with it, what have we learned as we moved higher in terms of the volumes we had.

MH: As you think about the growth in telehealth, what’s your message to policymakers and payers in terms of the need for flexibility to keep telemedicine going forward after the pandemic is over?

Patel: Hopefully, many of our policymakers have had family members who have utilized virtual care. That’s an important part of all this—familiarity.

My message is very simple: We know healthcare is changing. We’ve talked about the evolution of healthcare and driving things outside of hospital for my entire career. And my hope is that this pandemic truly drives policymakers to really think about reimbursement models that help us do that. The more we keep patients out of the hospital, the better it is for all of us. And the more we can truly impact the cost curve, not only regionally but nationally.

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