Reduce Cost. Improve Outcomes.

Your solution for Post Discharge Planning.
We combine technology, knowledge and expertise to reduce readmissions,
improve outcomes and provide more coordinated care.

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Why Post Acute Solutions?

Recent regulatory changes now put you at risk for managing where patients go after discharge. Our solutions, expertise and technology enable you to deeply understand and adapt to the changes taking place.

Key Focus Areas
  • Leakage outside your system network
  • Reduction in length of stay
  • ICU bottlenecks and reduction in readmissions for acute partners
  • Defining the network, identifying the providers with great outcomes and cost efficiencies
     
     
Our Advantage
  • All levels of post acute care coordinated and organized without one entity owning all
  • Meet the needs of new models of care transformation such as bundling and population health
  • Readmission avoidance and management programs for no/limited penalty and the readmission bonus portion for ACOs
     
Core Solutions
  • Patient placement and provider matching
  • Readmission assessment, prediction and mitigation using a multitude of sources: DRGs, medications, and social/psychographic sources
  • Transition of care and care coordination. Enables patient tracking through the continuum of care

Network Tools

Post Acute Solutions offers three tools designed to help you manage costs for your high risk patients.

  • Assessment/placement tool with readmission risk stratification
    • Allow for placement into the most appropriate level of care
    • Follows the patient from the acute discharge to home
      • Identifies patients at risk of readmission
      • Monitors patient througout their PAC stay and enables documentation at each level of care
      • Tracks and collates data elements for ongoing review
  • Episodic Cost Monitoring
    • Identify costs at each level of care
    • Monitor and tracks throughout the entire episode of care
    • Identify cost saving opportunities within the episode of care
  • eHealth Home Monitoring
    • Identify patient issues in the home
    • Support patient/caregiver concerns after PAC discharge

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patient matching

High-Risk Readmission Assessment

Our best-in-class readmission assessment tool enables real-time evaluation of patient risk for readmission. Leveraging data analytics such as DRGs, medications, patient statistics, co-morbids/procedures, social and psychographic sources the tool facilitates more proactive care to be delivered for high risk patients.

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Patient Matching

Our proprietary patient matching algorithms enable placement of patients in the optimal level of care

  • Assimilates expert knowledge at each care setting including: LTAC, IRF, SNF and HH
  • Ensures consistency in referral recommendations
  • Automates much of the process by accepting electronic Continuity of Care Documents
  • Monitors patient progress via automated daily reassessments using EHR data

Intuitive dashboarding enables flexible integration of placement algorithms within a wide degree of clinical workflows. Placement recommendation can be determined soley by the tool or the Care Transition Manager can be the next level.

Reporting is available to manually place complex cases.

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patient matching
transition

Care Transition Management

Our care transition platform eases entry for patients to downstream providers and provides continuous
feedback through all stages of the care continuum.

transition

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patient matching

Data Analytics

We enable you to harnesses the power of actionable data through unparalleled technology architecture.

  • Adaptive learning algorithms, powered by IBM Watson enable dramatically improved predictive accuracy
  • Aggregates and integrates patient data from all levels of the care continuum, including EMR records
  • Model driven architecture optimizes financial and health related outcomes

Our data analytics solutions standardize vast amounts of complex data across multiple sources in order to produce clear, clinically-relevant insights you can act on.

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