California plan boosts chronic illness management with IT

By Bernie Monegain
10:20 AM

CareMore Health Plan, Inc. has gone live with TriZetto's Clinical CareAdvance application to help manage members' acute and chronic illnesses and improve health status across its member population.

This brings to more than 30 million the number of covered lives on TriZetto's care management system, TriZetto executives announced.

CareMore Health Plan provides Medicare Advantage health plans for 32,000 seniors, largely in key markets in California. TriZetto provides software and IT services that help payer organizations move toward integrated healthcare management - the convergence of benefits administration, care management and constituent engagement.

In October, CareMore Health Plan began running its in-patient program on TriZetto's Clinical CareAdvance system. In November, the payer moved its new-member intake program to TriZetto's platform. Following additional configuration, CareMore Health Plan will migrate its diabetes and other disease management programs to the Clinical CareAdvance application.

"In using TriZetto's system, we'll further improve the uniformity and quality of care we provide our members," said Leeba Lessin, president at CareMore Health Plan. "Early identification, coordination, intervention and member involvement are critical in an aging population. The Clinical CareAdvance application allows us to leave behind episodic care delivery and engage patients and clinicians in methodical management of chronic conditions and the real-time needs of the frail elderly."

"CareMore Health Plan is focused on improving the health status of its members and sought a platform that would support expansion," said Joe Manheim, TriZetto's senior vice president of benefits administration and care management. "We're pleased they chose TriZetto's Clinical CareAdvance system for its ability to deliver automated, consistent workflows and support quality care and cost-efficient business growth by the organization."

TriZetto's care management application applies clinical algorithms that create targeted interventions to help improve members' health. The Clinical CareAdvance platform is based on flexible business rules that incorporate claims data, utilization measures, diagnostic triggers and optional data sources such as laboratory, biometrics and pharmacy.

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