Readmission Breakthrough: How Structured Insights Improve Transitions of Care & Close Discharge Gap

Reducing hospital readmissions remains a central goal of value‑based care, yet many effective solutions are difficult to scale due to cost or operational burden. ilumed and Connective Health have pioneered a different approach that reduced hospital readmissions in Q4 2025 from 16% to 11% (27.5% reduction). By rethinking post‑discharge workflows, this program enables care teams to focus on patient engagement rather than manual data retrieval. Key elements include standardized, data‑driven, patient-specific discharge PDFs, complete clinical context at the point of care, and proactive risk identification to support timely interventions. Join Marri Brackman, DO, Chief Medical Officer at ilumed, and Ryan Hess, CEO of Connective Health, as they discuss how this approach is transforming post‑acute care delivery. The session will outline practical frameworks for building scalable, effective transitional care management programs for ACOs and provider organizations. In This Webinar, You Will Learn How To: ● Move beyond basic ADT notifications to access complete clinical context, including discharge summaries and medication changes ● Use real‑time clinical intelligence to intervene within the first 24–48 hours after discharge ● Engage provider partners and scale care management workflows efficiently ● Enable care teams to concentrate on serving high‑risk patients instead of chasing down charts and entering data manually ● Achieve and measure utilization outcomes, including reducing hospital readmissions from 16% to 11%.