DENVER--(BUSINESS WIRE)-- The TriZetto Group, Inc., today announced that Leon Medical Centers Health Plans, which meets the healthcare needs of the Medicare community in Miami-Dade County, has made major improvements in administrative efficiency and the cost and quality of care through the use of TriZetto integrated technology-enabled solutions.
TriZetto solutions have helped Leon Medical Centers Health Plans achieve a 95 percent auto-adjudication rate for claims. This degree of automation in claims processing helps reduce administrative costs while increasing speed and accuracy. Leon Medical Centers Health Plans also has achieved an unusually high level of member retention. Since 2005, the member-disenrollment rate has remained below 5 percent per year, an indication of high satisfaction levels among members.
“We’ve been able to integrate our healthcare IT infrastructure so tightly that, to our patients, it seems seamless,” said Jennifer Puglisi, vice president of IT at Leon Medical Centers Health Plans. “Whether they call the provider or the payer, our members can get all the information they want regarding their healthcare. And our member-service representatives can immediately access all the information they need as well.”
Leon Medical Centers Health Plans operates a staff-model health maintenance organization (HMO) that serves more than 37,000 Medicare Advantage members. The organization uses TriZetto’s FacetsTM enterprise core administration system; NetworX Pricer® application, which automatically prices claims, regardless of complexity; and Constituent Engagement Solutions, a suite of web tools that automate transaction processing and information exchange among the health plan, members and providers.
TriZetto helped Leon Medical Centers Health Plans integrate the Facets platform with an electronic practice management/electronic medical records system used by clinicians affiliated with the HMO. Through the interface, the administrative staff can quickly share data with clinicians and vice versa.
The value of integration becomes evident immediately after a member enrolls in the health plan, Puglisi said. “As soon as the enrollment is in the system, it is immediately sent to the providers’ system. When the patient walks in for a medical appointment—even if it’s that very same day—the provider already has the member’s demographic and eligibility information. The patient is seen, and all the clinical information related to that visit is then brought back to our system, so that we can immediately start doing analytics and benchmarking the member’s healthcare experience.”
“Fragmentation drives up costs, increases errors, lowers quality, and reduces member and provider satisfaction,” said Jude Dieterman, TriZetto’s executive vice president and payer markets president. “With TriZetto’s integrated solutions, Leon Medical Centers Health Plans is addressing all of these issues. And as this approach becomes more prevalent throughout the industry, we as a nation will address the challenges of healthcare quality and affordability.”
Helping manage 31 percent of Medicare Advantage and Medicare Part D lives today, TriZetto offers a proven track record and the industry experience to help Medicare plans achieve their business objectives.
About Leon Medical Centers Health Plans
Leon Medical Centers Health Plans was established to meet the healthcare needs of the Medicare community in Miami-Dade County. At Leon Medical Centers Health Plans members receive "Personal Attention At All Times” and the respect, care and human kindness they deserve. Leon Medical Centers Health Plans, as a Medicare contracted Health Management Organization, is qualified to provide such service to its members with its unique and comprehensive medical center benefits. Both Leon Medical Centers and Leon Medical Centers Health Plans were founded by Mr. Benjamín León, Jr., an industry veteran with more than 45 years experience in healthcare. Through their unwavering dedication over the years, Leon Medical Centers and Leon Medical Centers Health Plans have established a reputation for providing healthcare with compassion and offering peace of mind to the patients they serve. For more information, visit www.lmchealthplans.com/English/index.htm.
About TriZetto
TriZetto provides world-class healthcare IT software and service solutions that drive administrative efficiency, improve the cost and quality of care, and increase payer and provider collaboration and connectivity. TriZetto solutions, many of which are patented or patent-pending, touch half the U.S. insured population and reach more than 21,000 physician practices. TriZetto’s payer offerings include enterprise and component software, application management services, business management services and consulting services. Provider offerings, delivered through TriZetto’s Gateway EDI wholly owned subsidiary, include tools and services that monitor, catch and fix claims issues before they can impact a practice. TriZetto’s integrated payer-provider platform will enable deployment of promising new models of post-reform healthcare. For information, visit www.trizetto.com.
CONTACT:
The TriZetto Group
Loren Finkelstein, 303-542-2460
[email protected]
or
Schwartz MSL Boston
Davida Dinerman/Nicole Solera, 781-684-0770
[email protected]
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INDUSTRY KEYWORDS: Technology Data Management Networks Software Practice Management Health Professional Services Insurance General Health Managed Care
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