Neighborhood Health Plan and CareFirst BlueCross BlueShield TriZettos Win First Annual IT Power Awards

The TriZetto Group, Inc. announced that Neighborhood Health Plan (NHP) and CareFirst BlueCross BlueShield (CareFirst) were the winners of the first annual Integrated Healthcare Management (IHM) Power Awards in the categories of Operational Excellence and Innovation, respectively. The awards honor innovative customers that are demonstrating tangible success in the pursuit of IHM, the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The awards were presented at TriZetto’s annual Payer Conference in Marco Island, Fla.

“We are thrilled with the overwhelming number and quality of the excellent customer stories that have come forward through the IHM Power Awards nomination process. Selecting winners from among the outstanding nominees was extremely difficult as each of these innovative and forward-thinking health plans has wholeheartedly embraced the IHM vision,” said Jeff Margolis, chairman and chief executive officer of TriZetto. “Neighborhood Health Plan and CareFirst have both demonstrated how the systematic implementation of TriZetto’s products, combined with a clear understanding of IHM, can yield significant results across the enterprise.”

NHP, a licensed, not-for-profit managed care organization, was selected for the IHM Power Award for Operational Excellence for significant automation of key functions across the enterprise, including a 95 percent increase in automation of electronic enrollment transactions, an increase in professional claims auto-adjudication from 60 percent to 97 percent and an increase in institutional claims auto-adjudication from 0 percent to 90 percent. The organization attributed a considerable portion of these increased efficiencies to its purchase of TriZetto’s QNXTTM enterprise application system and the subsequent move to TriZetto’s application hosting. NHP was founded in 1986 by the Massachusetts League of Community Health Centers and Greater Boston Forum for Health Action to provide accessible healthcare delivery systems that are member-focused, quality driven and culturally responsive to members’ needs.

“To best support the needs of our constituents, we needed to shift our department from providing IT operations to delivering business value through information,” said Marilyn Daly, chief information officer of NHP. “The first step was to consolidate our core administration platforms onto the QNXT system and make it easier to adjudicate claims and enroll members. Then, with TriZetto’s application hosting, we were able to lower our total cost of ownership, reduce risk and ensure 24/7 support.”

CareFirst, the not-for-profit, non-stock, parent company of CareFirst of Maryland, Inc., and Group Hospitalization and Medical Services, Inc., received TriZetto’s IHM Power Award for Innovation for its success in completely reengineering and streamlining the organization’s systems, processes, infrastructure, data availability and accessibility, resulting in significant increases in overall business functionality.

“We are excited to be this year’s IHM Power Award Winner for Innovation,” said Etta Maguire, CareFirst’s senior director, information systems. “Our goals were to move to a platform where our core processes and data were tightly integrated, be able to introduce new technologies and improve our infrastructure, and prepare CareFirst for future membership growth. By choosing TriZetto solutions as the cornerstone of our new infrastructure, we met all of our goals and are now positioned to offer new solutions like consumer-directed healthcare, improve our overall provider relations and meet the changing demands of the market.”

Additional successes by award nominees selected as finalists included significant cost savings of more than $3 million per year in the first three years of implementation by one customer, a jump in institutional claims auto-adjudication from 0 percent to 90 percent by a second health plan, and a 35-percent reduction in administrative costs and 42-percent reduction in cost-per-claim by a third healthcare payer.