Linea: AI Approach To Cut Heart Failure Readmissions

An estimated 6.5 million Americans over the age of 20 live with heart failure, a leading cause of hospitalization and a major contributor to healthcare costs. Readmission rates remain a stubborn challenge, with more than 40% of patients returning to the hospital within 90 days of discharge. For providers, it’s a familiar and costly cycle, as patients move between hospitals and homes without the necessary continuity, coordination, or support.

Linea, a startup launched in January 2024, aims to break this pattern by combining artificial intelligence with high-touch care teams to deliver more proactive care and reduce preventable hospital readmissions. The company’s platform integrates generative AI for hospital admission detection, medication prescribing and dosing optimization, proactive virtual care, and real-time patient engagement into a single, scalable model. Backed by Redesign Health and kidney care provider DaVita, Linea is tailored for accountable care organizations and other risk-bearing providers, with the goal of lowering readmission rates to 20% or below.

CEO Rishi Madhok, M.D., an emergency medicine physician at UCSF Medical Center, emphasizes the opportunity to use agentic AI to scale high-quality care for a high-risk, high-cost population. By identifying patients early in their hospital stay, engaging them before discharge, and guiding them through recovery, Linea provides 90 days of coordinated hybrid care. The model includes pharmacist-led medication reviews, remote monitoring with real-time biometric alerts, and round-the-clock virtual nurse support. It also integrates with existing clinical workflows, connecting primary care, cardiology, nephrology, and ACO teams.

Early results are promising: Linea reports a 50% reduction in readmissions for ACOs, with a 90-day rate below 25%, far outperforming the national average of 40%. On average, patients engage with the platform within two days of a health event, and nearly 80% are reached before hospital discharge. Most receive more than a dozen check-ins in the first month—an engagement level far above the national norm, where 60% receive no follow-up at all. The company’s value-based pricing model ensures partners pay only for actively enrolled patients, aligning incentives and controlling costs.

The partnership with DaVita expands Linea’s reach and addresses the frequent overlap between heart failure and chronic kidney disease, which can affect nearly half of patients with either condition. DaVita executives see Linea’s AI-driven engagement as a critical piece in managing complex, high-need patients and transitioning from a fragmented fee-for-service system to a coordinated, value-based approach.

Looking ahead, Linea plans to roll out its solution to more states in 2025, onboard additional ACO partners, and explore expansion into kidney and metabolic diseases. Redesign Health’s Neil Patel describes Linea as a prime example of a company integrating AI, clinical expertise, and patient engagement to deliver scalable, high-value care across the post-acute landscape.