Post-Acute Care and Vertical Integration After the Patient Protection and Affordable Care Act

Hospital Vertical Integration Into Subacute Care as a Strategic Response to Value-Based Payment Incentives, Market Factors, and Organizational Factors: A Multiple-Case Study

“…This finding is consistent with arguments made my pervious theoretical research in health care management. 3 , 16 Our research validated the theoretical arguments and also shed light into the complexity associated with the adoption of such networks. Each case described complex processes associated with adopting and managing such virtual integration strategies.…”

“…Some providers have pursued these capabilities through vertical integration. Vertical integration is defined as “the provision of a continuum of office-based care, acute care, and post-acute care services within a single organizational or joint ownership structure, allowing for a coordinated progression of services across the patient care spectrum.” 3 (p16) Researchers have long argued that organizations pursue vertical integration strategies in an effort to reduce market transaction costs, 4 , 5 increase market share, 6 and mitigate environmental threats 7 , 8…”

“… 11 , 12 Within the potential providers along the continuum of care, researchers have predicted that hospitals will vertically integrate into subacute care (SAC) in response to payment reform and adoption of ACO models. 3 , 13 , 14 SAC provides inpatient care to patients who no longer require acute care services but still require 24-hour care during this phase of their recovery. 15 , 16 Theoretically, vertical integration into SAC may have the potential to improve communication between acute care providers and SAC providers, facilitate safer patient transfers between providers, and enable hospitals with the ability to take advantage of new payment systems, although very little is known empirically about such potential benefits.…”

Which Patients Require More Care after Hospital Discharge? An Analysis of Post-Acute Care Use among Elderly Patients Undergoing Elective Surgery

“…As with previous changes in Medicare payment policies, 1,7,17 these reforms will likely result in a reorganization of care delivery and alterations in the types of care provided. 18,19 One concern is that payment reform will result in greater use of the lowest costs and least intensive PAC, potentially resulting in misuse of services. 3 To prevent such unintended consequences, further research is needed to ensure that each PAC service is reserved for patients who will benefit most from the specific type of care offered.…”

Accountability across the Continuum: The Participation of Postacute Care Providers in Accountable Care Organizations

“…Prior research suggests ACOs are taking varying paths with respect to integration, as predicted based on theoretical work (Shay and Mick 2013). Many ACOs are choosing to coordinate care across the continuum without formally integrating hospitals or postacute providers, and they may be motivated by their strong informal networks or degree of market power (Shay and Mick 2013). The lack of inclusion may also be because of where surveyed ACOs are on the path to clinical integration.…”