When the Centers for Medicare & Medicaid Services (CMS) enacted an enrollment moratorium on home health providers on May 13, it transformed CommonSpirit Health at Home’s largely de novo-driven growth strategy.

Trisha Crissman, CommonSpirit Health at Home’s president and CEO, said the company’s new five-year growth strategy includes geographical expansion, boosting its market share and pushing patient care farther upstream.

Crissman has served as president and CEO of CommonSpirit Health at Home since September 2024, previously serving as the company’s interim president since 2023. Her prior appointments include vice president and chief operating officer for the home health and hospice division of CommonSpirit.

Based in Loveland, Ohio, CommonSpirit Health at Home is the home-based care arm of the Catholic healthcare organization CommonSpirit. CommonSpirit Health at Home provides home health, hospice, palliative care and home infusion services to over 16,000 patients across 15 states.

A replay of that TALKS episode for HHCN+ members is below, along with a transcript of the conversation. The transcript is lightly edited for style and clarity.

HHCN: What were your priorities for 2026?

Crissman: CommonSpirit Health at Home has significant initiatives in play right now tied to our larger strategic plan.

For us to realize the ROI tied to the implementation of, for example, ambient scribing technology, which we began implementing this past summer, as well as gaining some efficiencies through some referral management platform technology that we also just began implementing that will ease administrative burden tied to the admissions process. These are two huge bodies of work requiring a substantial lift by my teams. I expect that this will continue to be a focus this year from an initiative standpoint.

Additionally, we are laying the groundwork for some emerging strategies that will support our growth plan well into 2030. Those initiatives require a lot of pre-planning, and those are also top priorities for us as we formulate plans around a couple of those key avenues. When I look back on ’26, I will consider it successful if Health at Home continues to grow its EBITDA and our bottom line. This is essential because it provides the resources needed to reinvest in growth and carry out our mission for the larger organization.

To achieve this, we must reduce administrative complexity and realize additional benefits driven through our streamlined centralized function. We’re working on that and driving increased capacity through some of the technology that we’re implementing right now. That will help us have more capacity to care for the people that need our help every day.

Those are our top priorities for the remainder of ’26. I’m optimistic that I’ll look back and recognize that our investments were well worth it and we’ve been successful.

Can you walk us through CommonSpirit Health at Home’s five-year growth strategy?

Crissman: A lot of the five-year growth strategy has been halted because it’s been dominantly de novo-driven and heavily hospice-focused.

However, with the current moratorium in place, we’ve had to re-evaluate opportunities for our growth and expansion until that is lifted. We’ve pivoted. We’ve put on hold some components, but we identified several key growth strategies enabling us to continue to serve more patients in the markets where we already exist.

Our first strategic move is making sure we’re expanding our geographical footprint and increasing market share. That will align with CommonSpirit Health’s coverage and service where they need us to serve our hospital partners.

That’s true for markets where we’re serving CommonSpirit Health, but also for our 15 joint ventures with regional hospital systems, dominantly in the Midwest. Our first strategic move is making sure we’re expanding geography and gaining market share.

The second strategic move is tied to increasing access to care earlier and upstream and in alignment with physician enterprises across CommonSpirit Health. [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.

We’ll help physicians and practitioners understand and identify eligibility for services earlier and engaging patients with the right level of care at the right time before the next acute exacerbation takes place. This will be particularly powerful for those who may be eligible for hospice when maybe physicians and practitioners possibly have not had advanced goals of care conversations with them and what their hopes and wishes are at the end of life.

A third strategic move is making sure we can drive greater success in value-based care and deliver quantifiable enhancements in clinical quality, patient outcomes and reducing total cost of care across the eight [clinically integrated networks] CINs and shared populations with CommonSpirit Health.

Technology is everywhere and embedded in all of the strategies, and so [we will be] making sure we are accelerating the utilization of some technological solutions. More specifically, we’ll be deploying AI and some digital capabilities to enhance clinician engagement, expand clinical capacity and optimize patient navigation.

There are so many byproducts of doing this well. Empowering our clinical teams with some technology solutions that will make their lives easier and reduce documentation. I’m excited about that. Of course, the admin burden, just to give them the space and the freedom to engage patients and their caregivers without the obstacles of the hardware in front of them that we’ve been hearing complaints about for decades. Then hopefully, we’ll be able to give them an opportunity to connect more deeply with patients as a result.

We’ll pick up the de novo expansion once we hear that CMS lifts the freeze, which will have Health at Home adding about an additional 23 locations through fiscal [year] 2032 in key markets that will support the care continuing for CommonSpirit Health as a whole. Those are the top priorities that will take years.

Did the moratoria change growth goals or just the strategy for growth?

Crissman: The overarching goal is that we need to grow our EBITDA. We know the percentage of patients that we’re not able to serve because of capacity or geography limitations right now. The numbers don’t really change. The budgets have been set. We just have to figure out and be agile with how we’re going to make it happen.

One of the things I love about Health at Home is that we’re really good at pivoting. We’re really good at being flexible and finding a way. The moratoria is not within our control, but what is within our control and focusing there to be architects of our own destiny. I’m proud of my team’s ability to do that quickly.

What might we see with the moratoria?

Crissman: My crystal ball is broken right now on my desk. I wish I could tell you.

I do know CMS made a promise to us at the Alliance Conference that they would give us, obviously, if it’s in writing, they would give a 60-day notice. That notice timeframe has passed if they were going to extend it. I’d like to be optimistic and say, “Well, it must be being lifted.” That’s what I would expect because we haven’t heard.

I never thought it would only be six months. I thought it would likely be extended. I’m on the fence with that. When I get my crystal ball fixed, I’ll tell you what it says.

What is your strategy for expanding value-based care contracts?

Crissman: It starts with ensuring that Health at Home is included in the contracts in each of the markets where they have shared populations. That’s the biggest piece that we’re working on right now: having visibility to being a preferred partner and educating the markets and these CINs around the value that care in the home brings and the impact that we can have on reducing total cost of care.

It sounds really basic, but when you’re an organization the size of CommonSpirit Health, it’s not surprising that there are gaps from where we should be to where we need to be in the future. That’s been elemental, making sure that we’re included in the contract and that we, Health at Home, are educating key stakeholders with each of those CINs.

Has the ability to build those contracts and be included in them changed recently?

Crissman: It’s been pretty consistent. You’d think that it would be automatic, but you push it forward. It’s not necessarily a boulder going up a mountain, but it’s pretty consistent.

Let’s talk about your five-year plan of moving access to care upstream. What does that mean on a practical level?

Crissman: I’m really excited about this because I think it will provide the opportunity for patients to access service when they’re eligible and earlier.

We know that accessing the right level of care at the right time improves overall outcomes, patient satisfaction and quality of life. As far as what it would look like for a patient visiting with a physician or specialty clinic, our vision is that utilizing AI and some technology, some triggers in the EHR, that will flag possible eligibility for either home health or hospice, and that practitioners and physicians would be automatically notified of this eligibility in preparation for maybe an upcoming visit.

Ideally, maybe it would even happen before the patient’s next visit so that we could preemptively encourage a sooner visit with their provider to review their eligibility for that level of care: again, home health, hospice, at the right time, why they qualify.

Then, ultimately, if we’re successful at doing that, preventing the next exacerbation, which obviously would likely result in another hospitalization, which nobody wants.

The vision is that we can positively impact quality outcomes and patient experience by maximizing and leveraging key touchpoints on the patient’s care trajectory.

Doing that earlier and allowing them to have a better quality of life and a much lower likelihood of additional hospitalizations because of the interventions that historically are not provided timely enough. We move from a reactive model, which we have always been, both for home health and hospice, to a proactive engagement of the patient within the care continuum, earlier, more effective — likely to be more receptive because they’re not in the midst of a crisis, and they have time to absorb the reasons why they qualify and how it will benefit them, which all, again, contributes to better outcomes and lower total cost of care. I’m just really excited about this opportunity that we’re working on.

Does moving care upstream help get patients into hospice earlier?

Crissman: It can, it will, it should. Being able to impact access to hospice care for patients who are eligible to receive the benefit and to do so earlier than they currently do, that would bring about such a great end-of-life experience for the patient, for their caregivers. I believe all physicians and practitioners desire that for them as well.

You can imagine being a part of a large healthcare system and serving our hospital partners as the care-in-the-home platform, hospice patients come to us at the end of life way too late and subsequently do not have the ability to benefit from all the ways that this beautiful hospice care benefit can support and enhance someone’s last days of life.

The care teams at Health at Home, we’re so well equipped to have meaningful and powerful goals of care conversations with patients and their loved ones. This can and should be done and will be a part of how Health at Home serves clinics and specialty clinics’ physicians moving forward in the larger health system.

We do this all day long, and we’re good at it. We want to be leaned on to serve physicians and practitioners that way, and of course patients and families. Having the opportunity to be engaged with patients and their loved ones earlier in the disease trajectory, earlier in their treatment, I think it could have really impactful and powerful outcomes.

Do you think there’s an industry-wide trend of organizations moving care upstream?

Crissman: As I look back in the past three decades, we’ve always wanted it to be that way. We haven’t always been successful for lots of different reasons.

I do hope that the AI that’s available to us and how it can be embedded in an EHR that can help us to see earlier, what we don’t normally maybe see in a regular visit or over the course of a year and a half of a patient’s decline, they show up in little tiny changes that we don’t pull the thread together and put a whole story together, but the technology can help us do that.

I would expect that all health systems will be looking at their EHR, and how a patient’s experience and ability to access the right level of care at the right time could be exponentially served by using the data that’s always been there, but we haven’t had an ability to pull on. That’s my hope.

What are the most meaningful problems that you want AI to solve at CommonSpirit Health at Home right now?

Crissman: All of them, but I have to pick and choose.

Our approach to AI and emerging technology solutions must always have consideration and evaluation through the lens of our mission and our values.

We’re very interested in finding solid solutions that will help us be more efficient, drive greater accuracy and be more productive. We have solutions for almost every pain point being thrown at us and coming at us all the time. They’re all very enticing, particularly for reimbursement challenges, workforce shortages and the headwinds of inflation.

I am most excited about the ways that some of the new technology that we’re implementing right now will enable our frontline clinicians to be able to connect more deeply with patients and caregivers that they interact with daily. To give them more time to maybe have deeper conversations. It could drive higher levels of human kindness and opportunities to connect more deeply, I think, relationally in the living rooms and at the kitchen tables [where] our clinicians are sitting with patients and their loved ones.

Technology that enables clinicians to really be the nurse, therapist, social worker or chaplain they dreamed of being, but software and hardware historically has gotten in the way of that. We’ve been listening to that for a long time. If we’re removing those kinds of obstacles with the new technology, such as ambience scribing that we are currently in the midst of implementing, that can be the solution to help create the environment to be successful there.

When you think about mission and culture, always with the patient at the center of everything that we do, the innovation that we seek to embrace has to enable us to be better versions of ourselves tomorrow than we are today.

It has to enable us to live out our mission in more powerful ways. It also has to help us, and this is still important, it has to help us reduce administrative complexity and redundancy and help us be more efficient, care for more patients through our own growth strategies, and without adding additional resources in the future.

CommonSpirit Health at Home is also really focused on how these technological solutions will help us with our retention efforts. Candidates today, in general, are becoming extremely tech-savvy and sophisticated. They have an expectation that organizations like Health at Home, that if they choose to be a part of that, those organizations are utilizing the newest, latest and greatest technology as solutions to help them have an overall better experience — no matter their role. Of course, when you’re a field clinician in home health, hospice or palliative care, the administrative burden of documentation and the time that it has always been one of the top complaints from our staff. Even back to the days of paper at the bedside.

Being able to offer the latest technology as a part of our operational platform and culture, to me, that’s going to be really attractive to candidates. I’m banking on that. Not just attracting them, but retaining them. That’s extremely important for us to be successful in our ministry.

In the recruitment process, does CommonSpirit discuss the type of technology candidates will be using?

Crissman: Yes. We’re telling the story of a day in the life of each of the interdisciplinary team members and how that technology is being used in their role to make it simple for them to understand. We’re using that in advertising, our website and certainly as a part of what we’ll send to an interested candidate when they apply for certain positions.

It’s here to stay, and it’s not going away. It’s an expectation to all our staff that we embrace it for the good it can bring us.

You talked about the ambient scribing technology. How are you using that technology? Where are you with the implementation process?

Crissman: We began implementing ambient scribing early this past summer. We are 100% implemented for home health, just beginning for hospice.

Everyone’s really excited about it when we explain what it can do for clinicians and our team members. I thought originally that we would have 1,000% embrace, and that this is the best thing since sliced bread, and that we would have really quick adoption. Well, that hasn’t been the case.

We do have a small portion of our employees that are hesitant around using AI and ambient scribing for various reasons. We have some that are slower to adopt in the ways that we educate and redevelop our teams around having conversational assessment dialogue versus using the tablet, clicking and doing a narrative maybe later or copying — all the things that have historically been a part of how we documented on our current EHR without ambient scribing.

It hasn’t been as smooth as I want. The change management piece, we underestimated. It doesn’t mean we won’t get to where we’re going because we always do. It’s just a little bit slower of an adoption timeline than we expected.

I have anecdotal stories of clinicians that came back day one and said, “I can’t believe that I’m done. I get to go to my son’s baseball game.” That’s really powerful to me. I want all of our team members to experience that, and I know that they will. That’s where we stand today.

How do accelerate AI utilization?

Crissman: I happened to have looked at our action plan this morning. I liked a couple of components where we’re going to tap super users. We’re going to turn them into zealots for us and embrace those who may be slower, hesitant or resistant to adoption, and then do co-visits together so it may dispel what might be threatening to a nurse or therapist who is not using it.

Let’s partner folks up with those who are really seeing how it changes their life. I’m going to put a lot of weight on that. I think it’s brilliant.

I also think continuing to explain why we are doing this will help individuals understand. The reality is, likely, a couple of years from now, all providers will be utilizing ambient scribing. We can’t afford not to with workforce shortages.

It’s not like individuals who want to be in this industry — and I hope more decide to join us to care for people where they want to be cared for in their own home — are going to be able to find somewhere that isn’t going to use some level of this technology.

Is there another technology you want to highlight?

Crissman: We have our hands full right now with the ambient scribing, and then we also are implementing referral management AI. Right now, those are the bites of the elephant that we’re taking off.

There are some other components that, when I look at technology, it has to be through, again, the lens of how are we going to grow? We need to grow our EBITDA, and that means we need more efficient processes and less administrative complexity. It means we need more capacity so that we can see more patients with the same workforce that we currently have.

I’m confident the technologies we have moved forward with this year will help us accomplish all that together. I don’t have anything else in the hopper. I’m sure that we’ll be looking, once we’re successful with these two components, for what the next opportunity is for us to be more efficient and lean into technology to serve the outcomes we’re looking to improve on.

It sounds like the admission technology would help serve both patient need and increasing efficiency.

Crissman: It does. Not just reducing the clunkiness and time of the referral-to-admission process, which is way too long, but it removes subjectivity around, “Should I say yes to this referral? Can I take this patient? Can I admit this patient?”

It’s automated. In my mind, we say yes, and we figure it out. Because these patients need our help.

It’s amazing what does go into the discernment currently around whether we accept a referral. We’re better than that. We have to move beyond it. We have to figure out how to admit the patients that need our help every day. That’s being a good partner to our hospital system and our joint ventures.

Again, there’s a lot of change management and taking that off an agency’s autonomy and having it be automated, but we’ll get there.

Are you in the implementation phase for the admissions AI or pilot? What part are you at right now?

Crissman: We’re entering phase two on Tuesday next week. Maybe 15% of my agencies are on it. We’ll be rolling this out and complete by end of December.

How is it important for providers to make sure that tech enhances patient care rather than replacing it?

Crissman: This is in my roots as a hospice chaplain. How we frame the opportunity that AI offers our clinicians to be more authentic and to make more authentic human connections in the day-to-day practice of caring for patients in their own home.

That’s really vitally important, as well as defining what success looks like upfront. For example, in the ambient scribing piece, we’re retraining clinicians to engage in conversational assessment and dialogue with their patients, which is very different from tablet charting during a visit.

We’re going to maximize the accuracy and the effectiveness of ambient listening. Alongside that, more importantly, we are framing up and leveraging AI as an empathy enabler. Our clinicians are maximizing the opportunity to become more enhanced and advanced compassionate healers, to embrace this newfound time to maybe slow down, maybe listen more deeply and to provide more personalized care and support during their visit.

Defining success has KPIs tied to whether we are efficient and accurate, but we have to define success also related to this enhanced, accelerated human kindness. That will include improved patient experience. This is the piece that I’m really excited about, this deeper, more meaningful clinician connection to their “why” and their purpose. Why did they want to get into this work in the first place?

This has to be a part of the rationale and the business case for utilizing AI for our clinicians, and to ensure the technology we use helps humanize the care we provide, not just make us more efficient.

On a leadership level, does that look like having conversations with clinicians, listening throughout and after the implementation process?

Crissman: Yes. I would say asking really good questions of our clinicians for them to articulate what has changed, what’s different. Can you make that tangible? How does it feel when you go home at night, when you have no more documentation to do? How does it feel sitting on the living room couch with your patient now, and you don’t have a tablet in front of you that’s maybe been an obstacle?

Let’s get our people talking about the difference that it makes, and then lean on that and leverage it.

Health at Home obviously has the unique position of being under the broader CommonSpirit Health system. What opportunities do you see to leverage that?

Crissman: I remember, early in my career, reflecting on what it would be like to be a part of a larger health system. I salivate around the referral stream and all the resources that would come. There are pros and cons to all different types of relationships. It is really wonderful to be a part of the larger CommonSpirit Health ecosystem that provides a unique opportunity for Health at Home to understand more deeply the pain points of the larger organization, and to ensure that we’re providing solutions for the gaps between where we are today and what’s possible.

Having access to, whether it’s IT or HR or strategy or business development, a standalone provider would never be able to for example, have bots created to be a part of a national IT department, we wouldn’t be able to afford to develop that on our own. We benefit greatly from being a part of a larger health system.

At the same time, you’re a part of a large health system, and you have lots of people that want to weigh in on your business, and there’s bureaucracy, and things take a long time. It’s all give-and-take, but we benefit greatly from being a part of a larger perspective and system resources that are available to us right now.

What’s the big change that you’re hoping for patients to see out of all of this? What’s the core outcome you’re looking for?

Crissman: I’ve mentioned clinician connection to their “why.” I will just lean on that again. Attraction and retention.

I also am hopeful that maybe technology will help us more broadly take better care of patients. Maybe that’s where predictive analytics come in around anticipating clinical decline, preventing adverse events and making more personalized care plan. Home health problems don’t start as a code blue. They start as micro trends. They go unnoticed until a patient winds up in the ER.

We’re inundated with information. From medication changes, supply requests, standard documentation, this clinical early warning system that parses the noise to a nurse [and describes] based on the last three visits that this patient’s baseline is shifting. Because some of this stuff just happens in the gaps between our visits. It’s happening in the day-to-day life of patients. It’s happening in the social determinants of health, all those little things.

It would be really nice if our clinicians could have access to that information to be impactful and have interventions before their patients hit a threshold of a crisis.

That might be something that I would look forward to having in their hands. Something that solves for the gaps between the visits. Helping us be better versions of ourselves tomorrow, which translates to our patients [being] happier. Our patients have a better quality of life. The story that patients tell can ooze with loyalty to the larger CommonSpirit Health organization, and that they would never consider having a provider other than the one that’s caring for them right now.

That’s how I would translate the outcomes that I’m hoping that we’re all going to be experiencing through these changes that we’re making.