Operationalizing a Portfolio of Substitutive Acute Care

For almost 2 centuries, the US health care system has relied on the hospital as the central site for acute care delivery.Hospitals remain essential for life-saving care, but they are increasingly under strain.Mounting capacity pressures from an aging population and a rising health care cost burden are forcing health systems to reconsider the role of this central societal health care resource.Health care delivery science and technological advancements have also inspired consideration of substitutive acute care strategies (SACS)-care pathways designed to substitute for traditional brick-and-mortar (BAM) hospitals.1 Most SACS research to date has evaluated a single clinical pathway in isolation; the more pressing question for health systems is whether several can be run together, at scale, as a coordinated portfolio.