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General

What is Theon Care Collaborator?

Theon Care Collaborator is a patient centric tool that provides information in the following areas:

Cost

Theon Care Collaborator allow providers to see cost trends over time. If use of the module is maximized, the user can find opportunities for reducing costs and improving financial performance.

Quality

Theon Care Collaborator offers tools that can be used to identify coding and care opportunities to improve care delivery.

Patient experience of care

Theon Care Collaborator highlights information about engagement in clinical programs and provides information about preventative care opportunities that can be used to coordinate and close gaps in care.

Is Care Collaborator being provided to all providers contracted with Capital Blue Cross?

No, Care Collaborator is currently provided only to providers within Capital Blue Cross Accountable Care Arrangements and QualityFirst Medical Neighborhoods.

Data

How often is the watch list updated?

It is updated monthly.

What are non-acute hospitalizations?

Non-acute can be defined as a service that did not require an acute hospitalization. Rather short stay in SNF for low level PT or follow up care after an outpatient procedure.

Are substance abuse events viewable?

No, substance/alcohol abuse is always masked but mental health data is available depending on the user access level.

When a patient is termed, when are they out of the system?

Termed patients are listed until their claims are no longer included in the date parameters listed in the message center.

How often will the data be refreshed in Theon?

The data is refreshed monthly. Also inpatient admissions and discharges in the last 10 days is updated daily.

Functionality

How are alerts defined?

Alerts are defined as notifications of admissions and activities that are due.

How are alerts closed?

Alerts can be closed from the alerts notification window or from patient explorer by marking the alert as resolved for a specific patient.

Who sets up alerts and what criteria is used?

Alerts can be set up at the initiation of the client agreement. Currently, alerts are based off admissions & lab events.

Is the clinical workbench icon accessible?

The clinical workbench icon provides a link to the user Care Management activities related to @home patient-monitoring services. This icon is reserved for future development of the process and is not functional at this time.

How are the chronic diseases defined in the watch lists?

There is an algorithm that supports how people meet specific cohorts which changes based on patient utilization and claims experience.

What is the timing from when a provider selects the referral option?

Within 24 hours an email will be generated to a Care Management team member who initiate outreach to the member. Pending agreement by the member into the program, the information would be reflected in the module.

Can a medication list be exported from the patient explorer screen?

No.  This functionality is currently unavailable but has been identified as a future enhancement.

Why is the count in the “total # of closed opportunities” column listed and underlined on the clinical quality screen?

The total number of closed opportunities count allows the users to track closed quality opportunities. The underline allows direct access to opportunities that have been closed.

What dates of service are included on the patient timeline?

The timeline represents 27 months of medical events.

When looking at the number of visits, it looks like it shows the number of units for the patients not the number of distinct dates/visits, is this correct?

When looking at the utilization (ED & Outpatient services) at the population level you will see the actual number of visits, but when you look into the patient explorer the visit count will reflect the total number of claim lines.

Is there a way to list all the medical events in patient explorer?

The timeline is the best way, but it currently is not exportable and is limited to 27 months.

How can you search for a patient to add him/her to an activity/watch list?

From population explorer, you can add patients by initiating the wrench and selecting a patient to include on the activity/watch list or from population explorer select one or multiple patients by hitting shift + enter.

Where can you find information on whether the patient's insurance is active or termed?

The patient’s coverage status can be found on the patient panel and the exact eligibility start and end dates can be found on patient overview.

Where can you find information on admission and discharge dates?

The patient’s admission and discharge dates can be found on the patient explorer page within the hospital medical events section.

Metrics

When you hover over the field - high specialist utilization, what is the time period this covers?

This covers a rolling 12 month time period as stated in the Message Center.

How are visit counts reflected in pharmacy?

A member had 15 prescriptions filled but when you drill to the patient detail, you will see 5 lines. The calculation for the patient panel "number of prescriptions filled" is days supply/ 30 rounded up to the nearest integer. Each of the 5 lines contains 84 days supplied. Therefore 84/30=2.8 which rounds up to 3. Thus, 5 lines with 3 scripts each equates to 15 prescriptions.

Care gap closures

Is there a limit to the number of patients a user can bring over from Care Optimizer into Care Collaborator?

No. there is no limit.

Is there a size limit to the uploaded file?

Each file has a 20 megabyte limit. If the file exceeds this amount, the user will receive an error message. Files over 20 megabytes should be broken down into separate files.

Can a user upload more than one file per measure?

Yes, a user can upload multiple attachments to support the measure. Note that each file is limited to 20 megabytes in size.

If a user filters on diabetes measures, why would patient explorer show other measures for the patient?

Patient explorer will show the user all of the patient’s open opportunities, even if the user has selected just one measure.

Could a user just type “diabetes” using control-F to find those patients?

Yes. This is browser functionality and not specific to the Theon application.

If a measure has sub-measures, does the uploaded documentation support the main measure, the specific sub-measure or both? (Example: immunizations)

The documentation needs to support all sub measures to be able to close the main measure.

Can you tell which HEDIS measures are part of the value based program?

A contracted measure is indicated by the symbol on the gap closure screen; the hover-over feature also informs the user if the measure is contracted.

Does the user receive a notification when documentation is rejected or returned?

No, the user does not receive a notification. The status will be updated in the patient opportunity summary report by the end of the following business day and will be displayed in the “total returned opportunities” column. The user will need to monitor the patient opportunity summary report regularly.

Will there be a document that provides detail on what is acceptable documentation for submissions by measure?

Yes. See the supplemental HEDIS guide which is included in the Care Optimizer welcome kit.

What measures are available for gap closure?

Open measures are included in Care Optimizer within the patient opportunity summary action report. The majority of these measures will be closed using the normal claims submission and adjudication process. There are currently 17 measures with actionable gap closure screens in which supplemental information is allowed for closure.

Is there a time stamp to inform the provider when the opportunity has been closed?

No, there is no time stamp at this time.

How long will it take to close an open opportunity using the gap closure screens?

Trained nurses must review the documentation uploaded to the gap closure screens, thus it may take 4-6 weeks before an actionable measure will be closed.

What is the difference in the way opportunities in care are displayed now compared to how they were previously displayed?

To help you better identify Capital Blue Cross members in need of a service or screening, we made revisions to our former opportunities for recommended care reports in order to make this information more timely and actionable. This updated display of open care opportunities now includes a combined nine-month “look back” of claims data for missed opportunities and a prospective view for those measures that are not event driven, which identifies services that your patients will be due for in the next three months.

What are my options for the information provided as an open opportunity?

You can do one of three things with the information:

  1. Perform a service that was past due and submit a claim.
  2. Submit supplemental data to identify that a service was performed for which a claim will not be received by Capital Blue Cross (e.g. colonoscopy performed 7 years ago under a different insurer).
  3. Perform outreach to a patient for which a service is about to be due to ensure they have access to a timely appointment.

How will I know the right time frame for which I may submit data?

As this display is a rolling twelve-month display, we recommend utilizing the supplemental data guide for closing opportunities in care found in the Theon Care Optimizer digital welcome kit in order to determine the proper time frame for submission. This document includes an introduction to the medical record submission process, a tool to calculate the acceptable supplemental dates per measure, and a description of each measure for which we are accepting supplemental data.

I am a provider participating in value based programs with Capital Blue Cross. How will this data submission tie to the performance period in my current quality program?

Any compliant data submitted during your performance period, whether it be calendar year (1/1/20 - 12/31/20), fiscal year (7/1/19 - 6/30/20), or any other time frame, may positively impact your contract year or performance period during that particular time.

How does the “patient refused services” effect the HEDIS measures?

The use of the “patient refused services” or another option under the “service were not performed” option will result in the measure moving from an open to pend status. The measure will remain in a pend status for 2 months before it returns to open status. You can view the measure in a pend status by selecting “pending opportunities” on the patient explorer screen under quality opportunities. The pend status has no effect on the HEDIS numerator and denominator and will not count as a measure closure, therefore we do not recommend that you choose this option.

When I submit information to close a gap how will I know I have completed the submission successfully?

Once a record has successfully been submitted, you will receive a “record submitted” notice via a pop-up box that fades away 5 seconds after submission.

If, after successfully submitting a record, I realize it was incorrect or insufficient information, will I be able to access the submitted record and make corrections?

You will have the capability to alter opportunities in a pending status via an “edit” button on the pended recon screen until it is opened by an abstractor. Once the abstractor accesses the opportunity the edit button will become gray and you will no longer be able to make edits until the submitted opportunity is returned by the abstractor.

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Comprehensive performance measures guide