CCHP implements TriZetto systems to improve its network and health management programs

Feb 5 2010

The TriZetto Group, Inc. today announced that Chinese Community Health Plan (CCHP) has successfully implemented several TriZetto systems, including the Facets^®, NetworX Pricer^® and Clinical CareAdvance^® applications. The products are enabling the health plan to more efficiently administer its enrollment, membership billing, claims and customer service, as well as its network and health management programs. TriZetto is managing and hosting all of the applications for CCHP.

“For each CCHP member enrolled in a disease management program, TriZetto’s application is tracking the enrollee’s activity and providing an audit trail that helps extend the reach and benefit of CCHP’s diabetes, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure and hypertension disease management programs”

CCHP provides managed care plans for individuals & families, employer groups and Medicare beneficiaries, including those with Medicaid. CCHP currently serves more than 13,000 community members in San Francisco and Northern San Mateo County.

“CCHP is a trusted community partner in San Francisco, so it’s important to keep our focus on providing members with a range of high-quality care solutions at affordable prices,” said Larry Loo, MPH, director of business development & operations at CCHP. “We used to have two separate enterprise administration systems. The one integrated Facets administration system from TriZetto makes it easier for us to manage our business in several locations. Our member services department can see, real-time, when authorizations for services are in the system. And TriZetto’s application hosting services enable us to focus on differentiating ourselves from competitors instead of on managing the technology.”

There’s particular excitement at CCHP about the value that TriZetto’s Clinical CareAdvance application brings.

“For each CCHP member enrolled in a disease management program, TriZetto’s application is tracking the enrollee’s activity and providing an audit trail that helps extend the reach and benefit of CCHP’s diabetes, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure and hypertension disease management programs,” explained Dana Samples, RN and director of care management at CCHP. “Moreover, TriZetto’s Clinical CareAdvance application is enhancing productivity and helping our disease managers more effectively and efficiently reach out to the members of our CCHP family living with these chronic diseases.”

“Local, provider-owned plans such as CCHP sometimes find it difficult to cost-effectively invest in and staff information systems,” said Mike Jenner, executive vice president, TriZetto Services. “Innovative solutions, delivered and managed by TriZetto, allow CCHP and other smaller health plans to enjoy the benefits of such applications, which support flexible benefit and campaign design, greater efficiency and operational stability for an affordable, predictable fee.”

CCHP uses TriZetto’s Facets system as its core administrative platform to help improve efficiency, increase accuracy and reduce labor costs. TriZetto’s NetworX Pricer application helps ensure accurate and precise claims pricing. TriZetto’s Clinical CareAdvance system provides comprehensive health monitoring and reporting tools; provider and nurse-manager alerting; template-based, secure messaging between members and case managers; near real-time member identification and stratification; customized real-time statistics and reports; and outbound communication methods tailored to CCHP’s members.