What is Pre-Acute Care and Why Do We Need it?

What is pre-acute care?

Pre-acute care is a term that describes the care provided to patients before they need acute care services such as hospitalization or an emergency department visit. Like preventative care, pre-acute care aims to prevent the onset of acute conditions — such as infections, injuries, or exacerbations of chronic diseases — by providing more comprehensive and coordinated primary care. Pre-acute care may include preventive screenings, health education, and early intervention programs.

The concept of pre-acute care goes beyond preventative care to help address social determinants of health that can affect a patient’s health status and access to care. For example, a lack of housing, food, transportation, or education can lead to health problems over time. Pre-acute care can involve identifying and helping to ameliorate a wide range of health factors to maintain and sustain patient health. It benefits healthcare organizations by decreasing the demand for acute care and improving patient outcomes.

Pre-acute care improves post-acute care

Pre-acute care can positively impact both the acute and post-acute care sectors by improving the quality and efficiency of care across the continuum. By avoiding hospitalizations through better preventative care, fewer people will need acute care — including people who are currently in skilled nursing facilities, home health, long-term care, and inpatient rehabilitation. Forbes cited study findings that a growing number of acute care patients come from post-acute care facilities due to infections and other preventable events.

By decreasing the need for acute care, pre-acute care could help acute care organizations achieve significant resource savings, and the healthcare industry overall could potentially save millions. Practices such as better medication management, regular weight monitoring, better palliative care, and better management of chronic conditions such as asthma, chronic obstructive pulmonary disease, and congestive heart failure could help patients before they reach critical condition and circumvent more costly interventions.

Building patient relationships that start with pre-acute care

Pre-acute care helps ensure that patients are well-informed, well-supported, and well-managed from the beginning. Healthcare organizations focusing on pre-acute care can build early connections with patients that extend throughout a patient’s care journey — perhaps even over their lifetimes. Long-term patient-provider relationships help build continuity of care and will most likely align with future healthcare payment models that will focus more on improving the health status of the overall population.

By its nature, preventative care must begin well before the need for acute care arises. Sometimes viewed as optional, preventative care is necessary to ensure optimal health. Providers who emphasize routine pre-acute care have more opportunities to coach patients, especially those who may not benefit from other sources of education about healthy behaviors, risk factors, and recommended health assessments at different life stages. If the goal of health care is to achieve a healthy population, more focus must be placed on wellness — and providing pre-acute care is a method to achieve that.

How does pre-acute care relate to value-based care?

Value-based care is a model of healthcare delivery that rewards providers for improving the quality and efficiency of care rather than relying on the traditional model of reimbursement per service. It aligns the incentives of providers, payers, and patients to achieve better health outcomes and lower costs. Like pre-acute care, a central tenet of value-based care is to treat the patient as a “whole person” by integrating all aspects of care relating to a person’s physical, mental, behavioral, and social needs instead of focusing on one specific health problem.

Pre-acute care is a key component of value-based care (and person-centered care), as it can serve the patient’s best interests by reducing the need for costly and potentially avoidable acute care services and the risks of complications, infections, and adverse events. In addition to improving health outcomes and quality of life, it can improve patients’ satisfaction, engagement, and loyalty — along with provider satisfaction and retention.

Pre-acute care requires patient communication and care coordination

Pre-acute care relies on effective patient communication and care coordination to achieve its goals.

• Patient communication — Educating, empowering, and motivating patients to take an active role in their health and wellness, as well as providing timely and relevant information and feedback.
• Care coordination — Ensuring that patients receive the right care, at the right time, in the right setting, by the right provider and that all the providers involved in a patient’s care communicate and collaborate with each other.

These efforts may involve interventions to identify and address social determinants of health — or the non-medical factors that can affect a patient’s health and well-being — such as housing, food, transportation, and education, and connecting patients with appropriate resources and support.

Currently, hospitals with outpatient clinics, community health centers, accountable care organizations (ACOs), and integrated delivery networks (IDNs) may already offer pre-acute care services, even if they do not identify them as such. Additionally, many home health agencies and primary care practices offer pre-acute care services as part of their care delivery models.

Benefits of pre-acute care: staffing and savings

Pre-acute care can help mitigate some of the most serious challenges that the U.S. healthcare system is currently facing, such as the shortage of healthcare workers and the rising costs of hospital care. Reducing the demand for acute care services can help overstretched and overworked hospital staff and free up hospital beds and resources for other patients who need them.

Lowering the costs of hospital care can benefit payers and providers. By shifting the focus from illness to wellness, pre-acute care can help attract and retain healthcare workers by offering them more rewarding and satisfying roles and more opportunities for professional development and career advancement.

Many more people will benefit from preserving and strengthening their health and well-being through pre-acute care. It will also create opportunities for a range of activities that are not sufficiently addressed by healthcare organizations when they are taxed with a heavy caseload of patients needing treatment for advanced conditions.