Patient Sortal uses the Johns Hopkins ACG System to improve care for justice-involved individuals reentering the community, addressing their complex medical, behavioral, and social needs. By analyzing pre-release data, patients are stratified into risk tiers and assigned case managers within 48 hours of release. This proactive, data-driven model helps reduce emergency visits and inpatient admissions. With over 85% engagement and 95% retention, Patient Sortal’s culturally sensitive, whole-person care approach improves outcomes and supports value-based contracts that incentivize lowering healthcare costs for returning citizens.

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