For Members: Using OnePoint to Track Readmissions
As practices focus on quality and utilization measures heading into year-end, OnePoint can help care teams identify patients who may benefit from timely follow-up and additional support. The following tools can provide valuable insight into hospital utilization and readmissions:
Admission, Discharge and Transfer Registry
OnePoint includes the Tennessee Hospital Association’s ADT feed, giving practices visibility into patient admissions, discharges and transfers. The registry can help practices identify patients who may need follow-up after an acute event.
Use the registry to:
- Identify patients who may need primary care follow-up or medication reconciliation.
- Monitor for transitional care management or chronic care management opportunities.
- Review recent admissions and discharges by discharge date and proactively reach out to patients who may need additional support.
Vista: Readmissions Dashboard
The Vista Readmissions Dashboard uses inpatient claims data for readmission-eligible events to provide insight into hospital readmissions. Provider organizations, care management teams and operational leaders can use the dashboard to explore trends in utilization and cost related to readmission events.
Use the dashboard to:
- Track readmission key performance indicators over time.
- Compare facility and provider performance with plan, payor and DRG-adjusted averages.
- Review event volume by discharge disposition, including home, skilled nursing facility and home health.
- Filter and export event-level details for further analysis.
Turning Data Into Action
These tools can help clinical and care management leaders identify where targeted intervention may have the greatest impact.
Clinical leaders can review readmission trends over time and identify payors or practices with higher readmission rates, helping inform quality improvement efforts and resource allocation.
Care management leaders can identify providers with higher numbers of readmitted patients who did not have a follow-up visit. This information can help prioritize provider engagement and strengthen transitions of care.
Used together, the ADT Registry and Vista Readmissions Dashboard provide practices with both timely information about individual patient encounters and broader insight into readmission trends.
To learn more about the quality and utilization measures included in your payor contracts, visit the performance standards page on VHAN Hub or browse the contract tools in the VHAN Resource Library.