Post-discharge care

Improve post-discharge care with powerful decision support tools.

Managing post-discharge care is one of the most challenging tasks for healthcare organizations today. Coordinating care among multiple clinicians at different post-acute settings and ensuring clear communication between providers, patients, families and caregivers can be exceptionally complex. Managing post-discharge follow up and tracking patient progress is difficult once patients leave the acute care settings, yet ensuring that patients are receiving the appropriate post-discharge care and are actively engaged in their recovery is key to preventing readmissions and maximizing reimbursements under new value-based payment paradigms.

To manage post-discharge care more effectively, organizations can benefit from powerful discharge software that can accurately predict needs for post-acute care and create an individualized plan that guides patients to the most appropriate care setting.

For healthcare organizations seeking to improve post-discharge care, naviHealth offers a suite of decision support tools for managing post-acute care more successfully.

Post-discharge care solutions from naviHealth.

Serving both payers and providers, naviHealth provides clinical support services, advisory solutions and data-driven technologies that help to manage care transitions more effectively while improving quality and reducing cost across the continuum.

Our post-discharge care technology includes:

  • nH Discharge, an embedded workflow tool that helps to standardize and streamline transitions of care.
  • nH Identify, a tool that provides a need score for post-acute care and risk score for readmission along with a level of care recommendation.
  • nH Predict, a tool for predicting a patient’s outcomes in various post-acute settings, through an algorithm that uses patient function and the data gleaned from more than 2 million patient outcomes records to predict optimal PAC setting, length of stay, recommended therapy and expected functional improvements.
  • nH Perform, a tool for ranking and trending the performance of post-acute care providers to build high-performing, high-quality PAC networks.

Additionally, we offer medical referral software for post-acute care providers that enables real-time referral management with acute providers to improve post-discharge care and maximize patient satisfaction.

An Experienced Partner

We’ve spent more than 18 years pioneering ways to improve every aspect of care transitions for health plans, providers and patients. From discharge planning efficiencies to managing risk for payors and providers, naviHealth is equipped to provide you with a tailored suite of capabilities.

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Benefits of naviHealth post-discharge care technology.

With solutions for post-discharge care from naviHealth, organizations are able to:

  • Reduce readmissions by placing patients in the most appropriate setting for post-discharge care.
  • Enhance maximum patient function outcomes by leveraging historical data to predict the best journey in post-discharge care.
  • Create a more personalized care plan to improve outcomes and increase patient satisfaction.

Learn more about post-discharge care and naviHealth, and about naviHealth solutions for hospital scorecard and physician reimbursement.


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