Community Hospitals & Health Systems
Every Patient.Every Discharge.Every Family.
With Mira, more patients can be screened, triaged, and followed up — helping teams connect patients to social care before discharge becomes readmission.
Family Thread · Powered by Mira
The Hospital Problem
Social Need Impacts Readmission.
Across community hospitals, patients with unmet housing, food, transportation, and behavioral health needs often experience higher rates of ED revisits and 30-day readmissions. Medical social workers know who they are — they just don't have the bandwidth to reach them all before discharge.
Unmet housing needs can disrupt post-acute care and recovery plans.
Food insecurity complicates chronic disease management like CHF and diabetes.
Lack of transportation leads to missed follow-up appointments and delayed care.
What Mira Does
Mira supports the patient journey
At Admission
Mira can support SDOH screening for admissions and ED registrations — bedside tablet, family phone, or patient portal — in any language.
Discharge Planning
Positive screens can be organized into a triaged work queue for medical SWs, case managers, and care coordinators with clinical context.
Post-Discharge
Mira can conduct follow-up to confirm medication pickup, transportation, and follow-up appointments, and close the referral loop.
For Medical Social Workers & Case Managers
What the team gains
For Patients & Their Families
What patients experience
Real Impact
A Day in the Life
Toggle between before and after to see how a typical hospital medical social worker's day shifts with Mira.
Medical Social Worker
Marcus Williams, LCSW
Lakeview Regional Medical Center · Care Management
Fictional name and organization
"I'd start each shift with a list of patients to see. SDOH screening was supposed to happen on every admission, but we rarely got to all of them. The patients I worried about most were the ones I knew we'd see again in two weeks."
SDOH screening incomplete due to time constraints
Post-discharge follow-up handled inconsistently
No closed-loop referral tracking
Discharge assessments typed manually, often after-hours
Illustrative scenario built from typical workflows of hospital medical social workers and care management teams. Quote, name, and organization are fictional and do not represent a specific person or customer. Stock photography used with license.
Screening
Better coverage
Triage
Prioritized work
Support
Post-discharge tracking