The Role of Post-Acute Care in New Care Delivery Models

This American Hospital Association (AHA) white paper discusses the role of post-acute care (PAC) in new care delivery models via presentation of both background information and select case studies. The authors note a consistent rise in PAC utilization over the past several years coupled with geographic disparity in PAC spending has prompted an increased focus toward evidence-based PAC processes. Factors influencing PAC placements – such as patient diagnosis and provider preferences; the redesign of care processes and tools; and bundled payments that include PAC services – are discussed.

Case studies include both PAC- and partner-led innovations:

RML Specialty Hospital: This Chicago-based hospital demonstrated value to ACOs by employing a three-prong approach that included specializing in the most chronically critically ill patients.

Christiana Care Health System: In an effort to reduce preventable CHF readmissions from skilled nursing facilities, Christiana Care implemented a virtual telemonitoring program and risk prediction model in partnership with these SNFs.

Brooks Rehabilitation: Brooks, the largest U.S. inpatient rehabilitation facility, began participating in the BPCI bundled payment demonstration and redesigned their care approach (including using nurse care navigators to support patient transitions).

Kindred Healthcare: Kindred adopted an integrated market strategy in key locations where they assessed the most potential impact (e.g., Cleveland, where they began participating in BPCI bundling and implemented a quality improvement program in conjunction with the Cleveland Clinic).

Outcomes, lessons learned, and next steps (AHA recommendations for policy change) are also discussed in detail.