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Theon Care Optimizer

release notes

Enhancements

Release notes 2020.2.3.3

Global filter timeout issue

Description

Global filters within the Care Optimizer platform were causing intermittent failure of the application for some users.

Impact

Created an 'apply' button for the global filter feature. Users can select values from the drop downs and press 'apply' to execute the query.

Release notes 2.3.1

New quality opportunity benchmark action report

Description

This is a new action report that consumes and reports contractual opportunity data from the client in the same way that the quality opportunity summary action report consumes and reports clinical opportunity data from the client.

  • benchmark count & percentile reporting
  • national & regional benchmarks available
  • hyperlink to patient level detail report capability
  • refinement capability
  • report export capability

Users with standard Care Optimizer® roles will have access to this new action report.

Impact

Users can evaluate quality performance by comparing their rates to an appropriate benchmark.

Update quality opportunity pop-up descriptions

Description

On the member opportunity detail & quality opportunity summary action reports, users have the ability to click on the measure name and see a brief description of the quality measure. 

Impact

Measures affected are:

  • adolescent immunization – HPV
  • breast cancer screening
  • diabetes care – HbA1c poor control
  • use of high risk medication in the elderly

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

NCQA readmission rates – new bubble

Description

Readmission rates that are displayed within the Theon® applications will be calculated using the NCQA definition of readmission.

Impact

Users will now be able to see readmission rates that will be calculated based on the NCQA definition within all of the Theon® applications.

Exclusion logic update and reporting

Description

The calculation for the number of open quality opportunities has been adjusted to more accurately consider patients who no longer qualify for a measure.

Impact

Users will now be able to view a more accurate quality opportunity closure percentage for patients who no longer qualify for a measure. 

New dashlet – “Variable time period cost overview”

Description

A new dashlet has been added to Care Optimizer® displaying an overview of cost which can be displayed based on several different time periods selected by a user. Dashlet allows for the client to compare an overview of their cost to their peers.

Impact

Users now have the ability to select various time periods to display on the new cost overview dashlet. This allows users to compare their performance to their peers for the selected time period.

Update sub-measure screen headers

Description

The reconsideration form headers have been shortened to better 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

Release notes 2.2

All patient level reports should contain the patient birth date field

Description

The following reports need to have the “patient birth date” added to the UI and the Excel output file:

  • claim detail report
  • claim summary report
  • inpatient admission report
  • pharmacy detail report

Impact

Clinical staff expressed the need for 2 (non-payer specific fields) to identify a member.  Currently they only have one (patient name).  External entities (providers) need this information to effectively use the tools. The patient birth date field will be masked when the record presented is considered sensitive.

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:

  • The ability to collect clinical data related to members with an open W34 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.

Impact

The W34 screen provides:

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

Release notes 2.1

User guide update – Page 58 - Table updated with new definition for open returned

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.

Impact

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

Updated type of service (TOS) logic

Description

The type of service cost bucket (TOC-CB) logic was updated so that urgent care services are no longer classified as emergency department (ED) visits.

Impact

With this change many of the urgent care services previously identified as ED will move to the specialty services cost bucket. It is expected that users will see a drop in ED utilization.

Release notes 2.0

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.

New quality deviation report

Description

The quality deviation action report has been added to Care Optimizer® . This report is similar to the quality opportunity summary action report but focuses on instances when a patient received treatment that did not follow widely accepted standards of care.

Impact

Users will be able to report on an additional dimension of quality using this action report. This new report supports the deviation metric shown on the quality opportunities dashlet. The new report presents information by quality deviation and includes an appropriate treatment rate. Users have the ability to drill through to see supporting patient level detail.

Actionable opportunities added as refinement option for patient opportunity summary report

Description

Previously, users could not refine the patient opportunity summary report to contain only those patients with at least one actionable opportunity.

Impact

In the refinement drop down, an option for “actionable opportunities” has been added. Users can refine the patient opportunity summary action report to include only those members with actionable opportunities. This will allow users to select a member(s) and “bridge” from Care Optimizer® to Care Collaborator® to submit or abstract information related to closing the opportunity.

Added total number of submitted opportunities to patient opportunity summary action report

Description

Added “total submitted opportunities” column to the patient opportunity summary action report, showing how many opportunities had information submitted via the Care Collaborator® reconsideration screens.

Impact

Users can now view and track progress related to submission of information for open opportunities. This column is updated nightly with information from Care Collaborator® .

Remove opportunity state and update opportunity status

Description

Previously, when viewing the patient opportunity detail action report, there were two fields that described the status of an opportunity (opportunity status and opportunity state). In an effort to be more user friendly, the “opportunity state” option will be removed. Values displayed under “opportunity status” will contain revised status codes to better describe the complete status of an opportunity.

Impact

Users can review the patient opportunity detail action report and determine the status of an opportunity in the reconsideration process by looking at only one field, “opportunity status”. Users will also be able to refine the report using the single field.

Identified issues and associated resolutions

Release notes 2.2

Selected bubble counts are not supported by data returned when hyperlink is used.

Description

Population measures: “patients currently admitted” and “discharged in last 10 days”.  The bubble count for each of these metrics does not tie to the record count shown when using the hyperlink to the patient panel to see the supporting detail backing up the bubble count.

Resolution

This issue was resolved with the 2.2 release.  Bubble counts are now tied to the record count shown when using the hyperlink to the patient panel.

Procedure code field missing from claim detail report excel export for 3 external access levels.

Description

The excel export for the claim detail report did not contain all of the fields that a user saw within the user interface.

Resolution

The procedure code field has been added to the excel output.

Phone number added to patient panel export

Description

The excel export for the patient panel report did not contain all of the fields that a user saw within the user interface.

Resolution

The patient phone number field was added to the excel output.

Release notes 2.1

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

Release notes 2.0.1

Missing subscriber ID’s

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 impacted. The search function in CO is not based on subscriber ID and subscriber ID is not used in the user interface.

Impact

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.

Update inpatient admission action report to show “original” fields correctly

Description

In the inpatient admission action report, the “original” admission and discharge fields were being populated incorrectly.
When there is a readmission, a patient has a line in the action report showing the initial hospital stay and a line showing the readmission.
The original admission date and the original discharge date columns on the readmission record should contain both admit and discharge dates for the initial admission (the stay preceding and associated with the readmission). The admission and discharge dates, however, were previously being placed on the initial or original admission line instead of the readmission line.

Impact

This issue has been resolved. On the CO inpatient admission action report, the “original” fields are populated only on the related readmission line.

Release notes 2.0

Opportunity closure acceptance of terms flashes too quickly

Description

Previously, users with newly assigned opportunity closure role, who have not yet accepted the terms of use, were not able to bridge from CO to CC. When the terms of use agreement appeared, users could not view or accept the terms because the dialog box flashes too quickly and disappears.

Impact

Terms of acceptance dialog box now remains on screen longer, giving the user the ability to accept the terms.

Quality opportunity action report — remove the report from the dropdown

Description

Previously, users with newly assigned opportunity closure role, who have not yet accepted the terms of use, were not able to bridge from CO to CC. When the terms of use agreement appeared, users could not view or accept the terms because the dialog box flashes too quickly and disappears.

Impact

The report was found to be redundant and removed in lieu of the clinical quality action report. users will no longer see the quality opportunity action report as an option to choose.

Unable to complete exports in claim detail report

Description

Previously, users were unable to export the claim detail action report when the report was sorted by paid LOB.

Impact

Issue has been resolved and users can now export the claim detail report correctly.

Update the definition for the “last IP visit date” on the patient panel action report

Description

Previously, users were confused by seeing dates in the future and dates that did not reflect the most recent inpatient admission.

Impact

Definition of the “last IP visit date” has been updated to clearly state why a user might see dates in the future, as well as why they might not see the most recent inpatient admission date.

Small H in master patient ID on the patient opportunity summary report not allowing bridge to Care Collaborator®

Description

Previously, this issue was preventing, in some limited situations, the ability to bridge from Care Optimizer® to Care Collaborator® .

Impact

Issue has been resolved and the bridge now works efficiently for all master patient IDs.

Home button and logo causing endless loading when hyperlinks are used

Description

Previously, when user was on the home page, clicking on the home button or logo caused the application to lock — up and the user to see an endless loading message.

Impact

The hyperlinks on the home page have been removed.

Sort order in action reports not working correctly

Description

Previously, when a user attempted to sort an action report, the results were not displayed in the expected order.

Impact

Affected action reports can now be sorted in the expected order and are more useful to users.

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.

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