The challenge

MaineHealth faced several major post-acute care (PAC) challenges that contributed to prolonged length of stay (LOS). Limited bed availability, driven by Maine's aging population and the closure of more than 25 facilities over the past decade, reduced placement options across the state. At the same time, many skilled nursing facilities (SNFs) were hesitant to accept higher-cost patients due to Medicaid reimbursement gaps and financial instability. Limited clinical capabilities also further restricted capacity for patients with complex needs, including dialysis, behavioral health conditions, and bariatric care.

The organization

MaineHealth is a not-for-profit, integrated health system that offers a range of care and services. With more than 2,000 employed providers and approximately 24,000 care team members, MaineHealth provides preventive care, diagnosis, and treatment to 1.1 million residents in Maine and New Hampshire.

The approach

MaineHealth has taken three key steps to improve patient throughput and reduce LOS. First, MaineHealth established a post-acute leadership structure, including a multidisciplinary leadership team.

Next, the organization aligned leadership to PAC through relationship-based engagement. Leaders invested time in visiting facilities, understanding their capabilities and constraints, and engaging executive leadership.

Finally, MaineHealth prioritized financial alignment. The organization used single-case agreements, transportation support, and targeted subsidies to improve the financial sustainability of caring for high-needs patients.

The partnership

MaineHealth engaged Optum to assess its post-acute landscape and build a durable improvement plan. Optum advisors supported the facility and stakeholder research across MaineHealth's post-acute network, helped define the new system-level PAC leadership structure, and modeled the financial levers — single-case agreements, transportation support, and targeted subsidies — used to unlock placement for high-acuity patients. MaineHealth led execution; Optum provided the analytics, benchmarking, and change-management support behind it.

3 ways MaineHealth improved patient throughput and LOS

Facing limited post-acute bed and clinical capacity, financial pressures on SNFs, and challenges placing high-acuity patients, MaineHealth implemented a multipronged strategy to improve patient throughput and reduce LOS.

Results

MaineHealth’s multipronged approach, centered on stronger post-acute partnerships, greater accountability, and targeted financial support, led to meaningful improvements in patient throughput and LOS.

The results within SNF settings are also particularly notable as SNF discharges increased by 363 patients while both average and total excess days declined. Average excess days per patient decreased from 8.55 to 7.05 days, eliminating 1,297 total excess days and generating approximately $4.6 million in avoidable excess-day costs compared to baseline performance. Overall, MaineHealth fundamentally improved patient throughput and strengthened relationships with its SNF partners.

These results underscore important lessons: relationships matter, and trust is the foundation on which transformative change can occur. By strengthening post-acute partnerships, MaineHealth was able to improve care and enable more efficient patient transitions across the care continuum.

The MaineHealth–Optum partnership translated stronger post-acute relationships and targeted interventions into measurable results: 1,811 additional post-acute discharges, 5,356 excess days avoided, and roughly $5.6 million in avoidable excess-day costs.

Optum is a health services and innovation company helping health systems improve care delivery, clinical performance, and operational and financial sustainability. Optum Advisory partners with provider organizations on care transitions, throughput, and post-acute network strategy, combining data-driven diagnostics with hands-on implementation support.

This case study is in partnership with Optum, an Advisory Board member organization. Representatives of Optum helped select the topics and issues addressed. Advisory Board experts wrote the case study, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.