Case Study

How an Enhanced Home Health Program Creates Hospital Capacity

    How UNC discharges patients from the ED to their Enhanced home health program


    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 (pseudonym) 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.

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