Source: https://ensurecare.ai/modules/readmission-reduction

> EnsureCare checks in after discharge, books the follow-up visit, and routes warning signs to the care team while a readmission can still be prevented.

Care access & continuity

# Every discharge to a follow-up kept.

EnsureCare checks in during the first days after discharge, books the follow-up visit, and routes warning signs and questions to the care team while a readmission can still be prevented.

[Book a demo](https://ensurecare.ai/book-demo) See how it works

**Eleanor W.** Home since Mon · No follow-up booked

Text message

1. EnsureCare Hi Eleanor, checking in after your hospital stay. Any questions?
2. Should I still take the new water pill?
3. Question routed to care coordinator
4. EnsureCare Your care coordinator will call you today. Can I book your follow-up for Thursday at 10:00 AM?
5. Yes, Thursday works.
6. Follow-up booked · care team updated

- **11.8%** of Medicare admissions lead to an unplanned readmission within 30 days. Tak et al., JGIM 2021
- **$48,030** average inpatient cost of a readmission stay. Tak et al., JGIM 2021
- **5.7 days** average length of the readmission stay. Tak et al., JGIM 2021

Where it stalls

## Discharge ends the stay. Recovery happens at home.

Recovery can slip at many points after discharge, including these three.

1. 01. **No follow-up booked** The patient goes home without a follow-up visit on the calendar. **No visit scheduled**
2. 02. **Questions go unasked** New symptoms, missing medications, and unmet needs surface at home, with no one checking in. **Warning signs missed**
3. 03. **Too many discharges to call** Care managers cannot check in with every patient in the first days at home. **Patients not reached**

How it works

## From readmission risk to resolved.

The first days after discharge decide whether recovery holds. Patients go home with new medications, questions, and a follow-up visit to book.

**Care Adherence Intelligence & Recovery Platform** **CAIR Platform**

[See it on your discharges](https://ensurecare.ai/book-demo) [Explore the platform](https://ensurecare.ai/platform)

What makes it different

## Built to finish the work.

- **Acts in the window that matters** Analytics find risk after the fact. EnsureCare acts in the days after discharge.
- **Check-ins that listen** New symptoms, missing medications, and unmet needs surface and route right away.
- **More reach for care managers** Routine check-ins run on their own, so your team spends time where it is needed.

Measured from day one

## Results you can see and report.

Every action is logged, so impact is measured against your own baseline.

- 30-day readmission rate
- Follow-up visits within 7 days
- Check-ins completed
- Escalations resolved

Built for

- [Health Systems](https://ensurecare.ai/customers/health-systems)
- [FQHCs & CHCs](https://ensurecare.ai/customers/fqhcs-chcs)
- [Rural Care](https://ensurecare.ai/customers/rural-care)
- [Ambulatory Surgery Centers](https://ensurecare.ai/customers/ambulatory-surgery-centers)

Pairs well with

- [No-show recovery](https://ensurecare.ai/modules/no-show-recovery)
- [Referral closure](https://ensurecare.ai/modules/referral-closure)
- [Medication adherence](https://ensurecare.ai/modules/medication-adherence)

Integrates with your existing stack

Epic Oracle Health athenahealth MEDITECH eClinicalWorks Twilio

## Bring us your discharges. Let’s keep patients home.

Show us how follow-up works after discharge today. In a 30-minute walkthrough, we will show how EnsureCare covers the first days at home.

EnsureCare

[Book a demo](https://ensurecare.ai/book-demo)

[Run your ROI numbers](https://ensurecare.ai/roi)