Stroke is a leading cause of mortality, morbidity, and medical expenditures in the United States. For those who survive the initial stroke, serious gaps exist in the transition to post-acute care. For example, 25% of stroke patients discharged home without post-acute care are readmitted within 90 days. Comprehensive post-acute services for stroke survivors require bridging hospital-based acute care with expanded care teams for rehabilitation, primary care management, access to community resources, and caregiver support. Our team?s COMprehensive Post-Acute Stroke Services (COMPASS) model of care, which combines transitional care and early supported discharge services, is being implemented in a pragmatic cluster randomized trial of 41 NC hospitals. Ultimately, sustainable implementation of COMPASS will be influenced by the return on investments for health systems and costs for payers. Given trends in reimbursement policies, the effect of COMPASS on readmissions will likely be the key incentive for healthcare systems to adopt and sustain such evidence-based post-acute services. The overall goal of this study is to analyze the business case for both payers and hospital systems for the post-acute services for stroke included in COMPASS. These outcomes have not been assessed previously in a randomized control trial. Our study will estimate the cost of implementing COMPASS (Aim 1). We will also estimate the change in payments in the 90 days after stroke caused by COMPASS for major insurers in North Carolina (Aim 2). Finally, we will combine these estimates to calculate the return on investment of COMPASS under alternative payment models (Aim 3). Insurers need evidence of interventions that can achieve lower cost without sacrificing quality of care. Our study will provide timely evidence of the economic value of post-acute stroke care and can inform the design of a stroke bundle that ensures hospitals and payers benefit.
By investigating the return on investment to post-acute stroke services, this study will evaluate the financial incentives for hospital systems to adopt and sustain such activities. In addition, the results will inform the design of alternative payment models for post-acute stroke services that achieve lower cost without sacrificing quality of care.
