Successful Transitions Home

Whether going home after a hospital stay, outpatient procedure, or emergency department visit, Smart-ER™ organizes the work flow for the callback staff in performing re-contact phone calls.

Checking on a patient's well being and compliance with medications and follow-up prevents readmissions, and supports BOOST (SHM)RED (AHRQ), and Care Transitions efforts. In fact, telephone follow-up reduced costs by 84% in CHF patients.

Accountable care organizations appeal to payers when they manage medically-fragile patients using a nurse coach model with diagnosis-specific risk indicators.

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