Gaps
Stewardship
GAPS - BLUE CROSS AND BLUE SHIELD OF ALABAMA PATIENT HEALTH SNAPSHOT
Stewardship provides patient specific information pulled directly from the EHR.
Stewardship is a clinical cost transparency tool that displays costs of medications, labs, and radiology studies side by side with other clinical data while suggesting lower cost alternatives without interrupting provider workflow.
Please note – what you see in Stewardship may be different than the image above. Items are configurable to be turned on or off based on health system requirements.
Many providers today access Blue Cross and Blue Shield of Alabama data on care gaps and other quality measures using a web portal and printed reports. Now, providers can see that same data presented in their EMR workflow, without requiring a complex EMR integration or added expense.
Patients in at-risk populations tend to get their care from more than one provider. The Gaps app from IllumiCare automatically checks the patient you're viewing in the EMR against their documented quality and risk measures to ensure that no care or HCC coding gaps exist.
Frequently Asked Questions about Gaps
What is the Gaps App?
The Gaps app automatically checks the patient you're viewing in the EMR against their documented quality risk measures to ensure that no care gaps exist.
What are the measure groupings for each measure?
There are 2 measure groupings for each measure to fall under:- Gaps in Care - If the patient has a care gap that is due by year end then it will be listed within this section.
- Compliant / Controlled - If the patient has a care gap that is already met then it will be listed within this section.
What are Potential Conditions?
The Potential conditions are the HCC (Hierarchical Condition Categories) sets of medical codes that are linked to specific clinical diagnoses. Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions.
What does Recent Care section show?
Recent Care section shows all Hospitalizations, ED visits, Readmissions that the patient has had in the past 12 months. Within this section we also show the last annual wellness visit the patient had with the date of the visit and the name of the provider who they had the visit with.
What's displayed under the Medication Non-adherence forecast section?
This section displays all of the medication that the patient is on with it's Fill Rate, Last Fill date and the risk score next to it.
What are the Health Management Programs?
Health Management Programs are the programs that are offered to the patient for educational purposes to enroll into by Blue Cross and Blue Shield of Alabama if they have certain conditions.
What kind of information is displayed under the All Medical Group Patients section?
All Medical Group Patients tab shows all patients that attributed to that specific Practice.
What does Print Selected Patients button do?
You have ability to select patient/patients under this section and once you have the patients selected, you are able to print info on the selected patients by clicking on the Print Selected Patients button.
What does View/Print Patient Health Snapshot button do?
View/Print Patient Health Snapshot Button lets you print/view selected patient health snapshot.
Frequently Asked Questions about the Stewardship app
What can be found within the At-A-Glance?
At-A-Glance gives users a quick look into the current patient’s clinical data and is configurable based on the additional clinical information sent to IllumiCare. The following clinical information may be found within the At-A-Glance header: Patient Vitals, Patient Devices, Patient’s CMP, Patient’s CBC, Patient’s Input/Output, Patient’s Blood Transfusions, and Timers (patient’s current class/type and length of time). If there is data missing, it is because IllumiCare is not sent that clinical data or the data point has been configured to off within your health system.
What timers can be seen and what are they?
The following timers will be displayed based on the patient’s current patient class/type: Inpatient (Length of Stay based on patient days), Observation (length of time patient has been on observation status), and ED (time since the patient checked in).
How is C Diff % Risk calculated?
This is the iatrogenic C Diff risk, related to current active scheduled medications. Our calculations consider the specific risk that exists for each specific antibiotic and/or protein pump inhibitor as well as the compounding affect that occurs when the patient has been prescribed multiple antibiotics and/or PPIs concurrently.
How is Fall Risk calculated?
The fall risk represents the relative risk of falling based on the intake of scheduled sedatives and opioids if aged 65 or greater. Please note, this calculation only considers current scheduled medications. Medications prescribed as PRN are not currently factored in as a part of this fall risk calculation.
What lab costs are displayed in the Stewardship app?
Lab costs derive from the Medicare Allowable Rate. The costs are not charges or what the patient pays.
How is blood loss calculated?
IllumiCare calculates the total phlebotomy blood draw that occurs based on the average amount of blood that must be drawn for each test ordered. We do consider other factors in our calculation, for example, when multiple lab tests are ordered at the same time, they may leverage the same blood draw.
What Rad costs are displayed in the Stewardship app?
Rad costs derive from the Medicare Allowable Rate. The costs are not charges or what the patient pays.
Contacting IllumiCare support staff:
1st - Click the lightbulb on the right side of your ribbon to open the ribbon menu
2nd - Click Help & Support
3rd - Let our support staff know how they can help you.