b'Deloitte interviewed 36 health care executives representing 10 large systems and found that many leaders only have a very rudimentary understanding of the post-acute care providers in their area and the differences between them, giving little thought to where patients end up after they are discharged. Considering the outsized role that post-acute care plays in driving both cost and ultimate outcomes, this is significant and concerning.SignificantVariationinPost-AcuteCareSpendingThe post-acute care world is highly fragmented and siloed, making better care coordination anPost-acute careeven more difficult challenge. Many large health systems refer to multiple post-acute providers. looks like an According to the Deloitte interviews, the number can reach upwards of 30 in some markets.archipelago ofA major retrospective analysis of 3,246 hospitalizations followed by post-acute care engagementslittle islandsfound that the risk of re-hospitalization varied significantly between facilities, and that the variationwith no bridges. could be traced to specific risk factors. Hospital readmissions from post-acute care (PAC) facilities- Health system executiveis also associated with higher mortality rates, the authors concluded. 4 Similarly, the HealthcareCost and Utilization Project (HCUP) found the best performing Skilled Nursing Facilities (SNFs) hadan average Medicare length-of-stay of less than 24 days, but low-performing SNFs have an averageof more than 34 days. Additionally, 30-day readmissions can reach as high as 22 percent from some post-acute care facilities, as compared to a national average readmissions rate of 17 percent. 5Our analysis on the Care Gap shows there is low-hanging fruit and reason for hope. Health systems can focus on high impactpopulationsandbegintoreducethenumberofpatientswhofallthroughthecracks.Doingsowillbenefitpatients,reduce costs, and support long-term objectives througout the health care system.The Impact on Employers and IndividualsEvery year, human resource department leaders examine their company spending on employee health insurance and nearly every year that spend goes up. Similarly, the cost for individuals and families has also been increasing every year for decades.According to a gold standard annual report on employer health benefits, undertaken each year by Kaiser Family Foundation, annual premiums for employer-sponsored health coverage reached $22,221 in 2021, up from $15,073 a decade ago. The share of that cost paid by workers has also continued to rise, from a $4,129 average annual contribution in 2011 up to $5,969 in 2021. 6Those increases also continue to outpace both inflation and wages by significant margins. 7 And outpacingeverythingare deductibles, which have risen 92 percent. For employer-based plans, the average deductible now stands at $1,669, up from $991 a decade ago.While there are many contributing causes for the increasing cost of health insurance, we know that hospitals and physician services together account for a large proportion of U.S. spending on health care. Health System Tracker estimated that hospitals and physician services accounted for 51% of health care spending in 2019. 8 Addressing Care in the Gap offers the possibility of reducing overall spending by impacting the most significant domains of cost in health care.Efforts to contain these costs have been multidimensional, even resulting in some dramatic ventures, such as employers that actually pay their employees to travel internationally for major surgeries rather than pay for the cost of those procedures at U.S. hospitals, or self-funding unions that have directly contracted with providers to set up locations with incentives for their members to use those dedicated facilities. While laudable, there are much more compelling and immediate solutions at hand. Forlargenumbersofhighintensitypatients,thefirst7-10daysafteraninitialEDvisitoffersanopportunitytoreduceavoidableEDvisitsandhospitalizations,andincreasesatisfaction.Additionalcarecoordinationandclinicalsupportafterhospital stays or visits to the ED is compelling indeed.Together, we healTogether, we heal 4Together, we heal SCP HEALTHITHE GAP: WHY WE SHOULD CARE'