Enhancements

Release notes 2.4.3

Controlling high blood pressure measure

Description

The controlling high blood pressure HEDIS® measure is now displayed.

Impact

Changes include:

  • This measure will now be available for collection of supplemental data towards the closure of quality measures.
  • Users will also be able to view the progress towards completion.

Release notes 2.4.2

Updates to diabetes care – HbA1c reconsideration screens

Description

Update the reconsideration screen to allow all testing results to be entered into one screen.

Impact

Changes include:

  • HbA1c > 9 Reconsideration screen has been removed.
  • The HbA1c < 8 Reconsideration screen has been modified to accept all testing results.

Release notes 2.3.1

Updates to the breast cancer screening reconsideration screen and pseudo claim logic

Description

Update the reconsideration screen to reflect HEDIS 2018 specifications & update the logic to create the correct pseudo claims. 

Impact

Changes include:

  • Update the existing alert statement with more detailed information on what types of services can be used to address the opportunity.
  • Update the existing description statement to align with the HEDIS 2018 specification wording.
  • Add the ability to collect a modifier for each unilateral mastectomy service entered. 
  • Add pseudo claim logic to create a record that indicates the modifier entered into the screen.

Change the existing “mammography” answer in the screening procedure dropdown to “mammography, including 3-D tomosynthesis”.


Updates to diabetes care – blood pressure reconsideration screen

Description

Update the reconsideration screen to reflect HEDIS 2018 specifications.

Impact

Changes include:

  • Add a note statement describing the type of services that cannot be used to address the opportunity.

Updates to colorectal cancer screening reconsideration screen and pseudo claim logic

Description

Update the reconsideration screen to reflect HEDIS 2018 specifications & update the logic to create the correct pseudo claims.

Impact

Changes include:

  • Change the existing iFOBT/Immunochemical answer in the FOBT type dropdown to “FIT/Immunochemical”.
  • Add the ability to collect data for 2 new screening procedures:
    • “FIT-DNA” procedures
    • “CT Colonography” procedures
    • Add a new date field for the “FIT-DNA” procedure service date which allows dates to be entered during the measurement period or the 24 months prior to the measurement period.
    • Add a new date field for the “CT Colonography” procedure service date which allows dates to be entered during the measurement period or the 48 months prior to the measurement period.
    • Add pseudo claim logic to create a record for the FIT-DNA procedure.
    • Add pseudo claim logic to create a record for the CT Colonography procedure.
    • Change the procedure code assigned on the pseudo claim for the colorectal cancer exclusion.

Updates to adolescent immunization – human papillomavirus vaccine reconsideration screen

Description

Update the reconsideration screen to reflect HEDIS 2018 specifications.

Impact

Changes include:

  • Change the existing alert statement to a directions statement and include reference to the general guideline 38 “14 day rule” for services that can be used to address the opportunity.
  • Rearrangement of the screen to be consistent with the other adolescent immunization sub-measures.
  • The addition of a dose type field to allow the screen to move through the workflow when complete dosage information is entered.
  • Update the existing description statement to align with the HEDIS 2018 specification wording.

Dosing requirements updated to allow for 2 or 3 dose vaccine to count towards gap closure.


Updates to STARS indicators to HEDIS18 specifications

Description

Updated the measures that are marked as being part of the CMS STARS program to align with HEDIS 2018 Part C & D Star ratings measures.

Impact

Indicators within Theon® will reflect CMS HEDIS 2018 guidelines 
 

Release notes 2.3

Deconstruct comprehensive diabetes care (CDC) screen into screens for each sub-measure

Description

Deconstruct the current complex CDC1 screen into separate screens for each sub-measure: blood pressure, HbA1c, medical attention for nephropathy, and retinal or dilated eye exam.

The HbA1c screen covers opportunities for members with either the HbA1c testing or HbA1c <8.0% sub-measure that is open.

Impact

All return reasons that can be selected or assigned within the Theon® platform are now listed and explained within table 3.0 – quality opportunity form return reasons in the user guide.


Deconstruct immunization for adolescents (IMA) screen into screens for each sub-measure

Description

Deconstruct current complex IMA screen into separate screens for each sub-measure: Meningococcal and Tdap.

Impact

Users can now enter the data for each sub-measure and submit individually rather than partially filling out the screen when data for the entire complex measure is not available.


Deconstruct weight assessment and counseling for nutrition and physical activity for children (WCC) screen into screens for each sub-measure

Description

Deconstruct the current complex WCC screen into separate screens for each sub-measure: BMI, counseling for physical activity, and counseling for nutrition.

Impact

Users can now enter the data for each sub-measure and submit individually rather than partially filling out the screen when data for the entire complex measure is not available.


Deconstruct childhood immunization status (CIS) screen into screens for each sub-measure

Description

Deconstruct the current complex CIS screen into separate screens for each sub-measure: DTaP, Flu, HepA, HepB, HiB, IPV, MMR, PCV, RV, and VZV. 

Impact

Users can now enter the data for each sub-measure and submit individually rather than partially filling out the screen when data for the entire complex measure is not available.


Update sub-measure screen headers in deconstructed form

Description

Form headers have been shortened to fit the space available on the page. The measure names within Care Optimizer® module (CO) were adjusted to be consistent with the names in the Care Collaborator® module (CC).

Impact

Users are now able to see the name of the measure without having any characters cut off. Examples of these headers include:

  • MCR – Medicare
  • MKT – Marketplace
  • COMM – Commercial
  • MCD – Medicaid

Ability to ‘pend’ form when single line entry is completed

Description

Workflow will allow a form to be moved to ‘pending’ when a single line of data is to be abstracted when all boxes are checked.

Impact

Users are now able to enter the data available to them when applicable.  This enhancement applies to measures AWC and W34.  In addition, if all subcomponents of this measure are not documented in one visit, the measure will return to ‘open’ status.

Release notes 2.2

User guide updates explaining all current return reason values related to reconsideration screens

Description

Additional information needed in user guide document explaining all current return reason values that could be seen related to reconsideration screens.

Impact

All return reasons that can be selected or assigned within the Theon® platform are now listed and explained within table 3.0 – quality opportunity form return reasons in the user guide.


User guide updates to define reconsideration screen types – inappropriate and future enhancement

Description

Additional information needed in user guide to explain the meaning of the inappropriate & future enhancement reconsideration screen types.

Impact

The inappropriate and future enhancement indicators are now listed and explained on page 151 of the user guide.

Release notes 2.1.1

New screen for adolescent well-care visits (AWC)

Description

A need for a new screen for adolescent well-care visits (AWC) was identified. The screen is similar to the well-child visits in the first 15 months of life screen (W15) in terms of:

  • screen presentation
  • screen functionality
  • screen workflow
  • data workflow

Impact

The AWC screen provides:

  • The ability to collect clinical data related to members with an open AWC opportunity when a contract has been built within Care Collaborator covering the opportunity.
  • The ability to classify open AWC opportunities within both Care Collaborator and Care Optimizer as “actionable”. This allows users a bridge between Care Optimizer and Care Collaborator when a contract is built within Care Collaborator covering the opportunity.
  • Defined submitter, abstractor, peer review or read only roles and access levels.
  • The ability for users to submit clinical data over time while sending data, in the form of a “pseudo claim”, back to the client.
  • The ability to apply peer review sampling and functionality to the data collected for these opportunities.

New Screen for well-child visits in the third, fourth, fifth and sixth years of life (W34)

Description

A need for a new screen for well-child visits in the third, fourth, fifth and sixth years of life (W34) was identified. The screen is similar to the well-child visits in the first 15 months of life screen (W15) in terms of:

  • screen presentation
  • screen functionality
  • screen workflow
  • data workflow

Impact

The W34 screen provides:

  • The ability to collect clinical data related to members with an open AWC opportunity when a contract has been built within Care Collaborator covering the opportunity.
  • The ability to classify open W34 opportunities within both Care Collaborator and Care Optimizer as “actionable”. This allows users a bridge between Care Optimizer and Care Collaborator when a contract is built within Care Collaborator covering the opportunity.
  • Defined submitter, abstractor, peer review or read only roles and access levels.
  • The ability for users to submit clinical data over time while sending data, in the form of a “pseudo claim”, back to the client.
  • The ability to apply peer review sampling and functionality to the data collected for these opportunities.

Release notes 2.1

HEDIS 2017 basic screen changes

Description

Due to changes in HEDIS 2017 specifications, enhancements to Care Collaborator reconsideration screen were required for the following:

Impact

All changes have been made per HEDIS 2017 specifications. Users will be able to enter data and meet HEDIS 2017 requirements for these measures.

  • breast cancer screening (BCS)
  • cervical cancer screening (CCS)
  • childhood immunization rotavirus (CIS-RV)
  • colorectal cancer screening (COL)
  • immunization for adolescents (IMA)
  • use of imaging studies for low back pain (LBP)
  • well-child visits in the first 15 months of Life (W15)

Ability to print a group of reconsideration forms at one time

Description

In order to allow users to print a group of reconsideration screens at one time, the time-out associated with printing reconsideration screens has been increased to 10 minutes.

Impact

Change has been made within the tool to allow this functionality. Users will be unable to do any other functions within the tool until the print function is completed. If the time-out limit (10 minutes) is reached, a popup box will appear stating: "print form generation failed - time limit exceeded".


User guide update - page 65 & page 75

Description

Table seen on page 65 of the user guide has been updated for the “open: returned” status to reflect the following new definition:

  • “The submitted opportunity has been returned for more information.” The associated reason code will display why the reason was returned.

Also, on page 75, a small wording change was made for clarification.

Impact

Additional clarification surrounding this opportunity status has been provided to users.

Release notes 2.0

Submitter role enhancement

Description

Users in submitter role will now see confirmation when forms are submitted. Records can be edited until abstraction begins and sorting of care opportunities has been improved.

Impact

Enhancements will make the submission process more efficient and user friendly. Specifically, submitters will:

  • Received onscreen notification that a form was successfully submitted after uploading a document
  • Be able to edit the record until an abstractor ‘accepts’ the submission
  • View care opportunities on the patient explorer page sorted first by descending due date and then alphabetically by measure name

The well-child visits in the first 15 months of life (W15) — partial information entry

Description

Supplemental data that has been submitted, abstracted, and as appropriate, peer reviewed can now be extracted for inclusion in the members W15 reconsideration screen. This pseudo claim process will give users an efficient method to collect data for quality reporting.

Impact

A pseudo claim file is created containing the information presented on behalf of patients for open opportunities. This file can then be sent to Capital BlueCross for processing to close open opportunities. Upon assessment by the client’s gap closure process, information will be delivered back to Theon for display in all modules.


Measures and definitions update

Description

A wide variety of enhancements and fixes have been made to Care Collaborator and Care Optimizer. Online help resources have been updated as a result.

Impact

Updated user guide and measures and definitions documents reflecting all changes for this release have been made available to users.

Identified issues and associated resolutions

Release notes 2.2

Forms changed to “pending: pending closure” during the HEDIS® conversion project do not re-open after 60 days

Description

During the HEDIS® conversion completed in April, screens that were in certain statuses were converted to the “pending: pending closure” status based on those forms re-opening after 60 days.  This did not occur, therefore users were unable to enter additional information related to open opportunities.

Resolution

The daily process was updated to include the “pending: pending closure” status in the 60 day logic.  This fix will correct any record, in production, that is currently in this “dead-end” status and has been there for at least 61 days.  The first day this logic will run is the day after the 2.2 implementation.

Release notes 2.1.1

Missing subscriber IDs

Description

The timeframe for the use of imaging studies for low back pain recent trauma exclusion was changed for HEDIS 2017. The HEDIS 2016 specifications were being applied to this field within the screen allowing for dates starting 1 year prior to the index episode start date (IESD).

Resolution

The screen now applies the HEDIS 2017 specifications related to this exclusion allowing for dates starting 90 days prior to the index episode start date (IESD).

Release notes 2.1

The following defects/issues were identified and resolved in release 2.1: None

Release notes 2.0.1

Missing subscriber IDs

Description

It was discovered that some subscriber IDs were missing within the Care Collaborator (CC) user interface and were not being populated in the CO back-end tables. As a result:

  • In CC, if a user searched for a member using subscriber ID, master patient ID or patient name, the members without subscriber IDs could not be found because the search function key is based on subscriber ID.
  • In CO, users were not directly resolutioned. The search function in CO is not based on subscriber ID and subscriber ID is not used in the user interface.

Resolution

Changes have been made so that:

  • In CC, the searching by subscriber ID will function correctly.
  • In CO, subscriber ID is correctly populated in back-end tables and available for future use.

Release notes 2.0

Prepopulate rotavirus immunization type

Description

Previously, dates were populated on the rotavirus reconsideration screen, but the type of immunization was not. There is a requirement for the type of rotavirus immunization used to appear on the screen; each immunization type carries with it a certain number of necessary immunizations.

Resolution

The type of rotavirus will be displayed and prepopulated with corresponding date(s). Update will allow the user to view the number of remaining immunizations required in order to be compliant.


Update HbA1c hover overs with enterable range

Description

Previously, there was no hover over indicating what constitutes an acceptable range for HbA1c results.

Resolution

Users will now see a hover over to indicate a range of appropriate results.


Check box column added to W15 to indicate performed by primary care physician (PCP)

Description

Previously for well-child visits in the first 15 months of Life (W15), there was no attestation for a provider to indicate that the service was provided by a PCP.

Resolution

A “check box column” has been added to indicate that the service was performed by a PCP, which is one of the requirements for each service. This will assist with the audit process and support attestation of the service being performed by the appropriate clinician.


Data source column added to W15: admin vs. recon

Description

Previously, there was no ability to determine how a measure or submeasure was addressed for well-child visits in the first 15 months of life (W15).

Resolution

Users will now see a display column added to W15 screen indicating the data source. For prepopulated data, the value will display a value of  admin. For data entered into the screen by an abstractor, it will populate on entry to be recon.


Filter counts in population explorer

Description

Previously, users viewing any of the population explorer views, including action reports, and selecting a dropdown in one of the filters, the small indicator by the “filters” section was not showing the correct count of the number of filters that had been applied to the population being viewed.

Resolution

Users will now see that the “filters” counter is displaying the correct number of selected filter options.


Theon® is a product of Geneia®. On Behalf of Capital BlueCross, Geneia provides health data informatics and analytical support and services. Geneia is an independent company. Healthcare benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital Advantage Assurance Company® and Keystone Health Plan® Central. Independent licensees of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies.