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.

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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.

How will eviCore’s Transitional Care Team communicate with patients?

eviCore’s Telehealth and Remote Patient Monitoring offers several communication tools for patients and caregivers. Patients can interact with their clinician through text messaging, voice calling, and video conferencing.

In addition to these communication platforms, eviCore’s Transitional Care Team will make telephonic outreach to members. Telephonic outreach from eviCore is patient-centered. A customized call plan with your eviCore Care Coordinator will be developed on your first call.

How will my doctor be notified if my condition worsens?
eviCore’s Transitional Care Team will monitor all information recorded by our members (ie. vital signs, symptoms, etc.) to identify and respond to abnormalities. When abnormalities are detected, such as shortness of breath or significant weight gain, eviCore’s Transitional Care Team will review the member's health information and status and report the change to the member’s physician and home health care team. This enhanced communication between eviCore and our member’s healthcare providers enables providers to quickly respond to and resolve member’s health needs, preventing hospitalizations and keeping our members in the comfort of home.
What are the benefits of telehealth and remote patient monitoring?

eviCore’s Telehealth and Remote Patient Monitoring program features several key goals and benefits for our members and for our partnering healthcare providers:


-       Reduce hospitalizations and ED visits

-       Individualize care

-       Increase engagement and satisfaction

-       Improve quality of life

-       Streamline care services

-       Reduce cost of care.

What does a normal day on the Telehealth and Remote Patient Monitoring program look like?

Each day, members will be expected to record their medications, vital signs, and symptoms on the tablet provided to them. Members may also be asked to watch a short video on their condition to help educate them on their symptoms and how to manage their care.

By clicking the link below, you can read about one member's journey on the Telehealth and Remote Patient Monitoring program.

Meet Rose »

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.

Who is eligible for eviCore Telehealth and Remote Patient Monitoring program?

A broad range of members are eligible to receive enhanced at-home care through Telehealth and Remote Patient Monitoring. eviCore members with chronic conditions or multiple comorbidities, recovering from surgery, or at an increased risk for hospitalization may be offered enrollment in the Telehealth and Remote Patient Monitoring program. Qualifying conditions include:

 

-       Hypertension

-       Chronic obstructive pulmonary disease (COPD)

-       Congestive heart failure (CHF)

-       Diabetes

-       Post-surgical complications.

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 Program is patient centric, we work directly with the patient and family to establish goals for the care in a PAC facility and Home.  Our Transitional Care Program provides members with education needed to remain safely in home.  Our remote patient monitoring program will help reduce readmissions with real time access to member information.

 

Corrine McKeever RN BSN

Vice President Clinical Operations Post Acute Care & Network Management

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