ED Post-Discharge Patient Navigation

A health system located in a large metropolitan area with other large health systems is competing to capture and retain patients. One of the key entry points for this health system is their emergency department locations. However, after discharge, they are seeing a large percentage of patients seeking prescribed follow-up care at non-network aligned facilities. In addition, they are dissatisfied with the amount of ED readmissions due to lack of timely follow-up care. 

Leveraging Care Continuity's ED Post-Discharge Patient Navigation solution, a data feed is sent to Care Continuity where the software's AI uses dozens of data points -- including diagnoses, discharge notes, patient information, social determinants of health, and more -- as well as a set of customizable prioritization rules to create a navigation queue for a team of expert navigators to personally contact and navigate. 

This allows for a multi-dimensional approach to patient navigation that can predict which patients are most in need of, as well as open to, navigational assistance. 

As a result, the health system sees a reduction in post-ED outmigration to competitor facilities. Discharged patients are 83% more likely to receive in-network follow-up care, and ED readmissions are reduced by 33%. This leads to an average ROI of 4:1 within 120 days of program launch. 

Medium to extra-large health systems

Leading EHR functionality takes a very basic approach to patient navigation. When utilized, the EHR prioritization queue is binary, labeling every patient as urgent or non-urgent. Instead, Care Continuity not only expands the total number of evaluated data points needed to properly prioritize a patient, but Care Continuity also expands the priority listing to 10 levels, allowing for a more nuanced and tailored navigational experience. 

In addition, the EHR functionality requires the health system to staff a team of navigators. Unfortunately, this largely non-clinical function is staffed by clinical staff, severely hampering their ability to work at the top of their license. 

Care Continuity pairs their purpose-built software with a team of trained, non-clinical concierges who are experts in patient experience and proper navigation.