Clinical Journeys are a healthcare management system created to automate the follow-up of high-risk patients post discharge or after significant medical events. The solution offers a digital alternative for clinical & case management teams for patients that traditionally require frequent outreach. Using predefined clinical logic, Clinical Journeys monitors the health of discharged patients through chat based interactions, tracking the progression or resolution of their symptoms, reports status back to clinical teams, and prompts proactive outreach by providers if patients’ conditions worsen. As a patient's condition improves, the solution intelligently ends monitoring for the patient.

Discharged patients who fit eligibility criteria are automatically enrolled and receive a text with their unique Clearstep link. Patients are then asked questions about their overall status, signs / symptoms, objective information, and medication compliance. Clearstep then calculates (1) risk + severity score, (2) relevant endpoints (including need for intervention), and (3) frequency of auto-follow up. All calculated data is associated with the patient and made available to population health or care teams.

A few conditions include Chronic Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), COVID-19, and complex therapeutics. 

Clinical Journeys is meant to reduce the number of “touches” chronic and high-risk patients require between appointments and post discharge. The solution automates the outreach to these patients to collect vital information regarding their condition and packages the insights into concise, easy to use reports for their care teams. Care teams can feel assured that the clinical monitoring is capturing the appropriate care trends while requiring minimal manual intervention. Care teams only need to reach out when clinically appropriate – Clearstep handles the rest.

Healthcare organizations are under constant pressure to provide high-quality care while minimizing costs and negating inefficiencies. Clinical Journeys allows care teams to not worry about sacrificing the quality of care post-discharge by ensuring patients are continuously monitored without needing to do the monitoring themselves. Additionally, the ability to escalate worsening conditions to care teams before patients need urgent care helps healthcare organizations reduce readmissions and avoid adverse health events among their patient populations.