DENVER--(BUSINESS WIRE)-- The TriZetto Group, Inc., today announced that a combination of its technology solutions and innovative Voice of the Client program is enabling one of the largest managed care plans in the New York metropolitan area to improve operational efficiency, serve additional members and meet regulatory deadlines.
“Our EDI and claims auto-adjudication rates weren’t what they needed to be,” said Robert Allen, senior vice president and chief information officer at Affinity Health Plan, a Bronx-based healthcare payer that provides benefits for more than 260,000 underserved New Yorkers. “After implementing TriZetto’s enterprise core administration solution, the EDI and first-pass resolution rates rose significantly to 87 percent and 80 percent, respectively. This was a key improvement.”
Key as well, said Allen, has been the ease with which TriZetto’s system has accommodated an influx of additional members to Affinity’s Medicaid managed care plan. Over the past two years, New York State has worked to reduce its Medicaid costs by transferring members and populations to managed care plans. Several hundred additional members each month have come aboard Affinity’s plan, and more are expected. Many of these new members have brought challenging circumstances – homelessness, underweight newborns, end stage renal disease, personal care needs – that traditionally have not been covered by New York State managed care plans.
“Fortunately, we use TriZetto’s enterprise administration solution,” Allen said. “Its flexibility has eased the process of configuring benefits-administration changes in the system, testing the changes and enrolling the additional members without disrupting the business.”
Allen said Affinity will incorporate more changes and new benefits in its Medicaid plan over the next two years. He is confident TriZetto’s solution will continue to enable the independent, not-for-profit healthcare payer to readily scale to membership growth.
Enabled for HIPAA 5010 and ICD-10, the advanced technology platform last year supported Affinity in meeting 5010 compliance targets on time and on budget. Allen said the system positions the health plan enterprise-wide to “meet upcoming delivery dates” for ICD-10 transitions.
“Our technology solution for Affinity is augmented by TriZetto’s Voice of the Client program,” noted Rob Scavo, TriZetto’s regional accounts market president. “This collaborative approach to strategic planning helps ensure that our integrated technology and services align with each client’s IT and business goals. Our active listening syncs project planning, follow through and results with what each client wants.”
“Under its Voice of the Client program, when TriZetto’s account team sits down with us, they use a methodology to systemically get our input to the things that concern us and the objectives that we have,” said Allen. “Frankly, such active listening isn’t customary among technology vendors. It’s encouraging to see.”
Voice of the Client is an organizational commitment, methodology and culture of accountability in which TriZetto account teams listen to clients, improve encounters with clients and deliver measurable business outcomes and value. “It’s a three-step, repeating cycle,” explained Scavo. “Listen, align and act. We’re listening through our client satisfaction surveys, user groups, client councils and strategic business reviews with clients.”
Scavo said TriZetto aligns with clients through a variable incentive compensation structure and rigorous associate training, as well as by evaluating performance and service against client-facing metrics.
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About Affinity Health Plan
Affinity Health Plan is an independent, not-for-profit organization offering quality health care coverage to underserved New Yorkers. Its programs are sponsored by New York State and include Child Health Plus, Family Health Plus, Medicaid managed care, and Medicare. Founded in 1986, Affinity serves more than 260,000 members in New York City, Nassau, Suffolk, Westchester, Rockland and Orange counties. For more information, visit www.affinityplan.org or follow Affinity on Facebook and YouTube.
TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. TriZetto solutions touch over half the U.S. insured population and reach more than 200,000 care providers. TriZetto helps healthcare organizations enhance administrative efficiency; improve the cost, quality and delivery of care; address compliance; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance, claims editing, revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.
Schwartz MSL Boston
Davida Dinerman / Maggie Fairchild, 781-684-0770
The TriZetto Group
Loren Finkelstein, 303-542-2460
Source: The TriZetto Group, Inc.