Health plan drills down to reveal member attribution by provider and practice

Health plan drills down to reveal member attribution

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Health plan drills down to reveal member attribution by provider and practice. Health plan saves the data view as custom list: affected providers notified through cloud based platform. Care team member opens customer list in the Theon® platform’s Care Collaborator module. Provider easily maps open opportunities to upcoming appointments: reaches out to schedule rest Care team member closes the opportunity during the patient visit and records it in the Theon platform. With a single click, the information is readily available to both provider and payer (AHIP, 2016). This writer’s organization currently only has the nurse case manager to monitor, assess, and implement education for the member/patient and the program is lacking because the Case Managers have very little time along with all of their other duties to really focus on the HEDIS measures. Ultimately, this writer feels that the cost of having a separate team strictly for the HEDIS measures and implements this process, is worth the cost because in the end, it will likely save the organization money in the long term. Members of the Project Team For the implementation of this project, this writer suggests that the organization purchase the Theon care optimizer program, then add a new department for this new program to be implemented. In this program, there should be a HEDIS operations unit manager, and then the employees underneath the manager that are responsible for the entire process. This team should include clinical staff, such as Case Managers as well as at least 1-2 nurse informaticist on the project team.
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THE IMPACT OF NURSING INFORMATICS ON PATIENT 6 References How to Improve HEDIS® Reporting Among Providers and Improve Your Health Plan Ranking. (2016, May). Retrieved from How Health Informatics Transforms the Insurance Industry. (n.d.). Retrieved from Glassman, K. S. (2017). Using data in nursing practice. Retrieved from HEDIS Measures and Technical Resources. (n.d.). Retrieved from:
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