Post-Acute Client Case Study

Post-Acute Care Outlook:

A Growing Concern for Health Plans

Many health plans have realized that they need to manage post-acute care (PAC) more closely. Unnecessary risks drive costs and decrease patient outcomes.

  • $60 billion

    The amount Medicare spent on PAC services in 20161

  • 25%

    Percentage of PAC total spend in an average MA plan2

  • $17.5 billion

    The annual cost of readmissions to Medicare (at nearly $10,000 cost per hospital readmission)3

  • 96%

    Of patients are sent to a PAC facility without consideration of provider quality4

The Challenge

Client Profile:

  • 300,000 members
  • Medicare Advantage and Commercial plans
  • Little oversight of care in post-acute care facilities (SNFs, IRFs)
  • High readmission rates

Approach Implemented:

  • The CareCentrix comprehensive Post-Acute Care program, 90-day full-risk option

CareCentrix’s extensive experience and ability offered a holistic solution which addressed all of the health plan’s needs.

Key Components of the Post-Acute Care Program

  • Discharge Management

    Identifying patient risks, helping guide to the right setting of care.

  • Facility Management*

    Partnering to manage in-facility care helping to ensure the right length of stay and level of care.
    * SNFs, IRFs, LTACHs

  • Readmissions Management

    Lining up the right support for the patient to help avoid readmission – regardless of site of care.

  • Home-based Services

    Coordinating the right care at home for the patient.

Program Details

  • Reduces risks and costs for both payors and patients
  • Determines the path of care & length of stay to improve outcomes
  • Coordinates all patient services for a safe transition home
  • Manages patients for up to 90 days post-discharge
  • Identifies patients most at-risk for readmissions

“CareCentrix is committed to service excellence and continuous process improvement. They listen to their customers and are willing to be open-minded, creative & solutions-oriented. They provided us with best in class implementation, project management, and account management resources.”

– Director, Clinical Relationships Management

Impact: First 3 Months Post-implementation

  • 11%

    Savings of total post-acute care spend.

  • 100%

    Of Service Level Agreements with client met and exceeded.

  • 33%

    Readmissions reduction in commercial line of business.

  • 95%

    Of members indicate the program has empowered them to manage their own health going forward.

  • 9%

    Readmissions reduction in Medicare line of business.

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