The PRAXIS Nexus The PRAXIS Nexus

Promising Practices in COPD Care: Catholic Health Initiatives (CHI)

Posted on October 22, 2015   |   

Christine Cunningham

Christine M. Cunningham, RRT, Director of Clinical Services at CornerStone Medical Services, tells us about CHI’s COPD care and readmissions reduction approaches.

Tell us a little bit about your organization.

CHI Health at Home offers a full line of home care services and is dedicated to meeting the total needs of our patients with four distinct yet coordinated home care companies, including home health care and hospice, home respiratory services, home infusion therapy and non-emergency medical transportation. We serve as the national home health provider for Catholic Health Initiatives (CHI). One of the nation’s largest health systems, as of this posting, CHI operates in 18 states and is comprised of 93 hospitals, including four academic medical centers and teaching hospitals; 24 critical-access facilities; community health services organizations; accredited nursing colleges; home-health agencies; and other facilities that span the inpatient and outpatient continuum of care.

CHI Health at Home specializes in health care management and partners with hospital systems to manage the day-to-day operations of the home care-related companies, allowing the health system to focus on their primary business of running the hospital.

Can you please describe your COPD care approach for our PRAXIS NEXUS readers?

We are blessed to be a part of a diverse and vast healthcare system. In some markets we work directly with our Home Health Agency to care for our COPD patients which gives us access to telehealth. Our Breathe Better with COPD program is highly customizable and lead by Respiratory Care Practitioners (RCP). We utilize The Global Initiative for Chronic Obstructive Lung Disease (GOLD) stratification process to categorize patients according to COPD staging, risk and severity. Then we assign patients to a care plan tailored to their risk and severity. Patients are actively enrolled for 30 days before we transition them into our long-term care. Our Breathe Better with COPD approach:

  • Assess and treat – RCP assigns patient to a care plan based on risk and severity. RCP completes a comprehensive assessment of the patient, their living environment and related respiratory equipment, matching the patient to the most appropriate, advanced technology therapy at the lowest cost
  • Educate and empower – RCP educates the patient on their disease and all related equipment.  Teaches patient about the green, yellow and red zones – equipping and empowering the patient to engage in self-care
  • Monitor – Ongoing monitoring after active enrollment; patients monitored beyond 30 days with automated calls, live calls and interventions when needed by RCP. Outcomes shared with healthcare partners monthly

Our current focus is avoiding readmissions. Our next step is working with our Clinically Integrated Networks to identify and enroll patients sooner to avoid an index admission by utilizing tools like the COPD population screener from the COPDF.

What lessons learned can you share with us?

Our Avoiding hospital Readmissions through Care at Home (ARCH) Pulmonary CareLink which predates our Breathe Better with COPD program has already documented successful results in our Des Moines, IA ACO: reducing 30-day readmissions for COPD from 28% to 8% from FY13 to FY14. Our Breathe Better with COPD (respiratory therapist driven) program is at various stages of implementation across multiple markets. Though we have yet to report outcomes, we are seeing success and anticipate that our program will indeed achieve the triple aim – better health, better experience and lower cost per capita.

What elements of your COPD care approach do you think make you most successful?

We are fortunate to have had the opportunity to learn from other successful care transition programs. We built our program by taking successful components of pioneer programs along with related therapies proven to reduce exacerbations and hospital admissions to create a robust and sustainable population health program. We studied their root cause analyses to plan our program accordingly to safeguard against their “lessons learned.” We utilize respiratory therapists who specialize in caring for the COPD patient to execute our program. We risk stratify and treat the patient according to risk and severity. Following in the footsteps of the COPDF, we strive to educate, empower and engage individuals living with COPD. We also help the patient to identify their personal goals that they hope to achieve as we help them to Breathe Better with COPD.

What do you find about working in COPD care most challenging?

Changing mindsets and behaviors in both healthcare professionals and patients; the interoperability of technology among disparate IT platforms (sharing information) and funding sustainable programs.

And most rewarding?

Improving the lives of the patients we serve while creating healthier communities is the most rewarding part of working in COPD care. We enrolled a woman into our Breathe Better with COPD program. She had 10 hospital admissions and multiple Emergency Department (ED) visits in the 12 months prior to our program. One of her goals in working with us was to be able to play outside with her grandchildren. Two weeks into our program the patient was readmitted due to Acute Exacerbation of COPD (AECOPD) after playing outside with her grandchildren over the weekend. Root cause analysis: unmanaged/uncontrolled adult asthma. Solution: coordinated care with PCP to address and treat her asthma; also added yellow zone protocol which is a first dose antibiotic and steroid. Pleased to say that seven months later, our patient has neither made a visit to the ED nor been admitted to the hospital.

What other things would you like to tell readers like you about your work in COPD?

Healthcare reform provides the impetus for the continued alignment of all stakeholders in the care continuum – payers, health systems, physicians and community based organizations – to pursue collaborative solutions to manage the overall health of the most complex and costly populations. As we move from fee for service to fee for performance, home-based healthcare professionals play a critical role in keeping our communities healthy. We plan to be agents of change!

This page was reviewed on March 5, 2020 by the COPD Foundation Content Review and Evaluation Committee


You need to login to comment.
  • Hey, Christine, hello! We met at Pulmonary Horizons, I think. Who's your ACO in Des Moines? I live there, and I'm curious! My pulmonologist is affiliated with Mercy (through CIC Associates) and my PCP is affiliated with Unity Point, so I have a foot in both doors. I had no idea that you had an affiliate in DM......small world!

    Jean Rommes
    • Greetings, Jean; so nice to hear from you! Indeed our paths have crossed a few times - most recently at PH. We are affiliated with David Swieskowski, MD, MBA, Senior VP & Chief Accountable Care Officer, Mercy Medical Center. Who is your pulmonologist? I will be out there again in the near future.

  • It sounds like you are really gaining traction in your area. I was wondering if you could share a little more about how your Respiratory Therapy professionals are billing for their time? That seems to be a troublesome point of concern for many healthcare professionals I encounter. They know they need to incorporate RT, but are unsure of how to get it done with limited reimbursement. I am a strong believer in a multidisciplinary approach, and am pleased to see that your efforts are doing so well.
    Thank you for any additional information.
    • Stephanie, we are being very creative about getting paid for what we do. We are negotiating several options across various markets. Some examples include a Professional Service Agreement to directly cover the cost of our respiratory care professionals and their interventions. We are seeking payment from payers, hospitals and ACOs within our health system and we are having success. It's all about showing them the value we bring to the patients we serve and demonstrating how our program can achieve the triple aim.