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CommonSpirit Health at Home is focusing on identifying patients for home health, hospice and palliative care earlier through primary and specialty clinics. CEO Trisha Crissman said enrollment moratoria have changed the organization’s growth approach, but not its financial targets; the provider is also looking to AI tools to increase capacity, though adoption of ambient scribing has been slower than expected.
CommonSpirit Health at Home is pursuing earlier identification of patients who may qualify for home-based services, while using AI-supported administrative tools to expand capacity as federal enrollment moratoria constrain some growth plans. In a recent HHCN+ TALKS conversation, President and CEO Trisha Crissman said the organization’s financial targets remain in place despite the need to rethink how it expands.
Crissman described a strategy to work more closely with primary care and specialty clinics across the CommonSpirit Health system. The aim is to identify patients who may qualify for home health, hospice or palliative care before an acute episode or hospital discharge makes the need more urgent. The approach could bring discussions about care at home into patients’ existing clinical relationships and care planning.
CommonSpirit Health at Home is part of a broader health system and has 15 joint ventures with regional hospital systems, relationships the report says may support coordination with clinicians and hospitals. But shared ownership or affiliation does not automatically produce referrals or early access to patients. Crissman said the organization still has to advocate for inclusion in value-based care contracts and explain its role to internal stakeholders.
Growth plans have also been affected by federal enrollment moratoria on new home health and hospice enrollment, according to the report. Crissman said the organization’s budgets and financial expectations had not changed, requiring it to find other ways to meet its targets. One part of that effort is using ambient scribing and AI referral management to reduce administrative work and increase the number of patients staff can support.
Earlier Referrals Could Change Care
Earlier referral pathways could give clinicians and patients more time to discuss whether home health, hospice or palliative care is appropriate, rather than starting the conversation only after a hospital stay or a sudden decline. For patients, the potential value is access to support as needs emerge. For providers and health systems, identifying needs sooner may help connect care across clinical settings.
The strategy’s practical importance rests on whether those connections lead to action. A system can identify a possible need in a clinic or electronic health record, but staff still need to contact patients, assess eligibility and arrange services. CommonSpirit’s health-system and joint-venture relationships may provide a starting point, but the report does not establish that they have already produced a measurable increase in earlier referrals or improved patient outcomes.
The effort also addresses a business constraint. If moratoria limit some routes for adding service locations, increasing capacity within existing operations becomes more important to the organization’s stated growth plans. AI tools may help with that objective, but their impact depends on whether clinicians use them and whether administrative time saved translates into additional care capacity.
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System Ties Meet Growth Limits
Moving care upstream has been a long-running goal in home-based care: identify people who may need support before an acute exacerbation, rather than relying mainly on referrals after hospitalization. The HHCN report frames the difficulty as operational as well as technological. Providers need a way to identify eligible patients, build referral pathways and make sure someone follows up.
CommonSpirit Health at Home’s position within a health system and its 15 regional hospital joint ventures offer established relationships to work from. Crissman’s stated focus is to build pathways through primary and specialty care clinics, including transitions into home health, hospice and palliative care. The organization must still coordinate across stakeholders and secure a role in value-based care arrangements for those pathways to function consistently.
At the same time, the report describes federal moratoria on new home health and hospice enrollment as a constraint on parts of the organization’s de novo expansion strategy. Rather than changing financial targets, Crissman said the organization is looking to serve more patients with its existing workforce. Ambient scribing and AI referral management are among the tools being considered for that work.
““[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.””
— Trisha Crissman, president and CEO of CommonSpirit Health at Home
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Adoption And Results Remain Open
The available report does not quantify how many additional patients CommonSpirit Health at Home expects to reach through earlier clinic referrals, or whether the approach has changed hospitalizations, patient outcomes or costs. It also does not detail the scope or timing of the enrollment moratoria’s effect on specific locations or services.
Crissman said adoption of ambient scribing has been slower than expected, and the organization is working with superusers to help clinicians become comfortable with the tool. The report provides no adoption rate, productivity measure or estimate of how much capacity the technology may add. It is also not clear how widely AI referral management has been deployed or what safeguards and workflows govern its use.
More broadly, an electronic health record alert or a clinic referral does not itself establish eligibility or guarantee that a patient will receive services. The report describes a strategy and the rationale behind it, not independently measured results.
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Track Clinic Pathways And Tool Use
The next indicators will be whether CommonSpirit Health at Home can establish routine referral pathways with primary and specialty clinics and gain the internal and contractual support Crissman says is needed. The organization’s progress will also depend on how it responds to enrollment restrictions while keeping its stated financial targets.
For the technology effort, the key developments to watch are clinician adoption of ambient scribing, implementation of AI referral management and evidence that administrative efficiencies create usable staff capacity. The report does not provide a schedule for these milestones or a date for outcome data. Further details on rollout, referral volumes and results would clarify whether the strategy is changing access to home-based care.
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Key Questions
What is CommonSpirit Health at Home trying to change?
It is seeking to identify patients who may qualify for home health, hospice or palliative care earlier, particularly through primary and specialty care clinics rather than mainly after a hospital discharge.
Why does the organization see its health-system relationships as useful?
CommonSpirit Health at Home is part of a larger health system and has 15 joint ventures with regional hospital systems. Those ties may give it relationships through which to coordinate referrals, though they do not guarantee that earlier referrals will happen.
How are enrollment moratoria affecting its growth strategy?
The HHCN report says federal moratoria on new home health and hospice enrollment have put parts of the organization’s de novo growth strategy on hold. Crissman said its financial targets have not changed, prompting a focus on other ways to grow capacity.
What role could AI tools play?
CommonSpirit Health at Home is looking to ambient scribing and AI referral management to reduce administrative complexity and help staff support more patients. Crissman said ambient scribing adoption has been slower than expected; the report does not provide measured productivity or patient-care results.
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