T. Vonsternberg et al., POST-HOSPITAL SUBACUTE CARE - AN EXAMPLE OF A MANAGED CARE MODEL, Journal of the American Geriatrics Society, 45(1), 1997, pp. 87-91
OBJECTIVE: This article describes Transitional Care Centers (TCC), an
innovative sub-acute care program developed by a large managed care or
ganization (HealthPartners in Minnesota) in partnership with five area
nursing homes. The purpose of the TCC is to promote continuity of car
e for frail older members covered under a TEFRA risk contract. DESIGN:
This is a retrospective study of the experiences and outcomes of enro
llees who received TCC compared with a like group of enrollees who rec
eived customary continuity care through contract services. SETTING: Th
e TCCs are established contractually in five area nursing homes; these
facilities keep at least 15 beds available to the health plan for rou
nd-the-clock, 7 days per week admissions for sub-acute care. Designate
d staff from these facilities and designated geriatric nurse practitio
ners and geriatricians from HealthPartners follow established targetin
g, admissions, assessment, care planning, and discharge planning proce
dures to provide team care for these patients at the facilities. PARTI
CIPANTS: The TCC program is targeted to patients requiring rehabilitat
ion therapy (post-cardiovascular accident, post-fracture/replacement)
who are deconditioned, or those with uncomplicated infections (urinary
tract infection, pneumonia). A total of 1144 patients participated in
the TCC program in the 1-year program under report, and 253 were surv
eyed in regard to their experience. One hundred HealthPartners physici
ans were surveyed about the program. RESULTS: Post-acute length of sta
y in the TCC was substantially lower than that in customary care setti
ngs in contract nursing homes (14.3 versus 20.5 days). Rehospitalizati
on rates from these units were comparable to or better than those from
other sub-acute units. Patient and primary care physician satisfactio
n with the units was high. The program provided economic benefit to bo
th partners. The health plan's negotiated rate for the TCC units was 3
8% less than that paid in noncontractual facilities. CONCLUSION: The T
CC partnership provides rehabilitative and geriatric evaluation servic
es in settings more conducive to and less costly than such care usuall
y, and yields improvements in care and utilization outcomes.