Post-Acute Care

There are a hundred paths to home in post-acute care. We guide patients to the right one.

The Challenge

Post-Acute Care (PAC) is fragmented.

Health plans often do not have the specialized resources to manage the complexity of the post-acute care continuum, resulting in increased risk for adverse patient outcomes, waste, and additional costs. To solve for this, CareCentrix implements an end-to-end post-acute care program on behalf of our clients, managing patients’ post-hospital discharge throughout the entire care continuum.

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  • Post-acute care accounts for an estimated 20-25 percent of total spend in Medicare Advantage plans1

  • Payers absorb $17.5 billion in wasteful spending while patients face unnecessary medical risks and costs2

  • 75% of hospital readmissions are caused by preventable errors3

Why Choose CareCentrix as Your Post-Acute Care Partner?

To help select the right site of care for the right length of stay, the CareCentrix Post-Acute Care program provides personalized care with an emphasis on the home. The CareCentrix program:

  • Reduces unnecessary utilization of SNFs
  • Reduces readmission rates
  • Makes the home the center of care
  • Proactively engages patients from hospital to home

The CareCentrix Approach

CareCentrix works with network providers – including hospitals, Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and home care providers – to connect a patient’s journey across the continuum, identify paths for care that help optimize clinical outcomes, and identify patients most at-risk for readmissions so we can help them get the follow-up care they need. The program also coordinates the services patients need to transition to care at home safely, via home health, durable medical equipment (DME), and home infusion providers.

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Benefits

  • Provides expertise

    • We have served 2.5+ million members to-date
  • Reduces overall costs

    • We help plans reduce PAC costs by an average of 15%
  • Diminishes hospital readmissions

    • We have helped health plans decrease all-cause readmission rates by nearly 40%
  • Keeps patients happy

    • 95% of patients would recommend the CareCentrix program to a friend

Questions About The Post-Acute Care Program

  • Answer: CareCentrix supports the patient discharge process for patients most at-risk for hospital readmissions by providing onsite staff in facilities and phone consults to:

    • Identify the patient’s unique, post-discharge needs
    • Through the use of data-driven analytics, advise on the path of care for the patient after the hospital by helping to identify the best facility (e.g., SNF, IRF) or home care agency, based on the patient’s specific needs
    • Support the patient and caregivers during any additional facility stays, as well as on their journey home
    • Arrange for care at home, including home health, DME, and home infusion
    • Work with the patient one-on-one post-discharge to help ensure their path to healing, reduce readmission risk, and achieve self-management
  • Answer: In order the best serve patients who need post-acute Skilled Nursing Care, CareCentrix provides the following services to in-network SNFs:

    • Local, in-market Nurse Liaisons, who participate in case rounds in the SNFs, work collaboratively with the clinicians at the SNF on the care plan, and work with patients and caregivers to ensure patients are progressing towards their goals; they also work collaboratively with the attending physician or facility medical director when and/or where appropriate
    • The CareCentrix provider management team reviews quality scores and assessments with SNFs to drive continued performance improvement, sharing robust performance reporting
    • CareCentrix’s advanced analytic tools help identify the ideal length of stay for each patient to ensure appropriate and timely discharge to the home, estimate readmission risk, and the timeframes in which hospital readmissions are most likely to occur
    • CareCentrix generates a care plan that outlines the right path of care for a patient and will manage all of the post-acute care services that are required in the home post discharge
  • Answer: CareCentrix has a robust implementation process that begins with a dedicated and experienced implementation team, focused on flawless execution of an effective implementation plan. The team reports directly to the Chief Operations Officer and uses six-sigma methodology and team collaboration to offer an expedited implementation process. This process begins with a kickoff meeting to introduce teams, identify stakeholders, and establish expectations. Our standard is to execute on a successful implementation within 90-120 days from sign-off of the requirements gathering process by both client and CareCentrix.

  • Answer: We use a variety of levers to drive savings, including:

    • Utilization Management: We reduce post-acute care utilization (e.g. SNF days/1,000) by ensuring that appropriate utilization of post-acute services at the right site occurs across the entire post-acute continuum.
    • Hospital Readmissions Reduction: CareCentrix provides all-cause readmission management, addressing the broadest population at risk for readmissions. The majority of readmissions come from members discharged home without any services; programs that only focus on managing inpatient post-acute care facilities do not address this need. Our programs provide outreach to all members discharged from hospitals and post-acute care facilities.
    • Payment Integrity: CareCentrix evaluates all claims for fraud, waste and abuse and coordinates recoveries with clients. In addition, we scrub claims for payment accuracy and perform service validation calls to ensure services billed have been delivered.
    • Administrative Costs: Our clients realize a reduction in overall administrative expenses. These savings are a result of CareCentrix assuming operations accountability associated with utilization management and related functions (including call centers, denials, and letters) and if delegated, network related costs.
    • Network Management: Optimization of networks can reduce readmissions as well as drive unit cost savings.

    CareCentrix has highly competitive and flexible pricing options and stands at the ready to meet the needs of our clients to maximize anticipated outcomes of our post-acute care program.

Through HomeBridge, our purpose-built care coordination technology platform, we combine the power of insight from 100 million patient records with a personalized approach for each individual’s care that can eliminate dangerous gaps as a patient transitions from hospital to home.

Health plan business leaders can build optimal provider networks, ensure that the right provider is matched with the patient based on his or her unique needs, and future-proof their patient engagement approach by deploying the clinical and technology services that a patient needs to heal and age at home.

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Need help optimizing your post-acute care strategy?

Sources:

  1. Medicare Payment Advisory Commission. (2017) Report to the Congress: Medicare Payment Policy.
  2. The Revolving Door: A Report on U.S. Hospital Readmissions. (2013).
  3. DRAFT Measure Speci­fications: Potentially Preventable Hospital Readmission Measures for Post-Acute Care (2015)