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Case Study

How an Enhanced Home Health Program Creates Hospital Capacity

15 Minute Read


The challenge

Amid the Covid-19 pandemic, health systems need to create capacity to prepare for the surge in demand for acute care. While most systems are adopting a home first approach for discharge, doing so without the proper structure and support for patients could lead to poor health outcomes such as increased lengths of stay and hospital readmissions.

The organization

Starwell Health Care is a not-for-profit medical system based on the East Coast. Starwell currently comprises Starwell Hospitals and its provider network, a home health agency, the clinical programs of the Starwell School of Medicine, and eleven affiliate hospitals and hospital systems across the state.

The approach

Starwell Health Care created an Enhanced Home Health program to manage patients presenting in the ED with low-acuity conditions. Instead of being admitted for observation or initiation of therapy, those patients are discharged directly to home with support from a team of home health clinicians. The program liaison identifies patients eligible for the program in the ED and coordinates follow-up care. RNs conduct in-person visits under the supervision of a physician— providing hospitalist-like functioning in support of the patient’s PCP— who conducts virtual visits to monitor the patient’s progress, guaranteeing timely follow-up within 36 hours of the patient’s discharge from the ED.

The result

Starwell has observed high patient engagement and is collecting data to quantify the reduction in care costs and improvement in health outcomes. A number of payers in the market have expressed interest in the program as well as a willingness to increase reimbursement and cover virtual visits. As of June 1, 2020, this program has treated 61 patients. Out of those 61, just four have returned to the ED, with only two of those having a hospital admission.



How Starwell discharges patients from the ED to their Enhanced Home Health program

To create capacity and reduce the risk of patient exposure to Covid-19 in the hospital, Starwell created an Enhanced Home Health program to deliver in-home care to low-acuity patients presenting in the ED. Instead of being admitted for observation or initiation of therapy, they are discharged directly to home after stabilization in the ED. Starwell convened a group of 10 specialists to determine the patients most suitable for the program. An nurse liaison embedded in the ED identifies and enrolls eligible patients, trained Covid-19 Response RNs then conduct in-person visits under physician oversight.


The three program components

Below are three components necessary to launch a high-value home health program for low-acuity patients presenting in the ED:

  • Component

    Embed liaisons in the ED to identify patients

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  • Component

    Upskill clinicians to deliver complex in-home care

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  • Component

    Incorporate advanced-level clinician oversight

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Early results

While the Enhanced Home Health program is still a pilot, Starwell is currently collecting data on patient satisfaction, reduction in readmissions and overall care costs to prove it’s value. They are also negotiating with payers in the region to increase reimbursement rates to match the potential program benefits and resource investments.

  • High patient engagement: So far 61 patients have been referred to the program and only 11 have declined to participate translating to an 82% acceptance rate.
  • Expected improvement in outcomes: Of the 50 patients they have treated, only four have been readmitted to the ED, and just two of those four were hospitalized. Additionally, over the month of May, 30% of patients have been discharged back into the community with goals met.
  • Engaging payers in reimbursement increases: Starwell has also engaged various payers in the market in discussions on increased reimbursement given the relative resource intensity of the program. The state’s Medicaid program has agreed to increase the visit rates for patients receiving home health care during the Covid-19 pandemic.

Beyond the pilot, Starwell expects to expand the program to other patients presenting in the ED or those discharge early from the hospital. They hope to continue with the program even after the pandemic slows down.

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