Proactive Patient Follow-Up Across the Care Continuum

Easily follow patient populations, stay informed of their progress, and ensure timely care interventions to improve outcomes

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Ensure Timely, Coordinated Patient Follow-Up

Patient Follow-Up Software helps care teams stay connected with patients throughout their recovery journey. With real-time updates and clear accountability, the platform supports timely interventions, closes care gaps, and improves overall patient outcomes.

Automate follow-up workflows and outreach

Align care teams with real-time patient updates

Drive timely, informed decisions and reduce communication delays

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“PAC Management has become an integral part of our team. It’s always there, never gets sick, and it helps us be proactive in patient care. The most valuable impact is having real-time insight into what’s happening with our patients, allowing us to catch significant changes and collaborate with SNFs to prevent avoidable ED visits and readmissions. It’s a feel-good moment knowing that we’re making a real difference in patients’ lives and supporting our SNF partners.”

Samantha Caruso, Manager, Care Manager

Ascension Illinois

Close Care Gaps With Actionable Follow-Up Workflows

Patient follow up software allows you to actively monitor the post-acute transition process. Eliminate time spent searching and calling for patient status updates and reduce readmissions and SNF length of stay (LOS) with real-time data.

View admissions and recent discharges for timely follow‑up
Prioritize outreach with our Predictive Return to Hospital (pRTH) machine learning model
See LOS and estimated discharge dates to plan next‑site care
Access patient‑level clinical data (vitals, medications, labs, notes, therapy)

Improve Follow-Up

Empower Teams to Deliver Effective, Personalized Follow-Up Care

Patient follow up software allows hospitals and health systems to better monitor their post-acute populations, quickly identify patients of concern, and provide timely intervention.

Eliminate inconsistent collaboration across patients and providers
Confirm medication reconciliation and key intake completion steps like clinical assessments were completed at the SNF.
Collaborate with SNF partners using shared performance and patient insights

Empower Your Teams

Monitor Follow-Up Completion and Patient Recovery

Care coordinators and case managers can conveniently track their patients, keep informed about their progress, and guarantee prompt interventions that lead to better outcomes.

Optimize skilled nursing LOS by identifying patients ready for discharge
Capture signs of deterioration and escalate care automatically
Improve value-based care outcomes by easily identifying patients, groups, and diagnoses driving LOS or readmissions

Monitor Recovery

Product Capabilities

Real time post-acute
visibility

See SNF admissions, active stays, and recent discharges at a glance to trigger timely follow up.

Gain real-time visibility
into patient status

Monitor SNF length of stay to plan for discharges and aftercare with deep, up-to-date clinical information.

Improve value-based
care outcomes

Detect potential risks at an early stage, empowering teams to strategize care, resolve identified problems, and prevent avoidable readmissions.

Enhance post-acute
collaboration

Drive timely collaboration between hospitals, health systems, and their SNF partners with real-time data.

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