Emplify Health has transitioned its first 12 patients to supportive housing and care through its partnership with Homecare Hub, marking a milestone in addressing a critical gap in post-discharge care. The collaboration, announced in 2025, centers on a model called Transitional Placement Services (TPS), developed within Emplify Health's innovation investment team, Edge. TPS provides an intermediate care option for patients with complex needs who face barriers to hospital discharge, such as multiple chronic conditions, need for specialized equipment, or ongoing therapy.
The initial TPS site is in Tomah, Wisconsin, operated by Blackberry Hill, making it the first in western Wisconsin. Emplify Health by Bellin is planning a site in Green Bay, which would be the first in the state's northeast region. Homecare Hub CEO Vipan Nikore, MD, noted that the program offers a personalized environment in small homes, benefiting patients, health systems, providers, and payers.
The TPS process begins with an interdisciplinary evaluation of hospitalized patients ready for discharge but unable to return home due to care needs exceeding available support. Homecare Hub's technology platform connects patients with vetted small homes and provides wraparound services. The model aims to identify and remove barriers to discharge, ensuring timely transitions to appropriate settings.
In its first week, the TPS home surpassed one-month milestones, providing immediate return on investment. The model has reduced hospital readmissions, with only one readmission among complex patients, putting the rate in single digits—well below the national average. Emplify Health CEO Scott Rathgaber, MD, emphasized that the partnership addresses the challenges of the 'silver tsunami'—the aging baby boom generation—which has increased demand for healthcare services.
The partnership also alleviates hospital burden by improving discharge efficiency and reducing avoidable patient days. Homecare Hub, which has a network of nearly 100 small homes, has already achieved success with Froedtert ThedaCare Health System in Milwaukee, presenting positive outcomes at the Wisconsin Hospital Association's Post Acute Seminar. The company also received an SBIR grant from the NIH/National Institute on Aging to research small home outcomes.
Mandi Pericak, Clinical Operations Director for Post-Acute Care at Emplify Health by Gundersen, highlighted that the TPS model provides a safe placement option for patients with diverse needs, such as dementia or substance abuse history, while freeing hospital beds for acute care. The partnership is expected to expand to La Crosse and other regions based on demand and outcomes.
