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Readmission prevention

Out of the hospital, but not out of sight.

Intelligence stays with every patient after discharge, checks in across voice and text, catches early signs of trouble, and brings in your care team when needed.

Join the Healthcare Organizations Scaling with Intelligence

Problem

The moment patients go home is when most systems lose track of them.

Recovery doesn't happen in the hospital. It happens at home, alone, between appointments, where no one is watching. The ones who struggle slip through, and you only find out when they're back in a bed.

23%

OECD avg. readmission rate for stroke

31%

OECD avg. readmission rate for congestive heart failure

1 in 4

hospital readmissions estimated to be preventable

~$16k

avg. cost of 30-day all-cause adult readmissions

Solution

Our AI Care Managers give every patient the follow only a few used to get.

They guide every discharged patient through the weeks that matter, flag the ones who need a closer look, and route them to your team with the full story attached.

100%

Outbound and inbound coverage, every discharged patient followed

34%

Reduction in 30-day readmissions

Your team focuses on the patients who actually need them.

How it works

Follow up. Guide. Escalate. Prevent.

Voice, SMS, Email, Chat Readmission risk prediction EHR real-time integration Human in the loop

Automatic Enrollment

Follow up on every discharge, no referral needed.

The moment a patient is discharged in your system, Intelligence picks it up and the post-discharge journey starts. No manual referral, no patient action, no one falling off the list because the ward was busy.

Technology

Meet your AI Care Managers.

Behind every interaction is an intelligent agent purpose-built for healthcare operations. They contact patients, read documents, navigate legacy platforms, and act on what they find. Every action is logged, auditable, and configurable to your clinical protocols.

Always on, reaching every discharged patient across your system.

Communication across every channel the patient already uses, without losing context.

Conversational AI that speaks naturally in any language and local accent.

Continuous monitoring that surfaces concerns early and routes them to your team, with full context.

Capable of coordinating appointment schedules, patient transportation and mailing logistics.

Trusted by the most regulated industry in the world.
ISO 13485 Accredited SOC 2 Compliant MDR Class IIa Compliant NHS Compliant HIPAA Compliant Cyber Essentials Plus
No EHR migration. No platform overhaul.
Testimonials

Don’t take our word for it, take theirs.

Prof. Rowan Pritchard-Jones

“With the evidence so far and the wider benefit to patients, elective recovery and capacity usage, there is a real desire to develop a business case and find funding for a long-term expansion of this service.”

Prof. Rowan Pritchard-Jones

Medical Director

34%

Reduction in 30-day readmissions

FAQ

  • It follows the rhythm of recovery: discharge instructions confirmed in the first hours, medication and symptom check-ins through the first week, mobility and adherence across the first month. Every step happens on the channel the patient already uses, and every response is logged in one place for your team.

  • For as long as your protocol defines. The default journey covers the first 30 days, the window where most avoidable readmissions happen, but it's configurable by condition, procedure, or risk level. A hip replacement and a heart-failure discharge don't need the same follow-up, and they don't get it.

  • No. The cadence adapts to each patient, their condition, their risk level, how they're responding. A patient who's recovering well and answering check-ins gets a lighter touch. A patient who reports problems or goes quiet gets closer follow-up. The effort goes where it's needed.

  • Every discharged patient receives outreach. AI Care Managers work through the full list, adapting channel and timing to each patient's responsiveness profile, and continuing until every patient has either completed their post-discharged journey, declined, or been escalated to a human team member.

  • Both. Patients can call in, to reschedule, ask a question, or raise a concern, and Intelligence handles it the same way it handles outbound: it resolves what it can, captures what matters, and escalates anything that needs a person.

  • Within your protocols, yes. As part of a normal conversation, Intelligence can pick up the social and access factors (SDOH) that affect recovery, transport, food access, whether someone has support at home, and surface them to your team. It's the kind of context that usually only emerges when a person has time to ask, captured consistently across every patient.

  • No. The system is informational and non-decisional. It never interprets symptoms, recommends treatment, or discusses prognosis. Any clinical question triggers a handoff to your team, and every outbound message passes an automated safety gate before it reaches a patient.

  • Human escalation can be built into every workflow. When the AI detects complexity — an unusual situation, a failed contact, or a clinical concern — it routes immediately to the right team member.

  • Once your team resolves the case, monitoring resumes automatically. The handoff isn't the end of the journey, it's a moment a person steps in, after which Intelligence picks the patient back up and keeps going. Nothing falls through the gap.

  • AI Care Managers are the AI agents that run the workflows built by Intelligence. They contact patients, process responses, deliver coaching content, navigate scheduling systems, and trigger the next action — 24/7, across every channel, in any language. They're not chatbots. They are objective-driven and like your best care teams, they're trained on healthcare operations and adapt to your existing infrastructure.

  • AI Care Managers can make and receive calls, send and interpret chat messages, SMS and email, read and act on documents, navigate legacy portals and platforms, check eligibility, confirm appointments, offer reschedule slots, and escalate to a human when needed. They can be trained to handle any administrative task or logic the workflow requires. Every action is logged, auditable, and configurable to your protocols.

  • Our agents always disclose they are AI, following your organization's guidelines and applicable regulatory requirements. This is communicated naturally — adapting tone, language, and channel to each patient. What patients consistently experience is fast, clear, helpful contact that never feels scripted or limited.

  • Intelligence sits between your patients and your existing infrastructure — connecting to EHRs, scheduling systems, CRMs, and national health platforms via FHIR APIs and HL7 messaging. It's designed to work with what you have, not replace it.

  • Yes. AI Care Managers can log into, read, and act within legacy portals and third-party platforms — not just systems with open APIs. They use computer vision and document understanding to operate in environments that weren't built for integration. If your team navigates it today, our agents can be trained to navigate it too.

  • No. Intelligence is an interoperability layer — it connects to your existing systems and operates within them. There's no rip-and-replace. Your data stays where it is, your workflows stay familiar, and Intelligence adds the coordination layer on top.

  • Every deployment meets HIPAA, HITRUST, SOC 2, and GDPR standards where applicable. All patient data is encrypted in transit and at rest. Every AI interaction is fully auditable, with role-based access controls throughout. Compliance requirements are scoped during the discovery phase and built into deployment from day one.

  • Sword has spent over a decade pioneering AI Care — trusted by more than 1 million patients, covering 100 million lives, across 5 continents. Intelligence was built because we ran into the same operational bottlenecks our customers face today. We didn't theorize the workflows. We built them for ourselves first.

Send them home. Help them stay.