Post-Acute Complete
Manage post-acute recovery across facility care, home health, DMEPOS, and Care Navigation with one accountable model.
Managing the full post-acute journey with one accountable model
Post-Acute Complete helps your health plan manage recovery after hospitalization by connecting utilization management, Care Navigation, facility-based care, home health, DMEPOS, and specialty referrals.
By bringing together risk identification, clinical review, discharge coordination, referral routing, and reporting into a single workflow, you can better track member status, approvals, triggered support, and next actions across care settings. This visibility can help support governance, escalation, and implementation across the post-acute care journey.
Lines of business:
- Medicare
Audience:
- Payers
What should integrated post-acute care management deliver?
In post-acute care, fragmented processes can quickly become costly as members move from the hospital to the next stage of recovery — often with different providers, systems, and approvals involved. Post-Acute Complete is designed to connect decisions, services, and member support across settings so you can improve coordination, manage costs, and support the member experience.
Reduce avoidable handoffs across settings
We align facility-based care, home health, DMEPOS, and Care Navigation so you are not relying on disconnected workflows to manage recovery. Our approach helps reduce duplicate steps, close communication gaps, and keep care plans moving after discharge.
Match members to the appropriate level of care
We use evidence-based criteria, physician review, and level-of-care oversight to help determine whether a member is best supported in a skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), long-term acute care hospital (LTACH), home health, or another setting.
Support recovery after discharge
Our Care Navigators help eligible high-risk members understand next steps, access services, follow care plans, and connect to programs such as Wound Care Connect, social drivers of health support, palliative care, or DMEPOS coordination when needed.
Impact of our Post-Acute Complete solution
Inside Post-Acute Complete
Post-Acute Complete brings the core capabilities of post-acute management into one connected operating model, helping you move from early risk identification through ongoing oversight and reporting.
Risk identification
Use predictive analytics to flag high-risk members before discharge so teams can plan for follow-up, service needs, and barriers earlier
Clinical appropriateness and level-of-care review
Validate level of care, length of stay, home health needs, and DMEPOS needs using evidence-based criteria and physician review when needed
Care Navigation
Provide eligible high-risk members and caregivers a consistent point of support for follow-up, resources, referrals, and recovery needs after discharge
Specialty program referrals
Connect eligible members to support including Wound Care Connect, social drivers of health interventions, palliative care, behavioral health, pharmacy, or other health plan programs
Reporting, governance, and escalation
Gain visibility into utilization, outcomes, referral activity, and care gaps to strengthen reporting, review performance, and escalate complex cases when needed
Unified authorization and data flow
Route facility care, home health, and DMEPOS requests through a common workflow, giving you visibility into status, decisions, referrals, and reporting while offering a digital submission path for providers
How our solution works
Our connected workflow helps move post-acute care forward from identifying member needs through coordination and ongoing oversight.
Identify
Predictive analytics and clinical inputs identify members who may need additional support before or after discharge.
Review
Our automated platform reviews requests in real time against applicable clinical criteria.
Decide
Clinical reviewers validate the appropriate setting, length of stay, and service needs. Complex cases can move to physician review or peer-to-peer discussion.
Coordinate
We coordinate discharge needs, facility or home health transitions, DMEPOS delivery, specialty referrals, and support for members and caregivers.
Report
We provide member status, utilization, referral, care gap, and outcomes data to support claims, care management, reporting, and program oversight.
Ask us about our Post-Acute Complete solution
Contact us to explore how Carelon can help you create a more connected post-acute experience while improving coordination, visibility, and cost management across settings.
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Frequently asked questions
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, 2024. Individual health plan results will vary based on membership.