Close Every Care Gap. Prevent Every Avoidable Readmission.
Zabrizon's AI care coordination platform connects the full care continuum — from discharge planning through post-acute follow-up — ensuring no patient falls through the cracks between sites of care.
Where Care Falls Apart Between Sites
Care coordination failures are among the most costly — and preventable — quality and safety problems in healthcare.
Preventable Readmissions
20% of Medicare patients are readmitted within 30 days at a cost of $26 billion annually. Most are preventable with structured post-discharge follow-up and remote monitoring — but manual processes can't scale.
Lost Referrals
Studies show 25–50% of specialist referrals are never completed. Without closed-loop tracking, PCP practices have no visibility into whether referred patients were ever seen.
Discharge Planning Delays
Inefficient discharge planning extends length of stay by an average of 1.2 days per patient — a direct cost driver and throughput bottleneck in high-census environments.
Care Team Fragmentation
Nurses, social workers, case managers, and physicians work in disconnected systems with no unified view of a patient's care plan, resulting in duplicated work and critical handoff failures.
Care Coordination AI Capabilities
Intelligent automation across every transition point in the patient journey.
ADT-Triggered Care Workflows
Learn moreReal-time admission, discharge, and transfer alerts that automatically trigger the right care coordination actions — transitional care outreach, follow-up scheduling, and care plan activation.
- Real-time ADT feed integration from EHR and HIE
- Automatic post-discharge outreach within 24–48 hours
- High-risk readmission flag on discharge with assigned care manager
- Emergency department visit alerts for high-risk attributed patients
Discharge Planning & Post-Acute Placement
Learn moreAI-assisted discharge planning that matches patients to the most clinically appropriate and cost-effective post-acute care setting based on clinical, functional, and social factors.
- Predictive readmission risk scoring at point of discharge
- Post-acute facility matching by quality score, proximity, and capacity
- Automated referral packet generation for SNF, IRF, and home health
- Post-acute performance tracking by facility partner
Referral Management & Closed-Loop Tracking
Learn moreEnd-to-end referral lifecycle management — from order creation through specialist consultation — with automated follow-up and care gap closure confirmation.
- Electronic referral routing to in-network specialists
- Real-time referral status visible to referring and receiving teams
- Automatic patient reminders and rescheduling for no-shows
- Consultation result documentation back to referring provider
Integrates with your existing systems
Works With Every Major EHR Platform
HL7 FHIR R4 native • SMART on FHIR • REST APIs • Custom HL7 v2 connectors
Ready to Build a Care Coordination Programme That Scales?
See how Zabrizon connects your care teams across every transition — reducing readmissions and improving patient satisfaction.