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Senscio Solution: Daily Care Continuity for Every Member

Traditional healthcare is organized around encounters. But the greatest risks emerge between office-based visits — in the unobserved days where symptoms evolve, medications drift, and members struggle quietly.

Senscio delivers the missing layer: daily care continuity. Enabled by Digital Twin for Health™ (DT4H™) and delivered through the Ibis Care Continuity Team, we interpret risk every day and guide the right actions by members, caregivers, and clinicians. The result: fewer emergencies, more stable chronic conditions, and a more efficient care ecosystem.

Illustration of proactive care continuity at home
Who we serve

One continuity layer, shared value for every partner.

Senscio’s Care Continuity Paradigm™ adds a single, intelligent layer across the ecosystem. Health plans, health systems, ACOs and physician groups, and home health and senior living all benefit from the same daily modeling, interpretation, and action—expressed in ways that match their responsibilities, workflows, and economics. Below, we show how the same core solution lands for each partner type.

Health Plans

The Problem

  • High-cost utilization driven by unmanaged day-to-day risk
  • Limited visibility into members’ real-world health trajectory
  • Fragmented care coordination, especially for multi-condition members
  • Preventable escalations driving PMPM volatility

How Senscio Solves It

  • DT4H™-powered daily risk interpretation across clinical, behavioral, and social factors
  • Next-best actions delivered to the member every day, reducing drift and decompensation
  • Care Continuity Team coordinates in real time with PCPs, specialists, and care managers
  • Enables plans to operate like a continuous care model, not a claims-based one

Expected Outcomes

  • 30–55% reduction in avoidable hospital utilization
  • Higher medication adherence and vital monitoring compliance
  • Stabilized PMPM and better cost predictability
  • Increased member satisfaction and retention

Evidence

We reduce hospitalizations by up to 40% and days in hospital by up to 55%, consistently across high-risk populations.

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Health Systems

The Problem

  • Rising acuity and readmissions stress inpatient capacity
  • Lack of visibility into patients’ home-based recovery
  • Fragmented communication between hospital teams and community providers
  • Pressure to manage value-based contracts without longitudinal support

How Senscio Solves It

  • Daily monitoring of symptoms, vitals, medications, and behavior after discharge
  • Early detection of decompensation to prevent readmissions
  • Seamless coordination with discharge planners and care managers
  • Creates a single, continuous view of patient risk across care settings

Expected Outcomes

  • Reduced LOS and readmissions
  • Improved throughput and bed availability
  • Higher success in value-based arrangements
  • A more connected hospital-to-home experience

Evidence

Average LOS for members under Senscio-supported continuity is 4.01 days, alongside measurable reductions in readmission risk.

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ACOs & Physician Groups

The Problem

  • Risk-bearing contracts require consistent management of chronic populations
  • Physicians lack time and tools to monitor patients between visits
  • Actionable, timely data from the home is scarce
  • Gaps in behavioral, social, and medication adherence drive avoidable risk

How Senscio Solves It

  • Daily interpretation of risk, offloading monitoring responsibility from PCPs and specialists to a physician-led team
  • Direct instructions delivered to members and caregivers to maintain stability
  • Timely escalations only when clinical intervention is needed
  • Strengthens proactive, team-based care

Expected Outcomes

  • Improved quality scores and shared savings
  • Fewer unplanned visits and escalations
  • Greater physician efficiency and less administrative burden
  • More engaged, self-managing patients

Evidence

Our daily risk operationalization consistently translates into lower emergency utilization and stronger clinical control across chronic conditions.

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Home Health & Senior Living

The Problem

  • High-risk clients between visits with limited real-time insight
  • Staff unable to monitor daily changes in condition
  • Escalations occur too late, often resulting in ED transfers
  • Need for stronger family communication and transparency

How Senscio Solves It

  • Daily risk interpretation for every client, not just episodic check-ins
  • Action prompts for clients and staff to maintain stability
  • Early warning system that helps prevent ED visits
  • Continuous communication loop with families, clinicians, and community partners

Expected Outcomes

  • Lower ED transfers
  • Better client stability and satisfaction
  • Reduced staff burden and more focused visits
  • Stronger competitive positioning for home health and senior living programs

Evidence

Senscio programs routinely cut avoidable emergency utilization by 30–40%, even in high-acuity populations.

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Ready to explore how Senscio can support care continuity for your population?

Whether you’re a health plan, health system, ACO, or home health partner, our team can help you understand how the Intelligent Care Continuity System™ fits your organization.

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