What You Should Know
- UPMC is expanding its AI-native transitional care management program to 18 hospitals, scaling from an initial single-campus deployment at UPMC Jameson (New Castle, PA) to 10 live hospitals today, with one launching September 1 and seven more on September 22.
- Operates on ThinkAndor®, Andor Health’s agentic AI infrastructure, paired directly with clinical care delivery provided by Andor’s Psynergy Health licensed clinical workforce.
- Unifies technology, outreach, scheduling, clinical visits, documentation, billing, and regulatory compliance under a single accountable operating partner rather than splitting responsibilities across point-solution software vendors.
- Reaches 100% of enrolled discharged patients within 48 hours of leaving the hospital, performing automated initial engagement and routing patients requiring live intervention directly to care coordinators.
How ThinkAndor and Psynergy Health Cut Transitional Care Costs by 45%
The first 30 days after a patient leaves the hospital are widely recognized as the most dangerous window in healthcare. Discharged patients frequently miss follow-up appointments, struggle with medication changes, and end up back in the emergency department for complications that could have been managed at home. While hospital leaders have long understood the value of structured transitional care management, severe nursing shortages have left in-house care teams stuck spending hours manually dialing call lists and logging voicemails rather than delivering clinical care.
To eliminate those post-acute gaps, UPMC is scaling an AI-native transitional care model across 18 hospitals this fall. The program—which originated as a pilot at UPMC Jameson in New Castle, Pennsylvania—is live across 10 hospitals today, with one additional facility launching September 1 and seven more going live on September 22.
Pairing Agentic Software with an Embedded Clinical Team
Rather than licensing standalone software and leaving hospital staff to manage the administrative workload, UPMC’s model unifies technology, patient outreach, scheduling, clinical visits, EHR documentation, and billing under a single accountable operating team.
The workflow automates the repetitive mechanics of post-acute tracking:
- Universal 48-Hour Outreach: Autonomous AI agents initiate contact with 100% of enrolled UPMC discharge patients within 48 hours of returning home, conducting initial symptom screens and routing rising-risk cases directly to live care coordinators.
- Pre-Encounter Chart Synthesis: ThinkAndor aggregates electronic health records, discharge notes, and remote telemetry before clinicians begin an encounter—reducing non-clinical documentation time by 63% and filtering out 82% of non-actionable remote alerts.
- 15-Day Complication Triage: Automated check-ins are pushed to day 15 post-discharge to catch emerging complications before they escalate into an unplanned readmission.
- Documented Outcomes: Across active deployments, the integrated model has generated a 180% increase in post-discharge follow-up completion rates alongside a 45% reduction in total cost of care.
