Health Plans | Utilization Management Post-Acute Care

eviCore’s Post-Acute Care solution provides a patient-centered approach that expands upon standard utilization review and prior authorization processes to fully coordinate the post-acute recovery process. We help patients receive the right care in the most appropriate setting by applying evidence-based guidelines to determine the appropriate level and site of post-acute care. The ultimate goal is to transition the patient to their home in a timely manner. Our solution supports the patient throughout the entire care continuum.

Members

Our patient-centric, comprehensive solution provides an individualized plan of care across the most appropriate continuum of post-acute care. We manage patient cases from day one of the inpatient stay to 30-, 60-, or 90-days after discharge from the acute setting.

 Corrected providers icon

Providers

Our Post-Acute Care solution relies on clinical protocols that utilize nationally recognized evidence-based guidelines. Our unmatched experience in care management and utilization management ensures improved clinical outcomes, lower readmission rates, and enhanced care coordination.

Health Plan

eviCore’s Post-Acute Care solution works closely with the patient, their caregivers, and providers throughout the duration of the care continuum. This staying power enables us to better manage quality of care, cost, and readmission risk, while improving both patient and provider satisfaction.

PDPM

Our current Skilled Nursing Facility (SNF) payment model is consistent with the new SNF payment model that CMS is mandating beginning October 2019.

Frequently Asked Questions

How does eviCore interact with Post-Acute Care patients?

Our nurse care managers begin engagement prior to hospital discharge, bringing evidence-based guidelines specific to the patient’s recovery needs into the discharge planning discussion. We involve patients, patient’s families, their doctor and nurse teams, and community resources to create the most supportive and consistent recovery plan available.

What is Post-Acute Care?

eviCore’s Post-Acute Care solution was developed to close the existing care gaps within the post-acute care continuum. Our solution eliminates inefficiencies, reduces cost, focuses on transitional care efforts, and improves the quality of patient care. The post-acute services include:

  • Analytics
  • Utilization review
  • Site-of-service management
  • Network development and management
  • Transitional care management (clinical staff embedded within acute and post-acute facilities and dedicated facility assigned telephonic clinical teams)
  • Provider education.
Where do you provide Post-Acute Care?

eviCore facilitates the delivery of post-acute care services in the most appropriate setting based on the patient’s medical necessity. The frequency of transitional care touchpoints is based on each patient’s clinical needs and the nature of the post-acute care setting. The modes of communication used may include in-person contact, telephonic, secure email/text, or a combination of methods.

Who and what guides the eviCore Post-Acute Care solution?

Our teams of medical directors, RNs, and their support teams utilize a proprietary case management system built specifically for managing post-acute care using evidence-based and CMS guidelines.

Why is Post-Acute Care needed?

The continuum of care from hospital to home can be very fragmented, involving many teams of caregivers, multiple post-acute providers and services, as well as various home-health options. Each step of the post-acute decision process can be complex and provide a significant risk for re-hospitalization or a setback to clinical progress. Our post-acute solution has been developed to proactively identify hazards to successful recovery and provide one consistent source of support throughout the care continuum.

clinical expertise

Our Post-Acute Care Program is patient centric. We work with the patient and establish goals with them. We have a transitional care program where we coordinate their care across the entire continuum.

Bridgette McGrath, RN, MSN

Senior Vice President, Post-Acute Care Operations