{"id":8621,"date":"2025-05-12T16:23:04","date_gmt":"2025-05-12T20:23:04","guid":{"rendered":"https:\/\/uniteustailstg.wpengine.com\/?p=8621"},"modified":"2025-06-16T14:45:35","modified_gmt":"2025-06-16T18:45:35","slug":"eliminating-inefficiency-scaling-impact-how-51-of-patients-of-bayhealth-patients-avoided-ed-readmissions-with-unite-us","status":"publish","type":"post","link":"https:\/\/uniteus.com\/case-study\/how-bayhealth-reduces-healthcare-utilization\/","title":{"rendered":"Eliminating Inefficiency, Scaling Outcomes: How 51% of Bayhealth Patients Avoided Future Healthcare Utilization"},"content":{"rendered":"

Bayhealth<\/a>, a leading healthcare system in Delaware, launched an effort to address non-medical drivers of health as part of its patient care model. Using Unite Us\u2019 closed-loop referral system, Bayhealth has reduced ED readmissions, enhanced operational efficiency, and improved whole-person health outcomes.<\/p>\n","protected":false},"excerpt":{"rendered":"

Bayhealth, a leading healthcare system in Delaware, launched an effort to address non-medical drivers of health as part of its patient care model. Using Unite Us\u2019 closed-loop referral system, Bayhealth has reduced ED readmissions, enhanced operational efficiency, and improved whole-person health outcomes.<\/p>\n","protected":false},"author":6,"featured_media":8632,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[108],"states":[13],"topic":[86,130,88],"industry":[74],"series_name":[],"class_list":["post-8621","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-case-study","states-delaware","topic-healthcare","topic-roi","topic-technology","industry-providers"],"acf":{"layout":"report","gated_page":{"":null,"title":"","featured_image":null,"description":"","form_title":"Fill out the form to download the white paper.","code_editor":"","title_2":"","description_2":"","embeds":null,"display_cta_button":true,"button_text":"Download the White Paper"},"columns":null,"download_page":{"document":""},"reports_component":{"components":[{"acf_fc_layout":"buttons","_acfe_flexible_toggle":"","action_buttons":[{"name":"Read the Case Study","style":"button-solid","link_type":"external","page_link":null,"link":"#background","icon":"down-caret","is_blank":false,"background_color":"","text_color":"","background_color_hover":"","text_color_hover":""},{"name":"Download Case Study","style":"button-hollow","link_type":"external","page_link":null,"link":"","icon":"","is_blank":true,"background_color":"","text_color":"","background_color_hover":"","text_color_hover":""}]},{"acf_fc_layout":"key_takeaways","_acfe_flexible_toggle":"","id":"","menu_label":"","header":"

Key Takeaways<\/h2>\r\n\"\"Enhanced Data Visibility: <\/strong>Unite Us provides real-time data and reporting, enabling Bayhealth to track referral status and outcomes efficiently.\r\n\r\n \r\n\r\n\"\"Improved Collaboration: <\/strong>Unite Us\u2019 platform enables seamless integration with Bayhealth's EHR system and its robust directory of community resources, streamlining the referral process.\r\n\r\n \r\n\r\n\"\"Improved Health Outcomes: <\/strong>Preliminary analysis shows that 51% of patients with resolved cases did not experience any emergency department (ED) or inpatient (IP) utilization in the six months following case resolution.","takeaways":null,"text":"","tiles":null},{"acf_fc_layout":"wysiwyg","_acfe_flexible_toggle":"","id":"background","wysiwyg":"

Background<\/h2>\r\nBayhealth<\/a>\"\"<\/a> is the largest healthcare system in central and southern Delaware, encompassing two hospitals, a freestanding emergency department, urgent care centers, and a variety of specialty physician practices. As a technologically advanced not-for-profit system with nearly 4,000 employees and a medical staff of more than 450 physicians and 200 advanced practice clinicians, Bayhealth is committed to delivering exceptional care. Affiliated with Penn Medicine for advanced specialties and a member of the Penn Cancer Network, Bayhealth serves a rural, diverse community with many non-clinical needs.<\/span><\/span>\r\n\r\nWith a mission \u201cto strengthen the health of our community, one life at a time,\u201d Bayhealth recognizes that drivers of health (DOH) or non-medical needs play a critical role in patient outcomes<\/a>. To strengthen the health of its community, Bayhealth began identifying and addressing DOH as part of its patient care model.\r\n\r\n
\r\n\r\n "},{"acf_fc_layout":"wysiwyg","_acfe_flexible_toggle":"","id":"challenge","wysiwyg":"

Challenge<\/h2>\r\nDriven by its mission, Bayhealth was determined to meet the non-medical needs of its patients.<\/span><\/span> However, before implementing Unite Us\u2019 platform\u2014which enables streamlined referrals and actionable data insights\u2014the health system faced several key challenges:\r\n
    \r\n \t
  1. Screening Without Support: <\/b><\/span>Bayhealth recognized the importance of screening for DOH and aimed to integrate it into routine care, identifying food insecurity as one of their patients\u2019 top needs. However, many care team members were reluctant to screen for DOH needs, knowing they lacked tools and systems to adequately respond to identified needs.<\/li>\r\n \t
  2. Fragmented Referral Process<\/b>:<\/span> The existing manual referral process was inefficient and inconsistent, often leading to delays and gaps in care.<\/span><\/span><\/li>\r\n \t
  3. Limited Data and Reporting<\/b>:<\/span> Because Bayhealth lacked the infrastructure to generate meaningful reports or track outcomes related to its DOH efforts, measuring the impact of related interventions proved difficult.<\/span><\/span><\/li>\r\n<\/ol>"},{"acf_fc_layout":"blockquote","_acfe_flexible_toggle":"","id":"","text":"\u201cI had tried other software tools to conduct social care referrals in the past, but found them difficult to use.<\/span><\/span> Not many of the organizations would actually receive referrals on the platform, which made it difficult to connect patients with resources,\u201d Heather shared. There were also challenges with engaging community-based organizations (CBOs), resulting in a referral process that required extra steps and ongoing follow-ups. \u201cIt was just hard to find things, and it was always extra work or an extra step to get patients connected to resources.\u201d\r\n\r\nHeather Walker<\/strong><\/span>, RN, Population Health Coordinator at Bayhealth"},{"acf_fc_layout":"wysiwyg","_acfe_flexible_toggle":"","id":"Solution","wysiwyg":"

    Solution<\/h2>\r\nIn early 2022, after evaluating multiple vendors, the Bayhealth team selected Unite Us for its comprehensive, user-friendly platform<\/a> that prioritized strong partnerships with CBOs and provided the tools needed for effective patient referrals and support.\r\n\r\nWith Unite Us, the Bayhealth team has been able to scale a comprehensive solution across the health system that includes:\r\n