Post-Discharge Evidence Intelligence

The gap between discharge and recovery is where readmissions happen.

TriunityCX built Trisana to close that gap, at no cost to health systems, generating evidence that pharmaceutical companies need and cannot get anywhere else.

Trisana · Heart Failure Cohort
Live Network
90
Day protocol window
76
Days of unique evidence
$0
Cost to hospitals
The Sample Cliff — Trisana vs. Industry
Proprietary
MAV Score
Live
SDOH Data
Direct
Evidence
HFPE
$26B
Annual US readmission cost burden
2,400+
Hospitals penalized under HRRP annually
76
Days of evidence no other platform captures
$0
Cost to hospital partners
The Problem

Two industries. One shared blind spot.

The 90 days after discharge is the highest-risk window in the patient journey. It is also the window where both health systems and pharmaceutical companies lose the signal entirely.

For Health Systems

Readmission penalties are a direct reduction to Medicare revenue, and the exposure is growing.

The Hospital Readmissions Reduction Program penalizes facilities for excess readmissions in heart failure, COPD, pneumonia, and other high-burden conditions. The average penalized hospital loses approximately $217,000 per year. For FY 2027, CMS changes are projected to penalize 75 to 82 percent of all hospitals. The passage of the One Big Beautiful Bill compounds this pressure, introducing an estimated $1 trillion in Medicaid cuts over the next decade with more than 300 rural hospitals at immediate risk of closure.

For Pharmaceutical Companies

Real-world evidence built on claims data arrives too late to change the outcome it describes.

Pharmaceutical companies building real-world evidence frameworks for market access and payer strategy are working with data that captures what was billed and what was dispensed, not what the patient actually experienced. Claims data arrives weeks or months after the clinical window has closed. It does not capture why a patient stopped taking their medication, what social barrier prevented a follow-up appointment, or how the patient's confidence in managing their condition changed across the weeks following discharge.


The Solution

Trisana was built to solve both problems at the same time.

A two-sided health technology platform connecting health systems, patients, and pharmaceutical companies through a shared post-discharge patient management infrastructure.

Navara · For Health Systems

A 90-day post-discharge patient management program operated entirely by TriunityCX, at no cost to the hospital.

TriunityCX case managers conduct structured patient contact at defined intervals across the post-discharge window, collecting medication adherence data, SDOH barrier information, self-efficacy scores, and follow-up appointment status in real time. The platform classifies each patient and surfaces the cases requiring immediate attention. Hospitals receive monthly executive reports showing financial impact in readmission penalty avoidance. There is no subscription fee, no implementation cost, and no change to clinical workflows.

Learn how Navara works →
Lumaris · For Pharma

De-identified post-discharge patient evidence built on a different kind of data than anything currently available.

Lumaris gives pharma market access and health economics teams access to High-Fidelity Patient Evidence, the structured behavioral and social evidence generated through the Navara protocol. HFPE is prospective, patient-sourced, and collected during the highest-risk post-discharge window. It captures medication adherence velocity, individual-level SDOH barriers, self-efficacy trajectory, follow-up status, and clinical profile at structured intervals across 90 days.

Learn how Lumaris works →

How It Works

One platform. Three stakeholders. One shared outcome.

01

Patient Discharge Enrollment

A patient is discharged from a hospital partner and enrolled in the Navara protocol with their verbal consent. TriunityCX case managers take responsibility for the 90-day post-discharge engagement from that point forward, with no action required from hospital clinical staff.

02

Structured Patient Engagement

Case managers contact the patient at defined intervals across the 90-day window, collecting direct data on medication adherence, social barriers, self-efficacy, and follow-up status. The platform classifies each patient by risk level in real time. Hospital leadership receives a monthly executive report automatically.

03

Evidence Generation

De-identified evidence from patient interactions flows into Lumaris, where pharmaceutical partners access aggregate cohort analytics, adherence trajectory data, SDOH barrier distributions, and novel evidence outputs unavailable from any other real-world data source. That subscription revenue funds Navara's operations.

The Business Model

The model is designed so that everyone wins or no one does.

Pharmaceutical partners pay for evidence that Navara generates as a byproduct of reducing readmissions.

That payment funds the case management operations that keep Navara free for hospitals. And the hospital program generates the patient volume that makes the pharmaceutical evidence meaningful. Each part of the model reinforces the others. This alignment is not incidental. It is the structural foundation of everything TriunityCX builds.

🏥
Health Systems
Receive a post-discharge management program that reduces readmissions and generates a direct financial return, without paying for it, without hiring additional staff, and without requiring clinical teams to change how they work.
💊
Pharmaceutical Companies
Receive access to a category of real-world evidence unavailable through existing data vendors, generated during the clinical window that matters most for understanding how their drugs perform in the real world.
🧑
Patients
Receive structured follow-up from a case manager during the most vulnerable period of their recovery, when the risk of deterioration is highest and the support is typically absent.

The Sample Cliff

The evidence gap has a name.

Structured data collection drops sharply after the first two weeks following discharge. Claims data thins. EHR entries stop. The gap occurs precisely during the window when adherence failure and readmission risk are highest. Trisana closes it.

Patient Engagement Retention vs. Industry Baseline
Discharge Day 14 Day 30 Day 60 Day 90
Trisana protocol engagement
Industry baseline
Unique Evidence Window
76 days
Days 14 through 90 post-discharge, unavailable from any existing real-world data vendor
Industry Day 90 Retention
~12%
Of patients have any structured data collected by Day 90 in existing platforms
Trisana Evidence Standard
HFPE
High-Fidelity Patient Evidence, prospective, patient-sourced, collected at structured protocol intervals
Get Started

TriunityCX is actively seeking hospital and pharmaceutical partners nationally.

Whether you are a health system administrator exploring post-discharge patient management solutions, a pharmaceutical professional interested in a new category of real-world evidence, or an investor or collaborator interested in what TriunityCX is building, we welcome the conversation.