Improving the quality and value of care for patients undergoing hip and knee replacement surgery


Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries in the U.S. Patients undergoing these procedures experience substantial variability in care, outcomes, and cost during hospitalization and post-acute care.

Patients discharged from hospitals to a rehabilitation or nursing facility have higher costs but not necessarily improved outcomes. Readmission after hospitalization is substandard and costly for patients and health systems.


HomeConnect+ is an automated hovering program designed to improve the quality and value of care for patients undergoing hip and knee replacement surgery.  

Patients are enrolled in the program before surgery and monitored for 45 days afterward. The intervention supports recovery by monitoring movement with wearable activity trackers, sharing post-operative goals and milestones via text message, and tracking patient pain scores. Users can also readily connect with their care team if they have questions or concerns.

HomeConnect+ is powered by Way to Health. Way to Health enables the HomeConnect+ team to rapidly validate how additional program features such as gamification and social support might improve patient outcomes and care value.


During initial pilots at Pennsylvania Hospital and Penn Presbyterian Medical Center that included patients at intermediate risk of discharge to a facility, only 3 percent of HomeConnect+ patients were readmitted to the hospital after surgery, compared to 12 percent of those not enrolled in the program.  

While the pilot showed a fourfold decline in readmissions, the team did not observe an increase of discharges home after surgery or improvement in physical activity rates post-discharge. Ongoing implementation of the HomeConnect+ program is underway, and there are plans to incorporate additional messaging while expanding to a broader risk profile of patients.

Phase 2: It does work

Eric Hume, MD
Andrea Troxel, ScD
Laurie Norton, MA
Hannah Lacko, MA
Jason Freeman, MLA
Noora Marcus, MA
Kevin Volpp, MD, PhD

Innovation leads

Shivan Mehta, MD, MBA, MSHP
David Asch, MD, MBA
Cathy Reitz, MPH
Caitlin McDonald, MPH

External partners


Innovation Methods

Show me

Instead of relying on a verbal recount of experience, ask users to show you how they use a product or service. What people say they do is often quite different than what they do.

Observing users in action will help you understand the spectrum of experiences users can have with the same product or service.

Surveys, interviews, questionnaires, and focus groups don’t tell you what you need to know. Prompting users to show instead of tell often reveals what others have missed.

Show me

Extensive observations were performed in clinical settings where patients are offered a choice of facility post-surgery.

We found that there was no single decision-driver for discharge disposition. In fact, most patients made decisions based on social influence and insurance coverage.