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The WellSky® 2023 Evolution of Care Report Reveals Critical Changes to Care Delivery In the Past Year 

New proprietary data from WellSky highlights referral rejection rates, increasing length of stay, staffing shortages, and regulatory changes as top challenges for care providers 


OVERLAND PARK, Kan. – July 25, 2023WellSky, a leading health and community care technology company, today released its second annual Evolution of Care report. Based on proprietary data from WellSky’s CarePort solutions, which are used by over 2,000 hospitals and 130,000 post-acute care (PAC) providers, the report explores the ways care delivery has changed over the past year and sheds light on the implications for patients and providers as we enter a new era of post-pandemic healthcare.

WellSky’s analysis found:

Placing patients in post-acute care after hospital discharge remains challenging, with home health referral rejection rates hitting an all-time high. Since early 2023, referral volume to skilled nursing facilities (SNF) has doubled from 2022, while referral volume to home health agencies (HHA) remains higher than pre-pandemic levels. With higher demand for post-acute care services, acute providers are struggling to secure timely placements, leading to increased referrals sent per patient. HHAs are also experiencing challenges in accommodating the rising volume of referrals, with rejection rates increasing by 40% and reaching an all-time high in December 2022.

The time patients spend in the hospital prior to discharge lessened from its peak during the pandemic but is still higher than pre-pandemic levels. While improving since its peak in winter 2022, the average hospital length of stay (ALOS) before post-acute discharge has increased by approximately one day since 2019. Increased hospital ALOS can increase costs, as patients require more resources and care for each additional day they spend in the hospital. It can also lead to longer wait times and decreased patient satisfaction and access to care.

“We’re entering a new era of care delivery and there is a dramatic shift happening in the healthcare landscape. Providers, whether it’s the hospital or the doctor’s office, and health plans need to be connected to post-acute and home-based providers as care shifts to home and value,” said Lissy Hu, president of connected networks at WellSky. “Our data shows that it’s truly a care continuum — that what happens in the post-acute setting has a direct impact on the hospital setting and vice versa — so improving patient outcomes requires a holistic cross-continuum approach.”

Staffing shortages continue to be a challenge, with widespread burnout and increased turnover leading to the use of costly contract labor to fill gaps. Staffing issues have a significant impact on the healthcare industry as they can affect patient care, staff workload and burnout, and contribute to facility capacity issues. Staffing is particularly low in SNFs, with 87% of nursing homes facing moderate or high staffing shortages. Adequate staffing allows agencies to provide high-quality care—without it, there can be longer wait times, delayed treatments, and decreased patient satisfaction.

With the end of the public health emergency (PHE), providers need to prepare for the changes in policy, practice, and waived requirements. The end of the PHE brings changes to patient choice, qualifying hospital stays, and hospital-at-home programs. Previously waived regulatory flexibilities regarding patient decision-making are now lifted, leading to a need for increased transparency and access to information for patients and their families when selecting post-acute care providers.

“The aftermath of the pandemic, combined with the financial climate and an increasing need for technology and data, will present new challenges and opportunities to achieve the best possible outcomes for patients,” said Hu. “Technology that connects care teams to the full continuum of care will play a critical role by giving providers the visibility and intelligence to influence patient care and provide the right care at the right time, in the right setting.”

For more details on these findings and what they mean for the healthcare industry, download the complete 2023 Evolution of Care Report.


About WellSky®

WellSky is one of America’s largest and most innovative healthcare technology companies leading the movement for intelligent, coordinated care. Our proven software, analytics, and services power better outcomes and lower costs for stakeholders across the health and community care continuum. In today’s value-based care environment, WellSky helps providers, payers, health systems, and community organizations scale processes, improve collaboration for growth, harness the power of data analytics, and achieve better outcomes by further connecting clinical and social care. WellSky serves more than 20,000 client sites — including the largest hospital systems, blood banks, cell therapy labs, home health and hospice franchises, post-acute providers, government agencies, and human services organizations. Informed by more than 40 years of providing software and expertise, WellSky anticipates clients’ needs and innovates relentlessly to build healthy, thriving communities. For more information, visit

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