POST-HOSPITAL SUBACUTE CARE - AN EXAMPLE OF A MANAGED CARE MODEL

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.