Post-Acute Complete
Improved recoveries with connected care
Post-acute care is one of the highest-cost, least-controlled phases of the healthcare journey and a major driver of avoidable readmissions, extended length of stay, and member dissatisfaction. As inpatient stays shorten and more recovery shifts to home and post-acute settings, gaps in coordination now carry greater financial and quality risk for health plans — while providers face administrative barriers that delay timely, appropriate care.
Carelon’s Post-Acute Complete addresses these challenges by unifying utilization management and care navigation into a single, accountable program. Through connected support across facility care, home health, and durable medical equipment, Post-Acute Complete improves care coordination, reduces post-acute costs, and delivers a more seamless recovery experience for members.
Lines of business
• Medicare
Unlike traditional post-acute management, Post-Acute Complete extends beyond authorization to actively coordinate member needs across diverse post-acute care settings.
Clinical appropriateness
Real-time, evidence-based reviews ensure the right care, in the right setting, for the right amount of time.
Connected transitions
Care Navigators support members from hospital discharge planning through 30–60 days post-recovery, helping avoid gaps and prevent readmissions.
Whole-person focus
Engagement strategies address physical, behavioral, and social drivers of health, such as food, housing, transportation, and caregiver support.
Streamlined operations
A single platform reduces administrative burden, improves provider collaboration, and accelerates time to care.
To change outcomes in post-acute care, health plans need more than authorization — they need coordinated execution across settings.
Making recovery more seamless
Leading health plans are rethinking what their post-acute model looks like. For them, it’s about uninterrupted care, frictionless collaboration within their network, and simplified decision-making. Our connected set of features puts these needs into motion at scale.
Post-Acute Complete follows a four-step workflow:
Step 1: Request
Providers submit prior authorization requests for facility care, home health, or durable medical equipment through our digital portal, enabling timely review and faster access to care.
Step 2: Review
Clinical experts evaluate requests in real time using evidence-based criteria, with peer-to-peer consultations available when additional clinical discussion is needed.
Step 3: Coordinate
Care Navigators connect members, caregivers, and providers to align discharge plans, coordinate services, and ensure smooth transitions across post-acute settings.
Step 4: Support
High-risk members receive extended follow-up and referrals to specialty programs such as wound care, palliative care, or social drivers of health services.
Together, these steps ensure the right care, at the right time, across every phase of post-acute recovery.
Results that matter
- 80% savings per episode for a skilled nursing facility redirected to home health.*
- $756 saved per member, per month through Care Navigation.*
- Consistent quality across a high-performing network of 4,000+ agencies.
Let’s redefine recovery, together
Post-Acute Complete transforms post-acute care into a connected, member-centered experience.
Contact us to learn how we can help you lower costs, improve outcomes, and deliver better recovery journeys.
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* Internal data, 2024. Individual health plan results will vary based on membership.