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Optimized Home Health Network & Care Coordination
A data-driven initiative that strengthened the home health network by improving capacity, communication, and collaboration that ultimately ensured patients received timely, high-quality post-acute care.
Role: Manager Of Transition Care
At Highmark Health, capacity limitations within home health agencies were causing delays in patient discharges and inconsistent quality across transitions of care. I led an initiative to build a Narrow Home Health Network; a focused collaboration with high-performing agencies designed to improve efficiency, streamline referrals, and enhance patient outcomes.
The work began with a deep benchmarking and quality assessment process, evaluating agencies on key performance metrics like acceptance rates, response times, and overall care outcomes. From there, I implemented digital discharge planning tools to improve referral speed and communication between hospital and agency teams.
To promote transparency and shared learning, I established quarterly forums where home health partners could collaborate, align on best practices, and surface operational challenges. This initiative not only encouraged partnership but also led to broader adoption of CarePort, our digital referral platform, across agencies to support real-time tracking and reporting.
Impact: This initiative improved timely start-of-care rates, reduced discharge delays, and increased the percentage of patients placed within high-quality network agencies. It also laid the foundation for stronger data integration and ongoing collaboration across providers, helping ensure that every patient received coordinated, efficient, and compassionate care.
