High-Intensity Postacute Care at Home

Abstract

SummaryThe value of postacute care has been debated recently as the costs of rehabilitation and medical care in postacute care facilities have increased, particularly in light of patient outcomes that remain variable. Improvement in physical function is a critical outcome for patients discharged to postacute care. To improve value, we need innovative care models that can achieve functional improvement at reduced costs. Cleveland Clinic developed and implemented a high-intensity home-based rehabilitation (HIHR) model to shift postacute care from costly facilities to patients’ homes. With the first iteration of HIHR in the Cleveland health system, patients improved their functional independence and average savings were $3,320 per episode compared with reimbursement for a typical short-term stay in a skilled nursing facility. The authors provide an overview of their initial implementation, with challenges they encountered and their plans for improvement.