Leon Medical Centers Health Plans Uses TriZetto Solutions to Deliver Integrated Healthcare to Medicare Advantage Members

Healthcare IT and Technology News January 25 2012, Leon Medical Centers Health Plans Uses TriZetto Solutions to Deliver Integrated Healthcare to Medicare Advantage Members

Healthcare IT and Technology News January 25 2012

The TriZetto Group, Inc., today announced that Leon Medical Centers Health Plans, which meets the healthcare needs of the Medicare community in Miami-Dade County, has made major improvements in administrative efficiency and the cost and quality of care through the use of TriZetto integrated technology-enabled solutions. TriZetto solutions have helped Leon Medical Centers Health Plans achieve a 95 percent auto-adjudication rate for claims. This degree of automation in claims processing helps reduce administrative costs while increasing speed and accuracy.

Leon Medical Centers Health Plans also has achieved an unusually high level of member retention. Since 2005, the member-disenrollment rate has remained below 5 percent per year, an indication of high satisfaction levels among members. "We've been able to integrate our healthcare IT infrastructure so tightly that, to our patients, it seems seamless," said Jennifer Puglisi, vice president of IT at Leon Medical Centers Health Plans. "Whether they call the provider or the payer, our members can get all the information they want regarding their healthcare. And our member-service representatives can immediately access all the information they need as well."

Leon Medical Centers Health Plans operates a staff-model health maintenance organization (HMO) that serves more than 37,000 Medicare Advantage members. The organization uses TriZetto's Facets(TM) enterprise core administration system; NetworX Pricer(R) application, which automatically prices claims, regardless of complexity; and Constituent Engagement Solutions, a suite of web tools that automate transaction processing and information exchange among the health plan, members and providers. TriZetto helped Leon Medical Centers Health Plans integrate the Facets platform with an electronic practice management/electronic medical records system used by clinicians affiliated with the HMO. Through the interface, the administrative staff can quickly share data with clinicians and vice versa.

The value of integration becomes evident immediately after a member enrolls in the health plan, Puglisi said. "As soon as the enrollment is in the system, it is immediately sent to the providers' system. When the patient walks in for a medical appointment--even if it's that very same day--the provider already has the member's demographic and eligibility information. The patient is seen, and all the clinical information related to that visit is then brought back to our system, so that we can immediately start doing analytics and benchmarking the member's healthcare experience."

"Fragmentation drives up costs, increases errors, lowers quality, and reduces member and provider satisfaction," said Jude Dieterman, TriZetto's executive vice president and payer markets president. "With TriZetto's integrated solutions, Leon Medical Centers Health Plans is addressing all of these issues. And as this approach becomes more prevalent throughout the industry, we as a nation will address the challenges of healthcare quality and affordability."

Helping manage 31 percent of Medicare Advantage and Medicare Part D lives today, TriZetto offers a proven track record and the industry experience to help Medicare plans achieve their business objectives.

Healthcare IT and Technology News January 25 2012, Leon Medical Centers Health Plans Uses TriZetto Solutions to Deliver Integrated Healthcare to Medicare Advantage Members

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