BloomTransitions
BloomTransitions™
A 30-day post-discharge program that helps patients return home safely. After a hospital stay, skilled nursing facility discharge, or emergency department visit, BloomTransitions™ provides structured RN-led follow-up and care coordination during one of the highest-risk moments in the care journey.
First 30 Days
Connect
RN outreach after discharge to review what happened, what changed, and what comes next.
Reconcile
Medication reconciliation across discharge plans, home medications, and pharmacy records.
Coordinate
Follow-up appointments, referrals, and navigation of transportation, nutrition, and home resources.
Monitor
Symptom check-ins, warning-sign education, and structured escalation to the care team.
Beyond Day 30
When the 30-day window ends, patients who need continued support can move into longitudinal care programs, so the relationship with the care team does not stop at the end of the transition.
Partner Fit
BloomTransitions™ is designed for hospitals, health systems, ACOs, and provider organizations that want structured post-discharge support without building every part of a transitional care operation internally.
BloomTransitions™ supports safe transitions home and does not promise prevention of readmissions or guaranteed reimbursement. Timing, responsibilities, and reporting depend on the partner agreement.