TriZetto QNXT Essentials solution to streamline administration of Ventura County's HMO

Ventura County, Calif., has selected The TriZetto Group, Inc., to help improve the administrative efficiency, care delivery, and provider and member service of the county's health plan. TriZetto's end-to-end solution will streamline the administration of Ventura County's HMO, which serves employees and their families, retirees, Medicare recipients, and county-affiliated organizations. The county expects to go live on the hosted solution this summer.

“TriZetto's QNXT Essentials offering takes Software as a Service to a new level, providing an ideal end-to-end solution for smaller plans. It delivers a top-shelf plan, accelerated implementation, and worry-free performance and reliability for a low, predictable monthly fee.”

"TriZetto's QNXT Essentials^TM offering is a smart, cost-effective investment by the county," said Theresa Stanley, Ventura County's managed care director and health care agency deputy director. "It'll help keep administrative expenses in check and allow us to focus resources on delivering even better healthcare. TriZetto's solution set will automate processes that once required manual touches and support utilization analysis to improve both the cost and quality of care delivery by the county."

The integrated software and services solution set was especially well-suited for the county, Stanley said. "Managing a technology platform would not be the best use of our limited resources. TriZetto brings a proven solution that will provide speed to value and predictable costs."

Stanley also points to the Provider Service and Member Service capabilities of TriZetto's solution. She believes clinicians and patients will value the ready availability of web-based information that can enhance care delivery. Stanley also said that the TriZetto platform will support timely, accurate reporting of data to the California Department of Managed Care. For example, information about grievances, appeals and resolutions, once consigned to multiple spreadsheets, will be at the fingertips of the county's staff, easing compliance with the state's reporting requirements.

"Ventura County is among many health plans that do not have the internal IT resources of larger regional and national payer organizations," explained Rob Scavo, president of emerging markets at TriZetto. "TriZetto's QNXT Essentials offering takes Software as a Service to a new level, providing an ideal end-to-end solution for smaller plans. It delivers a top-shelf plan, accelerated implementation, and worry-free performance and reliability for a low, predictable monthly fee."

Specifically for health plans, accountable care organizations, and risk-bearing providers with limited capital and architecture, the QNXT Essentials solution includes TriZetto's entire QNXT enterprise administration system, six-month implementation process and toolkit, and comprehensive application management services for a monthly fee with no upfront investment. TriZetto's QNXT Essentials package includes the following components:

• The QNXT enterprise administration system, a rules-driven, user-configurable application, with .NET architecture, that automates and supports all core plan administrative processes, including membership enrollment, premium billing, claims adjudication and customer support.
• Application management services, including hardware, infrastructure, 24/7 support, updates, upgrades and disaster recovery.
• A proven implementation methodology with a rapid go-live; pre-configured quick-start templates for plans, contracts, benefits and policies; data-conversion support and other technical assistance; modeled reports; project oversight; and user training.