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.

* Cox HealthPlans –– Based in Springfield, Mo., Cox HealthPlans covers approximately 40,000 lives through a variety of products, including HMO and PPO offerings. The market is highly competitive, with both national and local health plans serving the region.
* Capital Health Plan –– A local HMO focused solely on serving the four-county area surrounding Tallahassee, Fla., providing coverage to 113,000 members. A federally qualified, non-profit HMO created in 1982 to provide comprehensive and coordinated medical care.
* CareOregon –– A not-for-profit organization committed to improving and protecting the health of low-income and vulnerable Oregonians, to providing access to high-quality, cost-effective and culturally competent care for its members, and to supporting the providers who care for them.
* Motion Picture Industry Pension & Health Plans –– A national organization of trust funds established by collective bargaining agreements between many of the unions and employers in the motion picture production industry primarily supported by employer contributions.
* The ODS Companies –– Founded in 1955, The ODS Companies (ODS) is a multi-faceted organization that provides medical, dental, vision, pharmacy and professional liability insurance products, along with a variety of business services including dental practice management software and benefits administration to residents of the Pacific Northwest and Alaska.
* BlueCross® BlueShield® of Tennessee –– BlueCross BlueShield of Tennessee is the state’s oldest and largest not-for-profit health plan, serving nearly 3 million Tennesseans. Founded in 1945, the Chattanooga-based company is focused on financing affordable health care coverage and providing peace of mind for all Tennesseans.
* Fidelis Care Organization –– One of the largest health plans offering government-sponsored health programs in New York state. It was founded on the belief that all New Yorkers should have access to affordable, quality health insurance.
* SelectHealth –– For more than 25 years, SelectHealth has been committed to helping Utah residents stay healthy, offering superior service and providing access to the highest quality of care. As part of Intermountain Healthcare®, SelectHealth shares a nonprofit mission of healthcare excellence.
* Providence Health & Services –– A not-for-profit health system committed to providing a comprehensive array of services to meet the needs of communities across five states, including Alaska, Washington, Montana, Oregon and California. Providence continues the legacy of the Sisters of Providence and the Sisters of the Little Company of Mary in the West, spanning more than 150 years.

For more information on the IHM Power Awards, winners or nominees, please visit www.trizetto.com/IHMPowerAward.

Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry. With its technology touching half of the U.S. insured population, TriZetto is Powering Integrated Healthcare Management™. TriZetto provides information technology solutions that enable health insurance payers and other constituents in the healthcare supply chain to improve the coordination of benefits and care for healthcare consumers. The company’s offerings include enterprise and component software, hosting and consulting services that help payers implement and optimize their operations and minimize the risk of bringing new products to market that drive competitive differentiation.