Understanding and addressing the sociodemographic challenges patients face outside of the hospital is key to improving individual health outcomes and partnering with patients.

Whole Patient Insights Creating Personalized Engagement

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Readmission Risk Management

Bundled Payment Initiatives

Chronic Condition Management


According to the CDC, sociodemographic and behavioral factors impact up to 70% of consumer health

With Connance’s Value-Based Risk Analytics Platform, hospitals and health systems can:

  • Identify on admission the 20% of their patients that will generate greater than 80% of future readmissions,
  • Identify on admission the 30% of their patients that will most certainly not readmit,
  • Improve their predictive accuracy versus LACE by 20% or more without the need for clinical data.

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Readmission Risk Management Solution

Reducing readmissions requires understanding the factors that affect a patient’s life outside the hospital and proactively offering the resources and post–acute care plans that protect against negative outcomes.

Clinical complexity alone does not dictate a patient’s post-acute success. Sociodemographic predictive analytics uncover hidden risk factors that allow you to better triage and prioritize which patients truly need placement versus those that can be sent home with a targeted set of home care resources.

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Bundled Payment Initiatives Solution

Patient compliance with a treatment plan is dependent not only on their clinical recovery but also on the factors that constitute their daily lives. A lack of transportation can adversely affect physician access and medication compliance. Financial challenges could necessitate care and treatment tradeoffs for a patient. Understanding these issues early and intervening in a targeted manner is critical to bundled payment program success.

Chronic population management begins with understanding which patients have sociodemographic challenges that could exacerbate their risk of an acute episode. Connance offers targeted, proactive interventions that enhance a low-cost strategy, keeping chronic populations out of the hospital and improving their overall wellness.

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Chronic Condition Management Solution

Sociodemographic predictive analytics embedded into worklists act as an automated, consistent prescreening and risk stratification tool for care navigators and managers, thus eliminating the need for cumbersome reviews of progress notes or manual risk algorithms. Connance helps frontline staff prioritize patient interactions and offers the specific programs and interventions that address a patient’s needs.

Population risk assessment

  1. aligns home and community-based services to specific patient populations based on sociodemographic stressor prevalence;
  2. determines which programs and interventions require development for underserved populations; and
  3. supports government-mandated community health needs assessments.

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