TriZetto’s Pre-Integrated, Comprehensive Care Management Solution Fills Void in Regional Health Plan Market

DENVER--(BUSINESS WIRE)--TriZetto Corporation today announced the availability of a comprehensive care management and analytics solution for regional healthcare organizations. Bundled with accelerated implementation and application management services for a predictable monthly fee, the solution simplifies deployment and provides a lower total cost of ownership. Through pre-integration with TriZetto’s QNXT^TM enterprise core administration system, the care management solution can accelerate time-to-market and boost productivity.

“This is a long-awaited, welcome development in the community of regional health plans”

“This is a long-awaited, welcome development in the community of regional health plans,” said Rob Scavo, president of TriZetto’s regional accounts market. “Such plans have cobbled together disparate applications that often have proved inadequate in providing a comprehensive, real-time care management solution that meets today’s need for sophisticated population health management. Now, for the first time, regional payers can have a single-source care management platform that delivers the full spectrum of disease, case and utilization management, as well as a powerful clinical analytics engine.”

Pre-integrated with TriZetto’s QNXT administration system, the combined solution offers regional health plans an affordable, full-feature enterprise platform that can deliver much higher administrative efficiency and greatly improved population health management, according to Jeff Rideout, M.D., TriZetto’s senior vice president and chief medical officer.

“TriZetto’s configurable, end-to-end platform supports the most effective case, disease and utilization management – for better, faster, more informed decisions about member care,” he said. “For example, users retrieve clinical information in real time, instead of a day later. They access the most current benefits information without leaving a 360-degree dashboard view of a member in the care management application. Users receive immediate feedback and validation for treatment authorizations submitted to the benefits application.”

TriZetto employs its proven TriZetto Advantage Framework^® methodology, an event-based approach, to complete accelerated “go-lives” of the solution in the implementation center at its worldwide headquarters in Denver. Ongoing application management services enable quick problem resolution, optimal application performance and greater availability. TriZetto’s 24x7 monitoring and support, as well as its direct access to development and support teams, help ensure the solution performs at the highest level. These application management services enable a lower, more predictable total cost of ownership.

TriZetto’s integrated, enterprise-wide solution for regional healthcare payer organizations includes:

• Core Administration – Pre-integration with TriZetto’s QNXT core administration system is especially important to regional health plans interested in higher productivity with reduced complexity. The QNXT solution is used by nearly 60 regional health plans touching 17 million lives. This award-winning solution automates and streamlines benefits administration, including member enrollment, premium billing, claims administration and customer service.
• Care Management – The CareAdvance Enterprise^® system reaches more than 36 million lives. TriZetto’s care management solution enables health plans to stratify member populations, provide programmatic support for members with chronic conditions and administer wellness programs that help low-risk members remain healthy. Through case, disease and utilization management, this solution helps improve the cost and quality of care delivery and enhance clinical outcomes. The system includes both the Clinical CareAdvance^® and CareAdvance Provider^® applications.
• Analytics – Configurable analytics automatically drive workflows and member outreach by analyzing data from claims, authorization, pharmacy, lab and other sources. Adding TriZetto’s Clinical AnalytiX™ pre-integrates powerful predictive modeling into the solution, allowing regional health plans to manage predicted utilization while achieving better outcomes.
• Implementation Services – TriZetto’s consulting team employs a deliverables-based approach covering the life cycle of services, from project inception through completion. Leveraging TriZetto’s implementation center, the team provides implementation planning and project management support; implementation execution; data conversion and development services; and implementation of extensions, interfaces and mini-applications.
• Application Management Services – TriZetto lessens the work and worry of owning, managing and maintaining the technology by providing optimal, reliable performance. The team provides disaster recovery services and mitigates risk and disruption by using an on-demand environment that mirrors the client’s production environment to model changes, upgrades and other solution enhancements.

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About TriZetto

TriZetto delivers world-class information solutions that enable healthcare organizations to work more efficiently and collaboratively to deliver better health. Its solutions reach 200,000 care providers, streamline processes for more than 360 payers and touch over half the U.S. insured population. TriZetto solutions help health plans and TPAs increase administrative efficiency, improve the cost and quality of care, and succeed in the retail healthcare market. Its solutions help physicians and health systems simplify business processes and execute strategies for population health management and accountable care. TriZetto’s healthcare experience, innovative solutions and comprehensive services help simplify healthcare for everyone. For more information, visit www.trizetto.com.