Like many new clinicians, Caroline Hodge, MS, PA-C, MBA, began her first job in emergency medicine with lofty goals of healing patients and saving lives. After only a day, she was left wondering how she could have been so busy without getting patients what they actually needed. “From that moment, I realized I needed to understand why the system was so hard,” she says.
Hodge found herself constantly beginning thoughts with the words, “ If only…”
- This patient was able to get in to see their doctor sooner
- I’d gotten them their antibiotic a couple of days ago
- Someone had seen that surgical site earlier
- Someone had done their medicine reconciliation
- The patient wasn’t home alone
“There are so many different ways things can go wrong after someone leaves the hospital,” says Hodge.
Those “if only” thoughts became the driving force behind Dimer Health, a startup she co-founded in 2023. Their mission is to provide real-time, personalized, post-discharge clinical care to help patients heal and prevent readmission.
The problem: A black hole in post-discharge care
After a hospital stay, patients typically leave with instructions, medications and a directive to make an appointment. What’s missing is real-time clinical oversight. If the surgical site becomes infected, if the medications clash or if patients simply feel unsure of what to do and can’t get in touch with their doctor, they often have nowhere to turn but the ER.
Hodge notes that there are a lot of existing resources, like social workers and nurse case managers. What’s missing is convenient clinical oversight. NPs and PAs working in settings like Dimer can monitor a surgical site, order antibiotics or recommend pain relief all while the patient remains at home.
“An Amazon package can come in two days, and most people still can’t get basic healthcare at home. At what point do we stop doing things the way we’ve done them for so long and start getting healthcare to people where they are?” says Hodge.
This gap in transitional care stayed with Hodge throughout her career. It wasn’t until surviving two battles with cancer that she set out to fix the problem.
The solution: What Dimer Health does differently
Nurse practitioners (NPs) and physician associates (PAs) at Dimer Health deliver what hospitals and health systems struggle to provide: high-level, proactive decision-making during the fragile window after discharge.
They partner with health systems to serve patients after discharge in the following ways:
- Initiate care within 48 hours post-discharge
- Risk-stratify patients and create custom care plans
- Text, call, photo check-ins and home monitoring
- Clinical decisions in real time
- Reduce ER readmissions and calls to surgeons and PCPs
Because Dimer Health partners directly with hospitals, patients experience a warm handoff. “One provider passes the baton, and we grab the patient’s hand before they fall,” says Hodge.
It’s like leaving the hospital with a virtual call button.
Why NPs and PAs are uniquely qualified to fill care gaps
Dimer Health now employs more than 30 NPs and PAs, many of whom left traditional roles for a more fulfilling clinical experience. They spend more time with patients (30–45 minutes per visit), work virtually and make meaningful clinical calls without the burnout of back-to-back office visits.
Providers who refer to Dimer aren’t just supporting continuity, they’re reducing follow-up calls and emergencies.
Referring physicians report getting fewer calls from patients, says Hodge. “Patients are getting the care they need from someone with training and authority to make clinical decisions.”
The model complements primary care and specialty providers rather than replacing them. Dimer communicates directly through EMRs and returns patients to their care team when they’re stable.
The bigger vision: A new step in the care continuum
The average post-discharge care in the United States today is 29 days, which is inefficient and even dangerous. Dimer’s founders see their work as creating a new layer in the care continuum.
“We need a wedge between hospital and home. Right now, there’s nothing there,” says Hodge. “It’s a huge opportunity to improve outcomes, reduce readmissions and do right by patients.”
Advice for clinicians who want to innovate
Clinicians are the first to recognize care gaps and the most equipped to fill them. To other NPs and PAs who see broken systems every day, Hodge recommends trusting your clinical intuition and taking action.
Innovation is where clinician voices can shape the future
“If you see a problem, start asking questions. Put one foot in front of the other. The hardest part is zero to one, but once the jar starts to turn, it pops,” she says.
Building a network of superstars
Hodge made a habit of asking people what they do better than anybody else. She copied what she liked about them, created relationships and learned new skills. “I had a really great network of people so when it came time to start the company, I brought my favorite people together with the right set of skills,” she says.
Dimer currently operates in three states. Hodge says the market is wide open for other NPs and PAs to fill similar needs. “I’d love to see more of us out there starting companies and solving the problems we know exist,” she says.
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