In the wake of the COVID-19 pandemic, like many hospitals and health systems across the country, WellSpan Health (WellSpan) was struggling with increased lengths-of-stay, a shortage of available post-acute beds, and rising costs of care. Recognizing the need to take action, WellSpan health system engaged Health Dimensions Group® (HDG®) to chart a new course for their post-acute care strategy.


WellSpan is a York, Pennsylvania headquartered, clinically integrated health system with approximately 2,600 physicians and advanced practice providers and 20,000 employees. WellSpan teams serve patients in eight highly respected hospitals, with more than 200 patient care locations, and through diverse supportive service lines, including a home care portfolio.

WellSpan 2025

WellSpan’s 2025 strategic plan includes four key areas that support their vision to be a trusted partner, re-imagining healthcare and inspiring health. WellSpan’s mission is to work as one to improve health through exceptional care for all, lifelong wellness, and healthy communities. The key areas are:

  • Engage: Foster diverse and highly engaged individuals and teams.
  • Innovate: Be relentless in re-imagining healthcare to exceed the expectations for our community and customers.
  • Deliver: Deliver on our promise of improving the health of individuals and populations.
  • Thrive: Grow as a value-based organization pursing diversification, affordability, and a leading market position.

Building on an Existing Plan

In 2015, a post-acute strategic plan was completed by the health system. However, this work was completed prior to the COVID-19 pandemic and subsequent labor crisis. This plan was innovative, comprehensive, and visionary, it included four key areas:

  • Leadership Infrastructure
  • Partnerships
  • Operations
  • Team members
Unforeseen Environmental Impacts

Even the best strategic plans could not predict that since 2020:

  • 579 nursing homes have closed, according to the American Health Care Association.[1]
  • 210,000 jobs have been lost since the 2020, and it will take up to 2027 for nursing homes to employ the same number of staff, according to data from the Bureau of Labor Statistics analyzed by the American Health Care Association.[2]
  • In the last two years, 37 percent of facilities reduced skilled beds; 71 percent of these facilities reduced beds by 11 to 50 percent, according to a December 2023 Ziegler CFO HotlineSM* survey.[3]
  • In addition, skilled nursing beds have been reduced by licensure, or staffing limitations, at free-standing SNFs as well as life plan communities, and other discharge settings including home health and hospice have also been plagued by resignations and staffing shortages, limiting capacity.

The challenges above have created consternation for post-acute and long-term care providers, as well as for hospitals and health systems who rely on these services to improve throughput, reduce length of stay, and improve patient outcomes.

Organizational Impact

For WellSpan, factors including the above resulted in:

  • Increased acute care lengths-of-stay for hospital patients, leading to higher costs of care.
  • Shortages of available licensed and staffed post-acute care beds, leading to post-acute providers becoming risk averse to patients with various diagnoses.
  • Delays in insurance authorization for discharges to post-acute care.
  • Meeting the utilization and financial goals for value-based care.

Solution: Health System’s Path to New Post-Acute Strategy

WellSpan engaged Health Dimensions Group® (HDG®) to facilitate and develop an updated post-acute strategy for the health system that took into consideration significant changes to the post-acute market and internal challenges. The goals of the project were to:

  • Manage the cost of post-acute care by aligning the goals of post-acute care to system goals given risk-based payment models in value-based care with multiple payors.
  • Allow WellSpan leadership to move from a reactive approach to a proactive strategic approach.
  • Provide a framework to evaluate new and proposed opportunities and plans within post-acute care against agreed-upon strategic directions.

HDG worked with an interdisciplinary team to complete several key tasks to inform the process, including:

  • A services and resources assessment that included data review, interviews, and comprehensive analysis.
  • An interactive strategy session to identify key strategic directions and goals.
  • A gap analysis to understand the gaps between the identified services and resources and the desired state.
  • A second interactive strategy session to identify key initiatives to meet the strategic directions identified in the first session.
  • Using the above, HDG developed a consolidated summary of the impact of all initiatives—the summary included financial impact of selected initiatives.

Action Items

To ensure that the plan was implemented, successful, and measured, HDG provided a final selection of strategic initiatives, the collaborative development of a work product for tactics and action items to achieve the desired goals. HDG also assisted in the development of key performance indicators (KPIs) and scorecards for post-acute strategy implementation.


The culmination of the above work resulted in achieving the three identified project goals. In order to measure ongoing progress toward the goals, four KPIs that could measure the progress of the goals on an ongoing basis were created. The KPIs are:

  • Decrease hospital avoidable days for every post-acute discharge
  • Increase the percentage of in-network (PPN) post-acute discharges
  • Increase the percentage of hospital patients discharged to home and to home-with-services
  • Decrease the post-acute cost of care per beneficiary per year for ACO population

Measurement of the KPIs began in July of 2023. Progress has been made in decreasing hospital avoidable days for every post-acute discharge and by increasing the percentage of patients discharged to the PPN. Increasing the percentage of hospital patients discharged to home and to home-with-services has had mixed results, while decreasing the post-acute cost of care per beneficiary per year for the ACO population is a work in progress.


[1] American Healthcare Association [2] American Healthcare Association [3] Ziegler

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