Premera Blue Cross Uses TriZetto Services and Technology Solutions to Further Improve Case Management

Premera Blue Cross Uses TriZetto Services and Technology Solutions to Further Improve Case Management

<0> Schwartz MSL BostonDavida Dinerman / Maggie Fairchild, 781-684-0770orThe TriZetto GroupLoren Finkelstein, 303-542-2460 </0>

, today announced that , which serves 1.5 million members in the Pacific Northwest, has further improved its case management processes by using TriZetto’s and .

Health insurers typically provide case-management services to members who have chronic, costly conditions, helping ensure that these members receive the medical care they need, when they need it. In 2011, Premera, which manages member care on TriZetto’s platform, implemented a new case-management model called Integrated Case Management (ICM). In the ICM model, “integrated case managers” work on an interdisciplinary basis to assist members who have conditions such as medical, mental health and chemical dependence, and to help those who face social and health-system barriers that impede access to care. Concurrently, Premera decided to pursue case-management accreditation from the National Committee for Quality Assurance, effective in 2013.

“We worked with TriZetto’s consulting services team to reconfigure functionality within its care management system to meet the unique requirements of the ICM model,” said Nancy Carosso, director of care management at Premera. “We also added NCQA-required documentation templates and assessment reports that track patient progress. TriZetto’s consulting services team was instrumental in completing the project successfully. With its technical experience with the care management solution and its clinical understanding, TriZetto’s services team quickly grasped what we were trying to achieve and translated that into system capabilities.”

“With TriZetto’s system functionality, Premera can use the ICM model to assess and score the complexity of members’ healthcare needs and develop individualized plans of care that take that complexity into account,” said Sal Gentile, TriZetto’s Blue Cross and Blue Shield market president. “Premera also is now ideally positioned to seek NCQA case-management accreditation in 2013.”

“In an initial NCQA mock survey that was conducted before we implemented this solution, we struggled to meet all the NCQA requirements for case management and documentation. But in a subsequent NCQA mock survey, we received very positive feedback in the areas of patient assessment, documentation of care plans, goals and interventions,” Carosso said. NCQA auditors commented favorably on the new solution, as did the Case Management Society of America, which endorses the ICM model.

In 2012, Premera was nominated for the TriZetto IHM Power Award for Innovation, in recognition of the company’s pursuit of Integrated Healthcare Management, TriZetto’s vision for the healthcare industry.

Premera Blue Cross is a leading health plan in the Pacific Northwest, providing comprehensive health benefits and tailored services to more than 1.5 million people, from individuals to Fortune 100 companies. Premera is committed to providing its members peace of mind about their healthcare coverage. The company offers innovative health and wellness solutions focused on quality outcomes for patients and controlling costs. Premera Blue Cross, which has operated in Washington since 1933, is a not-for-profit, independent licensee of the Blue Cross Blue Shield Association.

Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Wash., providing health, life, vision, dental, stop-loss, disability, workforce wellness and other related products and services. The family of companies employs approximately 3,000 people and provides healthcare coverage and related services to nearly 1.7 million members. Please visit and for more information.

TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and to deliver better health. TriZetto solutions touch over half the U.S. insured population and reach more than 180,000 care providers. TriZetto helps healthcare organizations ; ; and compete to win in an emerging retail market. Payer solutions include , , and portal platforms, as well as , and . Provider solutions include real-time eligibility assurance, claims editing, that help providers get paid quickly and accurately. For more information, visit .

Suggested Articles

Physician groups slammed a court ruling that overturns CMS' site-neutral payments rule for clinic visits.

Sixteen medical professionals, including six doctors and seven pharmacists, were among those charged in a Texas healthcare fraud and opioid takedown.

Blue Shield of California is piloting transportation benefits with some of its members in Sacramento.