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Paul Diaz
Paul Diaz

The future of healthcare: Post-acute care

Not an add-on: Integration of post-acute essential in care of chronically ill patients


By Paul Diaz and William Altman
Posted: July 25, 2011 - 12:01 am ET
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The growing trend in our nation's healthcare system toward integrated care and payment models comes from healthcare reform and private market demands. Providers need to demonstrate value by producing quality outcomes in a cost-effective manner as policymakers, payers and consumers rightfully demand a higher degree of accountability in the evolving delivery system.

In the past, post-acute care has been largely regarded as an “add on” to our nation's healthcare system. Data proves the fallacy of this view as a growing number of patients require continued nursing and rehabilitative care after a hospital stay to recover fully.

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If the goal is to ensure that every individual should recover to the best of their abilities and return home as safely and quickly as possible, then post-acute care must be recognized as an essential element in our nation's healthcare equation. This is especially true for the growing number of chronically ill patients with multiple co-morbidities whose high healthcare consumption can be addressed only through targeted and coordinated care before and after acute hospitalizations.

Looking toward the future, it is essential that healthcare services for patients be regarded more as an interwoven network rather than a patchwork of services that reflects today's system in America. In large part, we are headed in the right direction. Regardless of whether one looks at public or private accountable care organizations, plans for bundled payment systems, or other private initiatives aimed at eliminating the silos of care, our delivery system is trending toward a more integrated system based on team-based approaches to care that ensures better outcomes.

Becoming partners

William Altman
William Altman
At Kindred, our approach to meet these trends is to partner with health systems, managed-care organizations, and acute-care hospitals so we may provide high-quality, integrated care in settings across the entire post-acute continuum. Active and ongoing communication between acute and post-acute providers ensures a better understanding of patient needs, better care transitions and discharge to the most appropriate, lowest cost, post-acute setting.

Kindred has worked toward developing the capacity to provide quality post-acute care and rehabilitation services across the entire post-acute continuum. We now proudly serve patients and residents in 46 states through our long-term acute-care hospitals, inpatient rehab facilities, acute rehabilitation units, skilled-nursing/rehabilitation centers, home care and hospice. Through collaboration with our internal and external network of physicians, caregivers, therapists and others, we are better able to transition patients seamlessly across care settings and begin to manage their entire episode of care.

Our value to the system is ultimately measured by the results we achieve. Like many of our peers, we are caring for more and sicker patients, yet our “Continue the Care” coordination model is delivering improved care outcomes. As we reported in our 2010 Quality and Social Responsibility Report, our long-term acute-care hospitals and skilled nursing/rehabilitation centers continue to outperform national benchmarks on key quality indicators. In our nursing and rehabilitation centers, from 2008 to 2010 we achieved an 11% increase in patients discharged home, a nearly 6% reduction in re-hospitalizations within 30 days of admission, and a 19% decrease in the average length of stay.

Coordinating care

A key component to achieving these outcomes is the emerging capacity to coordinate care across acute and post-acute settings through “joint operating committees” with our acute-care partners, investment in electronic health records, which can be linked with our care partners, and a relentless focus on providing superior clinical outcomes across an episode of care.

But as healthcare providers struggle to absorb payment cuts that were included as part of reform—as well as the potential for additional cuts related to deficit reduction proposals—the greatest challenge will be to test and implement these new integrated-care and payment models in a manner that protects patient care.

We therefore urge caution in applying payment policies to save money in the short term that are inconsistent with the longer-term goals of providing coordinated care in the right place at the right time for the right cost.

We are at an exciting crossroads in the delivery of healthcare in our nation. As initiatives advance with the goal of breaking down silos of care, there are opportunities and challenges ahead for post-acute care providers if we are to deliver on our promise of high-quality, person-centered care.

We are excited about post-acute care's role in the future of healthcare in America, and look forward to developing new partnerships with other healthcare providers and collaborating with policymakers so that we may continue to raise the bar and improve healthcare for all.

Paul Diaz is president and CEO and William Altman is senior vice president of strategy and public policy at Kindred Healthcare.



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