HCAP V Healthcare Spotlight:
Puzzle Healthcare
Founded in Detroit, MI, Puzzle Healthcare is a post-acute care management platform providing physiatry (physical therapy and rehabilitation) and care coordination to improve functional ability and quality of life for patients following hospitalization or serious injury or illness. The company treats patients in skilled nursing facilities (SNFs) and supports them for 90 days after discharge. Puzzle partners with more than 60 hospital systems to deliver post-acute care across SNF networks, reducing readmissions and improving quality of care, with services provided at over 200 SNFs across 15 states.
Amid rising healthcare costs driven by an aging population and increasing patient acuity, HCAP supports companies that reduce the cost of care and expand access for patients across the United States.
HCAP’s 2025 investment in Puzzle Healthcare (Puzzle) is an example of a company creating significant reductions in cost of care through targeted healthcare services that achieve better patient outcomes.
The Patient Care Journey At Puzzle-supported SNFs
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SNF ADMISSION
On-site Care Management
Upon admission to the SNF, eligible patients are assigned a care manager and begin treatment with Puzzle’s clinical team, including physiatrists. Clinician performance is monitored by a regional clinical manager, alongside on-site quarterly reviews with the SNF Director of Nursing.
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SNF STAY
Care Planning and Delivery
Puzzle’s care team collaborates with SNF staff on care planning, delivers treatment, documents in the EMR, and produces summaries of the patient’s stay. The team also coordinates with the patient’s Primary Care Physician and maintains communication with family members.
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SNF POST-DISCHARGE
Day 1-30
After discharge, care managers conduct weekly or more frequent check-ins based on risk level. Support includes medication reconciliation, pharmacy coordination, follow-up care, medication delivery, home safety needs, and social supports such as transportation, caregiving, and meals.
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SNF POST-DISCHARGE
Day 31-60
Puzzle continues weekly or biweekly check-ins as needed, monitoring symptoms, coordinating refills and appointments, and maintaining communication with the patient’s primary care physician and specialists.
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SNF POST-DISCHARGE
Day 61-90
Puzzle maintains check-ins as needed, monitors for hospitalizations or emergency visits, confirms care plan completion, and tracks readmission trends to inform reporting and feedback to SNFs and health systems.
Puzzle and HCAP Partners’ Healthcare Impact Thesis
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EXPAND ACCESS TO CARE
Puzzle’s physiatry and care management services are at no-cost to health systems or SNFs and are billed directly to Medicare and insurance payors. This zero-cost model spurs adoption for SNFs and healthcare systems and helps Puzzle scale to provide physiatry and care management to more patients across the U.S. In 2025, Puzzle treated over 27,000 patients, a 34% increase from 2024.
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IMPROVE QUALITY OF CARE
Puzzle’s services help SNF patients heal and recover, providing patients and families with continuity of care during their most vulnerable period of recovery. Puzzle’s care management structure catches patient deterioration before it leads to readmission, resulting in better patient outcomes.
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REDUCE COST OF CARE
Puzzle helps SNF patients avoid hospital and facility readmissions post-discharge, which are costly and impact quality of care ratings. Hospitals and SNFs are penalized by the Centers for Medicare & Medicaid Services (CMS) with payment reductions for high patient readmission rates. For one of their hospital system partners, Puzzle reduced readmission rates from 29% to 9%, lowering Medicare penalties from 2.7% to 1.4%.