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Chronic Diseases: deliver coordinated and integrated care to prevent hospitalizations

85%

of people elderly people live with chronic conditions

~ $1500

could be saved annually with adequate care coordination on chronic patients management


Problem

Fragmented care is making providers spend too much with avoidable interventions, and patients experiencing poorer outcomes

Care integration is an unequivocal necessity for today's health systems, creating opportunities for transforming people’s experiences of care from disjointed to coordinated, reactive to proactive, and service-orientated to personalized. However, as it is not well stablished yet, patients feel lost in complex care journeys and providers spend too much time and resources with preventable emergency admissions and hospitalizations that could be avoided with timely interventions.

Solution

Connect the dots for everyone with a continuous, multi-level, multidisciplinary care journey

Decision support for diagnosis and treatment, to upskill generalist physicians and deliver self-sufficient primary care;

Decision support for referral criteria (from prevention to palliation), to always have the patient at the right level of care;

Automatic patient stratification through validated questionnaires and scores, that route the patient to the right care setting depending on risk;

Automatic follow-ups using an omnichannel approach with automatic identification of red flags, to conveniently detect patient deterioration ahead of time;

Patient progress monitoring in real time shared with multi-level care teams, providing a single source of truth for the patients needs and history;

Patient empowerment on self-care and autonomy to report disease deterioration, to increase care plan adhesion and participation as well as to anticipate health needs;

Interoperability capabilities linking different systems, to reduce repetition.

Benefits

Anticipate care needs to avoid decompensation;

Reduce unnecessary hospitalizations or admissions in the ED;

Reduce high-cost healthcare;

Optimize allocative efficiency (keep teams focused on differentiated tasks and high risk patients);

Improve patient experience.


Trusted by top performing leaders

UpHill is driving our institutional-wide effort to standardize care.

Filipe Costa

Head of Value Based Care

Luz Saude



UpHill brings enormous added value in a context of constant changing.

Diana Carvalho

Diana Carvalho

Customer Solutions Manager

Novartis



UpHill's medical expertise allows us to offer our patients the latest best practices of care.

Floarian Rossiaud

Florian Rossiaud-Fischer

Director for Innovation & Strategic Partnerships

Hôpital de La Tour

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