Why We Save Money

An economic framework

Better Coordination Can Prevent Unnecessary Cost

Hospitals Without Walls™ is designed to reduce avoidable healthcare spending by identifying risk earlier, coordinating care across settings, strengthening transitions, addressing care gaps, and helping patients receive appropriate services before manageable problems become expensive crises.

We do not save money by withholding necessary care.

We seek to save money by reducing fragmentation, duplication, preventable deterioration, avoidable utilization, and failures in communication.

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Earlier identification of clinical risk

Reduced fragmentation across settings

Safer transitions after hospitalization

The Economic Problem

Fragmented Care Is Expensive Care

Patients with serious illness, multiple chronic conditions, frailty, functional limitations, or complex social needs frequently receive services from numerous professionals and organizations.

Their care may involve:

Hospitals
Emergency departments
Primary care practices
Medical specialists
Pharmacies
Laboratories
Imaging centers
Skilled nursing facilities
Home health agencies
Rehabilitation providers
Behavioral health professionals
Palliative care providers
Community organizations
Family and unpaid caregivers

When these participants operate without adequate coordination, the patient may experience:

Conflicting treatment plans
Medication discrepancies
Duplicated testing
Delayed follow-up
Missed appointments
Unanswered symptoms
Unclear responsibility
Poor transitions between settings
Unaddressed caregiver limitations
Repeated emergency department visits
Potentially avoidable hospitalizations
Unnecessary institutional care

Each failure may generate additional clinical risk and additional cost.

Hospitals Without Walls™ is designed to connect these separate activities around one coordinated patient centered plan.

Our Savings Principle

Reduce Waste and Preventable Escalation Not Necessary Care

The most expensive avoidable healthcare event is often the event that could have been prevented through earlier recognition, appropriate treatment, better communication, or timely support.

Not every adverse event or hospitalization is preventable. Necessary services should not be delayed or avoided merely to reduce spending.

Potential Savings

Savings may occur when the program helps:

Identify deterioration before a crisis
Resolve gaps in treatment
Improve medication management
Strengthen post-discharge follow-up
Coordinate care among multiple providers
Address barriers that interfere with the care plan
Use lower intensity settings when clinically appropriate
Prevent unnecessary duplication
Support patients and caregivers at home
Align treatment with informed patient goals
Connect patients with appropriate palliative or supportive services
Escalate care promptly when a higher level of care is truly necessary

How Our Model May Reduce Cost

Twelve Drivers of Coordinated Savings

Each of these areas represents a practical lever for reducing waste, improving quality, and preventing avoidable escalation.

01Earlier intervention

Earlier Identification of Clinical Risk

Patients often show warning signs before a major deterioration.

These may include:

Increasing shortness of breath
Sudden weight gain
New swelling
Changes in blood pressure or blood glucose
Worsening pain
Fever or signs of infection
Reduced food or fluid intake
New confusion
Medication problems
Increasing weakness
Falls or near falls
Changes in mobility
Caregiver exhaustion

When warning signs are identified and communicated promptly, qualified professionals may be able to intervene before the condition becomes more difficult and expensive to manage.

Earlier intervention does not guarantee prevention. It creates an opportunity for appropriate action.

02One view of the patient

Reduced Fragmentation

Fragmented care can cause several organizations to address separate parts of the patient's condition without anyone maintaining a complete view.

Hospitals Without Walls™ seeks to organize:

Diagnoses
Medications
Treatment plans
Symptoms
Functional needs
Behavioral and emotional needs
Social barriers
Caregiver capacity
Appointments
Referrals
Diagnostic results
Patient goals
Assigned responsibilities

A coordinated plan may reduce conflicting instructions, unnecessary repetition, overlooked needs, and delays caused by uncertainty about responsibility.

03High-risk window

Safer Transitions After Hospitalization

Hospital discharge is a high-risk transition.

Patients may return home with:

New diagnoses
Changed medications
Pending test results
New equipment
Functional limitations
Wound care needs
Dietary instructions
Follow up appointments
Warning signs requiring attention
Confusion about whom to contact

Our transitional-care approach may include:

Timely post discharge contact
Review of discharge instructions
Medication reconciliation
Symptom and functional assessment
Confirmation of appointments
Coordination of equipment and services
Patient and caregiver education
Communication with responsible clinicians
Escalation of unresolved concerns

Better transitions may reduce failures that contribute to avoidable emergency department visits and hospital readmissions.

04Reconciliation & review

Medication Management

Medication-related problems can result from:

Incomplete medication lists
Duplicate medications
Drug interactions
Incorrect dosing
Conflicting instructions
Side effects
Failure to obtain prescriptions
Cost barriers
Cognitive impairment
Difficulty opening or organizing medications
Multiple prescribing professionals
Changes made during hospitalization

Medication reconciliation and appropriate professional review may identify discrepancies and treatment-related risks before they cause harm or additional utilization.

Medication changes must be ordered or authorized by appropriately qualified professionals.

05Between encounters

Chronic-Disease Management

Chronic conditions can become expensive when they are addressed only during acute episodes.

Hospitals Without Walls™ may support longitudinal management of conditions such as:

Heart failure
Diabetes
Hypertension
Chronic obstructive pulmonary disease
Chronic kidney disease
Cardiovascular disease
Dementia
Neurologic disorders
Chronic wounds
Multiple chronic conditions

Depending on program design, support may include monitoring, education, medication review, nutrition guidance, appointment coordination, functional assessment, caregiver support, and communication with the patient's established healthcare professionals.

The purpose is to maintain continuity between major medical encounters and respond appropriately when the patient's condition changes.

06Right setting

Appropriate Use of Mobile and Virtual Care

Some healthcare needs require a hospital, emergency department, medical office, laboratory, or specialized facility.

Others may be addressed safely through:

Mobile clinical visits
Home based services
Telehealth
Remote patient monitoring
Community based care
Qualified home health services
Caregiver education
Structured follow-up

When clinically appropriate, providing care closer to the patient may reduce transportation burdens, missed appointments, delayed assessment, and unnecessary use of higher-cost settings.

Mobile and virtual care must never be used to delay necessary emergency, hospital, or in-person evaluation.

07Preserving independence

Fall and Functional-Decline Prevention

Falls, weakness, immobility, and loss of function can lead to:

Emergency care
Hospitalization
Fractures
Rehabilitation
Skilled nursing placement
Long term dependence
Increased caregiver burden

A coordinated care model may evaluate:

Gait and balance
Medication related fall risk
Vision and hearing
Muscle weakness
Assistive devices
Home hazards
Orthostatic symptoms
Cognitive impairment
Nutrition
Caregiver capacity

When risk factors are identified, the plan may include professional evaluation, rehabilitation referrals, home-safety interventions, medication review, education, or appropriate equipment.

No program can prevent every fall or functional decline.

08Coordinated wound care

Prevention and Management of Wounds

Chronic and complex wounds may worsen when contributing factors are not identified or services are fragmented.

Cost may increase through:

Infection
Emergency treatment
Hospitalization
Surgery
Prolonged treatment
Repeated transportation
Increased caregiver needs
Loss of mobility

A coordinated program may help connect wound evaluation with management of pressure, mobility, nutrition, diabetes, vascular disease, infection risk, equipment, supplies, caregiver education, and follow-up.

Wound outcomes depend on the underlying condition, severity, adherence, circulation, nutrition, infection, pressure relief, and other individual factors.

09Quality of life

Palliative-Care Integration

Patients with serious illness may experience pain, breathlessness, fatigue, anxiety, repeated crises, difficult treatment decisions, and substantial caregiver burden.

Palliative care may help address:

Symptom management
Patient priorities
Goals of care discussions
Treatment benefits and burdens
Family communication
Caregiver support
Advance care planning
Coordination among multiple professionals
Hospice evaluation when appropriate and voluntarily elected

CMS evaluations of palliative care initiatives have examined effects on Medicare spending, emergency department use, inpatient admissions, hospice use, and patient experience. Results have varied across programs, populations, enrollment levels, and evaluation designs.

Accordingly, Hospitals Without Walls™ does not assume that palliative care automatically produces financial savings in every population.

Its primary purpose is to improve serious illness care and quality of life. Any savings must be measured rather than presumed.

10Whole-person support

Caregiver Support

Family caregivers frequently provide medication assistance, mobility support, symptom observation, personal care, transportation, and communication with healthcare professionals.

When caregivers lack information, capacity, or support, the patient's care plan may fail even if the clinical recommendations are appropriate.

Caregiver support may include:

Education
Warning sign recognition
Medication guidance
Safe transfer instruction
Care plan clarification
Assessment of caregiver burden
Connection to community resources
Respite referrals
Emergency planning

Supporting caregivers may strengthen the patient's ability to remain safely in the community when that is clinically appropriate and consistent with patient preference.

11One record, one plan

Reduced Duplication

Unnecessary duplication can occur when healthcare organizations do not have access to current information.

Examples may include:

Repeated laboratory tests
Repeated imaging
Multiple medication lists
Uncoordinated specialist referrals
Overlapping assessments
Repeated intake processes
Conflicting plans of care
Services that do not address an active need

Hospitals Without Walls™ seeks to improve information-sharing and coordination while preserving each professional's responsibility to order tests or services that are clinically necessary.

Avoiding duplication does not mean refusing appropriate reassessment or follow-up testing.

12Right care, right place

Better Matching of Services to Need

Patients may receive care in a setting that is more intensive than necessary because appropriate alternatives are unavailable, delayed, or poorly coordinated.

Other patients may remain in a lower intensity setting even when their condition requires urgent escalation.

Both situations can create harm and unnecessary cost.

Our model seeks to match:

The patient's clinical condition
The urgency of the need
The required professional
The appropriate setting
The patient's functional capacity
Available caregiver support
The patient's informed preferences
The safest available service

The objective is appropriate care not simply less care.

Where Potential Savings May Occur

Understanding the Total Cost of Care

Depending on the population and contract, potential savings may be associated with reductions in:

Avoidable emergency department visits
Potentially preventable hospital admissions
Avoidable hospital readmissions
Unnecessary institutional care
Duplicated tests and services
Medication related adverse events
Delayed treatment of manageable problems
Transportation related barriers
Prolonged episodes caused by poor coordination
Unnecessary out of network utilization
Preventable complications
Administrative duplication
Missed follow up
Unaddressed care gaps

The model may also require additional spending on assessments, care coordination, mobile services, technology, monitoring, caregiver support, and community interventions.

The correct economic question is therefore not whether the program costs money.

The correct question is whether the program's total measurable benefits and avoided costs exceed the cost of delivering it while maintaining or improving quality.

The Savings Equation

Savings Must Be Calculated Transparently

Step 1

Gross Avoided Spending

Minus

Program Operating Costs

Minus

Increased Appropriate Healthcare Spending

Equals

Net Financial Impact

Program operating costs may include:

Clinical personnel
Care coordinators
Technology
Mobile services
Remote monitoring equipment
Administrative support
Data integration
Quality oversight
Patient and caregiver education
Contract management

Gross avoided spending may include validated reductions in qualifying utilization or expenditures.

Increased appropriate healthcare spending may occur when previously unmet needs are identified.

For example, a program may increase spending on primary care, medications, home services, rehabilitation, or palliative support while reducing more expensive emergency or inpatient utilization.

That may represent better allocation of healthcare resources, but the net effect must still be measured.

We Do Not Count Every Utilization Change as Savings

Rigorous Financial Attribution

A decrease in utilization does not automatically prove that a program caused the decrease.

Reliable evaluation should consider:

01The patient's baseline risk
02Historical utilization
03Population changes
04Enrollment criteria
05Regression to the mean
06Seasonal patterns
07Concurrent healthcare programs
08Changes in benefit design
09Changes in provider networks
10Mortality and disenrollment
11Data completeness
12Comparison populations
13Statistical uncertainty
14Program implementation timing
15The difference between billed charges, allowed amounts, and actual paid claims

Savings calculations should use an agreed methodology and clearly defined data.

Hospitals Without Walls™ will not treat unsupported estimates as proven savings.

Quality Must Be Measured With Cost

Lower Spending Alone Is Not Success

A program should not be considered successful merely because spending decreases.

Financial results should be evaluated alongside:

Mortality
Patient safety
Hospitalizations
Emergency department use
Readmissions
Patient reported outcomes
Symptom burden
Functional status
Patient and caregiver experience
Access to appropriate care
Medication safety
Goal concordant care
Equity
Grievances and complaints
Adverse events
Timeliness of follow-up

A reduction in spending accompanied by worse outcomes, reduced access, inappropriate denial of care, or increased patient harm would not represent acceptable value.

Not All Savings Strategies Work Equally

Evidence Must Be Applied Honestly

Healthcare interventions that appear promising do not always produce savings in every setting.

Results can differ because of:

Patient selection methods
Clinical complexity
Program intensity
Staffing
Geographic access
Patient engagement
Caregiver availability
Payment structure
Data integration
Implementation quality
Duration of follow-up
Comparison methodology

Federal evaluations have shown that some care models achieve measurable savings or utilization reductions, while others show limited, mixed, or no significant financial effect.

Hospitals Without Walls™ therefore treats savings as an outcome to be demonstrated—not a result to be declared in advance.

Contract-Specific Financial Design

Building the Model Around the Partner's Population

Hospitals Without Walls™ may work with contracting organizations to define:

Eligible patient populations
Risk identification criteria
Covered geographic areas
Included services
Excluded services
Baseline periods
Performance periods
Quality measures
Utilization measures
Financial measures
Data sources
Attribution methodology
Risk adjustment
Reporting frequency
Savings calculation
Program costs
Reconciliation procedures
Shared savings terms, when applicable
Quality guardrails

Financial terms must be documented in the applicable contract.

No general website statement replaces a negotiated methodology or legally binding agreement.

Value by Partner Type

How Different Organizations May Benefit

Each partner type has distinct financial and operational responsibilities—and distinct ways the model may support its objectives.

Value for hospitals and health systems

Supporting Better Transitions and Appropriate Utilization

Hospitals and health systems may benefit from programs designed to:

Strengthen discharge transitions
Improve follow up
Support high risk patients after discharge
Reduce care fragmentation
Improve communication with community providers
Address medication discrepancies
Support readmission-reduction initiatives
Improve patient and caregiver experience
Coordinate post acute and community services
Support value based payment responsibilities

Actual financial effects depend on the hospital's payment model, patient population, baseline performance, program design, and applicable reimbursement structure.

Value for health plans

Managing Quality and Total Cost Across the Continuum

Health plans may benefit from programs designed to:

Identify high-risk members
Close care gaps
Improve chronic-condition support
Coordinate care across provider networks
Reduce avoidable out of network utilization
Support medication management
Improve transitions
Strengthen member and caregiver engagement
Connect members with appropriate community services
Measure total cost of care

Savings cannot be determined without valid claims, encounter, eligibility, clinical, and program-cost data.

Value for government and public programs

Responsible Stewardship of Healthcare Resources

Government healthcare programs must balance access, quality, equity, patient rights, and fiscal responsibility.

Potential public-sector benefits may include:

Improved access for vulnerable populations
Better coordination of publicly funded services
Reduced duplication
Improved transitions
Earlier response to clinical and social risk
Support for aging in the community
Greater accountability for outcomes
Transparent measurement of program costs and effects

Any public contract must comply with applicable procurement, program-integrity, privacy, civil rights, payment, and reporting requirements.

Value for employers and commercial partners

Coordinating Access and Supporting Appropriate Care

Employer and commercial programs may be designed to address:

Barriers to accessing care
Delayed follow up
Chronic condition support
Navigation among healthcare providers
Mobile and virtual access
Caregiver responsibilities
Avoidable work disruption
Appropriate use of healthcare services

Financial outcomes depend on the covered population, benefit structure, claims experience, participation, program cost, and evaluation methodology.

Our Financial Integrity Commitment

Evidence Before Claims

Hospitals Without Walls™ is committed to the following principles:

01We will not invent savings figures.
02We will not promise that every hospitalization can be prevented.
03We will distinguish potential savings from demonstrated savings.
04We will measure quality alongside financial performance.
05We will identify program costs when calculating net impact.
06We will use agreed data sources and methodologies.
07We will disclose material limitations.
08We will avoid double counting savings.
09We will not classify necessary care as waste.
10We will not reduce appropriate care merely to lower spending.
11We will report uncertainty when the evidence is uncertain.
12We will seek reproducible, contract specific results.

Our goal is not simply to make healthcare less expensive.

Our goal is to make healthcare better organized so that resources are used more intelligently, effectively, and responsibly.

Let us evaluate the opportunity in your population

Hospitals Without Walls™ works with healthcare organizations to identify fragmentation, utilization patterns, transition failures, care gaps, and opportunities for measurable improvement.

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Important information

Hospitals Without Walls™ does not guarantee cost savings, utilization reductions, readmission reductions, or other financial outcomes.

Results vary according to patient population, baseline risk, participation, program design, implementation, clinical circumstances, benefit structure, data quality, evaluation methodology, and contractual terms.

All savings claims must be supported by appropriate data and an agreed analytical method. Information on this page is educational and does not constitute financial, actuarial, legal, insurance, or medical advice.

Evidence and authoritative sources

The economic principles presented on this page are informed by federal healthcare policy, program evaluations, and evidence reviews concerning coordinated care, home-based primary care, serious-illness care, transitions, and value-based healthcare.

CMS — Value-Based Care
CMS — Independence at Home Demonstration
CMS — Synthesis of Evaluation Results Across 21 Medicare Models
CMS — Palliative Care Projects: Synthesis of Evaluation Results
CMS — Hospital Readmissions Reduction Program
CMS — Transforming Episode Accountability Model
AHRQ — Care Coordination
AHRQ — Home Based Primary Care Interventions
AHRQ Patient Safety Network — Post Acute Transitional Services and Home-Based Safety
AHRQ Patient Safety Network — Hospital at Home