Emplify Health has successfully transitioned its first 12 patients through a partnership with Homecare Hub, marking a significant advancement in addressing a critical gap in post-hospital care. The collaboration centers on Transitional Placement Services (TPS), an innovative model designed for patients who are medically ready for discharge but face barriers due to complex needs that cannot be met in their current living environments.
The TPS model provides an intermediate care option for patients with multiple chronic conditions, specialized medical equipment requirements, or ongoing therapy needs. This approach is particularly crucial as healthcare systems face the demographic challenge of the "silver tsunami" - the aging baby boom generation creating increased demand for specialized care services. "This innovative model ensures patients receive the high-quality care they need in a timely manner, and it provides our staff with tools and support to manage increasingly complex patient needs," said Emplify Health CEO Scott Rathgaber, MD.
Homecare Hub's technology platform, accessible at https://homecarehub.com, streamlines care coordination by connecting patients with vetted care and housing options while providing wraparound support services. The process begins with interdisciplinary evaluation of hospitalized patients, followed by matching them to appropriate transitional small homes in Homecare Hub's curated network. The platform then works to identify and remove barriers to eventual discharge to permanent settings.
The initial implementation at an Adult Family Home in Tomah, Wisconsin, has already demonstrated significant impact. In its first week, the TPS home surpassed one-month milestones and began providing immediate return on investment for the health system. Despite serving a complex population with many Medicaid patients, the home has maintained a readmission rate in single digits - well below national averages. This success follows positive outcomes from Homecare Hub's partnership with Froedtert ThedaCare Health System in Milwaukee, data from which was recently presented at the Wisconsin Hospital Association's Post Acute Seminar.
"Rarely in healthcare do solutions benefit all stakeholders, but here we are pleased that the solution is a win for patients, health systems, providers and payers," said Homecare Hub CEO Vipan Nikore, MD. The model reduces the burden on hospital staff by freeing acute care beds for those who truly need them while ensuring complex patients receive appropriate care in suitable environments.
The partnership addresses a growing crisis in healthcare where decreasing availability of long-term care beds combines with unique patient care needs that exceed current post-acute care capabilities. This shortage has placed immense burden on hospitals, contributing to poor patient experiences and financial losses. The TPS model is expected to help Emplify Health prevent hundreds of hours in avoidable patient days and result in significant savings.
Emplify Health and Homecare Hub plan to expand the program, with additional homes planned for La Crosse and throughout the region based on demand and patient outcomes. Emplify Health by Bellin is also working to establish a TPS site in Green Bay, which would be the first in Northeast Wisconsin. The innovation investment team behind the TPS concept, Edge, which can be explored at https://ghsedge.com, played a crucial role in developing and vetting the model through operational review of data.
Homecare Hub's national impact is further evidenced by their recent award of a nationwide SBIR grant from the National Institutes of Health/National Institute on Aging to research outcomes of small homes across the country. This research will contribute valuable data to the growing field of transitional care solutions as healthcare systems nationwide grapple with similar challenges of aging populations and care coordination gaps.
