For providers — AnsibleHealth

What we take on.

Per physician, and only as much as you want.

We watch and respond

Early detection Home vital signs reviewed every day, with alerts for hospital and ER visits and for missed refills. A clinician reviews every flag.
24/7 call support Your patients reach a clinician day or night: their own team by day, our on-call team with physician backup after hours.
Acute issue management COPD: action plans and rescue packs to intercept exacerbations. Heart failure: volume tracking and proactive diuretic management.

We treat

Medication optimization GOLD-aligned for COPD and the four GDMT pillars for heart failure, titrated to treatment doses, with adherence, refills and prior authorizations handled.
Comorbidity management Heart failure and COPD together, with diabetes, kidney disease and sleep apnea, alongside the PCP. Cancer screening and vaccines kept current.
Continuous management The same four to six clinicians for each high-risk patient, daily rounds and about 30 clinical contacts a year, for as long as the patient needs it.
Specialists when there are none If your patient has no cardiologist or pulmonologist, ours provide that care and you stay informed.

We carry out your plan

Transitions of care After a discharge or an ER visit we contact the patient, reconcile the medicines against the prior regimen, and confirm oxygen, equipment, home health and follow-up visits.
Care plan execution Your plan carried out between visits: labs and imaging arranged, referrals made, appointments kept.
Reports back to you The care plan at enrollment, a note at every medication change, ER visit, admission and discharge, and a monthly summary.
DME and supplies Oxygen, CPAP, nebulizers and home sleep studies ordered and followed up. Each patient gets a monitoring kit with its own cellular connection.

We look after the patient and family

Patient education Respiratory therapists teach the disease, symptoms, and inhaler technique or diet, one to one and in small groups.
Smoking cessation Counseling, with varenicline or nicotine replacement prescribed by our clinicians.
Support group Peer support groups and group sessions. For homebound patients it is some of their only social contact.
Caregivers Named at the start, taught what to expect and what is concerning, and called at every escalation.
Cardiac and pulmonary rehab A 36-session home-based program, up to five days a week.

What changes for your patients.

43%

lower all-cause mortality

Annual rate against controls, independently validated at a large health system.

25%

lower 30-day readmissions

Full-program patients against propensity-matched controls.

20%

fewer emergency visits

Compared with matched patients not in the program.

18%

fewer hospital stays

Compared with matched patients not in the program.

+78

patient net promoter score

Rising to +84 among patients who finish the program.

What you get back.

Your patients stay yours.

Your plan sets the direction. Where we work with you regularly, we discuss significant medication changes with you before acting. In an emergency we treat first and tell you straight after.

You hear from us.

You receive the care plan at enrollment, a note at every medication change, ER visit, admission and discharge, and a monthly summary, by EHR, fax, phone or the health information exchange.

Their specialists, or ours.

If your patient already sees a cardiologist or pulmonologist, we carry out that plan and report to both of you. If not, our physicians provide that care.

A physician and a nurse going over a patient's chart together

We do the work between your visits.

From the clinicians we work with.