Capital BlueCross goes live with TriZetto's care management application

The TriZetto Group, Inc. today announced that Capital BlueCross, the leading health insurer in central Pennsylvania and the Lehigh Valley, recently went live with TriZetto's Clinical CareAdvance^® 4.61 care management application.

“We carried out the Clinical CareAdvance upgrade in close consultation with them and completed the work to meet Capital BlueCross' business goals. The go-live went smoothly, so we're quite proud of the team's execution.”

The Clinical CareAdvance application combines case, disease and population management in one system to help Capital BlueCross increase administrative efficiency and promote quality care to members. For instance, the system provides support for specially trained nurses' care coordination, which is particularly beneficial to members with more than one chronic condition or who are catastrophically ill. The system also gives case managers easy access to helpful information for member care, such as community resources and educational materials.

"The 4.61 version of TriZetto's Clinical CareAdvance system is a welcomed resource to enhance our best-practices model," explained Denise Fessler, vice president of clinical services at Capital BlueCross. "TriZetto's system also helps streamline our care management processes and supports Capital BlueCross member-centric care management, such as our use of motivational interviewing techniques and Intrinsic Coaching^®. Partnering with TriZetto is one more way that Capital BlueCross is demonstrating how we bring medical value - a commitment to high quality care, cost-effective care and member satisfaction - to our market."

"TriZetto focused on mapping the product and processes to Capital BlueCross' specific business goals for care management," said Carolann Engler, associate vice president, care management services practice lead at TriZetto. "We carried out the Clinical CareAdvance upgrade in close consultation with them and completed the work to meet Capital BlueCross' business goals. The go-live went smoothly, so we're quite proud of the team's execution."

Capital BlueCross' upgrade to the robust care management system is in keeping with guidance from Gartner, Inc. in a recent industry research report by the firm.

"Care management relies on technology and a business culture that focuses on a high-touch approach with members and providers to ensure that high-quality, appropriate and safe healthcare is delivered," wrote Gartner analysts Robert Booz and Joanne Galimi. "However, many payers haven't implemented an integrated or interoperable care management system, nor have they standardized IT platforms to support the care management process. These payers are missing opportunities to leverage technology to enhance care management. By changing an internal culture focused on manual, paper-based processes to a platform designed to support the natural workflow of care managers, financial and efficiency gains can be realized."¹

The Clinical CareAdvance application is part of TriZetto's Clinical CareAdvance Enterprise^® suite. The suite also includes the Personal CareAdvance^® application for members, providing population management, and the CareAdvance Provider^TM application, offering a self-service extension of utilization management for physicians and their staff. The CareAdvance Provider product is also equipped with a Member Clinical Profile (MCP). The MCP conforms to the HL7 Continuity of Care Document industry format and provides a real-time view into the clinical information available in the CareAdvance Enterprise system. The CareAdvance Provider module will be offered as an add-on application to the Clinical CareAdvance solution.