Create an AI that follows up with patients after discharge to reduce risk of readmission. About 15% of patients are readmitted within 30 days of a discharge, and there are comorbidities that can greatly increase this risk for curtain patients. It is very costly to readmit patients, and CMS does not like it.

Aligns with our patient engagement focus and AI forward strategy.

Inspired by Tricia Baird MD FAAFP MBA and other Corewell Health leaders work in Epic to follow up with patients after discharge to lower the risk of readmission within 30 days of discharge. Corewell has set up and elaborate program with a decent amount of staff.

CSM initiative: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp

Tricia's work: https://www.linkedin.com/posts/craigjoseph_ehr-ugm2025-activity-7363988385536864261-qua7?utm_source=social_share_send&utm_medium=member_desktop_web&rcm=ACoAAA4tY5IBP_3cEe-Xr5-DCGD6nFJ5RjqR-AM