Facility-Based Post-Acute Solution
Support appropriate facility care with level-of-care review, length-of-stay planning, and safer transitions.
Optimizing post-acute care management in facility settings
Facility-based post-acute care management helps health plans make consistent decisions about care delivered in skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term acute care hospitals (LTACHs).
Our Facility-Based Post-Acute Solution connects clinical review, setting optimization, length-of-stay planning, and provider collaboration so members receive the right services at the appropriate site of care. Unlike a narrow authorization workflow, our model follows the facility episode from request through transition planning, giving health plans clearer visibility into utilization, care progression, and avoidable cost.
Lines of business
- Commercial
- Medicare
Audience:
- Payers
What should facility-based post-acute care deliver?
Facility-based care can vary widely by setting, member acuity, and discharge readiness. Our model focuses on three outcomes health plans need from post-acute care coordination: appropriate placement, disciplined length-of-stay management, and safer transitions to the next level of care.
Place members in the right level of care
Clinical review and setting optimization help determine whether an SNF, IRF, LTACH, or lower-acuity setting best matches the member’s current needs and medical history. This reduces variation across facilities and supports appropriate use of post-acute care benefits.
Manage length of stay without disrupting recovery
Length-of-stay planning and continued-stay review monitor whether the care plan is moving toward recovery goals. Health plans gain a clearer way to identify unnecessary days while preserving needed clinical support
Plan transitions before discharge risk builds
We coordinate across hospitals, facilities, and health plans to support discharge planning and follow-up care. Our goal is to prevent delays, avoid gaps between settings, and identify referrals that can support the member after facility care.
Impact of our facility-based model
Inside our Facility-Based Post-Acute Solution
Our connected capabilities support the facility episode from request review through care progression, provider collaboration, discharge planning, and reporting.
Clinical appropriateness review
Apply evidence-based criteria to facility requests and support real-time approvals when clinical requirements are met
Clinical setting optimization
Validate the least restrictive, appropriate level of care based on current needs, history, and requested setting
Length-of-stay planning
Monitor progress and continued-stay requests to determine when the next level of care is appropriate
Provider collaboration and peer-to-peer review
Offer proactive clinical discussion with a medical director when a request may not meet criteria
Transition-of-care coordination
Support safe discharge plans and identify referral opportunities for health plan or Carelon programs
Advanced analytics and reporting
Track setting mix, utilization, length of stay, authorization outcomes, and referral opportunities
How our solution works
Request
Providers submit requests for post-acute facility care through an online platform.
Review
The platform checks the request against clinical criteria, discharge information, plan requirements, and case management referral opportunities.
Determine
Requests that meet criteria can be approved in real time; complex cases move to clinical review to confirm setting and length-of-stay needs.
Collaborate with providers
When needed, Carelon supports peer-to-peer clinical discussion to align on the appropriate level of care and treatment plan.
Monitor the stay
Clinical teams track progress, review requests for additional days, and identify when a member may be ready for the next level of care.
Plan transition and report
Carelon supports discharge planning and shares authorization, utilization, and reporting data for claims and care management.
Ask us about our Facility-Based Post-Acute Solution
Contact us to explore how Carelon can help you optimize post-acute care management and improve outcomes across facility settings.
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Frequently asked questions about facility-based post-acute care
Are you a health plan member?
Are you a health plan member? If you have a question about your health plan, please call the Member Services number on the back of your member ID card.
Provider inquiries: For questions about a request or the Provider Portal: Call 844-411-9622 or contact our support team.
For questions about the provider network, call 833-585-6262 or email our network team.
1 Carelon internal data, 2023. Individual health plan results will vary based on membership.