Información precisa de su plan de salud

The Theon Care Engager module, is your resource for successful health plan management. Esta innovadora plataforma analítica le brinda la información que necesita para analizar su plan de salud y tomar decisiones estratégicas y fundamentadas al proporcionarle detalles sobre la inscripción, el costo, la calidad y el uso de datos, incluidos el análisis de desempeño de la red de proveedores y las oportunidades de cuidado/bienestar.

Entender los dashlets y los informes de acción

Dashlets and action reports provide quick access to detailed information that can be used in both strategic and detail-level analysis and decision-making. Según su rol de seguridad/nivel de acceso, es posible que pueda acceder a la mayoría de estos informes o a todos.

Dashlets

Cost overview

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.

Uso de servicios para pacientes hospitalizados

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

Inscripción de miembros (titular del contrato, cónyuge y/o dependiente) publicada en el último mes del período de informes en diversos tipos de cobertura de beneficios con contrato.

Payment by drug type

Comparación de los costos actuales y anteriores pagados por el plan en concepto de recetas surtidas clasificadas según la categoría de los medicamentos.

Payment summary

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.

Manejo de programas

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.

Desempeño de calidad

Cantidad total de oportunidades identificadas, los miembros con oportunidades de atención de la salud recomendadas, la cantidad total de oportunidades abiertas de atención de la salud de calidad y aquellos miembros identificados con oportunidades abiertas de atención de la salud de calidad.

Subscriber enrollment by contract type

Inscripción del suscriptor (titular del contrato/empleado) publicada en el último mes del período de informes en varios tipos de cobertura de beneficios con contrato.

Utilization by drug type

Comparación del volumen actual y anterior de recetas surtidas clasificadas según la categoría de medicamentos. El total de recetas surtida se basa en un cálculo equivalente de 30 días.

Resumen de usos

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.

Acton reports

Resumen de costos y usos por categoría de costos

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 detail

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 summary

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.

Executive summary

An overview of medical and pharmacy data for the current and previous year as well as a comparison against the norm.

Financial summary

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.

Hospitalización

Hospitalizaciones anteriores y actuales basadas en una reclamación de respaldo o datos censales. La información se presenta en una línea por hospitalización con múltiples campos descriptivos.

Member opportunity detail

Un nivel de miembro que detalla las oportunidades de atención de la salud, desviación y codificación faltante. 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. La fecha de nacimiento del paciente, el sexo y la edad se proporcionan junto con el nombre del consultorio/centro/lugar y el nombre del proveedor.

Member summary

Un resumen de alto nivel de cada miembro. La información se presenta en una línea por miembro con múltiples campos descriptivos. Provides the ability to drill down to specific 'action reports,' such as claim detail, member opportunity detail, pharmacy detail, etc., through clickable information.

Patrón de receta

Diferentes criterios de medición de datos de farmacia. 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.

Program detail

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.

Program summary

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.

Resumen de oportunidades de calidad

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.

Los 10 principales proveedores por costo

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.

Los 10 principales proveedores por especialidad

Los montos en dólares PMPM reales para los 10 proveedores principales agrupados por especialidad. Other metrics include total paid, total visits, percentage of total cost bucket, and percentage of total specialty bucket.

Obtener ayuda

Para solicitar ayuda, solo tiene que llamar o hacer clic. Nuestro equipo de apoyo especializado de Theon está a su disposición para responder preguntas o brindarle la asistencia técnica que necesita. Contact them via email or by calling the Theon support hotline at 1.866.868.4366.


Theon ofrece servicios de informática y analítica de datos de salud.