Home-Based Post-Acute Solution
Improve post-acute recovery with coordinated, clinically appropriate care in the home.
Optimizing home health benefits in post-acute care
Carelon’s Home-Based Post-Acute Solution helps health plans create a more coordinated path from hospital discharge through recovery at home. Rather than treating authorization, care delivery, and member support as separate handoffs, we bring them together through real-time clinical review, home health network insights, and referrals to specialty programs. This connected approach can help members begin care sooner and recover safely at home, while providing you with stronger visibility into utilization, outcomes, and costs across the home health journey.
Lines of business:
- Medicare
Audience:
- Health plans
What should connected home health care deliver?
In home health, speed matters, but speed without oversight can create variation. We focus on three outcomes: helping members start care quickly, aligning services with clinical need, and closing gaps that could put recovery at risk.
Start care sooner after discharge
Real-time review supports timely decisions for home health requests and helps reduce delays between facility discharge and the first home health visit. That matters for members who need skilled nursing, therapy, wound care, or other Medicare home health benefits.
Match services to clinical need
Clinical guidelines, length-of-service planning, and progress monitoring help align the amount and type of care to each member’s needs. This provides a more consistent way to manage home health utilization without disrupting appropriate recovery.
Close gaps that can slow recovery
We connect home health providers, care management teams, and specialty programs such as social drivers of health and Wound Care Connect. The goal is to prevent avoidable gaps that can lead to readmissions, unnecessary services, or stalled recovery.
Proven outcomes in post-acute care
Inside our Home-Based Post-Acute Solution
Our connected capabilities help manage the home health episode through clinical oversight, care coordination, specialty support, and quality reporting.
Clinical appropriateness review
Apply evidence-based criteria to home health requests and support real-time approvals when criteria are met
Length-of-service planning
Monitor recovery progress and determine when care should continue, step down, or close
Care Coordination
Connect providers, health plan care management, and member support services so care plans carry through after discharge
Social drivers of health program
Address nonclinical factors that impact recovery at home
Star gap closure program
Use home-based touchpoints to identify and close quality gaps that can affect Medicare performance
Wound Care Connect program
Support members with complex wounds or ostomies through wound nurse collaboration, provider documentation review, and healing-focused care pathways
Advanced analytics and reporting
Track utilization, outcomes, length of service, readmission trends, and provider performance
Network management (optional)
Leverage value-based home health providers where delegated or evaluate other network providers using quality scorecards
How our solution works
Request
Providers assess member needs, develop a care plan, and submit the home health request online.
Review
The platform evaluates the request against clinical criteria, plan requirements, and discharge information.
Determine
Requests that meet criteria can be approved in real time. More complex requests are routed to clinical reviewers for further evaluation.
Coordinate
We help align the care plan, start-of-care timing, specialty program referrals, and discharge needs.
Monitor and report
We share data on progress, length of service, utilization, care gaps, and outcomes for claims, care management, and reporting support.
Ask us about our Home-Based Post-Acute Solution
Contact us to explore how Carelon can help you start home health care sooner, manage utilization more consistently, and improve post-acute recovery.
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Frequently asked questions about Home-Based Post-Acute Solutions
Member and provider inquiries
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 800-252-2021 or contact our support team.
Business hours: 8 a.m. to 5 p.m. CT.
1 Carelon internal data, 2023. Individual health plan results will vary based on membership.