Hospital readmission rates play a major role in determining the quality of healthcare provided by hospitals. Readmission rates directly impact CMS Star Ratings and the overall cost of healthcare. Some studies estimate that patient readmissions are associated with over $40 billion in hospital costs annually. Not unexpectedly, hospitals with high readmission rates tend to receive lower Star Ratings, which negatively affects the perception of care delivery and the level of provider reimbursement. Forward-looking health plans and hospitals should use FHIR-enabled management platforms to improve hospital readmission rates.

As readmissions account for 22% of a hospital’s quality score  is driven by a diverse set of medical conditions, it is an effective strategy to use health data to identify condition-specific opportunities for improving care. From a clinical data integration best practices perspective, the most effective readmission rate improvement strategy would be supported by 4 health data components:

• Longitudinal patient record
• Comprehensive patient record with clinical, claims, EMR, care partner and patient-sourced data
• Real-time admission, discharge and transfer (ADT) data
• Enriched and curated heath data accessible to health plan users in FHIR-based repositories

To learn why several leading 4 and 5 Star rated Medicare Advantage plans are collaborating with Health Chain to improve data-driven health care delivery, contact us today.