ADT & Transitional Care

Click any KPI or member row to open the transitional care checklist.
48h contact rate
+5.4pp
79.9%
Target: 90%89% to goal
14-day TCM completion
+3.8pp
47.4%
Target: 65%73% to goal
30-day readmission
-1.8pp
13.8%
Target: ≤ 14.5%105% to goal
Transition funnel
This week · from ADT feed to completed visit
ADT events received
412
65% conversion
Attributed member
268
80% conversion
Outreach attempted
214
75% conversion
TCM visit scheduled
161
79% conversion
Visit completed ≤14d
127
Event-to-visit rate30.8%
Drop-off before visit285 members
Weekly follow-through
Events received vs contacted vs completed
Who needs follow-up today
8 events · sorted by time remaining in the contact window
MemberEventFacilityDischargedContact windowReadmit riskStatusAction
Leo Martinez
82y · Dr. Patel · Stroke rehab completion
SNF dischargeCedar Hills SNF64h ago16h overdue
52%
Not started
James Anderson
75y · Dr. Brown · CKD stage 4, volume overload
IP dischargeSummit Medical52h ago4h overdue
46%
Outreach attempted
Grace Oduya
59y · Dr. Thompson · Cellulitis
ED visitNorthgate ED40h ago8h left
11%
Visit complete Closed
Priya Raman
68y · Dr. Thompson · Pneumonia
IP dischargeHarbor General31h ago17h left
22%
Scheduled
Alice Nguyen
78y · Dr. Brown · Post-op hip, deconditioning
SNF dischargeHarborview SNF26h ago22h left
38%
Outreach attempted
Robert Wilson
63y · Dr. Thompson · CHF exacerbation
IP dischargeNorthgate Regional18h ago30h left
41%
Not started
Denise Carter
71y · Dr. Kim · Chest pain, ruled out
ObservationRiverside14h ago34h left
19%
Not started
Marcus Bell
55y · Dr. Kim · COPD, no admission
ED visitLakeshore ED9h ago39h left
27%
Not started