Laura Kaiser—President and CEO of SSM Health, a Catholic, nonprofit health care system that spans Illinois, Missouri, Oklahoma, and Wisconsin—recently spoke with Steven Berkow, Advisory Board's VP of Provider Research, about SSM Health's agile approach to resuming scheduled procedures and Kaiser's vision for the future.

Q&As: How top health systems are tackling Covid-19

Question: Hi Laura, thank you so much for taking time to speak with me. Last time I touched base with SSM Health, your system had successfully emptied its facilities of elective patients but then did not see the expected Covid-19 surge. How prevalent is Covid-19 across your system today?

Laura Kaiser: That's not a question I can answer with one number or ratio. As you know, SSM Health spans four states, and each of those states or regions is experiencing community spread differently. Covid-19 volumes in rural Missouri and southern Illinois peaked about two weeks ago, but other regions saw peaks at different times. Fortunately, social distancing and other measures seem to have limited the spread of the disease in our communities. At this point, I'd say we're at a plateau in most of the markets we serve from this first wave.   

Question: How about looking forward? Are you anticipating a prolonged plateau like we currently see nationally or a second wave?

Kaiser: We are currently looking at a gradual downward trend in cases. However, we are anticipating significant ebbs and flows across our system, with the most significant upticks in communities that have not really been hit yet.

Additionally, there's still so much we don't know about this virus. If we, as a community, don't continue to do things such as socially distance, shelter in place where necessary, and wash our hands voraciously, a second wave will likely occur. All that said, we are now actively working through how best to move forward. We are carefully reopening SSM Health for deferred surgeries and ambulatory procedures and implementing our restoration plan to safely bring the entire organization back up and running.

Question: So who is making these calls on what, when and where to reopen? To what extent are you centralizing these decisions at the system level versus allowing your different regions or individual facilities to make them?

Kaiser:  In the early days of Covid-19, we set up a multidisciplinary incident command center at the system level led by our Chief Medical Officer and Chief Operating Officer. We also set up regional incident command centers that reported into the system incident command and about 20 different system-wide task forces to provide guidance on specific topics like infectious disease, employee health, clinical operations, facility planning, supply chain, and so on.

The purpose of these task forces has evolved over time. They first focused on emergency preparation and care delivery, then expanded to include recovery, and now also include reopening. For example, our supply chain task force is now working on PPE usage rates for non-Covid patients, their providers, and visitors.

The team members closest to the work make the final call on timing and resumption of services based on patient and employee safety criteria, resource availability and the regulations of their local municipality or jurisdiction. We're essentially asking local leadership to take our broad system thinking and apply it in a manner that is consistent with local needs.

Question: So your system-level experts and incident command center establish overarching criteria for reopening and local leaders apply it?

Kaiser: Not exactly. There are local dynamics that come into play, such as the rules and regulations around social distancing or sheltering in place, which can vary significantly. The situation is extremely fluid.

We are a multi-state system and there is tremendous brainpower across the entire enterprise. We are striving to create a productive dialogue between system and local leaders to foster ongoing refinement of our response efforts. Best practices emerge in every corner of SSM Health. Every time an individual facility applies system guidance in a novel way, it creates new data points that, in turn, inform our system-level thinking.

Question: Thinking system-wide for a moment, what are your greatest constraints on reopening? Are you more concerned about immediate resource constraints, or what might be required to treat a second wave?

Kaiser: Right now, I'm very concerned about PPE and testing kits. There's been a lot of media attention lately on the need for more testing and contact tracing to safely reopen, but concern over PPE shortfalls remains for both the short and long term.

We have a great supply chain team here, and they've literally scoured the earth to find the PPE we need. There is a global shortage of medical grade PPE, and I fear many providers don't have the wherewithal to handle the curveballs of worldwide competition for PPE. For example, we ordered 5,000 test kits in the early phases of Covid-19, and 4,000 of those kits were sequestered and taken away. And now there is a lot of misinformation out there about what PPE and testing is trustworthy.

There are still parts of the world on the upside of the surge, like Africa and Russia, and second waves across the globe are likely. Our worldwide supply chain is not working well, and it needs to be highly functional to safely reopen every community.

Question: Zeroing in on the demand side, is SSM Health revising its policies for PPE and testing as you consider reopening? I assume, like most hospitals, the crisis forced you to dramatically scale up PPE and testing use but also put in place some novel conservation tactics. Are you now rethinking your PPE or testing policies, or setting minimum capacity thresholds for resuming certain procedures?

Kaiser: At SSM Health, we are unwilling to compromise on employee and patient safety. So it's not a matter of changing policy; it's a matter of ensuring patients and caregivers have the supplies they need to be safe. As one example, we know we're going to need way more masks to fully reopen. We will have to ensure we have the PPE and other supplies needed to meet our longstanding safety standards for everyone.

Question: So, you're essentially saying, "We won't relax standards; we need to supercharge our supply."

Kaiser: Exactly. I am accountable for 40,000 people and I'm not messing around with employee or patient safety.

Question: I'd like to talk big picture in what little time we have left. When you think about what our health system will look like post-Covid-19; do you foresee any transformational changes triggered by the pandemic? Put another way, are you readying SSM Health for any big changes in how we provide care in this country?

Kaiser: Top of mind, two key things. One is economic, and the other, social. First, we need to reshape our physical footprint on a much faster timeline. Going forward, volumes are projected to return relatively slowly. Also, there will be fewer commercially insured people and more uninsured individuals and Medicaid beneficiaries due to record unemployment, as well as continued migration of aging baby boomers from procedural to chronic care. We will struggle to support our fixed overhead with this patient mix.

Covid-19, however, has presented opportunities as well as challenges. Our patients have embraced alternative, more cost-efficient ways to access care, such as telehealth and home care. But we will struggle to scale these new care models and offerings if we don’t expedite strategies for improving access for seniors and other customers while shrinking our bricks-and-mortar footprint.

Second, the pandemic has clearly illustrated that socioeconomic disparity and poverty go hand-in-hand with health disparity and, in turn, increased comorbidities and costly acute-care episodes. I hope this national spotlight prompts more national conversations around access to health care and greater investment in addressing the social determinants of care. And I hope this comprises a major component of SSM Health’s agenda on the other side of the pandemic.