One Patient. One Coordinated Plan. One Connected Continuum of Care.

Traditional healthcare is often organized around institutions, departments, specialties, and individual episodes of care.

Hospitals Without Walls™ begins with the patient.

We seek to understand:

• What conditions does the patient have?
• What risks require attention?
• How does the patient function?
• What matters most to the patient?
• Which professionals and services are already involved?
• Where are the gaps?
• What barriers interfere with care?
• Who is responsible for each necessary action?
• How will important information be communicated?
• How will progress and outcomes be measured?

The answers form the basis of an individualized, coordinated plan.

The Right Care, From the Right Qualified Professional, in the Right Setting, at the Right Time

This principle guides every part of our model.

Services must respond to the patient's actual condition, risks, goals, and authorized needs.

Each service must be provided by a person or organization that is appropriately qualified, licensed, certified, credentialed, enrolled, or otherwise authorized.

Care may be delivered in a hospital, medical office, facility, home, community location, or virtual environment according to medical necessity, safety, authorization, availability, and applicable law.

Routine needs should be addressed promptly, material changes should be communicated appropriately, and emergencies should be escalated immediately.

A patient may enter an authorized Hospitals Without Walls™ program through an approved pathway established by the applicable organization or contract.

Potential sources may include:

• Hospitals and health systems
• Physicians and medical practices
• Health plans
• Government programs
• Military or veterans' healthcare organizations
• Skilled nursing and post acute facilities
• Assisted living or senior communities
• Home health organizations
• Employers or commercial programs
• Patients or authorized representatives, when permitted

Every referral must be handled according to applicable consent, privacy, eligibility, contracting, and payer requirements.

A referral is not a guarantee of acceptance, coverage, or service.

Before enrollment or service initiation, the responsible organization determines whether the patient meets the requirements of the applicable program.

The review may consider:

• Clinical condition
• Medical necessity
• Patient safety
• Geographic location
• Service availability
• Payer eligibility
• Required authorization
• Patient consent
• Home or residential environment
• Caregiver availability
• Technology requirements
• Professional capacity
• Applicable laws and regulations

Patients whose needs exceed the capabilities of the program must be referred to an appropriate level or source of care.

The patient or legally authorized representative should receive understandable information about:

• The nature of the program
• Available services
• The organizations involved
• Expected responsibilities
• Potential benefits
• Material risks and limitations
• Reasonable alternatives
• Privacy and information sharing
• Financial obligations, when applicable
• How to ask questions or make complaints
• How to decline or withdraw from voluntary services

Consent must be obtained and documented as required.

Participation in a Hospitals Without Walls™ program does not eliminate the patient's right to seek emergency care, another professional opinion, or other legally available healthcare services.

Before a routine comprehensive assessment proceeds, urgent concerns must be identified.

The responsible qualified professional should evaluate whether the patient may require:

• Emergency medical services
• Emergency department evaluation
• Hospital admission
• Urgent physician assessment
• Immediate medication related intervention
• Protective services
• Crisis mental health evaluation
• Another higher-acuity service

The program is not intended to keep a patient at home or in a lower acuity setting when that setting is unsafe or clinically inappropriate.

The patient is assessed according to the scope and purpose of the applicable program.

Relevant areas may include:

• Current diagnoses
• Symptoms
• Recent hospitalizations
• Medical history
• Treatment plan
• Clinical risks
• Preventive care needs
• Medication Related
• Current medications
• Allergies
• Medication discrepancies
• Adherence barriers
• Potential adverse effects
• Duplicate therapies
• Need for prescriber or pharmacist review

Medication changes may be ordered only by professionals with appropriate legal authority.

• Mobility
• Transfers
• Balance
• Falls
• Activities of daily living
• Instrumental activities of daily living
• Assistive devices
• Rehabilitation needs

• Memory
• Orientation
• Judgment
• Decision-making
• Ability to understand and follow instructions
• Need for further evaluation

• Mood
• Anxiety
• Coping
• Grief
• Behavioral concerns
• Substance related concerns
• Risk of harm
• Need for qualified behavioral health evaluation

• Living arrangement
• Family and caregiver support
• Transportation
• Food access
• Housing stability
• Financial or practical barriers
• Social isolation
• Community resources

• Home accessibility
• Fall hazards
• Sanitation
• Utilities
• Equipment
• Medication storage
• Emergency planning
• Other safety concerns

• Symptom burden
• Pain
• Serious illness concerns
• Quality of life
• Patient goals
• Caregiver needs
• Advance care planning preferences

• Language and communication needs
• Cultural preferences
• Personal values
• Religious or spiritual concerns, when desired
• Sources of meaning, hope, and support

Not every patient requires every component. Assessment must be individualized and performed by appropriately qualified personnel.

Assessment findings are organized according to urgency, importance, and responsibility.

Potential categories include:

Conditions requiring emergency or same day action.

Concerns requiring prompt professional evaluation or intervention.

Conditions requiring scheduled treatment, monitoring, or follow-up.

Mobility, fall, rehabilitation, equipment, or environmental concerns.

Barriers that may interfere with care, safety, or the patient's ability to remain in the preferred setting.

Issues that should be addressed as part of continuing health maintenance and care planning.

Risk identification does not establish a diagnosis unless the assessment is performed by a professional authorized to make that diagnosis.

An individualized care plan is developed using the assessment findings, professional recommendations, patient goals, payer requirements, and available resources.

The plan may identify:

• Patient goals
• Clinical priorities
• Responsible professionals
• Authorized services
• Medication-related actions
• Monitoring requirements
• Follow up schedule
• Patient and caregiver education
• Rehabilitation needs
• Home safety interventions
• Community-resource referrals
• Communication procedures
• Escalation instructions
• Reassessment intervals
• Expected outcomes
• Quality measures

The plan should be understandable, actionable, and updated when material circumstances change.

Every material action should have an identified responsible party.

The care plan should distinguish among:

• The treating physician or authorized prescriber
• Other licensed clinicians
• Care coordinators
• Participating healthcare organizations
• Home health or community providers
• Rehabilitation professionals
• Pharmacies and diagnostic providers
• Patients
• Authorized family members or caregivers
• Health plans or contracting organizations

Coordination does not eliminate individual accountability.

Each participant remains responsible for performing assigned duties within the limits of applicable law, professional authority, organizational policy, and written agreements.

Authorized services may be delivered or arranged according to the individual care plan.

Depending on the program, services may include:

• Physician or advanced-practice professional services
• Nursing services
• Palliative or supportive care
• Transitional care support
• Chronic disease management
• Medication review
• Rehabilitation
• Behavioral health services
• Social work services
• Mobile health services
• Telehealth
• Remote patient monitoring
• Laboratory or diagnostic services
• Home health
• Medical equipment
• Caregiver education
• Community resource connection

Availability varies by location, contract, provider capacity, clinical need, payer authorization, and applicable law.

Authorized participants require timely, relevant, and accurate information.

Communication procedures may include:

• Referral documentation
• Assessment findings
• Care plans
• Medication information
• Clinical updates
• Transition summaries
• Alerts regarding material changes
• Orders and treatment instructions
• Follow up status
• Referral completion
• Escalation reports
• Quality and outcomes reporting

Information must be shared only as permitted by applicable privacy, confidentiality, security, consent, and contractual requirements.

Technology may support communication, but it does not replace professional responsibility to review and act upon information appropriately.

The care plan is not a one-time document.

Depending on the patient's needs and program design, follow up may include:

• Scheduled clinical reassessment
• Symptom review
• Medication review
• Functional reassessment
• Monitoring of defined health indicators
• Review of service completion
• Patient and caregiver communication
• Evaluation of barriers
• Review after a transition or acute event
• Confirmation of referrals and appointments
• Revision of goals and interventions

Monitoring frequency must be based on clinical need, professional judgment, contractual requirements, and available services.

Monitoring does not guarantee that every change in condition will be detected or prevented.

When a material concern is identified, the responsible participant follows the applicable escalation pathway.

Possible actions may include:

• Patient or caregiver instruction
• Notification of the treating clinician
• Same-day clinical evaluation
• Urgent care referral
• Emergency medical services
• Emergency department referral
• Hospital admission
• Specialist consultation
• Medication review
• Protective services referral
• Behavioral health crisis intervention

Hospitals Without Walls™ does not define success as keeping every patient outside the hospital.

Success means helping the patient receive the clinically appropriate level of care including hospitalization when necessary.

A care plan should be reconsidered when:

• The patient's condition changes
• A hospitalization or emergency visit occurs
• New diagnoses are identified
• Medications change
• Function improves or declines
• A caregiver becomes unavailable
• The living environment changes
• Patient goals or preferences change
• Services are ineffective or unavailable
• A transition of care occurs
• A scheduled reassessment is due

Reassessment allows the care plan to remain relevant to the patient's current circumstances.

A patient may transition from or complete a particular program when:

• Program goals are achieved
• The defined episode ends
• Another provider or setting assumes responsibility
• The patient no longer meets eligibility requirements
• The patient moves outside the service area
• Services are no longer clinically appropriate
• The patient or authorized representative elects to withdraw
• Required authorization ends
• Safety needs cannot be met by the program
• Continued participation is otherwise unavailable or impermissible

Transitions and discharges should be planned and communicated appropriately whenever circumstances permit.

Patients should receive information about continuing needs, follow up, medications, warning signs, responsible professionals, and available alternatives.

Depending on the patient and program, participating professionals may include:

• Physicians
• Advanced practice professionals
• Registered nurses
• Licensed vocational or practical nurses
• Pharmacists
• Physical therapists
• Occupational therapists
• Speech language pathologists
• Medical social workers
• Behavioral health professionals
• Palliative care professionals
• Dietitians
• Care coordinators
• Community health workers
• Other qualified personnel

The patient and authorized family members or caregivers are essential participants.

Not every professional is involved in every case. Participation must be based on need, authorization, availability, and legal scope.

Patients are encouraged to:

• Share their goals and preferences
• Provide accurate health and medication information
• Ask questions
• Report meaningful changes
• Participate in agreed follow up
• Explain barriers affecting the plan
• Identify authorized caregivers or representatives
• Express cultural, communication, or spiritual preferences
• Raise safety or quality concerns
• Make informed decisions about offered services

Patients may decline recommended care, subject to applicable law and the consequences of that decision. Qualified professionals should explain material risks and alternatives when a patient declines important care.

Authorized family members and caregivers may help with:

• Observing changes
• Communicating concerns
• Medication organization
• Appointment coordination
• Transportation
• Nutrition
• Mobility and safety
• Daily activities
• Emotional support
• Following emergency instructions
• Participating in care planning

The model should also assess whether caregivers have the information, ability, resources, and willingness required to perform an expected role.

Family involvement is not assumed. It must respect patient authorization, privacy, legal decision-making authority, and caregiver capacity.

Technology may support:

• Telehealth
• Remote patient monitoring
• Secure communication
• Electronic care plans
• Clinical documentation
• Medication information
• Patient and caregiver education
• Referral tracking
• Appointment coordination
• Alerts
• Outcomes reporting
• Population health analysis

Technology must be implemented with appropriate privacy, security, accessibility, reliability, and clinical response procedures.

A device or alert is not a substitute for emergency services. Patients must receive clear instructions regarding whom to contact when symptoms or urgent concerns arise.

A contracted program may monitor:

• Access to services
• Timeliness
• Care plan completion
• Medication reconciliation
• Transition follow-up
• Referral completion
• Adverse events
• Falls
• Emergency department utilization
• Hospital admissions
• Readmissions
• Functional outcomes
• Symptom burden
• Patient experience
• Caregiver experience
• Complaints and grievances
• Documentation quality
• Privacy or security incidents
• Program cost
• Total cost of care, when reliable data are available

Measures must be defined according to the population, contract, data source, reporting period, and intended use.

An outcome should not be attributed to the program without an appropriate analytical basis.

Hospitals Without Walls™ does not impose one identical program on every organization.

A partner-specific model may be developed through:

Identify the population, needs, risks, utilization patterns, and existing resources.

Determine where fragmentation, access barriers, unmet needs, or unnecessary duplication may exist.

Define services, eligibility, workflows, responsibilities, geographic scope, staffing, technology, and escalation pathways.

Evaluate applicable licensure, consent, privacy, contracting, payer, billing, coding, referral, and regulatory requirements.

Establish baseline data, performance indicators, reporting methods, targets, and limitations.

Document responsibilities, services, financial terms, data requirements, quality standards, and governance.

Train participants, activate workflows, test communication pathways, and begin services according to the approved plan.

Review quality, safety, utilization, experience, financial performance, and operational findings. Modify the program through the agreed governance process when appropriate.

Depending on the population and program, intended objectives may include:

• Better continuity across care settings
• More complete assessment of patient needs
• Stronger patient and caregiver engagement
• Improved communication
• Earlier recognition of meaningful changes
• Better supported transitions
• Improved access to appropriate services
• Reduced duplication
• More appropriate use of healthcare settings
• Improved quality and patient experience
• Responsible management of healthcare resources

These are program objectives—not guaranteed results.

Actual performance must be measured using valid data and an agreed methodology.

Hospitals Without Walls™ does not:

• Guarantee that every hospitalization will be prevented
• Replace emergency medical services
• Keep patients at home when hospital care is necessary
• Replace the treating clinician's judgment
• Authorize unlicensed practice
• Guarantee insurance coverage
• Guarantee cost savings
• Make every service available in every location
• Eliminate the responsibilities of participating organizations
• Permit unrestricted sharing of protected information
• Substitute website information for individualized medical care

Hospitals Without Walls™ works with hospitals, health plans, government agencies, military and veterans' healthcare organizations, employers, facilities, physician groups, and community healthcare organizations.

Tell us whom you serve, what challenges you need to address, and which outcomes matter to your organization.

Hospitals Without Walls™ is an independent healthcare-delivery and collaboration model. Its name does not, by itself, represent a licensed or Medicare-certified hospital, participation in a government hospital at home program, or authorization to provide any particular healthcare service.

Services are available only through appropriately authorized professionals and organizations and depend on individual need, eligibility, location, payer authorization, contractual scope, operational capacity, and applicable law.

This page describes a general care model. It does not promise enrollment, coverage, treatment, financial savings, or a particular clinical outcome.

If you believe you are experiencing a medical emergency, call 911.

Quality and safety are integral to the Hospitals Without Walls™ model.

Care coordination is not complete merely because services have been arranged. Participating organizations should have appropriate processes to evaluate whether authorized services are being delivered safely, timely, effectively, and consistently with the patient's individualized plan of care.

Depending on the program, contract, patient population, and services involved, quality oversight may monitor:

• Access to services
• Timeliness of care
• Care plan completion and implementation
• Medication reconciliation
• Transition of care follow-up
• Referral completion
• Missed or delayed services
• Adverse events
• Falls and fall related injuries
• Emergency department utilization
• Hospital admissions
• Hospital readmissions
• Functional outcomes
• Symptom burden
• Patient experience
• Caregiver experience
• Complaints and grievances
• Patient safety concerns
• Changes in condition
• Service interruptions
• Documentation completeness and timeliness
• Communication and escalation performance
• Compliance with applicable program requirements
• Other clinically or contractually relevant quality measures

The specific measures used should be appropriate to the population, services, contractual obligations, and objectives of the applicable program.

Measurement alone is not sufficient. Information should be reviewed and, when appropriate, used to identify opportunities for corrective action, education, process improvement, or changes in care delivery.

Patient safety requires active attention throughout the care continuum.

Participating organizations and qualified professionals should maintain processes appropriate to their responsibilities for identifying, communicating, escalating, documenting, and responding to significant safety concerns.

Potential safety concerns may include:

• Significant changes in clinical condition
• Medication discrepancies or potential medication related harm
• Falls
• New or worsening cognitive impairment
• Behavioral health emergencies
• Risk of self harm or harm to others
• Suspected abuse, neglect, exploitation, or unsafe living conditions
• Inadequate caregiver support
• Unsafe mobility or transfer conditions
• Equipment failure
• Infection related concerns
• Failure or interruption of necessary services
• Inability to obtain necessary medications or treatment
• Communication failures affecting patient care
• Environmental hazards
• Other circumstances that may place the patient at significant risk

The appropriate response depends upon the nature and urgency of the concern, the professional authority of the person identifying it, and applicable organizational procedures.

When circumstances constitute or may constitute an emergency, emergency procedures should be followed without unnecessary delay.

Hospitals Without Walls™ is not intended to substitute routine monitoring, telehealth, remote patient monitoring, or care coordination for emergency medical services.

Hospitals Without Walls™ may coordinate multiple professionals and organizations, but coordination does not transfer professional responsibility from one participant to another.

Each participating healthcare professional remains responsible for:

• Practicing within applicable licensure and scope of practice requirements
• Maintaining required credentials
• Exercising appropriate professional judgment
• Following applicable standards of care
• Maintaining appropriate documentation
• Communicating significant findings
• Responding appropriately to changes in condition
• Following applicable laws, regulations, organizational policies, and contractual requirements
• Recognizing when a patient requires a different or higher level of care

Clinical decisions must be made by professionals legally authorized and appropriately qualified to make those decisions.

Administrative personnel, technology platforms, care coordinators, and organizational leadership may facilitate healthcare delivery, but they do not replace the independent professional responsibilities assigned by law to licensed healthcare professionals.

Participating organizations should maintain processes appropriate to their responsibilities for confirming that professionals providing regulated healthcare services possess required qualifications.

Depending upon the professional, service, jurisdiction, payer, and contract, this may include verification of:

• Professional licensure
• Certification
• Registration
• Education and training
• Professional experience
• Scope of practice
• Required background screening
• Professional liability coverage
• Payer enrollment
• Organizational credentialing
• Privileging, when applicable
• Required continuing education
• Other legally or contractually required qualifications

Credentialing requirements vary by profession, organization, jurisdiction, payer, and care setting.

Participation in a Hospitals Without Walls™ program does not independently authorize any person to perform a healthcare service that the person is not otherwise legally permitted and appropriately qualified to perform.

Accurate and timely documentation is fundamental to coordinated care.

Depending on the applicable program and professional responsibilities, documentation may include:

• Referral information
• Eligibility determinations
• Patient consent
• Assessments
• Diagnoses documented by authorized professionals
• Medication information
• Orders
• Individualized care plans
• Services provided
• Patient and caregiver education
• Changes in condition
• Communications among authorized participants
• Referrals
• Escalations
• Follow up activities
• Patient preferences
• Declined services
• Adverse events
• Transitions and discharge information
• Outcomes

Documentation should be sufficiently accurate, complete, timely, and accessible to authorized persons to support safe continuity of care.

Records must be created, maintained, retained, accessed, disclosed, and protected according to applicable legal, regulatory, contractual, privacy, and security requirements.

Fragmented communication can create significant patient risk.

The model therefore emphasizes clear procedures for communicating material information among authorized participants.

Depending on the circumstances, communication procedures should identify:

• What information must be communicated
• Who is responsible for communicating it
• Who must receive it
• The appropriate level of urgency
• The communication method
• Required documentation
• What action is expected
• What should occur if the intended recipient cannot be reached
• When escalation is required

Urgent clinical information should not depend solely upon passive electronic messaging when circumstances require more immediate communication.

Technology can transmit information. Responsibility remains with the appropriate people and organizations to review, communicate, escalate, and act upon information according to their respective duties.

Medication discrepancies may occur when patients move among hospitals, facilities, medical practices, pharmacies, and home settings.

When medication reconciliation or medication review is part of the applicable program, qualified personnel may help identify:

• Differences between medication lists
• Missing medications
• Duplicate therapies
• Potential adherence barriers
• Reported adverse effects
• Patient misunderstanding
• Access or affordability barriers
• Potential concerns requiring pharmacist or prescriber review

Potential medication concerns should be referred to the appropriately qualified professional.

Only professionals with applicable legal authority may prescribe, discontinue, or modify medications.

Patients should not be instructed to alter prescribed therapy solely on the basis of an administrative or non prescribing review.

Depending on program requirements, significant incidents and adverse events should be documented, communicated, reviewed, and addressed appropriately.

Events requiring review may include:

• Patient injury
• Serious falls
• Medication related events
• Unexpected deterioration
• Emergency transfers
• Hospitalization
• Significant delays in necessary care
• Equipment related events
• Privacy or security incidents
• Allegations of abuse, neglect, or exploitation
• Significant communication failures
• Serious complaints
• Other events defined by applicable organizational, contractual, regulatory, or accreditation requirements

The purpose of review is not merely to record what happened.

When appropriate, review should seek to determine:

• What occurred?
• Was the patient protected?
• Were required notifications completed?
• Were established procedures followed?
• Were there contributing system factors?
• Is corrective action necessary?
• Is additional education required?
• Should a process, policy, or care plan be changed?
• Could a similar event reasonably be prevented?

Serious events should be escalated to the appropriate clinical, administrative, regulatory, contractual, or legal authority when required.

Patients and authorized representatives should have an accessible process for raising concerns regarding care, service, communication, privacy, safety, or other aspects of participation in the applicable program.

Complaints and grievances should be handled according to applicable organizational, contractual, payer, accreditation, and regulatory requirements.

Appropriate processes may include:

• Receiving and documenting concerns
• Acknowledging the concern
• Determining urgency
• Protecting the patient when an immediate safety concern exists
• Routing the matter to the responsible person or organization
• Investigating when appropriate
• Communicating findings or resolution as required
• Documenting corrective action
• Identifying recurring patterns
• Protecting patients from inappropriate retaliation for raising legitimate concerns

Complaints can provide important information about failures that may not otherwise be visible through routine quality measurement.

Measure. Learn. Improve.

Hospitals Without Walls™ supports a continuous quality improvement approach.

Quality information may be evaluated at the individual-patient, provider, program, population, or organizational level, as appropriate.

The improvement process may include:

Collect meaningful and reliable information about care delivery and outcomes.

Recognize significant problems, variations, delays, gaps, risks, and opportunities for improvement.

Determine contributing factors rather than relying solely on assumptions.

Implement appropriate corrective or preventive interventions.

Determine whether the intervention produced the intended improvement.

When an improvement is demonstrated and appropriate, incorporate it into policies, procedures, training, workflows, technology, or contractual expectations.

Quality improvement should focus not only on individual performance but also on systems and processes that influence patient care.

The appropriate outcome measures depend upon the population and program.

Potential measures may include:

• Ability to obtain needed care
• Timeliness of services
• Completion of clinically indicated follow up
• Medication reconciliation
• Successful transitions of care
• Emergency department utilization
• Hospitalization
• Readmission
• Falls
• Functional status
• Symptom control
• Patient reported outcomes
• Patient experience
• Caregiver experience
• Referral completion
• Care plan goal attainment
• Service utilization
• Identified care gaps
• Resolution of identified barriers

These measures must be interpreted carefully.

Healthcare outcomes are influenced by numerous factors, including disease severity, comorbidities, socioeconomic circumstances, patient preferences, treatment adherence, caregiver availability, access to services, and events outside the control of any individual provider or program.

Hospitals Without Walls™ therefore does not assume that every hospitalization, emergency visit, adverse event, or unfavorable outcome is preventable.

The objective is to identify opportunities where better coordination, timely intervention, appropriate clinical care, or improved communication may reasonably improve outcomes.

Hospitals Without Walls™ may operate through relationships among independent healthcare professionals, healthcare organizations, contractors, vendors, community resources, health plans, government entities, or other authorized participants.

Responsibilities should be defined through applicable agreements, policies, care plans, scopes of work, and professional obligations.

Depending on the relationship, oversight may address:

• Required qualifications
• Scope of contracted services
• Performance expectations
• Documentation
• Reporting
• Patient safety
• Privacy and security
• Quality measures
• Complaints
• Incident reporting
• Corrective action
• Contractual compliance

Hospitals Without Walls™ coordination does not make one independent organization automatically responsible for the professional acts, omissions, regulatory obligations, or legal duties of another.

Each organization remains responsible for its own personnel, services, professional obligations, regulatory compliance, and contractual responsibilities except to the extent otherwise established by applicable law or written agreement.

When a significant quality, safety, compliance, or performance problem is substantiated, appropriate action should be considered.

Depending upon the circumstances and the authority of the responsible organization, actions may include:

• Immediate patient-protection measures
• Additional clinical review
• Education or retraining
• Increased supervision
• Process modification
• Care plan revision
• Documentation correction
• Technology or workflow modification
• Performance improvement planning
• Contractual remediation
• Referral to another provider
• Suspension or removal from a program when appropriate
• Reporting to appropriate authorities when legally required

Corrective action should be proportionate to the nature, severity, recurrence, and potential consequences of the identified problem.

Each Hospitals Without Walls™ program should have a defined governance and oversight structure appropriate to the services being provided.

The structure should identify responsibility for applicable areas such as:

• Program administration
• Clinical oversight
• Patient safety
• Quality improvement
• Professional credentialing
• Compliance
• Privacy and information security
• Incident review
• Complaints and grievances
• Contract performance
• Data and outcomes reporting
• Corrective action

Clinical authority must remain with appropriately licensed and authorized professionals where clinical judgment or professional practice is required.

Administrative governance should support not improperly interfere with—the lawful exercise of professional clinical judgment.

Hospitals Without Walls™ seeks to support care processes that are informed, when applicable, by credible clinical evidence, recognized professional standards, authoritative guidance, applicable regulatory requirements, and measurable program experience.

Policies and care processes should be reviewed as relevant evidence, technology, regulations, professional standards, and patient needs evolve.

No clinical guideline applies identically to every patient.

Qualified professionals must consider the individual patient's condition, risks, goals, preferences, contraindications, available alternatives, and applicable standard of care when making clinical decisions.

Coordinated. Accountable. Measurable. Patient-Centered.

The Hospitals Without Walls™ model is built around a straightforward objective:

Do not allow fragmentation of healthcare to become fragmentation of responsibility.

Every patient should have a coordinated pathway.

Every material need should have an appropriate response.

Every assigned responsibility should have an accountable party.

Every significant change should have an appropriate communication pathway.

Every preventable gap should become an opportunity for improvement.

And every decision should ultimately return to the central question:

What is the safest, most appropriate, legally authorized, and patient centered course of action for this individual patient?

That is the foundation of quality and safety within Hospitals Without Walls™.

Hospitals Without Walls™ is a healthcare delivery and coordination model that may be implemented through different affiliated or participating healthcare organizations, professionals, contractors, health plans, government entities, and other authorized organizations.

Specific services, professionals, technologies, eligibility requirements, geographic availability, coverage, payment arrangements, and clinical capabilities vary by program and contract.

Nothing on this page creates a physician patient relationship, guarantees eligibility or insurance coverage, guarantees a particular clinical or financial outcome, or substitutes for individualized medical evaluation.

Healthcare services must be provided by appropriately licensed, credentialed, certified, enrolled, or otherwise authorized professionals and organizations as required by applicable law.

If a patient is experiencing a medical emergency, call 911 or the applicable local emergency number or seek emergency medical care immediately.

Hospitals Without Walls™ brings the pieces of healthcare together around the person who matters most:

The patient.