Building Hospital-at-Home: How Harris Health Built a System-Level Home Division
Rohan Dwivedi, operational leader for the Harris Health Home Division explores how one of the nation’s largest safety-net health systems designs and scales home-based care models that intentionally bridge the hospital, home, and community - particularly for patients facing significant access barriers such as transportation challenges, food deserts, and limited primary care connectivity.
Rohan outlines Harris Health’s necessity-driven approach to care innovation. Rather than chasing novelty, the Home Division is built around the practical needs of an underserved population: reducing avoidable emergency department utilization, improving inpatient throughput, and removing socioeconomic friction by delivering care where patients live. The division operates through three intentionally distinct platforms - Hospital at Home (waiver-based inpatient care), House Calls (home-based primary care and transitions of care), and OPAT (outpatient parenteral antibiotic therapy) - each deliberately “bucketed” to preserve analytical clarity, operational rigor, and long-term sustainability.
Outcomes shared during the conversation include rapid growth of the Hospital at Home program (approaching ~400 patients within two years), expansion of a ~600-patient home-based primary care panel, and a mature OPAT program supporting ~40–50 active patients at any time. Across all models, Harris Health emphasizes closed-loop care design: identify → validate → prepare → provide → follow up with success measured through reduced readmissions, fewer ED touches, and “bed days saved” by shifting appropriate care into the community. (00:44:51–00:46:07)
What’s your personal journey—and how did it shape how you build care models?
(Timestamp: 00:01:04)
Rohan reflects on growing up in India and moving to the U.S. after 9/11, an experience that shaped his sensitivity to inequity and access. Initially drawn to pharmacy through family influence and a personal loss to cancer, he discovered his true passion lay in cross-functional problem-solving and relationship-driven operations. His administrative pharmacy training—particularly in pediatrics—instilled a culture of precision, vigilance, and intentional change. That foundation ultimately drew him to Harris Health, where Hospital at Home demanded deep collaboration across departments and partners.
“Coming from somewhere that is so… operated so differently… molded how I looked at things.” (00:01:48)
“I lost my mom to cancer… that personal connection… drove me into understanding how drugs work.” (00:02:41–00:03:05)
“What kept driving me back… was working with different people and solving different problems.” (00:03:05–00:03:30)
“Pediatrics… there’s a culture of hypervigilance… dosing and modifying daily.” (00:04:41–00:05:28)
“In hospital at home… you have to integrate available resources and build partnerships.” (00:06:40–00:07:21)
What’s the North Star for the Harris Health Home Division and what problems are you solving?
(Timestamp: 00:07:48)
As Houston’s largest safety-net system, Harris Health must design care around access realities rather than convenience. Transportation barriers, geographic sprawl, food insecurity, limited health literacy, and ED overcrowding fundamentally shape decision-making. The Home Division exists out of necessity—to bring care to patients, reduce avoidable hospital utilization, and address socioeconomic barriers that prevent timely, appropriate care.
“We’re a county institution… serving the indigent, uninsured, and underserved.” (00:08:39–00:09:03)
“ED overcrowding… is everyone’s problem… and it’s magnified here.” (00:09:03–00:09:26)
“Getting somewhere is a problem… Houston is broad and vast… no-show rates are high.” (00:10:53–00:11:49)
“There are tangible socioeconomic barriers we can remove by bringing care to the community.” (00:12:14–00:12:51)
“This isn’t about the new fancy tool… it’s about strict necessity.” (00:12:26–00:13:17)
Follow-Up: Why is home and community care uniquely valuable clinically?
(Timestamp: 00:13:58)Greg highlights how home visits reveal context that traditional care settings miss, making social determinants visible and actionable.
“Make a house call… meet people where they are.” (00:14:17–00:14:31)
How did you build Harris Health’s waiver-based Hospital at Home program?
(Timestamp: 00:14:48)
Harris Health chose a fully homegrown model, requiring strong executive sponsorship and significant upfront investment. Planning began nearly two years before launch; Rohan joined late in the process to operationalize and scale. The program is staffed entirely by Harris Health employees and follows a disciplined workflow: identify inpatient-appropriate candidates, validate clinical need, prepare logistics, deliver 24/7 care in the home, and discharge with standard inpatient services such as meds-to-bed. Internal assets—including EMS transport and strategically located pharmacies—enabled tighter integration and control.
“You need executive support… top-down alignment matters.” (00:16:53–00:17:47)
“If you homegrow it… there’s heavy upfront investment before yields.” (00:18:35–00:19:01)
“We applied for the waiver… mid-2022.” (00:20:13–00:20:37)
“Identify… validate… prep… provide… follow up.” (00:20:37–00:21:02)
“We staff this model 24/7 with our own nursing team.” (00:21:02–00:21:25)
“We transport our own patients home using our EMS.” (00:21:50–00:22:14)
“Select the patient… consent… transport… meds… Epic access.” (00:23:57–00:24:22)
“You can’t scale forever without partnerships—but ownership matters early.” (00:24:22–00:25:04)
Why keep Hospital-at-Home strictly inpatient-only?
(Timestamp: 00:26:22)
Rohan argues that strict adherence to inpatient criteria protects the long-term viability of Hospital at Home. Because the model is reimbursed at inpatient rates, blending transitionary or outpatient care risks muddying length-of-stay data and weakening payer confidence. Transitional services are essential—but are intentionally housed in separate Home Division platforms to preserve analytical clarity and defend the model over time.
“If you want this to survive… adhere strictly to the criteria.” (00:28:12–00:28:43)
“I want this to survive forever… there’s a clear benefit.” (00:28:44–00:29:11)
“If reimbursed at inpatient rates… payers expect inpatient-appropriate care.” (00:29:51–00:30:12)
“Muddying the waters distorts length-of-stay data.” (00:31:07–00:31:30)
“We support transitional care—but not under hospital at home.” (00:32:04–00:32:29)
Can you describe the House Calls model and who it serves?
(Timestamp: 00:34:03)
The House Calls program predates Hospital at Home and was consolidated under the Home Division. It includes home-based primary care, transitions of care, and home safety evaluations. Harris Health serves both clinically and socially homebound patients, focusing on family medicine, geriatrics, and palliative care. By meeting patients where they are, the program reduces no-shows, improves continuity, and prevents avoidable ED use.
“Home-based primary care plus transitions of care.” (00:35:09–00:35:34)
“Functionally, it’s a clinic—delivered in the home.” (00:35:59–00:36:15)
“Clinically or socially homebound… access challenges.” (00:36:40–00:37:05)
“When access is hard, people sacrifice their own health.” (00:37:05–00:37:28)
“Family practice, palliative care, geriatrics.” (00:37:28–00:37:53)
How does OPAT fit into the Home Division?
(Timestamp: 00:40:46)
OPAT supports complex patients who no longer need inpatient care but require extended IV antibiotics. The Home Division coordinates identification with infectious disease, discharge preparation, home health setup, education, monitoring, and therapy completion—creating a closed loop that reduces readmissions and care gaps.
“Patients well enough to leave—but needing extended IV therapy.” (00:41:23–00:42:11)
“Identification, validation, prep—every morning.” (00:42:19–00:42:41)
“If prep doesn’t happen, patients bounce back.” (00:43:01–00:43:02)
“Completion, follow-up, and line removal close the loop.” (00:43:02–00:43:27)
As you scale, how will staffing and operations evolve?
(Timestamp: 00:46:08)
Scaling requires flexibility. Harris Health is already shifting toward shared Home Division staffing, cross-coverage, and census-based ratios. Over time, centralized roles (e.g., care management, pharmacy) will be justified by volume, followed by selective decentralization as geographic density increases.
“It has to evolve—that’s how scaling works.” (00:47:06–00:47:54)
“Nursing is now Home Division staff, not siloed.” (00:48:19–00:48:44)
“Ratios create clarity and enable growth.” (00:49:08–00:49:33)
“Centralize, then decentralize as you scale.” (00:50:47–00:51:26)
Where do you see the future of the Home Division going?
(Timestamp: 00:51:27)
Rohan points to innovation that reduces friction—such as drone medication delivery—and emphasizes intentional decision-making rooted in integrity and service to vulnerable populations. He’s confident home-based care will continue expanding as leaders recognize its clinical, operational, and human value.
“Reduce windshield time… drone delivery is exciting.” (00:51:36–00:52:01)
“Be mindful of intent and downstream consequences.” (00:52:06–00:52:27)
“Keep it real, keep it clean, and help the people who need it.” (00:52:27–00:52:47)
“Home-based care is ingrained in executive thinking.” (00:53:12–00:53:37)