War-game a home health hand-off by proving each hand-off lane has a named owner, a measured age-out, and a reverse path before draft lanes start governing every home health transfer.
Home health hand-offs fail when "accepted" means a status without a decision artifact, when teams dual-count a draft lane as both approved and live, and when high-risk transfer families still pin to one thin coordinator because the lane inventory is incomplete. The review needs one written inventory of hand-off lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed lane ages past the deadline.
Freeze one hand-off family first
State which transfer families the hand-off covers, the effective date, which lanes change, how versions are stored, and what happens to transfers already in flight. Name the units that feel it first and the care promises that depend on coherent home health handling. If the memo mixes a home health hand-off with a rehab length target and a post-acute hand-off, split them.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed lane, agency gap, or patient deadline that would force a hand-off rollback within a stated window.
| Lane | Owner | Age-out | Reverse path |
|---|---|---|---|
| Skilled nursing start | Named coordinator | Measured hours | Documented re-route |
| Therapy-only start | Therapy ops | Measured hours | Documented re-route |
| High-acuity dual start | Care management | Measured hours | Documented escalate |
Fill the table from stored exports, not from memory. Empty cells are blockers, not notes for later.
Break points to rehearse
- A high-dollar transfer class stays soft while the aggregate hand-off dashboard stays green.
- Two teams claim the same lane ownership and neither can force a freeze at week end.
- A restore has already left a case without a trusted home health state.
- The primary hand-off export lags beyond the planned observation window.
- An operator skips a hand-off gate because a discharge cutoff is near.
For each break point, require detection time, agency impact, containment, and the authority to force a hand-off rollback. Commands and export links belong in the runbook.
Run the lanes through hostile seats
Feed Pingpong the hand-off memo, the lane exhibits, and seating briefs for care management, therapy ops, utilization review, and quality. First pass steelmans the hand-off. Later passes attack from those seats. Final pass turns surviving objections into phased lane rules, mitigations, or a changed recommendation. Agreement across passes is not proof. Keep the objections that still have evidence gaps.
Pair with a post-acute hand-off, the therapy ops lead seat, a rehab length target, and the care management lead seat. More operating decisions live in the war-game decisions hub.
Ship the hand-off only when approved and blocked lane labels can be reproduced from stored home health exports without a verbal override.