Carelon

Carelon, operating as mynexuscare.com and officially known as Carelon Post Acute Solutions, is a healthcare services company focused on providing integrated, whole-person care. The company was launched in 2022 as part of the Elevance Health family. Previously, it was an independent company called myNEXUS, which was acquired by Anthem, Inc. (now Elevance Health) in 2021. The acquisition was completed on April 29, 2021, after which myNEXUS began operating as a wholly-owned subsidiary within Anthem's Diversified Business Group. In June 2022, myNEXUS joined the Carelon family of companies and officially rebranded to Carelon Post Acute Solutions on March 1, 2023.

The business centers on managing post-acute care services for health plans and other risk-bearing organizations. Carelon serves as a comprehensive home-based nursing management company for payers, delivering integrated clinical support for Medicare Advantage members. The company's business model involves collaborating with members, caregivers, and healthcare facility staff to coordinate transition planning and manage pre-service and concurrent review authorizations for post-acute care. Revenue is generated on both an at-risk and fee-for-service basis, targeting the total medical expenses of patients. The company offers a range of value-based pricing models to meet the specific needs of its payer clients.

Carelon's core service is a technology-enabled platform, NexLync, combined with a clinical team to optimize and automate home and post-acute care. This platform features an advanced analytic rules engine and is supported by a clinical staff of over 400 clinicians. Key features include automating the home visit authorization process, which helps to accelerate the time to care and enhance provider effectiveness. The services managed through this program encompass skilled nursing, home health aide, various therapies (physical, occupational, speech), wound care, and medical social work. By leveraging a nationwide network of high-performing home health providers, Carelon aims to improve health outcomes, reduce hospital readmissions, and create a more streamlined experience for members and their families.

Keywords: post-acute care, home health benefits management, nursing management, care coordination, Medicare Advantage, transition planning, utilization management, value-based care, clinical support services, healthcare technology platform, provider network management, claims processing, home nursing, integrated care, Elevance Health subsidiary, payer solutions, healthcare services, risk-bearing organizations, whole-person care, home health aide