Because health care is being moved to a higher level of accountability, there has been a focus on improving outcomes through improving postacute care. The issues of cost and readmissions to acute care settings are very important, but the focus on patient function has not been foremost. Because of the fact that most postacute care needs are based on functional limitations and that physiatrists are well versed in transitions of care, rehabilitation of patients back to community settings, team building, and leadership, it is appropriate for rehabilitation medicine to take a leadership role in the planning and development of postacute care services in the new integrated healthcare systems that are becoming prevalent in healthcare. This review discusses some of the issues in postacute care, the growth of the integrated health system model, and how there are opportunities and challenges for physiatric leadership to help develop these new models of care.