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Emplify Health has transitioned its first 12 patients to supportive housing and care through its Homecare Hub partnership, marking a major milestone in efforts to address a critical gap in care that can occur once patients leave the hospital.

In 2025, Emplify Health announced its partnership with Homecare Hub, a home care and housing coordination platform focused on creating high-quality small-care homes. Emplify Health’s post-acute care team and Edge, the health system’s innovation investment team, both partnered with and led Homecare Hub’s investment to improve patient care and outcomes through an integrated technology portfolio.

The partnership centers around an innovative model called Transitional Placement Services (TPS), which was concepted within Edge, vetted through operations after review of data and targets a critical gap in patient care, while supporting a growing aging population. TPS is a comprehensive approach designed to ensure that patients with complex needs who face barriers to hospital discharge have an additional intermediate option to receive the appropriate care necessary before returning home or transitioning to a long-term care environment. This model is particularly crucial for patients who have multiple chronic conditions, require specialized medical equipment or need ongoing therapy and monitoring.

“As a hospitalist, I’m thrilled we can provide a new post-acute option that offers the personalized environment of small homes, which is often exactly what is needed for patients post-discharge. The program is not just about discharging patients to any open bed, but rather a bed that will allow individuals to heal and receive outstanding care with enhanced support,” said Homecare Hub CEO Vipan Nikore, MD. “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.”

Emplify Health by Gundersen’s initial residential Homecare Hub site is an existing Adult Family Home in Tomah, run by Blackberry Hill, making it the first TPS site in Western Wisconsin. Emplify Health by Bellin is working on standing up a TPS site in Green Bay, which would be the first in the Northeast Region of the state.

“This innovative partnership represents a significant leap forward in coordinated patient care,” said Emplify Health CEO Scott Rathgaber, MD. “By implementing TPS, we are addressing a critical gap that has long plagued healthcare, especially as we face the challenges of the so-called ‘silver tsunami’ — a major demographic shift marked by the aging of the baby boom generation. 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.”

How the TPS model works

Homecare Hub's technology platform streamlines care coordination by connecting patients with a network of vetted care and housing options, and they also support with wraparound care services, ensuring high-quality, consistent care. With deep clinical expertise, Homecare Hub has a particular focus on serving complex patients.

The TPS process begins with a thorough interdisciplinary evaluation of a hospitalized patient who is ready for discharge but unable to be discharged due to care needs that have exceeded the available care and support in their current living environment. This evaluation helps determine the most appropriate care setting for each patient, and if appropriate, a referral is sent to Homecare Hub to match the patient to the most appropriate transitional small home in their curated network. Next, Homecare Hub collaborates with the patient and community supports to identify the next most suitable care setting — whether that be another small home, a traditional care and housing environment, or back home with in-home care supports. Homecare Hub identifies barriers to discharge and creatively removes them to allow patients to be discharged from the transitional space in a timely manner.

Implementation and expansion

The partnership's initial implementation in Tomah provides a seamless transition for patients who still require clinical care, have psychosocial needs, and whose previous living environment cannot meet those requirements for a safe transition. Emplify Health and Homecare Hub plan to expand and create more homes in La Crosse and throughout the region based on demand and patient outcomes.

“Our patients have a wide variety of clinical and social needs, and it is our job to find them the safest, healthiest placement possible,” said Mandi Pericak, Emplify Health by Gundersen Clinical Operations Director for Post-Acute Care. “Whether it’s dementia, a history of substance abuse or difficulty with daily basic tasks, the TPS model gives us another avenue for safe and effective placement when these patients are ready. It also helps us ensure our hospital beds are available for those who truly need them, allowing us to provide the right care in the right setting at the right time.”

Impact and benefits

In its first week, the TPS home surpassed its one-month milestones and began providing an immediate return on investment for the health system. By leveraging Homecare Hub's network of close to 100 small homes across multiple regions, Homecare Hub’s wraparound support services, and Emplify Health's clinical expertise, the partnership delivers enhanced patient care with smoother transitions and reduced readmissions. The TPS model reduces the burden on hospital staff, allowing them to focus on acute care, while optimizing resources and improving discharge efficiency. The initial implementation is expected to help Emplify Health prevent hundreds of hours in avoidable patient days and result in significant savings. Despite caring for a complex population with a large number of Medicaid patients, the Homecare Hub TPS home has had only one readmission, putting its readmission rate in the single digits, well below the national average.

The “silver tsunami” demographic shift has created a surge in older adults requiring healthcare services. This is compounded by decreasing availability of long-term care beds and unique patient care needs that require a care transition that is outside of what the current post-acute care landscape can manage. This shortage has placed immense burden on hospitals, contributing to poor patient experiences and financial losses.

Homecare Hub has already achieved success with its partnership with the Froedtert ThedaCare Health System in Milwaukee, with positive outcomes data recently presented at the Wisconsin Hospital Association’s Post Acute Seminar. Homecare Hub also recently was awarded a nationwide SBIR grant from the National institute of Health / National Institute for Aging to help research the outcomes of small homes across the country.

“Our partnership with Homecare Hub represents a new era in post-acute patient care, offering a practical solution to one of healthcare’s most pressing challenges,” Rathgaber said. “We are proud to mark this milestone and we look forward to continued growth.”

About Emplify Health

Emplify Health is a not-for-profit, patient-centered, community-focused healthcare network with headquarters in Green Bay and La Crosse, Wisconsin. Emplify Health has 16,000 employees, including more than 1,000 clinicians, in 11 hospitals and more than 100 clinic locations in Wisconsin, Minnesota, Upper Michigan, and Iowa. With community partners, Emplify Health strives to lead local, regional and national healthcare transformation to enrich individuals for their healthiest lives at every stage. Learn more at emplifyhealth.org.

About Homecare Hub

Homecare Hub was created to help expedite discharges from hospitals and to address the housing and home care needs of individuals by offering exceptional housing with more personalized, higher-quality care at a lower cost when compared to large nursing homes or retirement facilities. Homecare Hub does this by creating small, high quality shared care homes of 2-15 people on-demand at an affordable price by matching people by care needs, language, disease process, and interests. For more information on Homecare Hub, visit homecarehub.com.

About Edge

The Edge mission is to radically transform the future of healthcare through innovation. Fueled by internal and community ideas, energized by other disruptors, and funded by our corporate ventures, we will harness the power of entrepreneurship, creativity, open-mindedness, and curiosity. Together we'll inspire, build, and distinguish ourselves by sharing healthcare innovations to benefit our organization, our community and our world. Learn more at ghsedge.com.

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Family Friendly Workplaces is pleased to announce that Emplify Health has earned a gold-level certification as a Family Friendly Workplace, recognizing the organization’s strong commitment to employee well-being and life balance.

“At Emplify Health, we recognize that supporting a healthy life balance is critical to our employees’ well-being and long-term success,” said Scott Rathgaber, MD, CEO of Emplify Health. “This certification reinforces our commitment to fostering a workplace where our team can thrive both professionally and personally. When our employees feel supported, our entire
community is stronger.”

Emplify Health earned this certification following a comprehensive evaluation of its workplace policies, including flexible work options, parental leave, healthcare benefits, and family-centered support programs. As a certified employer, Emplify Health is now entitled to use the Family Friendly Workplaces logo in its talent attraction and retention efforts and gains access to
additional program benefits.

As a Certified Family Friendly Workplace, Emplify Health also makes an annual conduit contribution to a nonprofit organization that supports families. This year, they selected The Parenting Place in La Crosse and Encompass Early Education and Care in Green Bay.

To honor this achievement, Family Friendly Workplaces hosted simultaneous news conferences in La Crosse and Green Bay. Wisconsin Governor Tony Evers attended the La Crosse event and delivered remarks recognizing Emplify Health’s leadership and commitment to families. A news conference, including Green Bay Mayor Eric Genrich, was held in Green Bay to celebrate the certification.

In our conversations, Emplify Health was quick to recognize that supporting families not only strengthens their organization — it’s also simply the right thing to do,” said Neil Kline, Executive Director of Family Friendly Workplaces. “Emplify Health is the largest employer to be certified as a Family Friendly Workplace, and we are thrilled that they are leading the way for employers
across Wisconsin. With Emplify Health in the family, 71 employers across Wisconsin have been certified, covering over 24,000 employees and their families.

Wisconsin’s long-term workforce shortage threatens the state’s economic vibrancy in the years ahead. From now through 2050, Wisconsin’s workforce is expected to shrink before stagnating. This long-term human resources shortage requires a strategic response.

Emplify Health is the latest employer to join this effort to address our workforce shortage,” said Kline. “They were quick to recognize the importance of strategically engaging with this challenge, and of securing Wisconsin’s future economic vibrancy.

For more information about Family Friendly Workplaces and its certification program, visit familyfriendlyworkplaces.org.

About Emplify Health

Emplify Health is a not-for-profit, patient-centered, community-focused healthcare network with headquarters in Green Bay and La Crosse, Wisconsin. Emplify Health has 16,000 employees, including more than 1,500 clinicians, in 11 hospitals and more than 100 clinic locations in Wisconsin, Minnesota, Upper Michigan, and Iowa. With community partners, Emplify Health strives to lead (with love) local, regional and national healthcare transformation to inspire people’s best lives at every stage. Learn what we are becoming at emplifyhealth.org.

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As healthcare rapidly changes and our population ages, the need for innovative solutions to address the growing challenges of their care has never been more pressing. 

Emplify Health, a leading not-for-profit regional health system with 11 hospitals and over 100 clinics in Wisconsin, Minnesota, Michigan, and Iowa, and Homecare Hub, a cutting-edge home care & housing coordination platform focused on the on-demand creation of high quality small-care homes, are joining forces to revolutionize the way patients transition from hospitals and other acute care settings to the community. 

Emplify Health’s exceptional acute care team and Edge, Emplify Health’s innovation investment team, are powering the Homecare Hub investment to improve patient care and outcomes through an integrated technology portfolio.  This partnership set to launch in fall 2025 is centered around an innovative model called Transitional Placement Services (TPS), which was concepted within Edge and targets a critical gap in patient care, while supporting the "silver tsunami" of aging populations.

"Emplify Health's partnership with Homecare Hub represents a significant leap forward in coordinated patient care. By implementing TPS, we are addressing a critical gap that has long plagued healthcare, especially as we face the challenges of the 'silver tsunami.' This innovative model ensures that 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. We are proud to be at the forefront of this change, and we believe it will make a meaningful difference in the lives of both our patients and our dedicated healthcare professionals,” shares Andrea Hauser, RN, Vice President of Acute Care and Nursing Practice and Chief Nursing Officer for Emplify Health’s Gundersen Region.

“Solving the post-acute care crisis is highly complex and requires not only a creative solution, which we have been crafting for years, but also innovative health systems willing to work through the complexity to implement the solution and disrupt the status quo. Homecare Hub is thrilled to work with the Emplify Health team to implement the model and further expand across the Midwest. Emplify Health has a tradition of innovation, and their commitment is yet another example of their forward thinking” states Vipan Nikore, MD, CEO of Homecare Hub and a former IBM software developer turned internal medicine physician, who has spent his career discharging patients from hospitals.

The Silver Tsunami and the Healthcare Crisis 

The Need for Transitional Placement Services (TPS) 

How TPS Works 

Homecare Hub's advanced technology platform plays a pivotal role in this process. It streamlines the coordination of care by connecting patients with a network of vetted care & housing options and home care providers, ensuring that patients receive high-quality, consistent care. The platform also provides real-time updates and communication tools, allowing the Homecare Hub TPS team to monitor the patient's progress and adjust the Post Acute care plan as needed.

The Initial Launch of TPS in La Crosse 

The designated TPS home in La Crosse is designed to provide a seamless transition for patients who have been discharged from the hospital but still require intensive care, social support, or simply do not have their discharge needs met. Homecare Hub will manage all aspects of patient care, from daily medical needs to social and emotional support, ensuring that patients are well-prepared for their return home.  

The formal launch of the TPS model is scheduled for fall 2025. Emplify Health and Homecare Hub have been working diligently in preparation, and the launch will mark a significant milestone in the healthcare industry, demonstrating the power of collaboration and innovation in addressing complex patient needs.

Benefits of the Partnership 

Enhanced Patient Care: By leveraging Homecare Hub's technology platform and their experience overseeing a network of close to 100 small homes in multiple regions in Wisconsin and beyond, and Emplify Health's deep clinical expertise, patients will receive more personalized and efficient care. This ensures that patients have a smoother transition from the hospital to their next care setting and reduces the risk of readmissions. 

Reduced Burden on Hospital Staff: Hospital staff, including clinicians, nurses, and social workers, will benefit from the TPS model as it offloads the responsibility of long-term care placement. This allows them to focus on providing acute care and improving patient outcomes. 

Increased Hospital Throughput & Cost Efficiency: By optimizing the use of resources, discharging patients in a timelier manner, and minimizing unnecessary hospital readmissions, the partnership aims to lower overall healthcare costs and free up hospital beds for patients requiring inpatient care. Just the initial pilot program in La Crosse is expected to help Emplify Health prevent hundreds of hours in avoidable patient stay time and save hundreds of thousands of dollars which can be put towards patient care.  

Scalability and Replicability: The TPS model has enormous potential to scale and replicate and the ability to serve as an exemplary model for the country’s health system. Emplify Health and Homecare Hub are committed to sharing their findings and best practices with the broader healthcare industry, paving the way for a more coordinated and effective approach to post-acute care for other health systems.

Bright Future for Post-Acute Care 

The tightly integrated partnership between Emplify Health and Homecare Hub represents a new era in post-acute patient care. By combining their strengths and expertise, they are creating a unique model built on the power of small homes that not only improves patient outcomes but also supports the healthcare professionals who are on the front lines of care. As the "silver tsunami" continues to reshape the healthcare landscape, the TPS model offers a beacon of hope and a practical solution to one of the most pressing challenges in the industry.

About Emplify Health

About Homecare Hub

About Edge

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