Now that hospitals are being held responsible for what happens to a discharged patient, health care providers are beginning to use higher level clinicians—even physicians—to make home visits for high-risk patients. Two healthcare systems are developing and deploying home-based care transition programs to improve post-discharge care outreach.
In my last blog, I talked about a branch of analytics called predictive analytics, which help identify patients who are at highest risk for being hospitalized. Focusing on such patients can help dramatically improve their health outcomes—and yield significant cost savings. But first you have to identify and prioritize the individuals in need of help.