The Theon® Care Engager® module, imagined by Geneia, is your resource for successful health plan management. This innovative analytics platform brings you the information you need to analyze your health plan and make strategic, informed decisions by providing insight into enrollment, cost, quality, and utilization data including provider network performance analysis and care/wellness opportunities.
Dashlets and action reports provide quick access to detailed information that can be used in both strategic and detail-level analysis and decision-making. Depending on your security role/access level, you may have access to most or all of these reports.
Collapsible Panel DnD
Costs per member per month for the service area (ED, hospital services, lab, pharmacy, primary care, radiology, and specialty) within the current period as compared to the norm.
Cost overview outliers only
Costs per member per month equal to or exceeding the outlier setting for the service area (ED, hospital services, lab, pharmacy, primary care, radiology, and specialty) within the current period as compared to the norm.
Cost overview without outliers
Costs per member per month excluding those equal to or exceeding the outlier setting for the service area (ED, hospital services, lab, pharmacy, primary care, radiology, and specialty) within the current period as compared to the norm.
Utilization by inpatient service type (i.e. acute, mental health and substance abuse (MHSA), readmits, rehabilitation, and skilled nursing facility (SNF)) showing admission per 1,000 members for the plan and the norm.
Member enrollment by contract type
Member (contract holder, spouse, and/or dependent) enrollment posted in the last month of the reporting period in various contract benefit coverage types.
Payment by drug type
Comparison of current and previous plan paid cost of prescriptions filled categorized by the classification of drugs.
Comparison of current and previous paid costs by claim type for inpatient hospital, outpatient hospital, professional, and pharmacy services.
Pharmacy utilization summary
Prescription utilization and plan paid amount for retail and mail order as well as prescription utilization and plan paid amount for specialty and non-specialty.
Percentage of member population engaged in case management and disease management programs by product line as well as the number of members identified for a case management or disease management program.
Total number of opportunities identified, the members with recommended care opportunities, the total number of open quality care opportunities, and those members identified as having open quality care opportunities.
Subscriber enrollment by contract type
Subscriber (contract holder/employee) enrollment posted in the last month of the reporting period in various contract benefit coverage type.
Utilization by drug type
Comparison of current and previous volume of prescriptions filled categorized by the classification of drugs. Script count is based on a 30-day equivalent calculation.
Utilization per 1,000 members by type of service (ED, hospital services, lab, pharmacy, primary care, radiology, and specialty) for the plan and evaluated against the norm.
Collapsible Panel DnD
Cost and utilization summary by cost bucket
PMPM dollar amounts spread across the seven (7) cost and use buckets (ED, hospital services, lab, pharmacy, primary care, radiology, and specialty). Each bucket has PMPM’s divided into ‘actual’ and ‘norm’ categories.
Enrollment information related to the product at the member level such as contract type and description, plan and product description, and eligibility start and end date.
Enrollment information related to the product at the employer group level such as plan and product description, total member, subscriber, and dependent count, and total member, subscriber, and dependent paid amount.
An overview of medical and pharmacy data for the current and previous year as well as a comparison against the norm.
Employer PMPM medical and pharmacy cost for the previous and current period, as well as the previous PMPM adjusted for change in risk, in comparison to the norm.
Past and current inpatient admissions based on a supporting claim or census data. Information is presented one-line per confinement with multiple descriptive fields.
Member opportunity detail
A member level detailing of care, deviation, and coding-missing opportunities. This report contains information such as member name, attributed provider name, opportunity type, opportunities, opportunity status, star measure, etc.
Member opportunity summary
A member-by-member listing of various opportunities (total open opportunities, total number of open HCCs, open HCCs suspected, open HCCs missing, open care, open star, and number of deviations) along with counts for each category. Patient birth date, gender, and age are provided along with their practice/facility/site name and provider name.
High level overview of each member. Information is presented one-line per member with multiple descriptive fields. Provides the ability to drill down to specific ‘action reports,’ such as claim detail, member opportunity detail, pharmacy detail, etc., through clickable information.
Various pharmacy data metrics. From an overall perspective, total prescriptions and costs for data compared to the norm. Also, an NDC summarized list with multiple metrics including specialty drug indicator, generic name, class description, total cost, scripts filled, and generic available indicator.
Member enrollment in, and utilization of, care management programs, including program type, program level, enrollment open and close date, number of interactions, and currently engaged indicator.
Care management programs stratified by program level and program code. Also displays the number of enrolled members within each program as well as the engagement rate of those individuals.
Quality opportunity summary
A listing of quality measures that displays the measure description and number of Medicare advantage star opportunities. Also identifies the capture rate by dividing the number of quality opportunities met per measure by the number of quality opportunities per measure.
Top 10 performing providers by cost bucket
Actual PMPM dollar amounts spread across the seven cost and use buckets (ED, hospital services, lab, pharmacy, primary care, norm and a generated Index score to determine efficiency. Other metrics include: total paid, total visits, and percentage of total cost bucket.
Top 10 performing providers by specialty
Actual PMPM dollar amounts for the top 10 providers under specialty groupings. Other metrics include total paid, total visits, percentage of total cost bucket, and percentage of total specialty bucket.
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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.