Transitions of Care

Attempting to avoid preventable readmissions and reduce their risk of penalties, health systems are turning to their already limited care management resources to contact patients after discharge — an inefficient approach at the expense of clinical priorities. We become part of your overall population health program. With light and efficient multi-channel touches, we help you proactively reach more patients after discharge from acute care or ambulatory settings while you focus on the patients that need you most. Through a brief assessment, we review the patient’s experience and transitions of care needs. Based on their responses, some calls are escalated to our clinical team to review discharge instructions and coordinate follow-up care to support the recovery process.