Rely Health Emergency Department Discharge and Post-Acute Navigation Program

Problem

The Challenge: Emergency departments (EDs) across the nation face a significant challenge: up to 90% of patients leave without receiving any follow-up care or navigation support. This gap not only compromises patient outcomes but also places a heavy administrative burden on existing clinical and care management teams. Tasks such as completing documentation, capturing value-based care (VBC) activities, scheduling follow-up appointments, and conducting check-ins often overwhelm these teams, leaving minimal time to engage with patients effectively. This lack of engagement negatively impacts patient experience, care quality, and outcomes.

The Rely Health Solution

Rely Health addresses these challenges by deploying a hybrid care navigation program that combines the expertise of our care navigators with the power of our proprietary AI-driven technology. Our solution leverages AI to scale patient outreach efforts through personalized SMS messages and AI-driven phone calls, guiding patients through their post-ED care journey. This approach empowers on-site navigators to manage care coordination for 15-20 times more patients than traditional, non-tech-enabled programs. By supplementing current care navigation efforts, we optimize support for the entire discharged population, drive new appointments within in-network resources, and address critical value-based metrics such as readmission rates and quality measures.

Key Program Features:

  • Resource Identification & Access: Ensure patients have access to necessary resources such as transportation, in-home care, DME, and pharmacy services.
  • Intervention Management: Facilitate program introduction, provider scheduling, and appointment reminders.
  • EHR Integration & Automation: Streamline order activation, billing code documentation, and health plan communication through automated, structured EHR encounters.

Rely Health’s team will connect through simple scribe provisioning to access EHR data. Our technology seamlessly integrates with existing EHR systems, automating demographic data collection and generating customized reports for administrative needs. This not only enhances data accuracy but also provides valuable real-time insights for better decision-making and compliance.

Our program infrastructure supports the creation and adaptation of longitudinal workflows, ensuring continuous patient engagement well beyond their ED visit. Through a blend of AI and live patient care navigators, we ensure long-term sustainability and adaptability to meet the hospital’s evolving needs. Our virtual team scales to cover every member of your daily census, engaging patients via their preferred contact method—whether through SMS, email, or phone calls. Each patient’s journey is personalized to ensure they are retained within the health system and appropriately placed for their next steps in care.

Program Benefits

Implementing the Rely Health Navigation Hub optimizes patient interactions by freeing up your care management/transitional care team’s time by nearly 75%, allowing more one-on-one interaction with high-acuity patients and expanding longitudinal care pathways. Our virtual program ensures comprehensive follow-up for all patients, driving new patient acquisition and retention. It also improves hospital utilization rates by directing patients to appropriate PCP, outpatient, or community resources.

  • Efficiency Gains: Our program frees up nearly 75% of your care management/transitional care team’s time, allowing for more focused interaction with high-acuity patients and expanding longitudinal care pathways.
  • Comprehensive Follow-Up: Our virtual program ensures that every patient receives follow-up care, driving new patient acquisition and retention while optimizing hospital utilization rates.
  • Turn-Key Service: We handle everything from design to deployment, continuously iterating to meet your navigation goals with no additional overhead or technology lift required.
  • Actionable Insights: Monthly dashboards and analytics provide real-time health metrics to leadership.
  • Actionable Insights: Monthly dashboards and analytics provide real-time health metrics to leadership.

Rely Health’s comprehensive approach not only supports existing ED workflows but also provides visibility into the downstream impact of in-network referrals, maximizing the value of your investment. Our programs—both virtual and on-site—ensure that every patient receives high-quality, personalized care. By partnering with Rely Health, your organization can achieve enhanced patient outcomes, improved operational efficiency, and significant scalability, setting a new standard in emergency care patient experience and quality.

Program Results

Unique Insights

  • Critical Follow-Up Gap: A staggering 70-90% of patients leave the ED without follow-up care due to existing labor and clinical constraints, revealing a critical gap in patient support.
  • Strategic Patient Engagement: The ED is a pivotal touchpoint for engaging otherwise difficult-to-reach patients, providing a prime opportunity to drive patient acquisition and retention within the health system.
  • Targeted Interventions for High-Risk Populations: The ED is an ideal setting for identifying high-risk patients who contribute to poor utilization and quality gaps, enabling targeted interventions that significantly improve healthcare outcomes.

Value-Based Metrics

Our program has driven significant improvements in patient outcomes, reducing avoidable ED revisits and establishing consistent follow-up care with specialists, primary care providers, and community resources.

Conclusion

The success of this partnership lies in the close collaboration between Rely Health and hospital emergency departments, ensuring that each program is tailored to meet specific needs. The strategic design of the Navigation Hub and the hybrid program structure—combining a managed team of empathetic human navigators with AI-driven technology—was key to engaging with the entire discharged patient population and driving meaningful quality and value outcomes. By leveraging personalized SMS texts and AI-driven phone calls, Rely Health’s Navigation Hub effectively guided patients to better follow-up care, resulting in significant reductions in revisit rates. This partnership highlights the transformative impact of Rely Health’s hybrid approach, showcasing how technology and care navigators can work together to enhance patient care and drive value-based outcomes.

Contact Rely Health to optimize your Care Navigation.

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