Discharge Intelligence · Value-Based Care

Reduce avoidable readmissions before the patient leaves the hospital.

Preventra identifies high-risk discharges, explains the drivers, and gives care teams a prioritized action list, inside their existing workflow. Designed to add intelligence to your existing EHR, care management, and population health workflows, not replace them.

Designed for compatibility with

EpicCernerAthenahealtheClinicalWorksMeditechAllscripts

The Problem

$26B+

in avoidable readmission costs annually. The most preventable cost in U.S. healthcare.

1 in 5

patients returns within 30 days. For ACOs, every return is shared savings lost.

~$15K

average cost per readmission event. A 10% reduction pays for operational intelligence many times over.

Your highest-risk patients already exist in your data.

Most care teams have forecasting tools, but lack prioritized discharge visibility at the moment it matters most. Predictions are generated. Sorting and acting are left to the team. Preventra closes that gap, adding discharge operational intelligence alongside your existing systems to turn data into immediate, actionable care coordination.

Preventra · Discharge Console

From risk score to daily care-team action list.

Every patient flagged. Every driver explained. Every care team action prioritized, automatically, inside the workflows your team already uses. Complements your EHR, doesn't replace it.

Valley Medical Center · Unit 4 · Discharge Intelligence Console

S. Reyes, RN · Care Coordinator · 08:41 AM

3 new high-risk patients added overnight
43

Discharging Today

+3 overnight

11

High Risk

Needs action

17

Moderate Risk

Monitor closely

15

Low Risk

Standard discharge

Priority Worklist, Discharge Today · 11 High Risk

M. Rodriguez, 71 · Rm 412B

Cardiology · Dr. Chen · Prior admissions × 3 · CHF · High no-show risk

91

T. Washington, 83 · Rm 508

Internal Medicine · Dr. Okafor · Polypharmacy · Social isolation · COPD

87

S. Chen, 67 · Rm 301A

Endocrinology · Dr. Patel · ED visit Apr 18 · Diabetes · Uncontrolled HbA1c

74

A. Patel, 78 · Rm 214

Nephrology · Dr. Yuen · No PCP follow-up scheduled · Renal insufficiency

68

Top Risk Drivers · Unit 4

Prior Admissions73%
No-Show Risk61%
ED Visits (90d)48%
Polypharmacy39%
No Follow-up34%

30-Day Trend · Valley Medical

Readmission rate ↓ 18%

Apr vs Mar

Under 60 seconds per patient. Sorted automatically, most critical patients always appear first.

Who It's For

Built for organizations managing value-based care at scale.

Primary

Accountable Care Organizations

Every avoidable readmission erodes shared savings. Preventra gives care teams discharge visibility to protect financial performance, without adding operational burden.

  • Shared savings impact modeling
  • Population risk stratification at discharge
  • Transitional Care Management workflow support
Primary

Hospitals & Health Systems

High-risk and low-risk patients leave looking the same. Preventra gives discharge planners an automatic prioritization worklist, so critical patients are addressed before they walk out.

  • Discharge risk scoring for every patient
  • Automatic prioritization worklist
  • No-show risk for follow-up appointments
Primary

Transitional Care Teams

Discharge planners and transitional care nurses get clinical prioritization support without learning a new system or changing existing workflows.

  • Explainable risk drivers in plain clinical language
  • Recommended next actions at point of care
  • Designed around existing transitional care workflows
Also Designed For

Physician Groups & CINs

Discharge operational intelligence layered into existing clinical environments, without requiring a new platform investment or IT overhaul.

  • Value-based care contract performance support
  • Population health operational visibility
Also Designed For

Care Management Leadership

CMOs, VP Population Health, and CFOs get population-level trends and performance data, without adding complexity to clinical teams.

  • 30-, 60-, 90-day readmission trending
  • Shared savings performance reporting
Also Designed For

Value-Based Care Organizations

MSSP participants and VBC networks, built around the financial and operational realities you face every day.

  • Medicare Shared Savings Program performance support
  • Rapid adoption without IT burden

How It Works

Discharge operational intelligence that predicts, prioritizes, and prevents.

01, Predict

Risk Score at Discharge

Every patient receives an explainable risk score before leaving, primary clinical drivers surfaced in plain language. No interpretation required. No additional clicks.

02, Prioritize

Automatic Prioritization Worklist

The most critical patients appear first, automatically. No manual sorting. Your team sees exactly where to focus the moment they open their workflow.

03, Prevent

Recommended Coordination Actions

Recommended next steps surface alongside each risk score, giving discharge planners a concrete starting point for follow-up scheduling and transitional care coordination.

Operational Outcomes

Designed around real transitional care challenges.

Avoidable Readmission Reduction

Identify highest-risk patients before discharge. Prioritized worklists ensure clinical attention reaches the right patients before a preventable readmission occurs.

Transitional Care Prioritization

Discharge planners get automatically ranked patient lists, directing nurse bandwidth to patients who need the most support before leaving.

TCM Visibility

Transitional Care Management billing opportunities and care gaps surfaced automatically, supporting clinical and revenue cycle workflows simultaneously.

Discharge Follow-Up Coordination

No-show risk flags patients unlikely to attend follow-up appointments, enabling proactive outreach before the care gap becomes a readmission event.

Care Management Efficiency

Care teams spend less time sorting data and more time on direct patient intervention. The manual prioritization burden is eliminated entirely.

Shared Savings Protection

Every avoidable readmission prevented is shared savings protected. Discharge-level visibility ACOs need to meet financial targets.

$1M+

Potential annual savings per hospital

10%

Readmission reduction target

<60s

Clinician action time per patient

Implementation Reality

Operationally lightweight by design.

How hard? How long? Will IT get overwhelmed? Preventra was built to answer those questions before they're asked, with a phased deployment approach designed around your existing environment.

01

Connect to existing datasets

Works with your existing admission records, discharge patterns, and clinical history. No new data warehouse or infrastructure build required.

02

Phased rollout, no clinical disruption

Start with one unit or pilot cohort. Expand as teams build familiarity. Organization-wide rollout is not required before value is realized.

03

Minimal IT burden

Clinical staff begin using the discharge intelligence console without a retraining program. Extended IT involvement is not required for deployment.

04

Value visible from day one

From the first discharge prioritization session, care coordinators see a ranked worklist, explainable risk scores, and recommended coordination actions, immediately.

Pilot Engagements Available

Limited pilot engagements available for healthcare organizations to evaluate discharge risk visibility, care team prioritization, and transitional care workflows, using existing datasets and current infrastructure. No long-term commitment required.

Request a Pilot Conversation

Why Preventra

Operational augmentation for value-based care. Not another analytics layer.

Clinicians act in seconds, not minutes

Discharge planners can review, interpret, and act on a patient's risk profile in under a minute. Speed matters at discharge, Preventra is built around that reality.

No-show risk, standard, not optional

No-show risk is a core driver, a factor most discharge tools ignore. If a high-risk patient is likely to miss their follow-up, your team knows before discharge.

Batch and real-time, both supported

Morning rounds worklist or real-time discharge support, Preventra supports both operational models, adapting to how your organization already works.

Operational augmentation, not replacement

You already have forecasting and EHR infrastructure. Preventra integrates as a discharge operational intelligence layer, no rip-and-replace, no IT overhaul.

Frequently Asked Questions

What is Preventra?

Preventra is a discharge intelligence layer that gives hospitals and care teams early visibility into which patients are at elevated risk of returning within 30 days of discharge. It sits alongside your existing EHR and surfaces a clear, explained risk signal at the point where it matters most, discharge planning.

Does Preventra replace clinical judgment?

No. Preventra is a decision-support layer, not a decision-maker. It surfaces a prioritized, explained signal so your team can direct limited follow-up resources where they're likely to matter most. The clinical call always stays with your team.

Does Preventra require replacing our EHR or overhauling our workflow?

No. Preventra is designed to integrate with the systems you already use rather than replace them. It's an added layer of discharge visibility, not a new system your team has to learn from scratch.

What does implementation actually involve?

Preventra is delivered as a SaaS platform designed to work with standard EHR data structures. Our team works alongside your IT and implementation staff to scope integration and timeline for your specific environment.

How do we know if it's working?

We help you track the readmission rate among flagged, intervened-on patients against a comparable baseline, so impact is measurable rather than assumed.

Why should I trust a risk score?

You shouldn't trust it instead of your judgment, it's built to support it. Preventra is most useful for patients who look stable at discharge but carry risk factors that are easy to miss in a busy workflow. It's a second set of eyes across dozens of risk factors at once.

Start Today

Explore how Preventra fits into existing care coordination workflows.

Request a 15-Minute Walkthrough

$1M+ potential annual savings for a typical hospital from a 10% reduction in avoidable readmissions. Based on average readmission costs of approximately $15,000 per event. Actual results vary by organization.