NaviHealth

NaviHealth operates as a pivotal player in the post-acute care sector, specializing in care management services for health plans and provider systems. The company was established in 2012 by Tom Scully, a notable figure in healthcare policy who previously served as the administrator for the Centers for Medicare and Medicaid Services (CMS) from 2001 to 2004. His extensive background in shaping Medicare reform, including the influential Medicare Part D and Medicare Advantage legislation, directly informed NaviHealth's strategic focus on navigating the complexities of post-acute care.

The company's business model is centered on a value-based care approach, aiming to improve patient outcomes while managing costs for its clients, which primarily consist of health plans, hospital systems, and risk-bearing physician groups. NaviHealth partners with these entities to manage the entire continuum of post-acute care, from hospital discharge to recovery. Revenue is generated by providing technology-enabled services and clinical support to manage care transitions effectively. The company's core offering combines a proprietary technology platform with on-the-ground clinical staff to guide patient care decisions after a hospital stay. This "high-tech, high-touch" model uses data analytics and evidence-based protocols to determine the most appropriate post-acute setting for a patient, such as a skilled nursing facility, inpatient rehabilitation, or home health care, with a goal of reducing unnecessary readmissions and optimizing recovery.

NaviHealth's services include decision-support tools that help clinicians assess patients for post-acute needs and identify those at high risk of readmission. By analyzing extensive data from millions of patient records, the platform generates personalized care plans aligned with a member's specific goals and circumstances. This insight-driven approach helps to streamline discharge planning and coordinate care among various providers. Over the years, NaviHealth has expanded its capabilities through strategic acquisitions, including RightCare Solutions in 2015 and Curaspan in 2016, to bolster its decision support and care transition technologies.

The company has undergone significant ownership changes, reflecting its strategic importance in the evolving healthcare landscape. Cardinal Health acquired a majority stake in 2015, which was later sold to private equity firm Clayton, Dubilier & Rice in 2018. In a landmark deal in May 2020, Optum, a division of UnitedHealth Group, acquired NaviHealth for over $1 billion. Following the acquisition, NaviHealth continued to operate as a standalone entity under its existing leadership, including CEO Clay Richards, with a focus on integrating its clinical model with Optum's broader community-based health capabilities. Starting in 2024, Optum's post-acute-care companies, including NaviHealth, were rebranded as Home & Community Care.

Keywords: post-acute care management, care transitions, value-based care, Medicare Advantage, bundled payments, skilled nursing facility management, readmission reduction, clinical decision support, healthcare analytics, patient discharge planning, care coordination, population health management, senior care solutions, health plan services, provider solutions, Optum, Tom Scully, Cardinal Health, Clayton Dubilier & Rice, Home & Community Care